Arizona Advanced Medicine Clinic

Chronic Fatigue Syndrome - Myalgic Encephalitis - CFS/ME

Everyone knows the symptoms of chronic fatigue, right? Incapacitating fatigue, have to take a nap every day (for some the nap lasts all day), unable to engage in useful work or productive play because of fatigue. The syndrome was described as early as 1869 by George Beard. He called the illness "neurasthenia".[i] It has also been described as "Yuppie plague" and "Shirker's syndrome".[ii]

Did you know that there is an actual medical definition of Chronic Fatigue Syndrome?

On the Centers for Disease Control (CDC) website, we read: "CFS remains a diagnosis based on medical history, illness symptoms, physical examination, and exclusion of certain illnesses using a standard group of laboratory tests (1994 case definition)." The CDC even has a toolkit to help healthcare professionals make the diagnosis.

The following are necessary to make the diagnosis:

Strategies for treatment discussed on the CDC website involve mostly coping - do as much as you can and enjoy life as much as you can, there are no drugs to treat, and there is no cure. Good luck!

Physical impairment must be ruled out, of course. If you are in kidney failure, you will feel terrible with all the above symptoms, but your blood work will be abnormal, as will your urine.

Standard blood work is necessary to rule out obvious causes of physical illness - blood count, liver enzymes, kidney tests, markers of inflammation, thyroid studies, tests for autoimmune disease. People with chronic fatigue syndrome have pretty much normal blood work.

Standard blood work does not show mitochondrial disease. Chronic fatigue means we don't have any energy, right? What produces energy in our cells, and makes that energy available to us for our use? The mitochondria. Mitochondrial disease is characterized by lack of energy to run cellular function. One might suspect that mitochondrial dysfunction has everything to do with chronic fatigue syndrome.

The words actually are very helpful, when we search for causes. Myalgic Encephalomyelitis is the British term for chronic fatigue, relating inflammation and pain of the muscles (myalgia) to inflammation and pain of the brain and spinal cord. The World Health Organization has classified this illness as a disease of the central nervous system.[iii]

We will be looking for things that cause inflammation, whose effect just happen to end up in the muscles and the nervous system.

It takes time to restore the body's nutritional state, and to modify behavior from the "sickness behavior" to "wellness behavior". Figuring out what the body needs, and then supplying those needs is crucial.

Some bodies require more of certain substances than others. If you have a mutation in the MTHFR system, for instance, you may require vastly larger doses of vitamins that supply methyl groups for detoxification - folic acid and B12, to name a couple. If you have defects in your sulfation pathways, you may need to be very careful to limit exposure to toxins which are handled by those pathways.

Genetic testing is still expensive, but the price is coming down rapidly. We feel that the benefit of knowing your detoxification pathways is well worth the price of the tests.

Treatment of chronic infections is essential, to decrease the total body burden of unfriendly organisms. We may not be able to eradicate them all, but at least we can get them to a manageable level. We may use botanical remedies, pharmaceutical drugs or homeopathic substances to achieve a healthy balance.

At the Arizona Center for Advanced Medicine we diagnose the deficiencies and treat the cause of chronic fatigue syndrome. We look for the nutritional potholes and fill them, using the most modern and integrative techniques. We often use intravenous nutritional or antibiotic therapies to bypass the dysfunctional gut, so that the therapies actually reach where they need to go – the blood stream, the organs and the brain. Treatment may take as little as two months, or as long as twelve to eighteen months to complete, but in the end we find that the results are well worth the time it takes.

Call us for a free 15-minute consultation with one of our practitioners at 480-240-2600.

[i] Beard G. A Practical Treatise on Nervous Exhaustion. Publ New York, EB Treat, 1894. No longer in copyright. Downloadable as an e-book from Google.

[ii] Ali M. Hypothesis: Chronic Fatigue is a State of Accelerated Oxidative Molecular Injury.Journal of Advancement in Medicine, Volume 6, Number 2, Summer 1993.

