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HEALTH CONCERN? BioHealth Health Concerns

Chronic Fatigue Syndrome, Cause, and Impact

Contributing Author: Ross, Steven D.C, F.A.S.B.E, D.A.A.P.M.

Ross StevenDr. Steven Ross, President and Co-Founder of The Institute For Integrative Medicine. The IFIM is an evidence based educational institution focusing on teaching the integrative practitioner the evidence based medicine, business, marketing acumen and personal development needed to succeed in their practices. Dr. Ross has been practicing Integrative and Functional Diagnostic Medicine since 1982. He maintains an active practice in the southern California while consulting with patients and doctors worldwide. He is the author of Curing the Cause and Preventing Disease; a guide not only for patients seeking a new and scientific method of treatment but, also for health care professionals interested in incorporating evidence based treatment plans in helping their patients achieve optimum health without the use of dangerous drugs.

» Website: http://www.theifim.com/

 

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 a single clear cause, a single clear pattern of manifestations or a simple treatment regime.  Certainly, a comprehensive and multi-causal approach must be taken.  Different patients present with different symptoms, and individual variations in immunology, chemical toxicities, heredity and lifestyle must be examined to understand the disease and assess the most beneficial treatment regime for the patient.

CAUSES OF CFS

CFS certainly appears to indicate a chronically disturbed or compromised immune system.  This can result from a viral infection, recurrent fungal infections such as candidiasis, allergies and other environmental factors.

Viral
CFS has also been called myalgic encephalitis (ME) and chronic EBV syndrome.  These terms reflect 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 evident.

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.  A healthy immune system may keep the virus at bay; however, as soon as the immune system becomes compromised, viral activity and replication can increase.  Most CFS sufferers test positive for EBV antibodies, thus creating a link between the two.  However, in the United States today, the majority of the population has been exposed to the virus and carries its antibodies.

Candidiasis
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, such as 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 the use of antibiotics, cortisone and birth control pills.

The role of Candida in chronic fatigue should be examined closely if a patient with a history of Candida presents with CFS symptoms.  A yeast-free and low-sugar diet may help, and a general program to boost the immune system is appropriate, as is prescribing natural antifungals such as oregano oil and caprylic acid.

Allergies
Typical allergens include pollens, molds and foods such as milk and wheat.  Some allergens cause immediate symptoms, including wheezing, itching, hives and tearing of the eyes, 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.  Clearly, all allergies involve a situation of compromised immunity.

Chemical Toxicity
Many chemicals and toxins in our environment 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 do both.  More recently, controversy has arisen regarding the effects of mercury toxicity from amalgam fillings, which alone has contributed significantly to the health issues of many CFS sufferers.(2)

Medical Treatment
While antibiotics can be life saving medical tools, they may 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 may be responsible for weakening the immune system and contributing to the development of CFS.

Lifestyle Factors
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 debilitating factor, and may cause or contribute to fatigue, heart disease, high blood pressure, insomnia, back pain, stomach problems, hemorrhoids, ulcers and menstrual problems.

Ascertaining whether these conditions actually cause CFS or whether CFS causes an increase in other conditions is difficult.  For example, a nonallergic person may become allergic following a viral infection associated with their CFS.  As his or her body tried to combat the virus, it sent out antibodies to a whole range of substances that may only have been irritants, developing a sensitivity to all sorts of previously nonproblematic 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 exist in all muscles and joints.
  • Painful swollen glands and recurrent sore throats and coughing.
  • Tremors – shaking and quivering of the body, especially in the hands and feet.
  • Temperature – usually sensations of coldness, but may experience sudden increases in heat following a meal.
  • Fevers – low-grade fevers often present.
  • Sweats – night sweats, but also sweats that seem 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 a depressed immune system.
  • Allergies
  • Digestive disorders – including intestinal discomfort and constipation.
  • Depression – frustration with one’s situation, feelings of helplessness and that one 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 nonspecific, and there is no single test for CFS as such.  The conventional medicine field has three main accepted diagnostic criteria:

  • Severe, chronic and recurring muscular fatigue, pains, aches or stiffness brought on or aggravated by even slight physical exertion.  This condition must be present for six months or more.
  • Disturbances of the nervous system with mood, emotional or psychiatric disorders associated with depression, inability to concentrate, short-term memory impairment and anxiety.
  • 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 a delayed type sensitivity skin test.

The alternative approach, however, is much broader.  Generally, the main criteria are inexplicable tiredness, with a degree of muscular weakness and mood disturbance that 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 six 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 diagnostic task is to exclude all other possible causes for the symptoms of fatigue, such as cancer, lupus, diabetes or Addison’s disease.

Certain medical testing may be useful, such as testing for elevated EBV antibody levels, Candida testing, allergy testing and testing for vitamin and mineral deficiencies.  However, while these tests may indicate some of the factors that may be underlying the disease, they will not in themselves lead to the diagnosis of CFS.

TREATMENT OF CFS

In the treatment of CFS, it is generally recognized that a comprehensive program must be embarked upon, one that incorporates 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 create the long-term lifestyle changes necessary for the patient to maintain good health.

Detoxification
Many natural therapists recommend a liver detoxification program, especially in the first month of treatment, to try to remove all obstacles to improvement.  This treatment involves limiting exposure to all external toxins, including food allergens, chemicals and drugs, and attempting to remove internal toxins from the body, such as those in 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, and stimulate the activity of macrophages.

