Don't Underestimate the Impact of Internal Fatigue: 8 Self-Assessment Questions and Tips for Improvement

Don't Underestimate the Impact of Internal Fatigue: 8 Self-Assessment Questions and Tips for Improvement
Ellen Wan

"Internal fatigue" can lead to declining bodily functions and various health issues. However, since internal organs cannot be observed externally, it is difficult for individuals to know the current state of their organs. Therefore, Japanese doctors have introduced self-assessment methods for internal fatigue and simple breathing exercises to improve it.

Dr. Kotaro Nakata, an internal medicine physician and supervisor of the book "Recovering From Internal Fatigue (内臓疲労回復)," explained to Women's Health magazine that "internal fatigue" refers to a signal that the organs are overloaded and need rest. It lacks a medical definition but generally manifests as disordered organ functions such as bloating and constipation caused by gastrointestinal problems and fatigue due to suboptimal organ function.
A study published in BMC Medicine in 2016 revealed that fatigue shortens lifespan. The researchers conducted a 16-year follow-up survey on 18,101 men and women aged 40 to 79. The results showed that the all-cause mortality rate and cardiovascular disease-related mortality rate for individuals with the highest levels of fatigue were 1.4 times and 1.45 times higher, respectively, compared to those with the lowest levels of fatigue. Even after considering all assumed confounding factors and mechanisms, the all-cause mortality rate for individuals with the highest fatigue levels remained 1.26 times higher than that of individuals with the lowest.
Dr. Shiro Kotake, director of the Kotake Orthopedic Surgical Clinic in Japan and an exercise specialist, pointed out in the Japanese health program "Help You Find the Physician's Clinic" that consuming iced drinks and cold food reduces blood flow to the stomach and small intestines, leading to indigestion and abdominal pain. Additionally, it increases bacterial toxins in the intestines, which, when entering the bloodstream, exhaust the liver's ability to detoxify, causing overall fatigue throughout the body.

How to Self-Assess Internal Fatigue

How can you determine if you have internal fatigue? Kotake suggests asking yourself the following questions to self-assess internal fatigue:
  1.  Do you frequently feel physically tired?
  2.  Do you have a rough skin texture and recurring acne around the mouth?
  3.  Do you have persistent constipation or diarrhea?
  4.  Are you susceptible to common colds?
  5.  Do you experience a loss of appetite and frequent bloating and indigestion?
  6.  Are you tired even after getting sufficient sleep?
  7.  Do you feel depressed and have brain fog or sluggish mental responses?
  8.  Do you regularly consume cold foods and beverages?
If you said yes to one to three of these questions, your organs might be starting to experience fatigue. If four to six signs describe your condition, you already have internal fatigue. If seven or more signs match, it is recommended to seek medical attention promptly.

Improved Organ Function Starts With Breathing

Kotake introduced a breathing exercise that can improve internal fatigue.


1. Sit on a chair without a backrest, maintain an upright posture, and take a deep breath. 2. Make a "peko" sound while exhaling and let the abdomen sink in. This contracts the diaphragm and lifts the internal organs upward. 3. While continuing to exhale, make a "poko" sound, then allow the abdomen to expand. This relaxes the diaphragm and causes the internal organs to descend. 4. Once again, make a "peko" sound while using your hands to press and release the abdomen, exhaling all the air.

Repeat this exercise for three sets every day.

*Important note: Do not inhale until you have fully exhaled all air.

The "Taichung Veterans General Newsletter," (pdf) published by Taichung Veterans General Hospital, states that incorrect breathing patterns can accumulate stress in the body, leading to various internal changes and dysfunctions. Modern lifestyles with prolonged sitting and reduced physical activity result in decreased functionality of the respiratory and circulatory systems (heart and lungs). Additionally, many people have a habit of slouching, which compresses the abdomen, causing decreased efficiency in diaphragmatic (abdominal) breathing. This can lead to substituting chest and neck muscles for diaphragmatic breathing, known as "chest breathing," which causes chronic shoulder and neck pain.
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