Managing Chronic Fatigue Syndrome

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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)

Man rubbing his temples

Chronic fatigue syndrome can rob you of the ability to fully participate in life.

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)

Various nutrient-rich foods

Creating a diet that revolves around nutrient-rich whole foods can provide vitamins and minerals that are often in short supply in those with chronic fatigue syndrome.

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.


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)


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, 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)

Person holding a pill and a glass of water

Taking melatonin before going to bed can help promote better sleep while also supporting cognition and a healthier immune system.


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)


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.

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  1. Adamczyk-Sowa, M., Sowa, P., Adamczyk, J., Niedziela, N., Misiolik, H., Owczarek, M., & Zwirska-Korczala, K. (2016). Effect of melatonin supplementation on plasma lipid hydroperoxides, homocysteine concentration and chronic fatigue syndrome in multiple sclerosis patients treated with interferons-beta and mitoxantrone. Journal of Physiology and Pharmacology, 67(2), 235-242.
  2. Alegre, J., Rosés, J.M., Javierre, C., Ruiz-Baqués, A., Segundo, M.J., & Fernández de Sevilla, T. (2010). Nicotinamide adenine dinucleotide (NADH) in patients with chronic fatigue syndrome. Revista Clinica Espanola, 210(6), 284-288.
  3. American Myalgic Encephalomyelitis and Chronic Fatigue Syndrome Society. Diet.
  4. Bjørklund, G., Dadar, M., Pen, J.J., Chirumbolo, S., & Aaseth, J. (2019). Chronic fatigue syndrome (CFS): suggestions for a nutritional treatment in the therapeutic approach. Biomedicine & Pharmacotherapy, 109, 1000-1007.
  5. Cantó, C., Menzies, K., & Auwerx, J. (2015). NAD+ metabolism and the control of energy homeostasis – a balancing act between mitochondria and the nucleus. Cell Metabolism, 22(1), 31-53.
  6. Castro-Marrero, J., Cordero, M.D., Segundo, M.J., Sáez-Francàs, N., Calvo, N., Román-Malo, L., Aliste, L., … Alegre, J. (2014). Does oral coenzyme Q10 plus NADH supplementation improved fatigue and biochemical parameters in chronic fatigue syndrome? Antioxidant Redox Signaling, 22(8), 679-685.
  7. Castro-Marreo, J., Sáez-Francàs, N., Segundo, M.J., Calvo, N., Faro, M., Aliste, L., Fernández de Sevilla, T., Alegre, J. (2016). Effect of coenzyme Q10 plus nicotinamide adenine dinucleotide supplementation on maximum heart rate after exercise testing in chronic fatigue syndrome—a randomized, controlled, double-blind trial. Clinical Nutrition, 35(4), 826-834.
  8. Centers for Disease Control and Prevention. (2020). Myalgic encephalomyelitis/chronic fatigue syndrome.
  9. Centers for Disease Control and Prevention. (2018). What is ME/CFS?
  10. Daniels, J., Brigden, A., & Kacorova, A. (2017). Anxiety and depression in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): examining the incidence of health anxiety in CFS/ME. Psychology and Psychotherapy, 90(3), 502-509.
  11. Forsyth, L.M., Preuss, H.G., MacDowell, A.L., Chiazze Jr., L., Birkmayer, G.D., & Bellanti, J.A. (1999). Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Annals of Allergy, Asthma & Immunology, 82(2), 185-191.
  12. Griffith, J.P. & Zarouff, F.A. (2008). A systematic review of chronic fatigue syndrome: don’t assume it’s depression. Primary Care Companion to the Journal of Clinical Psychiatry, 10(2), 120-128.
  13. Hempel, S., Chambers, D., Bagnall, A.M., & Forbes, C. (2008). Risk factors for chronic fatigue syndrome/myalgic encephalomyelitis: a systematic scoping review of multiple predictor studies. Psychological Medicine, 38(7), 915-926.
  14. Institute of Medicine. (2015). Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. Committee for the Diagnostic Criteria for Myalgic Encephalomyelis/Chronic Fatigue Syndrome.
  15. Maes, M., Mihaylove, I., Kubera, M., Uytterhoeven, M., Vrydags, N., & Bosmans, E. (2008). Coenzymes Q10 deficiency in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is related to fatigue, autonomic and neurocognitive symptoms and is another risk factor explaining the early mortality in ME/CFS due to cardiovascular disorder. Neuro Endocrinology Letters, 30(4), 470-476.
  16. Mahoney, D.E., Hiebert, J.B., Thimmesch, A., Pierce, J.T., Vacek, J.L,. Clancy, R.L., Sauer, A.J., & Pierce, J.D. (2018). Understanding D-ribose and mitochondrial function. Advanced Bioscience and Clinical Medicine, 6(1), 1-5.
  17. Medline Plus. (2020). Chronic Fatigue Syndrome.
  18. Office of Women’s Health. (2019). Chronic Fatigue Syndrome.
  19. Roman, P., Carrillo-Trabalón, F., Sánchez-Labraca, N., Cañadas, F., Estévez, A.F., & Cardona, D. (2018). Are probiotic treatments useful on fibromyalgia syndrome or chronic fatigue syndrome patients? A systematic review. Beneficial Microbes, 9(4), 603-611.
  20. Santaella, M.L., Font, I., & Disdier, O.M. (2004). Comparison of oral nicotinamide adenine dinucleotide (NADH) versus conventional therapy for chronic fatigue syndrome. Puerto Rico Health Sciences Journal, 23(2), 89-93.
  21. Sapra, A. & Bhandari, P. (2020). Chronic Fatigue Syndrome. In: StatPearls (Internet).
  22. Sullivan, A., Nord, C.E., & Evergård, B. (2009). Effect of supplement with lactic-acid producing bacteria on fatigue and physical activity in patients with chronic fatigue syndrome. Nutrition Journal, 8, 4.
  23. Teitelbaum, J.E., Johnson, C., & St. Cyr, J. (2006). The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study. The Journal of Alternative and Complementary Medicine, 12(9), 857-862.
  24. Timbol, C.R. & Baraniuk, J.N. (2018). Chronic fatigue syndrome in the emergency department. Open Access Emergency Medicine, 2019(11), 15-28.
  25. van Heukelom, R.O., Prins, J.B., Smits, M.G., & Bleijenberg, G. (2006). The European Journal of Neurology, 13(1), 55-60.
  26. Wallis, A., Ball, M., Butt, H., Lewis, D.P., McKechnie, S., Pauli, P., Jaa-Kwee, A., & Bruck, D. (2018). Open-label pilot for treatment targeting gut dysbiosis in myalgic encephalomyelitis/chronic fatigue syndrome: neuropsychological symptoms and sex comparisons. Journal of Translational Medicine, 16(1), 24.
  27. Williamson, C.B., Burns, C.M., Gossard, C.M., Pizano, J.M., Dolan, K.E., Finley, H.J., Gasta, M.G., … Lipski, E.A. (2017). Probiotics and disease: a comprehensive summary—part 3, cardiometabolic disease and fatigue syndrome. Integrative Medicine: A Clinician’s Journal, 16(1), 30-41.


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