Can you think of a time you were tired to the bone? Maybe it was when you had a particularly stressful project at work, combined with family responsibilities and other obligations that kept you on the go from early morning until way after sundown for several days. By the end of the week, you felt like you could hardly move. Once you collapsed on the couch in the evening, even getting up for a drink of water felt like too much effort. Now imagine battling that kind of fatigue every single day for months, with no relief even after a restful weekend or a solid night of sleep. That’s how women with Chronic Fatigue Syndrome often experience life.
Also known as myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) this is an issue that is still largely misunderstood. There continues to be controversy in the conventional medicine community over whether it’s even a real condition. But I, like many functional medicine practitioners, know it’s real – and that it causes real distress for so many people. In fact, the Centers for Disease Control estimates that between 836,000 and 2.5 million people suffer from ME/CFS, though many are undiagnosed. The illness can affect anyone, but is most common in people between 40 and 60 years of age, according to the CDC. In adults, women are more often affected, and white people are more frequently diagnosed. That statistic can be deceiving, however, since so many (up to 90% by one report) go undiagnosed, particularly among minorities.
According to the CDC, People with ME/CFS cannot function the same way they did prior to illness. Many are not able to do basic self-care tasks like cooking a meal or taking a shower. It often impacts all areas of people’s lives, making it difficult to keep a job, attend school, and participate in family and social activities. The disease is estimated to cost the US economy $17 to $24 billion annually due to medical bills and lost income.
Diagnosing Chronic Fatigue Syndrome
One of the reasons there is such confusion and controversy around Chronic Fatigue Syndrome comes from the difficulty in diagnosing the condition. Because most medical schools in the US don’t include ME/CFS in their training, there’s a huge lack of understanding of the disease among health care professionals.
A set of criteria was developed in 1994 by a panel of international researchers, who determined that for a Chronic Fatigue Syndrome diagnosis, a patient must have severe chronic fatigue that is unrelated to any other known medical condition and lasts for six months or longer, along with four of the following symptoms:
- Sore throat
- Tender lymph nodes
- Muscle pain
- Diffuse and migratory multi-joint pain without swelling or redness
- Headaches of a new type, pattern or severity
- Un restorative sleep
- Aching and listlessness lasting more than 24 hours after exertion
These criteria brought attention to some of the other issues people with this condition face, but 1994 was more than two decades ago. Since then, another set of proposed criteria has been developed by a committee of experts convened by the Institute of Medicine which examined the data on myalgic encephalomyelitis/Chronic Fatigue Syndrome. Their report, titled “Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness,” outlined the following criteria:
“Diagnosis requires that the patient have the following three symptoms:
- 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 fatigue, 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.
- Post-exertional malaise* and
- Unrefreshing sleep*
At least one of the two following manifestations is also required:
- Cognitive impairment* or
- Orthostatic intolerance
* Frequency and severity of symptoms should be assessed. The diagnosis of ME/CFS should be questioned if patients do not have these symptoms at least half the time with moderate, substantial or severe intensity.”
These newer criteria add clarity and specifics on onset and the impact the disease has on the lives of those afflicted, but they aren’t widely accepted by medical professionals, and the debate rages on.
Research on Chronic Fatigue Syndrome has progressed significantly in recent years. Results of two large studies published in February of 2015 demonstrated that higher levels of several types of cytokines were present in the blood of those who were in the first three years of the disease. These results boost credibility for the idea that the condition is related to immune system dysfunction, but there is more work to be done.
What causes Chronic Fatigue Syndrome?
Many people with ME/CFS know exactly when their difficulties began. It may have been an illness, or something traumatic that happened in their life, that they were never quite able to bounce back from. Many scientists think that this trigger event compromises the immune system, allowing pathogens to attack cells and damage mitochondria, which are the energy source in the cells. When mitochondria function is hindered, the cells become weak and unable to perform their vital functions. If this impacts enough cells, your body’s systems will begin to suffer. While infections like Lyme disease and Epstein-Barr haven’t been shown conclusively to cause Chronic Fatigue Syndrome, there’s a good possibility that these could be at the root of a triggering event.
It’s essential to dig deep and find what’s really behind the condition, rather than simply treating symptoms. Masking the issue with antidepressants or other pharmaceutical remedies won’t heal the true problem. Research around infection, immune system dysfunction, stress that impacts the HPA axis, changes in energy production, and possible genetic links has raised questions on many possible causes for ME/CFS, but produced no definitive answers. Still, it seems likely that Chronic Fatigue Syndrome is the body’s response to a build-up of both physical and emotional stress.
Fibromyalgia expert Dr. David Brady emphasizes that the two conditions are not the same: one of the major differences, according to Brady, is that the symptom identified as most debilitating by patients with Chronic Fatigue Syndrome is extreme exhaustion; with fibromyalgia, it’s generalized pain throughout the body. But although Chronic Fatigue Syndrome and fibromyalgia are two distinct medical conditions, they share some similarities and the approach to treatment can often be the same. If you’re tired, in pain, or find your energy compromised, the real question is what’s happening upstream? Where have these symptoms come from?
Dr. Joseph Teitelbaum, author of several books including From Fatigued to Fantastic, has spent his career focusing on Chronic Fatigue Syndrome and fibromyalgia. He developed an integrated approach to treatment, called the “SHINE” protocol: sleep, hormones, infections, nutritional supplements, and exercise.
