Chronic Fatigue Syndrome
Chronic Fatigue Syndrome (CFS) is a condition that presents a wide array of symptoms and associated illnesses. Tiredness is the most recognized but certainly not the only symptom. CFS has been defined as “a virally induced, cytokine-mediated psychoneuroimmunologic disorder that occurs in genetically predisposed individuals.”(1) This definition reflects one certain aspect of CFS – it does not have one clear cause, nor one clear pattern of manifestations or one simple treatment regime. Certainly a comprehensive and multicausal approach must be taken. Different patients will present with different symptoms, individual variations in immunology, chemical toxicities, heredity and lifestyle must be examined, in order to understand the disease and assess the most beneficial treatment regime for the patient.
CAUSES OF CFS
CFS certainly appears to be indicative of a chronically disturbed or compromised immune system. This can be the result of a viral infection, recurrent fungal infections such as candidiasis, allergies and other environmental factors.
CFS has also been called myalgic encephalitis (ME) and chronic EBV syndrome. This reflects the original view that the syndrome has a viral causative factor. As other suspected causes are now being more widely investigated and recognized, this theory may be too limited, however a strong viral link is certainly in evidence.
The Epstein-Barr virus is a member of the herpes group of viruses, which includes Herpes simplex types 1 and 2, Varicella zoster virus, cytomegalovirus and pseudorabies virus. These viruses are characterized by their ability to establish a lifelong latent infection after the initial infection. While a healthy immune system is maintained, the virus may be kept at bay, however as soon as the immune system is compromised, viral activity and replication can increase. Most CFS sufferers test positive for EBV antibodies, and thus the link between the two was made. However, in the United States today the majority of the population will have been exposed to the virus, and will show antibodies to it.
Candida albicans is a yeast-like fungus that resides normally in the intestinal tract, oral cavity and vagina. A proliferation of the fungus can cause infections in these areas, known as thrush. The toxins released by the fungi weaken the immune system, penetrate throughout the body and spread to other systems, for example the bladder and respiratory systems.
The weakening of the immune system by Candida has been linked to symptoms including chronic fatigue, lethargy, depression, poor concentration, pain, sore throat and muscle weakness. Diets high in sugar and yeast may worsen the severity or recurrence of infection, as will use of antibiotics, cortisone and birth control pills.
The role of Candida in chronic fatigue should be examined closely should a patient with Candida history present with CFS symptoms. A yeast free and low sugar diet may help, and a general immune system boosting program would be appropriate, as well as caprylic acid.
Typical allergens include pollens, molds, or foods such as milk or wheat. Some allergens cause immediate symptoms, including wheezing, itching, tearing of the eyes and hives, while others produce delayed symptoms, such as joint aches and pains, eczema, fatigue and depression.
Some people are born with certain allergies; others develop over time, and still more arise following a viral infection. It is clear however, that all allergies involve a situation of compromised immunity.
There are many chemicals and toxins in our environment that cause health problems, including lead, mercury, volatile fuels, carbon disulphide, pesticides and other pollutants to name just a few. These can act as neurotoxins or directly on the immune system, and often work on both. More recently controversy has arisen regarding the effects of mercury toxicity from amalgam fillings. This alone has contributed significantly to the health of many CFS sufferers. (2)
While antibiotics can be life-saving medical tools, they can also cause major problems in the immune system, by reacting with the ‘goodies’ as well as the ‘baddies’ in the body. Thus a history of antibiotic use and other medical treatments can be responsible for weakening the immune system and contributing to the development of CFS.
Factors including patterns of rest and exercise, work and play habits, nutrition, relationships, emotional stress and attitudes towards life all have an impact on our body’s ability to resist illness and on our ability to cope. Stress can be a very powerful debilitator, and may cause or contribute to fatigue, heart disease, high blood pressure, insomnia, back pain, stomach problems, hemorrhoids, ulcers and menstrual problems.
It is sometimes difficult to ascertain whether these conditions actually cause the CFS, or whether the CFS leads to an increase in other conditions. For example, a non-allergic person may become allergic following a viral infection which has been associated with their CFS. As their body tried to combat the virus, it sent out antibodies to a whole range of substances that may only have been irritants, and so developed a sensitivity to all sorts of previously non-problematic substances.
