Everyone knows what it is like to feel tired. Perhaps after a poor night’s sleep, after a lot of strenuous exercise – or a stressful day at work. You don’t feel like doing anything. You just want to lie down and relax. You need rest. You go to sleep … and the next day you feel good again.

But some people don’t. For a growing number of people, fatigue is no longer a normal feeling that comes now and then. Millions of people around the world, a growing number of them, suffer from chronic fatigue. This emerging chronic illness is a source of frustration for many patients. In many cases, their doctors are frustrated too. At best, they have little to offer. At worst, they tell patients that it is all in their head, that it is just stress, they need more exercise or are depressed or crazy.

Some background

Chronic Fatigue Syndrome (CFS) is a diagnosis given to people whose symptoms meet strict criteria established by the US Centers for Disease Control (see table). Other commonly reported symptoms include abdominal pain, cough, chest pain, shortness of breath, diarrhea, dizziness, numbness, tingling or ringing of the ears, earaches, heart palpitations, jaw pain, morning stiffness and frequent allergies or intolerances.

About one million people in the US have CFS, only 20% of whom have been diagnosed. It affects women four times as often as men, usually in midlife. The good news for people with CFS is that they do not suffer serious medical problems or die younger than the general population. The bad news is that often their lives are seriously impaired.  Over 25% need to stop work and live on disability insurance or social assistance. People with CFS Most struggle to be good husbands, good wives, good parents or good friends. Fewer than 10% completely recover and up to 20% get worse over time.

This mystery illness is relatively new. The first report of a CFS-like syndrome was seen in doctors and nurses at LA County Hospital in 1934. Another similar cluster of cases in a UK hospital was reported in 1955 and referred to as benign myalgic encephalomyelitis.1

There is a long list of diseases that cause fatigue, including depression, anxiety, multiple sclerosis, diabetes, chronic lyme disease, thyroid disorders, autoimmune diseases and even cancer. It is important to rule these out in anyone with typical symptoms. There is also a lot of overlap between CFS and other poorly-understood syndromes with names like myalgic encephalomyelitis, neurasthenia, multiple chemical sensitivity and chronic mononucleosis.

What causes CFS?

CFS has been linked to many different infections. The most recent media craze was centered on xenotropic murine leukemia virus-related virus (XMRV), but other studies have linked CFS to a host of viruses – like Epstein-Barr virus, Human herpesvirus 6 and 7, Ross River virus, enterovirus, rubella, retroviruses, bornaviruses and GB virus-C.  While outbreaks in Nevada and Florida have suggested that CFS might be an infection, this is not the case in all people.

Another important link has been established between CFS and the immune system. Studies have shown weak immune natural kill cells, abnormal immune chemicals called cytokines and hints of chronic immune over-activation. Interestingly, people with CFS are not at increased risk of infections or cancer. Again, the link is not seen in everyone.

The third area that has received a lot of research attention has been the autonomic nervous system. While many people with CFS have abnormal postural changes in blood pressure, studies on the steroid drug fluodrocortisone that usually treats this syndrome did not help people with CFS. Of note, emotional and psychological stress is a major risk factor. People with CFS were six times more likely to have suffered sexual abuse, emotional abuse or neglect as children.2

Why has it been so difficult for researchers to figure out what causes CFS? The problem is deeply rooted in how doctors think. The search for a cause will never succeed because this is not a disease in the classical sense. It is a state of dysfunction.   

A better answer

Evidence-based treatment for CFS is very limited.  Symptoms are managed with antidepressants, anti-anxiety drugs, anti-inflammatories and anti-histamines. Cognitive-behavioural therapy mildly improves fatigue3  but not activity4.  Graded exercise therapy is also recommended but most of our patients report only minor benefit.5 Things like deep breathing, massage, yoga and tai chi are helpful but they are by no means a long-term answer.

Our integrative medicine understanding of CFS provides a simple explanation for all the confusion.  It is a state of dysfunction of the nervous system and/or the immune system.  In truth, these are not really two distinct systems.  They work together as a unit to identify and adapt to changes in your internal and external environment.

What kinds of changes in your environment might contribute to CFS? The list is relatively short. It includes infections, toxins, allergies, emotional stress, local injuries, poor nutrition and in some cases, a genetic predisposition. We treat as many of these as possible, and the results are impressive.

Addressing the causes

Chronic infection is suggested by flu-like symptoms, recurrent joint pains, unexplained fever or chills. There might be a history of lung, gut or sinus infections that were chronic or preceded the onset of CFS.  Pockets of infection in root canals, surgical wounds or other areas might be a factor.  In other cases, the infections are just a symptom of a sluggish immune response; we suspect this is because of constant stimulation from synthetic chemicals that leave the system ‘always on’. We use a range of strategies to treat infections and improve immune function.

Toxins are everywhere, but some people are more exposed than others. We have suspected CFS linked to toxins in hairdressers, landscapers, factory workers, people living in or near mining, pulp and paper or other industries. Toxic metals like lead and mercury, pesticides and PCBs, diesel fumes, natural gas and other harmful substances are common. Electromagnetic fields and geopathic stress also fit into this category. We are constantly improving our detoxification protocols.

Allergies are a big part of CFS in most cases. If not root causes, they eventually develop as a result of neuroimmune hyperactivity. Gluten and dairy are common food allergens, but individual testing is important. Inhaled allergens can come from pets, dust, mold, synthetic materials from furniture, construction materials or air pollution in the city. We do testing that identifies allergies, but our protocols also decrease sensitivity and eliminate allergies at the same time.

Emotional stress is a tough one. A big part of the solution is recognizing that it needs to be addressed. Most of our patients have undergone some sort of counseling, but talk is cheap. Counseling usually does not correct the problem. Innovative techniques use eye movements, acupuncture and other modern techniques to ‘turn off the switch’ linking the memory to the dysfunction. Preliminary results are impressive, and their popularity is growing.

The treatment of local injuries is based on neural therapy, a German discipline that we believe may one day revolutionize medicine. The classic injury is a surgical scar from tonsil, wisdom tooth, appendix removal, hysterectomy or even laparoscopy. Head injuries, fractures, infections or even ligament strains are also injuries. The lesion here is in the nerves – they are altered by the injury, and while the injury may heal, they do not. They remain hyperactive and a chronic stress on the nervous system as a whole. They can be treated.

Poor nutrition doesn’t cause CFS, but good nutrition provides important stuff that keeps the body strong. Sugars and starches, refined foods devoid of nutrients, lack of sunshine, caffeine and alcohol all lead to chronic dehydration, deficiency and tissue acidity. This makes it harder to deal with all the stresses listed above. We emphasize a plant-based, nutrient-rich, low-allergen, organic diet that gives CFS patients what they need to heal. Natural medicines and nutrient supplementation – both oral and intravenous – offer even more.

Genes play a role in every aspect of human function. The emerging era of personalized medicine allows us to use technology to find out what each individual patient needs to get well. We are now screening for MTHFR genes and liver detoxification genes.  Others will be coming soon.

Table 1. CDC Diagnostic Criteria for CFS

1. Fatigue for more than six months

2. Four or more of:

  • sore throat
  • tender lymph nodes
  • muscle pain
  • multi-joint pain
  • headaches
  • unrefreshing sleep
  • post-exertional fatigue >24h
  • impaired memory and concentration

 

References:

1.  BMJ 1957;5050:895.

2.  Arch Gen Psychiatry 2009;66:72.

3. Cochrane Database Syst Rev 2008; CD001027

4.  Psychol Med 2010; epub Jan 5.

5.  Cochrane Database Syst Rev 2004;  CD003200.