Chronic Fatigue Syndrome

by Nicolas Kats, ND, Lac.

Natural medicine is very helpful for CFS. The following discusses how and why.

First, a look at the symptoms:

Chronic fatigue has a constellation of symptoms that is highly variable from person to person. In the individual the pattern can change dramatically over the years.

Modern medicine has given chronic fatigue a bewildering array of names. Here are the commoner ones:

A name is important for what it implies. The term myalgic encephalopathy, a name commonly given CFS by doctors, is unfortunate. Myalgia means muscle ache, which many CFS sufferers donÕt have. Encephalopathy means dysfunction of the brain. Brain dysfunction or pathology is not demonstrable in CFS. Myalgic encephalopathy is a nonsensical term that should be discarded.

Several names for CFS emphasize the fatigue, while others emphasize the immunity aspect of CFS.

These names recognize the two fundamental elements of CFS. These are fatigue and immunity problems.

What can modern medicine do for CFS?

The most important thing the GP can do is to rule out any causes of persistent fatigue. When no cause is found, this helps to establish the diagnosis of CFS. In part CFS is a diagnosis arrived at when all else is excluded.

The connection of CFS with Epstein Barr virus, EBV, is persistent. Research finds very little to this.

There is no pathology of CFS, nothing objective to support the diagnosis of CFS. Bloodwork, diagnostic imaging, physical exams usually are all normal.

Because there are no objective findings, some GPs consider CFS psychogenic in origin, and they may say, ÒSee a psychologistÓ.

Aspirin may be prescribed. Aspirin can reduce a fever, but it does not address the problem of fatigue. There are no drugs in modern medicine for CFS.

CFS does not lend itself readily to modern medicine. Neither the understanding nor the tools are there.

In short, the GPÕs main contribution to CFS is to exclude causes of the persistent fatigue. It is important to do this. If nothing is found, so much the better; since that much more is known and we can move on to other things.

What can the natural medicines (diet, herbs, acupuncture, supplements, etc) do for CFS?

Does natural medicine Ð Western herbalism, traditional Chinese medicine, the US naturopathic doctor - have ways to understand CFS? And does it work? The rest of this article discusses these questions.

There are ways to understand CFS.

The most important thing to remember is that CFS is multifactorial. This means that there are many causes. One person may have several causes, another person a different set of causes. No two people are alike. If this is clearly understood, the practitioner can approach the CFS person with a clear mind, listen to his story, and work towards an understanding of this unique individual, this particular person in front of him.

This is about finding patterns that make sense. Patterns.

A common finding is a brief flu-like illness before the fatigue began, for example glandular fever.

If glandular fever, or mononucleosis, is not carefully respected, with plenty of rest and sleep, little stress, etc, the risk of long term fatigue Ð CFS - shoots up.

What is the insight for natural medicine when a mild flu leads to CFS?

The insight is that the immune system is awry. It is disrupted and unable to regain its balance. As the weeks pass into months and years, this becomes an established pattern. The disruption becomes a habit.

Immune support and breaking the pattern of an immune system gone awry are the goals to pursue. Ways to do this include immunomodulating herbs & mushrooms like astragalus and Echinacea, reishi and shiitake. The diet needs to be rich in minerals and vitamins. Supplements like the antioxidants Vitamin A, E, C and selenium help.

Chinese medicine recognizes this pattern of a brief flu-like illness leading to long term fatigue, swollen lymph nodes and other symptoms. The name is Ôresidual pathogenic factorÕ. Either the Ôpathogenic factorÕ is cleared from the body, or it remains within. Residual pathogenic factor presence soaks up energy, leaving the person fatigued and susceptible to opportunistic infections which in turn soak up more energy. Acupuncture and herbs are used to expel the pathogenic factor, and to build up energy.

Fatigue and inability to deal with stress are the keynote symptoms in CFS. In part this means that the adrenals are depleted. The adrenals are small glands atop the kidneys. They are responsible for hormones that deal with stress. These hormones are cortisol, DHEA (dehydroepiandrosterone), and to some extent testosterone and estradiol (an estrogen). These hormones are virtually identical, differing only in tiny biochemical detail. They all have to do with energy, strength, stamina. They are all made from cholesterol. Indeed, a person with CFS may have concurrent elevated cholesterol. This may be the bodyÕs effort to boost the depleted hormones of stress. (In this case, the use of statins to lower cholesterol is inadvisable. Statins, by reducing cholesterol, may compromise the bodyÕs ability to make the cholesterol-derived hormones of stress, and this can exacerbate CFS.)

