Tired Versus Fatigued
How’s your day? Do you wake up roaring to go? By lunchtime are you ready for a nap? Does the 2 to 4 pm sag hit you? Are you tired or are you fatigued? Is there a difference? Is there a difference that matters?
The words “tired” and “fatigued” are often used interchangeably, but there are very fundamental physiological, mental and emotional differences in causation, effect and remediation. A long day on the slopes, a long day at the office, a long day doing almost anything, and you feel tired. A change from “doing” to “not doing” brings revitalization; resting, relaxing, a good meal, a night’s sleep and you are ready for another day of doing.
Fatigue, on the other hand, is feeling dragged out and debilitated over a long period of time. Rest, relaxation and sleep, assuming you can get to sleep or stay asleep, do not remediate your feelings. The next morning you are not ready for another day, and the day seems to drag forever. You may experience other symptoms such trouble concentrating, anxiety or irritability, changes in your mood, or even depression. Besides a nuisance, fatigue may be a harbinger of underlying medical conditions such as infection, injury, inflammation, gastrointestinal issues, sleep apnea, obesity, thyroid, heart and kidney disease. Stöppler, M., “Symptoms and Signs of Fatigue,” emedicinehealth (Nov. 14, 2022). https://www.emedicinehealth.com/fatigue/symptom.htm Fatigue could also result from a vitamin D deficiency. Johnson, K. and M. Sattari, “Vitamin D deficiency and fatigue: an unusual presentation,” Springerplus 4:584 (Oct 7, 2015). https://doi.org/10.1186/s40064-015-1376-x
Whether you are just tired or fatigued there are common steps to take. The first is a visit to your primary care physician (PCP) for blood tests. Biomarkers such as vitamins D and B12, and cortisol, can indicate physiological issues to be addressed. Second is a personal inventory of lifestyle and habits; sleep and stress are two of the most important. Start by getting away from the blue-light screen at least an hour before bedtime; books were invented just for this purpose. Establish a regular sleep routine; go to bed about the same time every night – yes, including weekends. It is well established that sleep patterns affect athletic performance; want to ski better, sleep better. Charest, J. and M. Grandner, “Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health,” Sleep Med. Clin. 15(1):41-57 (March 2020). https://doi.org/10.1016/j.jsmc.2019.11.005; Doherty, R., et al., “The Sleep and Recovery Practices of Athletes,” Nutrients 13(4):1330 (April 17, 2021). https://doi.org/10.3390/nu13041330
Third, and perhaps most important in today’s world, is stress management. On the positive side of the ledger, induced stress from physical conditioning enhances performance. On the negative side of the ledger, physical and emotional stress from everyday living degrades performance. Regular exercise and a healthy diet contribute to enhanced athletic performance as well helping managing the stress of living. More on this below. Kocalevent, R., et al., ”Determinants of fatigue and stress,” BMC Res. Notes 4:238 (2011). https://doi.org/10.1186/1756-0500-4-238; Lopes Dos Santos, M., et al., “Stress in Academic and Athletic Performance in Collegiate Athletes: A Narrative Review of Sources and Monitoring Strategies,” Front. Sports Act. Living 2:42 (May 8, 2020). https://doi.org/10.3389/fspor.2020.00042; Mahaffey, K., “Reducing Stress and Improving Mindfulness for Athletic Performance,” NASM. https://blog.nasm.org/techniques-for-reducing-stress-and-improving-mindfulness-for-athletic-performance
What about the role of diet in both tiredness and fatigue? Generally, a meal or snack gives you an energy boost. Unfortunately, certain foods on a long list, and undoubtedly some of the ones we want most to choose, drain energy. However, there is good news to follow.
