6 Complementary and Alternative Therapies for Chronic Fatigue Syndrome

Chronic fatigue syndrome is a chronic illness that affects up to 2.5 million Americans. In cases identified through active surveillance for CFS, less than 20% reported receiving a diagnosis from a healthcare provider. CFS costs the U.S. economy around $20 billion annually in medical bills and lost income. Alternative approaches such as nutrition, acupuncture, cognitive behavioral therapy, herbs, and supplements may help support the management of symptoms associated with chronic fatigue syndrome.

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What is Chronic Fatigue Syndrome?

Chronic fatigue syndrome, also known as myalgic encephalomyelitis (ME/CFS), is a severe and chronic illness that affects many body systems. People with this condition often cannot perform their usual activities and have extreme fatigue and sleep problems.

Chronic fatigue syndrome is not improved by rest and may get worse after an activity, whether physical or emotional. This is called post-exertional malaise (PEM). It is a complicated disorder characterized by fatigue that lasts more than six months and cannot be fully explained or ruled out by another medical condition.

What Causes Chronic Fatigue Syndrome?

The cause of ME/CFS is unknown, but many hypotheses exist, including immune system dysfunction, inflammation and oxidative stress, autoimmunity, genetic alterations, hormonal imbalances, stress tolerance, impaired gut microbiota, and low cortisol levels, among others (7). Some people may be born predisposed to the disorder, which is triggered by a combination of factors. Some people have developed chronic fatigue syndrome post-viral infection, prompting more research on the topic. The most common virus many researchers are looking into is the Epstein-Barr Virus.

Other possible causes of chronic fatigue syndrome include abnormal levels of hormones produced in the hypothalamus, pituitary glands, or adrenal glands. Some people reported that they experienced an injury, surgery, or significant emotional stress shortly before their symptoms began (4). One study showed that some chronic fatigue syndrome patients had a higher incidence of certain bacterial infections such as Chlamydia pneumoniae, Mycoplasma, and Brucella. 10% of the CFS patients were positive for Brucella, 8% positive for C. pneumonia, and 50% positive for Mycoplasma spp.

This study shows evidence of oxidative stress in those with chronic fatigue syndrome. Oxidative stress refers to the body's ability to manage free radicals (molecules that can damage cells). Risk factors for oxidative stress include eating a diet high in processed foods, high sugar or high saturated fatty foods, drinking alcohol, and smoking cigarettes.

Chronic Fatigue Syndrome Diagnosis

To make a diagnosis, typically, there are three primary "core" symptoms required and one additional symptom as listed below (2).

Three core symptoms:

1. Significantly lowered ability to do activities that were usual before the illness. This drop in activity level occurs with fatigue and must last six months or longer. Fatigue associated with CFS is very different from just being tired. It can be severe and is not a result of unusual activity. It is not relieved by sleep or rest and was not a lifelong problem before becoming ill.
2. CFS symptoms may get worse or first appear, including difficulty thinking, problems sleeping, sore throat, headaches, dizziness, or severe tiredness. This is known as post-exertional malaise (PEM).
3. People with CFS may not feel better or rested after a full night's sleep. Some people with CFS may have problems falling asleep or staying asleep.
   

In addition to the core symptoms, one of the following is required for diagnosis:

• Problems with thinking and memory: CFS patients often describe "brain fog" and not being able to think clearly
• Worsening of symptoms while standing or sitting up is known as orthostatic intolerance.
  

Chronic Fatigue Syndrome Symptoms

Symptoms of chronic fatigue syndrome can vary from person to person, and the severity of symptoms can fluctuate from day to day. Signs and symptoms may include: (3)

• Fatigue
• Problems with memory or concentration
• Sore throat
• Headaches
• Enlarged lymph nodes in your neck or armpits
• Unexplained muscle or joint pain
• Dizziness that worsens with moving from lying down or sitting to standing
• Unrefreshing sleep
• Extreme exhaustion after physical or mental exercise
• Muscle pain and aches.
• Joint pain without swelling or redness.
• Headaches that are new or worsening.
  

Functional Medicine Labs to Test for Root Cause of Chronic Fatigue Syndrome

Although we don't know what causes CFS, lab testing can help rule out other diseases and provide insights into what might be lacking or deficient. When ordering and interpreting functional medicine labs, it is essential to order labs that will help determine the root cause of symptoms and interpret them with optimal values. Optimal values are a narrow range of lab values, meaning anything outside those values tends to show patterns toward disease progression. Functional medicine providers can then catch these markers early on and have a chance at managing or slowing disease progression.

Basic Labs

Basic laboratory markers: complete blood count and a comprehensive metabolic panel are standard to ensure organs are functioning properly and blood counts are within range. These tests should be done on every patient to get a baseline. Some conditions that can be ruled out with these tests are anemia, infection, and mononucleosis (atypical leukocyte count in white blood cell differential), which can have similar symptoms to CFS.

Comprehensive Hormone Panel

DUTCH Plus: many people with CFS commonly have hormonal imbalances and sleep problems. The DUTCH Plus™ offers an extensive assessment of sex and adrenal hormones and their metabolites. It also assesses the Cortisol Awakening Response (CAR) and includes the insomnia cortisol sample. The results from this test can help practitioners individualize options for patients to help manage symptoms associated with hormone imbalances.

Comprehensive Stool Testing

A stool test is one of the most common tests functional medicine practitioners use to help individualize approaches. A stool test can rule out other diseases like Crohn's disease, intestinal permeability, or gut infections that can cause various symptoms that overlap with chronic fatigue syndrome.

