By Elizabeth Lipski, PhD, CCN


(Chapter taken from Digestive Wellness, 3rd Edition McGraw Hill)

Author of Digestive Wellness, Digestive Wellness for Children, Leaky Gut Syndrome. Founder of and




Fatigue is one of the most common complaints that bring people into a physician's office. Fatigue can be caused by nearly every illness and is part of the natural healing process. Excessive fatigue that lasts and lasts may be a sign of illness or of chronic fatigue syndrome. Also called CFIDS, CFS, myalgic encephalomyelitis, chronic Epstein-Barr virus, and yuppie flu, chronic fatigue syndrome is a long-lasting, debilitating fatigue that is not associated with any particular illness. Although people have been fatigued for millennia, the term "chronic fatigue syndrome" was only coined in 1988. CFIDS affects about 3 people per 100,000, and 50% of people eventually return to normal health within five years.


People with chronic fatigue syndrome have by definition been extremely tired for at least six months for no obvious reason. The Center for Disease Control has provided the following criteria for diagnosis of CFDIS: First, the fatigue is not eliminated by rest, and the fatigue substantially reduces the person's ability to function normally. Second, the diagnosis includes at least four of the following symptoms for a period of at least six months: loss in ability to concentrate or short-term memory function; sore throat; swollen and tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern, or severity; sleep disturbances; and exercise-caused fatigue that lasts more than twenty-four hours. People with CFIDS share many common symptoms, but not everyone has all the same ones. CFIDS often begins with an infectious flu-like disease accompanied by fevers that come and go. There is often accompanying joint stiffness and pain, sore throat, cough, sleep disturbances, light sensitivity, night sweats, and extreme exhaustion after the slightest exertion. It's common that a short walk or bit of exercise wipes out your energy for days afterward. Some people have the Epstein-Barr virus, or Cytomegalovirus, but others don't. Sometimes healthy people have high blood titers for these viruses and have no symptoms of CFIDS. It's possible that these viruses trigger CFIDS, but it's also possible that the low immune function in people with CFIDS increases their chances of catching a wide variety of infectious illnesses.


Many people with CFIDS cannot hold down a job and many are depressed because the fatigue is so extreme. Those who do work come home exhausted and go immediately to bed so they can generate enough energy for work the next day. Because there isn't any apparent cause and no observable symptoms (like boils or measles), people with CFIDS are often confronted by people and doctors who just don't believe it's real.



Common Symptoms of Chronic Fatigue Syndrome


Percentage Affected
Fatigue 100
Mental sluggishness, foggy thinking, inability to concentrate 50-85
Depression 50-85
Pharyngitis 50-75
Exhaustion after minimal exertion that can last for days 50-60
Stiffness and muscle pain 50-60
Muscle weakness 40-70
Joint pain, arthritis-like symptoms 40-50
Headache 35-85



In 1990, the Center for Disease Control in Atlanta began to keep records and study people with CFIDS in order to understand more about possible causes and therapies. We now know that CFIDS is multifactoral and affects many biochemical systems. There is an impairment in the ability of the mitochondria--the power plants in each of our cells--to produce energy. Cytokine production of interleukin 2 is low and causes poor immune function. Other immune parameters appear to be overstimulated. Although this seems paradoxical, it's probably not. According to Hans Selye, an expert on stress, our systems initially react to stress by overproducing. If working harder doesn't eventually solve the problem, they underproduce. Many people with CFIDS have exhausted adrenal glands and produce low amounts of cortisone and other adrenal hormones. Almost always they have dysbiosis, and most have Candida infections. There is usually leaky gut syndrome, accompanied by a host of food and environmental sensitivities. The liver is overburdened and overworked. The toxic by-products of life accumulate in tissues, and the cycle deepens.


Eventually, the mitochondria are affected. Mitochondria are the energy factories inside our cells, creating ATP energy from glucose in a complicated process called the citric acid cycle, or Kreb's cycle. Mitochondrial function can be tested with an organic acid test, and this testing has provided evidence that mitochondrial DNA is damaged much more easily and is more susceptible to environmental toxins and other stressors. As chronic fatigue symptoms progress, the mitochondria often need nutritional support of their own. Many companies make products to facilitate this, including Mitochondrial Resuscitate and Kreb's Cycle Nutrients.


