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Chronic fatigue syndrome

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Chronic fatigue syndrome (CFS) is a mysterious illness with a long history of controversy. Early on, medical authorities were sceptical as to whether or not it even existed. Today, there are still disagreements as to its diagnosis, cause(s), treatment and prevalence-not to mention what to call it.

Sadly, two new studies have come up with nothing to help clear up the confusion. The first, an investigation by the US Food and Drug Administration (FDA), reportedly confirmed previous research that found a link between CFS and the so-called ‘xeno-tropic murine leukaemia virus-related virus’ (XMRV).

The study has yet to be published but, in a presentation at a blood safety meeting in the Croatian capital of Zagreb, virologist Harvey Alter, one
of the study researchers, reported a “very strong” CFS-XMRV connection, independently confirming data that had been published in the journal Science last year ( news/science/study-that-solves-chronic-fatigue-syndrome-blocked-2022195.html). Until now, other teams have failed to replicate the results (Science, 2009; 326: 585-9).

However, any hopes that such an association would offer a solid explanation-or lead to a potential treatment-for the puzzling condition were soon dashed when another US government study, this time by the Centers for Disease Control and Prevention (CDC), and two additional laboratories, reported contradictory findings.

In that study, blood samples from around 100 people with and without CFS were tested, with the result that the CDC researchers could find no evidence of a link between CFS and XMRV. This was in direct contrast to the Science study, which reported the presence of XMRV in 67 per cent of the CFS patients compared with 3.7 per cent of the healthy controls (Retro virology 2010, 7: 57; doi: 10.1186/1742-4690-7-57).

In response, Judy Mikovits, director of research at the Whittemore Peterson Institute in Reno, NV, and lead author of the Science study, stated that the CDC report was flawed because it failed to use patients that had been officially diagnosed with CFS, and it also lacked “positive controls” in the form of blood from people known to be diagnosed with XMRV infection.

“We’ve now got more than 1000 individual patients from around the world in whom we’ve detected and isolated the virus . . . I haven’t changed my mind on this,” Dr Mikovits said.

But the FDA study that supposedly supports Mikovits’ findings has also come under criticism, and is currently undergoing a rigorous scientific review process. Clearly, we’ll have to wait a bit longer to find out whether XMRV plays a role in CFS or not.

Multiple causes

Although there’s been a preoccupation with finding a single cause of CFS in conventional circles, holistic practitioners have long believed that the condition has many potential causes, each of which shares a common endpoint-severe immune suppression.

Within such a construct, every one of the proposed causes of CFS-including viruses, stress, depression, impaired liver function, environmental illness, medicine use, adrenal insufficiency, Candida albicans infection, leaky gut, hypothyroid, hypoglycaemia, anaemia, nutritional deficiencies, food allergies, sleep disturbances, emotional problems, poor posture and lack of exercise-is credible.

Successful treatment requires working with an experienced practitioner who knows the importance of a comprehensive diagnosis that takes into consideration the patients’ medical history as well as their physical and emotional lives. The most effective regime is likely to be the one that assesses all these factors to arrive at an individual plan tailored to the given patient’s needs.

Proven natural treatments

Conventional medicine has little to offer the CFS sufferer besides anti-depressants or pain relievers that only manage symptoms. Fortunately, although the scientific evidence is relatively weak, there are a number of promising natural treatments for CFS.


Research suggests that the following nutritional supplements may be beneficial. However, be sure to first consult a qualified practitioner who can check for any deficiencies and advise you on dosages.

o Magnesium. Some CFS sufferers have been found to have low levels of magnesium in their blood. Indeed, many of the symptoms of CFS resemble those of magnesium deficiency (Altern Med Rev, 2000; 5: 93-108). Also, in one small randomized controlled trial, patients who had weekly injections of magnesium sulphate were more likely to feel better after six weeks than those who had received injections of a dummy treatment (Lancet, 1991; 337: 757-60). Oral magnesium has also proved useful in magnesium-deficient CFS sufferers, according to a preliminary report (Lancet, 1992; 340: 426).

o Carnitine is essential for the production of energy in the power-houses of cells (mitochondria). Not enough of this nutrient can impair mitochondrial function, leading to symptoms of generalized fatigue, along with musle pain (myalgia), muscle weakness and malaise following physical exertion (Altern Med Rev, 2000; 5: 93-108).

