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immune system
Chronic Fatigue Syndrome
Integrative Therapies
Home Care
Chronic fatigue, also called chronic fatigue immunodeficiency syndrome or CFIDS, is a condition of extreme physical depletion which may last over a period of many months or years. During this time, you may experience constant tiredness, apathy, sore throats, low-grade fever, swollen glands, headaches, and muscle and joint pain. There may be moodiness, depression, inability to concentrate, and a lowered resistance to other infections.
There is a likely correlation between chronic fatigue and a long-lasting infection with the Epstein-Barr virus, or EBV, which is a herpes-like virus. It may persist for many years after the initial infection, even throughout a person's lifetime. The virus may become active in the body through prolonged emotional or physical stress such as overexertion, heat prostration, illness, or exposure to irritating chemicals or materials. A compromised immune system also leads to the virus becoming active in the body.
Chronic fatigue syndrome is difficult to pinpoint. If you have ongoing symptoms, consult your physician for a checkup and to eliminate the possibility of other disease processes at work.
You may now want to take notes.
THE FOLLOWING SUPPLEMENTS ARE USED AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE:
1. Beta-carotene 100,000 Units per day. Pregnant women (or women who may become pregnant) should not take more than 15,000 Units per day.
2. Vitamin C 1,000 milligrams 3 times per day.
3. Pantothenic acid 150 milligrams per day. Do not take at bedtime.
4. Zinc picolinate 15 milligrams per day.
5. Magnesium 200-300 mg three times, bound to citrate or Krebs cycle intermediates , especially if testing by your physician indicates a deficiency.
6. Multi-vitamin and Mineral supplement daily. See the product label for dosage. Make sure it contains no sugar or artificial ingredients.
7. Adrenal extract 1 to 2 tablets 3 times per day.
8. Thymus gland extract 1 to 2 tablets 3 times per day.
9. Iron 30 milligrams 3 times per day. Have your physician test for anemia to be sure that long term supplementation with iron is appropriate.
10. NADH (Nicotinamide Adenine Dinucleotide) 5-10 milligrams once a day in an empty stomach.
THE PROPER DIET FOR CHRONIC FATIGUE WILL INCLUDE THE FOLLOWING:
1. An overall healthy diet This includes using fresh foods as close to the natural, unpro-cessed state as possible. Eat daily servings of leafy green vegetables, whole grains, fruit, and proteins with a minimum of animal fat. Keep your intake of sugar foods and refined carbohydrates (such as white bread and white rice) to a minimum. For more information, refer to the article on healthy diet.
2. Be sure to get enough high-quality protein, such as in fish, beans, and soy products. Re-place red meat with fish and chicken as much as possible, and include beans, nuts, and seeds in your diet.
3. Another consideration is food allergies. Certain foods seem to be more likely to aggravate the symptoms of chronic fatigue. Eliminating these foods from the diet is a good way to determine if one or several of them are responsible for the problem. The main problem foods are dairy products (including milk, cheese, and ice cream), eggs, wheat, corn, yeast, and sugar.
After eliminating all of those foods from your diet, and the symptoms have gone away, one food at a time can be reintroduced to see if the symptoms reoccur. A new food would be introduced each week. As the condition improves, it may be possible to eat small amounts of such foods without ill effects. For more information about the elimination diet and food allergies, refer to the article on Food sensitivities.
4. Drink at least 8 to 10 glasses of distilled, well, or spring water each day.
5. Onions and garlic are recommended for their ability to inhibit viruses. Include them, raw as well as cooked, in your diet as often as possible. Also take 1 garlic capsule 3 times a day.
HERBS USED FOR CHRONIC FATIGUE:
1.Chinese or Panax Ginseng Root Take 1 dose twice daily, according to the manufacturer's instructions. Chew on a piece of the root thoughout the day as needed. Caution: Ginseng and vitamin C should taken at separate times of the day. Ginseng is taken on an empty stomach.
2. Poke Root tincture, which is a liquid herbal extract 3 to 5 drops, 3 times per day when symptoms are at their worst.
3. Echinacea Root is an essential herb for immune system support. It can be used as a tea, tincture, or in a capsule form.
As a tea, use 1 tablespoon of the herb per cup of boiling water. Simmer 3 minutes and steep for 15 minutes. Drink 3 to 4 cups per day.
As a tincture 1 teaspoon, 4 times a day.
In capsule form 2 capsules, 3 times a day.
4. Other important herbs are Golden Seal and Licorice, prepared the same as Echinacea and taken in similar doses. When taking Licorice, you should also increase the potassium-rich foods in your diet, such as fruits and vegetables.
Caution: Golden Seal is contraindicated in pregnancy.
PHYSICAL THERAPY MEASURES ARE AS FOLLOWS:
1. Exercise is of tremendous benefit. At least 30 minutes per day should be engaged in physical exercise that will get your heart working vigorously. Brisk walking, aerobics, swimming, tennis, and raquetball are all excellent forms of exercise. In addition, spend 15 to 30 minutes per day doing gentle stretching exercises. It may be necessary to work up to this gradually. Taking brisk walks for even 5 to 10 minutes per day is a good way to begin an exercise program.
