A study published last month showed that chronic fatigue syndrome is an inflammatory disease – researchers were able to show a difference in the levels of 17 different immune system proteins (13 of which were pro-inflammatory) between people with chronic fatigue syndrome and healthy controls; the concentrations of these proteins in the blood correlated with the disease severity. They say the findings provide a solid basis for a diagnostic test.
Chronic fatigue syndrome is a multifactorial condition which is difficult to diagnose and can result in an array of symptoms. Dysfunction of the immune system, along with compromised gut, liver, and endocrine function may be seen.
Also known as ME (myalgic encephalomyelitis), chronic fatigue syndrome is a debilitating disease which affects a sufferer’s everyday life and can lead to long-term illness and disability. It can affect both men and women, though women are more likely to suffer from it. A general practice with 10,000 patients is likely to see up to 40 cases of CFS.
Symptoms of CFS
The symptoms of CFS can vary with each individual though the most common symptom is extreme tiredness for a duration of at least 4 months. Other symptoms include:
- Sleep problems
- Muscle or joint pain
- Difficulties in concentration
- Sore throat with tender lymph nodes
- Feeling dizzy or sick
- Fast or irregular heartbeats (heart palpitations)
In diagnosed mild cases, the patient would be considered able to work, although needing to take days off, and able to care for themselves and undertake light domestic tasks, but with some difficulty.
Leisure and social activities may stop and leisure time used instead for rest to recover and cope with daily life and work. This situation can graduate through to the less commonly seen severe cases, with inability to carry out all but the smallest of tasks and severe difficulties with mental processing and mobility issues.
As can be seen from the variable symptoms, diagnosis can be difficult – particularly in the early stages of the condition – and is only arrived at after other potential causes have been eliminated. Unfortunately, this period of elimination can frequently take a considerable amount of time, resulting in a delayed diagnosis.
The type and intensity of the symptoms should also be viewed appropriately, as unfortunately the symptom listing does not reflect the true intensity of some of the symptoms experienced. For example, fatigue is very different to tiredness experienced after a hard day’s work, and can be described as an overwhelming physical and mental fatigue which is little improved by rest. Difficulties with mental function may be similar to symptoms many of us experience, such as poor concentration and reduced attention span. However, additional symptoms of poor short-term and recent memories, difficulty organising thoughts, and feelings of disorientation are often reported.
NICE (National Institute for Health and Care Excellence) guidelines advise that diagnosis should be given after other possible causes have been excluded, and after the symptoms have persisted for four months in adults and three months in children.
The cause and progression of CFS is still poorly understood, which unfortunately impacts on both the diagnosis and treatment of the condition. Various theories have been proposed for the causation, including viral infection with the Epstein-Barr virus (responsible for glandular fever). However, due to the slow onset/progression of the condition, a direct cause is frequently difficult to ascertain.
Exhaustion, stress and depression are considered factors. The symptoms of these conditions can be debilitating and additionally impact on immune function, thus potentially weakening the body’s natural ability to fight disease and infection. This may then link back to causation by, for example, viral infection.
Researchers suggest a potential link of origin in early life, citing prenatal and early postnatal exposure, to ‘a variety of factors, including environment contaminants, drugs, infectious agents and physical stressors’. The implications on the immune system, they consider, lead to a latent condition which in later life may produce unpredicted immune responses. Of particular interest, they consider ‘heavy metals, pesticides, halogenated aromatic hydrocarbons, alcohol, environmental tobacco smoke, estrogenic compounds and corticosteroids’. ‘Unpredicted immune response’ may provide a potential insight into the difficulty establishing a causative factor for CFS.
At the root of most disease lies inflammation. Leaky gut refers to the increase in permeability of the small intestine which allows pro-inflammatory toxins and undigested food molecules to be introduced into the bloodstream provoking an immune response and inflammation. Leaky gut is related to many factors including food allergies and sensitivities, poor food choices, stress and certain medications. Symptoms that may present as a result are broad and can include fatigue, joint and muscle pain, sleep disturbances, brain fog, anxiety and headaches etc – many symptoms often associated with CFS.
