Chronic fatigue syndrome (CFS) is a complex, debilitating condition characterized by extreme fatigue and inability to participate in one's usual activities of life. In the United States, chronic fatigue syndrome affects, on average, 4 in every 1000 Americans older than 18 years of age. With rising numbers and unknown concrete causes, medicine must continue to progress in finding answers and solutions to understanding chronic fatigue syndrome.
One area of research is the impact of environmental toxins on the onset of CFS or how they can be contributing factors that exacerbate the condition. In this article, we’ll explore the possible links between different environmental toxins, how to assess if these substances are impacting your health, and integrative healthcare options to support your return to health.
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What is Chronic Fatigue Syndrome?
CFS is a complex and taxing condition. Clinically, it is also referred to as myalgic encephalomyelitis, which is characterized by multi-system involvement and persistent debilitating fatigue for at least six months. Individuals experiencing CFS symptoms may have a long road undiagnosed because the symptom presentation is variable and systemic. While unrelenting fatigue is the primary complaint, the other symptoms of CFS may include:
- Headaches
- Sore throat
- Memory deficiency
- Trouble concentrating
- Unexplained joint and muscle pain
- Enlarged lymph (Example: axillary and cervical lymph nodes)
- Dizziness, especially from sitting/lying to standing
- Sleep does not improve fatigue
- Heightened exhaustion with physical or mental output
Diagnosing Chronic Fatigue Syndrome
These symptoms are what patients seek care for since feeling this way can affect their everyday lives, from work to childcare to enjoying their day-to-day. When CFS is considered, four major categories of diagnostic criteria must be met.
- Six months or longer of debilitating fatigue, which substantially impairs your ability to engage in educational, occupational, recreational, or activity of daily living.
- Getting adequate sleep and rest is not refreshing. You experience that sleep can make you feel worse due to poor sleep quality.
- New onset of worsening of symptoms after mental, emotional, or physical exertion. This is known as post-exertional malaise (PEM). This feeling can last days to a week after the exertion.
- Neurological symptoms. This typically presents as cognitive or orthostatic impairment. Cognitive impairment would include thinking, recalling, attention, memory, organizing, or processing information. Orthostatic intolerance includes symptoms that occur when you go from sitting or lying to standing. You may feel lightheaded, experience fainting spells, have headaches, or become nauseated.
Management of Chronic Fatigue Syndrome
Integrative medicine care for CFS requires a comprehensive individualized approach that addresses the diverse array of symptoms present. An integrative and holistic approach to chronic fatigue syndrome entails supporting your mental, emotional, and physical being. This includes functional medicine testing to evaluate for root causes like environmental toxicity, which can offer insight for targeted support.
Therapeutic intervention could combine conventional care with complementary and integrative medicine. Including nutritional support, mind-body practices, lifestyle modification, herbal medicine, vitamin and mineral supplementation, and integrative medicine practices like acupuncture.
Environmental Toxins Defined
Environmental toxins are contaminants in indoor and outdoor environments that can impact human health. Sources of environmental toxins are from both man-made exposure and naturally occurring substances. This includes heavy metals, pesticides, industrial chemicals, or organisms. While you may think you are not in contact with these substances, many are ubiquitous in our environment. Typical exposure routes are water contamination, air pollution, and soil. The World Health Organization has concluded that 7 million deaths yearly are associated with pollution due to airborne toxicity alone. The classes of toxins can be rather broad, and it is advantageous to know them as you may accidentally be exposed to these in your life.
Heavy Metals
Toxicity from metal elements that have a high density and can be lethal in minute amounts are considered heavy metals. While heavy metals can be present in natural elements, they predominantly form man-made production like industrialization and toxic waste. The leading heavy metals to be concerned about are Mercury, Lead, Arsenic, and Cadmium. While Aluminum is a lighter-weight metal, it often falls into this category due to the many heavy risks of aluminum toxicity. Some individuals may be at higher risk for exposure due to their line of work.
For example, metal workers may be in contact with metal dust and vapors, while dentists may risk mercury exposure from removing outdated mercury amalgams. Other areas of life include dietary intake, and seafood is one food category known to carry increased levels of mercury compared to other food groups. Knowing the sourcing of things you consume is essential, as products like chocolate and some supplements have also been in the spotlight for being contaminated with heavy metals.
Pesticides
Pesticides are used in residential and commercial spaces to kill insects, prevent the growth of weeds, and minimize disturbances to agricultural growth. The detriment of pesticides is that their use has now led to bodily absorption through skin contact, inhalation, and contaminated food and water. There are three categories of pesticides which are herbicides, insecticides, and fungicides. In the United States, over 800 kinds of pesticides are available. Some products have more detrimental effects than others.
A key herbicide is glyphosate, which has harmful health effects, including links to cancer, gut microbiome disruption, and hormonal imbalances. Pesticides have also been researched in correlation to neurological conditions, such as Parkinson’s disease. When it comes to adverse health outcomes, pesticides are highly concerning and should be avoided when possible.
Industrial Chemicals
Today’s industrial production uses an overabundance of chemicals for manufacturing, the production of commercial products, and the construction industry. The list is long, but a few common culprits referred to are persistent organic pollutants (POPs)- Polychlorinated Biphenyls (PCBs), and dioxins, which are a detrimental risk to human health and wildlife.
Organisms
Some specific naturally occurring organisms can release toxins, leading to a breakdown in bodily processes. One of the concerning categories is mycotoxins. Certain mold species produce these toxic byproducts. While there are dozens of mycotoxins, the most concerning ones are ochratoxin A, trichothecenes, zeralone, and aflatoxin. Like the other mentioned environmental toxins, exposure is through direct contact with surfaces, contaminated food sources, and inhalation in a toxic mold environment.
The Potential Link: Environmental Toxins and CFS
Environmental toxins risk multiple aspects of human health, which could lead to complex multi-system involved conditions like CFS. Cause and effect are subjective measures used clinically to help determine why patients present with specific signs and symptoms. In cases of CFS, there have been cases where the impacted individual reports a recent exposure to chemicals, food poisoning, or infectious agents like Epstein-Barr Virus.
Studies have found that, in some cases, there is a link to immune system alterations in those with CFS. Various high and low immune markers show dysfunction within the immune system. Research also shows that environmental toxins can all negatively impact the immune system by inducing immunotoxicity. Investigation into this area suggests that ecological insults to the immune system early in life can lead to developmental immunotoxicity and potentially a CFS phenotype.
Regarding toxic organisms and CFS, research has uncovered cases of mycotoxin affecting individuals. One study found that out of 112 CFS patients, 104 had at least one mycotoxin species in their urine. The species were either aflatoxins, ochratoxin A, or macrocyclic trichothecenes, all detrimental to health.
While prominent health establishments declare that the cause of CFS is unknown, the investigation coming out (in at least some cases) has a rather clear link back to environmental exposures.
Mechanisms of Toxic Impact
Several hypotheses suggest pathways in which environmental toxins could contribute to the development or exacerbation of CFS. As previously mentioned, research areas are discovering this potential link between immune system dysfunction and the development of CFS. An interesting caveat is that environmental toxins can cause an overactive immune response in some situations or immune suppression in others. Clinically, this can lead to allergic reactions, hypersensitivity-type reactions, or frequent infections. Multiple studies have found the presence of autoantibodies in CFS patients. While it is not definitive if they are the cause, there seems to be a link between immune dysfunction and these conditions.
Neurologically, environmental toxins can be widely detrimental. How toxins impact health, especially when it comes to nervous system function, is quite astonishing. We now know that heavy metals, industrial chemicals, and pesticides directly affect the central nervous system, which leads to cognitive and physical impairments. Toxins can also disrupt neurotransmitters by reducing their production and transmission within the nervous system. Reduced neurotransmitter quality can impact one's mood, sleep quality, and ability to function cognitively, all of which are symptoms consistent with CFS presentations.
