Chronic Fatique Syndrome

Sure, we’re all tired, at least some of the time. But people with chronic fatigue syndrome (CFS), have more than that occasional pooped-out feeling.

CFS, in fact, has an official definition that’s used for diagnosis in the medical community. It’s defined as debilitating fatigue that lasts for at least six months, accompanied by a number of other symptoms such as sleep disturbances, tender lymph nodes, sore throat, trouble with short-term memory, and various aches and pains. Needless to say, if you have such continuous fatigue, the first thing you need to do is see if you and your doctor can find a cause, since many health problems can cause a similar range of problems. If no other cause can be found, it’s possible that you have CFS.

Although CFS is still something of a medical mystery, doctors and researchers are continually learning more about it. "Many experts now think that chronic fatigue syndrome may be an example of the hypothalamus failing to properly regulate the brain’s influence on the immune system," says Jay Lombard, M.D., assistant clinical professor of neurology at Weill Medical College of Cornell University in New York City and co-author of The Brain Wellness Plan.

The hypothalamus is a regulatory gland in the brain. It normally stimulates the production of an important hormone called corticotropin. Corticotropin in turn is needed to stimulate the adrenal glands, which are located on top of the kidneys. When the hypothalamus isn’t doing its job and you don’t get enough corticotropin, your adrenal glands don’t produce enough cortisol, the body’s main stress hormone. "Clearly, chronic fatigue syndrome involves faulty communication among the nervous system, the immune system, and the endocrine system," Dr. Lombard says.

Lots of people with CFS also have low blood pressure, and a few studies suggest that some may also have difficulty producing and utilizing energy inside cells, Dr. Lombard says. Plus, some people have digestive problems that can cause improper digestion and absorption of critical nutrients, says Jeanne Hubbuch, M.D., a doctor in Newton Highland, Massachusetts.

One problem, called leaky gut, occurs when portions of improperly digested food elements seep through the lining of the intestine. Some experts speculate that this leakage sets off an immune response that can ultimately lead to attacks on the body’s own cells. Nutritional supplementation for CFS really depends on your particular symptoms, says Dr. Hubbuch. Doctors may use a wide array of supplements, each geared toward dealing with a particular symptom. Even doctors who consider themselves quite familiar with CFS, though, admit that it’s not easy to treat.

"Treatments may sound great in theory, but in practice it is a very difficult matter," Dr. Lombard says. "Chronic fatigue syndrome is a difficult disease to treat, medically and nutritionally. Often, there are psychological issues that may not be causing the disease but that certainly play a role." With that in mind, here are the nutritional and herbal treatments.

The Gut Connection

Practitioners of natural medicine advise that people with CSF have a comprehensive digestive stool analysis. This analysis will show whether they’re having problems with bacterial or yeast overgrowth in the intestines or with the incomplete breakdown of foods, Dr. Hubbuch says. A wide variety of nutritional supplements might be used to treat digestive problems, says Dr. Hubbuch. These include foods such as garlic or grapefruit seed extract, which can help kill bacteria or yeast.

Some people try introducing "friendly" bacteria such as Lactobacillus acidophilus and Bifidobacterium bifidum to restore a healthy balance of beneficial bacteria in the intestines and help crowd out the bad bugs. Others with CFS can benefit from enzymes that help the body break down food into digestible particles, she says. You may also want to take fiber formulas derived from plants, such as those made from psyllium seed, kelp, agar, pectin, and oat bran, to help elimination. It’s best to talk to your doctor about how much of each one to take.

Garlic is most effective if it’s fresh and raw, and it’s good to use at least one clove a day, says Dr. Hubbuch. If you are taking garlic supplements, you need a daily dose of at least 10 milligrams of allicin, the active ingredient in garlic that helps fight fungal infections. As for L. acidophilus and B. bifidum, you should get 1 to 10 billion viable organisms a day, so check the dosage on the product you use.

Follow the directions on the label or your doctor’s directions if you’re taking digestive enzymes. Dr. Hubbuch says that she normally suggests taking 5,000 units of lipase, 20,000 units of amylase, and 20,000 units of trypsin. You can also take 3 to 5 grams or more of soluble fiber each day at meals, she says.

Improving Immunity

Because so many people with chronic fatigue syndrome also have weakened immune systems, Dr. Lombard recommends several nutrients that have been shown to strengthen immunity. A high-potency multivitamin/mineral supplement may provide what you need. Look for these amounts in the supplement you choose: 30 milligrams of zinc, 25,000 international units (IU) of vitamin A (part can be from beta-carotene), 50 milligrams of B-complex vitamins such as pantothenic acid and riboflavin, 200 micrograms of selenium, 2 milligrams each of copper and manganese, and 400 IU of vitamin E. Dr. Lombard also recommends 4,000 milligrams of vitamin C a day in divided doses. For such a high amount, you’ll need a separate vitamin C supplement.

