Chronic Fatigue Syndrome (CFS) is described as a severe, debilitating fatigue, lasting at least six months (of new and definite onset), associated with at least four of the following symptoms: impaired memory or concentration, sore throat, lymphadenopathy, muscle pains, joint pains, new headaches, unrefreshing sleep, and post-exertion malaise. Other medical and psychiatric conditions that can produce fatigue should be ruled out, including Lyme's disease. After demanding physical exercise, chronic fatigue syndrome patients show impaired cognitive processing.
Fibromyalgia Syndrome (FMS) is a pain disorder associated with multiple tender points, sleep disturbances (insomnia and non-restorative sleep), and fatigue. Hypothalamic dysfunction, immune dysfunction, and nutritional inadequacies can all cause or perpetuate this sometimes severe syndrome.
may be opposite ends of the same disorder. With CFS the emphasis is on fatigue
; with FMS the emphasis is on the pain.
Causes and Development; Contributing Risk Factors
No single causative agent has been found. Many viruses have been considered and may play a role in CFS
including the Epstein-Barr virus
) and Cytomegalovirus
). Human herpes
virus 6 is under investigation.Fibromyalgia
develops slowly over many years, making the condition very difficult to diagnose in the early stages. It usually is well advanced before it is suspected. Educating yourself about this condition is the best way to catch it early. If any other family members have it, your chances of having it are increased. This is an important clue, for successful early diagnosis and treatment.
Based on a study by the University of Washington of over 1,400 individuals, it was found that those who drank well water on a regular basis during childhood were 10 times more likely to develop fibromyalgia
than those who did not. Since many wells contain environmental toxins such as pesticide run-off, we feel there could be a definite link, especially since fibromyalgia seems to be a central nervous system
In one study, 75% of urine specimens obtained from CFS
patients contained elevated levels of 5-HIAA, (5-hyroxyindole acetic acid), a breakdown product of serotonin
. This recent finding also showed that 70% of those taking NADH returned to normal levels of 5-HIAA, while 70% of placebo patients continued to show elevated or increasing levels of 5-HIAA. The urinary measurement of 5-HIAA may help predict which CFS patients respond to NADH therapy. However, if a person is taking guaifenesin, levels of 5-HIAA may be falsely elevated.
Signs and Symptoms
The key symptoms are disabling fatigue
, diffuse achiness that is worse with exercise, disordered sleep, brain fog (decreased memory and/or concentration), and perhaps increased thirst, all for more than six months. If these symptoms are persistent and not caused by other untreated organic problems such as anemia
, cancer, diabetes
, lupus, polymyalgia rheumatica, or a chronic infection such as sinusitis
or Lyme's disease, then a comprehensive treatment approach will likely help. CFS
are not "all or nothing" problems. Like arthritis
and many other illnesses, they occur in varying degrees of severity.
Diagnosis and Tests
can be difficult to diagnose. There are currently no lab tests to confirm what remains a clinical diagnosis. Many doctors encourage a comprehensive approach.
Treatment and Prevention
There are many treatment choices available in alternative medicine so it is necessary to find what works best for you.
The following is a summary of important areas that may require treatment in CFS
Consider and treat as necessary hypothyroidism
, low or borderline adrenal
function, and sex hormone deficiencies. DHEA
and 7-Keto DHEA may be useful; routine endocrine tests are normal in suspected cases of fibromyalgia
. Current research is focusing on growth hormone irregularities. Insulin-related growth factor-1 (IGF1) is secreted mainly by the liver
in response to growth hormone release. Growth hormone deficiency in adults has been associated with many symptoms that are similar to those described by fibromyalgia patients: low energy, poor general health, reduced exercise capacity, muscle weakness, cold intolerance, impaired cognition, dysthymia
and decreased lean body mass. IGF1 levels are often found to be low in FMS
patients and the few studies done so far have found symptomatic improvement of CFS
and FMS patients with growth hormone injections.
It is likely that the problem in cases of FMS is a "physiologic growth hormone deficiency". Evidence of this was provided by a study in which FMS patients were exercised to voluntary exhaustion on a treadmill; this is a standard test of growth hormone secretion. Unlike healthy controls, FMS patients were unable to mount a growth hormone response to exercise despite reaching an anaerobic threshold (an indication of an adequate exercise workload). However, when fibromyalgia
patients were given pyridostigmine 1 hour prior to exercising, they were able to mount a reasonable growth hormone response. As pyridostigmine is known to reduce somatostatin tone in the hypothalamus
, this result is compatible with the notion that growth hormone deficiency in fibromyalgia cases is a potentially reversible problem that has a physiologic basis i.e. increased hypothalamic somatostatin tone. [Eduardo S. Paiva, Atul Deodhar, Kim D. Jones, Robert Bennett; Oregon Health Sciences University, Portland (press release)
Immune dysfunction has been documented in cases of CFS and CFS has been called chronic fatigue
immune dysfunction syndrome (CFIDS). The immune dysfunction may result in recurrent infections, often with normally non-pathogenic organisms such as Candida albicans
or bowel parasites
. Treat any bowel infections or imbalances and any sinusitis
or nasal congestion.Nutritional Inadequacies:
Nutritional deficiencies, especially of the B-complex vitamins, magnesium
may be aggravated by malabsorption
or increased utilization. Treat any magnesium deficiency preferably with magnesium malate. Sometimes magnesium by injection or IV
Do not consume any sweets, alcohol or caffeine
for three to six months, and then limit them to moderate amounts. Expect withdrawal symptoms during the first week.
Consider vitamin B12
injections at higher doses (2,000-5,000mcg) at least once per week and possibly more for at least eight to ten weeks. Consider treating persistent fatigue
with CoQ10, evening primrose oil and possibly fish oil.
Liver detoxification and hidden food allergy management can be important and should not be overlooked. Get as much sleep as you need, or at least eight hours per night. Be sure to exercise, slowly at first and more with improvement, but be cautious about over-exertion. Seek to resolve unconscious life conflicts.
All underlying problems should to be treated simultaneously or a vicious cycle can be kicked into action in which each problem can trigger the others. Some call this the "fatigue
Diagnosis and treatment are combined in the use of the decongestant guaifenesin (often called "guai" by users). Dr. St. Amand in his book What Your Doctor May Not Tell You About Fibromyalgia
gives an excellent presentation on the subject with full details of "guai" use. He does not distinguish between Chronic Fatigue Syndrome
, Fibromyalgia or Candida, using "guai" for them all. This protocol requires the careful avoidance of all salicylates and a hypoglycemic diet if low blood sugar is a factor. There are extensive web sites on its use.