SYMPTOMS AND DIAGNOSIS
The most common symptoms of CFS are:
- Tiredness – strength fading by afternoon, sleeping long hours but not awaking refreshed, napping during the day, and generally feeling tired all day.
- Weakness – lack of strength in the muscles.
- Pain – especially head, neck and back pain, but may be in all muscles and joints.
- Painful swollen glands and recurrent sore throats and coughing
- Tremors – shaking and quivering of the body, especially in hands and feet.
- Temperature – usually coldness, but may experience sudden increases in heat following a meal.
- Fevers – low grade fevers often present.
- Sweats – night sweats, but also sweats which seem to be unconnected with temperature changes, and may occur in only one part of the body.
- Secondary infections – due to a depressed immune system, secondary infections may be chronic and persistent.
- Candida and thrush – again due to the depression of the immune system.
- Digestive disorders – including intestinal discomfort and constipation.
- Depression – frustration with their situation, feelings of helplessness and that they will never get better.
- Memory lapses
- Heart irregularities – chest pain, shortness of breath, missed or rapid heartbeats.
CFS can be difficult to diagnose as it is clinically non-specific, and there is no single test for CFS as such. Amongst the conventional medicine field, there are three main accepted diagnostic criteria –
1.Severe, chronic and recurring muscular fatigue, pains, aches or stiffness that is brought on or aggravated by even slight physical exertion. This condition must have been present for 6 months or more.
2.Disturbances of the nervous system with mood, emotional or psychiatric disorders, associated with depression, inability to concentrate, short term memory impairment and anxiety.
3.An abnormal cell-mediated immune response, as shown by either a reduction in the number of T cells or an abnormal response to certain other immunological test such as delayed type sensitivity skin test.
The alternative approach, however, is much broader. Generally speaking the main criteria is inexplicable tiredness, with a degree of muscular weakness and mood disturbance, which has not improved after medical (and sometimes alternative) methods of healing. (3)
Yet another set of diagnostic guidelines specify that at least eight of the following eleven symptoms persist or recur over 6 months: mild fever or chills, sore throat, painful lymph nodes, general muscle weakness, muscle pain, fatigue for more than 24 hours after mild exercise, headaches, joint pain without swelling, neuropsychological complaints, sleep disturbances, and development of initial symptoms over a few hours to a few days. (4)
It is generally recognized that the primary task in diagnosing is excluding all other possible causes for the fatigue, such as cancer, lupus, diabetes or Addison’s disease.
Some medical testing can be useful, for example testing for elevated EBV antibody levels, Candida testing, allergy testing, testing for vitamin and mineral deficiencies. However, while these tests may indicate some of the factors which may be underlying the disease, they will not in themselves lead to the diagnosis of CFS.
TREATMENT OF CFS
It is generally recognized in the treatment of CFS that a comprehensive program must be embarked upon, incorporating many lifestyle factors. There is no simple treatment protocol, and a mixture of several modalities may be used for optimum results. Most of the following treatments are designed to stimulate and support the immune system, and provide the long term lifestyle changes necessary for the patient to maintain health.
Many natural therapists will recommend a liver detoxification program, especially in the first month of treatment, to try and remove all obstacles to improvement. This would involve limiting exposure to all external toxins, including food allergens, chemicals, and drugs, and attempting to remove internal toxins from the body, such as toxins from the bowel, Candida, free radicals and heavy metals. Detoxification of the liver is of primary importance when the EBV is present.
Such a detoxification program should attempt to stimulate the eliminative organs as well as bile production and flow. It will also enhance lymph flow and blood flow around the body, plus stimulate the activity of macrophages.
Nutritional therapy is a very important part of treatment in CFS. Foods should support and accelerate the healing process, not stress the body. Diet should be based on whole, natural, living, unprocessed foods which are high in fiber and complex carbohydrates, low in saturated fats and moderate to high in protein. 8-10 glasses of water per day are recommended.
