April 2009 Issue

Eating for Energy
By Dina Aronson, MS, RD
Today’s Dietitian
Vol. 11 No. 4 P. 20

To best help their clients put some pep in their step, RDs should look beyond the hype, addressing fatigue and recommending diet and lifestyle modifications based on current advice and individuals’ unique needs.

If you see clients regularly, no doubt “having more energy” is high on their list of goals. With the demands of today’s hectic lifestyles combined with too few hours of quality sleep and poor eating habits, it’s no wonder many people complain of fatigue and low energy. Add to that a slew of possible health conditions and/or medications that may cause fatigue, and we are presented with challenges requiring strategic approaches and, all too often, trial and error. 

Neither the feeling of “having a lot of energy” nor fatigue can be measured empirically; we rely on self-reports. Establishing a diet-energy connection has its limits. First, energy level is largely subjective and thus difficult to define and measure (fatigue has been measured by symptom inventories; see sidebar); second, devising studies with a control group is complex, especially without an explicit intervention; and third, it would be challenging to control for variables that affect one’s interpretation of feeling energetic.

Fortunately, a well-constructed lifestyle questionnaire and health history, combined with a food-frequency questionnaire/24-hour recall, will provide dietitians with many clues pointing to the possible cause(s) of the complaint. Since we know that common culprits such as stress, lack of sleep, suboptimal diets, and lack of exercise explain the majority of scenarios, pinpointing trouble areas and addressing them directly may be 99% of the solution.

When conducting diet assessments, we need to look out for adequate intakes of the nutrients that, when deficient, are associated with fatigue. The ones to focus on include essential fatty acids (particularly omega-3s), iron, vitamin D, B vitamins, zinc, and magnesium. Routine blood tests will diagnose iron, vitamin D, and vitamin B12 deficiencies, and we can examine client intakes to establish whether they appear to be meeting their needs for other nutrients. 

Energy Is Often Lack of Fatigue
When attempting to help clients “eat for energy,” it is useful to examine whether they are fatigued. If so, relieving the fatigue may be the best approach to boosting energy.

Merriam-Webster’s Dictionary defines fatigue as “weariness or exhaustion from labor, exertion, or stress.” Lack of mental alertness, weakened muscles, and sleepiness are also part of fatigue as we perceive it. In our modern society, fatigue has become the norm for many people. For some, it goes unaddressed for months or years, until it starts to take its toll. Just one hour of sleep deficit per night, for example, can lead to serious exhaustion lasting several days. Some people don’t have the luxury of sleeping at night; they work night shifts and need to sleep during the day, which is hard on a body that naturally relies on darkness to signal sleep time. 

Unlike diabetes, heart disease, or Alzheimer’s disease, fatigue is a symptom rather than a disease, so treatment approaches vary as widely as its experience among sufferers. Fatigue can be transient (eg, after a long day) or chronic, and it can be a mild annoyance or a source of debilitation. Additionally, everyone feels fatigued from time to time, so pinpointing a cause can be truly perplexing.

As we age, it is normal to experience more fatigue than in our younger years. Reduced physical fitness, decreased periods of deep sleep, and the onset of chronic disease all impact our feelings of energy. If your older clients complain of fatigue with no obvious cause, the culprit may be the aging process. This does not mean that age-related fatigue is inevitable or untreatable. It simply gives us a framework on which to focus our efforts in combating fatigue.

Fatigue can also be a side effect of numerous health conditions. Sometimes these conditions have been diagnosed, but sometimes they have not, adding to the challenge of pinpointing the cause of low energy. Many fatigue-causing diseases are notoriously difficult to diagnose, such as fibromyalgia, seasonal affective disorder, and chronic fatigue syndrome. Others that may be easier to diagnose but still lead to fatigue include depression, anxiety, multiple sclerosis, infections, cancer, heart disease, anemia, kidney disease, and hormonal disorders. 

After identifying a client’s health challenges, acknowledging that these conditions can cause fatigue is the next step. Often, realizing the root cause of low energy gives people hope and incentive to try new techniques. Unless the disease is serious and requires hospitalization or close monitoring, approaches for feeling better are largely the same as for people without these conditions. Getting more sleep and regular exercise, adjusting medications (if safe and approved by the client’s healthcare provider), reducing stress, and improving diet can help people with fatigue-related health conditions.