Lyme Disease Testing

Lyme disease is known as "the great masquerader" and can cause similar symptoms as CFS. Ruling this out is an essential factor in finding the proper approach.

Autoimmune Panel

Some autoimmune diseases mimic chronic fatigue syndromes such as Lupus or Rheumatoid arthritis. Having a test for autoimmune markers can help rule out these conditions.

Oxidative Stress

Evidence shows those with CFS have a higher incidence of oxidative stress. The results from this test can provide a personalized assessment of a patient's nutritional and supplemental needs.

Micronutrients Testing

NutraEval: This test checks for nutrition imbalances. While the evidence is lacking in nutrient imbalances and chronic fatigue syndrome, there is an overlap in similar symptoms. Having proper micronutrient levels can aid in managing fatigue.

Sleep Study

Ruling out sleep apnea if the individual fits the symptom criteria can be very important in detecting sleep problems and helping manage fatigue. Sleep apnea can cause extreme fatigue due to not enough oxygen getting to the tissues.

Conventional Approaches for Chronic Fatigue Syndrome

Conventional approaches for chronic fatigue syndrome focus on the symptoms since the cause is unknown. Depression is a common symptom of CFS, so many providers may prescribe anti-depressants to help with depression and sometimes sleep problems. Many people with CFS have symptoms of orthostatic intolerance (feeling faint or dizzy when standing or sitting upright), so providers may suggest blood pressure or heart rhythm medications. Pain is a significant symptom of CFS, and medications that help manage pain in fibromyalgia patients may also help with pain from chronic fatigue syndrome. Some people also benefit from counseling, addressing sleep problems like sleep apnea with a CPAP (continuous oxygen during sleep), and low-intensity exercise (1).

6 Complementary and Alternative Therapies for Chronic Fatigue Syndrome

Nutrition

Certain dietary changes may help support the management of symptoms associated with chronic fatigue syndrome. Evidence suggests that adopting an anti-inflammatory diet such as the Mediterranean diet may be beneficial for chronic fatigue conditions.

The Mediterranean diet emphasizes a mostly plant-based dietary pattern, focusing on fruits, vegetables, nuts, seeds, olive oil, and whole grains.

• Experiment with your diet. There is no standard diet for those with chronic fatigue syndrome, so it may be helpful to experiment with whole foods and see what makes you feel better or worse.
• Fill up on vegetables! Red vegetables are full of phytonutrients that act as antioxidants and help support a healthy inflammatory response. Yellow vegetables contain essential minerals and vitamins A, C, and B6. Green veggies are rich in vitamins A, C, E, and K and many of the B vitamins. These vegetables also contain an abundance of carotenoids-antioxidants.
• Skip processed foods. All processed foods are low in nutrients and high in saturated fats and simple carbohydrates, which may contribute to inflammation in the body.
• Ensure you get enough calories for your height, weight, and activity level.
  

Address Gut Microbiome Changes

Many patients with chronic fatigue syndrome also have irritable bowel syndrome. It may be helpful to keep a food symptom journal and note the details of when and how your stomach or gut reacts to food or other changes. Talk to your provider about a possible food sensitivity test or an elimination diet to find dietary triggers. Prebiotics, probiotics, nutritional changes, and even some gut-supporting nutrients may help manage irritable bowel disease. You'll want to talk with your practitioner about your specific needs.

Metabolic Detox

If a patient's lab results come back with high levels of oxidative stress, a metabolic detox may be appropriate. Medical-Based Detox Programs usually combine a combination of nutrition and supplements that support all levels of detox. Metabolic detox programs should always be done under the care of a healthcare practitioner to ensure proper guidance and support.

Herbs and Supplements

• Glutathione: known as the master antioxidant, this supplement may help decrease oxidative stress.
• Vitamin B12: this vitamin, in particular, is known to support energy levels.
• Vitamin D: this vitamin is important for the immune system, and since there is a possible role of a decreased immune system in CFS, this vitamin is essential to maintain balance.
• CoQ10 + NADH (nicotinamide adenine dinucleotide): this study showed a decrease in cognitive fatigue and overall fatigue perception.
  

Acupuncture

In this review, 51 randomized control trials demonstrated that acupuncture with moxibustion (the burning of mugwort, a Chinese herb, over a specific acupuncture point) was significantly more effective than other approaches for chronic fatigue syndrome.

Lifestyle Changes

• Stay hydrated: Dehydration is known to make fatigue worse, so staying hydrated is very important in chronic fatigue syndrome.
• Most people with chronic fatigue syndrome have post-exertional malaise (PEM). This makes it challenging to perform strenuous exercises or mental tasks. It is essential to know your limits and not overdo them. For some people with CFS, exercise can worsen their symptoms, so it's important to discuss this with your practitioner. Graded Exercise Therapy has been shown to be effective in improving measures of fatigue and physical functioning (1).
• Decrease or limit caffeine use. Although caffeine is a natural stimulant, it can lead to more fatigue once it wears off.
• Cognitive behavioral therapy has been shown to be effective in managing chronic fatigue syndrome (1).
  

Summary

Chronic fatigue syndrome (CFS) affects up to 2.5 million people annually and costs the economy up to 24 billion annually in medical bills and lost income. Less than 20% of those who fit the criteria for CFS have a diagnosis. The cause is unknown, but there are medical conditions that mimic CFS that should be ruled out. There is evidence that the immune system, oxidative stress, and microbiome all play a role in the syndrome. Using functional medicine lab testing to find the root cause, nutrition, supplements, acupuncture, and lifestyle changes, patients with chronic fatigue syndrome may find support in managing their symptoms.