Chronic Fatigue Syndrome
Dietary and Lifestyle Considerations
Avoid Smoking and Chemical Exposures
People with CFS should avoid, as much as possible, exposure to tobacco smoke, toxic chemicals, and pollutants. Smoke contains many toxicants, including carbon monoxide and nicotine, which can cause fatigue, damage the nervous system, and increase risk of chronic pain (Balzan 1996; Shi 2010; Kirkpatrick 1987; Zvolensky 2009; Jay 2000). Exposure to cigarette smoke, even secondhand, is pro-inflammatory and suppresses or disorders immune response (Lugade 2014; Lee, Taneja 2012; Orosz 2007). In a large study of 984 fibromyalgia subjects of which 145 (14.7%) were tobacco users, the tobacco-using subgroup had significantly greater pain, joint stiffness, anxiety, depression, and fatigue compared to nonusers (Weingarten 2009).
Exposure to toxic compounds (including mercury, lead, petrochemical solvents, pesticides, and molds) has been linked to CFS-like symptoms (Brown 2014; Curtis 2004; Nacul 2009). Many people with chemical sensitivity also have severe chronic fatigue (Ziem 1999; Katerndahl 2012). Several studies have reported that a variety of generalized and multiple organ system symptoms have resolved in chemically sensitive subjects who reduce or eliminate toxicant exposure (Hillert 2013; Brown 2007; Yun 2013; Katerndahl 2012).
Heavy indoor exposure to molds has been linked to asthma, sinus problems, chronic fatigue, and significantly reduced levels of hormones essential for energy production such as growth hormone and thyroid hormones (Curtis 2004; Dennis 2009). In a study on 79 subjects with chronic fatigue, chronic sinusitis, and a history of mold exposure, 51% were deficient in growth hormone and 81% were deficient in the thyroid hormones T4 and/or T3. The subjects were then placed on a multifaceted treatment program including: cleanup of subject’s indoor environment to greatly reduce mold and moisture conditions that foster mold growth; saline nasal sprays; oral and nasal antibacterial and antifungal drugs; hormone replacement treatment with growth hormone, thyroid hormone, and other hormones as needed; and a broad range of nutritional supplements including vitamins, minerals, herbs, CoQ10 and L-carnitine. Following this treatment, sinusitis resolved in 93% of participants who achieved a normal indoor mold count; and fatigue improved in all 37 participants who received growth hormone and cortisol and/or thyroid hormone replacement based on a diagnosed deficiency in these hormones (Dennis 2009).
If possible, those with CFS should also live and work in well-ventilated buildings. Indoor levels of pollutants such as solvents, pesticides, and dust are generally higher in buildings that do not receive enough outdoor air ventilation, or in which the external air intake is improperly filtered or positioned. In a large study of 4106 office workers, symptoms of fatigue or difficulty concentrating were 38% less common in well-ventilated buildings (ie, ventilated with 100% outdoor air) compared to less well-ventilated buildings (Mendell 2008). Using an air purifier may also be advisable (Yun 2013).
Nutritional detoxification regimens may also be helpful for CFS. In a group of 111 patients with metal hypersensitivity and symptoms resembling CFS, removing mercury-containing dental amalgams was associated with major long-term health improvements in 76% of subjects (Stejskal 1999). A case series reported that treatment with oral vitamin C (ascorbate) and choline was associated with significant reduction in both fatigue and blood levels of organochlorine pesticides in four CFS subjects (Richardson 2000; Erkekoglu 2010; Mehedint 2013; Corbin 2012). Another case series of women with CFS reported that 35 days of once-daily thermal therapy (15 minutes of far-infrared dry sauna followed by 30 minutes resting in a very warm room) was associated with improvements in sleep, energy level, and concentration, as well as a reduction in depression (Masuda 2005). Sauna use may support detoxification, has sleep enhancing effects, and relieves muscular spasms related to muscle contraction and pain (Cecchini 2007; Crinnion 2007; Masuda 2005).
A review of detoxification strategies is available in the Metabolic Detoxification protocol.
Massage and Qigong
Alternative therapies such as massage and Qigong are often used by CFS patients. Qigong is a specialized form of gentle exercise that harmonizes breathing, posture, body movements, and mind in order to prevent and heal disease and improve quality of life (Dorcas 2003; Sun 2008; Alraek 2011). A small study of 20 CFS subjects reported that undergoing massage therapy twice weekly for five weeks was associated with significant reductions in pain and fatigue compared to placebo (which involved sham transcutaneous electrical nerve stimulation). Another study of 31 CFS cases reported that practicing Qigong and meditation for two hours weekly for 12 weeks was associated with significantly less fatigue and significantly greater work capacity compared with cases given no treatment (Alraek 2011).
Candida albicans (a yeast) is a common resident of the healthy human intestinal tract. However, overgrowth of Candida may cause health problems, including CFS-like symptoms, and may be involved in CFS in some individuals (Evengård 2007). One author reported on the treatment of 1100 CFS subjects with the oral anti-fungal drug ketoconazole (Nizoral) and a special diet that eliminated refined sugar, fruit juice, and alcohol. A favorable response was noted in 84% of CFS subjects after 3-12 months of treatment. Before treatment, 685 of these subjects were on disability, and after treatment, only 12 subjects were on disability (Cater 1995).
More information on fungal infections and Candida is available in the Fungal Infections (Candida) protocol.