2. It is very important that the effects of stress are dealt with through stress management and relaxation techniques such as visualization and meditation. Counseling is also suggested. For more information on stress management, refer to the article on that topic.
HOMEOPATHY:
From the following homeopathic remedies, choose the one that best matches your symptoms. Dissolve 3 pellets under your tongue.
Gelsemium 30C: For mental and physical weakness with drowsiness. Take once a day for 10 days.
Arsenicum album 12C: Take twice a day if restlessness or anxiety are the prevalent symptoms.
Note: A wide range of homeopathic medicines can be helpful for individuals with chronic fatigue. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.
AS AN ADDITIONAL MEASURE:
It is important to rule out the presence of a generalized candida yeast infection, which is very common in people who suffer from chronic fatigue syndrome. If you suspect this, refer to the article on candida.
Clinic
Footnotes
BarShalom R, Soileau J. (eds.) Natural Health Hotline. Beaverton, OR: Integrative Medical Arts, 1991-1999.
Baschetti R. Chronic fatigue syndrome and liquorice. New Z Med J 1995;108:156-157.
Brown D. Licorice root: potential early intervention for chronic fatigue syndrome. Quart Rev Natural Med. 1996;Summer:95-97.
Clague JE, Edwards RH, Jackson MJ. Intravenous magnesium loading in chronic fatigue syndrome. Lancet 1992;340:124-125.
Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic fatigue syndrome. Lancet 1991;337:757-760.
Demitrack MA. Chronic fatigue syndrome and fibromyalgia. Dilemmas in diagnosis and clinical management. Psychiatr Clin North Am. 1998 Sep;21(3):671-92, viii. (Review)
Demitrack, M.A. Chronic Fatigue Syndrome: A Disease of the Hypothalamic-Pituitary-Adrenal Axis? Ann Med 1994 Feb;26(1):1-5. (Review)
Demitrack MA, Crofford LJ. Evidence for and pathophysiologic implications of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Ann N Y Acad Sci. 1998 May 1;840:684-97. (Review)
Abstract: Chronic fatigue syndrome (CFS) is characterized by profound fatigue and an array of diffuse somatic symptoms. Our group has established that impaired activation of the hypothalamic-pituitary-adrenal (HPA) axis is an essential neuroendocrine feature of this condition. The relevance of this finding to the pathophysiology of CFS is supported by the observation that the onset and course of this illness is excerbated by physical and emotional stressors. It is also notable that this HPA dysregulation differs from that seen in melancholic depression, but shares features with other clinical syndromes (e.g., fibromyalgia). How the HPA axis dysfunction develops is unclear, though recent work suggests disturbances in serotonergic neurotransmission and alterations in the activity of AVP, an important co-secretagogue that, along with CRH, influences HPA axis function. In order to provide a more refined view of the nature of the HPA dusturbance in patients with CFS, we have studied the detailed, pulsatile characteristics of the HPA axis in a group of patients meeting the 1994 CDC case criteria for CFS. Results of that work are consistent with the view that patients with CFS have a reduction of HPA axis activity due, in part, to impaired central nervous system drive. These observations provide an important clue to the development of more effective treatment to this disabling condition.
Demitrack MA. Neuroendocrine aspects of chronic fatigue syndrome: a commentary. Am J Med. 1998 Sep 28;105(3A):11S-14S. (Review)
Forsyth LM, Preuss HG, MacDowell AL, Chiazze L Jr, Birkmayer GD, Bellanti JA. Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann Allergy Asthma Immunol. 1999 Feb;82(2):185-191.
Abstract: BACKGROUND: Chronic fatigue syndrome (CFS) is a disorder of unknown etiology, consisting of prolonged, debilitating fatigue, and a multitude of symptoms including neurocognitive dysfunction, flu-like symptoms, myalgia, weakness, arthralgia, low-grade fever, sore throat, headache, sleep disturbances, and swelling and tenderness of lymph nodes. No effective treatment for CFS is known. OBJECTIVE: The purpose of the study was to evaluate the efficacy of the reduced form of nicotinamide adenine dinucleotide (NADH) i.e., ENADA the stabilized oral absorbable form, in a randomized, double-blind, placebo-controlled crossover study in patients with CFS. Nicotinamide adenine dinucleotide is known to trigger energy production through ATP generation which may form the basis of its potential effects. METHODS: Twenty-six eligible patients who fulfilled the Center for Disease Control and Prevention criteria for CFS completed the study. Medical history, physical examination, laboratory studies, and questionnaire were obtained at baseline, 4, 8, and 12 weeks. Subjects were randomly assigned to receive either 10 mg of NADH or placebo for a 4-week period. Following a 4-week washout period, subjects were crossed to the alternate regimen for a final 4-week period. RESULTS: No severe adverse effects were observed related to the study drug. Within this cohort of 26 patients, 8 of 26 (31%) responded favorably to NADH in contrast to 2 of 26 (8%) to placebo. Based upon these encouraging results we have decided to conduct an open-label study in a larger cohort of patients. CONCLUSION: Collectively, the results of this pilot study indicate that NADH may be a valuable adjunctive therapy in the management of the chronic fatigue syndrome and suggest that further clinical trials be performed to establish its efficacy in this clinically perplexing disorder.
