Low energy is a common and frequently ignored symptom which many patients suffer from.
Wouldn't it be nice if you could take something to help increase your energy?
While there isn't a magical "energy supplement" that will cure your fatigue, there are many supplements which may help.
Learn more about targeting your supplements to help boost your energy in this guide:
What Causes Low Energy?
Fatigue or low energy is a very common complaint among many patients.
But why do so many people have low energy?
Is it because they are missing some critical supplement?
The problem with "low energy" is that it is very non-specific and doesn't necessarily mean anything on its own.
If you were to look at the number of diseases and conditions that are associated with low energy it would number in the hundreds (1).
This is probably one of the main reasons that Doctors tend to ignore low energy as a symptom.
It's quite non-specific and is related to hundreds of diseases.
Fortunately, there are a number of things that you can do to actually increase your energy level.
It all starts with understanding where energy comes from in the body.
From there you can then target therapies to treat these problems and finally increase your energy.
So where does energy production come from?
The vast majority of the energy produced in your body comes from a special portion of the cell known as the mitochondria (2).
Mitochondria take macro-molecules (fats and carbohydrates) and turn them into a molecule known as ATP or adenosine triphosphate.
ATP then acts as the energy currency in your body.
ATP helps your muscles contract (actually it helps them to relax but it is still required), it helps manage very important electrolyte gradients, allows nerve conduction (3) and so much more.
When ATP levels are reduced (even by a little bit) the consequence may be subjectively felt as "low energy" or "fatigue".
So when we take a 35,000-foot view of energy production in the body we can begin to target therapies to treat the underlying problem.
What do I mean?
Let's use a few quick examples and discuss how they alter energy production and why these conditions may lead to low energy:
#1. Nutrient Deficiency
Sub-optimal levels of certain nutrients may promote fatigue because they act as co-factors in mitochondria energy production.
We all know that B complex vitamins are routinely felt (at least subjectively) to increase energy levels when taking them.
Most people who take B complex vitamins, B12 shots or other forms of B12 have no doubt experienced an increase in energy.
Despite this, they may not even realize why it occurs.
While we aren't 100% sure, one such theory is that suboptimal levels of B12 in the body may reduce total energy production.
By repleting B12 in the body mitochondrial energy production may increase and therefore you may feel a "surge" of energy (4).
B vitamins aren't the only nutrients required for energy production either.
Low levels of iodine (5) may impair thyroid function and lead to sub-optimal thyroid status in the body as well.
One of the most common symptoms of hypothyroidism is fatigue (along with many others).
The moral of the story?
Many nutrients are involved in energy production and we will discuss the most important ones below.
#2. Lack of Sleep
It is well known that lack of sleep will lead to fatigue and low energy, I don't think anyone would dispute this fact.
Studies show that people who sleep less than 6 hours each night are at increased risk of developing weight gain, inflammation, and certain hormone imbalances.
Studies also show that these patients frequently experience fatigue and cognitive impairment (6) (difficulty with concentration or "brain fog").
It isn't clear exactly why this occurs, but we know that it does indeed happen.
The fatigue associated with lack of sleep has such a powerful influence on the total subjective sense of "energy" that if present it should become your top priority as far as treatment is concerned.
If you have low energy and you are sleeping less than 8 hours per night then you should make this your #1 priority.
#3. Reliance upon Caffeine
Caffeine is often used as a stimulant and an antidote to treat low energy level.
Every morning people wake up and make coffee and/or drink energy drinks to get through their day.
What they may not realize is that caffeine may be making their low energy problem worse.
Caffeine acts as a stimulant in the body but may put an increased demand on certain hormones (including cortisol and catecholamines such as epinephrine and norepinephrine).
Constant use of caffeine may reduce your quality of sleep and increase your risk of developing hormone imbalances that make fatigue worse.
The cycle is often made worse when people feel even more fatigued and then drink another cup of coffee in the afternoon or use it as a "pick-me-up".
This often leads to a perpetual state of fatigue which may get continually worse over time.
The trick to banishing fatigue related to caffeine reliance is to stop the use of caffeine and to take certain nutrients (we will discuss these below).
Extra weight gain on your body may actually be contributing to your energy levels as well.
It is well known that fatigue is a frequent complaint among people who are overweight.
The connection is not well understood but overweight patients often experience increased sleep problems, have other medical conditions, often are more depressed and may experience hormone imbalances (7) (such as leptin and insulin resistance).
In addition, extra weight on the body increases exertion for everyday activities such as walking and exercising and makes your heart beat harder to fit this demand.
The main issue with fatigue related to obesity is that the only way to improve energy is to lose the weight (and keep it off).
Fortunately, patients who experience fatigue related to weight gain often have other issues that contribute to their total "fatigue".
