Assessing 4 Nutrients to Reduce Fatigue

Summary

Here’s a short assessment of 4 nutrients that can help to reduce fatigue:

• Magnesium
• Vitamin D
• Vitamin B12
• Vitamin C

The body is an amazing energy-manufacturing plant. Believe it or not, each day we produce an average of 143 pounds of ATP (adenosine triphosphate), an organic compound that provides energy to our cells. (1) Essentially, your body cycles through its own weight in energy production every day! To fully support this amazing energy-production system, we must provide it with an abundance of nutrients.

Fatigue is likely a sign that your personal energy power plant lacks the wherewithal for optimal functioning. A good way to bolster your internal energy production is by assuring abundant intake of 4 key nutrients, all of which are essential for optimal energy production.

1. Magnesium

Magnesium is essential for more than 600 biochemical reactions in the body, many of which are involved in energy production. Without enough magnesium, our energy production machinery is inefficient. In fact, one of the first signs of early magnesium deficiency is fatigue.

ATP is our body’s energy currency. For every molecule of ATP we produce, we need a molecule of magnesium. Most of the ATP in our cells is in the Mg-ATP complex form. (2)

Most of us are not getting enough magnesium! Half of the U.S. population is deficient in magnesium and the vast majority have suboptimal intakes. (3)

Worldwide two-thirds of people in developed countries receive less than their minimum daily magnesium requirement. Further, as measured by the sophisticated oral magnesium load test, 10 out of 11 apparently healthy women have insufficient magnesium levels. (4)

Insufficient magnesium intake is causally related to fatigue:

• As early as 2011 noted magnesium researcher Dr. Mildred Seelig proposed that chronic fatigue syndrome was associated with low magnesium intake. (5)
• In effect, chronic fatigue syndrome patients have been found to have lower levels of red blood cell magnesium than healthy control subjects. Further, patients who were treated with intramuscular magnesium reported improved energy levels, better emotional state, and less pain.
• On the cellular level, researchers reported that alterations in the amount of magnesium ions in the mitochondria (where energy is produced) disrupts energy production mechanisms and makes our cells less healthy and viable. (6)

Suggestions on Detecting Suboptimal Magnesium Status:

• The blood test commonly used to measure magnesium is the serum magnesium test. Remember, that anything in the lower half of the normal range suggests magnesium deficiency. This condition is known as chronic latent magnesium deficiency. You will want to be at the high end of the normal serum magnesium lab range. (7)
• Even simpler, if your first-morning urine pH is below 6.5, it is most likely you have an inadequate magnesium intake (Dr. Russell Jaffe, personal communication, 2020).

2. Vitamin D

Vitamin D deficiency is VERY common in our modern society, with the vast majority of individuals having deficient or suboptimal blood levels. Fatigue and mood changes are common signs of vitamin D deficiency. This makes sense, since vitamin D impacts energy production in many ways. Just think about it — ¼ of all our DNA has receptors for vitamin D, and many of these relate to muscle strength and energy production!

• In MS patients (90% of whom were deficient in vitamin D), vitamin D supplementation significantly improved energy levels and physical function. (8)
• In cancer patients, fatigue was inversely correlated with vitamin D levels. (9)
• In an Italian study of 480 patients, vitamin D was inversely correlated with fatigue severity. (10)

As many studies suggest, resolving vitamin D deficiency and insufficiency leads to a lessening of fatigue, as well as improving overall health and deviant capacity.

Suggestions on Detecting Suboptimal Vitamin D Status:

This is quite simple. Ask your doctor for a test for vitamin D3. It is ideal to be at the 40 to 60 ng/mL level.

3. Vitamin B12

Chronic fatigue is recognized as a sign of moderate vitamin B12 deficiency and B12 deficiency is quite common, especially in vulnerable populations like vegetarians, vegans, and the elderly. Optimizing your vitamin B12 status can offer dramatic effects when it comes to feeling fatigued. This is because vitamin B12 is involved in oxygen transport, which, when compromised, can make us feel tired.

Here are some fast facts about the prevalence of vitamin B12 deficiency (hint: it runs rampant):

• In a systematic review, up to 86% of those following a vegan diet were deficient in vitamin B12. (11).
• Up to 81% of vegetarians were found to deficient in vitamin B12 in the same study.
• 62% of pregnant women are estimated to be vitamin B12 deficient. (12)
• 40% of the overall U.S. adult population has low plasma B12 levels. (13)
• 40% of older adults (aged 60+) are estimated to be deficient in vitamin B12. (14) In fact, the Institute of Medicine recommends vitamin B12 supplementation for adults aged 50 and older. (15)
• In lacunar stroke patients, those with vitamin B12 deficiency had 1.5 times more fatigue than their counterparts with higher B12 levels. (16)
• In chronic fatigue syndrome patients, levels of vitamin B12 and homocysteine in the cerebrospinal fluid were strongly correlated with ratings of mental fatigue (lower B12 status = worse fatigue). (17)

Hints on How to Detect Suboptimal Vitamin B12 Status:

The best test for vitamin B12 adequacy is the methylmalonic acid test, which can be done from urine or blood. Elevated methylmalonic acid suggests a vitamin B12 inadequacy.

