Chronic fatigue syndrome (CFS) is not a diagnosis; it’s a clinical picture of symptoms that may have many causes. Fatigue, in fact, is a protective symptom. It prevents you from damaging your body by doing too much. Since 1982, I estimate that I’ve treated more than 5,000 patients with CFS. I now know there’s only one way to get well, and it entails a package of treatment. That package has to be implemented in the right order, rather like building a house – there’s no point putting in the upstairs windows until the foundations and walls are in place.
Many patients come to me having tried things like thyroxine or B12 injections, but unless the appropriate diet, micronutrients, rest and activity pacing are in place, they may not see any benefit. The treatment I recommend requires a complete change in lifestyle and usually starts with the state of your gut. Patients have to become their own doctors, detectives and psychotherapists to work out their best strategies for recovery.
The cell’s powerhouse
We are made up of lots of different types of cells – including heart, blood, muscle and nerve cells. All these cells are different because they have different jobs to do, which require energy.
While every cell type is specialized, the way energy is supplied is the same: by mitochondria. I think of these organelles as little engines that power every cell in the body.
The job of mitochondria is to supply energy in the form of the chemical compound adenosine triphosphate (ATP). This is the universal currency of energy. It can be used for all sorts of biochemical jobs – from muscle contraction to hormone production. When mitochondria fail, the result is a poor supply of ATP; cells then go slow because they lack the energy to function at normal speed. When cells go slow, all bodily functions slow down.
CFS could be a sign of mitochondrial failure affecting every cell in the body.
We all have a pot of energy available to spend over the day. What prevents us from spending too much is feeling fatigue, a symptom that arises when energy demand exceeds energy delivery. That pot of energy must be spent just to stay alive on jobs like maintaining heart, gut, brain, kidney and liver functions.
These ‘housekeeping’ duties consume two-thirds of our energy, leaving one-third to be spent on extracurricular activities like physical actions and higher mental functioning. With CFS, either that pot of energy is small or too much energy is being spent on physical and mental activity.
Chronic fatigue syndrome (CFS) is not a diagnosis; it’s a clinical picture of symptoms that may have many causes. Fatigue, in fact, is a protective symptom. It prevents you from damaging your body by doing too much. Since 1982, I estimate that I’ve treated more than 5,000 patients with CFS. I now know there’s only one way to get well, and it entails a package of treatment. That package has to be implemented in the right order, rather like building a house – there’s no point putting in the upstairs windows until the foundations and walls are in place.
Many patients come to me having tried things like thyroxine or B12 injections, but unless the appropriate diet, micronutrients, rest and activity pacing are in place, they may not see any benefit. The treatment I recommend requires a complete change in lifestyle and usually starts with the state of your gut. Patients have to become their own doctors, detectives and psychotherapists to work out their best strategies for recovery.
How energy gets produced
Fuel from food is sent to the mitochondria of each cell to recycle ATP. ATP, converted to ADP and back again every 10 seconds in a healthy person, releases energy. When someone needs energy faster than it can be recycled, ADP is converted to AMP, which can’t be recycled. The body then has to make new ATP from glucose and D-ribose, but this slow process causes muscle pain and fatigue.
Do you have CFS?
Check out the list below to see if you’ve got symptoms that signal CFS, then turn the page to find out how to treat it.
Symptoms of CFS
Two key symptoms (mental and physical) in CFS patients that I believe reflect mitochondrial dysfunction are:
• very poor stamina – you can do things, but only for a few seconds before tiring
• delayed fatigue – symptoms persist for 24 hours when you overdo things.
Mental fatigue manifests as poor short-term memory, inability to follow a line of argument, difficulty reading or watching TV, poor problem-solving ability and difficulty dealing with more than one thing at a time (so-called ‘foggy brain’). As one patient put it, “Nothing right in my left brain, nothing left in my right brain!”
In addition, other common symptoms include:
• malaise (feeling ill)
• muscle pain, caused by poor antioxidant status, early switch into anaerobic metabolism or magnesium deficiency
• muscle weakness (including eye muscles, causing episodic, variable or blurred vision)
• sleep disturbance (the ‘biological clock’ moves on one to six hours, so CFS sufferers drop off to sleep late and wake up late), making them natural nightowls
• tendency to get recurrent infections
• general hypersensitivity to, for example, noise, light, touch, pain, smells
• drug/alcohol intolerance, especially to antidepressants, beta-blockers, statins and blood-pressure medications, reflecting poor detoxification pathways, cytochrome p450 enzyme (needed for drug metabolism) stress and an outpouring of free radicals
• feeling ‘not with it’
• poor temperature control
• gut symptoms
• headaches
• mood swings
• joint pain.
