1. Overview of Chronic Fatigue Syndrome [www.mayoclinic.com]

Definition

By Mayo Clinic staff

Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that may worsen with physical or mental activity, but doesn't improve with rest. Although there are many theories about what causes this condition — ranging from viral infections to psychological stress — in most cases the cause is still unknown.

Because its symptoms are difficult to measure, CFS wasn't widely accepted as a real medical condition for several years. Today, however, doctors and researchers agree that this chronic condition should be taken seriously.

Although an underlying cause often isn't found, effective treatments for the signs and symptoms of CFS are available. Many people recover from chronic fatigue syndrome over time.

Tests and diagnosis

By Mayo Clinic staff

To meet the diagnostic criteria of chronic fatigue syndrome, you must have unexplained, persistent fatigue for six months or more, along with at least four of the eight primary signs and symptoms.

Primary signs and symptoms of CFS include:

 Loss of memory or concentration

Sore throat

Painful and mildly enlarged lymph nodes in your neck or armpits

Unexplained muscle pain

Pain that moves from one joint to another without swelling or redness

Headache of a new type, pattern or severity

Unrefreshing sleep

Extreme exhaustion lasting more than 24 hours after physical or mental exercise

There's no diagnostic or laboratory procedure to confirm the presence of chronic fatigue syndrome. The diagnosis is based on exclusion. This means that before arriving at the diagnosis, your doctor has ruled out other well-defined diseases or conditions that may be causing your fatigue and related symptoms. Conditions your doctor may rule out or identify as contributing factors early on include:

Low levels of thyroid hormone (hypothyroidism)

Sleep apnea

Depression

Eating disorders

Substance abuse

A relapse of a previously treated illness, such as cancer

Severe obesity, defined by a body mass index (BMI) of 40 or greater

Treatments and drugs

By Mayo Clinic staff

There's no specific chronic fatigue syndrome treatment. In general, doctors aim to relieve signs and symptoms by using a combination of treatments, which may include:

Moderating daily activity. Your doctor may encourage you to slow down and to avoid excessive physical and psychological stress. However, too much rest can make you weaker, worsening your long-term symptoms. Your goal should be to maintain a moderate level of daily activity and gently increase your stamina over time.

Gradual but steady exercise. With the help of a physical therapist, you may be advised to begin an exercise program that slowly becomes more challenging. Research has proved that gradually increasing exercise can improve the symptoms of chronic fatigue syndrome.

Cognitive behavior therapy. This treatment, often used in combination with graduated exercise, also has been found to improve the symptoms of chronic fatigue syndrome. In cognitive behavior therapy, you work with a mental health provider to identify negative beliefs and behaviors that might be delaying your recovery and replace them with healthy, positive ones.

Treatment of depression. If you're depressed, medications such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) may help. Antidepressants may also help improve sleep and relieve pain. Commonly prescribed antidepressants include amitriptyline (Amitid, Amitril), desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil) and sertraline (Zoloft).

Treatment of existing pain. Acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin, others) may be helpful to reduce pain and fever.

Treatment of sleep problems. Changing your sleep habits may be enough to help you start getting restorative nighttime sleep. But if techniques such as sticking with a regular bedtime, skipping daytime naps, and avoiding substances such as caffeine and alcohol don't help, your doctor may prescribe a short course of sleep medication.

Treatment of allergy-like symptoms. Antihistamines such as fexofenadine (Allegra) and cetirizine (Zyrtec), and decongestants that contain pseudoephedrine (Sudafed) may relieve allergy-like symptoms such as runny nose.

Treatment of low blood pressure (hypotension). The drugs fludrocortisone (Florinef) and atenolol (Tenormin) may be useful for certain people with chronic fatigue syndrome.

Treatment for problems of the nervous system. Symptoms such as dizziness and extreme skin tenderness can sometimes be relieved by clonazepam (Klonopin). Your doctor may prescribe medications such as lorazepam (Ativan) and alprazolam (Xanax) to relieve symptoms of anxiety.

