Remedy Routes
    Energy
    Moderate Evidence

    Chronic Fatigue Relief

    Reduced persistent exhaustion and improved daily energy levels.

    TL;DR

    Persistent fatigue is a symptom, not a diagnosis. Correcting iron deficiency and B12 deficiency produces the largest effects; CoQ10, NADH and Rhodiola show smaller, more variable benefits and should follow, not replace, a workup.

    Why It Matters

    Fatigue lasting more than six weeks warrants screening for anaemia, thyroid disease, sleep apnea, depression, and medication effects before any supplement is trialled. Mitochondrial support has an evidence base mainly in ME/CFS and fibromyalgia cohorts.

    How to Measure

    Biomarkers

    Ferritin
    Vitamin B12 / MMA
    TSH
    CBC
    Vitamin D

    Optimization Protocol

    Test and correct ferritin below 50 ng/mL, B12 below 400 pg/mL, and vitamin D below 30 ng/mL. Then trial one agent at a time for 8 weeks: CoQ10 200-300 mg, NADH 10-20 mg, or Rhodiola 200-400 mg standardized. Pace activity to avoid post-exertional crashes.

    Supporting Supplements

    NADH

    Compound
    Mixed evidence
    Limited
    Effectiveness 2/5

    NADH shows promise for chronic fatigue in small trials, generally as an adjunct to CoQ10 rather than alone.

    Rhodiola Rosea

    Herb
    Likely effective
    Moderate Evidence
    Effectiveness 3/5

    Rhodiola reduces stress-related and burnout fatigue more consistently than it addresses pathological chronic fatigue.

    CoQ10

    Compound
    Likely effective
    Moderate Evidence
    Effectiveness 3/5

    CoQ10 shows moderate fatigue reduction in ME/CFS and fibromyalgia cohorts, often studied together with NADH.

    Iron

    Mineral
    Strong yes
    Strong Evidence
    Effectiveness 4/5

    Correcting iron deficiency is the single highest-yield intervention for unexplained fatigue in menstruating women.

    Supporting Research

    Frequently Asked Questions

    What should be excluded before treating fatigue with supplements?
    Iron deficiency, thyroid dysfunction, B12 deficiency, coeliac disease, diabetes, sleep apnea and depression. Each is common, treatable, and easily missed if supplements are started first.
    Does iron help if I am not anaemic?
    It can. Trials in women with low ferritin but normal haemoglobin show reduced fatigue, generally below a ferritin of about 30 mcg/L. Iron without a documented low level is not advisable.
    Is CoQ10 worth trying?
    There is modest evidence at 100-300 mg/day, with the clearest signal in statin users and in chronic fatigue syndrome combined with NADH. Effects are small and take 8-12 weeks.
    What about B12 if my level is normal?
    Supplementing above a normal level has not improved fatigue in trials. Borderline levels are worth confirming with methylmalonic acid before deciding.
    Do adaptogens like rhodiola help?
    Rhodiola at 200-400 mg/day of standardised extract has small trials showing reduced fatigue in stress-related tiredness. Study quality is limited and effects are modest.
    How long before I judge whether something works?
    Allow 8-12 weeks for most nutrient corrections, and keep a simple daily energy rating - fatigue fluctuates enough that memory alone is unreliable.

    Typical Timeframe

    4-12 weeks depending on the underlying driver

    Research Summary

    Studies5
    Supplements4
    Evidence
    Moderate Evidence

    My Notes

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    This information is for educational purposes only. Always consult a healthcare professional before starting any supplement regimen.