Additional areas that health practitioners should look for in diagnosed and undiagnosed CFS sufferers are adrenal health, blood sugar balance, iron status, liver and thyroid function.
Specialist care is available for CFS within the NHS. This is not automatically provided and takes into account the severity of the symptoms and complexity of the condition.
Due to the low mood presented, SSRI antidepressants are sometimes prescribed. Drugs may be used to alleviate individual symptoms such as pain relief and assistance provided for insomnia; the tricyclic antidepressants are often used to assist with poor sleep or pain. Specialised treatment in the NHS currently centres on assisting the patient to manage the emotional and physical symptoms, and may include cognitive behavioural therapy and graded exercise therapy.
The limited treatment options within the NHS bring many CFS patients to the complementary health sector. Careful and comprehensive case-taking of patient’s current and historical physical and emotional symptoms is essential, and may provide useful insights into appropriate intervention. Clinical tests may be useful to identify/eliminate some potential causes.
Nutritional Interventions and Support
A dietary review should be undertaken to ensure an appropriate intake of macro and micro nutrients, removal of food allergens and intolerances and guidance provided for a nutritionally-rich, unprocessed diet. Following an anti-inflammatory diet and minimising foods that may contribute to inflammation and leaky gut such as gluten, dairy, sugar, and processed foods is likely to be beneficial. Including lots of organic vegetables and fruit; healthy oils such as coconut and olive, nuts and seeds; grass fed meat and wild salmon equally so.
Digestive health should be thoroughly explored. Motility and permeability of the gut are important to review as is the potential for fungal and parasitic infections. Avoidance of medications where possible such as ibuprofen and other NSAIDS is recommended as these can damage the lining of the gut.
Around 70% of the immune system is located in the gut thus it is vital to heal the gut to help restore immune function. Vitamins A and D are both important for healing the gut and for immune function. Additional support may be provided with herbal preparations including curcumin, garlic, ginger, echinacea, goldenseal, ginseng and licorice and 1-3, 1-6 beta glucans are used as immune primers.
Vitamin E concentrations have been found to be significantly lower in patients with CFS. Researchers considered this to be due potentially to the increased presence of oxidative stress in these patients. They considered that anti-oxidative therapy or oxidative stress reduction, in conjunction with lifestyle and dietary support, may be effective for those with CFS. They did not distinguish if oxidative stress was causative or an effect of CFS, but considered it possible that ‘oxidative stress is an important mediator in the vicious cycle’.
Researchers have also reported finding reduced levels of CoEnzyme Q10 in CFS patients, and considered that the symptoms, such as fatigue, autonomic and neurocognitive symptoms, may be caused by CoQ10 depletion. They considered their findings suggest that ‘patients with CFS would benefit from CoQ10 supplementation in order to normalise the low CoQ10 syndrome and the IO&NS (inflammatory & oxidative and nitrosative pathways disorders). These findings come as no surprise when we consider the importance of CoQ10 to the mitochondria of the cells and its importance to the production of energy.
Vitamin D deficiency has also been identified, which the researchers considered was due to the reduced ability for CFS patients to take exercise and obtain their vitamin D requirements from sunlight. The study found that levels of vitamin D were moderate to severely suboptimal in those diagnosed with CFS, with a recommendation given for sun exposure, vitamin D-rich foods and consideration for supplementation.
B vitamins: A subset of CFS patients appears to be deficient in folic acid and/or vitamin B12 and there is data to support B12 injections in reducing CFS symptoms. Other B vitamins for which there is evidence of low levels in CFS include thiamine, riboflavin and pyridoxine.
Magnesium: Many of the symptoms and findings in CFS are similar to those of magnesium deficiency and even subclinical deficiency can produce symptoms similar to CFS. Low red blood cell magnesium has been found in many patients with chronic fatigue. Supplementation either via intravenous injection or orally has shown good results in a number of studies.