Vegetables are important nutrient sources, being high in magnesium, calcium and potassium, vitamin C, vitamin A and B-group vitamins, all essential in the healing process. They are easy to digest, and provide a healthy source of carbohydrates.
Fruits are also rich sources of vitamins and minerals, and also contain fiber, which can act as a gentle laxative to help relieve constipation common in CFS sufferers. The fiber of the fruit also slows its digestion, and allows the natural sugar to be absorbed without causing too great a fluctuation in the blood sugar levels.
Legumes are also good foods for CFS sufferers. They too contain magnesium, potassium and calcium, which are energy building, plus iron which is important especially for women.
Seeds and nuts are the best sources of the two essential fatty acids – linoleic and linolenic acids, which are essential in prostaglandin production. They also contain vitamin E and B-complex vitamins, important anti-stress vitamins for fatigue patients.
Fish and some poultry can be eaten as a source of protein. Fish also contains Omega-3 oils, which may be beneficial, as well as iodine and potassium.
As well as foods that can help a patient recover from chronic fatigue syndrome, there are also those that can hinder their progress considerably.
Caffeine is such a substance, and so tea, coffee, chocolate and soft drinks should be avoided. Caffeine can worsen fatigue and cause irritability, anxiety and mood swings. Caffeine stresses the nervous system and exhausts the adrenal glands. It also depletes the body’s stores of B complex vitamins, and inhibits the absorption of iron.
Sugar is another food that may cause stress in the CFS sufferer. It too depletes the B-group vitamins, increases nervous tension, anxiety and irritability. It disrupts carbohydrate metabolism by overworking the adrenal glands and pancreas, thus worsening the symptoms of fatigue and hypoglycemia. A high sugar diet can also worsen chronic Candida infections.
Alcohol affects the absorption of vitamins and minerals (especially B-group and magnesium), which can worsen fatigue, PMS, carbohydrate metabolism and mood swings. It is a sedative, leaving many CFS sufferers feeling ungrounded and unable to concentrate or process information efficiently. Alcohol should be avoided entirely by candidiasis sufferers, as Candida thrives on alcohol (many types of alcohol contain yeast), and many allergy sufferers do not tolerate alcohol well and so should avoid it. Alcohol is also toxic to the liver, brain and nervous system, and can affect the livers ability to metabolize hormones efficiently.
Dairy products can also cause problems for CFS sufferers, as they require hydrochloric acids, enzymes and fat emulsifiers for digestion, which a CFS sufferer may not be producing in sufficient qualities. Tryptophan levels in dairy, particularly milk, may also worsen fatigue, especially for women around the time of menstruation.
Red meats can be hard to digest, as they contain tough protein and saturated fats, and can worsen fatigue symptoms. It also produces series two prostaglandins, which can put stress on the immune system, decrease resistance and trigger allergy states.
Wheat and gluten may present a problem, especially in people with allergy problems. Wheat intolerance can cause fatigue, depression, bloating, intestinal gas and bowel changes. Effort should be made to incorporate alternative grains into the diet, such as rice, corn, millet and buckwheat.
Vitamin and Mineral Supplementation
Vitamin and mineral levels will be much improved by switching to a diet such as that outlined above. Supplementation may be beneficial, but should be closely monitored to ensure correct dosages and avoidance of toxicity. Many vitamins play a role in immune function, but it is essential to have a balance of vitamins in adequate amounts for the body to functioning and recovering at its optimum level. Vitamin C is particularly used in the treatment of CFS, often in large doses intravenously. However, like many other forms of treatment for CFS, what works magnificently for some, can produce no improvement in others. (5) Vitamins B6, B12, folate and pantothenic acid, plus the minerals zinc, selenium, chromium and manganese are commonly used for immune support.
Several herbal remedies can assist the healing process. These mainly work either as immunostimulatory remedies, or on the lymphatic system. They include Goldenseal (particularly when EBV has been a factor), Purple coneflower, Baptisia tinctoria, Pokeweed, Licorice root, Radix astragalus, Ginkgo biloba, and Dandelion root. Ginseng has been used successfully in the recovery phase of CFS. Larrea tridentata has had good results when herpes family viruses are involved, as it inhibits the replication of the virus.
