Naturopathic Newsletter February 2010: Chronic Fatigue Syndrome

CHRONIC FATIGUE SYNDROME (CFS): A Diagnosis of Exclusion

February 2010

I thought I would follow-up January's newsletter on Fibromyalgia Syndrome in a similar vein by discussing Chronic fatigue Syndrome (CFS).

Although the Centers for Disease Control and Prevention (CDC) only affirmed the existence of this condition in 1988, this syndrome is not really new. Medical literature over the past several hundred years has described the symptoms that make up this condition. The symptoms have been categorized under different names, including effort syndrome, hypoglycemia, total allergy syndrome, systemic yeast infection, post-viral fatigue syndrome, etc ...

Unfortunately, as the symptoms are often vague and unexplainable from a conventional medical perspective, many practitioners dismiss this condition as hypochondriasis or a psychosomatic illness. According to one survery, only 50% of general practitioner physicians believe CFS actually exists.

CFS is not the occasional mild fatigue that is commonly experienced. Rather, it is a profound, prolonged, debilitating fatigue brought on by minimal physical exertion.

CFS affects less than 1% of the population, more commonly women than men. 

The difficulty with CFS from a conventional medical perspective is the lack of laboratory findings and diagnostic testing to identify it. As a result, this condition is only recognized as a diagnosis of exclusion. Other than fatigue, symptoms can vary between patients, including:

Commonly Reported Symptoms of Chronic Fatigue Syndrome

Abdominal cramps Night sweats

Allergies Rapid pulse

Difficulty concentrating Rash

Fatigue Sleep disturbances

Feverishness Sore throat

Headache Tender lymph nodes

Muscle and joint aches Weight loss

Symptoms of CFS also mimic many other diseases and conditions, which must be ruled out before the diagnosis of CFS is made, including:

Conditions to Rule Out Before Diagnosing Chronic Fatigue Syndrome (CFS)

Addison's disease Hypokalemia

AIDS Hyponatremia

Anemia Hypothyroidism

Autoimmune disease Lyme disease

Bipolar disorder Malignancy

Chronic pain syndrome Myasthenia gravis

Depression Psychosis

Diabetes mellitus Psychotic depression

Drug use Renal disease

Fibromyalgia Schizophrenia

Heart failure Systemic lupus erythematosus

Hepatitis Tuberculosis

As discussed in January's newsletter, because of naturopathy's wholistic approach, the recognition of and approach to CFS often offers patients further understanding of their condition and more options in comparison to the conventional medical model. 

The remainder of this newsletter will focus on the naturopathic considerations in understanding the root cause(s) of CFS.

As with any condition, the naturopathic approach includes gathering information to understand the patient's physical, mental and emotional states leading up to the onset of their symptoms. In taking a detailed case history, patients often report the onset of CFS following either a diagnosed viral infection or the experience of a flu-like state.

Thus, as part of our work-up, it is very important to assess the state of the patient's immune system via conventional blood tests, including a complete white blood cell count. As research has shown a possible correlation, I will also verify if the patient has been exposed to the Epstein-Barr virus (responsible for what is commonly known as "mono").

Should the blood test results show abnormalities with the immune system, then your naturopathic doctor will make individualized, case specific recommendations for

herbs, vitamins and minerals

that will address  the specific immune imbalance. Such recommendations may include:

medicinal mushrooms

elderberry

astragalus

siberian ginseng

vitamin C

vitamin D

zinc ... just to name a few

Again, it is the individualized approach that often yields the best results.

As discussed above, the naturopathic approach includes a detailed patient history to try and understand what may have tipped the balance scales. In my years of practice, I have noticed that patients often describe the occurrence of a significantly stressful event within the months leading up to the onset of their symptoms. This is important as it potentially indicates that the adrenal glands, the master stress glands, are involved in the patient's current dis-ease state. When the adrenal glands are continuously assaulted from chronic stress, at some point, they may reach the point of burn out. Patients can experience varying degrees of burn out with varying symptom manifestations. This symptom manifestation is often attributed to abnormal levels of 1 or 2 principal adrenal hormones, cortisol and/or DHEA. 

If adrenal fatigue is suspected, then an adrenal assessment test can be performed using the patient's saliva samples to measure both cortisol and DHEA levels and daily patterns. Should this saliva test show that your adrenal glands are indeed "fatigued", then your ND will suggest a protocol to replete and replenish your adrenal health.

 

Research shows no correlation between vitamin-mineral deficiencies and CFS. However, the naturopathic approach also takes into consideration the possibility of nutritional insufficiencies, in which the patient lacks sufficient amounts of a vitamin or mineral to function optimally. Indications of possible insufficiencies come from taking a detailed patient health history. Some insufficiencies that may be present include: 

B complex vitamins

vitamin B12

vitamin D

magnesium,.... etc

Some research suggests that some patients with CFS may benefit from increased intake of antioxidants, including:

vitamin C

selenium

quercetin

n-acetyl cysteine,.... etc

Again, as this is NOT a one size fits all approach. A complete intake will allow your ND to make a final assessment, along with an individualized protocol recommendation.

A growing body of research suggests that patients with CFS are unable to keep up with their body's energy production, known as adenosine triphosphate (ATP). The body consists of billions of cells which act as tiny factories producing a necessary end product utilized by the body. Each factory (or cell) contains a power source, known as the mitochondria, generating the energy (or ATP) needed to drive the cell's factory. If the power source (or mitochondria) is unable to provide ample power, then the cell is fatigued and unable to produce it's product.

At this microscopic level, if the cell is unable to generate sufficient energy, than that may translate macroscopically into the patient feeling this lack of energy as chronic fatigue. So then, the next logical question is ... what does the mitochondria need to produce adequate ATP, allowing for the cell to have sufficient energy to function properly.

The growing body of research around this topic has identify some key players in mitochondrial ATP production:

NADH (nicotinamide adenine dinucleotide hydrate)

Coenzyme Q10

D-ribose

L-carnitine

Again, your ND will be able to further discuss whether you are a good candidate for this therapeutic approach, given the totality of your health state and history.