Chronic Fatigue Syndrome, or CFS, is found to affect at least 2 million Americans with no direct association with gender, age, ethnicity, or socioeconomic group. Even these estimates are largely underwhelming since many people suffering from CFS are dismissed, being told: "It's all in your head."

For a proper diagnosis of CFS, the patient must be suffering from fatigue that cannot be explained by any other disease for at least six months. Other common symptoms include suffering from headaches, low-grade fever, sore throat with or without enlarged lymph nodes, myalgia and migratory joint pains, neurological symptoms, and sleep disturbances.

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CC: Chronic Fatigue Syndrome, Hypothyroidism, Joint Pain, Headaches, and Constipation

Krista was a 36-year-old female when she presented with the main concerns of chronic fatigue (CFS), hypothyroidism, inflammation-related pain, and digestive issues. She had recently been given the diagnosis of chronic fatigue syndrome by a rheumatologist after her lab work showed inflammation but no signs of autoimmune markers. She had been dealing with poor energy and daily body pain for the last 4 years without any definitive answers as to why. Prior to having children, she felt her health was at its peak, having run triathlons regularly. On the day of her first visit, she rated her daily average energy a 2/10 and felt like she was "going through the motions" of the day while not actually being present.

Additional History

She was a mother of 3 young kids, aged 1, 3, and 5. She was working part-time from home while two of her children were home. She had very limited time for herself, prioritizing her family's health and diet. She was often eating leftovers from her child's plates for lunch and skipping breakfast, opting for a protein bar or shake for convenience. Dinner was a complete protein, vegetable, and gluten-free grain/starch side with ample water and electrolyte intake daily.

Upon gathering a history, it was revealed the patient was passing a bowel movement every 1-3 days with a Bristol 1-2 consistency, attributing the slow frequency to inconsistent fiber intake. She was also getting a headache 2-3 times a week that she treated with 1,000 mg of turmeric.  

She was still nursing her 1-year-old multiple times a day, with the goal of 2 years. However, in the initial visit, she got very upset when saying she felt she needed to wean her current baby to begin prioritizing her own health. Krista had been pregnant and/or nursing for the last 5 years straight since having her first child; early on, she heavily prioritized her health with exercise and homemade, paleo-heavy, nutrient-dense meals. However, with her second child, things became a lot more difficult, and her health and diet began to slip.

Initial Lab Work

Nutrient Panel and OAT Test

• Moderate Need/Deficiency: Zinc, Selenium, Omega 3/6/9 fatty acids
• High Need/Deficiency: Alpha lipoic acid, Vitamin C, glutathione, Vitamin B2, Vitamin B6, Vitamin B9, Vitamin B12
• Omega 3 index: 3.2 LOW (High risk <4%, Intermediate risk 4-8%, Low Risk >8% )
• 24 hour amino acid intake: High Need: for glycine, cysteine, and glutamine and low need for all others
• Moderately Elevated Levels: of mercury, MTBE, and Styrene derivatives

Lab Analysis

The Nutrient Panel and Organic Acid testing showed a high need for nutrients supporting detoxification. It also showed high levels of toxic metabolites and environmental chemicals, indicating overall detoxification difficulties. Also, it showed deficiencies of nutrients directly needed for optimal thyroid function, such as zinc and selenium, as well as low omegas all around, which can contribute to inflammation and future cardiovascular disease. This panel also showed poor amino acid intake, indicating the patient is not consuming enough protein to sustain her amino acid demand.

In addition to her amino acids, glutathione, low lipoic acid, and her CMP showed elevated liver enzymes, all indicating a need for liver support and detoxification support all around.

Some inflammatory markers were noted on her labs as well. CRP was overtly elevated for her age, and her sed rate was within range; however, it was also functionally elevated for her age. She was negative from an ANA and thyroid antibody standpoint. However, her hormone and thyroid output both showed less than ideal levels, indicating stress on her system again.

Homocysteine being elevated is likely driven by low B9 and B12 levels. However, it can also elevate in cases of systemic inflammation, and this could not be ruled out as a contributing factor at the time.

