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Chronic Fatigue Syndrome Diagnosis and Treatment - Part 3





MCS America

Lourdes Salvador's Column

...Co-founder of MCS America discusses the latest Multiple Chemical Sensitivity issues.









Lourdes Salvador volunteers as a writer and social advocate for the recognition of multiple chemical sensitivity (MCS). She was a passionate advocate for the homeless and worked with her local governor to provide services to the homeless through a new approach she created to end homelessness. That passion soon turned to advocacy and activism for people with MCS and the medical professionals who serve them. She co-founded MCS Awareness in 2005 and went on to found MCS America in 2006. She serves as a partner for Environmental Education Week, a partner for the Collaborative on Health and the Environment (CHE), and a supporter for the American Cancer Society: Campaign for Smokefree Air.


For more information visit MCS America




Monday, April 20th, 2009:


Chronic Fatigue Syndrome Diagnosis and Treatment - Part 3


by Lourdes Salvador





All people with CFS are physically impaired. The Centers for Disease Control and Prevention cites that roughly half of people with CFS partially recover, some returning to work and others growing progressively more disabled.[1,19] The sooner a patient is diagnosed and treated, the better the chances of recovery.[1,10]


Because CFS is a multi-system illness, it is important to address more than one symptom at a time. Treatment options include pharmacologic, nutitional, and alternative therapies along with managing activity levels.


Pharmacologic Treatments


There is no specific drug for treating chronic fatigue syndrome.[1,19] Specific symptoms may be treated with pharmacologic medications.[1,19] However, there are guidelines which should be exercised.[1,19]

  • A greatly reduced dosage of ¼ to ½ of the normal dosage is recommended as patients with CFS are often highly sensitive to pharmacologic interventions.
  • The least number of drugs possible should be used to avoid drug interaction. In some cases, a single drug may act on multiple symptoms.
  • Drugs should be aimed at correcting the cause of symptoms.
  • Patients should be monitored for side effects, particularly those which may cause cognitive problems.
  • Remember that one drug may not work for every CFS patient.

Medscape provides a detailed chart with by symptom with suggested drugs and dosages. It can be downloaded online from :

It provides drug suggestions for symptoms ranging from sleep problems, anticonvulsants, cognitive problems, muscle tension, restless leg syndrome, orthostatic intolerance, and pain to antidepressants.


Nutritional Treatment


Research indicates that malabsorption and deficiencies in a variety of vitamins, minerals, amino acids, and other nutrients may play a role in CFS.[19,20,21,46]. Basic guidelines for nutritional treatment include:

  • Test for nutitional deficiencies, particularly in vitamins B, D, C, E, magnesium, sodium, zinc, essential fatty acids, folic acid, tryptophan, carnitine, and CoQ10.[22]
  • Be aware that borderline results of nutrients may be exacerbating or mimicking CFS symptoms.[19]
  • Maintaining a well balanced diet and taking a multi-vitamin are recommended.
  • Be sure that all supplements taken are noted in the patient file and monitor for negative drug interactions.
  • Avoid foods and chemicals for which sensitivity exists.

Nutrition therapy with certain agents that down-regulate the nitric oxide and peroxynitrite (NO/ONOO-) cycle of biochemistry has also been recommended.[23] The following agents have been predicted to be useful to down-regulate the NO/ONOO- cycle and reduce symptoms in clinical trials:[23]

  • Nebulized Inhaled Reduced Glutathione (RX Only)
  • Nebulized Inhaled Hydroxocobalamin (RX Only)
  • Mixed Natural Tocopherols
  • Buffered Vitamin C
  • Magnesium as Malate
  • Four Different Flavonoid Sources:
  • Ginkgo Biloba Extract, Cranberry Extract, Silymarin, & Bilberry Extract
  • Selenium as Selenium-Grown Yeast
  • Coenzyme Q10
  • Folic Acid
  • Carotenoids Including Lycopene, Lutein and Alpha-carotene
  • Alpha-Lipoic acid
  • Zinc (modest dose)
  • Manganese (low dose)
  • Copper (low dose)
  • Vitamin B6 in the Form of Pyridoxal Phosphate
  • Riboflavin 5’-Phosphate (FMN)
  • Betaine (Trimethylglycine)
  • Green Tea Extract
  • Acetyl L-Carnitine


