What is chronic fatigue?
Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) refers to a condition that is set apart by abnormal fatigue, widespread inflammation, and multisystemic neuropathology. When a person works hard, participates in strenuous activity, or is under constant stress at work or home fatigue usually follows, but resolves after a period of rest or a relaxing holiday. However, CFS not resolve after rest or a relaxing holiday.
Exhaustion is extreme to the point that some people with CFS are get out of bed. Many CFS sufferers visit a number of specialist doctors such as a physician, neurologist, endocrinologist, or psychiatrists, only to be told that tests are normal and the fatigue and other symptoms are psychosomatic or ‘all in the mind’. At that point, a person will often seek alternative treatment with a naturopath or homeopath, for a solution.
CFS is an ill-defined, multisystem disorder of unknown cause. Up to 2.5% of the population are affected by chronic fatigue, depending on the intensity of the diagnostic criteria used. CFS predominantly affects young adults, with a peak age of onset between 20 and 40 years of age. Women are affected more than men, typically in a ratio of 2–3:1, but this may be because women are more likely than men to see a doctor about health problems. CFS appears to be more common among socially disadvantaged groups than those from socially advantaged groups, contrary to the earlier name of ‘yuppie flu’. CFS has shed the dismissive tag of ‘yuppie flu’ and is no longer thought to be only a psychiatric condition.
Extreme fatigue after physical or mental activity is the main feature of CFS, which can happen straight away or the next day and last several days. A serious ‘crash’ or relapse can last weeks, months, or even years and also involves worsening of other CFS symptoms, which can include muscle and joint pain, sore throat, sore and swollen lymph nodes, headaches, cognitive difficulties, muscle weakness, sensitivity to noise, smells, and light, orthostatic intolerance, digestive disturbances, and depression.
The physiological response to activity includes abnormal exhaustion after any form of exertion, compared with people without CFS. The response depends on the amount and type of exertion. Even small tasks such as a short walk, showering and getting ready for work, or housework can be followed by unusual tiredness that lasts longer than expected.
During the past two decades, public acceptance and awareness of CFS has improved. Living with a chronic disease that impacts much of your life is difficult enough, but living with a chronic disease that people are skeptical about makes coping with CFS even harder.
Conventional medical treatments doctors use to treat chronic fatigue
People who receive an early diagnosis and early treatment enjoy better health outcomes. Support from family and friends, people at school and work, and health workers who understand the potential seriousness of CFS, can make a significant difference to recovery. Find a good doctor you trust – a doctor who is sympathetic to CFS and knows how to treat the problem.
The treatment goal should be enhancement towards and preservation of an individual’s best functional capacity. The lifestyle restrictions associated with CFS can lead to isolation, frustration, and in turn secondary depression. Low doses of an antidepressant drug can treat depression, improve sleep quality, and relieve pain.
No one treatment has been shown to cure CFS and so symptoms are treated as needed. The most effective treatment for CFA can be an energy-management strategy called pacing – knowing when enough is enough and not overdoing mental or physical exertion.
A doctor will usually treat the most disruptive symptoms first, which usually includes:
- Fatigue and sleep problems
- Memory and concentration problems
- Depression and anxiety, or
- Dizziness and light-headedness.
The most commonly used medications and supplements are:
- Antibiotics for infections
- Sleeping tablets to enable quality sleep
- Antidepressants to manage depression
- Analgesics or nonsteroidal anti-inflammatory drugs to reduce pain
- Antifungal drugs to treat candida albicans
- Antihistamines for seasonal allergies
- Antiviral drugs
- Calcium channel blockers
- Beta blockers for low blood pressure
- Antioxidants to reduce oxidative stress, and
- Anticonvulsants to treat neuropathic pain, anxiety, or insomnia.
Antidepressant drugs are the most widely used treatment for CFS/ME. Most CFS patients have low amounts of seratonin and dopamine, two neurochemicals that affect sleep, cognitive function, and digestion. The antidepressants commonly prescribed include selective seritonin reuptake inhibitors (SSRIs), seritonin norephinephrine reuptake inhibitors (SNRIs), and tyicyclic antidepressants, which increase norepinephrine levels in the brain. All have been shown to improve sleep quality, energy levels, and cognitive function. Also, SSRIs and SNRIs provide anti-inflammatory and immunomodulatory effects, which can reduce symptoms.
Many people with CFS report an increased susceptibility to drug side effects, so any new medications should start with a small dose to assess tolerance. Start just one new treatment at a time to assess effectiveness. CFS symptoms reoccur so keep medications and supplement in case they are needed later on, just check the expiry date before reuse.
Speaking with a psychological counsellor might help a person to cope better with lifestyle limitations. An objective perspective from someone who cares can provide solutions to challenges and make a person feel more capable and in control, which in turn will improve a person’s outlook on life.
If depression is a problem, a general practitioner or psychiatrist might suggest a drug that inhibits serotonin reuptake called an SSRI (Specific serotonin Reuptake Inhibitor). Serotonin is a neurotransmitter that aims to maintain emotional stability and extend the ability to cope with symptoms.
Cognitive behavioural therapy aims to change the way a person thinks about problems and how he or she responds to frustrating circumstances, in order to reduce emotional stress. Accepting the diagnosis of CFS, challenging negative thoughts that might inhibit improvement, and focusing on the positive aspects of life are all part of cognitive behavioural therapy, which is used to help people cope with a number of chronic medical problems.
Eating a balanced diet leads to better health in general and will assist a person with any chronic medical condition.
Nutritional medicine treatment for chronic fatigue syndrome
For the nutrition medicine practitioner treating chronic fatigue syndrome (CFS), there are several points of special note. Symptoms of bowel disturbance are extremely common and appear to be related to bowel dysbiosis and maldigestion. A person with CFS is likely to have atopic diathesis, which means a tendency to get hayfever, allergic rhinitis, bronchial asthma, or atopic dermatitis. Multiple food or chemical sensitivity reactions are common and exacerbate CFS symptoms and bowel disturbance.
Marked sensitivity to alcohol, volatile hydrocarbons (propellants in aerosol sprays), and petrochemical fumes is likely. These substances will trigger neurocognitive and autonomic symptoms. Usually sensitivities emerge following the onset of CFS and reflect accompanying immune system disturbance.
Due to the nature of CFS, nutritional treatment has to be individualised because every patient has a different set of nutritional deficiencies, infections, or inflammations. Nutritional therapy requires careful assessment and management, with regular review by a nutritional therapy specialist.
If hyperinsulinemia and insulin resistance are present, a low Glycaemic Index (GI) diet will prevent episodes of hypoglycemia.
Vitamin and mineral supplement will usually include vitamin B12 (preferably injections), folic acid, zinc, calcium, chromium, magnesium, iron, and copper.
Hormones and other supplements for improved energy will usually include DHEA, melatonin, Coenzyme Q10, Evening Primrose Oil, omega-3 fatty acid or Max EPA.
A person with CFS who includes more vegetables, legumes, whole grains, protein (from lean meat), and essential fatty acids found in nuts, seeds, and cold water fish will enjoy improved energy levels and immune system function. Nutritional medicine specialists also recommend avoiding refined and processed foods that contain added sugar and saturated fats, and avoiding stimulants such as caffeine and alcohol.
The following supplements may help reduce symptoms of CFS. Ask your doctor before taking a supplement and work with a knowledgeable nutritional medicine specialist.
- Magnesium combined with malic acid may reduce fatigue and boost energy levels
- Essential fatty acids, such as those found in fish oil and evening primrose oil may also help reduce fatigue. If you also take blood-thinners or aspirin check with your doctor before taking these supplements.
- NADH – a naturally occurring chemical involved in energy production in the body shown to reduce symptoms of CFS.
- DHEA – a hormone produced by the body that improves energy levels. The body uses DHEA to make the hormones testosterone and estrogen. Check with your nutritional specialist if you are at risk for breast cancer, prostate cancer, or any other hormonally influenced illness before taking DHEA. DHEA should not be taken while pregnant or breast feeding and DHEA can interfere with medications used to treat high cholesterol, liver disease, depression, anxiety and bipolar disorder.
- Vitamin B12 injections have been shown to improve energy in people who are not getting enough B12 or who have a functional B12 deficiency.
- Beta-carotene (a precursor to Vitamin A) will strengthen immune function.
- L-carnitine will support energy production at a cellular level. A person who takes thyroid hormone or blood-thinners should check with a nutritional specialist before taking l-carnitine.
- Vitamin D levels are lower in people with CFS, who are at risk of osteoporosis due to reduced physical activity. Too much time indoors leads to reduced vitamin D synthesis, which also worsens CFS symptoms.
University of Maryland Medical Center
The goals of nutritional medicine treatment of chronic fatigue are to treat underlying pathogens and improve energy levels.