There may be tender trigger points in muscles and tendons, signs of inflammation like tender, swollen lymph nodes in the neck and/or low-grade fever. Depression may also arise because energy-giving ATP is needed for neurotransmitters like serotonin and acetylcholine to work.
How to treat deep fatigue
Understanding the process of cell respiration and what’s going wrong in CFS sufferers provides the biological basis of treatment. In many, if not most, instances it has to do your diet and the state of your gut, which explains why the following are must-dos that make a positive difference:
• Follow a ‘Stone Age’ or low-glycemic index (GI) diet, which avoids major allergens and includes probiotics
• Correct mitochondrial function with d-ribose, magnesium injections, NAD 500 mg, acetyl-l-carnitine and coenzyme Q10
• Address poor antioxidant status with B12, coenzyme Q10, SOD (superoxide dismutase) and glutathione peroxidase
• Get plenty of sleep so mitochondria can be repaired. Aim for nine hours between 9.30 pm and 6.30 am
• Try detox regimes, if appropriate, such as far-infrared saunas and chelation therapy (see WDDTY September 2014), to unload heavy metals, pesticides, social poisons (alcohol, tobacco, recreational drugs), volatile organic compounds and prescription drugs
• Optimize gut function, including having sufficient stomach acid, pancreatic function and fermentation in the large bowel
• Pace your activities to avoid undue mitochondrial stress
• Address secondary damage partly caused by mitochondrial failure, such as immune disturbances, hormone gland (like the thyroid) failure and slow liver detoxification
• Correct secondary hypothyroidism,< /strong> secondary hypoadrenalism and poor melatonin levels
• Identify chronic allergies/infections, which can arise from fermentation in the gut caused by microbes to which the immune system is reacting inappropriately.
Natural ways to fight fatigue
Although some of the following recommendations (particularly those regarding the amount of rest) largely apply to those with extreme fatigue (i.e., CFS), anyone who feels tired all the time can benefit by adopting many of these suggestions.
Adopt a ‘Stone Age’ diet
Carbohydrates tend to cause fatigue even in ‘normal’ people. The modern tendency is to use carbs as a fuel source when we should be using fat. Long-chain fats from vegetables, nuts, seeds and fish are excellent building blocks for making new cell membranes. (If we laid all the body’s cell membranes flat, they would cover 10 km2!)
However, these long-chain fats don’t make good fuel. The body prefers medium-chain fats from meat, lard, butter (assuming no allergies), coconut oil and chocolate (dark, at least 70 percent cocoa solids). The normally functioning lower gut ferments vegetable fiber into short-chain fatty acids, another glorious fatty fuel.
Food allergy is a common cause of many symptoms, such as irritable bowel, asthma, mood swings, headache, arthritis, ‘allergic muscles’ (sensitization caused by mechanical muscle damage like tears and bruising) and, of course, fatigue. The most common offenders are grains, dairy, yeast and toxins.
Chemicals in the diet inhibit enzyme systems and slow metabolism down. This applies to drugs as well as food additives, and pesticide, hormone and antibiotic residues. Seafish caught inshore can carry a mercury load.
Avoid food with additives, colorings, flavorings and plastic wrappings (especially if heated), and switch to organic wherever possible.
The Stone Age diet:
• includes low-GI foods (they don’t raise blood sugar levels quickly)
• avoids common food allergens
• avoids moldy foods and highly fermentable foods
• is as chemical-free as possible.
Foods allowed in the Stone Age diet
The following are allowed both during the day and in the evening.
• All meats: chicken, beef, lamb, pork, turkey, duck, goose and any ‘game’ meats such as venison, pheasant and grouse. Organ meats like liver, kidney and offal are fine too.
•Eggs: an excellent source of lecithin, an essential fat that cells need, particularly those required for neural transmissions.
• All fish: this includes salmon, mackerel, cod, haddock (but take care with smoked fish, as they often contain dyes). Canned fish in brine or olive oil is fine, as are also canned shrimp, prawns, mussels and clams, provided there are no additives.
• All green vegetables.
• Root vegetables (but in moderation as they also contain carbohydrates): carrots, parsnips, turnips, rutabaga, celeriac.
• All salad ingredients, such as avocado, lettuce, tomato, cucumber, celery, peppers, onion, cress, bamboo shoots.
• French dressing: best to make your own from olive oil, lemon juice, garlic and mustard.
• Low-carbohydrate fruit: berries are excellent examples.
• Seeds: sunflower, poppy, sesame.
