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Chronic Fatigue Syndrome: The Nutritional Approach

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Headlines herald chronic fatigue syndrome (CFS) as the malaise of a generation and life. The syndrome entered public consciousness in the mid-1980s when an epidemic of a mysterious illness with symptoms akin to an exhausting and never-ending flu struck roughly 200 residents of a small Nevada town. Today, CFS is widespread, generating support groups and causing charitable organizations and government to unite in combating this debilitating illness.

What is CFS?

CFS is a complex illness marked by incapacitating fatigue, exhaustion, extremely poor stamina, neurological complaints, and an array of symptoms that can resemble other disorders. Some of the disorders that CFS may masquerade as are mononucleosis, multiple sclerosis, fibromyalgia, AIDS-related complex (ARC), Lyme disease, post-polio syndrome, and auto-immune diseases such as lupus.

Detoxification Agents

Antioxidant Vitamins and Minerals


Dietary Fibers (soluble and insoluble)




Milk Thistle (Silymarin)

N-acetylcysteine (NAC)



Proteolytic Enzymes (Pancreatin, Bromelain)

Symptoms of CFS tend to ebb and flow over periods lasting a few months or even years, at times becoming severely debilitating. In addition to pain and fatigue, symptoms ay include low-grade fever, sore throat, swollen lymph nodes, intestinal discomfort, and depression.

CFS is also known as chronic fatigue immune deficiency syndrome (CFIDS). In Britain, it is called myalgic encephalomyelitis. It has also been irreverently dubbed “yuppie flu,” since many victims are white, educated professionals in their 20s and 30s. CFS, however, does not discriminate among members of society, although women under the age of 45 appear to be most susceptible.

What Causes CFS?

The exact cause of CFS is unknown. For awhile it was believed that the Epstein-Barr virus (EBV) that causes mononucleosis was the culprit (EBV is present in more than 90% of American adults, usually in latent form). The thinking today seems to be that activation of Epstein-Barr (when it exists) is a result or complication of CFS rather than the cause.

It is clear that the immune system is affected in CFS, although a paradox exists. In general, the dysfunction manifests as an unregulated/overactive immune response characterized by head and body pain and migrating joint pain. On the other hand, in many sufferers there are also symptoms of immune suppression such as a functional deficiency in natural killer cells responsible for protection against viruses and cancer.

Research efforts are directed toward identifying fundamental agents responsible for triggering the disruption of the immune system. Stress and environment are also being researched because of their impact on the immune system. Avoidance of environmental irritants and sensitizing foods that cause an individual allergic reaction are known to relieve symptoms of CFS.

Diagnosing CFS

Because CFS has similar and overlapping features with other diseases, diagnosis is difficult. Most physicians familiar with the syndrome make the diagnosis by excluding other diseases or conditions and determining whether the patient fulfills certain criteria for signs and symptoms delineated by the Centers for Disease Control (CDC) in Atlanta. Symptoms of CFS, however, are individualistic and some practitioners believe that the official diagnostic criteria excludes too many patients. At present, there is no definitive test to determine a diagnosis of CFS.

Often, a CFS diagnosis is missed because of physician bias. Since fatigue and pain are subjective and can’t be seen, measured, or spotted in a blood test, the problem is often downplayed by physicians. The blood of CFS patients is often statistically no different from that of healthy control subjects, and if an abnormality can’t be found, doctors may think symptoms are imaginary. If a patient says he or she feels tired all of the time and the doctor can’t find anything wrong, the patient is often told the problem “in his or her head.”

Energy Enhancers

Coenzyme Q10





Liver Extract, Adrenal Tissue


Malic Acid

Mexican Yam

Pantothenic Acid



Vitamin B-12

Conventional and Alternative

There is no officially recognized treatment for CFS. Conventional treatment includes the use of antidepressants such as Prozac® and the pain relievers ibuprofen and naproxen. Occasionally, non-toxic therapies such as gamma globulin and interferon are employed. Gamma globulin is a fraction of blood serum closely associated with immune bodies. Interferon is a cellular protein that acts to prevent replication of viruses within infected cells.

Most CFS patients use at least one form of alternative therapy such as nutrition, herbs, acupuncture, deep tissue massage, chiropractic or biofeedback therapy to relieve symptoms. Broad spectrum nutrient support is critical for CFS suffers because of a possible defect in cellular energy production and/or a risk of decreased vitamin utilization.

Many patients and doctors report an improvement in symptoms with dietary supplements. Paul Cheney, M.D., of Charlotte, N.C., Jay Goldstein, M.D., of Anaheim Hills, Calif., Daniel Peterson, M.D., of Incline Village, Calif., and other prominent physicians are currently recommending a combination of malic acid and magnesium for their CFS patients. Both of these nutrients play a role in the production of adenosine triphosphate (ATP), the basic energy “currency” of the body.