Natural medicine has many ways to support the adrenals. Supplements that nourish the adrenals include B5 or B-complex, tyrosine, CoQ10 and Vitamin C. In the USA, supplements made of raw adrenal extract are used by NDs. Herbs that support the adrenals are called adaptogens. They are numerous and include ashwagandha, the ginsengs, rhodiola, schisandra, codonopsis, licorice. The Chinese herbalist uses Chinese licorice, Gan cao, in most of his herb mixes, as a ÒharmonizerÓ. This widespread use of Chinese licorice, to me, makes perfect sense, because licorice supports the adrenals that are stressed and depleted by the stress of most diseases.

Some CFS sufferers are addicted to licorice candy. Licorice is supportive of the adrenals. The problem is that the licorice in the candy is highly processed and worth little, and that the candy is full of sugar.

Diet should, again, be nourishing, rich in minerals and vitamins, and low in processed foods. Highly refined carbohydrates Ð the sugars and the refined wheat products high on the glycemic index Ð are particularly stressful for the adrenals. Coffee and, to a lesser extent, regular tea, due to their caffeine content, are also hard on the adrenals.

Sometimes the CFS sufferer is addicted to coffee. This tells me that he is horse whipping the exhausted adrenals in an effort to stimulate further secretion of the stress hormones.

Other CFS sufferers may be sugar junkies. In part this, like coffee, is an effort to stimulate the exhausted adrenals. The long term effect is to further deplete the adrenals.

Another characteristic of CFS is the inability to deal with stress. The CFS person may respond to stressful events adequately, but collapse thereafter, and take weeks or months to get back to ÔnormalÕ. This inability to deal with stress, and the life modifications arising from this inability, can be one of the most difficult aspects of CFS.

This means any and all stresses can make CFS worse. All stresses should be considered and the causes of stress dealt with, if possible.

CFS requires a thorough workup, a review of all organs, and bloodwork. A weak digestive system will exacerbate CFS, and strengthening the digestive system will boost energy levels. Weak lungs, with shallow breathing, poor posture, recurrent colds and flus, must be treated. Low thyroid function, indicated by bloodwork and low oral temperature, is a common finding in CFS. And so on. Any weaknesses on the organs must be supported or resolved. This reduces stress, and benefits energy levels, often dramatically.

Diet must be understood in this way too. Food intolerances are stressful. These foods should be identified by the elimination and challenge method. A poor diet must be changed. Processed foods need to be reduced, and junk food stopped. Whole foods easily digested are ideal. Crucifers (brussel sprouts, cabbage, cauliflower, broccoli) and the onion family (onion, garlic, leeks, chives) are immunosupportive and are rich in compounds that remove toxins from the body.

Emotions are another source of stress. Betrayal, resentment, abuse, anxiety, worry and sorrow can be severely stressful and depleting. Here is an example. A woman suffered 25 years of abuse from her husband. She finally worked up the courage to find an apartment, move out, find a job, and divorce him. After a few weeks of happiness in her new life she collapsed and entered years of CFS. This tells me that her adrenals, severely stressed by the decades of abuse and the process of separation, finally collapsed with the change and relief of her new life.

The type A personality Ð dominating, high expectations Ð contributes to CFS. In the USA many CFS women are Type A women, driven and perpetually unhappy, and stressful on themselves and for all around them. Two thirds of CFS sufferers are women.

Depression is not necessarily a cause of CFS. The person may have been happy before CFS. The effects of CFS Ð severe loss of energy, and collapse for months from any slightly stressful event - are profoundly crippling. The person cannot support himself, leave alone a family, and must depend on the generosity and goodwill of others. This is good reason to be depressed. Suicide is common in CFS.

Another cause of CFS is the chronic use of antibiotics. Antibiotics destroy all bacteria, including the beneficial intestinal bacteria. When these are killed, this creates a window of opportunity for dysbiosis, and CFS may begin soon after. This is uncommon when antibiotic use is short term use. Treatment should include normalizing the intestinal flora.

Recreational drugs, cigarettes and alcohol can severely aggravate CFS. All are toxins that stress the body.

A crucial question is to ask; What was going on at the time the CFS started? And if something big pops up, donÕt fixate on it. CFS is multifactorial.

Finally, letÕs take a patient with 20 years CFS. 20 years is a long time for a pattern to be around. This pattern is deeply entrenched. It becomes, by sheer force of habit, the way of life to be. The original cause(s) may have disappeared long long ago Old patterns die hard, and it takes time for new patterns to be born, to gel, and to take on permanence. Treatment of CFS requires consistent and long term support of the new patterns, to reduce the chance of relapse to the old pattern.

This article shows how I think.

Do these approaches work? Yes, often very effectively. Sometimes change for the better happens in shockingly little time. CFS is a problem that I enjoy treating.

To summarize: