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Iron
An essential component of red blood cells, iron combines w/protein & copper to make hemoglobin (pigment of red blood cells). Studies show women w/iron deficiency have decreased physical stamina & endurance. Iron deficiency, the main cause of anemia, is common during all phases of a woman's life, because of both poor nutritional habits & regular blood loss through menstruation. Iron deficiency frequently causes fatigue & low energy states.

Women who suffer from heavy menstrual bleeding are more likely to be iron deficient than woman w/normal menstrual flow. Some medical studies have found that inadequate iron intake may be a cause of excessive bleeding as well as an effect of the problem. Women who suffer from heavy menstrual bleeding should have their red blood count checked to see if supplemental iron & a high iron diet are necessary.

Good sources of iron are liver, blackstrap molasses, beans & peas, seeds & nuts, & certain fruits & vegetables. The body absorbs & assimilates the heme iron from meat sources, such as liver, much better than the nonheme iron from vegetarian sources. To absorb non-heme iron properly, you must take it w/at least 75 milligrams of vitamin C.

Zinc
Zinc plays an important role in combating fatigue. Supplementation w/zinc improves muscle strength & endurance. It reduces fatigue by enhancing immune function, acting as an immune stimulant & triggering the reproduction of lymphocytes when incubated w/these cells in a test tube. Zinc is a constituent of many enzymes involved in both metabolism & digestion. It is needed for the proper growth & development of female reproductive organs & for the normal functioning of the male prostate gland. Good food sources of zinc include wheat germ, pumpkin seeds, whole grain wheat bran, & high protein foods.

Magnesium & Malic Acid
Combinations of these 2 supplements are very important for the maintenance of energy & vitality. Magnesium is required for production of ATP, the end product of the conversion of food to usable energy by the body's cells. ATP is the universal energy currency that the body uses to run hundreds of thousands of chemical reactions. Malic acid is extracted from apples & is also an important component in the production of ATP. Another form of magnesium has been researched for the treatment of fatigue called magnesium aspartate, formed by combining magnesium w/aspartic acid. Aspartic acid also plays an important role in the production of energy in the body & helps transport magnesium & potassium into the cells. Magnesium aspartate, along w/potassium aspartate, has been tested in a number of clinical studies & has been shown to dramatically improve energy levels after 5 to 6 weeks of constant use. Many volunteers began to feel better even within 10 days. This beneficial effect was seen in 90% of the people tested, a very high success rate.

Magnesium is an important nutrient for women w/chronic candida infections. A magnesium deficiency can develop from the diarrhea, vomiting, & other digestive problems associated w/intestinal candida infections. Magnesium deficiency can worsen fatigue, weakness, confusion, & muscle tremor in women w/candida infections. Women w/these symptoms must replace the magnesium through appropriate supplementation. Magnesium deficiency has also been seen in women suffering from PMS; medical studies have found a reduction in red blood cell magnesium during the second half of the menstrual cycle in affected women. Magnesium, like vitamin B6, is needed for the production of the beneficial prostaglandin hormones & for glucose metabolism. Magnesium supplements can also benefit women w/severe emotional stress, anxiety, & insomnia. Taken before bedtime, magnesium helps to calm the mood & induce restful sleep. Good food sources of magnesium include green leafy vegetables, beans & peas, raw nuts & seeds, tofu, avocado, raisins, dried figs, millet & other grains.

Potassium
Like magnesium, potassium has a powerful enhancing effect on energy & vitality. Potassium deficiency has been associated w/fatigue & muscular weakness. One study showed that older people who were deficient in potassium had weaker grip strength. Potassium aspartate has been used w/magnesium aspartate in a number of studies on chronic fatigue; this combination significantly restored energy levels.

Potassium has many important roles in the body. It regulates the transfer of nutrients into the cells & works w/sodium to maintain the body's water balance. Its role in water balance is important in preventing PMS bloating symptoms. Potassium aids proper muscle contraction & transmission of electrochemical impulses. It helps maintain nervous system function & a healthy heart rate. Potassium is found in abundance in fruits, vegetables, beans & peas, seeds & nuts, starches, & whole grains.

Calcium
Helps combat stress, nervous tension, & anxiety. An upset emotional state can dramatically worsen fatigue in susceptible women. Calcium deficiency worsens not only emotional irritability but also muscular irritability & cramps. Calcium can be taken at night along w/magnesium to calm the mood & induce a restful sleep. Women w/menopause related anxiety, mood swings, & fatigue may also find calcium supplementation useful. It has the added benefit of helping prevent bone loss, or osteoporosis, because calcium is a major structural component of bone.

Like magnesium & potassium, calcium is essential in the maintenance of regular heartbeat & the healthy transmission of impulses through the nerves. It may also help reduce blood pressure & regulate cholesterol levels; it is essential for blood clotting. Good sources of calcium include green leafy vegetables, salmon ( w/bones), nuts & seeds, tofu, & blackstrap molasses.

Iodine
Iodine is necessary to prevent fatigue caused by low thyroid function. Iodine, along w/the amino acid tyrosine, is necessary for the production of the thyroid hormone thyroxin. Without adequate thyroid hormone women may suffer from excessive fatigue, excess weight, constipation, & other symptoms of a slowed metabolism. Iodine deficiency has also been linked to breast disease. Only trace amounts of iodine are needed to maintain its important metabolic effects. Good food sources include fish & shellfish, sea vegetables such as kelp & dulse, & garlic.

Tyrosine
This amino acid combines w/iodine within the thyroid gland to form the thyroid hormone thyroxine. Thyroxine has many important functions in the body, including control of metabolic rate, promotion of growth (particularly crucial in children), & carbohydrate & fat metabolism.

Women whose protein intake is low (which can be a problem for vegans who get their protein exclusively from plant sources) & women who can't absorb & assimilate protein due to severe digestive problems, may lack sufficient tyrosine in their diets & require manufactured thyroxine. These women may have border-line low thyroid levels which can be remedied by increasing their intake of thyroid hormone precursor nutrients. Besides increasing protein, tyrosine may be taken as a dietary supplement. Generally, 500 to 1500 milligrams of pure tyrosine per day may be used. It is best to take tyrosine w/a meal high in carbohydrates.

Tyrosine has been reported to help relieve depression, another cause of chronic fatigue. It has also been shown to relieve some symptoms in patients w/Parkinson's disease. Women using monoamine oxidase (MAO) inhibitor drugs for the treatment of depression should avoid taking tyrosine as should those diagnosed w/melanoma. Otherwise, tyrosine is safe for use by most people.

Phenylalanine
Tyrosine, the amino acid needed by the body to produce the thyroid hormone thyroxine, is actually manufactured from another amino acid called phenylalanine. This essential amino acid must be acquired through diet since the body cannot make phenylalanine from other amino acids. Good food sources of phenylalanine include fish, poultry, red meat, soybeans, almonds, lentils, lima beans, chickpeas, & sesame seeds. It can also be taken in purified form as a dietary supplement. Five hundred to 2,000 milligrams per day is the usual theraputic dosage. Be sure to start at the lower end of the range, increasing gradually.

Phenylalanine is a natural antidepressant & pain killer, but can also cause jitteriness & nervousness when used in too high a dose. As w/tyrosine, it should be avoided by women using monoamine oxidase inhibitor drugs for depression. Patients on phenylalanine may notice a greater alertness, an increased sense of well-being, & an enhancement of sexual interest.

Essential Fatty Acids for Chronic Fatigue
Essential fatty acids are very important nutrients for women w/fatigue & play an important role in maintaining optimal health. Essential fatty acids consist of two types of special fats or oils, called linoleic acid (Omega-6 family) & linolenic acid (Omega-3 family). Because your body cannot make these fats, you must sup-ply them daily via foods or supplements. Though these essential fatty acids supply stored energy in the form of calories, they also perform many other important functions in the body.

Essential fatty acids are important components of the membrane structure of all the body's cells. They are also required for normal development & function of the brain, eyes, inner ear, adrenal glands, & reproductive tract. The essential oils are also necessary for the synthesis of prostaglandins type I & III, which are hormonelike chemicals that help decrease the risk of heart disease by regulating blood pressure & platelet stickiness. Prostaglandins type I & II help reduce fatigue through their role in preventing a number of healthcare problems: they decrease inflammation, boost immune function, decrease menstrual cramps, & help to reduce PMS symptoms. One essential fat evening primrose oil has been tested in the U.S. & England for its beneficial effects on PMS & menstrual cramps.

Essential oils are particularly important to menopausal women because deficiency of these oils is responsible in part for the drying of skin, hair, vaginal tissues, & other mucous membranes that occurs w/menopause. Along w/vitamin E, which also benefits the skin & vaginal tissues, I have used essential oils extensively in my nutritional program for women. Essential fatty acids are important in treating immune problems such as candida infections, allergies, & CFS, which worsen fatigue in millions of women.

