Fatigue is a common complaint in people with joint pain or arthritis.  Fatigue can also occur with diabetes, depression, poor sleep, being overweight, or with some of the other factors that often go along with osteoarthritis.  But fatigue almost always has underlying biochemical factors that might be possible to address by dietary changes and nutritional support. 

In other words, it is possible to improve energy by careful use of selected nutrients.  Consider that vitamins, minerals, amino acids, and fatty acids are fundamental to our ability to generate energy.  Deficiency of one or more nutrients can lead to poor energy production or even to disease.  This is fundamental biochemistry as taught in all university and medical school curricula.

We can also not forget that once a disease process has begun, the disease process itself may produce higher needs for certain nutrients, or it may cause competition for or destruction of certain nutrients.

We'll use just one example to illustrate the potential benefit of a single nutrient in fostering improved energy--carnitine.  Carnitine is abundant in our tissues that need to work all the time, like heart muscle and skeletal muscle.  In the heart, 60 to 90 percent of the energy comes from burning fat.  Carnitine is the primary nutrient molecule responsible for shuttling our fatty acids (fats derived from our diet) into little structures within the heart muscle cells called mitochondria, where the fats can be burned as fuel.  Mitochondria are a bit like tiny furnaces. 

You might think of carnitine as the person that carries wood (or the fat) from the wood pile and puts it into the fireplace to be burned.  The carnitine-fatty acid shuttle is how you are able to generate energy from fat in your diet.  Too little carnitine, however, and the fats pile up like so many logs on the wood pile—waiting to be burned.  In this scenario, fat piles up (in the belly), energy production becomes inefficient, and fatigue sets in.

We can make our own carnitine—to a point.  But there are many things that can interfere with our manufacture of carnitine and, therefore, cause fatigue.  As a result, carnitine levels can drop sharply in certain diseases and as we age.

See How We Become Deficient in Carnitine

The importance of carnitine supplementation to improving energy was highlighted in a fascinating study of 66 people over 100 years old, who all complained of fatigue after even slight physical activity.  They were split into two groups.  One group was given 2 grams of carnitine daily for six months. The other group was given a placebo (or dummy pill).

The carnitine supplemented group experienced the following changes in comparison to the placebo group:

• Improvement in Physical fatigue score (-4.10 compared with -1.10)
• Improvement in Mental fatigue score (-2.70 compared with 0.30)
• Improvement in Fatigue severity score (-23.60 compared with 1.90)
• Improvement in Mental state score (MMSE: 4.1 compared with 0.6) 
• Reduced total body fat mass (4 pounds compared with 1.3 pounds)
• Increased total body muscle mass (8.4 pounds compared with 1.8 pounds)

[Malaguarnera, M, Cammalleri, L, Gargante, MP, et al. L-Carnitine treatment reduces severity of physical and mental fatigue and increases cognitive functions in centenarians: a randomized and controlled clinical trial. Am J Clin Nutr. 2007;86(6):1738-44.]

This is not an isolated study, meaning that the true effects of carnitine on energy and fatigue are probably quite pronounced and quite real.  Another study with 84 elderly people receiving 2 grams of carnitine per day showed the following improvements:

• Physical fatigue: 40 percent improvement (vs. 11% in placebo group)
• Mental Fatigue: 45 percent improvement (vs. 8%  in placebo group)
• Fat Loss: Loss of 6.8 pounds of FAT (vs. 1 pound in placebo group) 
• Muscle gain: Gain of 4.6 pounds of MUSCLE (vs.  0.5 pounds in placebo group)

[Pistone, G, et al. Levocarnitine administration in elderly subjects with rapid muscle fatigue: effect on body composition, lipid profile and fatigue. Drugs Aging 2003;20(10):761-7.]

These studies are really quite exciting.  They emphasize that there are legitimate biochemical tools that can be used to combat things like fatigue as we struggle with health conditions.  There are many conditions, such as diabetes, obesity, and cancer where carnitine has shown similar benefit. There are also many more nutrients, such as magnesium, that fall into the category of substances that benefit energy. 

Building a Better Furnace

An electric power plant usually burns something (like coal) to generate that electricty.  Then, the end user (us for example) uses the electricity to run almost anything we can imagine.  In the human body, the mitochondria within our cells generate energy (called ATP) that we use to power all our energy-demanding functions.  The fuel we use is our protein, fat, and carbohydrate (as simple sugars).

So, if we want to preserve our energy-making capacity we have to have a few things:

1) Enough fuel (sugar, fat, carbs)

2) Cofactors to burn the fuel (vitamins, minerals, etc)

3) Enought mitochondria to get the job done efficiently

We are usually not short fuel (though it does occur in different circumstances).  We are quite often low on cofactors (especially magnesium and certain B-vitamins).  But here's where it gets interesting.  Many people don't have enough mitochondria to generate the energy they need.  This takes a bit of a story, because raising the number of our mitchondria is one path to better energy.

Our skeletal muscles (the one's that hold us up and move us around) are filled with tiny organelles called mitochondria.  Skeletal muscle cells can have from 500 to 2000 of these mitochondria.  The more we have, the better we are at making energy.  Unfortunately, many people (especially those who are sedentary, overweight, obese, or suffer from diabetes) simply have too few mitochondria.  They have plent of fuel, but not enough furnace.

How Do We Make More Mitochondria?

If we want to remedy our fatigue and have more energy, we have to go to the source. We have to go to our mitochondria.  We've already addressed the needs for co-factor nutrients that drive mitochondrial energy.  This is critical.  But the way to make more mitochondria is to ask the muscles to do more.  As we ask them to do more, the mitochondria will duplicate themselves, increasing their numbers.  In short, exercise is the path to getting more mitochondria.