27 replies to this topic

[Zilla]

Hello,

I've just joined this community today and it's very exciting, intense and a little overwhelming. Here are the basics of my question:

I'm 33 and have suffered from fatigue all my life. Even when I was little when my mom would get me out of bed I would go sleep in the bathroom! I've been to all types of doctors and had a lot of different tests and they basically said to me that I could be just a naturally sleepy person. Generally, I get 9 1/2 hours asleep a night to feel rested. 8 or less and I'm irritable and feeling ill all day. I don't mind the time i spend sleeping at night but my energy level throughout the day is pretty lacking. I feel like I could take a nap at almost any time. I'm generally a pretty healthy person and I don't have any food allergies so i'm wondering if there are any additional supplements that I could take to help. Right now I'm taking C three times a day, and a multi. If the suggestions could include dosages that would be great.

Thanks in advance!

[VampIyer]

If you're talking strictly about energy production, a few of the following supplements might help:

Your multivitamin + C is a good start. I use the Orthocore multivitamin.

- ALCAR (acetyl L-carnitine) + other carnitine forms: In addition to being a nootropic (esp. when combined with R-ALA (the R enantiomer of Alpha Lipoic Acid)) Carnitine is used in Beta Fatty Acid oxidation, which directly produces Acyl CoA for use in the citric acid cycle (AKA krebs cycle = cellular respiration = energy production). Take carnitine separately from choline. Hopefully take some Fish oil (high in epa/dha) for some quality fats.

- CoQ10: used in Citric Acid Cycle (CAC)
- Additional B-vitamins (all of them): Used in Citric Acid cycle as necessary co-factors.
- other B-vitamins:
- Benfotiamine (form of B1 which in addition to AGE-fighting (Advanced Glycation End-products) properties, can boost TPP - thiamine pyrophosphate = required for CAC, and more specifically, is the prosthetic group in E1 enzyme of Pyruvate Dehyrogenase Complex (used to breakdown pyruvate into Acetyl CoA preceding CAC); TPP is also used directly in the CAC to clear Alpha-ketoglutarate)
- Sulbutiamine (form of B1 which promotes wakefulness/cognizance/alertness/reaction time/etc). Fat Soluble (other B-vitamins are water soluble and you'll just easily pass excess in urine). This is often seen as a nootropic AND an athletic supplement. Some people report negative effects.

- You could also experiment with dopaminergic supplements if you think you have a dopamine deficiency (N-acetyl Tyrosine, L-phenylalanine, etc) - low dose, slowly increase.
- Neurotransmitter imbalances get a bit complicated, and I wouldn't know what to recommend to be honest. I know that mild dopaminergics have a positive effect for me, as do Cholinergics.

- Amino Acid Supplementation: Some people are chronically deficient for one reason or another in BCAA's (Branched Chain Amino Acids: Leucine, Isoleucine, Valine) and EAA's (8 essential amino acids). I'd also add in Glutamine/Glycine. Amino Acid supplementation typically involves 15-30g taken throughout the day between meals + taken with B-vitamins (esp. B6 for BCAA's).

- Regular Exercise + proper nutrition + regular sleep: strength/resistance training + cardio on a regular basis. These steps are probably more important than all of the above. Watch the simple sugars: substitute complex carbs (whole grains/legumes/oats as opposed to white bread/sugars/soda) to prevent blood sugar spikes and hopefully improve insulin sensitivity in the long-term. Maybe you'll see less energy fluctuation.


Now then... noting the above, if you have a more serious health problem (which can be difficult to diagnose) - doing all of that probably won't help much. While the above supplements do help me a little, esp. the amino acids, I'm in that boat right now with a probable muscular/mitochondrial disorder (I'll be seeing a neurologist for an EMG + muscle biopsy as the next step).

Edited by VampIyer, 24 July 2008 - 12:02 PM.

[Mixter]

In your case, as you describe it, it may be really narcolepsia, in which case modafinil would be the best treatment.
Check narcolepsia on wikipedia or webmd. But, of course IANAD and I can't diagnose it like this, so...

