Chronic fatigue syndrome is a chronic illness that affects up to 2.5 million Americans. In cases identified through active surveillance for CFS, less than 20% reported receiving a diagnosis from a healthcare provider. CFS costs the U.S. economy around $20 billion annually in medical bills and lost income. Alternative remedies such as nutrition, acupuncture, cognitive behavioral therapy, herbs, and supplements can help improve symptoms of chronic fatigue syndrome.
What is Chronic Fatigue Syndrome?
Chronic fatigue syndrome, also known as myalgic encephalomyelitis (ME/CFS), is a severe and chronic illness that affects many body systems. People with this condition often cannot perform their usual activities and have extreme fatigue and sleep problems.
Chronic fatigue syndrome is not improved by rest and may get worse after an activity, whether physical or emotional. This is called post-exertional malaise (PEM). It is a complicated disorder characterized by fatigue that lasts more than six months and cannot be fully explained or ruled out by another medical condition.
What Causes Chronic Fatigue Syndrome?
The cause of ME/CFS is unknown, but many hypotheses exist, including immune system dysfunction, inflammation and oxidative stress, autoimmunity, genetic alterations, hormonal imbalances, stress tolerance, impaired gut microbiota, and low cortisol levels, among others (7). Some people may be born predispositioned to the disorder, which is triggered by a combination of factors. Some people have developed chronic fatigue syndrome post-viral infection, causing more research on the topic. The most common virus many researchers are looking into is the Epstein-Barr Virus.
Other possible causes of chronic fatigue syndrome include abnormal levels of hormones produced in the hypothalamus, pituitary glands, or adrenal glands. Some people reported that they experienced an injury, surgery, or significant emotional stress shortly before their symptoms began (4). One study showed that some chronic fatigue syndrome patients had a higher incidence of certain bacterial infections such as Chlamydia pneumoniae, Mycoplasma, and Brucella. 10% of the CFS patients were positive for Brucella, 8% positive for C. pneumonia, and 50% positive for Mycoplasma spp.
This study shows evidence of oxidative stress in those with chronic fatigue syndrome. Oxidative stress is the body's ability to detox free radicals (molecules that can damage cells). Risk factors for oxidative stress are eating a diet high in processed foods, high sugar or high saturated fatty foods, drinking alcohol, and smoking cigarettes.
Chronic Fatigue Syndrome Diagnosis
To make a diagnosis, typically, there are three primary "core" symptoms required and one additional symptom as listed below (2).
Three core symptoms:
- Significantly lowered ability to do activities that were usual before the illness. This drop in activity level occurs with fatigue and must last six months or longer. Fatigue associated with CFS is very different from just being tired. It can be severe and is not a result of unusual activity. It is not relieved by sleep or rest and was not a lifelong problem before becoming ill.
- CFS symptoms may get worse or first appear, including difficulty thinking, problems sleeping, sore throat, headaches, dizziness, or severe tiredness. This is known as post-exertional malaise (PEM).
- People with CFS may not feel better or rested after a full night's sleep. Some people with CFS may have problems falling asleep or staying asleep.
In addition to the core symptoms, one of the following is required for diagnosis:
- Problems with thinking and memory: CFS patients often describe "brain fog" and not being able to think clearly
- Worsening of symptoms while standing or sitting up is known as orthostatic intolerance.
Chronic Fatigue Syndrome Symptoms
Symptoms of chronic fatigue syndrome can vary from person to person, and the severity of symptoms can fluctuate from day to day. Signs and symptoms may include: (3)
- Problems with memory or concentration
- Sore throat
- Enlarged lymph nodes in your neck or armpits
- Unexplained muscle or joint pain
- Dizziness that worsens with moving from lying down or sitting to standing
- Unrefreshing sleep
- Extreme exhaustion after physical or mental exercise
- Muscle pain and aches.
- Joint pain without swelling or redness.
- Headaches that are new or worsening.
Functional Medicine Labs to test for Root Cause of Chronic Fatigue Syndrome
Although we don't know what causes CFS, we can use lab testing to rule out other diseases and fill in the gaps of what we know is lacking or deficient. When ordering and interpreting functional medicine labs, it is essential to order labs that will help determine the root cause of symptoms and interpret them with optimal values. Optimal values are a narrow range of lab values, meaning anything outside those values tends to show patterns toward disease progression. Functional medicine providers can then catch these markers early on and have a chance at reversing or stopping disease progression altogether.
Basic laboratory markers: complete blood count and a comprehensive metabolic panel are standard to ensure organs are functioning properly and blood counts are within range. These tests should be done on every patient to get a baseline. Some conditions that can be ruled out with these tests are anemia, infection, and mononucleosis (atypical leukocyte count in white blood cell differential), which can have similar symptoms to CFS.
Comprehensie Hormone Panel
DUTCH Plus: many people with CFS commonly have hormonal imbalances and sleep problems. The DUTCH Plus™ offers an extensive assessment of sex and adrenal hormones and their metabolites. It also assesses the Cortisol Awakening Response (CAR) and includes the insomnia cortisol sample. The results from this test can help practitioners individualize treatment options for patients to help ease symptoms associated with hormone imbalances.
Comprehensive Stool Testing
A stool test is one of the most common tests functional medicine practitioners use to help individualize treatment. A stool test can rule out other diseases like Crohn's disease, intestinal permeability, or gut infections that can cause various symptoms that overlap with chronic fatigue syndrome.
Lyme Disease Testing
Lyme disease is known as "the great masquerader" and can cause similar symptoms as CFS. Ruling this out is an essential factor in finding the proper treatment.
