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CHRONIC FATIGUE SYNDROMEWhat Is It?

Chronic fatigue syndrome (CFS) has been one of the most difficult health conditions to understand. Until recently, many doctors did not even believe that it was a true illness. Even the name of CFS has been debated. Some alternative names that have been proposed for CFS include myalgic encephalomyelitis, chronic Epstein-Barr virus, fibromyalgia, chronic immune activation syndrome, and post-viral fatigue syndrome. Probably the most accurate name that has been proposed for CFS is chronic fatigue immune dysfunction syndrome (CFIDS), but there is reluctance to change the name of CFS for fear of confusing people.

The definition of CFS has also been debated. According to the Centers for Disease Control (CDC), in order to be diagnosed with CFS, the patient must experience chronic fatigue lasting six months or more resulting in a considerable reduction in activity. In addition to this debilitating fatigue, four of the following eight symptoms must be found:1

• Loss of memory or concentration• Exhaustion lasting more than 24 hours

after physical or mental exercise• Unrefreshing sleep• Joint pain without swelling or redness• Persistent muscle pain• Headaches of a new type or severity• Tender lymph nodes• Sore throat

This definition excludes many other symptoms that are common in CFS. It also specifically excludes those people with depressive symptoms. But depression can occur as a result of CFS, and is thought by many to be a part of the illness.

What Causes It?

The exact cause of CFS is not known, though it is believed to be a combination of factors which contribute to immune

dysfunction. The onset of CFS is usually triggered by one event, often an infection, from which the individual does not seem to fully recover. Other events that might trigger CFS are physical or psychological stress.2

Some factors that may play a role in the development and/or worsening of CFS include:

• Infection• Immune dysfunction• Chronic inflammation• Mitochondrial dysfunction• Allergies and sensitivities• Poor diet• Endocrine (hormone) dysfunction• Adrenal dysfunction• Stress• Nervous system hypersensitivity• Chemical sensitivity• Impaired detoxification• Candida overgrowth• Dysbiosis

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• Leaky gut• Genetics

A few different viral infections have been linked to the development of CFS. These include the retroviruses, herpes virus type 6, enteroviruses and coxsackie B virus.3 Other infections that have been linked to CFS are pneumonia, Giardia lamblia, Borrelia burgdorferi, upper respiratory infections4 and the Epstein-Barr virus (mononucleosis).

Immune dysfunction occurs in just about everyone with CFS. There are differences in this dysfunction, however. In some people, the immune system is overactive. In others it is underactive. In those with an underactive immune system, chronic infection is common. Decreased amounts of natural killer (NK) cells are found in CFS.5 NK cells destroy cells that are infected with viruses or have become cancerous. In those with an overactive immune system, the body may attack its own tissues as it overreacts to an immune threat. This is known as autoimmunity.

Inflammation, which involves immune function, plays a role in CFS. Increases of certain inflammatory markers, such as C-reactive protein, inflammatory cytokines and mast cells are found in people with CFS. This increase in inflammation occurs usually in response to an infection of some kind. But in CFS patients, when the infection is defeated, the inflammation does not end. The immune system remains activated.6 This is thought to contribute to many of the symptoms of CFS.

Mitochondrial dysfunction is also involved in chronic fatigue. The mitochondria are the energy producers of the body—they produce ATP, the body's energy currency. When the mitochondria are not functioning properly, which can happen as a result of inflammation and oxidative stress,7 chronic fatigue results. Mitochondrial function is strongly affected by immune function, and both of these are influenced by nutrition and environmental influences like toxins and infections.

Food allergies and sensitivities also involve an overactive immune response in which the body identifies normal foods as a threat, and responds by making antibodies to those foods. This results in inflammation that leads to a host of symptoms—many of the same symptoms

experienced in CFS. Food sensitivities may affect as many as 84 percent of people with fibromyalgia and CFS.8

Additionally, patients with CFS have reported feeling better after cleaning up their diets by eating nutritious foods and eliminating junk foods and excess sugar.9 Optimizing the diet should be the basis of addressing any health problem, so these results are not surprising.

The hypothalamic-pituitary-adrenal (HPA) axis is part of the endocrine system and regulates how the body responds to stress. The HPA axis is comprised of three glands: the hypothalamus gland, the pituitary gland and the adrenal gland. These glands are involved in regulating many different hormones in the body. When a person experiences stress, messages are sent throughout the HPA axis that result in the adrenal glands secreting cortisol, the stress hormone. Throughout that messaging process many reactions occur in the body which affect many different systems—neurological, immunological, reproductive, digestive and metabolic. The varied symptoms of CFS involve each of these systems.10 When chronic stress

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is experienced, the adrenals become unable to secrete enough cortisol, as is seen in many CFS patients. This makes it more difficult to handle stress.