4. Vitamin C

One big reason why vitamin C is needed for energy production is because it’s essential for carnitine production. Carnitine is the molecule responsible for shuttling fat into the mitochondria to produce ATP. In addition, vitamin C as a super-antioxidant decreases oxidative stress in the body and oxidative stress is a biomarker for fatigue.

• A study at the University of Alabama Medical Center looked at the connection between vitamin C intake and fatigue in dentists and their spouses: (18) Those consuming just the RDA for vitamin C reported about twice the fatigue as those consuming as much as 7x the RDA. The average 57-year-old ingesting nearly 7x the RDA for vitamin C showed a mean exhaustion score less than the average 33-year-old who was consuming just the RDA.
• In another study, 10 grams of intravenous vitamin C was given to office workers. After 2 hours, the vitamin C–treated group showed significantly lower fatigue scores than the control group, and their fatigue scores remained lower for an entire day. (19)
• In obese adults following a calorie-restricted diet, supplementing with 500 mg of vitamin C per day for 4 weeks improved their general fatigue score, while fatigue scores worsened in the control group. (20)

The ascorbate form of vitamin is a major electron donor, which serves to energize every cell in the body. In clinical practice we find that a fully reduced, fully buffered ascorbate significantly reduces fatigue in most all cases.

Hints on How to Detect Suboptimal Vitamin C Status:

• Use simple at-home vitamin C urine test strips.
• Look for signs and symptoms of vitamin C inadequacy like fatigue, bleeding gums, and a tendency to black and blue easily.

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References:

1. Zimmerman, J. J., et al. 2011. Cellular respiration. Chapter 74 in Pediatric Critical Care, 4th ed. Edited by B. P. Fuhrman and J. J. Zimmerman. Elsevier Inc.
2. Tardy, A. L., et al. 2020. Vitamins and minerals for energy, fatigue, and cognition: A narrative review of the biochemical and clinical evidence. Nutrients 12(1):228.
3. Rosanoff, A., et al. 2012. Suboptimal magnesium status in the United States: Are the health consequences underestimated? Nutrition Reviews 70(3):153-164.
4. DiNicolantonio, J. J., et al. 2018. Subclinical magnesium deficiency: A principal driver of cardiovascular disease and a public health crisis. OpenHeart 5:e000668.
5. Seelig, M. 2011. Might patients with the chronic fatigue syndrome have latent tetany of magnesium deficiency. Journal of Chronic Fatigue Syndrome 4(2):77-108.
6. Yamanaka, R., et al. 2016. Mitochondrial mg2+ homeostasis decides cellular energy metabolism and vulnerability to stress. Scientific Reports 6:30027.
7. Costello, R. B., et al. 2016. The case for an evidence-based reference interval for serum magnesium: The time has come. Advances in Nutrition 7(6):977-993.
8. Beckmann, Y., et al. 2019. Vitamin D deficiency and its association with fatigue and quality of life in multiple sclerosis patients. The EPMA Journal 11(1):65-72.
9. Martínez-Alonso, M., et al. 2016. Vitamin D deficiency and its association with fatigue and quality of life in advanced cancer patients under palliative care: A cross-sectional study. Palliative Medicine 30(1):89-96.
10. Pennisi, M. et al. 2019. Decrease in serum vitamin D level of older patients with fatigue. Nutrients 11(10):2531.
11. Pawlak, R., et al. 2014. The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: A review of literature. European Journal of Clinical Nutrition 68(5):541–548.
12. Pawlak, R., et al. 2013. How prevalent is vitamin B(12) deficiency among vegetarians? Nutrition Reviews 71(2):110–117.
13. McBride, J. 2000. B12 deficiency may be more widespread than thought. USDA Agricultural Research Service website. Accessed March 9, 2021.
14. Andrès, E., et al. 2004. Vitamin B12 (cobalamin) deficiency in elderly patients. Canadian Medical Association Journal 171(3):251-259.
15. Institute of Medicine. 2006. Dietary reference intakes: The essential guide to nutrient requirements. Washington, DC, The National Academies Press.
16. Huijts, M., et al. 2012. Association of vitamin B12 deficiency with fatigue and depression after lacunar stroke. PLoS One 7(1):e30519.
17. Regland, B., et al. 1997. Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome. Scandinavian Journal of Rheumatology 26(4):301-307.
18. Cheraskin, E., et al. 1976. Daily vitamin C consumption and fatigability. Journal of the American Geriatrics Society 24(3):136-137.
19. Suh, S. Y., et al. 2012. Intravenous vitamin C administration reduces fatigue in office workers: A double-blind randomized controlled trial. Nutrition Journal 11:7.
20. Huck, C. J., et al. 2013. Vitamin C status and perception of effort during exercise in obese adults adhering to a calorie-reduced diet. Nutrition 29(1):42-45.