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Health Protocols

Chronic Fatigue Syndrome

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Chronic fatigue syndrome (CFS) is a complicated condition characterized by profound fatigue that persists for more than six months. It is often accompanied by cognitive difficulties, muscle and joint pain, depression, poor sleep quality, or other nonspecific symptoms. Many people with CFS have difficulty working, attending school, exercising, and carrying out daily activities. Sadly, conventional physicians often overlook this condition, and as many as 80% of individuals suffering with CFS may not receive an accurate diagnosis.

However, studies show people with CFS may benefit from such integrative interventions as magnesium, L-carnitine, and roburin-rich French oak wood extract.

Causes and Risk Factors

A specific cause of CFS has not been conclusively demonstrated, but several factors may correlate with CFS incidence:

  • More common in women in early or middle adulthood, and in African, Hispanic, or Native American descent
  • Viruses such as human herpesvirus-6 (HHV-6) and Epstein-Barr virus (EBV) may play a role in the development of CFS
  • Allergies, excessive inflammation, and mitochondrial dysfunction may also be involved


  • There is no specific diagnostic test for CFS. A diagnosis of CFS first requires that other potential causes of fatigue be ruled out.
  • Diagnostic guidelines for CFS include chronic, unexplained fatigue for at least six months, which is of new onset, is not the result of ongoing exertion, is not substantially relieved by rest, and hinders occupational, social, or personal activities.
  • In addition, at least four of the following symptoms must be present 50% of the time for at least six months:
    • Unrefreshing sleep
    • Impaired memory or concentration
    • Sore throat
    • Tender lymph nodes in neck or armpit areas
    • Aching or stiff muscles
    • Multi-joint pain
    • Headache of new type, pattern, or severity
    • Post-exercise malaise or illness feeling which lasts more than 24 hours

Conventional Treatment

  • Cognitive behavioral therapy and graded exercise therapy are generally agreed to have the highest level of evidence for success in treating CFS.
  • Stimulant drugs such as methylphenidate (Ritalin, Concerta) or amphetamine/dextroamphetamine (Adderall) have been used to treat CFS.

Novel and Emerging Therapies

  • Drugs with antiviral and/or immunomodulating properties have been shown to improve energy and exercise tolerance.
  • DHEA supplementation in women who had CFS and low DHEA-S levels significantly improved fatigue, pain, memory, and sexual functioning.
  • Immune/stem cell mobilization therapy by granulocyte-colony stimulating factor (G-CSF) has been used successfully for CFS by a pioneering doctor.

Dietary and Lifestyle Considerations

  • Avoid exposure to tobacco smoke, toxic chemicals, and pollutants.
  • Detoxification regimens, such as sauna therapy, may be helpful for CFS.
  • Massage therapy and qigong may help improve fatigue.

Integrative Interventions

  • Magnesium: Magnesium is an essential mineral involved in hundreds of enzymatic reactions in humans. Its deficiency may be linked to chronic fatigue, and supplementation may improve symptoms of CFS.
  • B-vitamins: B vitamin-related enzyme activity has been found to be lower in patients with CFS, and women receiving a daily low potency multivitamin/mineral supplement containing B vitamins had significantly less fatigue, better sleep, and fewer and less intense headaches.
  • Adaptogenic herbs: Adaptogenic herbs are of particular interest in CFS due to their reputation for boosting energy as well as their possible effects on the HPA-axis and on supporting healthy immune system function. Some adaptogens considered promising for CFS include Rhodiola rosea, Panax ginseng, and ashwagandha.
  • L-carnitine: A study of CFS subjects compared the drug amantadine, an FDA-approved antiviral medication, with L-carnitine; authors concluded L-carnitine was better tolerated and produced significantly greater clinical improvement.
  • Roburin-rich French oak wood extract: In an open-label controlled trial that evaluated patients with CFS, roburin-rich French oak wood extract was demonstrated to relieve a wide range of CFS symptoms.