Essential fatty acids – low levels are a common finding in chronic fatigue syndrome and it has been suggested that this is due to abnormalities in EFA metabolism which could be genetic or due to environmental factors eg viruses may reduce the ability of cells to make 6-saturated EFAs. Low EFA levels are then linked to immune dysfunction, for example EFAs are needed for interferon to exert its antiviral effects.
If you have any questions regarding the topics that have been raised, or any other health matters please do contact me (Clare) by phone or email at any time.
firstname.lastname@example.org, 01684 310099
Clare Daley and the Cytoplan Editorial Team
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P5P Extra – A high potency B-Complex multivitamin supplement in a beneficial Food State form – to help support a demanding lifestyle and to help balance energy and blood sugar.
B12 – Our sublingual Vitamin B12 is at a higher potency of 1 mg per tablet, and beneficially in the form of Adenosylcobalamin (500 mcg) and Methylcobalamin (500 mcg).
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Organic Vitamin B Complex – The Cytoplan Organic Vitamin B Complex contains good levels of B vitamins, including Thiamin (B1) Riboflavin (B2) Niacin (B3) Pantothenic Acid (B5), Vitamin B6 and folate.
Biofood Magnesium – Biofood Magnesium tablets are effectively an organic matrix form of magnesium, complete with natural amino acid carriers to ensure transport to sites of need within the body.
Krill Oil – Antioxidant and anti-inflammatory properties.
Phyte Inflam – Phyte-Inflam is a natural phytonutrient herbal complex containing curcumin from turmeric and gingerols from ginger root which collectively bestow a wide range of anti-inflammatory properties.
Vitamin D3 – Vitamin D is now considered one of the most vital vitamins for health and protection and one of the most depleted. It is important for the normal function of the immune system.
D-Ribose – D-Ribose supplementation is commonly taken in an effort to improve symptoms of CFS/ post viral fatigue such as M.E. or the effects of Epstein–Barr virus. It is a naturally-occurring sugar that is vital for energy production. D-Ribose is such a vital energy source for us as it is the main building block of ‘ATP’ production. D-Ribose supplements can help speed energy recovery, increase energy reserves and maintain healthy energy levels in heart and muscle tissue.
Thyroid Support – Thyroid Support has been developed to offer a Wholefood base multi mineral supplement to support thyroid health. Thyroid support contains Kelp, L-Tyrosine plus active nutrients to help ensure optimum levels of naturally-occurring thyroid hormones.
Related Cytoplan blogs:
Montoya J G et al (2017) – Cytokine signature associated with disease severity in chronic fatigue. PNAS, Epub ahead of print. http://www.pnas.org/content/early/2017/07/25/1710519114
National institute for Health and Clinical Excellence. Diagnosis and management of CFS/ME in adults and children. NICE clinical guideline 53. Developed by the National Collaborating Centre for Primary Care [online} Available at: https://www.nice.org.uk/guidance/cg53 [Accessed 15th July 2017]
Leonard A. Jason, 2008. A Case Definition for Children with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (PDF Download Available). Clinical Medicine: Pediatrics , 1, pp.53–57. Available at:
Myalgic_Encephalomyelitis Chronic_Fatigue_Syndrome [Accessed August 3, 2017].
Dietert, R.R. & Dietert, J.M., 2008. Possible role for early-life immune insult including developmental immunotoxicity in chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME). Toxicology, 247(1), pp.61–72.
Puri, B.K., 2006. Long-chain polyunsaturated fatty acids and the pathophysiology of myalgic encephalomyelitis (chronic fatigue syndrome). Journal of Clinical Pathology, 60(2), pp.122–124.
Miwa, K. & Fujita, M., 2009. Increased oxidative stress suggested by low serum vitamin E concentrations in patients with chronic fatigue syndrome. International Journal of Cardiology, 136(2), pp.238–239.
Maes, M. et al., 2009. Coenzyme 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), pp.470–6.
Berkovitz, S. et al., 2009. Serum 25-hydroxy Vitamin D Levels in Chronic Fatigue Syndrome: a Retrospective Survey. International Journal for Vitamin and Nutrition Research, 79(4), pp.250–254.