Although fully 20% of any doctor’s patients report being tired or fatigued, actual cases of chronic fatigue syndrome are (fortunately) rather uncommon. Yet it’s also a condition that, like fibromyalgia, is markedly complex and about which doctors disagree. CFS (also called CFIDS, for Chronic Fatigue Immune Dysfunction Syndrome) first came to prominence in the 1980s when young people, after suffering cases of really awful flu, simply couldn’t get their energy back to normal again. And even though they seemed to have symptoms of a lingering virus (muscle aches, headaches, swollen lymph glands, sore throats), no virus was ever found. Then more serious symptoms–poor memory, sleep problems and depression–developed and persisted.
Today, more than 20 years later, we know a little more about CFS. But not a lot. In many cases, the most beneficial results come from combining conventional and alternative strategies, as we do at WholeHealth Chicago. No single treatment, however, is “best.” In the end most people eventually recover much of their lost function without knowing exactly what worked.
What is Chronic Fatigue Syndrome?
As the name implies, chronic fatigue syndrome (CFS) is a disorder whose essential feature is persistent unexplained exhaustion. CFS is usually accompanied by a long list of associated symptoms, including difficulty concentrating, headache, sore throat, tender lymph nodes, muscle and joint aches, feverishness, difficulty sleeping, and depression. Most of those diagnosed with CFS are under age 50, and more women than men seem to be affected. The condition most often appears after a seemingly unremarkable bout of a flulike illness, but then it lasts…and lasts…and lasts. It’s important in diagnosing and dealing with CFS (or CFIDS) to try to differentiate this ailment from two very similar conditions, namely, fibromyalgia and chronic depression.
While fibromyalgia has diffuse muscle aching like CFS, fatigue is not fibromyalgia’s dominating feature. Nor are feverishness, sore throat, or lymph enlargement present. By far more common than CFS (by literally millions of patients), fibromyalgia seems more closely linked to chronic physical and emotional stress rather than to a previous viral condition. Likewise, chronically depressed patients may experience great exhaustion, but they lack the physical and immunologic symptoms of CFIDS.
Actually, chronic fatigue syndrome is not really a new disease. Medical literature has been reporting similar symptoms for well over 300 years. Chronic exhaustion was known as neurasthenia in the nineteenth century, and up until fairly recently outbreaks of the same ailment occurred under various names, including “the vapors,” chronic mononucleosis, chronic Epstein-Barr syndrome, and post-viral fatigue syndrome. In Great Britain and other Commonwealth counties, for instance, chronic fatigue is known as myalgic encepalopathy, or ME.
Severe, often disabling fatigue lasting at least six months despite adequate rest
Diminished ability to concentrate; memory loss
Listlessness; weakness; reduced stamina
Difficulty carrying out routine tasks
Headaches; low-grade fever; sore throat
Aching muscles and joints; swollen lymph nodes in the neck or armpits
What Causes Chronic Fatigue Syndrome?
Most physicians, given a symptom list like the one associated with chronic fatigue syndrome, would point to a lingering viral infection as the culprit. But no single CFS virus has ever been identified. Theories abound about the causes of CFS, but the most credible current thinking is that a virus is indeed responsible for the initial flulike illness. While active, it somehow disrupts both the body’s immune system and its endocrine (glandular) system before it departs. In its wake, however, this marauding virus leaves behind a laundry list of lingering CFS symptoms.
Treatment and Prevention
Doctors in both the conventional and alternative camps have no specific treatment or means to prevent CFS. Holistically oriented doctors, however, believe that living in an overstressed society compromises the immune system and renders people susceptible to CFS. Therefore, if any factor might be recommended as preventive, it would be to plan a healthy and balanced life.
Most practitioners agree that once faced with a newly diagnosed CFS patient, you pull out all the stops to put the patient in the best possible physical and emotional state. Then you hope that the patient’s own self-healing systems will start operating to their maximum capacity to turn the patient around on his or her own.
