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Fatigue is a feeling of extreme tiredness. It can make it hard for you to focus and do daily tasks.

Therapy and healthy habits can help prevent it. Natural therapies have also been used to ease feelings of fatigue.

Natural Therapies

Likely Effective

Supplements that can help:

  • Iron is an essential nutrient that is vital for blood blow. It is likely to improve fatigue in those with low iron levels. (Note: It should not be taken by people who have problems with their heart.)C11, C13

Other therapies that are likely to ease fatigue are:

  • Acupuncture A1-A9
  • Exercise therapy B2, B4, B5, B8
  • Foot reflexology uses pressure points on the feet to treat symptoms.E1
  • Massage D1, D2
  • Mindfulness and relaxation is a form of meditation.B7
  • Tai Chi and qigong combine gentle motions with meditation.B9-B11

May Be Effective

These herbs and supplements may help ease fatigue:

  • Astragalus is a root that can be taken as a supplement. (Note: It should not be taken by people who have problems with their immune system.)C7
  • Chinese herbal medicine is the use of herbs to restore balance to the body.C4, C9, C10
  • Coenzyme Q10 plus nicotinamide adenine are antioxidants thought to have health benefits.C5, C8
  • Ginseng is plant that can be used in drinks or taken as a supplement.C7
  • Guarana is a vine that can be made into a drink or taken as a supplement. (Note It should not be taken by those taking medicine for depression.)C2
  • Nicotinamide adenine dinucleotide (NADH) is a compound that the body uses to make energy.C1

Yoga is a type of mind-body exercise that may ease cancer-related fatigue.B1, B3, B6

May Not Be Effective

  • Carnitine is a nutrient in the body that may not ease cancer-related fatigue.C6, C12

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Herbs and Supplements to Be Used With Caution

Talk to your doctor about any supplements or therapy you would like to use. Some may get in the way of treatment. They can also make illness worse or cause new problems. Examples include:

  • Astragalus may make the immune system more active. Talk to your doctor before taking it if you have problems with your immune system.C
  • Guarana should not be taken by those taking medicine for depression.C
  • Iron should not be taken by people with heart problems.C


A. Acupuncture

A1. Deare JC, Zheng Z, et al. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev. 2013 May 31;(5):CD007070.

A2. He XR, Wang Q, et al. Acupuncture and moxibustion for cancer-related fatigue: a systematic review and meta-analysis. Asian Pac J Cancer Prev. 2013;14(5):3067-3074.

A3. Ng SM, Yiu YM. Acupuncture for chronic fatigue syndrome: a randomized, sham-controlled trial with single-blinded design. Altern Ther Health Med. 2013;19(4):21-26.

A4. Lu C, Yang XJ, et al. [Randomized controlled clinical trials of acupuncture and moxibustion treatment of chronic fatigue syndrome patients]. Xhen Ci Yan Jiu. 2014;39(4):313-317.

A5. Zeng Y, Luo T, et al. Meta-Analysis of Randomized Controlled Trials of Acupuncture for Cancer-Related Fatigue. Integr Cancer Ther. 2014 May;13(3):193-200.

A6. Lau CH, Wu X, et al. Acupuncture and Related Therapies for Symptom Management in Palliative Cancer Care: Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016 Mar;95(9):e2901.

A7. Tao WW, Jiang H, et al. Effects of Acupuncture, Tuina, Tai Chi, Qigong, and Traditional Chinese Medicine Five-Element Music Therapy on Symptom Management and Quality of Life for Cancer Patients: A Meta-Analysis. J Pain Symptom Manage. 2016 Apr;51(4):728-747.

A8. Wang T, Xu C, et al. Acupuncture and moxibustion for chronic fatigue syndrome in traditional Chinese medicine: a systematic review and meta-analysis. BMC Complement Altern Med. 2017 Mar 23;17(1):163.

A9. Zhang Y, Lin L, et al. Effects of acupuncture on cancer-related fatigue: a meta-analysis. Support Care Cancer. 2018 Feb;26(2):415-425.

B. Exercise Therapy

B1. Buffart LM, van Uffelen JG, et al. Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer. 2012 Nov 27;12:559.

B2. Mishra SI, Scherer RW, et al. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev. 2012 Aug 15;(8):CD008465.

B3. Langhorst J, Klose P, et al. Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatol Int. 2013 Jan;33(1):193-207.

B4. Tomlinson D, Diorio C, et al. Effect of exercise on cancer-related fatigue: a meta-analysis. Am J Phys Med Rehabil. 2014 Aug;93(8):675-686.

B5. Heine M, van de Port I, et al. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev. 2015 Sep 11;(9):CD009956.