Fine-Tuning Diet and Lifestyle
Even after addressing obvious offenders such as nutrient deficiencies, medications, lack of sleep, and stress, many people still seek more energy, and they come to us for help with fine-tuning their diet to feel more energized. Fortunately, many pearls of wisdom that we share with our clients to help improve their lifestyle also help with feelings of energy. Many nutrition experts report success with overall energy among their clients when they learn strategies for life balance and general healthy eating. But, of course, each client is unique. As trained experts, we must account for each client’s goals, history, health status, diet, preferences, and personality type. 

Improved Cognition = Improved Energy?
Improved cognition, particularly mood, is related to feeling energized, so following guidelines known to improve mood could help many people. Animal studies have shown that diets high in antioxidants and omega-3 fatty acids improve memory and cognition scores, and nutrition status is a predictor of mood, cognition, and memory in human studies. Being well nourished and getting plenty of antioxidants and omega-3s is good advice overall and likely contributes to these goals. 

Optimizing nutrient status for improved mood, in combination with other strategies, is the key to success for many people. Adjusting the diet to include more servings of fruits, vegetables, legumes, and whole grains—all rich antioxidant sources—and recommending at least one excellent source of omega-3 fatty acids per day (or recommending a supplement) can make a difference.

Lessons From Sports Nutrition
Human endurance studies point to several effective nutritional habits, including eating adequately throughout the day. “Studies consistently show that to increase stamina and endurance in physical activity, people need to fuel before and during the activity,” explains Nancy Clark, MS, RD, CSSD, a sports dietitian in the Boston area and the author of Nancy Clark’s Sports Nutrition Guidebook, Fourth Edition. “Yet, too many exercisers deem food as ‘fattening.’ They try to stay away from it in their efforts to shed a few pounds via their diet and exercise program. That is, they don’t eat before they exercise, have a low-energy workout that feels like drudgery, and, over time, get away from exercise because it is ‘no fun.’ Yet, we know that people who exercise, specifically strength train, become more active in the rest of their day.”

Most of us have seen this in our own clients: They are so motivated to lose weight that they will undereat to an extent that cannot sustain the workouts they impose on themselves. Undereating can cause similar effects in overall energy. Even standing up from a chair or staying awake during a meeting is a challenge for those who are simply not eating enough. 

Exercise is known to be a natural energy booster and mood lifter. Whether because of endorphins, increased fitness, enhanced oxygen consumption, or a combination, no one can argue that regular exercise is a powerful antidote for fatigue.

Getting Enough Calories—and the Right Kinds
Whether dieting for weight loss or simply skipping meals due to a busy schedule, skimping on calories ultimately decreases metabolic rate as the body tries to conserve energy. This is why skimpers may feel lethargic. Furthermore, as metabolism slows, the body subsequently burns fewer calories, leading to a greater propensity for weight gain when more calories are inevitably consumed. To keep energy levels high and metabolism revved up, it’s important for people to meet their daily calorie needs. 

Most people can easily understand why undereating zaps our energy. But they sometimes need extra help with choosing the right foods throughout the day. The car analogy is a good one to use with clients, suggests Lisa Raum, RD, owner of R.D. to GO, LLC. “Just as our cars need fuel to run efficiently, so do our bodies; without enough fuel, either will putter out.” 

Equally important, the car needs the right type of fuel; don’t expect a standard car to run on diesel fuel. “Since the body uses energy-yielding carbohydrates, protein, and fat in very specific ways, consuming each in proportion to the other is essential to ensure sufficient energy to complete daily tasks, feel good, and to maintain an optimal state of health,” Raum says. 

Exact proportions of each are subject to debate, so it’s worth a try to shift them around. But as a general rule, 55% of calories from carbohydrate, 15% from protein, and 30% from fat (along with adequate caloric intake) is a good approach. 

Whatever the preferred macronutrient breakdown, maximizing nutrient-dense foods is a good idea to maintain high energy levels. Not only will these foods supply ample macronutrients and micronutrients needed for optimal energy metabolism, but they discourage nutritionally void junk foods. The simple advice to eat at least two fruits and/or vegetables with every meal and at least one at snack time will help people meet their fruit and veggie goals while helping their bodies function optimally.