Top of the “not good” list are processed grains, those found in white bread, white pasta and white rice (although recent research is more favorable to white rice). These grains have had the bran, the fiber-containing outer layer, removed, as well as the germ, which contains vital vitamins. Consequently, foods made from processed grains are more quickly digested and absorbed in the intestine, resulting in a quick rise in blood sugar level and in insulin level. The quick rise is followed by a quick fall, the crash. Jonnalagadda, S., et al., “Putting the whole grain puzzle together: health benefits associated with whole grains--summary of American Society for Nutrition 2010 Satellite Symposium,” J. Nutr. 141(5):1011S-22S (May 2011). https://doi.org/10.3945/jn.110.132944 Whole grains, on the other hand, are absorbed more slowly leading to better regulation of blood sugar and insulin levels throughout the day; your energy level is more constant. Panlasigui, L., and L. Thompson, “Blood glucose lowering effects of brown rice in normal and diabetic subjects,” Int. J. Food Sci. Nutr. 57(3-4):151-8 (May-June 2006). https://doi.org/10.1080/09637480500410879
Next on the “not good” list are foods loaded with sugar, more particularly those with added sugar loads, such as sodas, breakfast cereals, yogurt, ice cream, juices, muffins and other baked goods (skip those yummy, gooey cinnamon rolls), and many more. You can find them predominately in the center aisles of most grocery stores; stay out of the center aisles for the sake of your energy levels. Added sugars can make up more than half of the total carbohydrates in some packaged cereals. Even worse, eating foods high in sugar increases your attraction to other foods high in sugar; there go your glucose and insulin levels. Avena, N., P. Rada, and B. Hoebel, “Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake,” Neurosci. Biobehav. Rev. 32(1):20-39 (2008). https://doi.org/10.1016/j.neubiorev.2007.04.019 Unfortunately, switching to artificial sweeteners is of no help. Research shows that artificial sweeteners increase your cravings. Yang, Q., “Gain weight by "going diet?" Artificial sweeteners and the neurobiology of sugar cravings: Neuroscience 2010,” Yale J. Biol. Med. 83(2):101-8 (June 2010).
As you must expect, alcohol joins the “not good” list, especially large amounts of alcohol. While low or even moderate amounts of alcohol can be relaxing and calming, alcohol affects sleep quality and duration. Although a drink or two can help you fall asleep more easily, they can cause you to wake up the next morning feeling unrested. Ebrahim, I., et al., “Alcohol and sleep I: effects on normal sleep,” Alcohol Clin. Exp. Res.37(4):539-49 (April 2013). https://doi.org/10.1111/acer.12006
Next is one of my favorite categories to avoid, energy drinks. To quote the ads, “big boost in energy.” Unadvertised is the “big crash” that follows. Each drink manufacturer has its own formulation of ingredients, but the big two are sugar and caffeine. The ups and let downs of sugar are described above; up to 54 grams of added sugar in a 16 oz. can. Caffeine has mixed effects. The demonstrated positive health effects of caffeine include energy boost, increased brain function, assistance in weight management, and mood enhancement. Chen, J., et al., QA, “Associations Between Caffeine Consumption, Cognitive Decline, and Dementia: A Systematic Review,” J. Alzheimers Dis. 78(4):1519-1546 (2020). https://doi/org/10.3233/JAD-201069 On the other hand, the demonstrated negative effects of caffeine include anxiety, insomnia, digestive issues, addiction, high blood pressure, and fatigue. Meredith, S., et al., “Caffeine Use Disorder: A Comprehensive Review and Research Agenda,” J. Caffeine Res. 3(3):114-130 (September 2013). https://doi.org/10.1089/jcr.2013.0016 The major issue with caffeine in energy drinks is the amount of caffeine, way more than the amount of caffeine in a cup of coffee, about four times as much. You do not get increasingly more caffeine benefits at this elevated level, but you most assuredly get increased negative effects. Moreover, people who regularly consume energy drinks can build up a tolerance to the increased caffeine levels that leads to consuming increasingly large amounts to get the same energy boost. Scholey, A., and D. Kennedy, “Cognitive and physiological effects of an "energy drink": an evaluation of the whole drink and of glucose, caffeine and herbal flavouring fractions,” Psychopharmacology (Berl) 176(3-4):320-30 (November 2004). https://doi:.org/10.1007/s00213-004-1935-2
Fast food and fried foods can also drain energy because they are generally low in fiber and high in the bad kind of fat. Furthermore, many of them have high added sugar levels. Taba Taba Vakili, S., et al., “Association of high dietary saturated fat intake and uncontrolled diabetes with constipation: evidence from the National Health and Nutrition Examination Survey,” Neurogastroenterol Motil. 27(10):1389-97 (October 2015). https://doi.org/10.1111/nmo.12630
What foods enhance energy levels? You will not be surprised that the list of beneficial foods are the obvious ones and the ones that have been talked about repeatedly … unprocessed foods; fresh and seasonal fruits and vegetables; non-caffeinated and unsweetened beverages; lean proteins, such as 100% grass-fed and grass-finished beef, poultry and pork, wild caught fatty fish such as salmon and tuna; nuts and seeds; whole grains such as oats (not the preprocessed, sugar added packets); foods that add vitamins to your diet such as bananas and berries … all foods that you find around the edges of your grocery store.