Related article: Constant Fatigue in Women – “Why Am I So Tired All the Time?”
I agree that all of those are elements that must be considered and addressed when looking to treat Chronic Fatigue Syndrome, but I think there’s something missing: toxins. Our environment is full of contaminants – lead and other heavy metals, chemicals in our cosmetics, pesticides in our food. While many of us can filter these toxins out through our bodies’ natural detoxification process, 25 to 30% of the population simply isn’t able to detoxify well. And holding on to these toxins can have a serious impact on the way you feel.
One telltale sign that you have trouble detoxifying is if you find yourself overwhelmed by the scent of perfumes and other fragrances. When you walk into a store, do you find yourself immediately bombarded by the scent, and feeling nauseous or lightheaded? If so, it’s likely that your body holds on to toxins in an unhealthy way – and the more you are exposed to these things, the sicker you will feel. That’s why it’s so important to be aware of and understand all of the factors that could be impacting your health, particularly when you are presented with symptoms that just won’t subside no matter what you try. That’s not the time to give up – it’s the time to dig deeper. Let me show you how.
An Integrated Approach to CFS Treatment
I have seen great improvement in patients with Chronic Fatigue Syndrome when Teitelbaum’s SHINE approach, along with considering toxins, is used – mainly because it addresses multiple concerns. A great place to start is by taking a look at the quality of your sleep, nutrition, exercise, and your ability to handle stress – both physical and emotional. Other important things to examine are the state of your digestive health, and the toxins you are exposed to every day. When you look at the whole puzzle, the picture is very different than if you are only examining a single piece.
Understanding what’s really going on in your body is the best way to find treatment solutions, and taking action is often the best path to understanding. Here are a few suggestions on where you can begin.
If you really want to understand what’s happening in your body, you have to have complete information. While no test will tell you whether or not you have Chronic Fatigue Syndrome, the following tests will give you solid information about what else is going on in your body. I know the list looks overwhelming, but remember these tests are just steps along the road to understanding. Here’s what I recommend to my patients who are struggling with unexplained health concerns:
- A full panel of thyroid testing. That includes TSH, FreeT3, FreeT4, Reverse T3 and thyroid antibodies testing.
- Rule out celiac disease, including HLADQ2 and 8 genetic testing, especially if there is a family history of celiac.
- Get tested for viruses – Epstein-Barr and Lyme disease,including the co infections, in particular. Know, though, that much like Chronic Fatigue Syndrome, Lyme is difficult to diagnose and there has been a fair amount of controversy around it.
- Blood sugar testing
- Testing for anemia
- Comprehensive Metabolic Profile (CMP)
- Fasting insulin and 2 hr. PP insulin tests
- HGBA1C, which gives you a three-month view of blood sugar levels
- Adrenal testing
- Testing for food sensitivities
- Stool testing
- If the basic tests don’t reveal answers, you might need to dig deeper and consider toxic metal testing.
Pay close attention to nutrition
I know that you know this, but it bears repeating. What you eat really matters! Your body needs the right fuel – just like your car does – to function properly. It simply can’t handle a constant diet of processed foods, chemicals, sugar and gluten. I can’t count the number of women who have changed just one thing – the way they eat – and come back astounded at how much better they feel. And remember, it’s not about one day or one week – what you eat over time has a cumulative effect. If you’ve been putting the wrong fuel in your body for years, it may take several weeks to feel your best. But I’m willing to bet you’ll notice some great changes in just a week or two – enough to keep you moving along the road to better health.
Boost your nutrients
When you are so depleted that you can’t get out of bed, your body might need a lot of quick support. Even with the highest quality food, it’s tough to get all the nutrients we need. I always recommend a high quality multivitamin, like my MultiEssentials to round out your nutrition. You might also need added adrenal support as you heal. I offer a range of Adrenal Health products tailored to your specific needs. Vitamin D and B vitamins might also be important for you; often people are woefully low in these important vitamins without even knowing it!
Take care of your emotional health
One of the most quickly dismissed or overlooked pieces is emotional health, but it might just be one of the most important. Research has shown that the trauma we experience in our past has a great impact on our future. Be comforted by the knowledge that you aren’t imagining things; psychological issues actually do change your biochemistry and cause a wide range of physical symptoms. While therapy can help, the answer often isn’t as simple as that. To really feel better, you have to look at the deeper issues. Avoidance isn’t a long-term solution, and eventually your body will require you to deal with your past. But be gentle with yourself – the process can be difficult, and you have to move at a pace that works for you. There are many ways to work through these emotional minefields. Talk with a trusted friend or doctor, explore the Quadrinity Process or the Emotional Freedom Technique. Whatever you choose, taking the time to heal past wounds can have great impact on the rest of your life.
You can manage CFS and take back control of your life!
I know that’s a lot to process, and you have to remember to be patient with yourself. There may be years of stress behind your exhaustion, and overcoming the fatigue might be complex. But I want to reassure you that it IS possible to bring your body to a balanced state. When you get there, celebrate the return of your energy and vibrancy – you deserve it!
Reviewed by Dr. Mark Menolascino, MD