Managing Chronic Fatigue Syndrome

Imagine not being able to get out of bed in the morning, despite getting a good night’s sleep. Or suddenly experiencing such debilitating fatigue that you aren’t able to take part in everyday activities. These are common experiences of those with chronic fatigue syndrome, a condition that affects up to 2.5 million people in the United States. Among those, at least twice as many women suffer from chronic fatigue than men. (8)

Despite its prevalence and its debilitating nature, chronic fatigue syndrome wasn’t a recognized medical condition until the late 1980s. (14) Even today, as symptoms can resemble a variety of other illnesses, getting a definitive diagnosis can be challenging. One survey of 282 emergency room patients found that 42% of those with chronic fatigue syndrome reported being dismissed by doctors as having psychosomatic complaints. (24) Fortunately, ongoing research is contributing to a greater understanding among both health care providers and patients.

Did you know? Approximately 90% of people with chronic fatigue syndrome have not been diagnosed. (9)

What is chronic fatigue syndrome?

Chronic fatigue syndrome, which is also known as myalgic encephalomyelitis or systemic exertion intolerance disease, is a long-term condition that can interfere with daily life. Characterized by extreme fatigue that lasts for more than six months, chronic fatigue syndrome primarily affects individuals between the ages of 40 and 60. (17) Symptoms can be mild or severe and may come and go. They may also develop over time or come on suddenly and without warning. (17)(18)

Chronic fatigue syndrome symptoms

Symptoms and severity can change from day to day, making life with chronic fatigue syndrome very unpredictable. Symptoms can also last for weeks, months, or even years. Common symptoms include:

• Difficulty concentrating or paying attention
• Dizziness or fainting upon standing
• Extreme exhaustion for more than 24 hours after physical or mental exertion
• Gastrointestinal problems
• Headaches
• Joint pain
• Low-grade fever
• Mood changes
• Muscle aches or pain
• Poor memory
• Sleep issues
• Sore throat
• Tender lymph nodes in the neck or under the arm (18)(12)(21)

Causes of chronic fatigue syndrome

While the cause of chronic fatigue syndrome remains unknown, several theories have been proposed. Some researchers speculate that it can be triggered by a flu-like illness or other viral infections such as Epstein-Barr or herpes. Others with the syndrome report that symptoms first appeared after extreme physical stress such as surgery. (18) Potential triggers may also include an impaired immune system, emotional trauma, or hormonal imbalances produced by the hypothalamus, pituitary glands, or adrenal glands (known as the HPA axis). However, to date, the only risk factors that have been directly linked to chronic fatigue syndrome are age and gender. (13)

Did you know? Although most people with chronic fatigue syndrome don’t develop the condition until they hit middle age, it can affect children and adults regardless of ethnicity, economic status, and geographic location. (9)

How to treat chronic fatigue syndrome

Since there is no readily identifiable cause of chronic fatigue syndrome and no way to test for the condition, it can be hard to diagnose, especially since symptoms can mimic other diseases. As a result, it’s not uncommon for healthcare practitioners to conduct tests in order to rule out other diseases like fibromyalgia or hypothyroidism before diagnosing chronic fatigue. (17)(21)

Once a diagnosis has been made, chronic fatigue syndrome treatment focuses primarily on managing symptoms. This can include lifestyle changes and supplements. Because approximately 30% to 40% of people with chronic fatigue syndrome develop depression, some healthcare practitioners may also prescribe an antidepressant medication. (10)

The chronic fatigue syndrome diet

The American Myalgic Encephalomyelitis and Chronic Fatigue Syndrome Society recommends that chronic fatigue patients avoid the following:

• Alcohol
• Animal fats
• Artificial colors and flavors
• Natural or artificial sweeteners, including sugar
• Stimulants like coffee, tea, or caffeinated sodas
• Preservatives such as MSG that may excite the nervous system (3)

Furthermore, individuals with chronic fatigue syndrome commonly experience unique dietary challenges, including food sensitivities and nutrient deficiencies. About two-thirds of chronic fatigue patients suffer from gastrointestinal issues, such as heartburn, nausea, diarrhea, or constipation. According to the American Myalgic Encephalomyelitis and Chronic Fatigue Syndrome Society, many of these chronic fatigue-related digestive problems may be caused by food sensitivities. (3) Keeping a food journal can help identify problematic foods. Your practitioner may also recommend an elimination diet or other food sensitivity testing to pinpoint foods that trigger symptoms.