Malic acid, a fruit acid, is an integral component of the Krebs cycle that transforms fats and glucose into energy. The combination creates a partnership important to muscle health and is potentially helpful in reducing the muscle pain associated with a deficiency of ATP-intensive nutrients. Peterson reports that 40 % of his patients who try the supplement benefit from it.

Physicians usually start their patients on a small dose of both magnesium and malic acid taken with their food, and gradually work their way up to as much as 600 mg magnesium and 2400 mg malic acid to avoid any possibility of gastrointestinal upset. Magnesium works best if taken in the morning when it is pumped into the liver’s circadian cycle and most needed. The magnesium/malic acid combination should be taken for several weeks to give it a fair trial.

Since proper magnesium metabolism is dependent on calcium, a magnesium supplement taken in the morning should be balanced with a calcium supplement in the evening. The best time to take calcium is an hour or two before bedtime (500 to 1000 mg), perhaps with a small snack. Calcium is taken up by the body during periods of inactivity and can be helpful for insomnia, a common problem among CFS sufferers. Calcium citrate is a soluble form easily absorbed.



Aloe Vera Concentrate


Bee Pollen

Cod Liver Oil


Liver Extract

Nutritional Yeast

Royal Jelly


Wheat Grass

Coenzyme Q10 is a supplement highly regarded by CFS patients and clinicians who find that it produces a significant increase in general energy and stamina. CoQ10 is an antioxidant present in the mitochondria of all cells, where it participates in the production of aerobic energy. CoQ10 supplies the biochemical spark that creates energy from food substances. Research suggests that CoQ10 helps power the immune system.

Clinical trials support the use of certain nutrients in CFS. In a trial with 14 CFS patients, the amino acid L-Carnitine was found to be more helpful in improving mental and physical fatigue symptoms in patients than amantadine, a drug used to treat multiple sclerosis-related fatigue. L-Carnitine assists the body in utilizing fat as a source of energy. Previous studies have shown that L-Carnitine increases energy, conserves muscle and liver glycogen (stored sugar), and improves exercise tolerance in heart patients.

CFS and Low Blood Pressure

Recently, researchers at Johns Hopkins Children’s Center reported a link between hypotension (low blood pressure) and symptoms of CFS. In one study, four of seven adolescents between the ages of 12 and 16 had prompt improvement in their chronic fatigue when hypotension was treated with the medication atenolol or disopyramide, for light–headedness.

The adrenal glands work to control blood pressure by secreting cortisone and adrenaline. Cortisone triggers sodium/water retention throughout the body while adrenaline causes constriction of the arteries. Adrenal insufficiency or exhaustion due to excessive physical, chemical, and/or emotional stress, as is common with CFS, causes blood vessel walls to become loose and flaccid. Lightheadedness or faintness may be experienced upon standing quickly due to a drop in blood pressure and a delayed blood flow to the brain. This is a common problem for CFS patients.

Many members of the natural foods and dietary supplement industry are aware of the connection between diet and adrenal exhaustion. Overconsumption of refined carbohydrates has an adverse effect on blood sugar control mechanisms and places stress on the adrenals to compensate for low blood sugar. Caffeine and other stimulants force the adrenals to work harder, eventually depleting them. These substances must be avoided to allow exhausted adrenals a chance to recuperate. Foods with a high-nutrient density along with appropriate supplements will nourish and energize the glands, not deplete them.

Nutrients of special importance to the adrenal glands are B vitamins (particularly pantothenic acid), vitamin C, magnesium, potassium, and tyrosine/phenylanoline . Both tyrosine and phenylanoline are converted into thyroid and adrenal hormones. Caution should be exercised with both tyrosine and phenylalanine since they can be over-stimulating and may cause temporary high blood pressure. There is no particular diet that is known to be superior for CFS patients. Most authorities agree, however, that the diet should be generous in fresh vegetables, fruits, and complex carbohydrates, adequate in protein, and contain a proper mixture of essential fatty acids. The Food Guide Pyramid can be used as a measure for basic nutrition. A natural whole foods diet that favors organically grown food provides high-quality nutrition and minimizes exposure to chemical pesticides, preservatives, and additives. Since digestion is an energy consuming process, fatigue sufferers should eat small but frequent meals, a practice which also helps to maintain blood sugar levels.

Immune Enhancers






Goldenseal (during infections)


Omega 3 Fatty Acids

Gamma Linolenic Acid (GLA)

Pau d’Arco

Shiitake/Reishi Mushroom Extracts

Thymus, Spleen Extracts

St. Johns Wort (Hypericum perforatum)

Will a single cause of CFS, such as a virus, be found or will it be determined that our capacity to adapt to human stressful and polluted environment has been exceeded? As with many other chronic diseases, multiple factors that culminate in CFS may ultimately be identified. In any case, we can be certain that nutrition will play a crucial role in preventing and managing this illness.

Ken Babal is a consulting nutritionist and a member of the Board of Directors for the National Society of Certified Nutritionists.

Reprinted with permission from the July 1995 issue of Natural Foods Merchandiser, a publication of New Hope Communications in Boulder, Colorado.

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