Herbs can stimulate your immune system, notes Dr. Lombard. He suggests 500 milligrams of a standardized extract of astragalus daily for long-term use. "Astragalus enhances antibody response, increases helper T lymphocytes and natural killer cell activity, and aids in immune system self-regulation," he says. "You should take this especially during periods of stress, such as during cold and flu season."

Along with astragalus, Dr. Lombard recommends 250 milligrams of a standardized extract of echinacea daily for 7 to 10 days with three-week rest intervals between dosage periods. "Echinacea stimulates macrophages, enhances the action of white blood cells, and stimulates the production of immune system–regulating biochemicals," he says. You need to take some time off between dosage periods, however, because echinacea loses its effectiveness after you take it for a while and your body builds a tolerance to it.

Dr. Hubbuch also recommends echinacea, often in combination with another immune-enhancing herb, goldenseal. "These are really good if you have a lot of viral symptoms, such as a sore throat, swollen glands, low-grade fever, or herpes," she says.

If you have only occasional flare-ups, you can use the herbs when symptoms start, as long as you consult your doctor. For flare-ups, you can take a 250-milligram capsule two or three times a day (a total of 500 to 750 milligrams) of a combination of echinacea and goldenseal, says Dr. Hubbuch. To suppress symptoms or as a maintenance dose, you can use two capsules twice a day, she adds.

You can also take echinacea and goldenseal as a tincture, using 15 to 20 drops—about a dropperful—three times a day if you have active symptoms. For maintenance, when the symptoms quiet down, you can take the tincture twice a day.

 Aiding Sleep

Tired as they may be, people with CFS often have trouble sleeping, To help improve sleep, Dr. Hubbuch recommends 5-hydroxytryptophan (5-HTP) and melatonin.

In your body, 5-HTP increases levels of serotonin, a chemical that helps regulate sleep patterns. Studies show that 5-HTP can shorten the time it takes to fall asleep and make you less likely to waken during the night. When Dr. Hubbuch prescribes this supplement, she instructs people to take 50 milligrams one hour before bedtime. You can increase the dosage up to 150 milligrams at night if necessary, but don’t go any higher than 200 milligrams, advises Dr. Lombard, since higher doses can cause disturbing dreams.

You should not take 5-HTP if you are currently taking antidepressant medication or have taken it recently, as the combined effects could cause a possibly fatal condition called serotonin syndrome. Otherwise, you can use 5-HTP safely for long periods of time, Dr. Hubbuch says. Decrease the dose if you are sleeping well, she advises. Along with the 5-HTP, she suggests taking 50 milligrams of vitamin B6. In addition to 5-HTP, some people may need to take melatonin, which can also be a sleep aid, Dr. Hubbuch says. She recommends two milligrams of timed-release melatonin at bedtime. For those who need still more help falling asleep, she suggests valerian, a calming herb that can help hasten sleep, improve the quality of sleep, and reduce nighttime awakenings.

Try one of these sleep remedies at a time and see if it works for you, Dr. Hubbuch says. If you don’t notice results after one to two weeks of using one product, try another. "Sometimes, you do use all of them," she says. "It depends on how bad your sleep problem is." It is safe to use all three, according to Dr. Hubbuch.

Enhancing Energy

People with CFS may also have impaired energy metabolism within the mitochondria, the energy producing areas of the muscle cells, Dr. Lombard says. The cells just don’t make or use energy as well as they should, for unknown reasons. To improve this situation, he recommends coenzyme Q10 (coQ10). This substance helps charge up the mitochondria. Both he and Dr. Hubbuch recommend taking 200 milligrams a day. Dr. Hubbuch suggests taking a type of coQ10 that is placed under the tongue (sublingual), where it dissolves and is absorbed through the mucous membranes, rather than the kind you swallow. "It is helpful in quite a few people," she says. "It’s better absorbed and seems to work better." If you start taking coQ10 and it helps, the results usually show up in about a month, says Dr. Hubbuch. "Try it for a month and see if it is worth it for you. If it’s not doing anything, then just stop." You can take it at any time of day, she says.

