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Fatigue is a normal, common state of tiredness or exhaustion. It can be physical, mental, or both, and usually responds to rest or sleep. Occasional fatigue is part of life (after long workdays, stress, poor sleep, etc.).
Chronic fatigue (or pathological fatigue) however, refers to fatigue that is persistent, often debilitating, and not relieved by rest. It may last for months and impair a person’s ability to function in daily life. In the most extreme form, it is diagnosed as Chronic Fatigue Syndrome (also called myalgic encephalomyelitis, ME/CFS). ME/CFS is characterized not only by profound fatigue, but also post-exertional malaise (worsening of symptoms after exertion), unrefreshing sleep, cognitive impairment, orthostatic intolerance, and other systemic symptoms.
According to a 2021–2022 National Health Interview Survey report, about 1.3 % of U.S. adults had physician-diagnosed ME/CFS (i.e. chronic fatigue syndrome) at the time of interview. In absolute numbers, that corresponds to approximately 3.3 million Americans living with ME/CFS. The prevalence increases with age up to a point (peaking in adults 50–69 years) and then declines in older age groups. Women are significantly more affected than men: about 1.7 % of women versus 0.9 % of men report ME/CFS. Among racial/ethnic groups, non-Hispanic White adults have a somewhat higher reported prevalence (≈1.5 %) compared to Hispanic (0.8 %) or Asian non-Hispanic (0.7 %).
Because many cases likely remain undiagnosed, the true prevalence may be higher.
What Are Causes and Risk Factors of Chronic Fatigue and Fatigue?
The causes of chronic fatigue and ME/CFS are not fully understood. In fact, the condition is considered multi-factorial and likely results from the interaction of biological, psychological, and environmental factors. Some of the hypothesized or associated mechanisms include:
- Neuroendocrine and Autonomic Dysfunction: Abnormal regulation of the stress-response systems (hypothalamic-pituitary-adrenal axis), abnormalities in autonomic nervous system function (dysautonomia) may contribute.
- Mitochondrial / Metabolic Dysfunction: Some research suggests impaired energy metabolism, mitochondrial abnormalities, and abnormal oxidative stress in ME/CFS patients.
- Infections / Immune Dysregulation: Many people report onset of their symptoms following viral or bacterial infections. Studies often implicate immune system activation, persistent inflammation, or dysregulation in immune responses.
- Genetic Susceptibility: There is growing evidence that genetic factors may influence risk, particularly genes involved in immune function and cellular energy processes.
- Psychological and Stress-related Factors: Psychological stress, trauma, or psychiatric conditions may predispose or aggravate fatigue, though they are not considered causal on their own.
- Other Triggers: Environmental exposures, hormonal changes, sleep disturbances, or nutritional deficiencies might also play roles.
- Female Sex: Women are 2 to 4 times more likely to be affected than men.
- Middle age / Adulthood: The onset is more common in adults between ages 30–50, though it can occur at any age.
- Lower Socioeconomic Status: Higher rates have been observed in adults with lower family income.
- Rural Residence / Less Urbanization: Some data suggest slightly higher prevalence in nonmetropolitan areas.
- Relapses triggered by exertion, infections, or stress: Many with ME/CFS experience cyclical courses where symptoms worsen (relapses) after overexertion, stress, infections, or inadequate rest.
Because ME/CFS is heterogeneous, it is unlikely there is a single cause for all cases — rather, multiple contributing factors that differ between individuals.
How Do You Reduce Risk of Chronic Fatigue and Fatigue?
Because fatigue and especially chronic fatigue/ME are complex, risk reduction is not guaranteed, but certain lifestyle and supportive strategies may help minimize the likelihood or severity of chronic fatigue. Some useful approaches to consider may include:
- Prioritize Rest and Sleep Quality: Ensure sufficient, consistent sleep duration and quality. Poor sleep worsens fatigue and may aggravate underlying vulnerabilities. Address sleep disorders (e.g., sleep apnea, insomnia) proactively.
