When Fatigue Becomes Chronic

Following a bout of mononucleosis in college, Sheila never felt the same.

As a teacher, she was constantly catching her students’ colds and flu viruses. On weekends, she liked to restore furniture, which exposed her to toxic chemicals. During summer vacations, she traveled abroad and, after one lengthy trip, came down with a month-long flu that wiped her out for months afterward. Even after several courses of antibiotics, Sheila continued to have a sore throat and aching muscles, along with periodic fevers. If she tried to exercise, she ended up in bed for days. But despite feeling exhausted, she couldn’t sleep. Depressed, she found herself unable to concentrate or continue teaching, and she could barely care for herself. 

Luckily for Sheila, her doctor told her about research at a local university comparing treatments for chronic fatigue syndrome (CFS). As a study volunteer, she had weekly assessments, 24-hour urine collections, blood tests, and questionnaires. She learned that her magnesium level had been extremely low, but after supplementing with 300 mg of this mineral twice daily, her fatigue lessened, and poor concentration, mood, and muscle weakness improved.
What’s clear is that this condition is not the same as feeling rundown from overwork. While symptoms and solutions for chronic fatigue vary from person to person, the following characterize this condition:
  • persistent fatigue that bed rest does not resolve
  • inability to perform half of one’s normal daily activities for at least six months
  • no other chronic conditions that might explain such severe fatigue. 
Between one and four million Americans have CFS. Of that number, four times more women than men have chronic fatigue. Fibromyalgia, or muscle pain all over the body (e.g., tenderness in 11 out of 18 possible trigger points), commonly accompanies CFS, as can anxiety, brain fog, candidiasis, decreased libido, frequent fevers, headaches, intestinal problems and pain, night sweats, recurrent upper respiratory tract infections, sensitivity to heat and light, sleep disturbances, swollen lymph nodes, unexplained sore throat, and weight gain. 
Dan Kenner, PhD, OMD, finds chronic fatigue symptoms correspond with low NK (natural killer) cell function. Like sentinels of a fort, NK cells are the first to encounter invading pathogens, he explains. “When NK cell function is high, pathogens are nipped in the bud,” before they can take hold, “and the rest of the immune system tends to be downregulated, rested, and better prepared to respond if called upon.”
Possible Causes
Some experts link CFS to infection with Epstein-Barr and/or cytomegalovirus (CMV), members of the herpes virus family. “Immune system difficulty somehow pulls down hormonal function,” adds integrative practitioner Martin Feldman, MD. “Almost all patients with this syndrome have low adrenal function, and many have low thyroid function.” 
Researchers at Emory University School of Medicine in Atlanta have found that 62 percent of chronic fatigue sufferers experienced some form of childhood trauma as well as glandular fever, Lyme disease, gastroenteritis, chickenpox, salmonella, or viral meningitis. “Allopathic drugs, conventional drugs, antibiotics, and steroids are major influences,” notes homeopathic physician Michele Galante, MD. “The use and abuse of these drugs in childhood, for example, sets up chronically weakened conditions that will extend into adulthood” and predispose that individual to chronic fatigue.
Environmental factors—chlorine in water to air pollution and electromagnetism from cell phones and similar devices—may also be culprits, possibly helping to explain the recent “outbreak” of chronic fatigue. A new study in the U.K. suggests that aluminum-containing adjuvants in vaccines can trigger the cascade of immunological events associated with CFS, for example. Other likely causes include anemia, allergies, arthritis, food additives, gluten, heavy metal toxicity, hypoglycemia, hypothyroidism, poor diet, nutritional deficiencies, and stress. “The patients I’ve seen have been very allergic,” adds Dr. Galante, not just to pollens and airborne agents but especially to foods and harmful chemicals. Intestinal parasites are also fairly common among people with chronic fatigue. 
Diagnosis & Support
Sheila was fortunate to find a healthcare provider who recognized her problem early on. Medically, CFS can only be diagnosed by ruling out other conditions including HIV, lupus, Lyme disease, rheumatoid arthritis, thyroid problems, and tuberculosis. In addition to a thorough medical history and physical, conventional physicians will usually perform a complete blood count, erythrocyte sedimentation rate to measure inflammation, blood glucose tests, thyroid-stimulating hormone tests, and more. 
People with CFS are as sick and functionally impaired as [those] with AIDS, breast cancer, or chronic obstructive pulmonary disease, finds William Reeves, MD, at the Centers for Disease Control. “Which treatments work varies from person to person,” adds Jacob Teitelbaum, MD, a researcher who trains other healthcare personnel about this condition. Overall, he recommends the following approach to CFS and fibromyalgia:
  • Sleep, preferably eight to nine hours a night
  • Hormone testing and treatment if needed
  • Infections prevented and treated
  • Nutritional supplements, as recommend by a nutritionally-trained practitioner
  • Exercise as able, starting slowly. 
“Optimal nutritional supplementation is essential,” he adds, as many nutrients can be depleted. “B12, magnesium, acetyl-L-carnitine, glutathione, as well as your basic A, B, C, and D vitamins need to be supplemented at a level that your average over-the-counter multivitamin cannot provide.” Some people with CFS may also benefit from intravenous nutritional therapy. 
“Although I strongly recommend taking nutritional supplements to ensure obtaining the necessary nutrients,” Dr. Teitelbaum adds, “I also want to stress that a healthy diet is important.” Fresh fruits and vegetables, plus whole grains are best, but you don’t need a hard-to-follow regimen. “The more unprocessed your diet is, the healthier you will be,” he says.

Be a Healthy Woman! by Gary Null, PhD, with Amy McDonald
“Comparative Epidemiology of Chronic Fatigue Syndrome . . . Prevalance and Recognition” by H. J. Cho et al., Br J Psychiatry, 2/09
“Curcumin, a Polyphenolic Antioxidant, Attenuates Chronic Fatigue Syndrome . . .” by A. Gupta et al., Immunobiology, 2009
“Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia . . .” by J. E. Teitelbaum, MD, et al., J Chr Fatigue Synd, 2001
From Fatigued to Fantastic! by Jacob Teitelbaum, MD
Hope and Help for Chronic Fatigue Syndrome and Fibromyalgia by Alison C. Bested, MD, FRCP(C), et al.
“Inflammatory and Oxidative and Nitrosative Stress Pathways Underpinning Chronic Fatigue . . .” by M. Maes, Curr Opin Psychiatry, 1/09
“L-Theanine May Reduce Stress” by Heather S. Oliff, PhD, HerbClip, 12/31/08
“Low Cortisol Levels May Be Risk Factor in Developing Chronic Fatigue Syndrome” by Madeline Ellis,, 1/9/09
The Magnesium Miracle by Carolyn Dean, MD, ND
“Neuropsychological Functioning, Illness Perception, Mood, and Quality of Life in Chronic Fatigue Syndrome . . .” by A. Dickson et al., Psychol Med, 1/15/09
Pain Free 1-2-3 by Jacob Teitelbaum, MD
Prescription for Natural Cures by James F. Balch, MD, and Mark Stengler, ND
Prescription for Nutritional Healing by Phyllis A. Balch, CNC
“A Role for the Body Burden of Aluminum in Vaccine-Associated . . . Chronic Fatigue Syndrome” by C. Exley et al., Med Hypotheses, 2/09
“The SHINE Approach and Treatment Protocol”; “Steps to Getting Well,”



Symptoms and Solutions

While symptoms and solutions for chronic fatigue vary from person to person, the following characterize this condition:

1. Persistent fatigue that bed rest does not resolve

1. Inability to perform half of one’s normal daily activities for at least six months

3. No other chronic conditions that might explain such severe fatigue.