In addition, low carnitine levels have been found in CFS patients, and one study saw a “statistically significant clinical improvement” in those taking l-carnitine supple-ments for two months (Neuro-psychobiology, 1997; 35: 16-23).

o Vitamin B12. Evidence suggests that high-dose injections of this vitamin may benefit people with CFS. Injections of 2500-5000 mcg of B12 given every two to three days led to improvement in 50 to 80 per cent of patients (Altern Med Rev, 2000; 5: 93-108).

o NADH (nicotinamide adenine dinucleotide) helps make adenosine triphosphate (ATP), the source of the energy that the body runs on. In a small double-blind crossover study, 26 CFS sufferers took either 10 mg of oral NADH or a placebo every day for four weeks, then switched to the other treatment after a four-week interval. In the NADH group, 31 per cent saw their symptoms improve compared with just 8 per cent in the placebo group (Ann Allergy Asthma Immunol, 1999; 82: 185-91).

o Essential fatty acids (EFAs). Low levels of various EFAs could be contributory to CFS (J Clin Pathol, 2007; 60: 122-4; Neuro Endocrinol Lett, 2005; 26: 745-51). However, whether supplements help is unclear.

When 63 CFS sufferers took either an EFA supplement (containing linoleic, gamma-linolenic, eicosapentaenoic and docosahexa-enoic acids) or a placebo every day for three months, those taking the EFAs saw significant improvement in their symptoms compared with the placebo. Moreover, the EFA supplementation corrected the abnormal fatty-acid levels noted at the start of the study (Acta Neurol Scand, 1990; 82: 209-16). In contrast, another trial using the same EFA supplement found no significant differences between the active-treatment and placebo groups (Acta Neurol Scand, 1999; 99: 112-6).

o Antioxidants may be beneficial, as oxidative stress is thought to play a role in CFS. Selenium, glutathi-one, N-acetylcysteine, alpha-lipoic acid, coenzyme Q10 and oligomeric proanthocyanidins (OPCs), as well as vitamins C and E, may prove to be invaluable in a CFS treatment protocol. Ginkgo biloba and bilberry (Vaccinium myrtillus) are also recommended (Altern Med Rev, 2001; 6: 450-9).

o Diet. As there may be a connection between food intolerance and CFS, identifying and addressing these intolerances should prove helpful. When Australian CFS patients eliminated wheat, milk, benzoates, nitrites, nitrates, and food colourings and other additives from their diet, 90 per cent of those
who were able to stick with the diet reported improvement in the severity of a wide range of symp-toms, with significant reductions in fatigue, recurrent fever, sore throat, muscle pain, headache, joint pain and cognitive dysfunction.

What’s more, the elimination diet resulted in a marked improve-ment in the irritable bowel syn-drome (IBS)-like symptoms seen in all patients, a significant finding, as CFS patients have a high rate of IBS (Altern Med Rev
, 2001; 6: 450-9).

Another study concluded that choosing organically grown fruit and vegetables is important for CFS patients, as they are found to have elevated levels of pesticides in their blood (Med J Aust, 1995; 163: 294-7). Pesticide exposure may be a direct cause of CFS symptoms by affecting cell membranes or, indirectly, by playing a role in the loss of natural tolerance for chemicals, including those present in foods (Toxicol Ind Health, 1999; 15: 386-97).

o Exercise. Traditionally, there is some concern that exercise may make symptoms of fatigue worse, but studies show that graded exercise-which builds up gradually from a gentle beginning-can improve CFS symptoms.

