Chronic fatigue syndrome: Getting to the root of the problem

Chronic fatigue syndrome (CFS) has long been a mystery condition. The underlying causes of CFS have not been conclusively determined. In fact, it was only within the last decade that it was even acknowledged as a legitimate health condition by the Centers for Disease Control and Prevention. Regardless of its recent acceptance into the fold of "official diseases," it seems to have existed in the past in many different incarnations from "effort syndrome" in World War I veterans and "the vapors" in 19th century women, to, more recently, hypoglycemia and chronic mononucleosis.

More than 2 million Americans, most frequently young, white, professional women, are estimated to suffer from CFS. For many people, a viral infection, such as the Epstein-Barr virus, precedes the onset of CFS. According to the Centers for Disease Control and Prevention, CFS is present when a person experiences persistent fatigue for at least six months as well as four or more of the following symptoms:

impaired short-term memory or concentration severe enough to interfere with usual activities;
sore throat;
swollen lymph nodes;
muscle and/or joint pain without joint swelling or redness;
unrefreshing sleep; and
post-exertion weariness lasting more than 24 hours.
General improvements in lifestyle, as well as stress management techniques, can combat some of the symptoms of CFS. On the other hand, poor health habits, such as smoking, an unbalanced diet, excessive alcohol use, and lack of exercise, can aggravate CFS symptoms. Although exercise is probably the last thing fatigued people feel like doing, research shows that moderate exercise can be a valuable part of a CFS treatment protocol; and, for many people, regular exercise prevents the fatigue from worsening. However, exercise seems to make the condition worse in some individuals.

Blood pressure may account for low energy
An emerging explanation for CFS is related to blood pressure. Some research suggests that an abnormality in the regulation of blood pressure is the underlying cause of CFS.

The condition called neurally mediated hypotension is caused when sensors near the heart misinterpret the pooling of blood in the legs that happens when a person stands for a prolonged period and signals the body to faint. Over time, this may lead to the feelings of fatigue seen in those with CFS. This problem with blood pressure regulation has been documented in adults and teenagers suffering from CFS. The treatment for regulating blood pressure is a high-salt diet and certain pharmaceutical drugs; however, this treatment should only be undertaken by those who have been diagnosed with neurally mediated hypotension.

The herb licorice is potentially valuable for CFS sufferers who have problems with blood pressure. Licorice that contains the compound glycyrrhizin (but not the "deglycyrrhizinated" licorice products) elevates blood pressure. One small study found that a CFS patient taking 2.5 grams of licorice daily showed improvement.

Nutritional support for chronic fatigue syndrome
The mineral magnesium plays an integral role in energy production, since it is needed to convert carbohydrates, protein, and fats into energy. Recent research from the University of Southampton, U.K., found that patients suffering from CFS tend to have low blood levels of magnesium. Furthermore, CFS patients taking magnesium supplements report greater energy levels, improved emotional state, and less pain than those taking a placebo.

Carnitine, an amino acid, is needed for the production of energy in the mitochondria of cells. Some researchers suspect that individuals with CFS may have mitochondria that do not function properly. Accordingly, deficiencies of carnitine have been reported in some people with CFS. Even more suggestive is a study that found that 3 grams of carnitine daily can alleviate some of the symptoms of CFS.

Lysine's biggest claim to fame is for the relief of cold sores (cold sores result from the herpes simplex virus); but there may also be a link to CFS. The development of CFS is often preceded by a viral "flu-like" illness. This viral infection may be in the herpes family, evidenced by the fact that the Epstein-Barr virus is in the herpes family.

Herpes viruses require the amino acid arginine for reproduction; whereas lysine blocks the absorption of arginine, and for this reason inhibits the replication of the virus. Lysine, by "starving" the virus may result in remission of CFS, as it does for cold sores. However, this is an area that still awaits further study with human CFS patients.

Coenzyme Q10 may also be important for those with CFS. Coenzyme Q10 is concentrated in the mitochondria, where it is crucial for energy production. Although there have not been any studies with coenzyme Q10 and CFS sufferers, several researchers suspect that there may be a link.

NADH (nicotinamide adenine dinucleotide) is a coenzyme that facilitates the body's energy-producing processes. Recently, NADH was approved by the FDA for an Investigational New Drug (IND) clinical trial in patients with CFS in which almost one-third of the CFS patients improved significantly while taking the NADH supplement.

Vitamin C and vitamin E levels were found to be lower in those with CFS, when compared to healthy people according to a recent study. Other nutrients that tended to be lower in the CFS group included magnesium and carnitine. Of the nutrients found to be low, vitamin C is particularly intriguing since inadequate vitamin C levels have been shown in other research to cause fatigue; in addition vitamin C is needed for a well-running immune system.

On the herbal front, echinacea and garlic are particularly helpful for boosting the body's immune defenses and fighting off infections, which in turn is valuable for CFS sufferers.

Ginkgo, by increasing blood flow, has been suggested to be of potential benefit in CFS; but studies directly examining this connection are still lacking.

Medicinal mushrooms are also well-known for strengthening the immune system. Maitake has been used traditionally to promote overall health, and modern research confirms the immune-modulating effect of this mushroom. Compounds in maitake known as polysaccharides (specifically beta-D-glucan) boost immune function, and in this way, are potentially useful in CFS.

For more information about coping with CFS, contact the Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America at (800) 422-3437.

Baschetti, R. "Chronic fatigue syndrome and liquorice," New Z Med J 108:156-157, 1995.

Bou-Holaigah, I., Rowe, P.C., Kan, J., et al. "The relationship between neurally mediated hypotension and the chronic fatigue syndrome," JAMA 274:961-967, 1995.

Cox, I.M., Campbell, M.J., Dowson, D. "Red blood cell magnesium and chronic fatigue syndrome," Lancet 337:757-760, 1991.

Grant, J.E., Veldee, M.S., Buchwald, D. "Analysis of dietary intake and selected nutrient concentrations in patients with chronic fatigue syndrome," J Am Diet Assoc 96:383-386, 1996.

Plioplys, A.V., Plioplys, S. "Amantadine and L-carnitine treatment of chronic fatigue syndrome," Neuropsycholbiol 135:16-23, 1997.


By Victoria Dolby, M.P.H.

Adapted by M.P.H.

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