Fatigue: the background to a vague and sometimes underestimated symptom

A simple question: How do you feel this morning?

Chronic fatigue and tiredness are often encountered in general practice settings. Very often, however, the answer to this simple question is underestimated.
Feeling tired in the morning, not fully rested, with little energy, or feeling that the night’s sleep was not as restorative as it should have been, are aspects that are not to be underestimated. Try the MUS® Vague and Aspecific Symptoms self-assessment form.
These signs are part of a series of symptoms that have been abundantly studied in the scientific literature and are grouped under the acronym MUS - Medically Unexplained Symptoms. They hide a series of hormonal, biological, behavioural, autonomic nervous system and body composition modifications that, as such, cannot be ignored nowadays. [1-8]
The causes are to be found in an alteration of biological rhythms as a result of multiple factors that can lead to this asynchrony between physiology and the current condition:

Monitoring the causes that can lead to these symptoms, i.e. assessing the autonomic nervous system (PPG Stress Flow) and the extent to which body composition (BIA-ACC) can trigger or rather be a consequence of these symptoms, allows us to best define the path to take in order to recover and maintain good health.
As a matter of fact, if our sympathetic nervous system (PPG Stress Flow), fully dominates in the morning, we will never be tired; on the contrary, we will feel very dynamic (see small tricks that can effectively support our natural defence system).
If we are properly hydrated (Total body Water) and have a good skeletal muscle mass (S-Score - Skeletal Muscle - BIA-ACC), the body has everything it needs to cope with limited periods of stress or an acute infection, a training session or a simple change of season (a time when mineral demand increases).

The use of supplements containing L-carnitine and coenzyme Q10 in the morning before breakfast is key in this context: L-carnitine is a useful tool in supporting cellular energy processes, while coenzyme Q10 is an essential component of the mitochondrial process that transforms energy from carbohydrates and fatty acids into ATP (the main form of cellular energy).  [09 -12]
In addition, taking supplements containing phosphate, bicarbonate in combination with magnesium and potassium before meals helps support the enzymatic and metabolic processes as well as all the situations in which the body is forced to use these components more constantly, precisely because of the above-mentioned causes. [13-14]

Authors: Dario Boschiero, Mariantonietta Lucafò - Date: 15/02/2021

Attention: these contents can be freely used for personal learning purposes only. The use is regulated by Law No. 633/1941 and subsequent amendments, as well as by the copyright and patent legislation in force. Any use for commercial and profit-making purposes is forbidden.


  1. Epstein RM, Shields CG, Meldrum SC, Fiscella K, Carroll J, Carney PA, Duberstein PR, Physicians' responses to patients' medically unexplained symptoms, Psychosom Med, 68(2):269-76; 2006.
  2. Ringsberg KC, Krantz G, Coping with patients with medically unexplained symptoms: work-related strategies of physicians in primary health care, J Health Psychol, 11(1):107-16; 2006.
  3. Woivalin T, Krantz G, Mantyranta T, Ringsberg KC, Medically unexplained symptoms: perceptions of physicians in primary health care, Fam Pract, 21(2):199-203. 2004.
  4. Smith RC, Korban E, Kanj M, Haddad R, Lyles JS, Lein C, Gardiner JC, Hodges A, Dwamena FC, Coffey J, Collins C, A method for rating charts to identify and classify patients with medically unexplained symptoms, Psychother Psychosom;73(1):36-42; 2004.
  5. Smith RC, Lein C, Collins C, Lyles JS, Given B, Dwamena FC, Coffey J, Hodges A, Gardiner JC, Goddeeris J, Given CW, Treating patients with medically unexplained symptoms in primary care, J Gen Intern Med, 18(6):478-89; 2003.
  6. Albrecht S, Naugle AE, Psychological assessment and treatment of somatization: adolescents with medically unexplained neurologic symptoms, Adolesc Med, 13(3):625-41; 2002.
  7. Reid S, Whooley D, Crayford T, Hotopf M, Medically unexplained symptoms--GPs' attitudes towards their cause and management, Fam Pract, 18(5):519-23; 2001.
  8. Alpern RJ, Sakhaee K. The clinical spectrum of chronic metabolic acidosis: homeostatic mechanisms produce significant morbidity. Am J Kidney Dis. 29(2):291-302; 1997.
  9. Fischer A, Schmelzer C, Rimbach G, Niklowitz P, Menke T, Döring F.Association between genetic variants in the Coenzyme Q10 metabolism and Coenzyme Q10 status in humans. BMC Res Notes. 21;4:245. 2011.
  10. Crane FL.Biochemical functions of coenzyme Q10. J Am Coll Nutr;20(6):591-8. 2001.
  11. Pekala J, Patkowska-Soko?a B, Bodkowski R, Jamroz D, Nowakowski P, Lochy?ski S, Librowski T. L-carnitine-metabolic functions and meaning in humans life. Curr Drug Metab. 12(7):667-78. 2011.
  12. Malaguarnera M, Cammalleri L, Gargante MP, Vacante M, Colonna V, Motta M. L-Carnitine treatment reduces severity of physical and mental fatigue and increases cognitive functions in centenarians: a randomized and controlled clinical trial. Am J Clin Nutr. ;86(6):1738-44. 2007.
  13. Siegler JC, Gleadall-Siddall DO. Sodium bicarbonate ingestion and repeated swim sprint performance. J Strength Cond Res;24(11):3105-11. 2010.
  14. McNaughton L, Backx K, Palmer G, Strange N. Effects of chronic bicarbonate ingestion on the performance of high intensity work. Eur J Appl Physiol Occup Physiol.80(4):333-6. 1999.