Imagine waking up each day feeling extremely fatigued. Not the kind of tiredness that goes away after you rest but an exhaustion which takes over your life and limits your ability to do even the most ordinary activities.
If you suffer from chronic fatigue syndrome you may have other symptoms too - muscle pain, memory problems, headaches, pain in multiple joints, sleep difficulties, sore throat and tender lymph nodes.
Dr Nicolas Kats, a US trained naturopathic physician and acupuncturist who holds clinics in the city and Clifden, says chronic fatigue has a constellation of symptoms which varies from person to person. This pattern can change over the years.
“Long term fatigue arbitrarily means six months minimum. The person may need 12 to 18 hours of sleep a day. Many suffer crippling fatigue for decades. If there is little or no fatigue it is not CFS. Shortness of breath may be pronounced, especially with physical exertion. There may be swollen lymph nodes on the neck. This can last years. There may be a slight and intermittent fever.”
The keynote symptoms of the condition are long term debilitating fatigue that cannot be explained by medicine and hypersensitivity to stress, he says.
“In part this means that the adrenals, small glands atop the kidneys, are depleted. They are responsible for hormones that deal with stress. These hormones are cortisol, DHEA (dehydroepiandrosterone ), and to some extent testosterone and estradiol (an estrogen ). All have to do with energy, strength, stamina. They are virtually identical and are all made from cholesterol. Indeed, a person with CFS may have concurrent elevated cholesterol. This may be the body’s effort to boost the depleted hormones of stress. (In this case the use of statins to lower cholesterol may be inadvisable. Statins, by reducing cholesterol, may compromise the body’s ability to make the cholesterol-derived hormones of stress and this can exacerbate CFS. )”
Inability to deal with stress
Sufferers may respond to stress but collapse afterwards taking weeks or months to get back to normal, he outlines. “This inability to deal with stress, and the life modifications arising from this inability, can be one of the most difficult aspects of CFS. This means any and all stresses can make it worse. All stresses should be considered and efforts made to deal with them.”
He says their immune systems may be weak and they may have a tendency to catch infections easily. “There may be muscle and joint pain. There can be variable strange pains and aches that wander all over the body and come and go without rhyme or reason. The skin may be hypersensitive. There may be dizziness. This may be aggravated by sitting or standing upright too quickly. There may be severe depression. Any exertion or stress can be a massive setback often leaving the sufferer in bed for weeks or months.”
How can modern medicine treat CFS? He claims the condition does not lend itself readily to modern medicine.
“Neither the understanding nor the tools are there. The most important thing the GP can do is to rule out any causes of persistent fatigue. When no cause is found this helps to establish the diagnosis of the condition. In part, it is a diagnosis arrived at when all else is excluded.”
Dr Kats says chronic fatigue syndrome is multifactorial. “There are many causes. A common finding is a brief flu-like illness before the fatigue began, for example glandular fever. If glandular fever is not carefully respected with plenty of rest and sleep, little stress, etc, the risk of long term fatigue shoots up.”
A mild flu may lead to CFS because the person’s immune system may be awry. “It is disrupted and unable to regain its balance. As the weeks pass into months and years this becomes an established pattern. The disruption becomes a habit. Immune support and breaking the pattern of an immune system gone awry are the goals to pursue.”
Boost immune system
People can boost their immune systems by including immunomodulating herbs and mushrooms, such as astragalus and echinacea, reishi and shiitake in their diet, which needs to be rich in minerals and vitamins, he says. Supplements like the antioxidants Vitamin A, E, C and selenium help, also.
“Chinese medicine recognises this pattern of a brief flu-like illness leading to long term fatigue, swollen lymph nodes and other symptoms. The name is residual pathogenic factor. Either it is cleared from the body or it remains within. Its presence soaks up energy, leaving the person fatigued and susceptible to opportunistic infections which in turn soak up more energy. Acupuncture and herbs are used to expel the pathogenic factor and to build up energy.”
Natural medicine can support the adrenals in many ways, he says. Supplements which nourish them include B5 or B complex, tyrosine, CoQ10 and Vitamin C. He recommends herbs such as ashwagandha, the ginsengs, rhodiola, schisandra, codonopsis and liquorice.
“Chinese herbalists use Chinese liquorice, Gan cao, in most of their herb mixes as a ‘harmoniser’. This makes perfect sense because it supports the adrenals that are depleted by the stress of most diseases. Some CFS sufferers are addicted to liquorice candy. The problem is this liquorice is highly processed and worth little and the candy is full of sugar.”
It is important that CF sufferers’ diets are nourishing, rich in minerals and vitamins and low in processed foods, he says.
“Highly refined carbohydrates - the sugars and the refined wheat products high on the glycemic index - are particularly stressful for the adrenals. Coffee and, to a lesser extent, regular tea, due to their caffeine content, are hard on the adrenals. Sometimes the CFS sufferer is addicted to coffee meaning that /she is horse whipping the depleted adrenals in an effort to stimulate further secretion of the stress hormones.
“Other CFS sufferers may be sugar junkies. In part, this is an effort to stimulate the depleted adrenals. However, the long term effect is to further deplete the adrenals.”
Boost energy levels
Dr Kats says a weak digestive system will exacerbate chronic fatigue syndrome so it is important to look at ways of strengthening it which will boost energy levels.
“Weak lungs with shallow breathing, poor posture, recurrent colds and flus must be treated. Any weaknesses on the organs must be identified and supported or resolved. This reduces stress and this will benefit energy levels, often dramatically.”
Diet must be understood in this way, too. Food intolerances ( “long term or permanent as opposed to allergy, meaning short term” ) are stressful to the body.
“A poor diet must be changed. Processed foods need to be reduced and junk food stopped. Whole foods easily digested are ideal. Crucifers and all members of the onion family (onion, garlic, leeks, chives ) are immunosupportive and are rich in compounds that remove toxins from the body. Positive dietary changes can go a long way towards reducing stress.”
Emotions are another source of stress. Betrayal, resentment, abuse, anxiety and worry are all severely stressful and depleting, according to the physician.
“Here is an example. A woman suffered 25 years of abuse from her husband. She finally worked up the courage to find an apartment, move out, find a job and divorce him. After a few weeks of happiness in her new life she collapsed and entered years of CFS. This tells me that her adrenals, severely stressed by the decades of abuse and the process of separation, finally collapsed with the change and relief of her new life.”
Having a Type A personality - “dominating, high expectations” - contributes to the condition, he claims.
“In the US many CFS women are Type A women, driven and perpetually unhappy and stressful on themselves and for all around them. Two thirds of CFS sufferers are women.”
Depression is not necessarily a cause of the condition, he explains. “The person may have been happy before it. Its effects - severe loss of energy and collapse for months from any slightly stressful event - are profoundly crippling. The person cannot support himself let alone a family and must depend on the generosity and goodwill of others. This is good reason to be depressed.”
The chronic use of antibiotics is another cause of CFS, Dr Kats claims. “Antibiotics destroy all bacteria, including the beneficial intestinal bacteria. When these are killed, this creates a window of opportunity for dysbiosis [microbial imbalances on or within the body] and the person may suffer chronic fatigue from that point on. This is uncommon with short term use of antibiotics. Treatment, in this case, should largely focus on normalising the intestinal flora. I am not putting down antibiotics, a most useful class of drugs, but chronic fatigue syndrome is one of the side effects of chronic antibiotic use.”