CFS has been considered a central sensitivity syndrome in which the nervous system is hypersensitive to stimuli—touch, light, odors, and temperature—which is the result of dysfunction of the central nervous system.11 This has also been linked to the HPA axis dysfunction mentioned previously, due to the interactions between bodily systems.

The hypersensitivity phenomenon in CFS extends to other influences like medications and chemicals. People with CFS may have trouble taking medications or coming into contact with chemicals. This could also be due to an impairment in the body’s ability to detoxify, or remove, toxins—also known as a sluggish liver. A sluggish liver produces many of the same symptoms as CFS. Indeed, reduced glutathione levels have been found in people with CFS, and can even contribute to the central nervous system dysfunction that leads to chemical hypersensitivity. Glutathione is one of the most important antioxidants in the body, and plays a vital role in the detoxification process.

Toxic exposure may even be the triggering event that occurs at the onset of CFS.12 Exposure to excess amounts

of certain toxins, such as solvents, has been associated with the development of CFS.

Candida overgrowth may also contribute to CFS.13 One way in which Candida may be involved in CFS occurs when the initial triggering infection occurs—antibiotics are often used. When antibiotics are used, they deplete the beneficial bacteria in the gut. Candida is not killed by antibiotics, and can proliferate during antibiotic treatment since there are no beneficial bacteria to keep it in balance. Candida organisms put out toxins that further weaken the immune system leaving the body more vulnerable to another infection. This can set the stage for the chronic immune dysfunction and associated symptoms that are seen in CFS.

Dysbiosis (an imbalance in gut bacteria), which may or may not be accompanied by Candida overgrowth, can lead to the development of CFS. When the gut is in a dysbiotic state, the pathogenic bacteria increase in number. These bacteria give off endotoxins, called lipopolysaccharides (LPS), which can enter the bloodstream through a leaky gut. When these endotoxins are found in the blood stream, the immune system responds. If the leaky gut persists, these endotoxins constantly leak into the body, and the immune system is constantly fighting them. This can lead to the immune dysfunction of CFS.14

Like most other health conditions, genetics also play a role. CFS is thought to run in families, and probably has a genetic component, but further studies are needed to determine just how this affects people with CFS.15

Other illnesses that may occur in conjunction with CFS include:18

• Fibromyalgia• Irritable bowel syndrome

At least one million Americans have chronic fatigue syndrome.16 Chronic fatigue syndrome a!ects women four times as often as men.17

Healing HOPETestimonial

"Chronic fatigue has been a daily struggle for me. I would often sleep nine hours a night and still need a nap in the afternoon. My companion works in a health food store, so I have been deluged with helpful information on nutrition and natural health. Diet became a priority. I now make a "ber shake every morning. I no longer need naps in the afternoon, and am able to sleep seven to eight hours at night. Adding "ber to my diet has helped me to alleviate my mental and physical fatigue. I recommend starting every day with a "ber shake." – Mary

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• Multiple chemical sensitivities• Interstitial cystitis• Temporomandibular disorder (TMD)• Chronic pelvic pain• Chronic low back pain• Gulf War Syndrome

What Are the Signs and Symptoms?

There are many symptoms associated with CFS. These may vary with each patient, and there is often a pattern of remission and relapse. The official symptoms of CFS are:

• Chronic fatigue lasting more than six months• Loss of memory or concentration• Exhaustion lasting more than 24 hours after physical or

mental exercise• Unrefreshing sleep• Joint pain without swelling or redness• Persistent muscle pain• Headaches of a new type or severity• Tender lymph nodes• Sore throat

There are many more symptoms of CFS, however. These include:19-21

• Abdominal pain• Alcohol intolerance

• Allergies or sensitivities • Bloating• Brain fog• Chest pain• Chronic cough• Constipation• Depression• Diarrhea• Dizziness• Dry mouth• Earache• Irregular heartbeat• Headache• Jaw pain• Morning stiffness• Fever or sensation of fever• Nausea• Chills and night sweats• Premenstrual syndrome• Depression• Insomnia• Irritability• Gas• Anxiety• Shortness of breath• Tingling sensations• Weakness• Weight loss or gain• Worsening of symptoms after physical activity

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How Is It Diagnosed?

Since fatigue can be a symptom of many illnesses, the diagnosis of CFS is one based on exclusion. Additionally, the many symptoms of CFS are also common to a number of other illnesses. The diagnosis of CFS may take some time due to its complexity. Underlying health conditions that must first be ruled out include:22-24

• Hypothyroidism

• Sleep apnea

• Anemia

• Depression

• Eating disorders

• Gluten sensitivity

• Substance abuse

• Relapse of previous illness

• Severe obesity

• Lyme disease

• Liver disease

• Autoimmune disease

• Cancer

A health care practitioner will conduct a thorough medical history and physical exam in addition to a mental status test. There is no specific lab test that determines the presence of CFS, but there are some tests that will likely be done to rule out other illnesses. These include:28

• Complete blood count (CBC)• Erythrocyte sedimentation rate (ESR)• Thyroid, adrenal and liver function tests• White blood cell count (WBC)• Urinalysis

Natural health practitioners may also suggest a comprehensive stool analysis (see the Appendix) which may be helpful to determine other causes of chronic fatigue such as bacterial imbalance, fungal, or parasitic infection.

