Chronic Fatigue Syndrome

The disorder we call chronic fatigue syndrome (CFS) does not appear to be new. It is a condition in which is characterized by muscle pain and weakness, with extreme fatigue that is prolonged after events such as exercise. It is usually coupled with symptoms associated with infection, such as sore throat, mild fever and enlarged tender lymph nodes.

The cause of CFS is controversial. Psychological factors may be the cause in some; however, chronic fatigue syndrome appears to be distinct from typical depression, anxiety, or other psychological disorders. A chronic viral infection has been proposed because many patients relate onset to an event similar to influenza or mononucleosis. Epstein-Barr virus is a possible cause, but the markers of exposure to the virus are not sensitive to show a specific causation.

The prevalence is impossible to state with precision, varying from 7 to 38 cases/100,000 population. This variation may be due to differences in psychologic or genetic makeup, social acceptability, or exposure to an infectious or toxic agent or to differences in diagnosing. Women are affected 1.3 to 1.7 times more often than men. Chronic Fatigue Syndrome primarily afflicts Caucasian women between the ages 25 and 45.

Allergic reactions have also been proposed as the aetiology; about 65% of patients complain of previous allergies, and for them, the rate of cutaneous reactivity to inhalants or foods is 25 to 50% higher than that in the general population.

Typically, CFS arises suddenly in a previously active individual. An otherwise unremarkable flu-like illness or some other acute stress leaves unbearable exhaustion in its wake. Other symptoms, such as headache, sore throat, tender lymph nodes, muscle and joint aches, and frequent feverishness, lead to the belief that an infection persists, and medical attention is sought. Over several weeks, despite reassurances that nothing serious is wrong, the symptoms persist and other features of the syndrome become evident—disturbed sleep, difficulty in concentration, and depression.

Many patients report that diverse complaints are linked—that during periods of greatest fatigue they perceive the most pain and difficulty with concentration. Patients also commonly assert that excessive physical or emotional stress may exacerbate their symptoms.

Symptoms of CFS

The main symptom is severe fatigue, generally longer than 6 months, which impairs daily life and is often made worse by exertion, exercise, headache, sore throat, and other stresses. It may be accompanied by enlarged, painful lymph nodes; sore throat; headache; joint pain; abdominal pain; muscle pain; low-grade fever; and cognitive difficulty, especially difficulty concentrating and sleeping. Many patients relate symptom onset to a viral-like syndrome, with swollen glands, extreme fatigue, fever, and upper respiratory symptoms.

Mild to moderate depression is present in half to two-thirds of people. Much of this depression may be reactive to the health situation, but its prevalence exceeds that seen in other chronic medical illnesses.

Diagnosis and Pharmaceutical Interventions

Because the cause is unknown, diagnostic evaluation aims to exclude conditions which may have a distinct cause and treatment first. A reasonable assessment includes looking at blood cell values and chemistries, and evaluation of some hormones such as thyroid. In some cases, and tests for antinuclear antibody, rheumatoid factor, Lyme disease antibody, hepatitis A or B antibodies, and HIV antibody should be added.

Pharmaceutical Medications

Treatment for CFS is needs to be individualised, geared towards reducing pain with making the fatigue worse. Non-steroidal anti-inflammatory drugs (NSAID’s) alleviate headache, diffuse pain, and feverishness. NSAID’s include over the counter medications like aspirin, ibuprofen, panadol as well as prescription medications like celebrex, and voltaren. NSAIDS can cause bleeding ulcers in the stomach, and may interfere with normal bleeding times.

Antidepressants appear to be the most successful treatment studied so far; as many as 80% of patients report benefit. Non-sedating antidepressants improve mood and disordered sleep and may attenuate the fatigue. However, a host of potential side-effects (or symptoms of withdrawal) accompany the use of many antidepressants. Some of the most serious of these are: anxiety, asthenia – loss of bodily strength, blurred vision, constipation , decreased ability to think clearly, development of drug dependency, development or worsening of suicidal tendencies, dizziness, dry mouth, insomnia , loss of libido and other sexual side effects, nausea, nervousness, rash , somnolence – sleepiness or a lack of energy and activity, and sustained increase in blood pressure (hypertension).

Lifestyle and Dietary Modifications

Exercise is important to prevent the worsening of fatigue. Many people report feeling better after undertaking a moderate exercise plan. However, most people with CFS are sensitive to overexertion, and excessive exercise may lead to consistently worsening fatigue and mental functioning. Exercise should be attempted gradually, starting with very small efforts. Intermittent exercise, in which patients walked for three minutes followed by three minutes of rest for a total of 30 minutes, usually does not create fatigue or make symptoms worse.

Eating a whole foods based vegan diet may improve body pain in some pain syndromes, including CFS. A vegan diet excludes all animal products, and increases the amount of vegetables and fruits, which are high in antioxidants.

Nutritional Factors Shown to be Beneficial

Magnesium

Magnesium is an essential mineral needed for proper muscle relaxation. Levels may be levels low in CFS sufferers. Magnesium that is bound to an organic compound called malic acid is absorbed form the body in higher amounts and may have an effect in reducing the pain of CFS.
Dose: 200-300 mg three times day.

B vitamin complex

Some people with CFS have reduced B-vitamin status when compared to people without the condition. B Vitamins are involved in many metabolitic processes in the body, including energy producing reactions.
Dose: B vitamin complex, 50 mg a day

L Carnitine

L-carnitine is required for energy production, and is extensively used by cells in muscle tissue. Deficiencies of carnitine are common in some CFS sufferers.
Dose: 1 gram of carnitine a day

Omega 3 Fish Oil

Low levels of essential fatty acids (EFAs) appear to be a common finding in chronic fatigue syndrome. With supplementation symptoms including fatigue, depression, aches and pains, showed a significantly greater improvement. Dose: 2-6 grams a day Vitamin C Depression is the first symptom of experimentally induced scurvy, the condition caused by vitamin C deficiency. Supplementing with Vitamin C produces an analgesic effect, as well as improves the immune response.
Dose: 3-6 grams a day

5-Hydroxytryptophan (5-HTP)

CFS suffers may have low levels of tryptophan, the dietary precursor of serotonin. 5-HTP, a metabolite of tryptophan and immediate precursor of serotonin may offer improvement in fatigue, pain intensity, anxiety, and sleep quality.
Dose: 50-300 mg three times a day

CoQ-10

CoQ-10 improves the energy of the cell. With supplementation, people with CFS may show improved exercise tolerance.
Dose: 30 -100 mg a day

Eleuthero (Eleuthrococcus senticosus)

Eleuthero, also called Siberian ginseng, is an adaptogenic herb. It may be useful for CFS patients—the herb not only has an immunomodulating effect but also helps support the normal function of the hormonal stress system of the body.
Dose: 300- 400 mg a day of the standardized extract

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