Using a tilt table, researchers have found that many people with CFIDS have low blood pressure with a test called the postural blood pressure test. Complimentary medicine physicians have long used reclining and standing blood pressures to detect poor adrenal function. Individuals with healthy adrenal function experience only a five-point rise in blood pressure when they move from a reclining to a standing position. In people with poor adrenal function, blood pressure remains the same or drops. So the real question is: Is the tilt-table hypotension the primary culprit behind or an indicator of poor adrenal function? In any case, some people with low blood pressure respond to an increase in salt intake to at least 1,000 milligrams daily, or by taking medication to increase blood pressure.


There aren't any panaceas for CFIDS, but there are therapies that can gradually help restore people to health. It's important to address detoxification, viral load, digestive function, dysbiosis (including Candida and parasites), mitochondrial function, intestinal flora, environmental contaminants, heavy metals, underlying allergies, and hormone imbalances (especially thyroid and adrenal), as well as to restore the immune system. If this seems daunting, it can be. The causes and specifics are different for each person. Careful partnership between practitioner and patient will give the very best results. CFIDS is one area in which conventional, mainstream medicine has little to offer. If you've tried everything that your doctor has recommended and still aren't any better, you need to broaden your approach.


Restoration of digestive competency and nutrition go a long way toward normalizing CFIDS. Work with a nutritionally oriented health professional to design a program that meets your specific needs. The first steps are discovering any underlying problems which aggravate and drive the condition using the tests listed below. It's important to check carefully for parasites; one study found Giardia in 2 8 percent of subjects with CFIDS. Giardia hangs out in the mucous membranes and is difficult to detect with random stool samples. Then develop and follow a diet based upon foods that are healthful for you and a nutrient-rich program designed to boost immune, brain, and cellular function. When you are ready, add exercise-a little bit at a time.


The biological, rather than medical, approach to chronic fatigue saves money and works better. In one study of cost-effectiveness it was determined that a nutritional approach costs $2,000 compared with $10,000 for a medical approach. The patients on nutritional programs reported greater improvements in function and subjective well-being. They were able to significantly reduce the amount of medications they used.


The CFIDS Association in Charlotte, North Carolina, California offers a wealth of information for people with CFIDS. See Resources for specific address information. You can obtain information about medications, herbs, nutritional supplements, diet, exercise, and additional therapies. See listing in the Resources.




Functional Laboratory Testing


1. Comprehensive digestive and stool analysis with parasitology.
2. Elisa testing for food, airborne, and chemical sensitivities. Elisa-Act test is the most inclusive.
3. Liver function profile.
4. Intestinal permeability screening.
5. Organic acids.
6. Hair analysis or urine test for heavy metals.



Healing Options


After testing, you'll have a better idea of any underlying problems. Look up related sections in this book to help you with the specifics. Then move on to the 4-R approach: Remove, Replace, Reinnoculate, and Repair.


Metabolic cleansing:
Metabolic cleansing involves going on a hypoallergenic food plan for one to three weeks and taking a nutrient-rich protein powder designed to help restore your liver's detoxification capacities. For a thorough discussion of metabolic cleansing, see chapter 9.


Food and environmental sensitivities:
Avoid all foods and chemicals that you are sensitive to from your diet for four to six months. Use shampoos, soaps, and toiletries that are hypoallergenic for your specific needs, and natural household cleaning products that are healthier for you, your family, and the environment. Some people are sensitive to their mattresses, gas stoves, carpeting, and upholstery. You may need to wear 100 percent cotton clothes and use 100 percent cotton sheets and blankets. Work with a health professional who can help you thread your way through the details.


Alkalizing Diet:
Read the section on acid/alkaline diets. Use pH paper to determine your pH levels. Use alkalizing foods, alkalizing salts, baking soda and Epsom salt baths, and vegetable juicing to bring your body into balance. See section on acid/alkaline.


Acidophilus and bifidobacteria:
Supplemental use of beneficial bacteria can make a tremendous difference in your ability to digest foods. Beneficial flora can help reestablish the normal microbial balance in your intestinal tract. The supplements you purchase may have additional microbes. Dosage: one to two capsules or 1/4 t o 1/2 teaspoon powder two to three times daily. Mix powdered supplement with a cool beverage and take on an empty stomach.


