Fighting fatigue with food - column

Fighting Fatigue With Food

"Am I sick? ... Am I tired? ... Is there something wrong with my diet?" These are questions athletes commonly ask me when they feel run down, dragged out and overwhelmingly exhausted. If this sounds familiar, you - like many of the people I counsel - may be grasping at nutrition for a cure-all, trading in hit-or-miss meals for quarts of orange juice and bushels of apples to keep the doctor away.

Peter, a 39-year-old marathon runner and lawyer, is a classic example of an athlete who came to me complaining he was always tired. He wanted a dietary overhaul. "I just don't take the time to eat right. I rarely eat fruits or vegetables. I live on junk. My diet is awful. I think poor nutrition is catching up with me." Peter lived alone, hated to cook, tended to survive on deli sandwiches, Chinese take-out and pizza. He rarely ate breakfast, barely ate lunch, but always collapsed after a long day with a generous feast of assorted fast (and fatty) foods. He struggled to wake up in the morning, stay awake during afternoon meetings and struggled to forge through his daily 10-mile run. He hoped dietary improvements would restore his energy. He also wondered if he needed some blood tests to help diagnose the problem.

Since there are both nutritional and non-nutritional causes of fatigue, here's what I looked for while trying to find some solutions to Peter's complaint:

Mental fatigue due to low blood sugar: Peter currently skipped not only breakfast, but also often missed lunch because he "didn't have time." No wonder he would doze off in the afternoon - he had low blood sugar. He'd eaten inadequate calories to feed his brain and it was running on fumes, making him feel sleepy! Lack of priority rather than lack of time was the real reason Peter skipped meals. The few minutes needed to eat breakfast and lunch could have contributed to increased productivity and hence saved, rather than wasted, precious minutes.

Muscular fatigue due to lack of carbohydrates: Peter's fast food meals filled his stomach, but left his muscles unfueled with adequate glycogen to support his training program. Higher carbohydrate fast food choices - such as thick crust pizza, submarine rolls (rather than pita bread), extra rice instead of egg rolls from the Chinese restaurant - could easily resolve that problem. Carbohydrate-rich snacks such as pretzels, juice boxes, fig bars, raisins and dried fruits kept at the office could also supplement his meals, and be readily available for "emergency food" on days when Peter truly had no time to stop for a meal. The snacks would not only fuel his muscles but also help maintain a higher blood sugar level, thereby providing energy for mental work as well as physical exercise.

Fatigue due to iron deficiency anemia: Peter restricted his red meat intake, hence simultaneously restricted his intake of iron, an important mineral in red blood cells that helps carry oxygen to exercising muscles. Since iron-deficiency anemia can result in needless fatigue during exercise, and since Peter looked pale, I recommended blood tests (hemoglobin, hematocrit, ferratin, serum iron and total iron binding capacity) to rule-out this possibility. I also encouraged Peter to boost his iron intake by eating small portions of lean beef two to four times per week (i.e., lean roast beef sandwich, stirfried beef with vegetables), as well as iron-rich foods like fortified cereals. Even if Peter wasn't anemic, an iron-rich diet would invest in future well being.

Fatigue due to lack of sleep: Peter's complaint about being chronically tired was justified because he was tired both mentally (from his intense job) and physically (from his strenuous training). He worked 8 a.m. to 8 p.m. By the time he got home, ran, bought dinner, ate dinner and "unwound," midnight had rolled around and 6:30 a.m. would come all too soon. I recommended Peter try eating smaller dinners but bigger breakfasts. The light dinner might help him sleep better; the heartier breakfast fuel him up for a high energy day (and prevent him from being ravenously hungry at night).

Fatigue due to overtraining: Although Peter took pride in the fact he hadn't missed a day of running in seven years, he felt discouraged he wasn't improving despite harder training. I questioned whether he was a "compulsive runner" who punished his body or a "serious athlete" who trained wisely. One or two rest days per week are part of a training program - they allow the muscles to replenish their depleted muscle glycogen.

Fatigue due to stress and depression: Peter not only had a stressful job, but was also dealing with the stress and depression associated with his recent divorce. Since he was feeling a bit helpless with those situations, I encouraged him to successfully control at least one aspect of his life - his diet. By making simple dietary changes, he'd not only feel better, but also feel better about himself - and that's energizing in itself.

Peter left my office with a "how to" list of dietary improvements, and the recommendation to see a physician if he continued to feel tired despite better nutrition. Although chronic fatigue can be a symptom of a medical problem, I suspected Peter's complaints could be resolved with better eating, sleeping and training.

Nancy Clark, M.S., R.D., is a nutrition counselor at the Boston-area SportsMedicine Brookline and helps althletes revise their diets for higher energy. She has also written Nancy Clark's Sports Nutrition Guidebook and The Athlete's Kitchen.

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