Nutritional Therapy
Nutritional therapy is a very important part of CFS treatment.  Foods should support and accelerate the healing process, not stress the body.  Diet should be based on whole, natural, living, unprocessed foods high in fiber and complex carbohydrates, low in saturated fats and moderate to high in protein.  Drinking eight to ten glasses of water per day is recommended.

Vegetables are important sources of nutrients, as they are high in magnesium, calcium and potassium, vitamin C, vitamin A and the B-group vitamins – all essential in the healing process.  Vegetables are easy to digest and provide a healthy source of carbohydrates.

Fruits are also rich sources of vitamins and minerals.  They contain fiber, which can act as a gentle laxative to help relieve the constipation common in CFS sufferers.  The fiber in the fruit also slows its digestion and allows its natural sugar to be absorbed without causing too great a fluctuation in blood sugar levels.

Legumes are also good foods for CFS sufferers.  They too contain magnesium, potassium and calcium, which help improve energy levels, as well as iron, important especially for women.

Seeds and nuts are the best sources of the two essential fatty acids – linoleic and linolenic acids –essential in prostaglandin production.  They also contain vitamin E and B-complex vitamins, important antistress vitamins for fatigue patients.

Fish and some poultry may be eaten as a source of protein.  Fish also contains iodine, potassium and Omega-3 oils, which may be beneficial.

While the foods listed above can enhance healing, the following foods can hinder progress considerably and should be avoided.

Caffeine should be avoided; therefore, 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 also depletes the B-group vitamins and increases nervous tension, anxiety and irritability.  Sugar disrupts carbohydrate metabolism by overworking the adrenal glands and the pancreas, thus worsening the symptoms of fatigue and hypoglycemia.  A diet high in sugar may also worsen chronic Candida infections.

Alcohol affects the absorption of vitamins and minerals (especially the 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 completely by candidiasis sufferers, as Candida thrives on alcohol (many types of alcohol contain yeast).  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 liver’s ability to metabolize hormones efficiently.

Dairy products may also cause problems for CFS sufferers, as they require hydrochloric acids, enzymes and fat emulsifiers for digestion, all of which a CFS sufferer may not be producing in sufficient qualities.  Tryptophan levels in dairy products, particularly milk, may also worsen fatigue, especially for women around the time of menstruation.

Red meats may be difficult for the body to digest, as they contain tough protein and saturated fats, and can worsen fatigue symptoms.  Red meats also produce series two prostaglandins, which can stress the immune system, decrease resistance and trigger allergic states.

Wheat and gluten may present a problem, especially in people with allergy problems.  Intolerance to wheat may 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 improve greatly by switching to a diet such as the one outlined above.  Supplementation may be beneficial, but should be monitored closely to ensure correct dosages and to avoid toxicity.  Many vitamins play a role in the immune function, and having an adequate amount of vitamins for the body to function and recover to its optimum level is essential.  In particular, vitamin C is used to treat CFS, often given in large doses intravenously.  However, like many other forms of treatment for CFS, what works magnificently for some may produce no improvement in others.(5)  Vitamins B6, B12, folate and pantothenic acid, and the minerals zinc, selenium, chromium and manganese, are commonly used for immune support.

Herbal Medicine
Several herbal remedies can assist the healing process.  These mainly work either as immunostimulatory remedies or on the lymphatic system.  Such remedies include Goldenseal (particularly when EBV is 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 replication of the virus.

Oxygen Therapy
Oxygen therapy uses ozone, which is oxygen with three oxygen atoms rather than two, meaning that the oxygen is activated.  This tends to support the liver’s efforts at detoxification and improves cell metabolism, which improves cells’ capacity to provide more energy for the body.  Ozone also improves circulation and kills many species of bacteria, viruses and fungi.

Exercise
While some CFS sufferers may be unable to exercise at all, it is generally advised that those who can should undertake some physical activity simply to keep their bodies active and to enhance the flow of oxygen into the cells.  Gentle exercise such as yoga or stretching can be beneficial and breathing exercises can 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.  Possibilities include counseling, relaxation techniques, positive affirmations, visualization techniques and group therapy.  Many CFS sufferers have feelings of frustration, impotence and an 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 specific symptoms, not at the syndrome as a whole.  Several antidepressants may be prescribed not only to elevate moods, but for pain relief and as energy boosters.  Aspirin and nonsteroidal anti-inflammatory drugs may be used to relieve headaches and general aches and pains.  Migraines are sometimes treated with beta-blockers, typically used to treat heart conditions.

As is often the case in our Western society, many people hope for the discovery of the single pill that will cure them overnight, while at the same time they take other medications that 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 practitioners of orthodox medicine see comprehensive nutritional therapy and long-term lifestyle changes as the most useful approaches in the treatment of CFS.

CONCLUSION

CFS is a debilitating syndrome that can be associated with several other health problems.  It may have been triggered by 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 because of the wide range of symptoms and their severities.  CFS does, however, generally seem to have an acute onset followed by a chronic phase with cycles of intensity.  This cycling can make the road to recovery quite bumpy, and the patient who suddenly feels better is often tempted to rush out and overdo the activity, only to end up relapsing.  Periods of remission vary greatly among 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 may be affected by many factors, including genetic factors, self care and self help, treatment, lifestyle changes, ongoing stresses and the intensity and exposure to the triggers of the illness.

In the recovery of a CFS sufferer, educating oneself on his or her own body is important in being able to recognize the symptoms, and in taking responsibility for one’s 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 his or her health and being able to live one’s 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.

ENDNOTES

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 a 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.