People with chronic fatigue syndrome may also suffer from nutrient deficiencies. For example, low levels of vitamin C, B vitamins, magnesium, zinc, l-carnitine, and essential fatty acids have been found to negatively impact immune function and aggravate symptoms. (4) Eating a whole foods diet based on nutrient-rich foods, however, may help provide these critical nutrients. Your health care practitioner can help you plan and monitor your diet, and can also recommend supplementation as required to prevent deficiencies or help manage symptoms.

Supplements for chronic fatigue syndrome

Studies suggest that the following supplements may play an important role in managing symptoms and may help reduce the risk of nutrient deficiencies in those with chronic fatigue syndrome.

CoQ10

Individuals with chronic fatigue syndrome have been shown to have abnormally low coenzyme Q10 levels, which can negatively affect cellular energy levels. According to one study of 58 patients with chronic fatigue syndrome and 22 healthy controls, those with CFS had significantly lower CoQ10 levels, and those with the lowest levels reported the most severe fatigue and memory problems. (15) Fortunately, other studies have found that combining supplemental CoQ10 with nicotinamide adenine dinucleotide (NADH) increased adenosine triphosphate (ATP) levels (your body’s main form of cellular energy), and significantly reduced symptoms of fatigue in individuals with the condition. (6)(7)

NADH

Nicotinamide adenine dinucleotide, also known as NADH or NAD+, is produced in the body from niacin (vitamin B3). As it plays a role in generating cellular energy, taking NADH in supplement form may be beneficial to those with chronic fatigue syndrome. (5) Several clinical trials report that NADH reduces symptoms of fatigue and anxiety, while potentially improving other symptoms of chronic fatigue. (2) (11) (20) One study, which appeared in the journal Antioxidants and Redox Signaling, reported that combining NADH with CoQ10 provided significant improvement in physical and cognitive abilities in 73 women with chronic fatigue syndrome. What’s more, as noted above, taking these two nutrients concomitantly increased the concentration of ATP in the bloodstream. (6)

D-ribose

D-ribose, a simple sugar, is a component of your DNA and of ATP, the primary energy source for your cells. (16) One pilot study involving 41 people with either fibromyalgia or chronic fatigue syndrome found that taking 15 g of d-ribose daily improved pain intensity, well-being, energy, mental clarity, and sleep. (23)

Melatonin

Melatonin, a hormone naturally produced by the body, regulates your sleep-wake cycles. It also provides anti-oxidative, immune, and anti-inflammatory benefits. (1) Among 29 patients with chronic fatigue syndrome who had difficulty falling asleep, taking 5 mg of supplemental melatonin before bedtime not only improved fatigue, it also boosted their activity levels and ability to concentrate. (25)

Probiotics

Chronic fatigue syndrome can also negatively impact mood, immunity, and, in many people, the gastrointestinal tract, all problems that may indicate a state of dysbiosis (an imbalance in your gut bacteria). As a result, some researchers have explored the possible role probiotics as a therapeutic approach. (27) One review that appeared in the journal Beneficial Microbes found that two probiotic strains, Lactobacillus casei shirota and Bifidobacterium infantis­, reduced anxiety and inflammatory markers. (19) Other studies focused on the gut-brain axis have suggested that certain probiotic strains may improve overall symptoms, sleep, and cognition. (26) (22)

The bottom line

Chronic fatigue syndrome is a long-term condition that can interfere with your ability to engage in daily activities. Identifying effective ways to manage your symptoms can take time, but working with an integrative healthcare practitioner familiar with the condition is a good place to start. They may be able to offer strategies that can help minimize your symptoms and improve your ability to take part in everyday activities.