Issue 127 the tired all the time generation alternative ways to re energise

CONDITIONS & DISORDERS

THE ‘TIRED ALL THE TIME’ GENERATION: ALTERNATIVE WAYS TO RE-ENERGISE Dr Emma Derbyshire Independent Consultant Emma heads Nutritional Insight Ltd, an independent consultancy to industry, government and communication channels. An avid writer for academic journals and media, her specialist areas are maternal nutrition, child nutrition and functional foods. www.nutritionalinsight.co.uk @DrDerbyshire

For full article references please email info@ networkhealth group.co.uk

Acknowledgement This article was supported by Red Kooga Ginseng. The article was written independently and its content reflects the opinion of the author only.

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Relentless tiredness is one of the most common complaints reported in GP surgeries today.1 There are many drivers behind feelings of incessant tiredness with this ultimately impacting on family, work and social lives. Unfortunately, in the battle to combat fatigue, there is a tendency to turn to sugary products, caffeine or energy drinks for a ‘lift’ which may even exacerbate the problem.

This article discusses alternative approaches to regaining energy.

Tiredness (or fatigue) tends to be described as a lack of or reduced energy and physical or mental exhaustion.2 In fact, amongst medics and health professionals, the problem of feeling exhausted is so common that it now has its own acronym ‘TATT’ which refers to feeling ‘Tired All The Time’.1 Survey data from the Royal College of Psychiatrists has shown that at any given time, one in five people feel ‘unusually tired’, while one in 10 people have ‘prolonged fatigue’.3 In general, there is a tendency for women to feel more fatigued than men.3 Fatigue also appears to be less common in the very young and old.3 A range of factors can affect the likelihood of feeling tired, including physical, psychological and lifestyle habits (see Table 1).3 It should, however, be recognised that in cases where tiredness persists for longer than four months, or accompanies unintentional weight loss (5% body weight in six to 12 months), immediate medical advice should be sought.1 ERRONEOUS APPROACHES

Unfortunately, when looking to combat tiredness, there is a general tendency to turn to sugary products, caffeine or energy drinks. For example, amongst night shift workers, such as nurses, one case reported, “feeling exhausted as the end of your night shift approaches…the quick energy boost offered by a fizzy drink or bar of chocolate is tempting”.4 Equally, evidence from the latest National Diet and Nutrition Survey5

www.NHDmag.com August/September 2017 - Issue 127

shows that mean intakes of non-milk extrinsic sugars (NMES) - now termed ‘free sugars’ - exceed the recommendation of no more than 11% of food energy for all UK adults. Some of the main sources of NMES in UK adults are confectionery, soft drinks and fruit juice, cakes and biscuits.

The energy drinks market has also expanded extensively, with many of these drinks containing caffeine, B vitamins, sugars, inositol and taurine with a view to counteracting fatigue.6 These drinks appear to be very popular, with one study reporting that 78.1% of student nurses use these to help with fatigue and 27.8% report experiencing palpitations.7 The authors of this work concluded that even student nurses need to be educated about how to prevent and reduce fatigue safely.

GETTING BACK GET UP AND GO

There are a number of strategies that may help to get to the bottom of TATT and improve energy levels. Several of these are discussed below.

B vitamins B vitamins have an important role in energy metabolism. Based on this, the European Food Safety Authority has authorised the claims that vitamin B6 and B12 contribute to the reduction of tiredness and fatigue.8 B12 screening may be worthwhile in older patients who report problems of tiredness, given the fact that malabsorption problems and pernicious anaemia are common with advancing age.9

Table 1: Possible reasons for tiredness3 Physical Being under/overweight Physical illness Pregnancy/having a young baby Poor sleep Doing too much physically/mentally Psychological Worrying and stress Insomnia Expecting too much of yourself Lifestyle habits Rollercoaster activities Night/shift work Work stress, e.g. long commutes Excessive caffeine/alcohol Dehydration

Caffeine check If caffeine is ingested in the evening, at night or before naps, it may disrupt sleep.10 This in turn can possibly phase-delay circadian rhythms, so contributing to sleep loss and subsequent decreases in alertness.11 Check iron status It may be worth checking iron status if feeling TATT. Presently, almost half (48%) of young British women have iron intakes below the Lower Reference Nutrient Intake (LRNI) along with a quarter (27%) of women aged 19 to 64 years.12 It is well recognised that iron can contribute to fatigue.13 Drinking enough water?

In one study comprised of healthy males, dehydration increased fatigue along with feeling of tension and anxiety.14 Ideally, adult males should be aiming for 2.5 litres of water and females 2.0 litres of water daily - from fluid and food sources.15 Improve your sleep There is sleep and there is good quality sleep.

Having a hot bath before bed, doing something relaxing before bed and avoiding eating late at night3 may help in trying to reduce fatigue and improve sleep.

GINSENG AND FATIGUE

There is growing evidence that ginseng could have a role to play in counteracting fatigue. Ginseng (Panax) is an herbaceous plant which contains signature phytochemicals (Saponin ginsenosides) that are regarded as having anti-fatigue effects.16 Recently, murine research has found that ginseng oligopeptides may also contribute to its antifatigue effects.17 In terms of clinical evidence, amongst females with multiple sclerosis, 0.25g ginseng taken twice daily over three months has been found to relieve fatigue and improve quality of life.18 Equally, research conducted on patients with cancer-related fatigue found that Panax ginseng at doses of 0.8g and taken over 29 days improved fatigue as well as sleep.19 Amongst patients with chronic fatigue syndrome, 1g or 2g of Panax ginseng taken daily over four weeks reduced fatigue severity scores, although this did not reach statistical significance.20 Other research has found that a daily dose of 0.4g of Panax ginseng taken over eight days improved calmness amongst a sample of healthy adults asked to undertake mental arithmetic tasks.21 Another study using red ginseng found associations with reduced cortisol levels, typically increased by stress, indicating that this may alleviate psychological rather than physical fatigue.22 Alongside this, there is some evidence that ginsenosides may have a role to play in the treatment of influenza viruses. It is thought that these powerful compounds may be able to attach to viral proteins, rendering them less active.23 Clearly, more human trials are needed, along with theories about how ginseng may exert its antifatigue actions. That said, there does appear to be some interesting evidence emerging in relation to the anti-fatigue effects of ginseng, particularly in at-risk populations.

SUMMARY

Taken together, feelings of incessant tiredness appear to be a common part of modern life. Work pressures, family life and lifestyle habits can all take their toll. Unfortunately, the easy and often readily available solutions, such as sugary products, caffeine or energy drinks, are not necessarily the most effective. Reflecting on daily eating habits, routines and natural approaches could be a more appropriate way forward. www.NHDmag.com August/September 2017 - Issue 127

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