Chronic Fatigue Syndrome, or CFS, is estimated to affect at least 2 million Americans, with no specific association with gender, age, ethnicity, or socioeconomic group. These estimates may be low since many people experiencing CFS are often misunderstood or not properly diagnosed.
For a diagnosis of CFS, a person must experience fatigue that cannot be explained by any other condition for at least six months. Other common symptoms may include headaches, low-grade fever, sore throat with or without enlarged lymph nodes, muscle pain, joint pain, neurological symptoms, and sleep disturbances.
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CC: Chronic Fatigue Syndrome, Hypothyroidism, Joint Pain, Headaches, and Constipation
Krista was a 36-year-old female who experienced chronic fatigue (CFS), hypothyroidism, inflammation-related pain, and digestive issues. She was diagnosed with chronic fatigue syndrome by a rheumatologist after her lab work showed inflammation but no signs of autoimmune markers. She had been dealing with low energy and daily body pain for the last 4 years without any clear reasons. Before having children, she felt her health was at its best, regularly participating in triathlons. On the day of her first visit, she rated her daily average energy a 2/10 and felt like she was "going through the motions" of the day without being fully present.
Additional History
She was a mother of 3 young kids, aged 1, 3, and 5. She worked part-time from home while two of her children were home. She had very limited time for herself, prioritizing her family's health and diet. She often ate leftovers from her child's plates for lunch and skipped breakfast, opting for a protein bar or shake for convenience. Dinner typically included a complete protein, vegetable, and gluten-free grain/starch side with ample water and electrolyte intake daily.
Upon gathering a history, it was revealed the patient was passing a bowel movement every 1-3 days with a Bristol 1-2 consistency, attributing the slow frequency to inconsistent fiber intake. She also experienced headaches 2-3 times a week, which she managed with 1,000 mg of turmeric.
She was still nursing her 1-year-old multiple times a day, with the goal of 2 years. However, during the initial visit, she became upset when expressing the need to wean her current baby to begin prioritizing her own health. Krista had been pregnant and/or nursing for the last 5 years since having her first child; early on, she heavily prioritized her health with exercise and homemade, nutrient-dense meals. However, with her second child, things became more challenging, and her health and diet began to slip.
Initial Lab Work
Nutrient Panel and OAT Test
- Moderate Need/Deficiency: Zinc, Selenium, Omega 3/6/9 fatty acids
- High Need/Deficiency: Alpha lipoic acid, Vitamin C, glutathione, Vitamin B2, Vitamin B6, Vitamin B9, Vitamin B12
- Omega 3 index: 3.2 LOW (High risk <4%, Intermediate risk 4-8%, Low Risk >8% )
- 24 hour amino acid intake: High Need: for glycine, cysteine, and glutamine and low need for all others
- Moderately Elevated Levels: of mercury, MTBE, and Styrene derivatives
Lab Analysis
The Nutrient Panel and Organic Acid testing indicated a high need for nutrients that support detoxification. It also showed elevated levels of certain metabolites and environmental chemicals, suggesting challenges with detoxification processes. Additionally, it showed deficiencies in nutrients important for thyroid function, such as zinc and selenium, as well as low omega levels, which may contribute to inflammation and future cardiovascular concerns. This panel also suggested insufficient amino acid intake, indicating the patient might not be consuming enough protein to meet her amino acid needs.
In addition to her amino acids, glutathione, low lipoic acid, and her CMP showed elevated liver enzymes, all indicating a need for liver support and detoxification support overall.
Some inflammatory markers were noted on her labs as well. CRP was elevated for her age, and her sed rate was within range; however, it was also functionally elevated for her age. She was negative from an ANA and thyroid antibody standpoint. However, her hormone and thyroid output both showed less than ideal levels, indicating stress on her system again.
Elevated homocysteine levels may be driven by low B9 and B12 levels. However, it can also increase in cases of systemic inflammation, and this could not be ruled out as a contributing factor at the time.