General fatigue treatment plan, by identifying the cause:

1. Make sure your Thyroid was checked thoroughly properly, i.e. bloodwork: no TPO antibodies, TSH below 1.50, normal fT3, fT4.
Do a complete blood count including CRP, interleukines etc. to look for hidden inflammation/autoimmune disease just in case...

2. Make sure nothing viral is/was involved. If you find no other explanation, you should supplement with natural antivirals (green tea, garlic, olive leaf extract) nonetheless. Less probably an issue if you had this since childhood.

3. Does low-moderate daily exercise improve or worsen the condition? You'd need to do this at least for a week (an hour of brisk walking and aerobics if nothing else) to determine positive results. If you get negative results, you may have chronic fatigue syndrom. With CFS, supplementing with everything the first poster, should help. The most important thing with CFS is pacing, which means being as active as you can despite the fatigue, but also not overdoing physical activity (e.g. daily walks for as long as tolerated, but keeping the 9h sleep/day).

4. If your condition improves slightly with exercise, it may be depressive and/or neurological. In that case, primarily exercise and try low-dose modafinil, increasing dosage as needed ("alertec" is a cheaper generic alternative). You may want to start with as little as 50mg and work your way up -- to avoid headache, if your slow metabolism isn't used to it.

Also:
- Use Acetyl-L-Carnitine and R-alpha lipoic acid, which should help with fatigue from any cause
- Do not *megadose* anti-oxidants, as that may bring on fatigue
- Try adaptogens like rhodiola, ashwagandha, adapton

[VampIyer]

http://en.wikipedia....wiki/Narcolepsy

So there is Narcolepsy.

Oddly enough, I have ALL of those symptoms, except "cataplexy" often persists throughout the day to varying degree, so I wouldn't call it cataplexy. All I can say is... Blah...

[FunkOdyssey]

Those are really excellent suggestions Vamp and mixter, nicely done.

[Lotus]

I agree, excellent advice. I had fatigue syndromes, and they're all gone since starting supplementing with olive leaf extract. Then when I added alpha lipoic acid, vit C and Coenzymeq10 my energy levels got much better. I feel energized during the day now, whereas I used to have problems getting out of bed and feeling really awake. I did have some sensitivity issues with the ALA, but they disappeared when I switched to 100mg instead of 300.

[Mouser]

In your case, as you describe it, it may be really narcolepsia, in which case modafinil would be the best treatment.
Check narcolepsia on wikipedia or webmd. But, of course IANAD and I can't diagnose it like this, so...

General fatigue treatment plan, by identifying the cause:

1. Make sure your Thyroid was checked thoroughly properly, i.e. bloodwork: no TPO antibodies, TSH below 1.50, normal fT3, fT4.
Do a complete blood count including CRP, interleukines etc. to look for hidden inflammation/autoimmune disease just in case...

I experience similar fatigue, or as I've more accurately realized, sleepiness. I say sleepiness because I've realized it's not muscle tiredness. Much like you, Zilla, I've remembered it my whole life, along with depression/unstable moods. But this last year I went back to school and was trying to work at the same time...I finally had to do something about it. Its been nearly a full year now and still no relief - have seen an endocrinologist, chronic fatigue specialist, and psychiatrist. Depression is much better thanks to St. John's Wort and possibly Lamictal (no thanks to the psychiatrist who's favorite advice is to keep trying what's not working and come back in 2 months). Around March a blood test showed I had low red and white blood cell counts along with low DHEA; B-12 and DHEA supplementation seems to have fixed that. But STILL the overwhelming sleepiness.

Mixter, when you mentioned TSH below 1.50 it really struck me. I had never realized high TSH represented the hypo end of the thyroid spectrum. I looked back at my blood tests and I have 3 TSH results for the last year(reference range in parenthesis): 2.24 (0.4-4.5), 4.0 (0.3-4.8), and 2.53 (0.35-5.5). I have one free T4 result: .88 (0.61-1.12). They're all within "normal". But as you said, and also from what I've heard, its possible should be lower for some people. What do you think about those results?