Experimental therapies
Research aimed at finding new treatments for chronic fatigue syndrome has included studies of the following medications:

Methylphenidate (Ritalin, Concerta, others). This psychostimulant appears to boost and balance levels of the brain chemicals called neurotransmitters. It's commonly used to treat attention-deficit/hyperactivity disorder (ADHD). One study found that methylphenidate lessened fatigue and improved concentration in some people with chronic fatigue syndrome.

Corticosteroids. Some studies have found that oral hydrocortisone may improve symptoms of chronic fatigue syndrome, while other studies have found no benefit.

Immune globulins and interferons. These medications are used to boost your immune system's ability to fight infection. Studies have not found them to be consistently effective in treating chronic fatigue syndrome, and some participants have experienced severe side effects.

Antiviral drugs, such as acyclovir. The possible connection between chronic fatigue syndrome and Epstein-Barr virus led researchers to test whether powerful antiviral medications could improve the symptoms of chronic fatigue syndrome. This approach has not been found effective, and the connection between Epstein-Barr virus and chronic fatigue syndrome has since been disproved.

Cholinesterase (ko-lin-ES-tur-ase) inhibitors, such as galantamine. These drugs improve the effectiveness of acetylcholine, a chemical messenger that is believed to be important for memory, thought and judgment. Galantamine is used in the treatment of Alzheimer's disease, but it has not been found beneficial for chronic fatigue syndrome.

Lifestyle and home remedies

By Mayo Clinic staff

Learning how to manage fatigue can help you improve your level of functioning and your quality of life despite your symptoms. You may work with a rehabilitation medicine specialist who can teach you how to plan activities to take advantage of times when you usually feel better.

These important self-care steps can help you to maintain good general health:

Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt.

Get enough sleep. Getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.

Exercise regularly. You may need to start slowly and build up gradually. But exercising regularly often improves symptoms. Many people find exercises such as walking, swimming, biking and water aerobics to be helpful. A physical therapist may help you develop a home-exercise program. Stretching, good posture and relaxation exercises also can be helpful.

Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days.

Maintain a healthy lifestyle. Try to eat a balanced diet, drink plenty of fluids, limit your caffeine intake, stop smoking, get adequate rest, and exercise regularly. Find a hobby or career that's enjoyable and fulfilling for you.

Alternative medicine

By Mayo Clinic staff

Many alternative therapies have been promoted for chronic fatigue syndrome, but few have been evaluated in clinical trials. Among those that have been studied, two that may offer benefit for CFS include.

D-ribose. Also called ribose, this form of sugar is an essential energy source for your cells. Scientists believe that impaired cellular metabolism — some kind of disorder in the way your cells do their work — may play a role in chronic fatigue syndrome. Some research has found that natural D-ribose supplements may significantly improve energy and decrease pain associated with chronic fatigue syndrome.

Acupuncture. Acupuncture has been evaluated as a treatment for the symptoms of fibromyalgia, a disease that is considered similar to CFS and is also characterized by fatigue and muscle soreness. Studies suggest that acupuncture may decrease fatigue, pain, anxiety and other symptoms associated with CFS.

Other complementary therapies that may reduce anxiety and promote well-being in people with chronic fatigue syndrome include:

Deep-breathing and muscle-relaxation techniques

Meditation

Massage and healing touch

Movement therapies such as stretching, yoga and tai chi

Natural doesn't mean safe
Makers of various dietary supplements and herbal remedies claim these substances have potential benefits for people with CFS. However, in most cases the effectiveness of these therapies hasn't been proved in controlled studies.

Though a product may be of "natural" origin, that origin doesn't ensure its safety. Dietary supplements and herbal preparations can have potentially harmful side effects and may dangerously interfere or interact with prescription medications.

Talk to your doctor before using any unprescribed remedy or new complementary therapy.

2. Nutrition and Supplements: [www.holisticonline.com]

One theory holds that a nutritional deficiency may be a contributing factor causing CFS, so it's important to maintain a healthy diet. Diet can be used beneficially to strengthen the ailing immune system of people suffering from chronic fatigue. It is now recognized that a well-balanced diet should be part of the treatment for all chronic illnesses. Chronic fatigue syndrome is not primarily a dietary disorder. But as in other debilitating illnesses, people suffering from CFS fail to consume a nutritious diet. This leads to dietary related complications. 