What Are the Standard Medical Treatments?

The most supported treatments for CFS are cognitive behavioral therapy, which is a type of psychological

therapy, and graded exercise therapy, which is an exercise therapy that begins slowly and gradually increases in intensity over time.

Standard treatment of CFS deals mostly with alleviating symptoms. Medications that might be prescribed include antidepressant drugs, either tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs); nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management; antihistamines and decongestants for allergy-like symptoms;29 sleep medication for insomnia; and anti-anxiety medication for anxiety.30 Other medications that are being used in the treatment of CFS include methylphenidate (such as Ritalin), corticosteroids, immunoglobulins and interferons, and antiviral drugs like Acyclovir.31

Many more medications could be added to these lists, as there are usually numerous drugs for each symptom, and standard CFS treatment largely targets symptoms. But CFS patients can be sensitive to drugs, so their use should be minimized if possible. Beginning at the lowest doses is prudent when medications are indicated.

Since unrefreshing sleep is a hallmark symptom of CFS, sleep hygiene practices can be helpful. (See the Insomnia section for more information on sleep hygiene.)

Did You KnowInterestingly, "bromyalgia is thought by some to be the same illness as CFS, but by others it is considered a separate condition. Most of the symptoms of CFS and "bromyalgia are the same. The main di!erence is that people with "bromyalgia may not exhibit the cognitive symptoms, such as memory loss or concentration di#culties, and people with CFS do not have trigger points, which are speci"c points on the body where pain is experienced in people with "bromyalgia. Some say that "bromyalgia and CFS are just two subcategories of the same illness.25,26 It is estimated that between 20 percent and 70 percent of patients with "bromyalgia have CFS and that 35 percent to 70 percent of those with CFS also have "bromyalgia.27 (See the Fibromyalgia section for more information on this condition.)

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Both the causes and treatments of CFS are multifactorial. In addition, there seems to be overlap with CFS, rheumatoid arthritis, and infectious diseases. Often there can be several events that all contribute to a given case of CFS. An example would be a problem with food sensitivities (like gluten) creating in$ ammation of the gut. That would cause further immune imbalance in the gut lining with concomitant dysbiosis, which would further increase intestinal permeability allowing more autoantibodies into circulation. This has the potential to create problems throughout the body causing a multitude of symptoms as are seen in CFS.

Even vaccinations may have an important role in CFS onset. Recently, a case report pointed toward a causal association between silicone breast leakage, hepatitis B virus vaccination, and CFS onset in a previous healthy woman.32 I have personally removed silicone implants from a woman with severe CFS who returned to a normal state of health after the surgery. She also went on a low-allergen, alkaline, plant-based diet, and took antioxidants, vitamins and minerals. She was well in about three months.

Viral infections are coming more into the spotlight when it comes to CFS. Often occurring in epidemics, enteroviruses are a signi" cant cause of respiratory

and gastrointestinal infections and non-speci" c $ u-like illnesses. A recent small study showed that three patients with acute enterovirus intestinal infections were followed by CFS.33

Some of these chronic viral infections actually can change gene function expression once they get well established inside the cells. In a recent article, researchers looked at global transcriptome analysis to identify genes that were expressed in the lateral thigh muscle of CFS patients.34 They found that the expression of genes that play key roles in mitochondrial function and oxidative balance, including superoxide dismutase, were altered as were genes involved in energy production, muscular growth and muscle " ber determination. In addition, the expression of a gene which encodes for a component of the cholinergic receptor binding site was reduced. These " ndings certainly help to explain the profound fatigue and muscle pains that plague most of the patients.

It may be that stem cell therapy will play an important role in the future. In a small study carried out in Central America, patients received their own fat-derived stem cells which contain potent immune balancing cell types. Many of these patients are doing better since their treatment. This seems reasonable since a central feature of CFS is immune dysregulation.

Dr. Smith’s Comments

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Chronic fatigue syndrome is another catch-all diagnosis that is given when the doctors do not know what is wrong. This is why it is so important to get to the bottom of what is causing the symptoms of chronic fatigue. The gut plays a huge role in this condition. Addressing gut imbalance should be the "rst step for people with CFS because many gut issues can lead to chronic fatigue itself, or can be underlying features of other contributors to chronic fatigue, such as adrenal imbalance. Often, addressing the gut "rst can clear up these other factors.

