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Over the last 100 years chronic fatigue syndrome (CFS) has been known by various different names; the earliest mentions of CFS in medical literature appear in the 19th century under the names Beard’s disease, neuromyasthenia and neurasthenia.
Although neurasthenia was generally thought to be a psychosomatic disorder, some descriptions suggested the condition originated from a viral or bacterial illness, and made mention of physical symptoms, strongly resembling what is now known as CFS. (1)
We always take an evidence-based approach and aim to provide you with actionable knowledge and tips to help you on your journey to optimal health. In this article we will look at the possible causes of CFS, symptoms and conventional therapeutic strategies, as well as nutritional approaches that can be beneficial.
CFS, also known as myalgic encephalomyelitis (ME), is a chronic, disabling, multi-system disease characterised by the recent or distinct onset of unexplained, persistent or relapsing fatigue that continues for six months. It leads to a significant reduction in ability to carry out daily activities previously considered normal. Minor exercise can worsen symptoms and rest brings minimal relief from fatigue. (2)
Cause of CFS
The cause of CFS remains disputed. Some experts believe it is a psychosomatic disorder and others believe it is due to immune dysfunction, following various triggers.
It can vary from person to person and is likely to stem from some kind of underlying imbalance. In order to diagnose CFS, medical practitioners use the Fukuda criteria to rule out certain diseases. (3)
In addition to the six months of unexplained, debilitating fatigue, patients must also present with four or more of the following symptoms:
- Impaired concentration
- Poor short term memory
- Depression
- Myalgia (muscle pain)
- Sore throat
- Sleep disturbance
- Unrefreshing sleep
- Mild fever
- Post exertional malaise
- Migratory arthralgia (joint pain)
- Lymphadenopathy
Additional symptoms
There is much more to CFS than fatigue. As well as the above mentioned symptoms required for diagnosis, patients may also experience the following:
- Headaches – present in more than 90% of cases (4)
- Abdominal pain
- Sensitivity to sound, light, smell, touch
- Muscle twitching
- Sudden attacks of generalised pain
- Undue sensitivity to viral infections – common amongst mildly affected children
- Problems with temperature control
- Postural hypotension – an abnormal drop in blood pressure when standing up, after sitting or lying down
Conventional therapeutic strategies
Currently, there is insufficient evidence to ascertain the effectiveness of any drug or curative treatment for CFS, although behavioural therapy interventions, such as cognitive behavioural therapy (CBT) and graded exercise treatment (GET), have been successful in some mild to moderate cases. (5)
Whilst there is no single way to treat CFS/ME that fits every individual’s symptoms, there are a few treatment options a doctor should offer, including medication to relieve symptoms such as pain and depression, combined with CBT and GET.
Nutritional approaches
Several nutrient deficiencies have been detected in patients with CFS – literature to date suggests there may be marginal deficiencies of B vitamins, vitamin C, magnesium, zinc, L-tryptophan, coenzyme Q10, L-carnitine, sodium and zinc. In addition, a deficiency in essential fatty acids may also contribute to CFS. (6)
It is likely that seemingly minor deficiencies not only contribute to the clinical manifestations of the syndrome, but are also detrimental to the recovery process.
A healthy well balanced diet is therefore of paramount importance to optimise micronutrient content. Planning menus should also include an awareness of food intolerances, as fatigue has been linked to sensitivity to grains such as wheat, corn and rice as well as sugar.
Following an elimination diet under the guidance of a Personalised Health practitioner could be beneficial for some individuals.
Interestingly, recent research has identified people with CFS have different patterns of gut bacteria compared to healthy people who don’t have the condition. (7) Nutritional support with prebiotics and probiotics may therefore add therapeutic value.
Supporting adrenal and mitochondrial function may also help to manage symptoms.
- Adrenal support
The adrenal glands produce several hormones and have many functions, including regulating blood pressure and blood sugar levels.
Supporting adrenal function helps maintain balanced blood glucose levels and sustain your energy levels throughout the day.