B6. Cramer H, Lauche R, et al. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev. 2017 Jan 3;1:CD010802.

B7. Duong N, Davis H, et al. Mind and body practices for fatigue reduction in patients with cancer and hematopoietic stem cell transplant recipients: A systematic review and meta-analysis. Crit Rev Oncol Hematol. 2017 Dec;120:210-216.

B8. Larun L, Bruberg KG, et al. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2017;4:CD003200.

B9. Xiang Y, Lu L, et al. Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials. PLoS One. 2017 Apr 5;12(4):e0174872.

B10. Song S, Yu J, et al. Ameliorative effects of Tai Chi on cancer-related fatigue: a meta-analysis of randomized controlled trials. Support Care Cancer. 2018 Jul;26(7):2091-2102.

B11. Wayne PM, Lee MS, et al. Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis. J Cancer Surviv. 2018 Apr;12(2):256-267.

C. Herbs and Supplements

C1. Alegre J, Rosés JM, et al. [Nicotinamide adenine dinucleotide (NADH) in patients with chronic fatigue syndrome]. Rev Clin Esp. 2010;210(6):284-288.

C2. de Oliveira Campos MP, Riechelmann R, et al. Guarana (Paullinia cupana) improves fatigue in breast cancer patients undergoing systematic chemotherapy. J Altern Complement Med. 2011;17(6):505-512.

C3. Etemadifar M, Sayahi F, et al. Ginseng in the treatment of fatigue in multiple sclerosis: a randomized, placebo-controlled, double-blind pilot study. Int J Neurosci. 2013;123(7):480-486.

C4. Su CX, Wang LQ, et al. Chinese herbal medicine for cancer-related fatigue: a systematic review of randomized clinical trials. Complement Ther Med. 2014 Jun;22(3):567-579.

C5. Castro-Marrero J, Cordero MD, et al. Does oral coenzyme Q10 plus NADH supplementation improve fatigue and biochemical parameters in chronic fatigue syndrome? Antioxid Redox Signal. 2015;22(8):679-685.

C6. An JH, Kim YJ, et al. L-carnitine supplementation for the management of fatigue in patients with hyperthyroidism on levothyroxine treatment: a randomized, double-blind placebo-controlled trial. Enocr J. 2016;63(10):885-895.

C7. Bach HV, Kim J, et al. Efficacy of Ginseng Supplements on Fatigue and Physical Performance: a Meta-analysis. J Korean Med Sci. 2016 Dec;31(12):1879-1886.

C8. Castro-Marrero J, Sáez-FrancásN, et al. Effect of coenzyme Q10 plus nicotinamide adenine dinucleotide supplementation on maximum heart rate after exercise testing in chronic fatigue syndrome – A randomized, controlled, double-blind trial. Clin Nutr. 2016;35(4):826-834.

C9. Chung VC, Wu X, et al. Chinese Herbal Medicine for Symptom Management in Cancer Palliative Care: Systematic Review And Meta-analysis. Medicine (Baltimore). 2016 Feb;95(7):e2793.

C10. Liu CH, Tsai CH, et al. Effects of the traditional Chinese herb Astragalus membranaceus in patients with poststroke fatigue: A double-blind, randomized, controlled preliminary study. J Ethnopharmacol. 2016;194:954-962.

C11. Low MS, Speedy J, et al. Daily iron supplementation for improving anaemia, iron status and health in menstruating women. Cochrane Database Syst Rev. 2016 Apr 18;4:CD009747.

C12. Marx W, Teleni L, et al. Efficacy and Effectiveness of Carnitine Supplementation for Cancer-Related Fatigue: A Systematic Literature Review and Meta-Analysis. Nutrients. 2017 Nov 7;9(11).

C13. Houston BL, Hurrie D, et al. Efficacy of iron supplementation on fatigue and physical capacity in non-anemic iron-deficient adults: a systematic review of randomised controlled trials. BMJ Open. 2018;8(4):e019240.

D. Massage

D1. Pan YQ, Yang KH, et al. Massage interventions and treatment-related side effects of breast cancer: a systematic review and meta-analysis. Int J Clin Oncol. 2014 Oct;19(5):829-841.

D2. Shin ES, Seo KH, et al. Massage with or without aromatherapy for symptom relief in people with cancer. Cochrane Database Syst Rev. 2016 Jun 3;(6):CD009873.

E. Other Therapies

E1. Lee J, Han M, et al. Effects of foot reflexology on fatigue, sleep and pain: a systematic review and meta-analysis. J Korean Acad Nurs. 2011 Dec;41(6):821-33.

Last reviewed February 2020 by EBSCO NAT Review Board Eric Hurwitz, DC