Symptoms of fatigue may be physical, mental or emotional, for example:

Tiredness, low energy Desire to rest or sleep Inability to perform physical activity, or exhaustion after doing so Muscles may be weak, and prone to aches and pains Inability to concentrate, slowness of thought, forgetfulness Poor decision-making skills, low levels of motivation Irritability, mood swings, bad temper Headache

Cravings for sugary or carbohydrate-rich foods Dizziness, or poor balance Vision may become blurry, or eyes may be tired and twitchy Appetite may reduced, or conversely, hunger may be excessive In severe fatigue, co-ordination may be impaired and micro-sleeps may occur, increasing the risk of road or industrial accidents

In many cases, fatigue is the consequence of diet and lifestyle factors or due to emotional issues. Contributing factors may include:

• Insufficient sleep (although excessive sleep can also increase daytime fatigue)
• Use of alcohol or drugs
• Physical inactivity
• Poor diet, often involving foods that are high in calories but low in nutrition. Eating a diet that is nutritious but imbalanced (e.g. rich in fruit and vegetables but lacking in protein) may also cause fatigue. A poor diet may also lead to deficiency of nutrients involved in energy production, including iron, B-group vitamins and magnesium
• Skipping meals, eating irregularly or consuming large quantities of sugary foods, alcohol or starchy carbohydrates (e.g. bread, cakes, potatoes) may lead to blood sugar problems and energy slumps
• Inadequate relaxation time
• Stress (including work and relationship stress, financial worries, shift work, caring for invalids or small children)
• Depression, grief or anxiety.

Fatigue may also occur as a consequence of almost every physical ailment, including (but not limited to):

• Infection of any kinds (e.g. colds and flu, hepatitis)
• Anaemia and iron deficiency
• Insomnia and sleep disorders (e.g. sleep apnoea)
• Chronic health problems, especially those associated with ongoing pain (e.g. rheumatoid arthritis, cancer)
• Thyroid underactivity and other endocrine disorders
• Digestive disorders involving impaired absorption of nutrients (e.g. diarrhoea states such as coeliac disease)
• Poor heart health
• Respiratory conditions, especially those associated with decreased availability of oxygen (e.g. chronic bronchitis)
• The use of certain medications (e.g. opiates).

• Take a high potency multivitamin that provides a broad spectrum of nutrients to support energy production and help combat nervous tension and stress, including the B-group vitamins and magnesium. A formula that also includes Korean ginseng may be particularly beneficial for men, because this herb has traditionally been used to raise energy levels and improve the ability to withstand stress. Siberian ginseng has similar properties, and is an ideal inclusion in a multivitamin supplement for women.
• Iron deficiency and anaemia are common causes of fatigue, especially amongst premenopausal women and girls. For optimal absorption, choose an iron supplement that also contains nutrients that work with iron in the body and enhance its absorption, most importantly vitamin C, vitamin B12 and folic acid. Iron supplements from organic sources like ferrous fumarate are less likely than those from inorganic sources (like ferrous sulfate) to cause digestive upset and other side effects.
• Co-enzyme Q10 plays a vital role in the cellular production of energy, and taking a supplement may assist in the temporary relief of fatigue, especially in seniors, who have increased requirements for this nutrient. Look for a supplement supplying 150 mg per day.

• Rhodiola has traditionally been used to support energy levels and promote vitality, stamina and endurance. It is considered particularly beneficial for supporting the body's natural defences against emotional and environmental sources of stress, and also aids the management of depressed moods, poor immunity and low libido. Rhodiola is often taken in combination with B group vitamins, which support energy production and are essential for healthy nervous system function
• Spirulina is a highly nutritious and easily digestible source of amino acids and other nutrients, and has a long-held reputation as an energy tonic and superfood

• Persistent fatigue or sleepiness may be indicative of underlying disease, and require medical investigation.
• Most people need 7-8 hours sleep each night in order to feel rested and energetic. Try to stick to a regular routine, even on the weekends, and sleep in a comfortable, well-ventilated room.
• Incorporate time for relaxation into your day and if you are feeling overwhelmed by stressful circumstances, ask others for support or take steps to start changing issues that are affecting your mental wellbeing. Learning and practising meditation or relaxation techniques may be beneficial.
• Eat a well-balanced, nutritionally varied diet, with an emphasis on fresh fruit and vegetables, whole grains, legumes, nuts, seeds and lean high quality protein.
• Don't skip meals, especially breakfast, which is vital to maintaining blood sugar balance. Eating several small meals per day can also help.
• Adequate hydration is vital for physical and mental performance. Drink at least two litres of water every day.
• Regular exercise and activity are important for energy levels, and can also help to improve stress levels, depression, low moods and anxiety. Even a brisk 30-minute walk has health benefits, but other options include swimming, yoga and going to the gym.
• Avoid the use of stimulants (e.g. coffee and other caffeine-containing beverages), especially during the afternoon and evening, as they may interfere with sleeping patterns.
• Don't smoke, drink alcohol or use recreational drugs - all of these can exacerbate the problem, even if they may make you feel better in the short-term.