What is chronic fatigue syndrome/ME? Is there a known cause?

CFS, Chronic Fatigue Syndrome, or ME, Myalgic Encephalomyelitis, is a chronic health condition which can affect anyone, including children. It is more common in women and tends to develop in individuals aged between their mid-20s and mid-40s. CFS is a condition characterised by severe and persistent fatigue, neurological disturbances, autonomic and endocrine dysfunctions and sleep difficulties (Arroll and Howard, 2012), which can have a wide-ranging impact on an affected client’s life.

There is not a specific test for CFS/ME available on the NHS, so the condition is diagnosed based on a client’s presenting symptoms and by ruling out other conditions that could be causing (similar) symptoms. 

As a Registered Nutritional Therapist, I have seen over 50 clients with this condition. As the symptoms of CFS/ME are similar to those of many common illnesses that usually get better on their own, a diagnosis of CFS/ME may be considered if a client does not get better as quickly as expected. It may also be considered for clients for whom fatigue has been consistently present in some form for six months or longer. 

There is no official known cause of Chronic Fatigue Syndrome. Recent research proposes that it may be caused by Mitochondrial dysfunction (Pizzorna, J, 2014); reduced immune function or bacterial/viral infection (shown through frequency of colds and flu before CFS onset), familial history of neurological illness, or contributing social factors, such as being single or having a lower-income, which may increase susceptibility to developing CFS (Lacerda et al, 2019). 

From experience of working with many clients with CFS, other clinical observations linked to potential development of CFS include; compromised gut health – in particular increased intestinal permeability and associated inflammation; food sensitivities and potential auto-immune reactivity; parasites and bacterial infections, viruses, namely Epstein Barr Virus (from Glandular fever, Coxsackie and mycoplasma, amongst others; unresolved childhood trauma, requiring psychological support; female hereditary issues, (it appears to pass down through the maternal line), and compromised detoxification issues, genetic SNPs on Methylation, often complicated by toxic metal or mould infections.

What are some of the symptoms of CFS? 

The main symptom of CFS/ME is an intense and often overwhelming feeling of extreme tiredness and fatigue. Other symptoms associated with the condition are wide-ranging and can include some or all of the following:

• Sleep issues 
• muscle or joint pain 
• headaches 
• a sore throat or sore glands that are not swollen 
• brain fog: problems with thinking, remembering or concentrating 
• flu-like symptoms
• feeling dizzy or sick 
• fast or irregular heartbeats (heart palpitations) 
• a difficultly in regulating blood pressure from sitting to standing 
• being an ‘achiever,’ ‘helper’ or ‘anxious’ personality-type 
• inability to cope with the exhaustion of social interactions 
• pacing issues 
• poor stress tolerance 

As the symptoms of CFS/ME are similar to the symptoms of some other illnesses, such as Crohn’s disease, it is important to see a GP to get a correct diagnosis.

Is there a specific diagnosis? 

As previously discussed, there is currently no universal criteria for diagnosing CFS, therefore diagnosis is made on the NHS if a client has shown signs of continuous fatigue for 6 months+ with no identifiable co-morbidity. This unfortunately means that many clients receive a formal diagnosis only when they are chronically ill and have been so for some time. Currently the only recognised treatments available on the NHS are cognitive behavioural therapy (CBT) and graded exercise therapy (GET), alongside prescribed pain-relief medication. Neither of these main approaches have consistent, significant success in the long-term improvement of CFS symptoms. Therefore, a CFS diagnosis is sometimes considered by many within the Medical field to be a chronic condition, to be self-managed, for life.

Are there any dietary interventions that can help to manage CFS? 

Working within the field of CFS and ME, I have experienced many clinical protocols which have had successful outcomes. Several clients have reported a full recovery and to be ‘symptom-free’ post extended Nutritional therapy interventions (and sometimes concurrent clinical psychological support). As Registered Nutritional Therapists are aware, every client is unique, due to their highly individual, genetic, socio-economic and environmental exposures. However, I have found the following general nutritional approaches to be clinically highly successful:

Establishing healthy blood sugar balance: As many CFS clients have often been in a sub-optimal health state for some time, prior to formal diagnosis, most have energy dysregulation, often as a result of varying degrees of underlying mitochondrial dysfunction. Establishing a healthy blood sugar balance throughout the day can contribute towards regulated energy. Clinically this involves increasing the client’s protein throughout the day (to approximately 1.2-1.7g per kg of body weight), minimising processed high sugar and/or high glycaemic-load foods and increasing their intake of oily fish (sardines, mackerel, anchovies, salmon and herring) to support the myelin sheath of nerve cells, for improved neurotransmitter response.