• Nuts: peanuts, Brazil nuts, hazelnuts, cashews, pistachios, walnuts; also nut butter spreads like tahini (sesame seed butter).
• Coconut oil: it’s delicious and a great source of medium-chain energy-giving fats.
• Cold-pressed nut and seed oils: use sunflower, olive, sesame, grapeseed, hemp, flaxseed oils liberally – but never for cooking, as heat damages their beneficial health-giving qualities.
• Fermented soy: I advocate growing the probiotic drink kefir in soy milk (instead of the usual cow’s milk) because the carbohydrate in soy is fermented out. Kefir also teems with friendly microbes to help repair
the gut
• Spices: chili, cumin, ginger, coriander, pepper, cloves.
• All herbs.
• Salt (ideally SOLO, an all-natural sodium-reduced
sea salt).
Drinks allowed during the day
• Bottled or filtered water
• Herbal teas.
Foods allowed with caution (low potential for allergy, but can be fermented)
• Rice and potatoes: brown rice cakes or puffed rice from healthfood stores
• Specific grains: millet, buckwheat, sago, quinoa
• High-carbohydrate fruit: bananas, grapes, melons
• Dried fruits: raisins, apricots, prunes, sultanas, figs, dates
• Pulses: lentils, lima beans, chickpeas, flageolet beans
• Mixtures of nuts, seeds, dried fruits
• Arrowroot flour: as a thickener for gravy.
Take supplements
Once again, this supplement program is for those with chronic fatigue syndrome, but anyone suffering from fatigue can modify it (i.e., take B12 and magnesium by mouth and not injection) according to needs
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Morning |
• One multivitamin/mineral capsule daily (be aware this contains B vitamins, which can cause insomnia, so don’t take it in the evening) • One omega-3 supplement that is particularly high in EPA (eicosapentaenoic acid); I recommend VegEPA (available online). Suggested dosage: 4 capsules/day for 1 month, then a maintenance dose of 2–4 capsules/day. For vegetarians, 1 capsule/day of BioCare MicroCell Essential Fatty Acids (online at www.biocare.co.uk, also sold ). Alternatively, 2 tsp hemp oil. • Multimineral supplement (2 tablets, depending on manufacturer) • Acetyl-l-carnitine, 1 g • d-Ribose, 2.5 g • Copper, 1 mg • l-Glutathione, 250 mg • VegEPA, 4 capsules • 2 tsp hemp oil • Coenzyme Q10, 200–300 mg • Niacinamide, 500–1,500 mg • Magnesium, up to 800 mg a day or for severe fatigue, magnesium sulfate, 0.5 mL (cc) by injection • Vitamin B12 one tablet, or for extreme fatigue, 0.5 mL (cc) |
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Mid-morning |
• d-Ribose, ½ tsp in tea or coffee |
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Midday or lunchtime |
Dissolve in ½ pint of water: • d-Ribose, ½ tsp • Multimineral supplement (one tablet, or depending on manufacturer’s instruction) • Manganese, 5 mg |
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Mid-afternoon |
• d-Ribose, ½ tsp in tea or coffee |
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Evening |
Dissolve in ½ to 1 pint of water: • Acetyl-l-carnitine, 1 g • Zinc, 30 mg • Multimineral supplement (1 tablet, or depending on manufacturer’s instruction) • d-Ribose, ½ tsp (or adjust to complete the daily dose) • Vitamin C, at least 2 g (depending on gut tolerance) ascorbic acid or 1,000 mg magnesium ascorbate if ascorbic acid causes gut irritation. Take up to 10 g ascorbic acid (5 g magnesium ascorbate). Because a fermenting gut is |
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Throughout the day |
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• Multimineral supplements, which should include calcium, magnesium, potassium, zinc, boron, potassium, manganese, copper, molybdenum (ideally as sodium molybdate), selenium and chromium. I have created my own multi-mineral blend that patients take as a drink throughout the day (see www.drmyhill.co.uk). • Cholecalciferol (vitamin D). Sunshine is the best way to increase vitamin D levels. Thirty minutes of good sunshine on skin exposed by a swimsuit provides about 5,000 IU of D3. But it’s impossible to get adequate vitamin D from sunshine in northern climates, especially from September to March, so you must supplement. You’ll need to take a total of 5,000 IU/day of vitamin D3. • Transdermal magnesium (delivery through the skin) contains 1 g/mL magnesium chloride (100 mg elemental magnesium) and can be used in any condition where magnesium is helpful. |
Rest
Here’s how to make the most of your rest periods
Those who suffer from extreme fatigue require complete rest from exercise, visitors, telephone calls, reading, computers, talking, child-minding, noise and TV – all activities that have to be carefully rationed throughout the day.