- Pace Activity and Avoid Overexertion: Particularly for those susceptible, pacing physical activity and avoiding pushing beyond one’s limits can prevent triggering post-exertional malaise (PEM). Gradually build activity tolerance under guidance (e.g. graded exercise therapy is controversial and must be individualized).
- Manage Infections and Immune Triggers: Promptly treat infections and avoid chronic low‑grade pathogen exposures. Support immune health through vaccination, hygiene, and reducing chronic inflammatory burden.
- Reduce Chronic Stress / Support Mental Health: Techniques like meditation, cognitive behavioral therapy, stress management, and counseling can support resilience and reduce risk of symptom exacerbation.
- Optimize Nutrition & Metabolic Support: Ensure a balanced diet, rich in anti-oxidant foods, whole grains, lean protein, fruits, and vegetables. Address deficiencies (e.g. vitamin D, B-vitamins, magnesium) under medical supervision. Support mitochondrial and cellular energy metabolism via appropriate micronutrients and, where indicated, nutritional therapies.
- Avoid Toxins / Support Detoxification: Minimize environmental toxin exposures (pollutants, heavy metals, chemicals) which may contribute to oxidative stress. Maintain good hydration and liver support.
- Monitor and Treat Coexisting Conditions: Conditions such as thyroid disease, anemia, sleep disorders, depression, or autoimmune disease may contribute to fatigue; diagnosing and treating these can reduce overall fatigue burden.
- Symptom Management & Supportive Care: For those with ME/CFS, a multidisciplinary approach (medical care, rehabilitation, pacing, symptom-relief, psychological support) is often needed.
Nutrients for Chronic Fatigue and Fatigue
Learn more about all of the nutrients linked to risk of chronic fatigue and fatigue, the other ways these nutrients improve our health, and the best food sources of each of them!
How Do Nutrients Improve Chronic Fatigue and Fatigue?
A Nutrivore approach emphasizes nutrients that help the body function at its best—including the cellular energy systems involved in fighting fatigue. Current research highlights the following nutrients for supporting chronic fatigue and fatigue, along with food sources to help you incorporate these nutrients through your diet.
| Nutrient | How it Supports Chronic Fatigue and Fatigue | Top Food Sources |
|---|---|---|
| Vitamin B2 (Riboflavin) | Riboflavin may help reduce fatigue by supporting iron absorption and preventing anemia, which is a major contributor to fatigue. Preliminary evidence suggests riboflavin may also reduce exercise-related muscle fatigue, though more research is needed for chronic fatigue conditions. | Rich sources include organ meat, mushrooms, leafy greens, eggs, milk, dairy products, almonds, yeast, legumes, and squash. |
| Vitamin B3 (Niacin) | Niacin plays a central role in cellular energy production as a precursor to NAD, and inadequate intake may impair energy metabolism and contribute to fatigue. Human trials are limited, and more studies are needed to clarify its effect on chronic fatigue. | Top sources include red meat, poultry, seafood (salmon and tuna), yeast, organ meats, shellfish, mushrooms, leafy greens, nuts, seeds, legumes, and fortified grains/cereals. |
| Vitamin B7 (Biotin) | Fatigue is a recognized symptom of biotin deficiency, and animal studies show that biotin insufficiency can impair energy production and provoke fatigue through disruption of biotin-dependent enzymes involved in fatty acid oxidation and Krebs cycle metabolism. More research is needed beyond deficiency contexts. | Richest sources include egg yolks, liver, yeast, almonds, walnuts, avocados, sweet potatoes, and tomatoes. |
| Vitamin C | Vitamin C reduces fatigue in several clinical contexts and may help with post-viral fatigue, obesity-related fatigue, and fatigue from shingles. Trials show significant improvements in fatigue scores, cognitive function, and perceived exertion, though many studies used supplemental or IV vitamin C. | Top sources include citrus fruits, kiwis, berries, red peppers, guavas, papayas, broccoli, Brussels sprouts, tomatoes, cantaloupe, leafy greens, and adrenal glands in organ meats. |
