Fatigue is a complex and multifactorial symptom that can manifest itself in different health conditions, significantly affecting the quality of life of patients.
Fatigue , which can be translated into Italian as “asthenia”, differs from physiological fatigue or tiredness, which can result from physical or mental effort, in that it cannot be counteracted with simple rest: in fact , it persists over time at least until the determining factor is removed or the effects of the therapies that caused it are disposed of ; it is therefore a sensation of physical and mental exhaustion that can manifest itself in various contexts, such as chronic diseases, stress, sleep disorders or medical-surgical treatments.
Causes of the fatigue
There are many pathologies that can cause fatigue , which , in general, is resolved indirectly through treatment - and therefore clinical remission - of the pathology that is at its origin. From inflammatory bowel diseases to kidney failure, from autoimmune diseases to tumors, from obstructive sleep apnea to mental disorders, fatigue is found very frequently in the clinical setting.
In particular, it can be part of the symptomatology of an oncological pathology, linked or not to its medical and surgical treatments and to the impact that the tumor can have on the psychological sphere of the patient. In some cases, fatigue can be a direct expression of a depressive state independent of organic conditions. This state of extreme tiredness and exhaustion, which must be distinguished from the generic sensation of “fatigue”, significantly influences treatment paths and affects the emotional well-being of patients, especially those affected by cancer .
Clinical and subclinical manifestations of fatigue
Clinical manifestations
It can manifest itself in different forms and intensities and can affect both the body and the mind of the patient. Some of the most common manifestations include:
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Physical fatigue: Feeling of muscle weakness, lack of energy, and difficulty performing even the simplest daily activities, such as walking or doing household chores.
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Mental fatigue: Difficulty concentrating, mental confusion, and a reduced ability to process information effectively. This can interfere with memory, critical thinking, and problem solving.
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Disturbed sleep: Fatigue can cause insomnia, either as early awakening or late falling asleep, or difficulty maintaining deep, restful sleep, thus contributing to a vicious cycle of tiredness and discomfort.
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Alterations in the psycho-emotional sphere : chronic fatigue can lead to anxiety, depression, irritability and mood swings, negatively affecting the patient's mood and overall emotional well-being.
Subclinical manifestations
In addition to the obvious clinical manifestations, fatigue can also manifest itself subclinically, that is, in the absence of obvious symptoms but still influencing the general well-being of the patient. This occurs when, for example, the patient reports reduced resistance to effort, increased susceptibility to infections, a decrease in the ability to concentrate and a general and unspecified sense of malaise.
Nutritional interventions for fatigue management
Fatigue management requires an integrated approach that includes targeted nutritional interventions. A well-structured diet, starting from a correct assessment , can play a significant role in providing the body with the nutrients needed to combat tiredness and increase energy levels. When a patient reports extreme exhaustion or, if reading the clinical documentation that he brings for review shows that the clinician has recorded a state of asthenia, the nutritionist can provide some nutritional advice useful in managing the problem, always after an adequate and complete nutritional assessment . In particular :
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Ensure adequate energy intake
A low-calorie diet can contribute to tiredness and lack of energy. Make sure the patient gets enough kilo calories to support vital functions and daily activities. In the event that a risk of malnutrition is found due to deficiency, integrating blood chemistry, anthropometric and test data, it is essential to correctly evaluate needs in order to avoid making dangerously restrictive decisions, especially in cancer patients, and always in compliance with international guidelines.
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Favor iron-rich foods , where necessary
Iron deficiency is a common cause of tiredness and fatigue. Making sure to include iron-rich foods such as red meat, liver, legumes and green leafy vegetables (consumed in acidic dressings to protect the iron from oxidation) in your diet can help maintain optimal levels of iron in your body. Clams are the most effective source of highly bioavailable iron that patients usually have access to. In some cases, it may be appropriate to proceed with a highly bioavailable iron supplement.
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Consume complex carbohydrates
Complex carbohydrates provide a long-lasting source of energy and can help combat tiredness and fatigue: as in other cases, whole grains, pseudocereals, legumes and all their derivatives play a key role in the nutrition of patients with fatigue , net of specific digestive problems.
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Supplement with B vitamins
B vitamins are important for the body to produce energy . Make sure to consume foods rich in B vitamins such as meat, fish, eggs, dairy products, whole grains, green leafy vegetables, and fruits. Generally, it is unlikely that a patient will be deficient in B vitamins, but folate and vitamin B12 may be deficient in certain conditions.
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Maintain adequate hydration
Dehydration can contribute to tiredness and lack of energy : it is known that in athletes, for example , there is a collapse in performance in the case of inadequate hydration . It is therefore important to ensure that the patient drinks enough water during the day, possibly also with the help of flavorings .