What about the glycemic index and glycemic load (GI/GL)? A controversial topic, eating according to the GI/GL may help some people with their energy. Because GI/GLs change when we combine foods (and the GI when portions are changed), using GI/GL in isolation is not very reliable. But swapping high-GI foods (eg, refined flour products, sweets, juice) for healthful low-GI foods (eg, intact whole grains, fresh produce, lean proteins) may help slow the release of insulin and be an effective approach to boosting energy.

Breaking the Fast and Timing Techniques
One of the most powerful and simple recommendations we can give our sluggish clients is to eat breakfast—and to make it balanced with complex carbs, protein, and a little fat. A good breakfast not only gets their metabolism going and keeps them satisfied until lunch, but it can also set the tone for a whole day of healthy eating. Swapping out processed foods such as donuts and pastries, white bagels, and waffles for healthier options such as fresh fruit, whole grain hot or cold cereal with nuts or seeds, whole grain bread with nut butter, or even last night’s casserole can help people take a giant step toward their energy goals.

Many find it effective to alter the timing of meals and snacks. One tried-and-true piece of nutrition advice for boosting energy is to eat minimeals throughout the day. For many people, getting a near-steady supply of food energy over the course of the day helps them keep their blood sugar levels in check and energy levels up. For others, however, the effort is too much, and their bodies do just fine on three meals. We should encourage clients to discover timing techniques that work for their lifestyle and preferences.

Avoid Consuming Too Many Calories
Just as undereating can lead to fatigue, overeating puts the body in overdrive, channeling tremendous amounts of energy to digest and absorb the large amounts of food consumed. How can a person feel refreshed after eating too much? It’s only natural to want to curl up and nap after a big meal; the resulting insulin overproduction can leave too little sugar available for immediate energy, resulting in lethargy. It is no surprise, then, that chronic overeating can contribute to low energy. Given that more than one half of the nation’s population is overweight, commonly due to overeating, it is understandable that this trend accompanies increased reports of fatigue. 

Unfortunately, just as eating too much can lead to fatigue, fatigue can lead to eating too much, creating a vicious cycle of weight gain and decreased energy. Clients in this predicament must break the cycle by focusing on portion control, adequate sleep, and stress management.

Drinking for Energy?
Tammy Lakatos Shames, RD, LD, CDN, CPT, and Lyssie Lakatos, RD, LD, LDN, CPT, also known as The Nutrition Twins and the authors of Fire Up Your Metabolism: 9 Proven Principles for Burning Fat and Losing Weight Forever, say, “Surprisingly, one of the things we’ve found most helpful when it comes to increasing our clients’ energy is drinking water consistently throughout the day. We are amazed by how many people go for a long period of time without drinking much fluid. The resulting fatigue and headaches are frequently a mystery to the client, yet the symptoms are easily and quickly reversed by simply drinking a cup or two of water and then remembering to drink 1/2 cup to 1 cup every couple hours.”

They go on to explain that the resulting improved energy then motivates people and encourages them to continue. Helpful compliance strategies include toting a water bottle or keeping a full glass of water nearby at all times. “An added bonus is that they have to use the bathroom more often, forcing them to move their body more during the day,” they say.

Alcoholic Beverages May Play a Role
Since alcohol is a depressant, it can contribute to low energy. It can also act as a stimulant several hours after consumption, disrupting sleep and causing fatigue the following day. Those who depend on a nightly drink to fall asleep or who overindulge on the weekend may find that eliminating or decreasing alcohol intake improves their energy considerably.

Choose Snacks and Drinks Wisely
Advertising and marketing efforts that appeal to people’s desire for quick-fix energy can bombard consumers and potentially lure them toward addictive habits. That’s why sales of energy bars, energy drinks, and workout supplements are so successful. For example, annual sales of certain popular energy drinks are in the billions of dollars, but have they cured America’s “energy crisis”?

“So many people grab coffee or diet soda for energy,” say The Nutrition Twins. “Although this will provide a short-term boost, it backfires. The mind and body get tricked into thinking that fuel was provided. Then when the caffeine rush wears off, the body realizes that it has nothing to use for energy, and the result is exhaustion and hunger, followed by overeating.”

Caught in this fierce cycle, caffeine may actually contribute to diet sabotage. They recommend that once clients make the connection among caffeine, fatigue, and overeating, they can edit their daily diets to ensure they provide a small amount of wholesome calories.

