"I have to get it done,” said Sarah. “I owe it to my family, my colleagues, and my responsibilities!” Sarah, aged 37, expressed her frustration about managing her demanding job in finance while taking care of her family and coping with chronic fatigue syndrome (CFS). “I can only manage a few hours of work each day. After that, I’m running on empty.” Sarah faced a dilemma: dedicating energy to her work left her with nothing for her family, and spending time with her family made her too tired to fulfill her job duties.
Energy in the body is more complex than a simple battery metaphor. In my experience with fatigue patients, there is a distinction between physical and psychological energy. Physical energy relates to the body’s capability to perform tasks, relying on physiological processes like cellular respiration and metabolic pathways. Psychological energy involves mental and emotional resources, influencing motivation, focus, and emotional regulation. 1,2
A study in PubMed Central highlights that mitochondrial dysfunction is a key feature in CFS, leading to impaired energy production at the cellular level. This explains why individuals with CFS, like Sarah, experience profound fatigue even after minimal exertion. 3
General fatigue is typically short-term and temporary, often alleviated with rest or lifestyle adjustments. It varies in intensity and may not significantly impair daily functioning. It is usually limited to feelings of tiredness and lethargy and is typically alleviated by adequate sleep, rest, or relaxation. It may interfere with daily activities but usually does not severely impair functioning. 1
CFS, however, persists for an extended period (usually at least six months) and is not significantly relieved by rest. It is often profound, persistent, and debilitating, significantly impacting daily activities and quality of life. CFS is accompanied by a range of symptoms including muscle pain, headaches, unrefreshing sleep, brain fog, and significant fatigue post-exertion. Symptoms persist despite efforts to recuperate, leading to substantial limitations in daily activities, work, social interactions, and overall quality of life. 1,2
Managing CFS requires a holistic approach, addressing various potential underlying issues. For sleep issues like severe insomnia or sleep apnea, assessment tools such as the ESS or StopBang can be used, and referrals for comprehensive sleep assessments might be necessary. 4
Hormone issues should be checked through thyroid function tests (TFT), adrenal function tests, and sex hormone evaluations for both men and women. 5
Hidden infections need to be considered, with tests for stool parasites, overseas bugs like schistosomiasis, and tick-borne illnesses. Viruses such as EBV, CMV, and HHV6 can be treated with therapies like low-dose naltrexone (LDN), ocean bathing, IV vitamin C, sunbathing, or hyperbaric oxygen therapy (HBOT). 6,7,8
For nutrition and gut issues, a full assessment for dysbiosis, yeast overgrowth, histamine intolerance, FODMAP sensitivities, small intestinal bacterial overgrowth (SIBO), gluten, and dairy intolerances is essential. Diet reviews, weight management, and checking for nutritional deficiencies like magnesium and omega-3 are also important. 9,10
Exposure to toxins needs to be assessed, considering sick building syndrome, mycotoxins, volatile organic compounds (VOC), and electromagnetic fields (EMFs). 11,12 Engaging a building biologist and testing for Aspergillus serology, urine organic acids, and relevant genes like HLA can be helpful.
Environmental issues should be addressed, using sequestering agents, xylitol nasal rinsing, and diet reviews, alongside therapies for mast cell activation syndrome (MCAS) to reduce inflammation. 13
Stress and mental health require attention through neural retraining, stress management techniques, and counselling, with specialist referrals as needed. 14
Congenital or inherited issues, such as MTHFR gene problems, should be evaluated and managed with appropriate supplements. 15
Conditions like postural orthostatic tachycardia syndrome (POTS)/dysautonomia can be addressed with blood pressure support (garments, electrolytes, herbs, medications), and hypermobility can be managed with a tailored exercise program. 16
Addressing CFS comprehensively involves continuous review of symptoms and lifestyle. Effective management requires medical and nutritional interventions alongside a holistic view of overall health. Through tailored strategies and ongoing support, individuals like Sarah can find ways to manage their energy more effectively and improve their quality of life.