The best sources of linoleic & linolenic acids are flax seeds & pumpkin seeds. Both the seeds & their pressed oils should be used absolutely fresh & unspoiled. Because these oils become rancid very easily when exposed to light & air (oxygen), they need to be packed in special opaque containers & kept in the refrigerator. Essential oils should never be heated or used in cooking because heat affects their special chemical properties. Instead, add these oils as a flavoring to foods that are already cooked. Fresh flax seed oil is my special favorite. Good quality flax seed oil is available in health food stores. Flax seed oil is golden, rich, & delicious. It is extremely high in linoleic & linolenic acids, which comprise approximately 80 percent of its total content. Pumpkin seed oil has a deep green color & spicy flavor. It is probably more difficult to find than flax seed oil. Fresh raw pumpkin seeds are a good source of this oil. They can be purchased from many health food stores. Both flax seed oil & pumpkin seed oil can also be taken in capsule form.

Linolenic acid (Omega-3 family) is also found in abundance in fish oils. The best sources are cold water, high fat fish such as salmon, tuna, rainbow trout, mackerel, & eel. Linoleic acid (Omega-6 family) is found in seeds & seed oils. Good sources include safflower oil, sunflower oil, corn oil, sesame seed oil, & wheat germ oil. Many women prefer to use raw fresh sesame seeds, sunflower seeds, & wheat germ to obtain the oils. The average healthy adult requires only four teaspoons per day of essential oils. However, women w/chronic fatigue, who may have a real deficiency of these oils, need up to two or three tablespoons per day until their symptoms improve. Occasionally, these oils may cause diarrhea; if this occurs, use only one teaspoon per day. Women w/acne & very oily skin should use them cautiously. For optimal results, be sure to use these oils along w/vitamin E.

Herbs for Chronic Fatigue
Many herbs can help relieve the symptoms & treat the causes of chronic fatigue. I have used fatigue relieving herbs in my practice for many years & many women have found them to be effective remedies. I use them as a form of extended nutrition. They can balance & expand the diet while optimizing nutritional intake. Some herbs provide an additional source of essential nutrients that help relax tension & ease anxiety. Other herbs have mild anti-infective & hormonal properties in addition to their nutritional content; these help to combat fatigue causing viruses & fungi, as well as provide support for the endocrine system w/a minimum of side effects. In this section, I describe many specific herbs useful for relief of chronic fatigue & related problems.

Chronic Fatigue & Depression
For women w/fatigue & depression, herbs such as oat straw, ginger, ginkgo biloba, licorice root, dandelion root, & Siberian ginseng (eleutherococcus) may have a stimulatory effect, improving energy & vitality. Women who use these herbs may note an increased ability to handle stress, & improved physical & mental capabilities.

Some of the salutary effects may be due to the high levels of essential nutrients captured in herbs. For example, dandelion root contains magnesium, potassium, & vitamin E, while ginkgo contains high levels of bioflavonoids. These essential nutrients help relieve fatigue, depression, PMS, & hot flashes, & they increase resistance to infections.

Siberian ginseng, ginger, & licorice root have been important traditional medicines in China & other countries for thousands of years. They"ve been reputed to increase longevity & decrease fatigue & weakness. These herbs have been found to boost immunity & to strengthen the cardiovascular system. The bioflavonoids contained in ginkgo are extremely powerful antioxidants & help to combat fatigue by improving circulation to the brain. They also appear to have a strong affinity for the adrenal & thyroid gland & may help to boost function in these essential glands. Oat straw has been used to relieve fatigue & weakness, especially when there is an emotional component. One note of caution: Licorice root should be used carefully & only in small amounts because, over time, it can cause potassium loss.

In modern China, Japan, & other countries, there is much interest in the pharmacological effects of these traditional herbs. Scientific studies are corroborating the medicinal effects of these plants.

Anxiety, Irritability, & Insomnia
Women suffering from anxiety, irritability & insomnia often have a worsening of their fatigue symptoms because of emotional stress & sleep deprivation. Luckily, a number of herbal remedies relieve such symptoms. Herbs such as passionflower (passiflora) & valerian root have a calming & restful effect on the central nervous system.

