It wasn’t that long ago that to proclaim the existence of ‘Chronic Fatigue Syndrome’ would have prompted the retort “it’s all in your head” in both medical and social settings. It was even given the unflattering nickname ‘Yuppie Flu’ to underline this inherent disbelief of it being anything more than a whining of the well-to-do in relation to life’s general responsibilities. That rather narrow minded view has, thankfully, largely faded away. Medical science now recognises CFS as a constellation of possible symptoms that are underpinned by the presence of fatigue at a level that causes disruption to daily activities in the absence of other medical conditions related to fatigue. It is a complex, multi faceted syndrome that can present in many different ways among the population, and which can be caused by a number of factors. CFS is estimated to affect approximately 10% of the adult population, however this figure varies depending on which diagnostic criteria you use. CFS seems to affect women at twice the rate of men.
The myriad symptoms associated with CFS
In addition to the fatigue mentioned above, associated symptoms of CFS can include:
- Mild fever
- Recurrent sore throat
- Painful lymph nodes
- Muscle weakness and pain
- Prolonged fatigue after exercise
- Recurrent headache
- Migratory joint pain
- Neurologic or psychological complaints such as sensitivity to light, forgetfulness, confusion, inability to concentrate, excessive irritability, and depression
- Sleep disturbance
Source: CDC diagnostic criteria for Chronic Fatigue Syndrome
There is also significant correlation in symptomatology between CFS, Fibromyalgia, and Multiple Chemical Sensitivities. In one study researchers compared symptomatology of 90 patients divided into thirds with either CFS, FM, or MCS and found that 70% of FM and 30% of MCS patients could be diagnosed with CFS according to the CDC criteria.
What causes Chronic Fatigue Syndrome?
The causes of CFS, like its symptoms, can be varied. They can include depression, prolonged stress or adrenal dysfunction, impaired liver function, impaired immune function and subsequent chronic infection, food allergies, and leaky gut. It is important to view every case in an individual light so as to determine the specific underlying drivers of an individuals presentation of CFS. These investigations should ideally be performed under the supervision of a practitioner of functional medicine such as a Naturopath or an Integrative GP, with specific treatment tailored to addressing these specific drivers. There are, however, some fundamental cellular processes that can be examined and treated in most cases of CFS that tend to be common to all. I will review these treatments here, however I want to stress that these approaches will be likely to fail in restoring complete health in the long run without properly addressing the underlying causes.
Mitochondria in crisis
Inside almost every one of your trillions of body cells is a powerful little engine that provides almost all of its energy needs. These engines are called ‘Mitochondria’ and they are an amazing example of symbiosis between an organism of bacterial origin and the human being. Mitochondria basically exponentially multiply the energy producing potential of the cell through a series of chemical chain reactions, and they are absolutely intrinsic to our health. In CFS, the structure and function of these mitochondria appear to be commonly badly damaged. This will clearly have an impact on the energy producing capacity of that individual. Furthermore, the damage to these mitochondria causes a leakage of their contents into the cellular space, prompting an immune reaction in the form of an inflammatory response and thus further destruction of mitochondria. Crucial to preventing mitochondrial damage and dysfunction are Glutathione and Coenzyme Q10. Both of these perform a protective function as powerful intra-cellular antioxidants. Glutathione can be be taken as a supplement, however due to its poor intestinal absorption it is often better to take it in its precursor form, N-Acetyl-Cysteine. CoQ10 has been shown to be significantly lower in CFS patients, reflecting its increased requirements in this condition.
Magnesium to the rescue (again)
Magnesium is a crucial component in the process by which the mitochondria produce energy in the cell. In one study of 32 CFS patients who received magnesium supplementation, 90% of those receiving active treatment reported significantly improved energy levels, improved emotional state, and less pain. The citrate and aspartate forms of magnesium are particularly beneficial in CFS as both of these chelating agents also take part in the mitochondrial energy production process.
L-Carnitine for premium fuel
The substance L-Carnitine is a crucial transporter of essential fatty acids into the cellular mitochondria, thus providing fuel for their function. This study compared the effectiveness of the drug amantidine (commonly used to relieve fatigue in patients with MS) to L-carnitine in CFS patients. While amantidine provided no clinically significant improvement after completion of the treatment period, L-Carnitine provided statistically significant clinical improvement in 12 of 18 studied parameters.
Cellular repair
The oxidative processes mentioned above damage not only the mitochondria housed within the cell, but also the cell itself. This damage is most apparent in the protective membrane of the cell, and through this damage the signalling capacity and utility of the cell becomes badly dysfunctional. This can have wide ranging effects in the body, most of which are encompassed in the CFS symptoms listed above. It is crucial to repair this membrane damage to restore the function of the cell, and this can be achieved by providing the building block of a healthy cellular membrane. Phospholipids in the form of phosphatidylcholine and phosphatidylserine, omega 3 fatty acids from fish and especially krill, tocotrienols from vitamin E, and vitamin D all play a crucial role in this membrane repair.
Herbal energy and adrenal restoration
Common to most cases of CFS is the presentation of low cortisol, a substance produced by the adrenal glands in response to stress. Low cortisol is a sign of adrenal dysfunction and can contribute to symptoms of fatigue and muscular pain. Fortunately herbal medicine is excellent at restoring adrenal function:
- Licorice extract can increase cortisol levels and provide adrenal support
- Panax (Korean) Ginseng produces corticosteroid like activity and can thus improve energy and reduce inflammation
- Rhodiola has been shown in this study to reduce the negative aspects of the cortisol response to prolonged stress in patients with fatigue syndrome, while increasing energy and mental performance
- Withania (Ashwaganda) is a gentle and restorative herb that can reduce anxiety and improve responses to prolonged stress
I hope the supplements mentioned above give you a starting point to explore the many treatment options available for those suffering from Chronic Fatigue Syndrome. Remember that these treatments, while effective at relieving many symptoms associated with CFS, will not provide true health resolution without significant investigations into the driving causes of cellular dysfunction underpinning any particular CFS presentation.
In wellness,
James