I always wondered if hypothyroid could be an issue for me. My energy and mood symptoms suggest it. However, I also have been having trouble this year not losing weight - I think a big part of that though has to do with going through a very stressful period of life.

Edited by dman081, 02 August 2008 - 12:07 AM.

[dachshund]

Why only R-ALA? I believe the racemic ALA would work as effectively to reduce fatigue and is much less expensive. Please do not respond with the standard R- is the only bioactive form, this is true, however the S-form more than likely is simply a spectator.

Don't get me wrong, I like and use R- ALA, but I believe many of the arguments that the racemic form is inferior are quite dubious and unsubstantiated. Honestly, I have been buying high quality racemic ALA more and more, recently.

The issue is that outside of the Geronova R-ALA products (which have published many papers in peer reviewed journals showing efficacy) and probably the AOR time release product, many of the R- form products suffer from inadequate delivery technology to protect from the inherent chemical instability of the pure R- form rendering them ineffective at delivering R-ALA through the gut into the blood. I have used a few of the R- products on the market and found them ineffective.

I do like NaRALA, but have found it should only be taken separately from ALCAR by several minutes and is unstable toward acidic beverages and non-sodium supplement salts like mineral ascorbates other than sodium ascorbate which it is perfectly stable in combination.

For a Newbie I think a good, high quality capsulated racemic ALA is just fine and more cost effective.

[VampIyer]

For Thyroid: Your TSH levels seem normal, but a value of 4 is a bit high (hypothyroid). TSH levels naturally vary somewhat, and should be used to diagnose a condition alone without free T3, free T4, and testing for thyroid antibodies (which can cause abnormal TSH variation).

For ALA: I think dachshund summarized the issues quite well. R-ALA is unstable unless bound to a salt, thus I do use NA-RALA. I'm not sure if I should be using something else though...maybe I should look into this later.

The R/S enantiomers are very similar chemical conformations, thus the S-form may compete with the R-form and inhibit activity.

There are some studies showing that the S-form inhibits the antioxidant activity of the R-form, but more importantly, that it interferes with the ability of R-form to penetrate the mitochondrial membrane for energy production.

I'm not sure how valid these studies are of course.

[Zilla]

Thanks for everyon'e responses.

So far I've bought acetyl l-carnitine, lipoic acid, and olive leaf extract.

I'm curious as to the different forms of Vitamin B. I've tried to look them up through iherb.com and haven't had much luck. Is there a vitamin B formula that might be comprehensive enough for me.

Thanks again!

[unbreakable]

One of the following drugs might be helpful: Bupropion, Modafinil, Methylphenidate, Selegiline. I think Xyrem (GHB) at night could be useful (even if somebody has no narcolepsy), but it's probably very hard to get in the US. Have you been to a sleep clinic?

[Mouser]

Thanks for everyon'e responses.

So far I've bought acetyl l-carnitine, lipoic acid, and olive leaf extract.

I'm curious as to the different forms of Vitamin B. I've tried to look them up through iherb.com and haven't had much luck. Is there a vitamin B formula that might be comprehensive enough for me.

Thanks again!

I've tried this sublingual co-enzymated B complex (link). Like the vast majority of supplements I've tried there's no noticeable effect.

With Source Natural's Alcar + ALA I also didn't notice any effect.

Wellbutrin did give me energy and generally made me feel pretty good. But also a little amped up and unnatural, similar to ritalin. If I try everything else and never get to the bottom of it, I may go back to it. One important thing I should share is that while 150mg was ok for me, 300mg was WAY too much (separated by several years). I experienced what I guess you'd describe as hypomania, and related or not, developed shingles a week after starting 300mg (that was also the day I stopped Wellbutrin). If you do try it, I'd recommend asking your doc to start low and see how it goes.