Digestive enzymes:
Pancreatic or vegetable enzymes supply the enzymes that your body needs to digest fats, proteins, and carbohydrates. Products differ. Some contain lactase, the milk digesting enzyme; others have additional hydrochloric acid to assist the stomach; and some contain ox bile to help with emulsification and digestion of fats. Dosage: one to two capsules with meals.


Multivitamin with minerals:
Because people with CFIDS have difficulty with absorption and utilization of nutrients, a highly absorbable, hypoallergenic nutritional supplement is necessary. Although products that contain herbs, bee pollen, spirulina, and other additional food factors are good for many people, people with CFIDS often feel worse after taking food-based supplements. Make sure you buy the supplements that are herb and food free. Choose a supplement that contains the following nutrients: 25-50 milligrams zinc, 5,000-10,000 IU vitamin A, 10,000-25,000 IU carotenes, 200-400 IU vitamin E, 200 micrograms selenium, 200 micrograms chromium, at least 25 milligrams of most B-complex vitamins, 400-800 micrograms folic acid and 5-10 mg manganese.


Vitamin C:
Vitamin C boosts immune function and helps detoxification pathways and has been shown to have antiviral effects. Clinicians have found it useful in people with CFIDS. Dosage: 3,000-5,000 milligrams daily. Do a vitamin C flush. See detailed instructions on pages 154-155.


Found in green leafy vegetables and whole grains, magnesium is involved in over three-hundred enzymatic reactions in the body. It is essential for energy production, nerve conduction, muscle function, and bone health. People with CFIDS are often deficient in magnesium. Supplemental magnesium can improve energy levels and emotional states, while decreasing pain. Most people improve with use of oral magnesium supplements, but some need intravenous injections. Physicians can give 1,000 milligrams magnesium sulfate by injection. In one study, magnesium injections improved function in twelve out of fifteen people, compared with only three receiving the placebo. Magnesium can be hard for many people to utilize. Use of 1 tsp. daily of choline citrate can significantly improve magnesium uptake. Dosage: 500-1,000 milligrams magnesium citrate or magnesium/potassium aspartate (aspartic acid helps mobilize magnesium into the cells).


Coenzyme Q10:
Coenzyme Q10 is necessary for energy production, immune function, and repair and maintenance of tissues. It also enhances cell function. CoQ1O is widely used in Japan for heart disease and has been researched as an anti-tumor substance. Dosage: 60-300 milligrams daily.


Essential fatty acids:
Several studies have shown people with CFIDS to have fatty acid imbalances. In a recent study, a combination of evening primrose oil and fish oil or a placebo of olive oil was given to seventy people with CFIDS. Of the people taking fish and evening primrose oils, 74 percent showed improvement at five weeks, and 85 percent showed improvement at fifteen weeks. In comparison, the placebo group showed 23 percent improvement at five weeks and 17 percent at fifteen weeks. Another study of the use of supplemental fatty acids showed improvement in twenty-seven out of twenty-nine people with CFIDS over twelve to eighteen weeks. Twenty people who had -previously been unable to work full-time for an average of over three years were able to go back to work full-time after an average of sixteen weeks. Sixteen months later twenty-seven out of twenty-eight remained improved, and twenty were still progressing. Dosage: Flax oil capsules 2-3 grams daily or EPA/ DHA fish oil once or twice daily plus evening primrose or borage oil 1-2 grams daily. Because magnesium and vitamin B6, as well as the proper genetics, are necessary to convert flaxseed oil into EPA and DH_A, it is advisable to take at least some preformed DFIA.


Methionine, an essential sulfur-containing amino acid, is commonly deficient in people with CFIDS. It acts as a methyl donor for transmethylation reactions throughout the body, especially in the brain. It also helps sulfoxidation for liver detoxification pathways and is a precursor for other sulfur-containing amino acids such as cysteine and taurine. People with CFIDS probably have an increased need for methionine. Some people find improvement with a general amino acid supplement that supplies methionine, lysine, and camitine simultaneously. Dosage: 500-1,000 milligrams.


SAMe, a compound that is naturally found in every cell in our body, is made from methionine. Research on SAMe shows it to have powerful antidepressant effects without the side effects of pharmaceutical antidepressant medications. SAMe has also been shown to be as potent an anti-inflammatory drug as indomethacin without the negative side-effects in people with arthritis. A good article on SAMe appeared in the March 22, 1999 edition of Newsweek.