Interventions
The following suggestions were provided to Krista as part of her wellness plan:
Nutrition Guidelines
Diet, diet, diet! Krista was surprised by her lab results and was eager to make changes to get back on track. We started with basic dietary goals and encouraged her to return to her original diet-focused mindset to optimize nutrient intake. Each plate was suggested to be 1 quarter protein, 1 quarter grains/starches, and ½ plate for vegetables. Lemon was added to water 1-2x daily for increased vitamin C, along with a snack of berries and nuts/seeds. Herbs were also emphasized, with a focus on cilantro to support the body's natural detoxification processes.
Supplemental Support
Krista was suggested supplements to help build up nutrient stores and support her body's natural processes. Supplemental support included:
- Lipoic acid at 500 mg 1x daily for 90 days paired with liposomal glutathione, gradually increased, then used 2x daily for 60 days.
- A protein shake was suggested with all essential and non-essential amino acids to increase protein intake and help meet protein goals. This also supported liver health, with the needed amino acids for proper conjugation and detoxification. We discussed meat preparation to optimize nutrient absorption: bone-in, skin-on, slow-cooked meats eaten in a relaxed setting and avoiding liquids before, during, and after meals to maximize absorption.
- High dose multivitamin 2x daily with meals for 1 month, then reducing to 1 dose daily ongoing. Vitamin D3 plus K2 were suggested at 6,000 IU daily.
- Fish oil capsules: with 1,300 mg EPA/DHA daily as well as 2 servings of foods high in essential fatty acids: SMASH fish (salmon, mackerel, anchovies, sardines, herring), olives/oil, avocados/oil, coconut/oil, chia/hemp/flax seeds, nuts (limiting peanuts).
Detox Support
She was encouraged to try a castor oil pack over her liver 3x weekly, dry brushing before her shower 3x weekly, and getting outside and sweating 3x weekly. She was already very active with her children, but encouraging her to sweat daily was the challenge.
Self Care
We discussed adding in 30 minutes for self-care, such as finding something she loves to do and doing it! Some examples were walking outside, reading a book, or being social with friends. Also, stopping the "mom guilt" about not spending every second with her child and focusing on her as a person and not as a parent. This tied into her going to bed and waking at a regular time as well since her children were sleeping through the night.
Follow Up 3 Months Later
Repeating labs at 3 months showed significant improvement in how Krista felt. Her energy increased from a 2/10 to 5/10, and she began working out 5 days a week with gentle yoga, walking, biking, and some light strength training without feeling depleted afterward. Her digestive health improved after the second week on the plan, and she had not experienced a headache in the last 6 weeks. She found mindful eating challenging with two small children at home, but she was incorporating nutrient-dense meals as discussed and following the supplemental suggestions closely. She was advised to follow up in 2 months to ensure continued progress and to repeat her nutrient panel at the 6-month mark without any supplemental influence to see how her system was responding.
6 Month Follow Up
At our 6-month follow-up, Krista reported feeling much better. She was sleeping 8-9 hours a night and had good energy during the day, rating it a 7-9/10 depending on the time of day. She still felt a little tired in the evening after a long day but would rest for 10 minutes and feel more energized. She also found that spending more time outside and getting sunlight in the afternoon helped her maintain energy levels throughout the day.
She felt positive about the diet, lifestyle, and supplement suggestions and was hesitant to stop them. However, we decided to continue only the fish oil at 1,000 mg daily, the occasional protein shake on days her workout was intense, and the weekly castor oil packs kept at 3x weekly.
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Summary
Chronic Fatigue Syndrome can be challenging to manage as there is no single cause or solution that applies to everyone. In Krista's case, as is often seen in young moms with multiple kids, she was low on nutrients, resources, and time. By encouraging her to focus on her diet, supplements, detox support, and general mental health/well-being, we were able to address some of the lab values that indicated areas of concern. Due to her busy schedule, providing support that was manageable for her was essential, and in Krista's case, it was very beneficial.
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