Chronic fatigue syndrome (CFS) affects between 836,000 and 2.5 million individuals in the United States.1 As many as 25% of those with CFS are homebound or bedridden, sometimes for extended periods.2
The pathophysiology of CFS is not well understood. Some experts believe that CFS and fibromyalgia are part of a single spectrum of disease. It is uncertain as to whether CFS is an autoimmune disorder.
Infection is a common precipitant of CFS, based upon patient histories. A hypothesized mechanism is immune system dysfunction, such that defense proteins called interferons continue to be secreted in high amounts from cells even after the resolution of acute infection. Excessive interferon can cause achiness, brain fog, and fatigue.3 Oxidative stress is a factor, but may well be a consequence rather than an underlying cause. Preliminary research in those with obstructive sleep apnea shows that sleep deprivation increases inflammatory proteins called cytokines by 40%.4
Stress and exposure to environmental toxins, including pesticides, herbicides, persistent organic pollutants (POPs), and toxic metals (such as mercury, lead, cadmium, and arsenic), are hypothesized to contribute to the development of CFS; 53%–67% of patients with CFS have reported at least one episode of symptom flare after specific chemical exposure.5 A survey completed 10 years after the Gulf War comparing the health of 1061 deployed veterans to 1128 non-deployed veterans found that their physical health was similar, but deployed veterans had an adjusted odds ratio of chronic fatigue syndrome of 40 (i.e. forty times as likely to be symptomatic).6 Hypothesized explanations for this very high odds ratio include stress and exposure to toxins.
The Institute of Medicine (IOM), in a February 2015 expert committee report, proposed the following diagnostic criteria.7
- A substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities, that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest
- Post-exertional malaise, after physical, cognitive, or emotional activity, at least half the time of moderate, substantial or severe intensity
- Unrefreshing sleep, at least half the time of moderate, substantial or severe intensity
- Cognitive impairment, at least half the time of moderate, substantial or severe intensity
SHINE is an acronym that can be used as a mnemonic for guiding treatment of CFS—treat the sleep disturbance, hormonal imbalances, infections/immune system dysfunction, nutritional deficiencies and insufficiencies, and exercise to tolerance. This acronym was created by Dr. Jacob Teitelbaum to summarize his treatment approach. The details of treatment guided by this approach are outlined in Dr. Teitelbaum’s book, From Fatigued to Fantastic!8 NAD+ and magnesium supplementation have also shown positive results.9 Supplements for adrenal gland support include the amino acid L-tyrosine, and the hormones DHEA and pregnenolone. In a survey of those with unexplained chronic fatigue, 65% of 17 subjects reported that DHEA was beneficial.10
At RMRM, true to our personalized and holistic mantra about wellness, we tailor our diagnostic and therapeutic approaches to the individual symptoms and needs of our clients. Come find out how we’ll be able to help you.
- L.A. Jason, J.A. Richman, A.W. Rademaker, et al.: A community-based study of chronic fatigue syndrome. Arch Intern Med. 159 (18):2129-2137 1999
- R. Marshall, L. Paul, L. Wood: The search for pain relief in people with chronic fatigue syndrome: a descriptive study. Physiother Theory Pract. 27 (5):373-383 2011
- I. Hickie, T. Davenport, D. Wakefield, et al.: Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study.BMJ. 333 (7568):575 2006
- A. Alberti, P. Sarchielli, E. Gallinella, et al.: Plasma cytokine levels in patients with obstructive sleep apnea syndrome: a preliminary study. J Sleep Res. 12 (4):305-3112003
- I.R. Bell, C.M. Baldwin, G.E. Schwartz: Illness from low levels of environmental chemicals: relevance to chronic fatigue syndrome and fibromyalgia. Am J Med. 105(3A):74S-82S 1998
- S.A. Eisen, H.K. Kang, F.M. Murphy, et al.: Gulf war veterans’ health: medical evaluation of a U.S. cohort. Ann Intern Med. 142 (11):881-890 2005
- Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. 2015The National Academic Press Washington, DC http://www.iom.edu/mecfs
- J. Teitelbaum: From fatigued to fantastic!. 2001 Penguin Putnam, Inc New York, NY
- T. Alraek, M.S. Lee, T.Y. Choi, et al.: Complementary and alternative medicine for patients with chronic fatigue syndrome: a systematic review. BMC Compl Altern Med.11:87 2011
- S.E. Bentler, A.J. Hartz, E.M. Kuhn: Prospective observational study of treatments for unexplained chronic fatigue. J Clin Psychiat. 66 (5):625-632 2005