If you want to try modafinil go to provigil.com (link) I used the coupon and didn't run into any trouble with the pharmacy (you do need to get a 7 day prescription, I'd suggest 200mg, since you can cut them in half making it a 14 day trial). I was expecting a lot. But after taking 100mg for a few days now I don't think I'll be getting any more. For me it helps with sleepiness, but not any of the other things that go along with mental fatigue. It doesn't seem to do anything for concentration, memory issues, feeling "out of it", etc. It's strange and hard to explain. Whereas a stimulant like Aderral or even coffee makes you feel alert, energized, and rested... for me modafinil only makes it more easy to not sleep. Plus it seems to give me a unique headache for several hours after taking.

For me selegiline (deprenyl) will probably be the next try.

The thing that gets me with all of these supps is that even if one of them really works well, it's still not getting to the root of the problem.

[happy]

What is wrong with taking acetyl l carnitine and choline together/at the same time?

Also, why should Na-RALA be taken away from acetyl l carnitine?

I take CDP-Choline because I take Piracetam, but I have been taking all of the above all at once.

Eh?

[krillin]

What is wrong with taking acetyl l carnitine and choline together/at the same time?

Also, why should Na-RALA be taken away from acetyl l carnitine?

There's competition for absorption and blood-brain barrier transport of quaternary amines like carnitine, choline, and TMG. NaRALA is incompatible with acidic supplements, because the salt becomes the polymerizable acid. I've also found that it doesn't go well with cissus: you get stringies in the water, which could be the unabsorbable RALA polymers we hear about.

[platypus]

Rhodiola Rosea is a great energy-booster, at least for me.

[zoolander]

Krillian mate your suggestions sound reasonable however, would you mind providing a refernce for those claims. I'm not questioning you about whether the claims are right or wrong I would just like to strengthen my understanding a little more.

Cheers matey. Thanks in advance

Edited by zoolander, 07 August 2008 - 12:39 PM.

[krillin]

Krillian mate your suggestions sound reasonable however, would you mind providing a refernce for those claims. I'm not questioning you about whether the claims are right or wrong I would just like to strengthen my understanding a little more.

Cheers matey. Thanks in advance

For lipoic acid I recommend reading this thread. The first link goes to an article on the pharmacokinetics of the different forms.

Regarding choline, carnitine, and TMG, look up the organic cation transporters. I learned about this from Micheal Rae and I don't think he cited a reference. Here's one that shows the competition.

Because OCTN2 mediates the uptake of TEA as well as carnitine, we investigated the ability of various organic cations and carnitine and its analogs to inhibit the uptake of [3H]carnitine via rOCTN2 (Table 1). The uptake was found to be inhibited by the organic cations TEA, cimetidine, MPTP, and choline. Similarly, unlabeled carnitine (D- as well as L-isomer), its fatty acid esters (acetyl-L-carnitine, propionyl- L-carnitine, and palmitoyl-DL-carnitine), and the structural analog betaine were also found to inhibit the uptake.

[spacey]

Well it doesn't seem like you have any issues with depression. Still I feel like Wellbutrin does provide a very slight stimulation + the mood-regulation effects that togheter make it a very good drug.

[Mouser]

The more I think about this the more I get angry at physicians who don't see the urgency in finding the cause or solution to a situation like this. Zilla, you mentioned your doc said you might just be a "naturally sleepy" person. I've encountered similar responses. And it's completely unacceptable. If I walked in and said I can't see out of my right eye, even if initial tests didn't reveal a cause, I find it hard to believe they'd stop there. But my symptoms, and I'm sure many other's, are just as real. In the end there's a chance that no root cause can be found. But by doing a few tests and saying everything looks good these docs are ensuring no cause will be found.

After trying a number of things I feel like herbs and supps aren't going to do it for me. There's something underneath it all.