Interventions

The following recommendations were given to Krista on her treatment plan:

Nutrition Guidelines

Diet, diet, diet! Krista was shocked to see her lab results and was ready to jump into treatment to get herself back on track. We started with basic diet goals and brought her back to her original diet-focused mindset to really optimize nutrient intake. Each plate needed to be 1 quarter protein, 1 quarter grains/starches, and ½ plate for vegetables. Lemon was added to water 1-2x daily for increased vitamin C, as was a snack of berries and nuts/seeds. Herbs also were stressed with a focus on cilantro to support mercury toxin elimination.

Supplemental Support

Krista was recommended supplements to help build up nutrient stores quickly and prevent any long-term damage from high levels of toxin exposure. Direct supplemental support included:

• Lipoic acid at 500 mg 1x daily for 90 days paired with liposomal glutathione, slowly increased, then used 2x daily for 60 days.
• A protein shake was recommended with all essential and non-essential amino acids to bump up protein intake and ensure protein goals were being met. This also assisted with liver support, with the needed amino acids for proper conjugation and detoxification. We discussed meat preparation to optimize nutrient absorption: bone-in, skin-on, slow-cooked meats eaten in a slow, relaxed setting and avoiding liquids before, during, and after meals to maximize absorption.
• High dose multivitamin 2x daily with meals for 1 month, then dropping down to 1 dose daily ongoing. Vitamin D3 plus K2 were recommended at 6,000 IU daily.
• Fish oil capsules: with 1,300 mg EPA/DHA daily as well as 2 servings of high EFA foods: SMASH fish (salmon, mackerel, anchovies, sardines, herring), olives/oil, avocados/oil, coconut/oil, chia/hemp/flax seeds, nuts (limiting peanuts).

Detox Support

She was recommended to do a castor oil pack over her liver 3x weekly, dry brushing before her shower 3x weekly, and getting outside and sweating 3x weekly. She was already very active with the kiddos, but encouraging her to sweat daily was the challenge.

Self Care

We discussed adding in 30 minutes for self-care, such as finding something she loves to do and doing it! Some examples were walking outside, reading a book, or being social with friends. Also, stopping the "mom guilt" about not spending every second with her child and focusing on her as a person and not as a parent. This tied into her going to bed and waking at a regular time as well since her children were sleeping through the night.

Follow Up 3 Months Later

Repeating labs at 3 months heavily reflected how much improvement Krista felt. Her energy has picked up from a 2/10 to 5/10, and she began working out 5 days a week with gentle yoga, walking, biking, and some light strength training without feeling depleted and fatigued afterward. Her constipation and bloating had improved after the second week on the plan, and she had not had a single headache in the last 6 weeks. She found the hardest thing to be mindful eating- having two small children at home makes focusing on her meals difficult. But she was bringing in nutrient-dense meals as discussed, as well as following the supplemental recommendations to a T. She was told to follow back up in 2 months to make sure everything was maintained as well as to repeat her nutrient panel at the 6-month mark without any supplemental influence to see how her system was responding.  

6 Month Follow Up 

At our 6 month follow-up, Krista was a new woman. She was sleeping 8-9 hours a night and had excellent energy during the day, rating it a 7-9/10 depending on the time of day. She was still getting a little fatigued in the evening after a long day but would sit for 10 minutes and feel back to her normal energized self. She also found bringing in more outside time and sunlight around her afternoon, 2 pm lul, really helped her pick up energy-wise to get through the rest of her work day. 

She felt so good with the diet, lifestyle, and supplement recommendations that she was hesitant to stop them. However, we decided to only continue the fish oil at 1,000 mg daily, the occasional protein shake on days her workout was intense, and the weekly castor oil packs kept at 3x weekly.

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Summary

Chronic Fatigue Syndrome is usually difficult to treat in that there is no direct cause and effect noted across the patient base. In Krista's case, as is commonly seen in young moms with multiple kids, she was depleted of nutrients, resources, and time. Forcing her to take a step back and focus on her diet, supplements, detox support, and general mental health/well-being, we were able to stop a lot of lab values that were starting to reflect some unhappy processes. Due to her busy schedule, bringing in patient support that's doable for that patient is essential, and in Krista's case, it paid off wonderfully.