Fatigue is a common complaint. Often, the fatigue is transient or can be attributed to a definable organic illness. Some patients present with persistent and disabling fatigue, but show no abnormalities on physical examination or screening laboratory tests. In these cases, the diagnosis of chronic fatigue syndrome should be considered.
   Fatigue may be due to depression, lack of exercise, poor diet with lack of adequate protein, anemia, diabetes, hepatitis, thyroid disorders, cancer, occult infections, autoimmune disorders, sleep apnea or sleep disturbances, or adrenal insufficiency. Fatigue is also associated with fibromyalgia.
   If a full medical evaluation is completed and no major causes are found, certain supplements may be tried to increase energy levels.

Supplements that may help decrease fatigue in some users
Vitamin-B-Coenzyme can help with energy
Carnitine 500 is a good, steady energy enhancer
Pantethine provides steady energy all day, Some people notice improved eyesight with pantethine.
Maca is an energy herb from South America
Spirulina is popular for energy improvement

Fatigue studies
L carnitine administration in elderly subjects with rapid muscle fatigue: effect on body composition, lipid profile and fatigue.
Pistone G,. University of Catania, Catania, Italy.
Drugs Aging. 2003;20(10):761-7.
L carnitine is an important contributor to cellular energy metabolism. This study aims to evaluate the effects of carnitine supplementation on body composition, lipid profile and fatigue in elderly subjects with rapid muscle fatigue. This was a placebo-controlled, randomised, double-blind, two-phase study. Eighty-four elderly subjects with onset of fatigue following slight physical activity were recruited to the study. Prior to randomisation all patients entered a 2-week normalisation phase where they were given an 'ad libitum diet, according to the National Cholesterol Education Program (Step 2). Subjects were asked to record their daily food intake every 2 days. Before the 30-day treatment phase, subjects were randomly assigned to two groups (matched for male/female ratio, age and body mass index). One group received carnitine 2g twice daily and the other placebo. Efficacy measures included changes in total fat mass, total muscle mass, serum triglyceride, total cholesterol, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), apolipoprotein (apo)A1, and apoB levels. The Wessely and Powell scale was used to evaluate physical and mental fatigue. Subjects were assessed at the beginning and end of the study period. At the end of the study, compared with placebo, the carnitine-treated patients showed significant improvements in the following parameters: total fat mass, total muscle mass, total cholesterol, LDL-C, HDL-C, triglycerides, apoA1, and apoB. Wessely and Powell scores decreased significantly by 40% (physical fatigue) and 45% (mental fatigue) in subjects taking carnitine, compared with 11% and 8%, respectively, in the placebo group. No adverse events were reported in any treatment group. Administration of carnitine to healthy elderly subjects resulted in a reduction of total fat mass, an increase of total muscle mass, and appeared to exert a favourable effect on fatigue and serum lipids.

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