Meaning obesity may only contribute 15-20% to their fatigue and other therapies will still increase their energy.
#5. Hormone issues
Lastly, another huge contributor to fatigue is hormonal issues.
Sex hormones do more than just influence your sex drive.
Low testosterone, for instance, has been shown to promote fatigue, decreased energy, poor concentration and a decreased sense of well-being (8).
These symptoms exist for both males and females, by the way, which means that checking your sex hormones is important if you are suffering from fatigue.
I won't mention much in the way of fatigue related to sex hormone imbalances because the treatment usually requires replacement of certain hormones and these don't "count" as supplements because they often require a prescription.
Energy Boosting Supplements That Work
The main idea behind supplementation to boost energy is that you need to go after the root cause.
If you are looking for a simple "energy" supplement, it really doesn't exist.
Some manufacturers may put various "energy nutrients" into 1 supplement and call it a day but it certainly won't work for most people.
Instead, I recommend taking a more targeted approach.
Try to use the supplements that match with your symptoms or known problems that you may be experiencing.
You can start with these 7 supplements that I find work for most patients (not in order of importance):
#1. Adrenal/Cortisol Boosting Supplements
One of the most common causes of fatigue among patients is a condition known as "burn out" or "adrenal fatigue".
This condition has been around for thousands of years and basically is used to define a state in which patients experience a certain set of symptoms (9) (more on that below).
Patients with this condition also tend to improve with the use of adrenal glandulars and adrenal adaptogens.
Even conventional physicians will admit that this condition exists (because many of them suffer from it just like you!).
What they don't agree on is the cause of this condition (10).
Alternative providers will argue that this condition exists as a result of changes to serum cortisol levels or cellular receptor resistance to the hormone cortisol.
The idea is that constant stress, a poor diet, lack of sleep, etc. all contribute to hormonal changes which lead to adrenal burn out.
The problem is that there aren't a lot of studies that confirm the pathophysiology behind the disease.
But does it matter?
Because the truth is that the condition exists and many patients find relief from the use of certain supplements.
So how do you know if you suffer from adrenal burn out or adrenal fatigue?
Patients often experience some or all of the following symptoms:
As you can see these symptoms tend to be non-specific but are often shared among individuals who have this condition.
If you suffer from adrenal related issues then you may stand to benefit from the use of adrenal supplements.
There are 2 main classes of supplements known to help in this category:
Adrenal glandulars and adrenal adaptogens.
Adrenal Glandulars contain bovine sourced adrenal gland while Adrenal Adaptogens are primarily plant-based.
Just because there is not an agreement on what causes adrenal burn out doesn't mean that these supplements don't work.
Certain adrenal adaptogens (such as ashwagandha) have been shown to increase testosterone, improve sleep, help with weight loss (11), improve thyroid function and help normalize serum cortisol.
Adrenal glandulars have fewer studies compared to adrenal adaptogens but in my experience, they tend to work quite well.
You can learn more about using adrenal glandulars here.
And you can learn more about using adrenal adaptogens here.
#2. B Vitamins (B Complex + B12)
B vitamins are especially important for energy production because of their role in mitochondrial energy production.
Most people who have used them no doubt have experienced some subjective improvement in energy levels.
Despite this most physicians do not routinely recommend B12 or B complex vitamins.
The main issue here is that we don't have great ways to assess for B vitamins in the serum.
Your serum Vitamin B12 level doesn't adequately reflect what is happening at the cellular level.
Physicians know this, but for some reason get stressed out when they see someone with a serum B12 level greater than 1,000.
All Doctors are taught in medical school that a more sensitive test to assess B12 levels is methylmalonic acid (12), but this is rarely ordered by conventional physicians.
Instead, physicians will often recommend against the use of B12 or B complex vitamins, even though they may help.
As a side note: high serum levels of B12 are generally not of concern because B vitamins are water soluble and will be eliminated through the kidneys (provided you have adequate kidney function).
So how do you know if you have sub-optimal B levels?
Potential warning signs of low cellular vitamin B status include elevated serum homocysteine (13) (greater than 10.0) and/or an elevated MCV (greater than 92.0).
These are not 100% sensitive or specific to sub-optimal B status (14) but they can provide a metric for you to follow.
When in doubt it's worth a trial of B complex (and B12) supplementation.
Supplements remain cost-effective and are generally very well tolerated.
When supplementing with B vitamins it's best to find supplements that contain pre-methylated formulations of B vitamins (when appropriate).
These pre-methylated preparations are easier to utilize for the body and will often yield superior results, they are also safe to use in those people with MTHFR defects or issues with methylation.
It's also important to use high concentrations of B vitamins.
You can learn more about properly using B complex vitamins and B12 here.