In a recent study of adolescent CFS sufferers, both graded aerobic exercise and progressive resistance training were able to significantly improve physical capacity and quality of life. However, only aerobic exercise improved fatigue severity and symptoms of depression (Clin Rehabil, 2010 July 6; Epub ahead of print).

Nevertheless, it’s generally advis-able that CFS sufferers only do the graded exercise that is prescribed and supervised by a trained thera-pist, such as a physiotherapist.

o Cognitive behavioural therapy (CBT). This form of ‘talking treatment’ is often used to treat chronically ill patients, and its effectiveness in CFS was recently the subject of a major review of the literature. It found that those who received CBT were more likely to feel less tired at the end of treatment than patients who received the usual care from their doctor. Moreover, the review concluded that “it may be more effective in reducing fatigue symptoms compared with other psychological therapies” (Cochrane Database Syst Rev, 2008; 3: CD001027).

o Massage has many proven benefits relevant to CFS sufferers, including better relief from pain, depression and anxiety, and improved sleep patterns.
A recent study from China found that a technique called ‘intelligent-turtle massage’ not only alleviated the physical symptoms of CFS, but also boosted immune function (J Tradit Chin Med, 2009; 29: 24-8).

o Acupuncture. A meta-analysis of the pooled results of several studies concluded that acupuncture is an effective therapy for CFS. However, it was also noted that more high-quality studies are needed to confirm this finding (Zhen Ci Yan Jiu, 2009; 34: 421-8).

o Sauna therapy. Two case reports from Japan have found that repeated far-infrared (FIR) saunas, a form of thermal therapy, may be an invaluable treatment for CFS. Symptoms such as fatigue, pain, sleep disturbances and low-grade fever were all dramatically improved after 15 to 25 sessions (J Psychosom Res, 2005; 58: 383-7). In fact, saunas may help by also encouraging the elimination of pesticides and other toxins from the body (which may
be involved in CFS). See WDDTY vol 20 no 10 for other effective ways to detox.

o Breathing retraining. A prelim-inary study carried out in Belgium identified specific breathing prob-lems in patients with CFS. One session of breathing retraining was able to improve lung function in these patients, suggesting that this form of treatment may be useful in some cases (Physiother Theory Pract, 2008; 24: 83-94).

o Relaxation techniques. According to one study from the Netherlands, stress may well play “an important predisposing, precipitating and perpetuating role in CFS” (Tijdschr Psychiatr, 2009; 51: 603-10). This suggests that stress-reduction activities such as meditation, tai chi or yoga may be beneficial. Indeed, yoga appeared to help with the characteristic symptoms of fatigue in an observational study (J Clin Psychiatry, 2005; 66: 625-32).

o Pacing is a form of treatment that is based on finding the optimal balance between rest and activity for the individual patient. It’s thought that, if those with CFS use what limited energy they have wisely, their energy levels will even-tually and gradually increase.

Randomized controlled trials are lacking, but an observational study found that three weeks of self-managed pacing led to a modest improvement in symptom severity and everyday functioning (J Rehabil Res Dev, 2009; 46: 985-96). For this reason, a randomized controlled comparative trial is currently under-way to confirm the effectiveness of pacing, as well as CBT and graded exercise, in addition to the usual specialist medical care of CFS (BMC Neurol, 2007; 7: 6).

Joanna Evans

CFS symptoms

Sufferers with chronic fatigue syndrome (CFS) can experience a wide range of signs and symptoms, but the main ones include:

o fatigue

o impaired memory or concentration

o sore throat

o painful and mildly enlarged lymph nodes in the neck or armpits

o unexplained muscle pain

o pain that moves from one joint to another with no swelling or redness

o headache of a new type, pattern or severity

o unrefreshing sleep

o extreme exhaustion that lasts for more than 24 hours after physical or mental exercise.


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