Alternative Treatment


Alternative therapies have been shown to decrease symptoms and increase function in some people with CFS.[19] Massage, healing touch, hydrotherapy, and acupuncture for example, can help to reduce pain, relieve fatigue, and improve balance.[19] Suggestions for alternative therapies:

  • Research the therapy to ensure it is safe and effective.
  • Keep an open mind to alternative therapies.
  • Keep exercise and movement therapy within tolerance.


Manage Activity


Symptoms generally worsen after exertion.[1,26]. The key to avoiding a fatigue “crash” is managing activity.[1,24,25] Excessive physical or mental exercise is counter productive and may lead to a relapse.[27,28] Suggestions for managing activity level[1,24,25,27,2829,30,31]:

  • Avoid extreme exercise.
  • Avoid mentally stressful work and encounters.
  • Aim for balance and moderation by pacing to manage energy and avoid the push/crash cycle. View available energy like a reserve which goes bankrupt when it runs out.
  • Experiment to find the optimal amount of exertion which won’t cause a relapse.

Some patients are too ill to exert themselves at all. Severe patients may be bed bound and should not be encouraged to push themselves beyond their capabilities.









1. Centers for Disease Control and Prevention. Chronic Fatigue Syndrome. 2008, November 18. Retrieved January 21, 2009, from FirstGov -- The U.S. Government's Official Web Portal Department of Health and Human Services “Safer Healthier People” Centers for Disease Control and Prevention. Web site:


2. Nisenbaum R, Jones JF, Unger ER, Reyes M, Reeves WC. A population based study of the clinical course of chronic fatigue syndrome. Health Qual Life Outcomes. 2003;1:49.


3. Buchwald D, Pearlman T, Umali J, Schmaling K, Katon W. Functional status in patients with chronic fatigue syndrome. Am J Med. 1996;101:364-370.


4. Christodoulou C, DeLuca J, Lange G, et al. Relation between neuropsychological impairment and functional disability in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatr. 1998;64:431-434.


5. Reeves WC, Jones JF, Maloney E, et al. Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia. Popul Health Metr. 2007;5:5.


6. Reyes M, Nisenbaum R, Hoaglin DC, et al. Prevalence and incidence of chronic fatigue syndrome in Wichita, Kansas. Arch Intern Med. 2003;163:1530-1536.


7. Jones JF, Nisenbaum R, Solomon L, Reyes M, Reeves WC. Chronic fatigue syndrome and other fatiguing illnesses in adolescents: a population based study. J Adolesc Health. 2004;35:34-40.


8. Myhill S, Booth NE, McLauren-Howard, J. Chronic Fatigue Syndrome and Mitochondrial Dysfunction. Int J Clin Exp Med (2009) 2, 1-16.


9. Lombardi VC, Redelman D, White DC, Fremont M, DeMerirleir K, Peterson D, and Mikovits JA. Serum cytokine and chemokine profiles of individuals with myalgic encephalomyelitis (ME) reveal distinct pathogen associated signatures. September 2008:43(3):245.


10. Sairenji T, Nagata K. Viral infections in chronic fatigue syndrome] Nippon Rinsho. 2007 Jun;65(6):991-6.


11. Lorusso L, Mikhaylova SV, Capelli E, Ferrari D, Ngonga GK, Ricevuti G. Immunological aspects of chronic fatigue syndrome. Autoimmun Rev. 2009 Feb;8(4):287-91. Epub 2008 Sep 16.


12. Barker E, Fujimura SF, Fadem MB, Landay AL, Levy JA. Immunologic abnormalities associated with chronic fatigue syndrome. Clin Infect Dis. 1994 Jan;18 Suppl 1:S136-41.