Removing common food sensitivities: There is a wealth of research on the role of gluten in affecting cell-junction response in the small intestine. Zonulin, the protein within gluten, is found to increase intestinal permeability (Sturgeon and Fassano, 2016), thus increasing the potential for protein auto-immune reactions and the potential progression towards various auto-immune conditions. The possibility of bacterial translocation and associated joint pain/ stiffness or even of molecular mimicry of gluten and neurotransmitters, potentially progressing to mood disorders such as depression, are also present with high gluten-intake. 

Removing gluten from a client’s diet removes the potential risk of food sensitivities/ intolerances. Often it is beneficial to remove dairy concurrently, due to the potential of cross-reactivity, with the chemical structure of both gluten and dairy being so similar.

Improving gut function: Alongside removing potential food sensitivities, gut integrity work can be transformative, in terms of improving a client’s ability to greater absorb nutrients from beneficial foods. Certain foods, such as bone broth, which contain an abundance of bovine collagen, have been shown to improve the integrity of the gut cell wall. In terms of bacterial balance and the microbiome, PCR- style stool tests can be useful to identify bacterial dysbiosis. Increasing appropriate strands of prebiotics and fermented foods (being mindful of SIBO), can assist in crowding out potentially pathogenic bacteria with useful bacteria such as bifido-bacterium.

Supporting detoxification: After improving nutrient intake and absorption, supporting toxic excretion is essential. Many CFS clients in clinic have genetic singular nucleotide polymorphisms (SNPs) which pre-dispose their detox pathways to be sub-optimal. Through nutrigenomic testing, examined alongside other functional tests, we can identify as practitioners, areas which need support and whether supplements would be useful to encourage particular detox pathways for a beneficial outcome. Alternative delivery mechanisms of supplements – for example taking a methylated form of B vitamins if the client has an MTHFR SNP can also improve outcomes. When improving detox and bowel frequency, it is sometimes necessary to test for heavy metals and/ or mycotoxins. If identified, a zeolite or chlorella binder, depending on the metal or mycotoxin found, can be used for a limited time to support the toxic excretions safely. 

Viral protocols: The most commonly known virus associated with CFS is Epstein Barr virus (EBV), which is associated with glandular fever (known as Mono in the US). However, there can be several other co-infections present in a client who has reduced immunity. Some of which, Coxsackie in particular, can cause debilitating fatigue. After IgG and IgM testing, there are various options to support these infections, including a mycology approach to modulate immune activation. 

Supplements and vital vitamins and minerals: It is known that CFS clients tend to react strongly to new supplements. This could be down to reduced immunity, general anxiety or impaired detox function, which are all associated with this client group. Specific, individually tailored supplements can have a transformative effect on a client’s health when administered safely, avoiding pharmaceutical contra-indications and after bespoke functional testing. In more general terms, in practice I have found the following supplements are useful for a baseline protocol on which to build: a powdered multi-vitamin, including B vitamins, vitamins C and D, zinc, selenium and CoQ10 (to allow for dose-tapering if reactive); an omega 3 and 6 supplement; a digestive enzyme (taken 20 minutes prior to eating); and electrolytes if indicated.

Are there specific lifestyle interventions that can also manage symptoms?

Depending on the advice of your Nutritional Therapist there are plenty of lifestyle interventions that may help a client’s recovery from/ or symptom-management of CFS. These include detox protocols such as infra-red saunas (www.getfitt.com) to assist in detoxification, alongside daily practices to encourage lymphatic drainage, including dry-skin brushing. 

Clients who are working towards lowering anxiety and supporting their adrenal dysregulation, often benefit from developing a daily mindfulness or meditation practice (www.calm.com) or gentle yoga or vagal nerve stimulation therapy. For clients where there is deep-seated (past) trauma, psychology is recommended. All clients have a greater success rate clinically (in my personal experience) when they develop and continually practice the skill of pacing their activities and everyday life. I find it extremely rewarding to support clients clinically which such an overwhelming medical diagnosis and to help them individually to restore their energy and abilities to live a fulfilling life.

References: Arrol M A and Howard A (2012) A preliminary prospective study of nutritional, psychological and combined therapies for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in a private care setting BMJ Open 2:e001079 Lacerda, E M, Geraghty K, Kingdon C, Palla L, Nacul L (2019) A Logistic Regression Analysis of Risk Factors in ME/CFS Pathogenesis BMC Nerol. No 7;19 (1):275 Pizzorno J (2014) Mitochondria—Fundamental to Life and Health Integr Med (Encinitas) Apr; 13(2): 8-15. Sturgeon C and Fasano A (2016) Zonulin, a regulator of epithelial and endothelial barrier functions, and its involvement in chronic inflammatory diseases Tissue Barriers 4 (4):e1251384

Karen Preece Smith at The Nutrition Guru