Definition:
Chronic fatigue syndrome (CFS) is an illness characterized by prolonged, debilitating fatigue and multiple nonspecific symptoms such as headache, recurrent sore throat, muscle and joint pain and memory and concentration problems. It is marked by a dramatic difference in the pre- and –post-illness activity level and stamina and can often follow a virus, where if may be known as post viral fatigue or ME (myalgic encephalomyelitis). CFS shares symptoms with many illnesses, including multiple sclerosis, lupus, sleep apnea, narcolepsy, hypothyroidism, hepatitis, Lyme disease and depression. CFS is also known as chronic fatigue and immune dysfunction syndrome (CFIDS).
"I first got ill at the age of 28 and started on a 12-year downward path (later diagnosed as ME) which left me bedridden for years. I wasn’t even strong enough for a longer telephone conversation, so my husband had to discuss my situation with Dr. Downing! I started improving almost immediately and quite soon I was able to start doing my own telephone consultations! Four years later I was strong enough to tolerate the EPD treatments for food and chemical sensitivities; after 5 years I cooked my first meal again, and after exactly 10 years I was able to travel abroad on holiday. Dr. Downing’s immensely skilful, patient and good-humoured help had given me back my life."
Tina
Dr Damien Downing on Chronic Fatigue, PVFS (Post Viral Fatigue Syndrome), ME (Myalgic Encephalomyelitis), Fibromyalgia, Tiredness:
Sick and tired of being tired and sick?
Fatigue is a symptom of very many diseases, but CFS is different. The prime feature is post-exertional fatigue; modest exercise, which would be insignificant to a healthy person, causes profound fatigue which takes some time to recover, and which is not noticeably helped by rest.
Post-viral fatigue happens after an infection, and may take anything from a couple of weeks upwards to recover; it is not until fatigue and other symptoms (see below) have been present for 6 months that a diagnosis of CFS is generally thought acceptable. Many other events can cause the development of CFS, including bacterial, yeast and other infections, injury, surgery, poisoning, bereavement, psychological trauma, and even sustained over-exertion. Caring for a loved one who then dies, for instance, can involve all of the last three triggers.
The USA CDC criteria for CFS comprises;
1. Unexplained, persistent fatigue that's not due to ongoing exertion, isn't substantially relieved by rest, is of new onset (not lifelong) and results in a significant reduction in previous levels of activity.
2. Four or more of the following symptoms are present for six months or more:
- Impaired memory or concentration
- Postexertional malaise (extreme, prolonged exhaustion and sickness following physical or mental activity)
- Unrefreshing sleep
- Muscle pain
- Multijoint pain without swelling or redness
- Headaches of a new type or severity
- Sore throat that's frequent or recurring
- Tender cervical or axillary lymph nodes
To this can be added;
- Allergies, food intolerances and chemical sensitivities
- Loss of temperature regulation
- Recurrent infection-like episodes
Bear in mind that the term is Chronic Fatigue Syndrome; a syndrome is not a diagnosis, it is a collection of symptoms that have been recognised as occurring together. CFS can have many causes, but I believe we are now a big step nearer to explaining how it happens. To do this we have to look at mitochondria; these are the batteries in every cell.
Mitochondria produce short-term energy in the form of the high-energy molecule ATP (Adenosine Tri-Phosphate); each cell produces around 10 million ATP molecules every second. The more work a cell does the more mitochondria it needs, so heart muscle cells, which are constantly working, have 10s of thousands of mitochondria, while other cells may only have hundreds. In CFS something goes wrong with this energy production, so mild exertion can use up the supply of ATP, and the cell then needs time to build it up again; hence the post-exertional fatigue.
The most obvious things that can go wrong with mitochondrial function are nutritional deficiencies and chemical toxicities. An important paper published in March 2009 showed that there is a close correlation between the level of mitochondrial dysfunction and of fatigue; this is available on the British Society for Ecological Medicine website (http://www.ecomed.org.uk/publications/reports/cfs-and-mitochondrial-dysfunction). The laboratory tests used in this study have opened up CFS to treatment in a new and exciting way.
Diagnosis
I can?t remember when I last had to tell someone ?You have CFS? ? it has usually been obvious to them for some time. There are some other diseases that can cause chronic fatigue, which may need to be ruled out, diseases such as;
- Anaemia
- Low thyroid function
- Heart disease
- Chronic infections
- Nutritional deficiencies
- Immune dysfunctions
? although most of them can overlap with CFS as well, in a chicken-and-egg way.
The CDC criteria provide the ?benchmark? symptom checklist for diagnosis.
Investigations
There is no test to confirm the ?diagnosis? of CFS (which is not really a diagnosis anyway), but there are tests to look at what is happening in your body.
Mitochondrial tests
The ATP Profile provides a rough-and-ready assesment of how well, or badly, your mitochondria are working. In the paper cited above, 71 confirmed (by the CDC criteria) CFS sufferers and 53 healthy controls were put through the test; only one of the CFS cases had a normal test, and none of the controls were abnormal. The overall score on the test correlated well with patients? score on the Bell Ability Scale.