Lastly, toxins can affect important cellular and physiological mechanisms. The mitochondria, known as the “powerhouse of the cells” is the primary organelle responsible for energy production. Chemicals, heavy metals, and mycotoxins can negatively impact mitochondria function, impairing or damaging mitochondria. The downstream impact is a deficit in energy production and thus impacted metabolic processes.
Diagnosing Toxin-Related CFS
There are several challenging areas to consider when it comes to diagnosing toxin-related CFS. In both conventional medicine and functional medicine, there is no specific biomarker that is used to diagnose CFS. Diagnoses are primarily based on subjective findings and through exclusion (all other potential options ruled out). When investigating environmental exposure, the variability in presenting patient symptoms does not always present as a toxin picture. During the patient intake, there may also not be a direct lineage of a recent exposure that the patient is aware of and their history of symptoms. Diagnostic testing also has limitations. Most primary care providers in conventional medicine are not running environmental toxin panels, and clinically speaking, many of them do not even know where to begin when it comes to looking for root causes in this manner. With a lack of guidance in this direction and no specific environmental panel for CFS, it can take months to years before a patient seeks a root cause answer from a functional medicine provider.
A functional medicine practitioner or naturopathic doctor accustomed to environmental toxicity testing would be the first-line approach when testing for toxin exposure in suspicious CFS individuals or in those already diagnosed. Testing options in this arena usually encompass multi-biomarker panels. Depending on the patient's presentation, running one or multiple times may be necessary. From mycotoxin urine testing to heavy metal hair analysis, testing would be determined on that individual's unique symptoms.
Treatment and Management Strategies
An integrative medicine approach can include both conventional and holistic treatment for the management of toxin-related CFS. From a traditional side, it would be geared toward symptom relief, such as medication for the varying symptoms present. This could include pain management medication, anti-depressants, anxiety medications, antivirals, or immunosuppressants. Historically, cognitive behavioral therapy (CBT) and graded exercise therapy (GET) were recommended as treatment options, but updated information states that these therapies were not very helpful due to the complex nature of CFS. Patients have better outcomes when their situation and lived experience are validated. Providing support for activities of daily living (physical assistance, wheelchairs, nutrition support, disability assignment, etc.) while educating the patient on pacing themself to reduce post-exertional malaise (PEM) is vital for long-term management and care.
Emerging treatment strategies for treating CFS in correlation to toxin exposure entail a more holistic and integrative medicine approach. Investigating for root cause is key. Depending on functional medicine testing results, targeted treatments can ensue. For example, if the patient returns with mycotoxins, a protocol for this condition must be in place. If heavy metals were a contributing factor, a detoxification and workup for treating this would be considered. It’s important to remember that individuals with CFS feel significantly depleted and are struggling to do even the most straightforward tasks. Detoxes, especially ones like heavy metal chelation, should never be done without prior workups and getting yourself to a stable health stage. Starting slowly with lifestyle modifications, minimal supplement implementations, and an easy-to-execute nutrition plan is essential. Patients here could benefit from individualized medicine through a naturopathic doctor, health coaching, and other professionals who will closely support the individual.
Preventing Exposure to Environmental Toxins
By adopting practice and conscious lifestyle choices, you can reduce your exposure to environmental toxins. Minimizing toxin risk includes being aware and specific about what you are putting into your body, surrounding yourself with, and what everyday habits you are engaging in. There are a variety of integrative health approaches you can take to decrease your toxic load. Eating a wholefoods-based diet that is void of excess processing, is organic, locally sourced, and produced with environmental sustainability in mind can inherently assist you in reducing your toxin consumption.