| CoQ10 | Chronic fatigue patients often exhibit low plasma CoQ10 levels, which correlate with greater fatigue, autonomic symptoms, and cognitive disturbances. Supplementation improves cognitive fatigue, physical fatigue, sleep duration, and quality of life in ME/CFS patients. | The best sources are oily fish (salmon, mackerel, yellowtail, trout, sardines), organ meats (heart, liver, kidney), beef, chicken, pork, and small amounts in Brassica vegetables, legumes, peanuts, nuts (pistachios, walnuts, hazelnuts), and seeds. |
| Iron | Iron deficiency is a major driver of fatigue, but even iron-replete individuals experience reduced fatigue with supplementation. Trials show improved fatigue in athletes, blood donors, and menstruating women—even without anemia—due to iron’s essential roles in oxygen transport and mitochondrial function. | Heme sources include liver, red meat, oysters, mussels, and clams; top non-heme sources include dark leafy greens, lentils, kidney beans, peas, white beans, chickpeas, and blackstrap molasses. |
| Zinc | Zinc deficiency is associated with chronic fatigue syndrome, immune dysregulation, and reduced T-cell signaling. Trials show zinc supplementation reduces fatigue in older adults, cancer patients undergoing chemotherapy, and ME/CFS patients when paired with melatonin (though effects of each component are unclear). | Good sources include red meat, liver, heart, oysters, eggs, legumes, nuts, and whole grains (higher bioavailability from animal sources). |
| EPA & DHA | Chronic fatigue patients commonly exhibit low omega-3 status and low EPA:AA ratios, which correlate with increased disease severity, immune abnormalities, and symptoms such as fatigue, pain, and cognitive issues. Small studies show EPA supplementation improves fatigue, though larger trials are needed. | Rich sources include salmon, herring, mackerel, sardines, menhaden, marine algae, cod liver oil, and shellfish such as mussels, crab, oysters, and squid. |
Nutrients for Chronic Fatigue & fatigue
Nutrients for Chronic Fatigue and Fatigue explains all the nutrients that matter most for maintaining healthy energy levels! This e-book is exclusively available in Patreon!
Plus every month, you’ll gain exclusive and early access to a variety of resources, including a weekly video podcast, a new e-book in a series, nutrient fun factsheet, and more! Sign up now and also get 5 free Nutrivore guides as a welcome gift! Win-win-win!
Benefits of a Food-Based Approach
A nutrient-focused, whole-food approach can play a supportive role in managing many health conditions, especially when paired with healthy lifestyle habits like physical activity and good-quality sleep. A food-based approach to nutrition offers health benefits that go far beyond what supplements can provide. Whole foods deliver a natural balance of nutrients that work synergistically, meaning vitamins, minerals, phytonutrients, healthy fats, carbohydrates and fiber can support each other for better overall health outcomes. Nutrient-dense foods like leafy greens, fruits, legumes, nuts, seeds, and fish are efficient, cost-effective, and widely accessible options that fit easily into a healthy diet and good eating patterns. By choosing whole foods first, you not only support a more balanced diet but also avoid the added costs and potential nutrient insufficiencies that can come with eating highly processed foods and relying solely on supplements to make up the shortfall.
The variety of nutrient-dense foods available across food groups makes it easy to enjoy a satisfying, diverse, and plant-forward (though not solely plant-based) way of eating. Many of these foods provide additional health benefits including antioxidants (which are anti-inflammatory), insoluble fiber for gut health, which in turn supports overall health and wellness. Because whole foods are often more accessible and affordable than supplements, a food-based approach creates a sustainable foundation for long-term well-being.
Nutrivore encourages filling your plate with a wide range of nutrient-rich foods without the need for restrictive rules, making it easy to prevent and support health conditions through the simple power of food. With a Nutrivore approach (maximizing nutrient density across food groups), a nutritious, balanced, and enjoyable way of eating becomes both achievable and flexible for any lifestyle. While it isn’t a replacement for medical care or the advice of a registered dietitian, a balanced, food-first approach can complement your overall strategy for improving many health conditions and support long-term health goals.
