Beth Israel Medical Center Exhaustion is an underrecognized epidemic in the US. Up to 75 million Americans report feeling "extreme" fatigue at work. Fatigue is among the top five complaints that people discuss with their doctors -- even though it’s estimated that two-thirds of people with chronic exhaustion never mention it to their doctors. Every physical activity, from the beating of the heart to running to catch a train, depends on adenosine triphosphate (ATP), chemical energy produced inside cells. Nearly everyone can significantly increase daily energy by *increasing the cellular production of ATP and reducing unnecessary consumption of ATP. Most people know that exercise boosts energy -- but you also can boost your ATP in other ways... STRESS REDUCTION Stress activates the sympathetic nervous system, which triggers thousands of chemical reactions that consume tremendous amounts of energy -- energy that is then unavailable to the body. People who experience chronic stress may have insufficient energy even for normal body repairs. It is estimated that up to 80% of all illnesses are due in part to stress. What to do... Keep a stress log. Every day, write down the events or situations that put you over the edge. These might include rush-hour traffic or dealing with a difficult boss. Once you recognize your flash points, try to eliminate them -- by taking a different route to work, for example, or avoiding unnecessary encounters with difficult people. Create the perception of control. People who feel helpless experience more stress than those who take a proactive approach -- even when they’re exposed to similar stressful events. Example: Maybe your job involves daily, high-pressure meetings. The source of stress won’t go away, but you can blunt the impact by deciding to do something about it -- by taking a brisk walk before each meeting, perhaps, or simply telling yourself to stay calm. Frequent breath breaks. Harvard mind-body researcher Herbert Benson, MD, found that the body’s energy expenditure dropped by as much as 17% during meditation. A less formal approach, when you notice signs of stress, is to take a "breath break." How to do it: Inhale slowly to the count of four, pause for one second, then exhale slowly and completely to the count of six. Pause for one second, then repeat four more times. People who take a breath break every one to two hours usually notice that they have more energy throughout the day. They also have a slower pulse, lower blood pressure and lower levels of cortisol (the primary stress hormone). high-ENERGY foods A Harvard study found that the *majority of American adults are *deficient in vitamins and minerals. These deficiencies usually aren’t severe enough to cause diseases, but they can impair the body’s ability to manufacture usable forms of energy. Helpful... Choose a "rainbow diet" -- including blueberries, broccoli, carrots, spinach, tomatoes and even dark chocolate. A variety of colors is important because different plant pigments, such as carotenes and flavonoids, help prevent metabolic by-products from damaging the mitochondria (energy-producing machinery) within cells. Eat fish two to three times a week. The omega-3 fatty acids in cold-water fish reduce inflammation -- saving the energy that is normally needed to fight it. To avoid the risk of excessive mercury, eat small fish, such as sardines, anchovies or trout. Large, predatory fish, such as tuna and sea bass, tend to have the most mercury. Avoid refined carbs. White bread, sweets and other refined carbohydrates are rapidly converted to blood sugar. This causes an energy surge that is followed by a longer-lasting energy decline. Spikes in blood sugar also cause glycation, a process that prevents cells from working efficiently. Better: Whole grains, lentils, beans and other foods high in complex carbohydrates. These are digested more slowly and provide the materials for longer-lasting energy. Drink water -- at least six glasses a day. The majority of my patients are dehydrated. Water supports the body’s ability to eliminate free radicals (cell-damaging molecules) and other toxins that impair energy production. THE JUICE CLEANSE Juice fasts allow the digestive tract to rest while promoting detoxification, reducing inflammation and dramatically increasing energy. One study even found that people who fasted once a month were 39% more likely to have healthy hearts than nonfasters. Once a month, consume nothing but juice for an entire day. Use a juicer to combine a variety of organic vegetables, such as spinach, carrots and broccoli. Add a small amount of apples, cherries or other fruits as a natural sweetener. It’s normal to feel a little worse during the day of the fast. That’s when the body is shedding the most toxins. Most people feel much more energized and clear-headed on the day after the fast. Caution: If you have a severe chronic disease, diabetes or are pregnant, consult your physician before fasting. SUPPLEMENTS can help I recommend supplements only to patients who don’t notice significant energy improvements within a few weeks of eating a healthier diet or making other lifestyle changes. If this is the case for you, try... Ashwagandha. It’s an "energy-*balancing" herb that improves the body’s ability to metabolize sugars as well as cortisol. Standard dose: 250 milligrams (mg) twice daily. Probiotics that include acidophilus and bifidophilus. People who take probiotic supplements have improvements in immunity and digestive function. Standard dose: One to two daily supplements containing at least 10 billion organisms per dose. ' Multinutrient that includes at least 400 international units (IU) of vitamin D. People who have been diagnosed with low vitamin D need 1,000 IU to 2,000 IU daily. Vitamin D is very important for immune strength and cardiovascular health -- and is crucial for maintaining healthy circulation and energy.' Bottom Line/Personal interviewed Woodson C. Merrell, MD, chairman of the department of integrative medicine at Beth Israel Medical Center and assistant clinical professor of medicine at Columbia University College of Physicians and Surgeons, both in New York City. He is author, with Kathleen Merrell, of The Source: Unleash Your Natural Energy, Power Up Your Health, and Feel 10 Years Younger (Free Press). www.woodsonmerrell.com.