Chronic Fatigue Syndrome (CFS) is a debilitating condition characterized by severe and long lasting exhaustion, but it can also manifest in symptoms of sleep disturbance, memory and concentration difficulties, widespread muscle and joint pain, headaches, and extreme tiredness following any physical or mental exertion. It is estimated that over 25 million Americans have severe fatigue, lasting at least one month at any time. *

The pathophysiology of CFS is not well understood. The one thing that we do know is that certain “triggers” cause the body to stop making the energy that it requires for anything other than basic functions of survival. The body goes into state of “energy deficit.” That is why these patients are always exhausted, as they expend more energy than their bodies can generate. This energy deficit essentially wipes out one’s hypothalamus function. This gland in the brain controls sleep, hormonal function, blood pressure, sweating, and temperature regulation.

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The symptoms of CFS are described as:

Overwhelming Fatigue. These people simply cannot function properly on a daily basis. Small physical efforts result in severe fatigue, which is energy deficit at play.

Poor Sleep. I consider this to be the sine qua non of CFS. CFS patients do NOT sleep despite being exhausted. When they do sleep, it is not restful or deep sleep.

Frequent Infections. Chronic, recurrent, multiple infections are not uncommon in CFS patients, and are a result of poor immune function.

Brain Fog. This frustrating symptom of CFS ranges from poor short-term memory, difficulty finding words, to episodes of disorientation. Decreased metabolic activities (food for the brain) as well as low hormone levels are most likely the cause of this.

Achiness. Pain in the muscles and/or joints is very common and also known as fibromyalgia. This comes from the poor sleep and energy deficit.

Decreased Libido. The brain is suppressed. It is trying to generate energy for important body functions like the cardio system. Hormone production is not a priority. No hormones = no sex drive.

What exactly is the cause of this syndrome? Every case is different, but the various common causes that can trigger CFS are:

Viral, Parasitic, or Bacterial infection. This is not uncommon for people who have had the flu virus, Mononucleosis, Coxsackie virus, Herpes, Epstein Barr, or Lyme disease. Most people are not aware that intestinal parasites are a common cause of CFS. CFS usually presents and lingers well after the infection has passed or has been treated.

Hormonal Deficiencies. It is not uncommon for menopausal and andropausal individuals to develop CFS, especially in stressful situations. Patients with hypothyroidism, low cortisol, adrenal fatigue, and low growth hormone all experience immune dysfunction, and are more susceptible to CFS.

Yeast Overgrowth. Chronic use of antibiotics can lead to this. Chronic sinusitis, bronchitis, nasal congestion, and IBS are all usually caused by yeast/Candida. Patients who develop CFS from other triggers can develop internal yeast simply due to the immune suppression.

Chronic Stress. Spiritually, physically and emotionally toxic home and work situations can wipe out one’s adrenal function. The adrenals are one’s battery pack, and are a source of energy. Stress can suppress that source of energy.

Autoimmune Diseases. Rheumatoid arthritis, Lupus, Crohns, etc. can predispose one to CFS.

Poor Sleep. Not only is sleep disturbance one of the main criteria in diagnosing CFS, but it can also be a predisposing factor. People with chronic disturbed sleep patterns are at higher risk for developing CFS, especially when faced with one of the other above mentioned triggers.

Understanding the root cause of a patient’s CFS is very important to me. That will determine the course of treatment to a certain extent. For the most part, most CFS patients require continuous, intensive treatment, especially in the beginning. It is almost impossible for a person to resolve CFS on their own. There are so many factors at play, and treatment can be tricky for even the most experienced functional physician.

The following is a basic treatment plan that I use for my patients.

• The first step is to place patients on a strict elimination diet and cleanse plan. This sets the groundwork for an effective treatment plan to work properly. Most patients actually get some relief (even if temporary) with this simple step. Most patients need continuous encouragement and education in order for this step to work properly.
• A CFS patient needs to sleep! Sleep is where we recharge our battery and restore immune function. In addition to creating a dark, quiet and comfortable sleep environment, I use many supplements that aid with sleep. I avoid sleeping pills because they actually worsen sleep quality.  Theanine, passionflower extract, lemon balm, and valerian root are very effective herbal remedies. I also use magnesium and calcium, 5-HTP, and melatonin. I encourage strict pre-bedtime regimen of the above supplements that must be followed nightly for several months.
• All of the hormone deficiencies must be addressed and REPLACED. It is not uncommon for me to use DHEA and prescription Cortef for severe adrenal fatigue. Thyroid hormone, estrogen, progesterone, and testosterone are all replaced (as needed) using Bio-Identical Hormones from a reputable compounding pharmacy. All of this should be managed by an experienced functional medicine physician.
• Discovery and treatment of infections is imperative! Bowel parasites can be treated with herbal remedies as prescribed by a Functional Medical Doctor. Prescription anti-parasitics are reserved for resistant and difficult to treat cases. I always treat for Yeast right from the start with CFS patients. I use a combination of prescription antifungal combined with probiotics, garlic, oregano oil, berberine, olive leaf, beta Glucan, and NAC. The most important part of treating yeast overgrowth is the sugar elimination diet.
• In addition to eliminating sugar, flour, and alcohol, I encourage all patients to eliminate caffeine. So many people with CFS rely on excessive amounts of coffee in order to boost their energy during the day. What it actually does is dehydrate you due to its diuretic effect, and the caffeine depletes their energy stores even more. Vitamin and mineral supplementation is so very important when treating CFS. The most important ones are Vitamin C, magnesium, and B-Complex with extra Vitamin B12, which are taken in higher doses along with a good multi-vitamin. Many of my severe CFS patients receive IV vitamins (known as a Meyer Cocktail), especially early on while the gut and immune system are being restored.
• Body Work and Energy Movement therapy with Chiropractic adjustments, massage therapy, and acupuncture. These hand-on therapies are very effective at alleviating pain, boosting immune function, and calming neuro-muscular inflammation

The treatment for CFS may be long, difficult, and sometimes repetitive. The good news is that the majority of patients do get better with controlled, continuous treatment.

*“A Community based study of Chronic Fatigue Syndrome”, Archives of Internal Medicine 159 (18) (11 October 2009): 2129-2137