The vast majority of people with CFIDS have low levels of acetylcarnitine, although their levels of free carnitine are normal. Carnitine, vital for the conversion of fats into energy, also plays some role in detoxification and is believed to be essential for heart function. Finally, carnitine helps transport long-chain fatty acids into the mitochondria. Carnitine deficiencies result in muscle weakness, aches, and poor tone. When people were supplemented with 4 grams daily of acetylcarnitine, half showed improvement in their symptoms. Dosage: 4 grams acetyl-carnitine daily.


Often people with CFIDS also have herpes infections. Some people find good results with a general amino acid supplement, which supplies carnitine, lysine, and methionine as well as other amino acids. Dosage: 1-2 grams daily at the first sign of an outbreak; 500 milligrams daily for prevention.


Malic acid:
Malic acid comes from apples and is important in energy production at a cellular level. Several physicians have found malic acid supplementation reduces fatigue and pain of fibromyalgia. Dosage: six to twelve tablets daily, decreasing dosage over time. Each tablet contains 300 milligrams malic acid/magnesium hydroxide.


Immune-stimulating herbs:
Echinacea, goldenseal, astragalus, phytolacca (pokeweed), licorice, and lomatium all have immune-stimulating properties. They can also help prevent secondary infections while you are in a susceptible state. Take them preventively or therapeutically as directed.


Adrenal support:
People with CFIDS often need adrenal support, such as adrenal glandular supplements or herbal supplements such as licorice and Siberian ginseng. Vitamin C and panthothenic acid (vitamin B5) are also needed for proper adrenal function. If your blood pressure is low, you can use whole licorice; if not, use DGL, which will not affect aldosterone levels and blood pressure. It's best to take adrenal support in the morning and at lunch. If taken too late in the day, adrenal support can stimulate energy when you want to be winding down.


Nicotinamide adenine dinucleotide (NADH):
In a study monitoring the effect of nicotinamide adenine dinucleotide (NADH) on people with CFIDS, twenty-six subjects were given the reduced form of NADH for four weeks and a placebo for an additional four weeks. Thirty-one percent showed improvement when on NADH, while only 8 percent improved when taking the placebo. Subjects were less fatigued and had improvement in quality of life. NADH is integral to the citric acid cycle of energy production. Once again, we are reminded that each person has unique needs. While most people did not benefit, NADH may be a useful treatment for those who did. More research needs to be done to see if 10 milligrams daily, the amount given in the study, is the proper dosage; if a longer treatment program would be of additional benefit; and what, if any, are the long-term benefits.


Meyer's Cocktail:
IV nutrients, given by a physician, can quickly help revitalize your nutrient status. Nutrients can be absorbed and used at higher concentrations. Meyer's cocktail is a combination of: magnesium, calcium, vitamins B12, B6, panthothenic acid, and vitamin C. It has been used successfully in people with a variety of ailments.


People with CFIDS find exercise to be totally exhausting and draining. It is common for one period of exercise to be followed within six to twenty-four hours by two to fourteen days of exhaustion and muscle aches. Paradoxically, exercise is helpful for restoring function in people with CFIDS, and so it's advisable to begin with simple walking, swimming, or biking for five minutes daily. If you can, increase by one or two minutes a day each week. If you feel that you are at your maximum, maintain your present length of exercise time until your fatigue lessens. Don't push yourself hard. Slow and steady wins the race. Studies have shown that two-thirds of people with CFIDS benefit through exercise, although it is critical to not overdo.


Stress management:
Development of strong support systems is vital. People with CFIDS often have the illness for a long time and can greatly benefit from support groups. Exchange of information and dialogue with people who understand what you are going through can expedite recovery. Take time for yourself, rest, and relax.


There is a new hypothesis that people with CFIDS are functioning in an anaerobic state, so light anaerobic exercise may be most beneficial. Working with light weights, leg lifts, and use of weight machines to your capacity without causing fatigue may be more beneficial than aerobic exercise. As you begin to feel better, incorporate aerobic exercise--walking, biking, swimming, and dancing. Prioritize, so you have energy for what's most important. Be patient, kind, and loving to yourself.



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