Chronic Fatigue Syndrome

Diagnostic summary

Mild fever, recurrent sore throat, painful lymph nodes, muscle weakness, muscle pain, prolonged fatigue after exercise, recurrent headache, migratory joint pain, depression, sleep disturbance.

Aetiology

• Epstein-Barr virus: EBV-herpes viruses produce latent lifelong infections; host’s immune system normally holds latent infection in check; immunocompromise allows recurrence; viral infection itself can disrupt immunity; elevated EBV antibody observed in diseases of immune dysfunction; elevated antibody titers to viruses observered in
CFS patients; antibody testing useful as measure of immune function and host resistance, but not reliable for diagnosis of CFS.

• Other infections agents under investigation: human herpes virus-6, Inoue-Melnich virus, Brucella, Borrelia burgdorferi, Giardia lamblia, cytomegalovirus, enterovirus, retrovirus.

• Immune system abnormalities: elevated antibodies to viral proteins; decreased natural killer (NK) cell activity; low or elevated antibody levels; increased or decreased levels of circulating immune complexes; increased cytokines (e.g. interleukin-2); increased or decreased interferon; altered helper/suppressor T-cell ratio.

• CFS, fibromyalgia (FM), and multiple chemical sensitivities (MCS): only difference in diagnostic criteria for FM and CFS is musculoskeletal pain in FM and fatigue in CFS; diagnosis of FM or CFS depends on type of physician consulted; 70% of patients with FM and 30% with MCS meet CSC criteria for CFS; 80% of both FM and MCS patients meet CFS criterion of fatigue for > 6 months with 50% reduction in activity; > 50% of CFS and FM patients have adverse reactions to various chemicals.

• Other causes of CFS: pre-existing pathosis, depression, stress/low adrenal function, impaired liver function and/or environmental illness, impaired immunity, food allergies, hypothyroidism, hypoglycaemia, anaemia and nutritional deficiencies, sleep disturbances, cause unknown.

Diagnosis

• Identify as many factors as possible contributing to fatigue.

• Complete physical exam: swollen: swollen lymph nodes (chronic infection); diagonal crease in both ear lobes (impaired blood flow).

• ICIM Lab tests: avoid expensive tests unless absolutely necessary, CBC and chemistry panel (including serum ferritin for menstruating women); avoid tests to confirm diagnosis that will not affect treatment; assess liver detox function, bowel dysbiosis and gastrointestinal permeability.

• Computerise Thermographic Imaging (CTI) at ICIM is very useful for identifying hepatic stress, gastrointestinal problems, compromised immune system (thymus gland).

• Stool analysis – ICIM provide patients with this option of testing to check for underlying parasitic infection that can contribute to gastrointestinal problems.

• ICIM blood analysis : extremely useful miscroscopy analysis which can identify white blood cell count and quality. Very useful for determining the immune status of the patient involved, it can also identify infection ; bacterial, yeast, signs of allergic responses, signs of leaky gut, signs of maldigestion.

Therapeutic considerations

• Multifactorial conditions require tailored multiple therapies.

• Energy level and emotional state determined by internal focus and physiology; mental focus on fatigue; physiology – chemicals, hormones, posture, breathing (shallow), address mind and body.

• Depression: a major cause of chronic fatigue (CF); common in CFS; most common cause of CF in absence of pre-existing pathosis.

• Stress: underlying factor in patient with depression, low immune function, or other cause of CF; evaluate stress effects.

• Impaired liver function and/or environmental illness: exposure to toxins causes ‘congested liver’ / ‘sluggish liver’ / ‘impaired hepatic detoxification’, leading to cholestasis and decreased phase I and / or phase II enzyme activity; use clinical judgement and lab tests (serum bilirubin, AST, ALT, LDH, GGTP, serum, bile acid assay, clearance tests); patient complaints: depression, general malaise, headaches, digestive disturbances, allergies and chemical sensitivities, premenstrual syndrome, constipation; hair mineral analysis; heavy metals – if inconclusive – lab tests to measure white cell sensitivity to heavy metal toxins.

