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Friday 25 May 2018

The nutritional approach to fatigue

Fatigue is a common complaint within nutritional practice. Nevertheless, it is not recommended that this symptom is treated in isolation. It is much better to concentrate first of all on the cause. Where does fatigue come from and what can we do to get the energy to once again flow freely in your client? 


Energy from food 

The macromolecules carbohydrates, proteins and fats are our power sources. One gram of carbohydrate supplies 4 kcal, fat 9 kcal and protein 4 kcal. They are oxidised in our body.An extramitochondrial anaerobic process takes place,  glycolysis. This is the breakdown of glucose, during which little energy is released. Pyruvate and NADH are formed. Pyruvate is oxidised and is therefore a source of energy for the intramitochondrial conversion with oxygen. 
Adenosine diphosphate is converted into adenosine triphosphate: a nucleotide that is a cofactor in many enzymatic reactions in the body, which is used in energy-requiring processes in cells. The yield in the aerobic conversion is 13 times higher than the yield in anaerobic conversion, furthermore lactic acid is a by-product of anaerobic conversion. 
B vitamins, magnesium,  zinc and iron are essential nutrients for mitochondrial processes. The co-enzyme Q10 is required to store energy in the bonds between the phosphates of ATP. When energy is required, the bonds between the outermost phosphates are broken, resulting in the release of the stored energy. ADP is then formed.
To make ATP again from ADP, creatine phosphate is required. During the regeneration of adenosine triphosphate, two molecules of adenosine diphosphate are combined. The remaining molecule is called adenosine monophosphate. This is associated with ammonia (brain-toxic) and uric acid (grout, rheumatism).

Everything was better in the past 

No, in the past everything wasn’t better, but we were fitter. The intake of macronutrients differed significantly from today’s intake. Hunters and gatherers did not consume any foods which only half consisted of carbohydrates, but this is still recommended today. This advice is definitely acted upon, 60-75% of our total calorie intake is from carbohydrates. This is mainly at the expense of proteins. Aside from that, carbohydrates are often refined and therefore form empty calories with no nutrients. We consume poor carbohydrates from bread, rice, pasta and sugars, instead of good carbohydrates from fruit and vegetables. 

 

Fatigue and excessively refined food

Why do refined carbohydrates make us feel tired? When we eat too many refined carbohydrates, this causes our blood sugar levels to rise sharply. As a result of this, the production of insulin also increases significantly, resulting in a situation of hyperinsulinemia. This is followed by an opposite reaction, where the blood sugar then falls sharply again. Suddenly, there is now insufficient glucose in the blood to provide cells and organs with energy. Your client then becomes tired and hungry, and experiences an increased appetite for sugar. When sugar is then consumed, energy levels temporarily rise again, but hyperinsulinemia soon occurs again. The vicious cycle is born. 
When this continues for a long time, a sugar addiction develops. Over time, this can lead to insulin resistance; the carbohydrates are no longer left in the cell and remain in the blood for too long, after which they are stored as fat. Fatigue becomes chronic, eating food only provides a boost for a little while and then the problems start again. To break this cycle, it is paramount that the dietary pattern changes (fewer refined carbohydrates and more fruit and vegetables) and exercise is increased.

 

Low-grade inflammation 

An additional immunological problem occurs when there is a chronic deficiency of glucose. The deficiency sounds an alarm in the brain, which triggers an activation of stress axes. Adrenaline, cortisol and glucagon are produced and form glucose from amino acids. BCAAs are broken down, whilst these are important for muscle tissue and for the immunoglobulins IgA, IgM and IgG. The immune system becomes weaker across the board.
The immune system starts with the body’s barriers: the skin, the gastrointestinal tract, the lungs, the nose and eyes are all capable of resisting pathogens. Should a pathogen nevertheless infiltrate, first of all the innate immune system is activated. Then the acquired immune system is activated. If the intestine is permeable, the body’s barrier is compromised. This causes activation of the immune system and therefore low-grade inflammation. An activated immune system requires a great deal of energy; one degree of fever will consume approx. 250 kcal a day.
Low-grade inflammation can be recognised from excessive fatigue. Exercise and social contacts are avoided, the libido is reduced, the appetite is disrupted and there is increased sensitivity to pain. Furthermore, the body’s composition can change: muscular atrophy and increased levels of fat reserves are often seen. But the treatment of a low-grade inflammation is relatively simple, provided your client can summon the strength for this, of course. Healthy intestinal function, which can be initiated with L-glutamine, prebiotics and probiotics, combined with plenty of outdoor exercise, considerably improves immune system function.

 

Stress

A stressor will result in the fight-or-flight mechanism being activated (the sympathetic nervous system). The body produces noradrenaline. The digestion is halted and it doesn’t have priority. Glycogen is taken from the liver for energy. Deregulation of NF-kB, COX 1,2 and TNFα occurs, resulting in the risk of inflammation. Furthermore, stress leads to the production of adrenaline, which stimulates the (undesirable) anaerobic carbohydrate metabolism.
The HPA axis response is a slower response to a stressful situation. Cortisol is produced in response to noradrenaline. It regulates the aforementioned reaction and is anti-inflammatory. However, when stressors continue for a protracted period of time, adrenal gland depletion causes the cortisol to fall.
A lack of energy leads to fatigue, even after a night’s sleep, and lethargy. Paradoxically, sleep problems may arise. It is then recommended to prescribe a higher dose of magnesium, an important cofactor in the formation of ATP. That then provides that little bit of additional energy to help relaxation.

 

Treatment

The relationship between stress and stress resilience must be restored.If an individual has little muscle tissue, the mitochondria are less active. This has, of course, an impact on energy production. Plenty of exercise is important for good mitochondrial function. 
There are also certain components from food that are essential for good mitochondrial function. Especially B vitamins, magnesium,  zinc, iron, creatine phosphate, co-enzyme Q10 and l-carnitine are needed. Not only is vitamin K  responsible for strong bones and blood vessel elasticity, research has demonstrated that this also improves insulin sensitivity. A good diet is therefore important in combatting fatigue. It is important to avoid refined carbohydrates in this respect, as described above.
Resilience can also be improved through relaxing exercise, listening to music, sleeping and learning. Music can contribute to regeneration and a feeling of relaxation and inspiration, whilst during sleep the glymphatic system (literally) clears the head of waste products. 

In the event of excessive fatigue, it is important to bear in mind that this is a symptom. Do not treat the symptoms, that is a futile exercise. It is important to identify the root cause of the problem.