13. Mihaylova I, DeRuyter M, Rummens JL, Bosmans E, Maes M. Decreased expression of CD69 in chronic fatigue syndrome in relation to inflammatory markers: evidence for a severe disorder in the early activation of T lymphocytes and natural killer cells. Neuro Endocrinol Lett. 2007 Aug;28(4):477-83.


14. Van Den Eede F, Moorkens G, Van Houdenhove B, Cosyns P, Claes SJ. Hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome. Neuropsychobiology. 2007;55(2):112-20. Epub 2007 Jun 27.


15. Cleare AJ. The HPA axis and the genesis of chronic fatigue syndrome. Trends Endocrinol Metab. 2004 Mar;15(2):55-9.


16. Gaab J, Hüster D, Peisen R, Engert V, Heitz V, Schad T, Schürmeyer TH, Ehlert U. Hypothalamic-pituitary-adrenal axis reactivity in chronic fatigue syndrome and health under psychological, physiological, and pharmacological stimulation. Psychosom Med. 2002 Nov-Dec;64(6):951-62.


17. Davis SD, Kator SF, Wonnett JA, Pappas BL, Sall JL. Neurally mediated hypotension in fatigued Gulf War veterans: a preliminary report. Am J Med Sci. 2000 Feb;319(2):89-95.


18. Maes M. Inflammatory and oxidative and nitrosative stress pathways underpinning chronic fatigue, somatization and psychosomatic symptoms. Curr Opin Psychiatry. 2009 Jan;22(1):75-83.


19. Harmon, M. Bateman L, Lapp C, McCleary KK. Chronic Fatigue Syndrome: From Diagnosis to Management CME/CE. Medscape. October 9, 2008.


20. Reeves WC, Jones JF, Maloney E, et al. Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia. Popul Health Metr. 2007;5:5.


21. Reyes M, Nisenbaum R, Hoaglin DC, et al. Prevalence and incidence of chronic fatigue syndrome in Wichita, Kansas. Arch Intern Med. 2003;163:1530-1536.


22. Werbach MR. Nutritional strategies for treating chronic fatigue syndrome. Altern Med Rev. 2000;5:93-108.


23. Pall ML. Explaining “Unexplained Illnesses”: Disease Paradigm for Chronic Fatigue Syndrome, Multiple Chemical Sensitivity, Fibromyalgia, Post-Traumatic Stress Disorder, Gulf War Syndrome and Others. Hawthorn Medical Press. 2007.


24. Rimes KA, Chalder T. Treatments for chronic fatigue syndrome. Occup Med. 2005;55:32-39.


25. Whiting P, Bagnall A, Sowden A, Cornell J, Mulrow C, Ramirez G. Interventions for the treatment and management of chronic fatigue syndrome. JAMA. 2001;286:1360-1368.


26. Komaroff AL, Buchwald D. Symptoms and signs of chronic fatigue syndrome. Rev Infect Dis. 1991;13(suppl 1)S8-S11.


27. Bailey SP. Chronic fatigue syndrome. In: ACSM's Guidelines for Exercise Testing and Prescription. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:186-191.


28. McCully KK, Sisto SA, Natelson BH. Use of exercise for treatment of chronic fatigue syndrome. Sports Med. 1996;21:35-48.


29. Lloyd AR. To exercise or not to exercise in chronic fatigue syndrome? No longer a question. Med J Aust. 2004;180:437-438.


30. Wallman, KE, Morton AR, Goodman C, Grove R, Guilfoyle AM. Randomized controlled trial of graded exercise in chronic fatigue syndrome. Med J Aust. 2004;180:444-448.


31. Taylor RR, Friedberg F, Jason LA. A Clinician's Guide to Controversial Illnesses: Chronic Fatigue Syndrome, Fibromyalgia and Multiple Chemical Sensitivities. Sarasota, Fl: Professional Resource Press; 2001:63-86.




For more articles on this topic, see: MCSA News.


Copyrighted 2009 Lourdes Salvador & MCS America



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