I've been reading a lot on people who experienced fatigue, along with other symptoms, and fought to be treated for hypothyroidism. What is seems to come down to is controversy as to what the "normal" range of TSH and free T4 and T3 should be. Throw in the fact that a lot of docs use older and unreliable tests and you have a big confusing mess where you don't know who to believe. One fact is that TSH recommendations have been revised downward in recent times. I think the limit now is 4.5, and talk of going lower to 4 or 3.5. Mixter, you were the one that keyed me in on that. I'm sure you have a lot more knowledge than I.

A lot of these thyroid sites and people posting on them border on sounding quackish. However, I've read enough to conclude that I'd at least like to try some low dose T4 and T3 and see how I feel with TSH under 2.0. Now I have to build my case to present to my doc. And to me that's the sad part...after all this time seeing various specialists and getting no relief I have to basically beg and "prove" to my physicians to try this.

[krillin]

A lot of these thyroid sites and people posting on them border on sounding quackish. However, I've read enough to conclude that I'd at least like to try some low dose T4 and T3 and see how I feel with TSH under 2.0. Now I have to build my case to present to my doc. And to me that's the sad part...after all this time seeing various specialists and getting no relief I have to basically beg and "prove" to my physicians to try this.

You can bypass the docs if you dread the prospect of preparing to do battle with them. These are cheap drugs that you can buy from an overseas pharmacy sans prescription, and LEF sells the blood tests.

[Connor MacLeod]

I have problems with fatigue as well and have spent the past couple years trying to get at the root of it. At first I thought it might be a metabolic problem, so I fixed up my diet (which was already pretty decent), took off a lot of weight (lost about 50 lbs) and generally improved my overall fitness level. The result: I strike a lean and dashing figure and get lots of looks from the honeys, but as I'm already happily married this avails me little; as far as the fatigue, it still persists. I haven't found any supplements that have had a positive impact. Only two things seem to help for me:

1) Taking short (~10 mintue) naps during the day when the sleep attack occurs. That's all it takes - I'll lay down, fall asleep within a minute or two, have some crazy dreams and wake up about 8 minutes later. This seems to tie me over for 2-3 hours at least. On good days I'll only need one or two naps, on bad days I'll take 5-6. It's a distraction but I've found it better than fighting off sleep with the brain only working at 40% capacity.

2) Meditation - lots of it. It seems my problem is that I dream too much when I sleep - very vivid dreams. And when I'm not dreaming I'm doing formal power series computations (that's a b*tch without pencil and paper!), or other mathematical gymnastics. In any case, I find that meditation, in addition to giving me additional energy, tends to make my dream life considerably more peaceful. I don't know if the meditation is actually decreasing the amount of dreaming - probably not - but it certainly makes dreams more peaceful (i.e. less bank heists and annoying generating function computations, and more flying over oceans and mountains, etc.), which seems to results in more restful sleep and hence fewer sleep attacks during the day.

I haven't tried any pharmaceuticals - this is not really an option for me at the moment and I rather avoid it if at all possible.

[Mouser]

You can bypass the docs if you dread the prospect of preparing to do battle with them. These are cheap drugs that you can buy from an overseas pharmacy sans prescription, and LEF sells the blood tests.

I appreciate that advice. It's been in the back of my mind all along. If I was at the point where I've tried everything and struck out with all the docs I'd go for it. But for now at least I'm going to try and exhaust my options with the medical professionals. While I feel I've done my research enough to conclude T4 and T3 might help and probably has a very low risk (at least in the short run), I readily acknowledge that I am by far no expert and have only a fraction of the understanding even my worst physicians has.

Conner, I get what you're saying about the meditation. It seems have the ability to shift your mind in to a lower gear. At least for me I think that's part of it... hard thinking (for lack of a better term) really takes it out of you whether awake or sleeping.

[Mixter]

Hi dman. According to the very latest normal ranges for thyroid you are in fact hypothyroid.
Even little maladjustment there can cause a lot of fatigue, so you should start there, and
maybe take ALCAR+RALA in addition, as hypothyroidism also impairs mitochdonrial function.