Some autoimmune diseases mimic chronic fatigue syndromes such as Lupus or Rheumatoid arthritis. Having a test for autoimmune markers can help rule out these conditions.
Evidence shows those with CFS have a higher incidence of evidence oxidative stress. The results from this test can provide a personalized assessment of a patient's nutritional and supplemental needs.
NutraEval: This test checks for nutrition imbalances. While the evidence is lacking in nutrient imbalances and chronic fatigue syndrome, there is an overlap in similar symptoms. Having proper micronutrient levels can aid in decreasing fatigue.
Ruling out sleep apnea if the individual fits the symptom criteria can be very important in detecting sleep problems and helping fatigue. Sleep apnea can cause extreme fatigue due to not enough oxygen getting to the tissues.
Conventional Treatment for Chronic Fatigue Syndrome
Conventional treatment for chronic fatigue syndrome focuses on the symptoms since the cause is unknown. Depression is a common symptom of CFS, so many providers will prescribe anti-depressants to help with depression and sometimes sleep problems. Many people with CFS have symptoms of orthostatic intolerance (feeling faint or dizzy when standing or sitting upright), so providers will put them on blood pressure or heart rhythm medications. Pain is a significant symptom of CFS, and medications that improve pain in fibromyalgia patients may help with pain from chronic fatigue syndrome. Some people also benefit from counseling, treating sleep problems like sleep apnea with a CPAP (continuous oxygen during sleep), and low-intensity exercise (1).
6 Complementary and Alternative Therapies for Chronic Fatigue Syndrome
Certain dietary changes may help the symptoms associated with chronic fatigue syndrome. Evidence shows that adopting an anti-inflammatory diet such as the Mediterranean diet shows promise in treating chronic fatigue conditions.
The Mediterranean diet emphasizes a mostly plant-based dietary pattern, focusing on fruits, vegetables, nuts, seeds, olive oil, and whole grains.
- Experiment with your diet. There is no standard diet for those with chronic fatigue syndrome, so it wouldn't harm to experiment with whole foods and see what makes you feel better or worse.
- Fill up on vegetables! Red vegetables are full of phytonutrients that act as antioxidants and help reduce inflammation. Yellow vegetables contain essential minerals and vitamins A, C, and B6. Green veggies are rich in vitamins A, C, E, and K and many of the B vitamins. These vegetables also contain an abundance of carotenoids-antioxidants.
- Skip processed foods. All processed foods are low in nutrients and high in saturated fats and simple carbohydrates, which lead to more inflammation in the body.
- Ensure you get enough calories for your height, weight, and activity level.
Address Gut Microbiome Changes
Many patients with chronic fatigue syndrome also have irritable bowel syndrome. It is a good idea to keep a food symptom journal and know the details of when and how your stomach or gut reacts to food or other changes. Talk to your provider about a possible food sensitivity test or an elimination diet to find dietary triggers. Prebiotics, probiotics, nutritional changes, and even some gut-repairing nutrients can help manage irritable bowel disease. You'll want to talk with your practitioner about your specific needs.
If a patient's lab results come back with high levels of oxidative stress, a metabolic detox may be appropriate. Medical-Based Detox Programs usually combine a combination of nutrition and supplements that supports all levels of detox. Metabolic detox programs should always be done under the care of a healthcare practitioner to ensure proper guidance and support.
Herbs and Supplements
- Glutathione: known as the master antioxidant, this supplement can help decrease oxidative stress.
- Vitamin B12: this vitamin, in particular, is known to increase energy.
- Vitamin D: this vitamin is vital to the immune system, and since there is a possible role of a decreased immune system in CFS, this vitamin is essential to balance.
- .CoQ10 + NADH (nicotinamide adenine dinucleotide): this study showed a decrease in cognitive fatigue and overall fatigue perception.
In this review, 51 randomized control trials demonstrated that acupuncture with moxibustion (the burning of mugwort, a Chinese herb, over a specific acupuncture point) was significantly more effective than other treatments for chronic fatigue syndrome.
- Stay hydrated: Dehydration is known to make fatigue worse, so staying hydrated is very important in chronic fatigue syndrome.
- Most people with chronic fatigue syndrome have post-exertional malaise (PEM). This makes it challenging to perform strenuous exercises or mental tasks. It is essential to know your limits and not overdo them. For some people with CFS, exercise can worsen their symptoms, so it's important to discuss this with your practitioner. Graded Exercise Therapy has been shown to be effective in improving measures of fatigue and physical functioning (1).
- Decrease or limit caffeine use. Although caffeine is a natural stimulant, it can lead to more fatigue once it wears off.
- Cognitive behavioral therapy has been shown to be effective in treating chronic fatigue syndrome (1).
Chronic fatigue syndrome (CFS) affects up to 2.5 million people annually and costs the economy up to 24 billion annually in medical bills and lost income. Less than 20% of those who fit the criteria for CFS have a diagnosis. The cause is unknown, but there are medical conditions that mimic CFS that should be ruled out. There is evidence that the immune system, oxidative stress, and microbiome all play a role in the syndrome. Using functional medicine lab testing to find the root cause, nutrition, supplements, acupuncture, and lifestyle changes, patients with chronic fatigue syndrome can get some relief from their symptoms.
Lab Tests in This Article
- Chronic Fatigue Syndrome: Diagnosis and Treatment | AAFP
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC
- Chronic fatigue syndrome - Symptoms and causes - Mayo Clinic
- Chronic Fatigue Syndrome (CFS) Causes - Who Gets It and Why (webmd.com)
- Chronic fatigue syndrome (CFS): Suggestions for a nutritional treatment in the therapeutic approach - ScienceDirect
- Diagnostics | Free Full-Text | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review | HTML (mdpi.com)