Many of the B vitamins as well as the amino acid l-carnitine are also essential for energy production. They’re important because they all appear to work together to boost muscle energy levels. You can make sure that you’re getting all of the B vitamins by taking a high-potency B-complex supplement, Dr. Lombard says. Look for one that includes about 50 milligrams of most of the B’s. Since you should get more folic acid and vitamin B12 than what’s provided by a B-complex supplement, you’ll probably need to take additional supplements, says Dr. Lombardo. He recommends a total of 1,000 micrograms of folic acid and 1,000 micrograms of B12 a day. In addition, he suggests supplementing with 500 milligrams of l-carnitine daily. But don’t take extra B-complex vitamins if you are already taking them to boost immunity, he cautions.

Have Some Magnesium

An essential mineral, magnesium, is also necessary for energy metabolism. Doctors have found that many people with CFS have low levels of magnesium in their red blood cells, and several studies have shown some improvement in energy levels with magnesium supplementation. Typically, magnesium comes as magnesium oxide or carbonate, but other forms may be better absorbed orally and utilized in the body. These include magnesium lactate, orotate, glycinate, and gluconate.

 Helping Your Hormones

People with CFS may need to reduce the amount of stress on their adrenal glands. That means limiting sugar and caffeine and taking vitamins, minerals, and herbs that help the glands function properly, Dr. Lombard says.

"The adrenal glands contain the highest concentration of vitamin C in the body," he says. Vitamin C helps influence neurotransmitters, the essential messenger chemicals that carry signals from one part of the body to another. Dr. Lombard recommends 4,000 milligrams of vitamin C a day, taken in divided doses. If you are already taking this amount to boost immunity, however, you don’t need to take more.

He also suggests 50 milligrams of pantothenic acid, 30 milligrams of zinc, and 600 milligrams of magnesium in divided doses. "These nutrients all play necessary roles in the manufacture of hormones by the adrenal glands," Dr. Lombard says. If you are already taking these nutrients for other reasons, though, there’s no need to add more. Siberian and Asian ginseng can also help support the adrenal glands, increase resistance to stress, and exert a number of beneficial effects on immune functions that may be useful in the treatment of CFS, Dr. Lombard says. In one study, people who took 10 milliliters a day of a liquid extract of Siberian ginseng had a significant increase in T-helper cells and in natural killer cell activity, both of which are of value in treating CFS. Dr. Lombard recommends 500 milligrams a day of standardized extract of Siberian or Asian ginseng.

Licorice for Low Blood Pressure

Licorice is also helpful in supporting the adrenal glands and increasing the production of cortisol, an important hormone, by this gland, Dr. Hubbuch says. Low amounts of cortisol or other adrenal hormones in the body can lower blood pressure. "Some people with CFS have problems with low blood pressure. As a result, they may feel dizzy and light-headed, especially when they are changing positions," she says. If you notice that you become dizzy when you stand up suddenly, low blood pressure may be the reason. Licorice can help relieve this symptom.

How much licorice you need to take depends on your symptoms and the type you use. A standard dose is 1,000 to 2,000 milligrams of powdered root or two to four milliliters (roughly 1¼3 to 2¼3 teaspoon) of liquid extract. Alternatively, you can take 250 to 500 milligrams of dry, powdered extract.

Be careful not to overdo it, though. You should talk to a doctor if you’re taking these amounts, since high daily doses for more than four to six weeks can cause symptoms such as headache and lethargy and may even lead to impaired heart or kidney function. Research

Help from DHEA

Dr. Hubbuch will also sometimes recommend dehydroepiandrosterone (DHEA), an adrenal hormone that the body can convert to various other hormones, including testosterone. People with CFS may produce inadequate amounts of it. She recommends that you have your doctor check your level of DHEA with a simple blood or saliva test before you supplement with it.

"I would try it only if other treatments aren’t helping enough and if DHEA levels are low," she says. In men, low DHEA levels are often associated with low sex drive. In women, often the only symptom is fatigue, Dr. Hubbuch says.

DHEA is available over the counter. If you have a prescription from your doctor, a compounding pharmacist can make up a specific dose, says Philip Mease, M.D., a rheumatologist at Minor and James Medical Center and clinical associate professor of medicine at the University of Washington Medical School, both in Seattle. DHEA has not been studied in chronic fatigue patients, but Dr. Mease says, "I have heard reports from patients that this hormone supplement can be helpful for reducing pain and fatigue."

The dose of DHEA varies depending on the strength of the product you are taking. If you can get the tincture from a pharmacist, the instructions are usually to take drops under the tongue twice a day, according to Dr. Mease. "My experience has been that the DHEA made by pharmacists is more effective than the capsules you’d get at a health food store," he says. Whatever you do, it’s wise to work with your doctor if you want to take DHEA, Dr. Mease advises.