According to http://www.lef.org/p...gulation_01.htm :

According to a study reported in Lancet, one of the world’s leading medical journals, various “normal” TSH ranges may actually be associated with adverse health outcomes (Dayan CM et al 2002):

* TSH greater than 2.0: increased 20-year risk of hypothyroidism and increased risk of thyroid autoimmune disease
* TSH greater than 4.0: greater risk of heart disease
* TSH between 2.0 and 4.0: cholesterol levels decline in response to T4 therapy

My suggestions:
- get a thryoid panel with freeT3 and freeT4. If these values are well below the 50% of the normal range, you will probably benefit from thyroid hormone prescription
- make sure to have a good doc that cooperates with you
- check iodine status for the most common cause, lack of dietary iodine
- check blood for thyroid antibodies: TPO-antibody & TR-antibody for the second most common cause, autoimmune thyroiditis

[Mouser]

Mixter, I very much appreciate the info. I've found LEF to a be a great source of seemingly balanced and well sourced information on thyroid. But I hadn't seen that particular article. I agree with you; I would say my TSH of 4.0 indicated an issue. At that time my free T4 was in the middle of the range at 0.88 (0.61-1.12). I believe that combo could be called subclinical hypothyroid. However in a follow-up test 2 months later TSH was down to 2.24 and Thyroglobulin anti-body was normal. So who knows where that leaves me. What I do know is I still feel the same.

[Mixter]

The truth is that it depends on your doctor, and that after
the Lancet 2002 study sunk in, a lot of doctors started treating
patients with TSH 2.0 or above. Also, more autoimmune diseases
were detected, since statistically, more people with high TSH have
autoimmune (Hashimoto's) problem at this level. Good doctors
do a thyroid antibody check-up at this level.

If you weren't fatigued before and are still, and your doctor sees
no reason for treatment, make sure to get a second/third opinion
on the thyroid stuff. The thyroid stuff is a controversy among doctors, and some
don't even treat TSH 4.0, just like 20 years ago they didn't treat TSH 9.0.

Edited by mixter, 09 August 2008 - 06:50 PM.

[Mouser]

Mixter, (or anyone else) what are your thoughts on synthetic vs natural desiccated thyroid? There seem to be a lot of people who say T4 only does not work well for them. That makes sense. But when you use synthetic T4 + synthetic T3, does that still hold true. Is there truly a difference between Armour (desiccated pig thyroid) and synthetic T4 + T3?

[yoyo]

Might be good idea to get a test for sleep apnea too.

[Mouser]

Might be good idea to get a test for sleep apnea too.

An update that I hope will help you Zilla and serve as data for others. I finally had my sleep and nap test done. The night time sleep results showed:

7 hours of sleep (good)
>155 awakenings (very bad),
time to fall asleep or "SOL" 5 minutes (much too short, indicates very tired or sleep deprived).
> 110 hypopnea episodes (maybe bad, could be cause of fragmented sleep but debatable as to whether these have same effect as apneas)
Increased REM latency (bad, but I don't know why)
No snoring or kicking (good)
No apneas (good)

Nap tests showed:

no REM sleep although I dreamt (good, REM in short naps indicates narcolepsy)
time to fall asleep or SOL 2 minutes (much too short, indicates very tired)

As bad as these results are, I am relieved to know that my fatigue wasn't all in my head. Now onto why my sleep is like this. The bad news is I am not obese With no overt health issues my doc doesn't really know what's going on. Its not certain that this is "central" and not an "obstructive" issue; if I had to guess I'd say central, but its possible that the hypopneas aren't even an issue.

The treatment plan is to try Provigil (Modafinil) at 200 mg or higher for a month, eliminate sleep meds like Ambien, and see if that will reset the sleep clock. I've also started a therapeutic trial of of 25 mcg Synthroid (T4) and 2.5 mcg Cytomel (T3). My doc probably thinks I'm crazy for trying thyroid but so far something is working. After less than a week I feel better. Still far from normal, but compared to where I was, a great improvement. Hopefully some of this might help others with some ideas as to what to try.