Fulcher KY, White PD. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. Br Med J 1997 Jun 7;314(7095):1647-1652.
Abstract: OBJECTIVE: To test the efficacy of a graded aerobic exercise programme in the chronic fatigue syndrome. DESIGN: Randomised controlled trial with control treatment crossover after the first follow up examination. SETTING: Chronic fatigue clinic in a general hospital department of psychiatry. SUBJECTS: 66 patients with the chronic fatigue syndrome who had neither a psychiatric disorder nor appreciable sleep disturbance. INTERVENTIONS: Random allocation to 12 weeks of either graded aerobic exercise or flexibility exercises and relaxation therapy. Patients who completed the flexibility programme were invited to cross over to the exercise programme afterwards. MAIN OUTCOME MEASURE: The self rated clinical global impression change score, "very much better" or "much better" being considered as clinically important. RESULTS: Four patients receiving exercise and three receiving flexibility treatment dropped out before completion. 15 of 29 patients rated themselves as better after completing exercise treatment compared with eight of 30 patients who completed flexibility treatment. Analysis by intention to treat gave similar results (17/33 v 9/33 patients better). Fatigue, functional capacity, and fitness were significantly better after exercise than after flexibility treatment. 12 of 22 patients who crossed over to exercise after flexibility treatment rated themselves as better after completing exercise treatment 32 of 47 patients rated themselves as better three months after completing supervised exercise treatment 35 of 47 patients rated themselves as better one year after completing supervised exercise treatment. CONCLUSION: These findings support the use of appropriately prescribed graded aerobic exercise in the management of patients with the chronic fatigue syndrome.
Gaby AR. Literature Review and Commentary. Townsend Letter for Doctors and Patients. Feb/Mar 1997, 27. (Review)
Hinds G, Bell NP, McMaster D, McCluskey DR. Normal red cell magnesium concentrations and magnesium loading tests in patients with chronic fatigue syndrome. Ann Clin Biochem 1994;31(Pt. 5):459-461.
Howard JM, Davies S, Hunnisett A. Magnesium and chronic fatigue syndrome. Lancet 1992;340:426.
Kaufman W. The use of vitamin therapy to reverse certain concomitants of aging. J Am Geriatr Soc 1955;3:927-936.
McCully KK, Sisto SA, Natelson BH. Use of exercise for treatment of chronic fatigue syndrome. Sports Med 1996 Jan;21(1):35-48. (Review)
Abstract: Chronic fatigue syndrome (CFS) is a condition that results in moderate to severe disability, the primary feature of which is fatigue of unknown origin. There is a lot of interest in classifying, characterising and treating patients with CFS. Currently, the two major theories of a medical cause of CFS are viral infection and immune dysregulation. Patients report critical reductions in levels of physical activity, and many experience 'relapses' of severe symptoms following even moderate levels of exertion. Despite this, most studies report CFS patients to have normal muscle strength and either normal or slightly reduced muscle endurance. Histological and metabolic studies report mixed results: CFS patients have either no impairment or mild impairment of mitochondria and oxidative metabolism compared with sedentary controls. Current treatments for CFS are symptom-based, with psychological, pharmacological and rehabilitation treatments providing some relief but no cure. Immunological and nutritional treatments have been tried but have not provided reproducible benefits. Exercise training programmes are thought to be beneficial (if 'relapses' can be avoided), although few controlled studies have been performed. CFS is a long-lasting disorder that can slowly improve with time, but often does not. Further studies are needed to better understand the multiple factors that can cause chronic fatigue illness, as well as the effect that exercise training has on the symptoms of CFS.
Murray M, Pizzorno J. Encyclopedia of Natural Medicine, Revised Second Edition. Prima Publishing: Rocklin, CA, 1998.
See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacology 1997 Jan;35(3):229-235.
Abstract: Extracts of Echinacea purpurea and Panax ginseng were evaluated for their capacity to stimulate cellular immune function by peripheral blood mononuclear cells (PBMC) from normal individuals and patients with either the chronic fatigue syndrome or the acquired immunodeficiency syndrome. PBMC isolated on a Ficoll-hypaque density gradient were tested in the presence or absence of varying concentrations of each extract for natural killer (NK) cell activity versus K562 cells and antibody-dependent cellular cytotoxicity (ADCC) against human herpesvirus 6 infected H9 cells. Both echinacea and ginseng, at concentrations > or = 0.1 or 10 micrograms/kg, respectively, significantly enhanced NK-function of all groups. Similarly, the addition of either herb significantly increased ADCC of PBMC from all subject groups. Thus, extracts of Echinacea purpurea and Panax ginseng enhance cellular immune function of PBMC both from normal individuals and patients with depressed cellular immunity.
Tinera, JW. The Hypoadrenocortical State and Its Management. NY State Med J 55;1955:1869-1876.