• Excessive Gastrointestinal permeability: measured by lactulose/mannitol absorption test; common finding in CFS; utilise food allergy control, nutrients to stimulate gastrointestinal regeneration, support hepatic phase I and II detox, and oligoantigenic rice protein food replacement formula.

• Impaired immune function and/or chronic infection: fatigue is body’s response to infection; immune system works best when body rests.

• Chronic Candida infection: impaired immunity allows gastrointestinal Candida overgrowth; diagnosis difficult; no single specific test; stool cultures and elevated Candida antibody levels plus detailed history and patient questionnaire.

• Food allergies: CF is a key feature of food allergies = ‘allergic toxemia’; fatigue, muscle/joint aches, drowsiness, difficulty concentrating, nervousness, depression, 85% of people with CFS have allergies.

• Hypothyroidism: most common cause of CF often overlooked; failure to treat reduces efficacy of other interventions.

• Hypoglycemia: must be ruled out as it contributes to depression; depressed people suffer from hypoglycaemia and depression is most common cause of CF.

• Hypoadrenalism: disruption of hypothalamic-pituitary-adrenal axis (HPA) may be major feature of CFS; symptoms of clucocorticoid deficiency; debilitating fatigue, stressing event followed by feverish, arthralgias, myalgias, adenopathy, post-exertional fatigue, exacerbation of allergic responses and disturbances of mood and sleep, pathophysiological antecedents (acute infection, stress, pre-existing/concurrent psychiatric illness) may converge into CFS; patients have reduced evening cortisol levels, low 24-h urinary free cortisol excretion, elevated basal ACTH, increased adrenal cortical sensitivity to ACTH, but reduced maximal response, and attenuated net integrated ACTH response to corticotrophin-releasing hormone; may reflect secondary adrenal insufficiency; adrenal ACTH receptors hypersensitive from inadequate exposure to ACTH and overall adrenal atrophy.

• Mind and attitude: mental attitude influences immunity and energy level; many with CFS are either depressed or have lost sense of enthusiasm for life.

Diet

Energy level directly related to food quality; eliminate caffeine and refined sugar; degree of fatigue is related to quantity of caffeine; cessation of coffee may cause caffeine withdrawal symptoms; fatigue, headache, intense desire for coffee for a few days.

Nutritional supplements

• High-potency vitamin-mineral: deficiency of any nutrient can produce fatigue and susceptibility to infection.
• Extra vitamin C
• Magnesium : even subclinical deficiency can cause CF

Other therapies

• Breathing, posture, and bodywork: diaphragm breathing, good posture, bodywork (massage, spinal manipulation, etc.)

• Exercise: moderate level improves mood, ability to handle stress, increases (up to 100%) NK activity; stimulates immune system; intense exercise can have opposite effect.

Botanical medicines

• Eleutherococcus senticosus (Siberian ginseng): supports adrenals; non-specific adaptogen, increases T-helper cells and NK activity – valuable in treating CFS.
• Glycyrrhiza glabra (licorice): antiviral and glucocorticoid-potentiating properties; use whole root, as glucocorticoid-potentiating glycyrrhiza and glycyrrhetinic acids are removed from DGL.

Therapeutic approach

At ICIM Medics a comprehensive diagnostic and therapeutic approach is taken to: identify underlying factors; optimise hepatic detox, control food allergy, restore gastrointestinal function, and support immune function.

• Diet: Identify and control food allergies; increase water; eliminate caffeine and alcohol; whole organic foods; control hypoglycaemia – eliminate sugar and refined foods, and take regular healthy small meals and snacks; use medical food replacement (e.g. Ultraclear) for several weeks to speed detox.

• Lifestyle: diaphragmatic breathing; proper posture; regular low intensity exercise.

• Supplements:

• - high-potency vitamin-mineral
• - vitamin C
• - vitamin E
• - thymus extract
• - magnesium bound to citrate or Krebs intermediates
• - pantothenic acid

Botanicals

• • Eleutherococcus senticosus
• • Glycyrrhiza glabra

Counselling: directly or referral to professional counsellor to reinforce pattern of mental, emtotional, and spiritual affirmations.

For more information on this topic please call ICIM Medics on +353 45 844 819 or email us at info@icim.ie

Tags: Headache, muscle pain