The level of glucose in the blood is carefully controlled by the hormone, insulin. After eating, blood glucose levels rise, triggering the release of insulin, which lowers glucose levels to a normal status.
However, if blood sugar rises too rapidly, it can result in excessive production of insulin. This causes blood sugar to drop suddenly and significantly, and can lead to extreme tiredness and irritability.
This state is often referred to as the blood sugar rollercoaster, but there are a number of steps you can take to control blood sugar.
Eat little and often – when you eat is as important as what you eat. Stick to three main meals a day, with a low GI snack in between. Complex carbohydrates, found in foods such as whole grains and vegetables, are particularly important as they supply a slow and sustained release of energy. To balance blood sugar levels try to eat every 3-4 hours.
Avoid all fizzy drinks – there are hidden sugars in many fizzy drinks. Squashes and fruit juices also contain high levels of sugar.
Harness the power of protein – protein slows glucose release from food so try to include some at each meal and snack. Good protein choices include skinless, organic chicken or turkey, fish, game, eggs, raw nuts and seeds. Red meat should be consumed in moderation.
Steer clear of stimulants – coffee, tea, energy drinks and alcohol disrupt blood sugar levels and are best avoided or minimised.
Include healthy fats – add 1 tablespoon of ground seeds or cold pressed oil such as flax, avocado or olive oil to meals just before serving. These foods contain beneficial fats which help to even out blood sugar peaks.
Eat foods containing vitamin B5 – mushrooms, fish, avocados, eggs, lean chicken, beef, pork, sunflower seeds, milk, sweet potatoes and lentils may be particularly helpful for adrenal support.
Vitamin B5 is required for the manufacture of energy in the adrenal glands and in particular for the production of Acetyl-coenzyme A (used in the important metabolic process called the Krebs cycle) to make ATP, the energy molecule.
- Mitochondrial support
Recent research interest in this area has generated a basis to support the idea that some manner of mitochondrial dysfunction may contribute to CFS/ME. (8)
Mitochondria are tiny structures inside each and every cell, which facilitate the transformation of food into energy via a series of complex chemical reactions.
However, in some CFS sufferers this energy production process may not work as efficiently as in healthy cells. This is thought to be due to deficiencies of key nutrients required for the energy production process, or as a result of damage to the mitochondria caused by a toxic build-up of free radicals.
Fortunately there are a number of options to help support the mitochondria, which may enhance energy production.
Coenzyme Q10 (CoQ10) – also known as ubiquinone, is an essential compound in metabolic reactions and energy production and is made in every cell in the body.
In addition, it is a potent antioxidant and prevents damage to the mitochondria by mopping up excess free radicals. CoQ10 levels tend to decline with age and may be deficient in individuals exposed to high levels of free radicals.
Early research suggests that CFS patients are deficient in CoQ10, predisposing them to fatigue and autonomic and neurocognitive symptoms. (10) Clinical trials have shown improvements in physical performance and aerobic energy capacity, following supplementation with CoQ10.
Alpha lipoic acid (ALA) – another important nutrient that plays a key role in energy production, as well as having powerful antioxidant properties.
It works particularly well in combination with acetyl-l-carnitine, which aids energy levels by helping to shuttle fatty acids into the mitochondria of cells where they can be metabolised.
Magnesium – may also help to support mitochondrial function because of its role as a cofactor for all energy production reactions. According to early research published in The Lancet in 1991, CFS patients treated with magnesium reported improved energy levels, a better emotional state and less pain. (11)
Takeaway
The complexities of this disease require a patient-centred approach that considers fatigue, quality of life, physical activity and psychological wellbeing. Whilst both nutritional and lifestyle interventions could be of great benefit in CFS, this can be difficult to achieve without considerable support.
At Amchara, our team of Personalised Health practitioners is dedicated to guiding you through challenging health conditions and helping you reach optimal health.
If you feel you need help, why not take advantage of a complimentary consultation today?
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