Making a deliberate effort to use non-toxic skin care products. which can cause endocrine disruption and can decrease your everyday personal exposure to toxins. This entails an overhaul in items such- as make-up, face and body cleansers, laundry soap, lotion, and deodorants, which can also decrease your everyday exposure to toxins. Endocrine disruptors are a form of environmental toxins, including pesticides and industrial plastics containing Bisphenol A, PCBs, Dioxins, and heavy metals. Eliminating household items such as plastic food storage containers, plastic cups, and plates and cooking in non-toxic cookware are a few ways you can minimize this type of exposure.
According to the EPA, drinking water can also be contaminated with toxins. This comes from runoff from industrial and agricultural practices, waste materials, treatment centers, and naturally occurring metals entering groundwater. Utilizing effective water filtration in your home, whether that is a whole house filter or specific to your drinking water, is an excellent option for reducing exposure through this route.
While many more options exist to reduce your toxic exposures, starting with what you are most in contact with is a good rule of thumb. Some environmental toxins are unavoidable, but building on top of your changes can help you reach your controllable toxin-free living goals.
The Role of Functional Medicine and Lab Testing in CFS Management
CFS is best treated when a whole-person approach is implemented. This allows for systemic support rather than just treating symptom presentations. Screening for toxin exposures should be a consideration for all people presenting with CFS. Although there is not a clear-cut connection between environmental toxins and CFS, there has been a plethora of research revealing toxicity in multiple categories of individuals diagnosed with this condition. Seeking functional medicine care can help further investigation. Obtaining labs that look at the common culprits can help get to the root cause of CFS. These include:
Heavy Metal Testing
A comprehensive and efficacious method of testing heavy metal is through hair analysis. One test is the Hair Elements toxin test by Doctor’s Data. This will look for 39 heavy metals, including mercury, lead, arsenic, cadmium, and aluminum. Hair analysis is an excellent option since toxins can be 200 to 300 times more abundant in hair than in blood or urine.
Pesticides and Industrial Pollutants
To determine if heavy metals or toxic chemicals are impacting your health and thus causing chronic fatigue syndrome, there is a robust panel that will cover both categories.
Mycotoxins Test
Ruling out mold toxins may be pertinent to an individual's particular case. Suppose water damage in a person's home is a known factor. In that case, they may have symptoms that align with sick building syndrome (similar to CFS), so ordering an in-depth mycotoxins panel could be a missing link. The Total Mycotoxin Panel by RealTime Laboratories is a urine test that detects 16 of the most common mycotoxins. This thorough test can help your provider determine if this area needs addressing.
Organic Acids Tests
An Organic Acids Test (OAT) provides information on metabolic processes. Organic acids are byproducts of cellular activity. Testing is through urine samples, which will reveal if and what you are eliminating. Metabolites in the urine can indicate how well your mitochondria are functioning, provide insight into neurotransmitter and micronutrient status, and whether more specific functional medicine tests need to be performed. An OAT test can also reveal if microorganisms are negatively impacting your health. There are various OAT options. This looks at dozens of biomarkers that can aid in a patient's case.
Functional medicine testing for CFS may be an underrated avenue. Still, in a medical world that has yet to determine how CFS evolves, it is becoming a more viable avenue to pursue. Functional lab testing can find root cause answers while also providing your practitioner with a CFS management tool and direction for personalized treatment for CFS.
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Environmental Toxins and Chronic Fatigue Syndrome: Key Takeaways
CFS is a complex condition involving many aspects of one's health, much of which is poorly understood by the medical system. Through recent studies and out-of-the-box attempts to understand how patients end up with this debilitating condition, areas of environmental toxicity have been investigated. Research areas have provided some context that heavy metals, pesticides, industrial chemicals, and mycotoxins could be at the root of CFS cases. While these may not be the only causes, they may be a piece of the puzzle worth exploring as testing could bring light to the complexity of presentations.
Working with a functional medicine practitioner who addresses CFS comprehensively will open the gate to specialty labs. Results could reveal whether or not these are targeted areas. Addressing results by taking a holistic approach could create a bridge between what conventional medicine is currently offering and the genuine need for healing in those with CFS.
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