The Translocator Profile looks at mitochondria and usually identifies any toxic chemical which is blocking energy production; this enables us to identify chemicals which may need to be removed in order to recover healthy mitochondrial function.
Nutritional tests
There are a number of nutrients that are necessary for normal mitochondrial function; some of them we can test for, some not. The ones we can test for include;
- Magnesium
- Zinc
- B vitamins
- Coenzyme Q10
- Essential Fatty Acids
Other tests
It is often useful to test for;
- Parasitic infections
- Yeast infections
- Leaky gut
- Hypochlorhydria
- Vitamin D deficiency
- Hyperventilation
- Adrenal hypofunction
Treatment
Sometimes this is simple, sometimes not. First steps include energy management and getting rid of any chronic infections, things which patients have often dealt with before coming to us.
Diet is important in two basic ways; improving nutrition and removing sugar/carbohydrates. Nutritional deficiencies are often a factor in CFS, and without correcting them you will not get well. The deficiencies we can identify we will attempt to correct, but often we also need to use a mix of nutrients that we know can be beneficial, without proof of deficiency.
Sugar and carbohydrates, of which we all tend to eat too much, interfere with the function of mitochondria by blocking their normal metabolism, which involves burning fats for energy, not carbs. Of course they also increase the risk of a list of diseases such as yeast infections, overweight, cancer, diabetes, heart disease and so on.
Where appropriate (and it often is) we will use nutritional supplements to correct deficiencies and support normal function. However people with a chronic illness can easily end up taking more and more supplements without knowing which, if any, are helping them. If you are taking more than 10 pills a day the ingredients you are swallowing most of are the excipients, fillers and other inactive ingredients. It pays to be targetted, to keep the list small, and to know about interactions (is your magnesium deficiency due to vitamin D deficiency, or to loss of magnesium due to caffeine and other dietary components, rather than to lack of magnesium in your diet?).
Allergies are a common feature in CFS; if necessary, and it isn?t always, we can deal with these by desensitisation. The method we use is called Enzyme Potentiated Desensitisation.
Toxicities: When chemicals are identified that need to be removed, we have state-of-the-art methods to achieve this. See Environmental Illness.
Breathing
One thing we have learnt from working as a team of specialists is that many people with CFS, environmental illness and related problems have a malfunction of breathing. It is not easy to recognise this in yourself, and some doctors may use it as a reason to label your problems as psychological. We have come to appreciate that breathing is a fundamental rhythm of life, which drives other key rhythms of both body and mind. Whether it is the chicken or the egg does not matter; it offers a valuable tool that you can control for yourself, and which influences both your biochemistry and your brainwaves. See Breathing Pattern Disorder.
Mr Stefan Chmelik on Chronic Fatigue, PVFS (Post Viral Fatigue Syndrome), ME (Myalgic Encephalomyelitis), Fibromyalgia, Tiredness:
Sick and tired of being tired and sick?
Anyone who has had ongoing tiredness will know that it is very different from just being worn out from a hard day. These types of tiredness, better described as lethargy, do not go away simply from having a good nights sleep, and often only small amount of activity will leave you feeling exhausted for days.
When working with people who are chronically tired, my approach is first to ensure I fully understand what has brought them to this state. Your story is individual, and the holistic approach is to look at all aspects of what has happened in the past and is going on for you now, to be able to identify what will provide the best assistance for recovery. I often see people who have had previous exposure to a virus or a reaction to medication or toxic chemicals. Adrenal exhaustion from prolonged over work, stress or trauma is also common.
Recovery can sometimes be surprisingly fast, when a particular cause can be established, but often it can take some time for symptoms to decrease and energy levels to improve and recover. I tailor each treatment plan to the individual, but a plan will often include stress management through discussion, acupuncture and exercises; eliminating toxic elements through diet; strengthening the immune system and increasing energy with herbal medicine. If pain is part of the problem, remedial massage can be very helpful as well.
Dr Brian Kaplan on Chronic and Post-viral Fatigue Syndrome & ME (myalgic encephalomyelitis)
This very debilitating problem is a challenge for both orthodox medicine and holistic practitioners.
Orthodox Medicine: Because this condition is difficult to diagnose and all tests are usually normal, orthodox medicine does not have a lot to offer in the treatment of Post-viral fatigue.
Homeopathy: I will always prescribe a remedy that suits the total symptom picture. Cases vary enormously and so different people suffering from this syndrome require different homeopathic remedies
Autogenic Therapy: As fatigue is the main symptom, a deep relaxation technique is a logical treatment and I recommend a course of Autogenics to nearly all patients suffering from this condition.
Nutrition: A healthy diet is essential in the treatment of this condition and I try to ensure that all patients eat regular and healthy meals.
Provocative Therapy: I only use this in patients who recognise that in their particular case, psychological factors are very important and are willing to have some painful facts about themselves mirrored to them in the empathic, warm, satirical world of reverse psychology and Provocative Therapy.