Nutritional supplements for fatigue management
In addition to nutritional interventions, the territorial nutritionist is the professional who can be most useful in directing the patient towards correct integration for the management of fatigue . However, it is important to always consult a health professional before starting any integration, as some supplements can interact with drugs or have unwanted side effects. If the patient is undergoing oncological treatment, it is important that the professional consults with the clinician, so as to evaluate together the opportunity for any microintegrations .
Below are some supplementation strategies that may be considered for the nutritional management of fatigue :
Coenzyme Q10
Coenzyme Q10 is involved in the production of energy in cells and may be helpful in improving energy levels and combating tiredness.
Ginseng
Ginseng is a root known for its energizing and adaptogenic properties . Supplementing with ginseng extract can help improve energy levels and reduce fatigue. Ginsenosides in ginseng are known to have a tonic effect , and clinical studies suggest that the effect is determined by a more efficient use of oxygen by muscle cells.
Vitamin D
Vitamin D deficiency has been associated with symptoms of tiredness and fatigue. Supplementing with vitamin D may be especially helpful in individuals with low blood levels of this vitamin.
Magnesium
Magnesium supplementation, a macroelement that performs countless functions within the body, is indicated in the management of mental fatigue, especially where there is a decline in the ability to concentrate and a reduction in cognitive performance. Its effect seems to be linked to the role of post-synaptic modulator, at the level of calcium channels that constitute the main glutamatergic receptors , therefore excitatory, called NMDA.
Omega-3
Omega-3 fatty acids have been shown to have beneficial effects on cardiovascular health and brain function, and may help improve energy levels and combat fatigue.
Pomegranate extracts
Among the dietary supplements that may play a role in managing fatigue , pomegranate extracts have attracted particular attention in recent years. Pomegranate is rich in bioactive compounds, including polyphenols, anthocyanins, and ellagic acid, which have been shown to have potent antioxidant and anti-inflammatory properties . Recent clinical studies have examined the effects of pomegranate extracts on overall health and energy, with promising results.
Clinical studies suggest that pomegranate extracts may help improve energy levels and reduce feelings of tiredness. For example, a study in adults with chronic fatigue syndrome showed that supplementation with pomegranate extracts led to a significant improvement in symptoms of tiredness and an increase in perceived vitality. Other studies have highlighted the positive effects of pomegranate extracts on physical and mental endurance, suggesting that they may be useful in the management of both clinical and subclinical fatigue .
To fully understand how pomegranate extracts act on fatigue , it is necessary to examine their mechanisms of action at the cellular and molecular levels. The bioactive compounds present in pomegranate are known for their potential antioxidant effect, which can protect cells from oxidative damage and reduce inflammation, both of which , in turn, contribute to the onset of fatigue . Inflammation, in particular, has emerged as a key biological pathway for cancer-related fatigue , with studies documenting links between inflammatory markers and fatigue before, during, and, particularly, after treatment.
Additionally , some studies have suggested that pomegranate extracts may influence the production of adenosine triphosphate (ATP), the main source of cellular energy, thus improving the ability of cells to generate and utilize energy.
Fatigue Management : An Integrated Approach
Effective management of the fatigue requires an integrated approach that goes beyond nutrition and supplements , although to date there is no gold standard for the multi-professional management of this problem . Further strategies to consider are:
Stress Management
Chronic stress can contribute to fatigue . Learning stress management techniques such as meditation , deep breathing, or yoga can help reduce feelings of tiredness and improve energy levels.
Physical activity
Although fatigue can discourage physical activity, regular exercise can actually help combat fatigue . Exercise releases endorphins, brain chemicals that act as natural painkillers and improve mood. Additionally, regular exercise can improve physical and mental stamina over time.
Rest and sleep
Making sure you get adequate rest and quality sleep is essential to combating fatigue . Maintaining a regular sleep routine, creating an environment conducive to rest, and practicing proper sleep hygiene are strategies that can help improve sleep quality and reduce daytime tiredness.
Drug Management
In some cases, fatigue may be a side effect of certain medications. If a medication is suspected to be contributing to fatigue, it is important to refer the patient to the clinician to discuss alternative options or adjust the dosage.
Psychological support
Coping with fatigue can be emotionally challenging. Cognitive behavioral therapy support , provided by qualified personnel, can provide a safe environment to explore emotions related to fatigue and acquire effective coping strategies.
Condition monitoring
Keeping a symptom diary can help you identify fatigue triggers and monitor your progress over time. Recording your energy levels, sleep patterns, physical activity, and nutrition can provide valuable information for tailoring your fatigue management plan .