[iii] Morris G, Maes M. Oxidative and Nitrosative Stress and Immune-Inflammatory Pathways in Patients with Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS). Current Neuropharmacology, 2014, 12, 168-185.

[iv] Werbach MR. Nutritional strategies for treating chronic fatigue syndrome. Altern Med Rev. 2000 Apr;5(2):93-108.

[v] Werbach MR. Nutritional strategies for treating chronic fatigue syndrome. Altern Med Rev. 2000 Apr;5(2):93-108.

[vi] Wiest R, Garcia-Tsao G. Bacterial translocation (BT) in cirrhosis. Hepatology 2005:41:422-433.

[vii] Wiest R et al. Pathological bacterial translocation in liver cirrhosis. J Hepatol. 2014 Jan;60(1):197-209. doi: 10.1016/j.jhep.2013.07.044.

[viii] Lucas K, Maes M. Role of the Toll Like receptor (TLR) radical cycle in chronic inflammation: possible treatments targeting the TLR4 pathway. Mol Neurobiol. 2013 Aug;48(1):190-204. doi: 10.1007/s12035-013-8425-7.

[ix] Suh S-Y et al. Intravenous Vitamin C administration reduces fatigue in office workers: a double-blind randomized controlled trial. Nutr J. 2012; 11: 7. Published online 2012 January 20. doi: 10.1186/1475-2891-11-7.

[x] Mikirova N, Hunninghake R. Effect of high dose vitamin C on Epstein-Barr viral infection. Med Sci Monit. 2014 May 3;20:725-32. doi: 10.12659/MSM.890423.

[xi] Cox IM et al. Red blood cell magnesium and chronic fatigue syndrome. The Lancet 337;8744:757-60 (March 1991).

[xii] Maes M et al. Lower serum zinc in Chronic Fatigue Syndrome (CFS): relationships to immune dysfunctions and relevance for the oxidative stress status in CFS. J Affect Disord. 2006 Feb;90(2-3):141-7.

[xiii] The GKh1, Verkes RJ et al. Tryptophan depletion in chronic fatigue syndrome, a pilot cross-over study. BMC Res Notes. 2014 Sep 16;7:650. doi: 10.1186/1756-0500-7-650.

[xiv] Reuter SE, Evans AM. Long-chain acylcarnitine deficiency in patients with chronic fatigue syndrome. Potential involvement of altered carnitine palmitoyltransferase-I activity. J Intern Med. 2011 Jul;270(1):76-84. doi: 10.1111/j.1365-2796.2010.02341.x.

[xv] Morris G1, Maes M. Mitochondrial dysfunctions in myalgic encephalomyelitis/chronic fatigue syndrome explained by activated immuno-inflammatory, oxidative and nitrosative stress pathways. Metab Brain Dis. 2014 Mar;29(1):19-36. doi: 10.1007/s11011-013-9435-x.

[xvi] Alfano CM et al. Fatigue, Inflammation, and ω-3 and ω-6 Fatty Acid Intake Among Breast Cancer Survivors. J Clin Oncol. Apr 20, 2012; 30(12): 1280-1287.

[xvii] Rainbow T. H. Ho et al. A Randomized Controlled Trial of Qigong Exercise on Fatigue Symptoms, Functioning, and Telomerase Activity in Persons with Chronic Fatigue or Chronic Fatigue Syndrome. Ann Behav Med. 2012 October; 44(2): 160-170. Published online 2012 June 27. doi: 10.1007/s12160-012-9381-6.

[xviii] Ryan MJ et al. Vitamin E and C supplementation reduces oxidative stress, improves antioxidant enzymes and positive muscle work in chronically loaded muscles of aged rats. Exp Gerontol. Nov 2010; 45(11): 882-895.

[xix] Dai D-F et al. Mitochondrial oxidative stress in aging and healthspan. Longev Healthspan. 2014; 3: 6. Published online 2014 May 1. doi: 10.1186/2046-2395-3-6.

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