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How to Overcome Exercise Intolerance

Sep 29, 2021 | Inflammation & Autoimmune Disease

Exercise intolerance is a thing. It seems crazy that your body may react adversely to exercise. But it can happen, and it is common within the autoimmune community. We all know that movement is really important to reduce inflammation. However, exercise intolerance can make moving seem almost impossible. If you feel completely wiped out after you exercise, or even experience severe reactions like vomiting, nausea, blurred vision, or even trouble breathing, you may be suffering from exercise intolerance. The good news is, there is a way to overcome this by making some small lifestyle and dietary shifts.

What is Exercise Intolerance?

Exercise intolerance sounds exactly like what it is, the inability to exercise. It is when your body completely rejects movement. With this condition, there is a visceral response to anything related to exercise. Those who suffer from exercise intolerance may feel extreme fatigue for days after working out. Additionally, it can cause extreme reactions such as:

  • Vomiting
  • Blurred vision
  • Nausea
  • Severe and/or unusual muscle pain
  • Flu-like symptoms
  • Autoimmune flares

For some, it only happens with intense and prolonged movement. For others, seemingly simple exercises can trigger these reactions. 

What Causes it?

Exercise intolerance is conventionally seen in people with heart disease. This happens when the heart cannot disperse enough oxygen to the muscles. The lack of oxygen sets off a chain reaction that causes muscle mass and mitochondrial loss (1). Keep in mind, the mitochondrial loss is significant. If you can think back to high school biology, the mitochondria are an important part of cells. They are what we call the “powerhouses” of cells. Their primary job is to make energy. That means that these organelles take the food we eat and convert it to energy for our bodies to use. Therefore, when there is mitochondrial loss, the body is less efficient at making energy. And when energy is not made, the body cannot function.

It’s important to note that exercise and the mitochondria are closely related. Contracting muscles need energy from adenosine triphosphate (ATP), and ATP is created by the mitochondria. In fact, exercise (especially endurance exercise) can actually boost mitochondria weight and make them more efficient in making energy. Additionally, the mitochondria are essential for muscle performance and oxygen distribution (2).

Exercise is a stressor

However, exercise is also a stressor. When you exercise, you are asking your body to work hard. It forces the heart to beat faster so more blood can circulate to your muscles. The lungs need to expand to get enough oxygen in. Microtears develop in the muscles. The body releases fight or flight hormones like epinephrine, norepinephrine and cortisol to help keep your body moving (3). The stress from exercise can also affect the mitochondria. In fact, the mitochondria plays a major role in oxidative stress and is the largest producer of reactive oxygen species (ROS) in the body. In turn, ROS influences the inflammatory response and researchers have recently discovered that the mitochondria are involved in the inflammatory process (4).

Why is it prevalent in autoimmune disorders?

Exercise intolerance is commonly seen in people with autoimmune disorders. Why? Because of inflammation and the immune system. To take it back a step, inflammation is one of the common denominators of all autoimmune diseases. Do you know what else is sensitive to inflammation? The mitochondria. 

As I’ve already discussed, the mitochondria are partly responsible for regulating inflammation and the innate immune system. The overproduction of ROS triggers specific inflammasomes connected to the innate immune system. These inflammasomes can trigger an inflammatory reaction in the body. So, if you have chronic inflammation, which is generally the case with many autoimmune diseases, it is likely that the mitochondria are not functioning properly (4). And when the mitochondria are not functioning properly, they are likely not producing enough energy for your body to work – which leaves you feeling tired and fatigued.

How to heal exercise intolerance

Healing exercise intolerance takes patience. If you are working out and feeling totally drained that day or even for days afterwards, you are likely pushing it too hard. In addition, living with an autoimmune disease means that your immune system is constantly changing. You may feel great and energized one day, and wiped out the next. This is because there are so many external factors that can affect your immune system.

To overcome exercise intolerance, it is incredibly important to listen to your body. Do not push it when the energy is not there. Additionally, when starting to ramp up exercise, go very slowly. Make sure you continue to feel good as you ramp up your activity.

Remember, healing is never linear. Feeling great for one week or one month does not mean you are totally in the clear. Set backs happen, so it is important to be very aware of your body and how you feel.

The last important piece of healing exercise intolerance is to ignore the messaging around exercise and fitness. Many people on social media convey messages that it is okay to push it, that you have to go full out every day to get results. For those of us living with autoimmune diseases, this messaging is toxic and harmful to the healing process.

What nutrients can help?

Besides taking it slow and listening to your body, there are some important nutrients to include in your diet to help with exercise intolerance. Generally speaking, it really comes down to eating a diet that meets your calorie needs (i.e. do not overeat) while consuming a variety of different organic fruits and vegetables, legumes, grass fed or sustainably raised animal proteins, nuts and seeds and spices. Below are some of the key nutrients to look out for:


Given that the mitochondria are the major producers of ROS, it is important to have plenty of antioxidants in your diet to help capture those free radicals floating around in your body. Some of the best sources of antioxidants are found in colorful fruits and vegetables. In addition, alpha-lipoic acid (ALA) has been shown to increase glutathione production. Glutathione is the major antioxidant in the body. ALA can also improve cognition and reduce oxidative stress (5). Foods that contain ALA include beets, carrots, organ meat and brussel sprouts.

B vitamins

B vitamins play a major role in energy production and mitochondrial health. In fact, there is a connection between the mitochondria and methylation, and methylation requires a number of B vitamins including folate, B12, B6 and thiamine. The best sources of B vitamins are from green leafy vegetables, animal protein, nuts, seeds and organ meat (6).


This mineral is another important player in reducing oxidative stress. Selenium can be found in brazil nuts, chicken, eggs and pork (6).

Sufficient protein

Protein is made up of amino acids, and amino acids are needed to produce antioxidant enzymes. Diets low in protein can impact mitochondrial function. Protein can be found from both animal and plant-based sources like beans, grains, nuts and seeds (6).

Overcoming exercise intolerance may seem daunting. However, with a little patience, intuition and small diet changes, you can heal your mitochondria and get back to feeling more active and alive. As always, if you feel like you need some support in this process, please contact me to schedule a free call. Remember, I’m always in your corner.

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