When resting, lie horizontal to reduce the work of the heart (it’s much harder to push blood around an upright body than one where everything is lying flat).
Take a proper rest, perhaps when you go to bed, regularly during the day, even on days when you feel well. The fatigue in CFS is delayed, so if you push yourself one day, expect to ‘pay’ for it 12–36 hours later. If you do feel well one day, don’t overdo things or you’ll be worse off the next.
Do things in short bursts. You’ll be more efficient doing things for 10–40 minutes (whatever your window of time is), then resting for the same length of time. I had one patient who could only walk 100 feet, but by walking 50 feet and resting, then going on again, she got up to walking a mile a day.
Vary your activity. This applies to the brain as well as the body. Listening to the radio or music uses a different part of the brain from watching TV, and doing the dishes (ideally, while sitting on a high stool) uses different muscles from walking.
Detox
Saunas are a great way to detox
When your cells have problems shunting ATP and ADP back and forth, it suggests blockage by some sort of toxin, either those produced within the body, such as free radicals) or exogenous (from outside the body, such as heavy metals, pesticides and VOCs (volatile organic compounds). However, these exogenous toxins can all be gotten rid of by heat/sweating regimes (with the exception of heavy metals). I would recommend a sweating detox at least three times a week, and my preferred technique is with far infrared (FIR) saunas. Hot Epsom salt baths may work as well.
The heat from far infrared radiation, present in sunlight, literally shakes up toxic molecules, so those that aren’t well stuck on are ‘shaken off’ and mobilized out onto the lipid layer on the surface of skin, where they can be washed off. It’s not essential to sweat for these regimes to be effective. The washing off is as important as the heat, or toxins will simply be reabsorbed.
I have carried out several tests on people before and after taking a sauna where tests prior to the sauna have demonstrated the toxic load of pesticides, volatile organic compounds and other toxic chemicals. On retesting after the sauna, in every single case every parameter has been improved.
For heavy metal detox, the best is chelation therapy, where a large molecule such as DMSA, DMPS, or EDTA is used either orally or intravenously to chelate out (gather up and expel) toxic minerals.
People can recover from fatigue first by getting their regimes as tight as possible (in terms of diet, supplements, pacing of activities, sleep and detox). When they start to feel better – and only then – should they start to increase their levels of activity, but if you experience delayed fatigue, reduce your activity levels again until your body has recovered.
Adapted from Dr Sarah Myhill’s book Diagnosing and Treating Chronic Fatigue Syndrome (Hammersmith Books, 2014), available on Amazon. Dr Myhill is a practicing GP, an expert on chronic fatigue and a WDDTY panel member.
How to find out why you are chronically tired
The following are among my favorite tests for determining why patients are so tired:
Mitochondrial function profile
This batch of tests includes:
• ATP profiles, to assess levels of ATP (basic form of energy at cellular level), how well energy is released from ATP, rate of production of ATP from ADP in cells, and movement of ATP and ADP across mitochondrial membranes
• Plasma cell-free DNA, to measure cell damage and antioxidant status
• Red-cell NAD levels, to measure efficiency of energy production in cells
• Coenzyme Q10 levels, to measure the most important antioxidant in mitochondria
• Acetyl-l-carnitine, which delivers fuel in the form of acetate to mitochondria
• Superoxide dismutase (SOD), to measure the three types of this major antioxidant enzyme as they reflect levels of zinc, copper and manganese
• Glutathione and glutathione peroxidase tests, to assess levels of the trace element selenium
• Red-cell magnesium, which may be part of the ATP profile or done separately.
Thyroid function profile
This batch of tests shows levels of the two thyroid hormones in blood – free T4 and free T3 – and of thyroid-stimulating hormone (TSH), which controls their production.
Adrenal stress profile
This package of tests looks at how the adrenal gland functions and the likelihood of adrenal fatigue by measuring salivary levels of the adrenal hormones cortisol and DHEA over 24 hours.
Tests suggested by gut symptoms
• Gut fermentation test, for evidence of fermentation by bacteria or yeast
• Salivary VEGF test, for assessing low stomach acid
• Urine hydrogen sulfide test, to measure this gas, produced by people who ferment food, which can inhibit mitochondrial function
• Comprehensive digestive stool analysis, to determine digestive ability and gut flora status
• Early-morning short-chain fatty acids and/or tests of fructose intolerance, to determine a tendency for low blood sugar (hypoglycemia).
Tests for chemical sensitivity and toxic stress
All tests are available at Biolab in the UK (www.biolab.co.uk) and Genova Diagnostics in the US (www.gdx.net).
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