Oxygen therapy uses ozone, which is oxygen with three atoms of oxygen rather than two, which means that the oxygen is activated. This tends to support the livers efforts at detoxification and improve metabolism of cells, which improves their capacity to provide more energy for the body. It also improves circulation, and kills many species of bacteria, viruses and fungi.
While some sufferers will be unable to do any exercise at all, it is generally advised that those who possibly can, do some movement, simply to keep their bodies active and to move the oxygen into the cells. Gentle exercise such as yoga or stretching can be beneficial. Breathing exercises can also help enhance the oxygen supply into the body.
Stress Release/ Emotional Healing
This aspect of therapy is essential in the recovery of the CFS sufferer. Choice will depend on the individual and the severity of the illness, but possibilities include counseling, relaxation techniques, positive affirmations, visualization techniques, and group therapy. In many CFS sufferers there is the feeling of frustration, impotence and inability to recover. A positive outlook can help the patient’s recovery greatly, and this aspect should not be overlooked.
Orthodox Medical Approaches and Drug Therapy
Orthodox medicine highlights the nutritional and lifestyle factors necessary to recover from CFS. Drugs are used as a treatment option, but are usually aimed at the specific symptoms, not at the syndrome as a whole. Several antidepressants are prescribed not only to elevate moods, but for pain relief and as energy boosters. Aspirin is used to relieve symptoms of headache and general aches and pains, as are non-steroidal anti-inflammatory drugs. Migraines are sometimes treated with beta blockers, which are typically used to treat heart conditions.
As is so often the case in our Western society, many people live in hope of the discovery of one pill that will cure them overnight, while at the same time taking other medications which may relieve the symptoms but compromise the body’s ability to heal itself from the root of the problem. It appears that at this stage even orthodox medicine sees comprehensive nutritional therapy and long term lifestyle changes as the most useful approach in the treatment of CFS.
CFS is a debilitating syndrome, which can be associated with several other health problems. Its trigger may have been a viral infection, environmental toxins, allergy states, recurrent Candida infections or stress and depression, all ultimately resulting in a compromised immune system.
The outcome of the disease is difficult to predict, due to the wide range of symptom severity. It is, however, generally considered to have an acute onset followed by a chronic phase with cycles of intensity. This cycling can make the road to recovery quite a bumpy one, and it is often the temptation for a patient who suddenly feels better to rush out and overdo the activity, only to end up in a relapse. Periods of remission vary greatly between patients, and some symptoms may disappear while others remain. Stressful events (either physical or emotional) are known to cause relapses.
Even in the recovery phase, where the general trend is towards health, relapses do occur.
Recovery time can be affected by many factors, including genetic factors, self care and self help, treatment, lifestyle change, ongoing stresses and the intensity and exposure to the triggers of the illness.
It is important in the recovery of a CFS sufferer to be educated to know their own bodies, to recognize the symptoms, and to take responsibility for their own progression and recovery. A positive outlook can make the difference between a downward spiral into frustration and depression, and an empowered patient with a strong desire to improve their health and get back into their normal lifestyle. For some patients, CFS becomes a road of self discovery and the impetus to change to a healthier lifestyle for the rest of their lives.
1. Definition offered by Jay Goldstein MD, Director of the Chronic Fatigue Institute in Beverley Hills, California, replicated in Collinge, W. Recovering From Chronic Fatigue Syndrome, The Body Press, New York, 1993, p 23-24.
2. According to William Vayda, expert in orthomolecular and environmental health conditions, in discussion in clinical situation, Vayda Institute, Sydney, Australia.
3. Vayda, W. Chronic Fatigue, The Silent Epidemic, Simon and Schuster, Sydney, 1995, p 69.
4. Tortora and Grabowski, Principles in Anatomy and Physiology, Eighth Edition, Harper Collins, New York, 1996, p 702.
5. Taken from clinical observation and discussion with William Vayda, Vayda Institute, Sydney, Australia.