It is unlikely that chronic fatigue syndrome is a single illness, yet it’s estimated to affect about 17 million people worldwide. It commonly affects young adults, with a peak age onset of between 20 and 40 years. The illness also appears to be more common in women.
Clinically, the exact cause of CFS is not completely understood. It appears the illness is a result of interactions between the individual and various external factors.
The main symptoms of CFS (disturbed perception of fatigue and pain, sleep disturbance, neurocognitive difficulties, and mood disturbances such as anxiety and depression) suggest a disturbance of central nervous system function.
There are a range of potential triggers, and each person may have unique contributing factors, such as infection, compromised immunity, metabolic, central nervous system disturbance, endocrine disturbance, and even genetic links.
There have also been reports of geographical clusters of CFS-like illnesses. This suggests the possibility of an infectious component to the disorder. Many CFS patients also report that the illness began with flu-like symtoms, and some symptoms resemble those of an acute viral infection (sore throat, myalgia, enlarged lymph glands). In addition, particular viruses have been implicated in CFS, including Epstein-Barr virus (glandular fever), parvovirus, chlamydia, herpes virus, and others.
There are thought to be multiple potential triggers all causing a similar fatigue response. Immune dysfunction is recognised as another possible cause for CFS, as many of the symptoms point to a chronic low-level immune system activation. Some test results have shown links between low or impaired cortisol response and CFS, as well as abnormalities of serotonin output. Some results reported DHEA levels significantly lower in CFS patients as compared to healthy subjects. Other patients with CFS have reported various food intolerances that exacerbate symptoms. As you can see, each case is different, with a different trigger and unique ways in which the body responds, although with some key similarities in symptoms.
Signs and symptoms
Fatigue is the hallmark of CFS, with patients describing abrupt onset of fatigue with a flu-like illness (fever, sore throat, myalgia). Patients note that physical exertion exacerbates the fatigue.
Other symptoms of CFS are nausea, night sweats, dizziness, intolerance to cold, sleep disturbance, headaches, muscle weakness, and prolonged post-exertional fatigue.
CFS impacts in other ways as well, with many CFS patients noting a decrease in social relationships and incapacity to work, and depression also being very common among individuals with CFS.
Sleeping longer doesn’t seem to improve physical or mental functioning in CFS, and daytime napping can disrupt night time sleep further.
Avoid going to bed too early, or too late in the evening. Too early, means it’s likely to trigger a night time wake up, and too late can mean we pass a window of when our body naturally starts to become sleepy (around 9.30pm – 10.30pm). Some people can pick up after again and feel more energy later into the evening.
Avoid stimulants from midday
Wake up at a regular time each morning, and try to go to bed at the same time each evening.
Create a good sleep hygiene routine. Start to wind down in the evening around 8.30pm or 9.00pm by listening to something relaxing, or reading, having a bath. Allow your body to understand it’s almost time to sleep.
Engage in enough physical activity during the day so that you are tired enough to sleep in the evening. This feels counter-intuitive for CFS patients, and for some it’s simply not realistic, however for those who can push a daily walk for example, are likely to find the benefits of that exercise after a few days.
The naturopathic perspective
As naturopaths, we aim to identify the underlying cause. We run tests to determine whether there is an infection, and will work to rebuild the immune system. We work to restore the circadian rhythm and repair any adrenal exhaustion. We should identify and minimise any food intolerances, allergies, or sensitivities. We must also address any nutritional deficiencies for optimal repletion.
All stimulants should be avoided, particularly after midday. These stimulants will delay recovery. (Caffeine, alcohol, sugar are all stimulants which place a burden on the body).
Avoid all substances that will weaken the immune function.
Ensure adequate protein intake so that energy is stable and sustainable. Protein is also required to make up components of the immune system, so without adequate protein our immune system is unable to facilitate a healthy immune response.
Consume smaller meals throughout the day, rather than 3 large meals. This maintains ease of digestion and regularity of blood sugar levels.
Focus on wholefoods. Food that are processed not only have chemicals, preservatives, and additives which put pressure on the body to eliminate them, but they are also likely to be nutritionally void.
Minimise raw food. Focus on cooking casseroles, soups, where the cooking process starts to break down the food. This places less burden on the digestive system, to allow more energy for other things. We all know how we feel after a large bowl of pasta (that’s because our energy has been taken to our digestive system to try and process the large meal). If we are eating smaller cooked meals, more frequently, then we won’t have the same energy slump after eating. Raw food takes quite a lot of digestive power to assimilate.
Essential fatty acids from oily fish, nuts, and seeds should be consumed. Clinical trials have shown essential fatty acids to be beneficial in relapse frequency and cognitive function for CFS patients.
Supplements and herbal medicines
Ideally a full nutritional review should be conducted, and if necessary, nutrients which could be useful for CFS patients are B vitamins, magnesium, vitamin C, vitamin E, zinc, coenzyme Q10, mood support and sleep support such as 5-HTP, GABA, and tryptophan.
Specific herbal medicines can be utilised depending on the root cause of the fatigue. Some herbal medicines that could be useful are Glycyrrhiza glabra, Hypericum perforatum, Eleutherococcus senticosus, Panax ginseng, Astragalus membranaceus, Withania somnifera, and Rhodiola rosea.
Make a time to talk to your naturopath, who can devise a tailored treatment plan to assist with your symptoms of chronic fatigue.
Yvette is a qualified Melbourne-based Naturopath and Nutritionist, MINDD Practitioner, member of the Naturopaths and Herbalists Association of Australia, and Complementary Medicine Association. Yvette specialises in the treatment of conditions commonly affecting women and children, with a key interest in children’s digestive and neurological conditions, as well as women’s hormonal concerns, digestive issues, fatigue, anxiety, and skin concerns. Yvette consults in South Yarra, Melbourne, as well as Australia-wide via skype/zoom/phone.
The Naturopathic Co. Melbourne Naturopath 2020
Hechtman, L (2012). Clinical Naturopathic Medicine. NSW, Churchill Livingston, Elsevier.