Passionflower has been found to elevate levels of the neurotransmitter serotonin. Serotonin is synthesized from tryptophan, an essential amino acid that has been found in numerous medical studies to initiate sleep & decrease awakening. Valerian root has been used extensively in traditional herbology as a sleep inducer. It is used widely in Europe as an effective treatment for insomnia. Research studies have confirmed both the sedative effect of valerian root & its effectiveness as a treatment for insomnia. For women w/insomnia, valerian root can be a real blessing. I have used it w/patients for the past 18 years & noted much symptom relief. Other effective herbal treatments include chamomile, hops, catnip, & peppermint teas. I have used them all in my practice & many pleased patients have commented on their effectiveness.

Chronic Fatigue Syndrome, Candida Infections, & Allergies
Women w/fatigue symptoms caused by severe immune dysfunction may initially have difficulty using any herbs at all because their bodies are too weak. In cases of severe fatigue, I often start the patient on aloe Vera & peppermint. Most women can tolerate these two supportive & soothing herbs. You can take aloe Vera internally as a juice. Buy the cold pressed, nonpasteurized brands. You can take peppermint as a tea or, even better, as an oil in capsules or an herbal tincture in water.

Once you are stronger & less fatigued, you may be able to tolerate herbs that can boost your energy & vitality (see information earlier in this section), as well as herbs that help suppress infections from viruses, candida, & other pathogens. One of the best herbs for this purpose is garlic. Garlic contains a chemical called allicin that is a powerful broad spectrum antibiotic. Studies have shown garlic to be effective against fungi such as candida, as well as the fungus that causes athlete's foot & the dangerous fungus that causes serious cryptococcal meningitis. Garlic also kills bacteria & viruses. In addition, garlic protects the cells through its powerful antioxidant effects.

Two other herbs have strong anti-infective properties & can be used to treat pathogens that cause fatigue. The first is echinacea, a powerful immune stimulant herb. Echinacea helps fight infections by promoting interferon production, as well as activa-tion of the T-lymphocytes (natural killer cells) & neutrophils (the cells that kill bacteria). Native Americans traditionally used this plant as a medicinal agent. I've used echinacea often w/patients & have been pleased w/its powerful anti-infective properties. The 2nd herb, goldenseal, is also an excellent immune stimulant. Goldenseal contains a high level of chemical called berberine. Berberine activates macrophages (cells that engulf & destroy bacteria, fungi, & viruses). When used in combination w/garlic & echinacea, goldenseal is an effective tool for suppressing infections.

Menopause, PMS, & Hypothyroidism
Many plants are good sources of estrogen, the hormone that helps control hot flashes in menopausal women. Blueberries, blackberries, huckleberries, & citrus fruit contain bioflavonoids. Bioflavonoids have weak estrogenic activity (1/50,000 the strength of estrogen), but are very effective in controlling such common menopausal symptoms as hot flashes, anxiety, irritability, & fatigue. Plants containing bioflavonoids may be particularly useful for women who cannot take normal supplements because of their concern about the possible strong side effects of the prescription hormones (increased risk of stroke, cancer, etc.). Other plant sources of estrogen & progesterone used in traditional herbology include Dong Quai, black cohosh, blue cohosh, unicorn root, false unicorn root, fennel, anise, sarsaparilla, & wild yam root. The hormonal activities of these plants have been validated in a number of interesting research studies.

Women w/PMS also benefit from herbs that relieve mood swings & anxiety, such as valerian root or passionflower, & those that directly reduce fatigue & depression, such as ginger root, ginkgo biloba, & dandelion. Ginger also helps relieve the bloating & fluid retention symptoms of PMS, as do dandelion & burdock root, which act as mild diuretics. Iodine containing plants, including dulse & kelp, help correct low thyroid function. These sea vegetables are also high in trace minerals, so are excellent for general health & well being. Iodine is used for the production of thyroxin, the thyroid hormone that helps boost metabolism & maintain energy level.

Anemia & Heavy, Irregular Menstrual Bleeding
Plants that contain bioflavonoids help strengthen capillaries & prevent heavy, irregular menstrual bleeding (menorrhagia), a common bleeding pattern in women approaching menopause. Besides controlling hot flashes, bioflavonoids also help to reduce heavy bleeding. Bioflavonoids are found in many fruits & flowers; excellent sources are citrus fruits, cherries, grapes, & hawthorn berries.

According to studies, they're also found in red clover & some clover strains in Australia. Medical studies have demonstrated the usefulness of citrus bioflavonoids in treating a variety of bleeding problems in addition to those related to menopause, including habitual spontaneous abortion & tuberculosis. Herbs such as yellow dock & pan d'arco are useful for anemia because of high iron content.


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