Chronic Fatigue Syndrome (CFS) is a multi-factorial, challenging condition with many possible underlying causes and contributory factors.
First reported in Southwest United States in the 1980s by a physician called Dr Paul Cheyney, Chronic fatigue syndrome was identified as a condition charactised by debilitating fatigue, swollen glands, exercise intolerance, brain fog, muscle weakness and a desire to sleep for long periods. A lack of clear criteria over the years has led to many going undiagnosed, or misdiagnosed due to overlapping symptoms with other conditions including depression, HPA axis dysfunction and chronic infections such as Lyme disease.
While it is not clear if CFS is autoimmune in nature, it is known that it involves alteration of the immune system and that it shares many features with autoimmune disease, including systemic inflammation, a female bias, improvement during pregnancy, chronic stress, genetic involvement, pathogen/viral infections; and many CFS sufferers are found to have other autoimmune diseases present on investigation.
Accurate diagnosis involves sufferers displaying three key symptoms:
1. 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 six months and is accompanied by fatigued, 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
2. Post exertional malaise
3. Unrefreshing sleep
Many other health conditions that present with fatigue as a symptom need to be ruled out through testing before a CFS diagnosis can be made, including cancer, autoimmune disease, heart disease, liver or kidney disease, anaemia, thyroid disease, diabetes and hypoglycaemia. Research has also revealed that other chronic health problems, such as fibromyalgia, HPA axis dysfunction and autoimmunity, share a set of symptoms common to CFS including fatigue, muscle and joint pain, brain fog and concentration problems, poor sleep and headaches. Such findings suggest that there may be a common imbalance or cluster of imbalances that occur in such health conditions.
The first of these underlying mechanisms thought to be responsible, at least in part, for the post exertional exhaustion that typifies CFS is mitochondrial dysfunction. Mitochondria are known as the battery of the cell because they generate energy (ATP). Martin Pall, an expert in CFS, hypothesized that damage to mitochondria can occur through activation of the immune system, perhaps caused by long-term stress. Other factors that can damage mitochondria include a lack of phospholipids, viral or bacterial infection, nutrient deficiencies and free-radical attack. Certain nutrients, such as Co Enzyme Q10, zinc, curcumin, lipoic acid, D-Ribose, L-Carnitine, magnesium and phospholipids are thought to help restore mitochondrial function.
HPA axis dysregulation and stress
Over time, chronic stress can overwhelm the adrenal glands’ capacity to respond and their function can therefore become compromised. Symptoms of compromised adrenal function overlap those of CFS including generalised fatigue and weakness, low blood pressure, insomnia, problems fighting off infections, anxiety, depression, blood sugar problems, and hormone imbalance. Early life stress may also raise risk of CFS in later life.
Thyroid hormones regulate metabolism and play a key role in energy production. Any thyroid dysfunction, even sub-clinical, could potentially contribute to the fatigue, desire to sleep and muscle weakness that presents with CFS.
Genetic Mutations (Or SNPs)
The MTHFR genetic mutation has been linked to CFS, fibromyalgia and chemical sensitivity. Those with MTHFR mutations tend to have depleted levels of the antioxidant glutathione, also found to be below normal in many CFS sufferers. Another mutation linked to CFS involves the gene NR3C1, which can make an individual more sensitive to the effects of stress.
In CFS sufferers, there may be a chronic, unresolved viral, microbial or bacterial infection that needs addressing in order to facilitate recovery, such as Lyme disease, Epstein Barr, or perhaps Candida overgrowth. Such infections place strain on the immune system and undermine health in myriad ways, too numerous to cover here.
Those with CFS may experience compromised detoxification, including that of heavy metals, leading to toxicity and unpleasant symptoms associated with it. Research suggests that CFS symptoms could improve after mercury removal therapy.
Digestive Disorders And Inflammation
Leaky gut and bacterial dysbiosis represent a real challenge to the immune system, promoting the inflammation commonly seen with CFS and autoimmunity.
A deficiency in certain nutrients, in addition to those that improve mitochondrial function, may be involved with the symptoms of CFS, such as vitamin B12 and iron.
With all of these possible underlying factors, it is best to seek the help of an experienced practitioner when dealing with CFS. Functional medicine practitioners investigate underlying imbalances through appropriate testing, and correct any problems by providing an individualized protocol for each client, which may include:
• Dietary approaches to balance blood sugar, increase phytonutrients, remove allergens, reduce inflammation and restore nutrient levels
• Supplements to restore deficiencies, reduce inflammation and promote mitochondrial health
• Identification and treatment of chronic infections
Evaluate enviornmental and heavy metal toxicity.
• Identification and correction of hormone imbalance
• Correction of dysbiosis or other digestive imbalances
• Advice regarding learning to pace oneself and relax regularly
• Advice for a healthy sleep routine
• NLP for stress management
• Mindfulness, meditative and deep breathing practices
• Gentle exercise
Written by Emma Rushe
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The London Clinic of Nutrition is a multi-disciplined health practice offering personalised nutritional medicine and naturopathy using the functional medicine approach.
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