Since fatigue is such a common symptom for so many conditions, conventional physicians usually order a battery of tests to make sure something treatable is not being missed. Then, they’ll prescribe medicines directed at symptoms: NSAIDs or narcotics for pain; antidepressants and counseling for emotional issues; sleeping pills for insomnia, and the like. They, like their integrative and alternative counterparts, will also recommend following a healthful lifestyle: good diet, plenty of rest, and keeping activities at a tolerable level.
Integrative physicians are more likely to suggest any of a variety of alternative therapies, depending again on the clinical situation. Traditional Chinese medicine, hormonal agents such as thyroid and DHEA, homeopathy, bodywork therapies, relaxation therapies, and nutritional supplements and herbs are not only used for symptom relief, but to strengthen and restore the overall body itself. Integrative physicians can also often be helpful in sorting out the effect that problem foods or chemical sensitivities have on individual CFS patients.
While there may be no specific treatment, most patients will need to make some downscaling adjustments in their lifestyle, and seriously change their outlook on life. On the positive side, many people with CFS eventually experience some improvement after a few years and some even recover fully. Strengthening the body’s immune system by careful, nutritionally sound eating, as well as using supplements, can play a role in achieving this.
Just a reminder: If you have a serious medical condition or are taking medication, always check with your doctor before beginning a program of supplements.
How Supplements Can Help
Begin by taking a well-balanced high-potency multivitamin along with extra vitamin C (1,000 mg a day) and E (400 IU a day) to ensure you’re receiving preventive doses of essential substances, especially if your diet is limited or poor due to the illness.
One of the indispensable supplements is vitamin C, which can be taken with carotenoids and vitamin E, all antioxidants and enhancers of the immune system. Other potent antioxidants include the procyanidolic oligomers(PCO) found in grape seed extract, and alpha-lipoic acid.
You can alternate two immune enhancing herbs: astragalus, known for its antiviral and immunity-boosting effects, and echinacea, an antiviral herb that also raises the immune system’s capacities to fight off minor infections.
Coenzyme Q10 is a potent antioxidant that aids in a variety of metabolic reactions. One key reaction involves the process of transforming what we eat into ATP, the energy our cells operate on.
NADH (nicotinamide adenine dinucleotide) is a cellular enzyme. It is related to the B vitamin niacin and involved in energy production. A recently published study in the Annals of Allergy, Asthma, and Immunology showed how NADH effectively improved energy levels in long-standing CFS patients.
For relief of muscle pain associated with CFS, as well as improving energy levels, take increased amounts of the mineral magnesium.
The herbs Siberian ginseng and licorice will stimulate the adrenal gland to raise energy and lower stress at the same time. Pantothenic acid, a B vitamin, can be added to bolster the actions of the ginseng and licorice. Licorice may also help raise an associated low blood pressure by helping the body retain salt. Rather than take each of these separately, most will be available in combinations called adrenal complex. You can then add separately whatever might be missing from the particular brand of adrenal complex you’ve chosen.
If depression is a significant part of your CFS, consider adding either St. John’s wort or SAMe. Some nutritionally oriented physicians believe that either of these may help with muscle pain as well.
Meditation, prayer, and other techniques that help connect you with your inner spiritual resources can assist you in managing the stress of dealing with CFS.
Get a good night’s sleep. Relaxation techniques can be very beneficial, as can supplements for insomnia, including valerian, 5-HTP, and melatonin.
Studies indicate that mild (repeat mild!) aerobic exercise is an excellent therapy for CFS. Relaxation and stretching exercises are also likely to help. But start slowly—doing too much too fast may only aggravate your symptoms.
Massage therapy is wonderfully helpful for relieving the painful muscles of CFS, especially when active exercise is too demanding.
Keep an energy diary to record your daily peaks and valleys. As patterns emerge, you can begin to plan your schedule around the peaks.
Over-the-counter pain relievers, such as aspirin or ibuprofen, or the new COX-2 inhibitors (by prescription) such as Celebrex, might help relieve joint pain, headaches, and fever.
If you have accompanying symptoms such as irritable bowel problems, sinusitis, or chronic nausea, try a food elimination diet for four to six weeks. You may need a low-allergy powdered food supplement if your diet is already restricted from illness symptoms.
When to Call a Doctor
Anyone with symptoms of chronic fatigue should work with their family physician to determine if a correctable underlying medical condition is responsible for the symptoms. Once the diagnosis of CFS has been established, however, it’s probably a good idea to work with a physician who understands this complicated illness.
If you have CFS but your underlying fatigue gets worse and lasts more than two weeks or is accompanied by sudden weight loss or muscle weakness. These symptoms may be signaling the presence of a more serious ailment.
If your fatigue is accompanied by new symptoms, high fever, severe nausea, joint swelling, and redness or severe mood disorder and depression, see your doctor.
If you are taking multiple medications. Fatigue is a common side effect of various prescription medications, so ask your doctor to determine if this is causing your problem.
If you’re experiencing some level of depression (and most people with CFS do). Try to seek out the advice of a therapist or counselor who can help you meet the challenges of coping with this illness. Antidepressant medications, often in very low doses, are a mainstay of regular medical management of CFS.
From David Edelberg, M.D. at WholeHealth Chicago: First of all, you want to make sure no component of your CFS is caused by nutritional deficiencies. So it’s important to take a high-potency multiple vitamin and a good all-purpose antioxidant. These are maintenance, and you’ll need to take them indefinitely.
How to Take Supplements
The supplements listed here address problems of CFS generally noted by nutritionally oriented physicians: depletion of magnesium, adrenal exhaustion, and a weakened immune system.
For at least six months you’ll need to take magnesium, alpha-lipoic acid, vitamin C, coenzyme Q10 as well as Siberian ginseng and licorice. Patients with severe fatigue should take the ginseng and licorice separately; those with milder symptoms can try an adrenal complex, a combination product that includes key nutrients. If you’re taking licorice, check your blood pressure weekly. If it goes higher than about 120/80, reduce or even discontinue the licorice.
In addition, NADH, a compound related to the B vitamin niacin, may be helpful, although it can take two to three months to reach its maximum effect. A 1999 survey showed that of every eight people who tried NADH on their own, approximately four improved, three had no benefit, and one felt worse.
Low levels of carnitine and vitamin B12 have been noted in CFS patients, and limited uncontrolled trials have shown improvement in energy levels when these supplements were administered. Studies testing vitamin B12 mainly used an injectable form, but daily use of a sublingual oral tablet for six to eight weeks will be enough to get your levels quite high.
The Also Beneficial supplements can be used as the situation requires. If you feel that you’re getting too many infections, consider adding immune-boosting echinacea in a two weeks on/one week off rotation.
St. John’s wort is an effective antidepressant with fewer side effects than prescription counterparts. Since this herb takes about four to six weeks to reach maximum effectiveness, you might prefer the more costly SAMe with a faster onset of action.
As the adrenal glands are frequently affected in CFS, try to get your blood level of DHEA (dehydroepiandrosterone) measured and correct the level to normal.
For special consideration
If sleep is a significant issue for you, consider taking 5-HTP (100-300 mg at bedtime). Or talk to your doctor about a good prescription sleeping pill, such as zolpidem (Ambien) or zaleplon (Sonata).
If your life is unusually stressful, setting off your CFS, try the natural relaxer kava (250 mg three times a day).
If your symptoms include dry eyes, dry mouth, dry skin, or dry hair, add essential fatty acids (3,000-8000 mg a day), found in fish oil capsules or flaxseed oil.
If you’re uncertain that your digestive system is deriving the maximum benefit from the healthful food you’re eating, try plant-based digestive enzymes (1-2 capsules with meals). Important:
We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.
Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.
For product recommendations and orders from the Natural Apothecary click here or call 773-296-6700, ext. 2001.
David Edelberg, MD