As a final note...
Some patients may also benefit from the use of B12 shots over B12 and B complex oral supplementation.
If you fail to improve on oral B12 then it might be worth a shot of IM B12.
#3. Thyroid Boosting Supplements (T3 Conversion Supplements + Iodine Supplements)
Low thyroid function is another very common reason for fatigue, especially in the US.
The main issue with hypothyroidism is that it is under-appreciated and under-diagnosed.
Many cases of hypothyroidism may be missed unless thyroid antibodies are checked, which may indicate the presence of an autoimmune disease known as Hashimoto's thyroiditis.
This condition may cause relatively "normal" thyroid lab tests but these patients often exhibit many of the symptoms of hypothyroidism and do benefit from treatment.
In addition, many conditions such as obesity and inflammation may lower thyroid function prematurely and lead to changes in free serum thyroid concentrations.
The idea with thyroid supplementation is to focus on 4 major areas:
If you aren't sure where to start I've written extensively about supplements and nutrients that are important for thyroid function here.
You can also find very specific and targeted supplements that promote T4 to T3 conversion here.
Supplements that help to increase thyroid hormone production, supplements that help
#4. Supplements to Improve Mitochondrial Function Directly
There are several supplements that may directly help improve mitochondrial function and may, therefore, increase energy levels.
These supplements seem to work by helping to reduce inflammation and oxidative stress in the mitochondria (and in other cells such as the liver).
Studies indicate that the use of these supplements may slow down damage in certain inflammatory diseases such as insulin resistance and non-alcoholic fatty liver disease (15).
The type of damage from oxidative stress is the result of the inevitable breakdown of cells over time.
The idea behind supplementation is to reverse this process and bring the mitochondria back to their "youthful" state.
Another benefit to these supplements is that they may help with weight loss.
By increasing the number and the efficiency of mitochondrial units in the skeletal muscle you can impact or improve basal metabolic rate.
This basal metabolic rate is what helps determine how much energy you burn at rest and, therefore, how many calories you burn day today.
Supplements that may directly increase mitochondrial function include:
#5. Anti-Inflammatory Supplements
Fatigue is frequently seen in several chronic inflammatory diseases such as rheumatoid arthritis, chronic pain syndromes, and even metabolic syndrome.
The exact mechanism behind why inflammation results in fatigue are not well understood.
It is felt that some of this fatigue is most likely the result of "physiologic fatigue" which basically means that the body is working hard to try and get back to normal and this puts a huge demand on the body.
For these reasons, chronic medical conditions often "sap" the body of energy and result in fatigue.
Beyond this, fatigue may also be the result of impaired immune function (18) (and the triggering of the inflammatory cascade and inflammatory cytokines (19)), dysregulation of the hypothalamic-pituitary-adrenal axis and central neurological changes which all may result in fatigue.
You can identify the presence of systemic (whole body) inflammation by checking serum levels of ESR, CRP, and ferritin.
These can help determine if inflammation is present, but they aren't 100% perfect and may not detect low-grade organ-specific inflammation.
Finding the root cause of inflammation can be tough in certain individuals so you may need physician assistance.
You can get started with some basic supplements to help reduce inflammation, however, including these well-studied nutrients:
#6. Supplements (& Therapies) to Improve Sleep
If you suffer from fatigue you need to make sure that you are sleeping at least 8 hours each and every night.
It's also that this sleep is high quality and leaves you feeling well rested when you wake up.
If you have trouble sleeping then try these tips to help improve the depth and quality of your sleep:
Do not neglect this step!
If you aren't sleeping well then it should be your #1 priority as it is most likely to help more than any other therapy listed here.
#7. Hormone Balancing Supplements (Testosterone, Estrogen, Progesterone)
Lastly, your hormones have an influence on the total amount of energy that you produce.
The problem with hormonal balance is that most physicians tend to ignore them, or simply say that hormonal changes are normal as you age.
This leaves a huge gap in treatment for many patients who stand to benefit from small therapies which can dramatically influence their hormones.
Achieving hormonal balance and increased energy depends on which hormone imbalance you are presenting with.
You can read more about managing estrogen here.
You can learn more about high and low testosterone in women here.
If you are serious about improving your energy the best thing you can do is find the source of fatigue in your body.
Most energy problems stem from some issue related to mitochondrial energy production.
Conditions such as inflammation, nutrient deficiencies, hormone imbalances, and even diet can influence this production of energy.
Whenever possible make sure you supplement for your body and target it to the root cause.
Now I want to hear from you:
Have you tried taking energy supplements before?
Did they work for you?
Why or why not?
Leave your questions or comments below!
References (Click to Expand)
This post was most recently updated on August 23rd, 2019