Some recommend eliminating caffeine; others maintain that when used correctly, caffeine can aid alertness. According to MaryBeth Augustine, RD, CDN, owner of The Natural Nutritionist in Brewster, N.Y., “Caffeine should be used like the psychoactive and stimulatory compound it is. When used short term and appropriately, it can increase mental alertness and enhance performance. A few instances where caffeine can be useful are for test taking, meeting a deadline, or increasing alertness before a long drive. It is the daily overuse and reliance on caffeine that is problematic.” Augustine also warns that caffeine may be contraindicated in patients with tachycardia, anxiety, or high blood pressure.

Another common trend is that as soon as people experience a dip in energy between meals, they automatically reach for a traditional snack—vending machine favorites such as pretzels, chips, snack cakes, or cookies. This can be a hard habit to break, but it is a mistake, explains Kate Geagan, MS, RD, author of Go Green Get Lean: Trim Your Waistline With the Ultimate Low-Carbon Footprint Diet. “Real food is the best source of real satiety,” she says. “I think it’s so easy for people to feel sluggish if they rely on highly processed snack foods. Many people don’t realize that these foods won’t give them the mental boost in energy they are craving and can often leave them feeling like they’ve eaten ‘air,’ while the brain wants more and more.”

What sorts of snack foods have passed the fatigue test? RDs have reported success among clients who combine wholesome foods in reasonable portion sizes. Combining complex carbohydrates with protein and fat provides lasting energy—the fiber, protein, and fat slow the release of glucose into the blood—and helps prevent energy crashes and overeating (see sidebar for snack ideas).

“I recommend people skip the snack packs and make their own ‘health packs’ instead,” says Geagan. “They can use a reusable container that holds about 1 ounce (think ‘airplane portions’) of food, like a small tin or plastic container.” To prevent relapse, Geagan recommends clients use a food log to pinpoint their “Hunger Zone,” then plan to have a snack about 20 to 30 minutes beforehand. It will help them steer clear of the “Hunger Danger Zone”—a place that makes it harder to make good choices.

Herbs, Supplements, and Natural Remedies
Examining the evidence surrounding the effectiveness of herbs and supplements in boosting energy is beyond the scope of this article. However, according to Augustine, some of these can help in certain circumstances. Dietary supplements she uses in her practice for managing low energy or fatigue include guarana, yerba mate, green tea, L-carnitine, and nicotinamide adenine dinucleotide (or NADH). “My approach to the use of dietary supplements in practice is to use the lowest, most effective dose typically used in studies and to advise on known side effects, contraindications, and drug-nutrient interactions,” she explains. “This aids the patient in informed shared decision making, which they can in turn discuss with their primary provider prior to implementation.”

Sticking With the Program
Motivating clients to continue with their “high-energy” lifestyle can be challenging. As with any lifestyle or dietary change, the benefits are most obvious after weeks of adherence, and this can act as a motivator in itself. To help clients reach and sustain this level, we can assist them in setting goals, achieving life balance (addressing stress, work, relaxation, and sleep issues), getting regular exercise, and discovering dietary strategies best suited for their unique goals and needs. 

— Dina Aronson, MS, RD, owns Welltech Solutions, a nutrition and technology consulting company.


Measuring Fatigue
If you would like to measure fatigue as part of your nutrition assessments, you may be interested in two validated tools used to assess fatigue in cancer patients: the Fatigue Symptom Inventory and the Multidimensional Fatigue Symptom Inventory. They assess the severity, frequency, and daily pattern of fatigue; its perceived interference with quality of life; and the principal manifestations of fatigue. You may need to adapt these for your needs (which may undo the validity) as a way to measure outcomes of nutrition intervention. For example, before-and-after intervention scores may be compared to document success.

— DA


Energy-Sustaining Snack Ideas
• Any mix of nuts (1/2 ounce) and dried fruit (1/2 ounce)

• 6 ounces soy or dairy yogurt topped with 2 tablespoons natural granola

• 1 serving fresh fruit dipped in 2 tablespoons almond butter or peanut butter

• 3 cups air-popped popcorn tossed with 1 teaspoon olive oil

• 5 whole grain crackers with 1/4 cup hummus

• Half of a sandwich made with whole grain bread

• 1/2 cup berries and 1 ounce walnuts

• Smoothie made with frozen fruit, flaxseeds, and milk (soy, cow, rice, or hemp)

• 1 ounce natural chips with 1/4 cup tomato salsa