It may also be that hormonal imbalance is at the base of chronic fatigue. It can take some time to rebalance hormones with testing and bioidentical hormones, but if this is what is causing your chronic fatigue, it is well worth the investigation.

For many people, CFS begins with an infection— sometimes the Epstein Barr virus—which triggers gut imbalance, immune dysfunction, and, ultimately, chronic fatigue. I had this myself when I was young. The gut imbalance that I developed as a result of overuse of antibiotics led to constipation, and resulted in chronic fatigue. If I knew back then what I know now, I could have saved myself a lot of trouble.

It may take some work to get to the bottom of this condition, but if you begin with the gut by following the suggestions below and on the next page, you will be well on your way to healing. This condition is not just in your head. It is the result of many imbalances in the body. So get to the bottom of it!

Rule Out:

• Gluten sensitivity (See the Gluten Sensitivity section.)• Candida overgrowth (See the Candidiasis section.)• Parasitic infection (See the Parasitic Disease section.)• Hormone imbalance (See the Menopause or PMS

section.)• Depression (See the Depression section.)• Sleep disorders (See the Insomnia section.)

• Diabetes (See the Diabetes section.)• Hepatitis (See the Hepatitis section.)• Anemia• Cancer (See the Cancer section.)

Recommended Testing

• Comprehensive stool analysis (CSA) (See the Appendix.)• Gluten sensitivity test (See the Appendix.)

Diet

• A diet high in fruits and vegetables and low in saturated and trans fats is bene"cial for chronic fatigue syndrome. Follow the Fiber 35 Eating Plan found in the Appendix.

• Replace saturated fats with monounsaturated and polyunsaturated fats.

• Limit sugar and simple carbohydrate (white $our, white rice, white pasta, etc.) intake, which may worsen symptoms of chronic fatigue. Replace these carbs with complex carbohydrates—whole grains.

• Avoid ca!eine and alcohol, which may interfere with sleep.

• Avoid arti"cial sweeteners and additives, which may trigger symptoms of chronic fatigue syndrome.

Lifestyle

• Exercise is important in chronic fatigue syndrome, but should be introduced gradually, to avoid exacerbating symptoms.

Complementary Mind/Body Therapies

• Stress can be a major component of this disease, so "nd ways to reduce it with therapies such as meditation, yoga, deep breathing, massage, biofeedback, or music therapy.

• Acupuncture may be helpful for people with chronic fatigue.

• Colon hydrotherapy is beneficial to help remove toxins.

Brenda’s Bottom Line

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Recommended Nutraceuticals Dosage Benefit Comments

Critical Phase

Adrenal Support Formula Use as directed Improves the body’s energy production.

Should contain yerba mate, ginseng, ashwagandha and rhodiola.

Total Body Cleanse See AppendixEncourages bowel

elimination and detoxi"cation.

Herbal formula should support the seven channels of elimination.

Heavy Metal DetoxAs directed, to be taken after 30 day

Total Body Cleanse.

Helps support the body in eliminating heavy metals.

Look for a two-part formula with vitamins/minerals and a formula

containing chlorella, cilantro, NAC, L-leucine and alpha lipoic acid.

Helpful

Multivitamin/mineral Formula

High potencyTo correct any insu#ciencies

that may a!ect metabolic function.

Be sure vitamins are in their natural forms.

L-Glutamine Powder with Gamma oryzanol

At least 1g daily

Needed during excess stress.

Take on an empty stomach.

D-ribose 5g 2 times daily

Helps with body’s ATP production.

Helps to increase body’s energy supply.

Medium Chain Triglycerides Use as directed Increases energy production.

Easily digested form of healthy saturated fat.

Daily Maintenance

Omega-3 Fatty Acids At least 2 grams daily

Reduces in$ammation, omega-3s often low in people

with chronic fatigue.

Get a concentrated, enteric coated, high dose EPA/DHA formulation.

Digestive Enzymes Take with meals Helps digest and absorb nutrients from food.

If low stomach acid is found, "nd a formula that contains

hydrochloric acid.

Fiber4-5 grams twice daily as part of a 35 gram per day

"ber diet

Helps regulate bowel movements and bind toxins.

Use a combination soluble/ insoluble "ber supplement.

Probiotics30 - 80 billion culture count

twice daily

Stimulates immune system, reduces in$ammation and protects digestive lining.

Look for high amount of bi"dobacteria, the main bene"cial

bacteria in colon.

Vitamin D31000-5000 iu daily

Anti-in$ammatory. Most people are low

or de"cient.

Blood levels should be between 50 and 70 ng/mL.

See further explanation of supplements in the Appendix

Daily maintenance recommendations should also be taken during this phase unless otherwise indicated.

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