Overview

Chronic fatigue syndrome (CFS) is a debilitating condition that is associated with various trigger events, such as viral infections ( Epstein-Barr virus COVID-19, etc.), bacterial infections such as Lyme, fungal infections such as Candida, and physical or psychological trauma.

However, association does not prove causation, and conventional Western (allopathic) medical practitioners (MD, DO, NP, etc.) do not recognize a mechanism for a causal link; they therefore tend to attribute the symptoms of CFS to depression and treat according to that model Go to CDCCDC

Chronic fatigue syndrome is a functional diagnosis, for which conventional medicine has identified no causative mechanism; its cause is most likely multifactorial, with multiple contributing factors which make each individual case unique and requiring an individualized treatment plan, rather than a "by-the-book" approach.

Although chronic fatigue syndrome, long COVID-19, Myalgic Encephalomyelitis (ME) [Lelu2011  🕮 ] and fibromyalgia appear to share many of the same symptoms and causative factors, they appear to be distinct disorders with different but partially overlapping treatments. It is also possible that a patient may present with diagnoses of more than one of these disease patterns, and may also benefit from the naturopathic protocols used for CFS plus additional naturopathic interventions.

Hence, careful differential diagnosis based on history, signs, and symptoms is necessary for effective treatment [Liptan2016].

As Dr. Weyrich is a board Certified Health Practitioner Diplomate in the Clinical Science of Anti-Aging by The American Board of Anti-Aging Health Practitioners (ABAAHP), he approaches treating CFS from the point of view of optimizing mitochondrial function, diet, and detox.

Please see conventional, complementary, and alternative medical treatments for important background information regarding the different types of medical treatments discussed on this page. Naturopathic, Complementary, and Alternative treatments that may be considered include:

Etiology

Among the theories that have been advanced, mitochondrial dysfunction and neurotoxins produced by dysbiotic Clostridium spp., yeasts, and fungi appear most credible.

Evidence suggesting that dysbiosis is associated with chronic fatigue syndrome includes the following:

  • Elevated urinary levels of 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (HPHPA) and other markers of dysbiotic overgrowth with Clostridium spp. are common in chronic fatigue syndrome [GP2008].
  • Elevated urinary levels of tartaric acid and other markers of dysbiotic overgrowth with yeasts and fungi are associated with chronic fatigue syndrome [Shaw2008].
  • However, note that hypothyroidism is associated with Functional Immune Deficiency, so addressing hypothyroidism may help clear the dysbiosis.

Another often-overlooked cause of chronic fatigue is sleep apnea.

Auto-immune processes may also contribute to this syndrome [Lelu2011  🕮 ]

Diagnosis

Symptom picture:

  • Decreased concentration and short-term memory
  • Headaches
  • Muscle and joint pain without inflammation
  • Tender lymph nodes
  • Sore throat
  • Unrefreshing sleep
  • Post-exertional malaise lasting 24 hours or longer

Note that most of the above are also commonly seen in hypothyroidism [Starr2005, pg 148], although other authors attribute these symptoms to overgrowth of Candida [Crook], [Starr2005, pg 150].

Diagnostic Testing:

  •  >   
    Organic Acid Test (elevated markers for gut dysbiosis or mitochondrial dysfunction).
  •        Basal Body Temperature (depressed if hypothyroid or mitochondrial dysfunction)
  •        Heavy metal urinalysis with provocation (possible cause of mitochondrial dysfunction).

Differential Diagnosis

  •  >   
    fibromyalgia [Liptan2016].
  •        Vitamin B12 deficiency [Pacholok2011].
  •  >   
    Lyme Disease.
  •        Copper toxicity can cause fatigue and exhaustion; this may especially be a problem in "red-rock" areas of Arizona, where the soil/water may be high in copper.

Treatment

Conventional Treatments

  • Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia - A Randomized, Double-Blind, Placebo-Controlled, Intent-To-Treat Study [Teitelbaum2000]

    • Naturopathic, Complementary, and Alternative Treatments

    • [Holtorf2008a] Has a great review; however it must be accessed using the Wayback Machine.
    • Treat hypothyroid if present.
    • Supplement CoQ-10, acetyl-L-carnitine, D-ribose, alpha-lipoic acid (treats mitochondrial dysfunction).
    • Heavy metal chelation if indicated.
    • Treat dysbiosis if present.
    • Supplement with malic acid if Organic Acid Test shows that urine tartaric acid is elevated [Russell1995  🕮 ].
    • Supplement with magnesium (why?) [Shaw2008].
    • Low doses of adrenal hormones may be beneficial [MckJefferies2004], [Starr2005, pg 151].