Julia Haimovich and Accredited Practicing Dietitian and Credentialed Eating Disorder Clinician at FerFit Dietetics and Nutrition (FFDN). I employ range of therapeutic approaches including cognitive behaviour therapy, nutrition and mindfulness To learn more or make an appointment with me, click HERE
References:
1. Marjolein van’t Leven, Gerhard A. Zielhuis, Jos W. van der Meer, André L. Verbeek, Gijs Bleijenberg, Fatigue and chronic fatigue syndrome-like complaints in the general population, European Journal of Public Health, Volume 20, Issue 3, June 2010, Pages 251–257, https://doi.org/10.1093/eurpub/ckp113
2. Castro-Marrero, J., Sáez-Francàs, N., Santillo, D., & Alegre, J. (2017). Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome. British journal of pharmacology, 174(5), 345–369. https://doi.org/10.1111/bph.13702
3. Holden, S., Maksoud, R., Eaton-Fitch, N., Cabanas, H., Staines, D., & Marshall-Gradisnik, S. (2020). A systematic review of mitochondrial abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome/systemic exertion intolerance disease. Journal of translational medicine, 18(1), 290. https://doi.org/10.1186/s12967-020-02452-3
4. Gamaldo, C., Buenaver, L., Chernyshev, O., Derose, S., Mehra, R., Vana, K., Walia, H. K., Gonzalez, V., Gurubhagavatula, I., & OSA Assessment Tools Task Force of the American Academy of Sleep Medicine (2018). Evaluation of Clinical Tools to Screen and Assess for Obstructive Sleep Apnea. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(7), 1239–1244.
5. Deumer, U. S., Varesi, A., Floris, V., Savioli, G., Mantovani, E., López-Carrasco, P., Rosati, G. M., Prasad, S., & Ricevuti, G. (2021). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): An Overview. Journal of clinical medicine, 10(20), 4786. https://doi.org/10.3390/jcm10204786
6. Cabanas, H., Muraki, K., Eaton-Fitch, N., Staines, D. R., & Marshall-Gradisnik, S. (2021). Potential Therapeutic Benefit of Low Dose Naltrexone in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Role of Transient Receptor Potential Melastatin 3 Ion Channels in Pathophysiology and Treatment. Frontiers in immunology, 12, 687806. https://doi.org/10.3389/fimmu.2021.687806
7. Zilberman-Itskovich, S., Catalogna, M., Sasson, E., Elman-Shina, K., Hadanny, A., Lang, E., Finci, S., Polak, N., Fishlev, G., Korin, C., Shorer, R., Parag, Y., Sova, M., & Efrati, S. (2022). Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: randomized controlled trial. Scientific reports, 12(1), 11252. https://doi.org/10.1038/s41598-022-15565-0
8. Vollbracht, C., & Kraft, K. (2021). Feasibility of Vitamin C in the Treatment of Post Viral Fatigue with Focus on Long COVID, Based on a Systematic Review of IV Vitamin C on Fatigue. Nutrients, 13(4), 1154. https://doi.org/10.3390/nu13041154
9. Campagnolo, N., Johnston, S., Collatz, A., Staines, D., & Marshall-Gradisnik, S. (2017). Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. Journal of human nutrition and dietetics : the official journal of the British Dietetic Association, 30(3), 247–259. https://doi.org/10.1111/jhn.1243
10. Haß, U., Herpich, C., & Norman, K. (2019). Anti-Inflammatory Diets and Fatigue. Nutrients, 11(10), 2315. https://doi.org/10.3390/nu11102315
11. Detection of Mycotoxins in Patients with Chronic Fatigue Syndrome Authors: by Joseph H. Brewer, Jack D. Thrasher, David C. Straus, Roberta A. Madison and Dennis HooperLink: https://www.mdpi.com/2072-6651/5/4/605
12. Miller, C.S., Palmer, R.F., Kattari, D. et al. What initiates chemical intolerance? Findings from a large population-based survey of U.S. adults.Environ Sci Eur 35, 65 (2023). https://doi.org/10.1186/s12302-023-00772
13. Sumantri, S., & Rengganis, I. (2023). Immunological dysfunction and mast cell activation syndrome in long COVID. Asia Pacific allergy, 13(1), 50–53. https://doi.org/10.5415/apallergy.0000000000000022
14. Requier, F., Demnitz-King, H., Whitfield, T., Klimecki, O., Marchant, N. L., & Collette, F. (2023). The Effect of Meditation-Based Interventions on Patients with Fatigue Symptoms: A Systematic Review and Meta-Analysis. Psychologica Belgica, 63(1), 64–81. https://doi.org/10.5334/pb.1182
15. Liao, Y., Qi, J. G., Yan, H., Zhang, Q. Y., Ji, T. Y., Chang, X. Z., Yang, H. P., Jin, H. F., & Du, J. B. (2021). Comorbidity of chronic fatigue syndrome, postural tachycardia syndrome, and narcolepsy with 5,10-methylenetetrahydrofolate reductase (MTHFR) mutation in an adolescent: a case report. Chinese medical journal, 134(12), 1495–1497. https://doi.org/10.1097/CM9.0000000000001387
Sheila Carew, Margaret O. Connor, John Cooke, Richard Conway, Christine Sheehy, Aine Costelloe, Declan Lyons, A review of postural orthostatic
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