Not a food, but having similar effect … exercise. Larun, L., et al., “Exercise therapy for chronic fatigue syndrome,” Cochrane Database Syst. Rev. 10(10):CD003200 (October 2, 2019). https://doi.org/10.1002/14651858.CD003200.pub8
When you choose to eat matters in dealing with tiredness and fatigue. Mother Nature provides us with an internal clock that moderates our sleep and wake patterns over twenty-four hours, a clock that reacts to changes in sunlight. This circadian rhythm not only affects how tired we feel, it also influences behavioral, mental and physical processes in the body, specifically including digestion. Potter, G., et al., “Circadian Rhythm and Sleep Disruption: Causes, Metabolic Consequences, and Countermeasures,” Endocr. Rev.37(6):584-608 (December 2016). https://doi.org/10.1210/er.2016-1083 Your eating window is 8 to 12 hours during sunlight. Keeping a consistent meal time in today’s hectic world is virtually impossible. What’s more, each person is different and reacts differently to eating. It is up to you to experiment and find the eating times best for you, trial and error, the times where food gives you an energy boost. Lopez-Minguez, J., P. Gómez-Abellán, and M. Garaulet, “Timing of Breakfast, Lunch, and Dinner. Effects on Obesity and Metabolic Risk,” Nutrients. 11(11):2624 (November 1, 2019). https://doi.org/10.3390/nu11112624
There are guidelines to help in your experimentation. The first and undoubtedly most important guidance is your mother’s … once again, your mother is right … breakfast is the most important meal of the day, and to continue her streak, eating the right food for breakfast is paramount. While we have slept, our bodies have been undertaking repair and maintenance. The first meal of the day replenishes the energy stocks used overnight; it gets us going.
Dr. David S. Ludwig, a nutrition expert at Children's Hospital Boston, says, “a good breakfast should include some carbohydrates with fiber (whole grains, fruits, or vegetables), some lean protein sources such as eggs or yogurt (Greek yogurt has more protein than regular), and some healthful fats such as those in nuts or salmon.” “Breaking the Fast,” Harvard Health Publishing (June 1, 2021). https://www.health.harvard.edu/staying-healthy/breaking-the-fast For some of us, that protein and fat combination is found in bacon (hopefully from pasture-raised hogs, not ones fed corn).
Eating both lunch and dinner earlier has been shown to have metabolic and weight loss benefits, and special benefits to the microbiome, the collection of bacteria in your gut. The microbiome harvests energy from digested food, regulates immune functions, protects against pathogens, and strengthens biochemical barriers to harmful bacteria. Dashti, H., et al., “Late eating is associated with cardiometabolic risk traits, obesogenic behaviors, and impaired weight loss,” Am. J. Clin. Nutr. 113(1):154-161 (January 4, 2021). https://doi.org/10.1093/ajcn/nqaa264; Thursby, E, and N. Juge, “Introduction to the human gut microbiota,” Biochem. J. 474(11):1823-1836 (May 16, 2017). https://doi.org/10.1042/BCJ20160510
You have undoubtedly heard the adage, “don’t eat after 7 pm.” As is so often the case, there are valid reasons and scientific support behind the advice. When you stop eating by 7 pm and do not eat breakfast before 7 am or later, you are fasting for at least 12 hours. During that fast insulin levels drop significantly, boosting fat burning, blood levels for human growth hormone (HGH) increase helping muscle gain and fat burning, norepinephrine (noradrenaline) increases to help breakdown visceral fat (the harmful fat surrounding the abdominal organs), cells undergo repair including removal of waste products, and there are beneficial changes in genes and molecules related to protection against diseases and longevity. Patterson, R. and D. Sears, “Metabolic Effects of Intermittent Fasting,” Ann. Rev. Nut. 37:1, 371-393 (August 2017). https://doi.org/10.1146/annurev-nutr-071816-064634
Late night eating increases waketime hunger, decreases waketime energy expenditure levels and twenty-four-hour core body temperature, and alters adipose tissue gene expression to favor lipid storage, all of which increase obesity risk. Vujovic, N., et al., “Late isocaloric eating increases hunger, decreases energy expenditure, and modifies metabolic pathways in adults with overweight and obesity,” Cell Metab. 34(10):1486-1498.E7 (October 4, 2022). https://doi.org/10.1016/j.cmet.2022.09.007
Feeling tired is natural after exertion, whether for work or for pleasure. Tiredness is readily corrected through rest and relaxation. Remedying fatigue is a longer-term path that necessitates addressing physiological, mental and emotional issues. Diet is a double-edged sword when it comes to diet and fatigue; bad food choices, Frankenfood, can significantly contribute to tiredness and fatigue, while good food choices help ameliorate the effects of tiredness and fatigue. Fortunately, making the correct dietary choices also contribute to overall health and longevity.
We all find ourselves in situations to Lilly von Shtupp, “Let’s face it, I’m tired … I’m so tired.”