    Nutritional Medicine

    Ketogenic Diet

    Research suggests that the ketogenic diet benefits chronic fatigue: [Craig2015  🕮 ]

    For general information on the ketogenic diet, please see: Ketogenic Diet

    Low Dose Naltrexone (LDN)

    According to the Low Dose Naltrexone home page [LDN], LDN has been seen to benefit chronic fatigue syndrome, which is considered to be an autoimmune disease. [LDN] reports that all patients with autoimmune processes whom the late Dr. Bihari [Bihari2003] treated using LDN "have experienced a halt in progression of their illness. In many patients there was a marked remission in signs and symptoms of the disease." Dr. Bihari suggests a 50% to 70% overall response rate [Bihari2003].

    [Bolton2020  🕮 ] describes three case studies:

    1. Caucasian female age 33 suffered viral meningitis, with only partial recovery. Upon starting LDN [at about age 53], and titrating dose up to 12mg/day, she regained "normal quality of life" over a period of about 3 years, which she has maintained for about 7 years subsequently.
    2. Caucasian female age 29 developed sudden onset profound fatigue and weakness. She was prescribed LDN at age 54, starting at very low dose of 0.25mg/day due to known immune hypersensitivity. She noticed benefits after 6 months (at a dose of 1mg/day), and continues to improve as her dose is slowly titrated up; she continues to have some symptoms.
    3. Caucasian male age 14 became bedridden and unable to self-care following "glandular fever" (Epstein-Barr Virus). He had a gradual partial recovery. At age 37 he started LDN and experienced improvements in sleep, energy, and mood that were "sufficiently marked that he intends to continue LDN long term."

    Dr. Weyrich has been trained to use Low Dose Naltrexone (LDN). However, Dr. Weyrich has not treated any cases of Chronic Fatigue Syndrome with LDN, but he strongly believes that LDN is a very beneficial intervention for treating Chronic Fatigue Syndrome, and he is actively recruiting patients.

    Please see What is Low Dose Naltrexone? for more information.

    Immune System Balancing

    [McCulley2018, pp 35, 89, 219-222] reports that chronic fatigue syndrome is a TH2-dominant autoimmune disorder. [Lelu2011  🕮 ] also suggests an autoimmune process. However, [McCulley2018, pg 180] also reports states that chronic fatigue syndrome is not an autoimmune disease because there are no antibodies.

    Dr. Weyrich has considerable interest in this topic, but has not treated any cases of chronic fatigue syndrome with Immune System Balancing.

    Please see What is Immune System Balancing? for more information.

    Neuro-Gen High-Performance Neuromodulation (HPN)

    HPN has been reported to be useful for treating chronic fatigue syndrome [Snook]. Dr. Weyrich has been trained to use Neuro-Gen High-Performance Neuromodulation system by it's inventor, Corey Snook. However, Dr. Weyrich has not treated any cases of chronic fatigue syndrome with this technique.

    Please see What is Neuro-Gen High-Performance Neuromodulation? for more information.

    Neurotransmitter Balancing

    Neuro Research [Hinz2015] reports that chronic fatigue can be benefited by balancing neurotransmitter levels in the body.

    Dr. Weyrich has been trained in neurotransmitter balancing protocols, but has not treated chronic fatigue using this technique.

    Please see What is Neurotransmitter Balancing? for more information.

    Pathophysiology

    • Elevated levels of tartaric acid (3-hydroxymalic acid or 2,3-hydroxy-succinic acid) are associated with chronic fatigue syndrome. Tartaric acid is an analog of the Krebs cycle intermediate malic acid that inhibits the Krebs cycle enzyme fumarase that converts fumaric acid to malic acid [Shaw2008] [Russell1995  🕮 ].
    • Long COVID and Post-infective Fatigue Syndrome: A Review [Sandler2021  🕮 ]
    • Chronic fatigue syndrome and long covid: moving beyond the controversy [Newman2021  🕮 ]
    • Myalgic encephalomyelitis/chronic fatigue syndrome patients exhibit altered T cell metabolism and cytokine associations [Mandarano2020  🕮 ]
    • Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment [Cabanas2021  🕮 ]
    • Diagnosis and Treatment of Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) [Holtorf2008]
    • Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups [Komaroff1966  🕮 ]
    • Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness [Committee2015  🕮 ]
    • Illness and disability in Danish Chronic Fatigue Syndrome patients at diagnosis and 5-year follow-up [Andersen2004  🕮 ]
    • Outcome and Prognosis of Patients with Chronic Fatigue vs Chronic Fatigue Syndrome [Bombardier1995  🕮 ]
    • The prognosis of chronic fatigue and chronic fatigue syndrome: a systematic review [Joyce1997  🕮 ]
    • Chronic Fatigue Syndrome: a survey of GPs' attitudes and knowledge [Bowen2005  🕮 ]
    • Primary healthcare provision and Chronic Fatigue Syndrome: a survey of patients' and General Practitioners' beliefs [Thomas2005  🕮 ]
    • Diagnosis and Treatment of Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) [Holtorf2007]
    • Decreased natural killer cell activity is associated with severity of chronic fatigue immune dysfunction syndrome [Ojo-Amaize1994  🕮 ]
    • Redox imbalance links COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome [Bindu2021  🕮 ]

    References