The following items are important if you are suffering from CFS:

Vitamins, Minerals, and Supplements

The following supplements are important for CFS patients: 

Some naturopathic physicians treat CFS with an intravenous solution containing pantothenic acid, vitamin C, and hydrochloric acid (HCl). Many people report remarkable improvement with this treatment.

Magnesium

Magnesium deficiency may also be a problem for CFS patients. Magnesium and malic acid assist in initiating the Krebs cycle, a series of biochemical reactions that transform nutrients into energy. In a recent study, twenty people with CFS were compared with twenty healthy volunteers. The blood magnesium content of the CFS patients were found to be significantly lower. In another study, thirty-two patients with CFS were given intramuscular injections of magnesium. Eighty percent of those receiving the magnesium had reduced symptoms and improved energy while less than 20 percent of those on placebo injections reported improvement. Take a combination formula that supplies 100 milligrams of magnesium and 300 milligrams of malic acid three times daily, twenty minutes before each meal, for six to eight weeks. 

Vitamin B-12

A New Zealand study found that injection of vitamin B 12 in CFS patients helped normalize imbalances in their red blood cells. 

The B vitamins, especially pantothenic acid, B2 and B6, are depleted in stressful situations. They lend the nerves support and help build reserves. Fortified yeast supplements are excellent sources of B vitamins and provide the body with extra energy. 

Evening primrose oil has proven helpful when taken over several months. The gamma-linolenic acid (GLA) in evening primrose oil is anti- inflammatory, reducing the aches and pains and other symptoms associated with the disease. 

Vitamin C is excellent for the immune system and helps to fend off colds and flus, common to chronic fatigue sufferers. 

Vitamin A is essential for the production of antibodies necessary to fight viral infections. 

Vitamin E is a powerful antioxidant, ensuring that vitamin A is not destroyed by oxygen, and improving the supply of oxygen to the cells. 

Chlorella is a replenishing supplement. It contains high amounts of chlorophyll, which detoxifies and helps destroy viruses. Blue-green algae, another green food, focuses on strengthening the immune system. 

Lactobacillus acidophilus and other friendly bacteria are necessary for a healthy immune system and are often lacking in those with chronic fatigue, especially if antibiotics have been taken. 

Bromelain, an enzyme derived from pineapple, and proteolytic enzymes help reduce inflammation. Take 500 milligrams of either of these enzymes twice a day, between meals. 

Digestive Enzyme Supplement: The digestion and assimilation of nutrients is often compromised in people with chronic fatigue syndrome. Take a full-spectrum digestive-enzyme supplement containing 5,000 international units of lipase, 2,500 international units of amylase, 300 international units of protease, plus 500 to 1,000 milligrams of pancreatin, with each meal.

Note: Long-term supplementation with pancreatin is not advised, as it can cause your pancreas to reduce its own production of this important enzyme. Overuse also has the potential to cause nausea or diarrhea. After two months on pancreatin, discontinue use and monitor your reaction. If you find that your problems recur, discuss pancreatin supplementation with your health-care provider. 

Gamma-aminobutyric acid (GABA) is very useful if the fatigue is associated with anxiety. Take 500 milligrams in the morning and again at bedtime.

Note: If you are taking melatonin in the evening, eliminate the evening dose of GABA. 

Glucosamine sulfate relieves joint pain by assisting in the production of cartilage. Take 500 milligrams of glucosamine sulfate three times daily (if you weigh over 200 pounds, take the same dose four times daily). It may take up to eight to twelve weeks to see results, so don't give up too soon. 

Lipotropics are emulsifiers that help in the digestion of fats. They also assist in the transmission of signals from one nerve cell to another, which is an important consideration if you are experiencing body-wide weakness. Take 1,200 milligrams (or 1 tablespoon) of lecithin twice daily, with meals. Or take 300 to 500 milligrams of a lipotropic complex three times daily, with meals. 

Thymus glandular extract enhances immune function, which is often impaired in people with chronic fatigue syndrome. Take 750 milligrams of thymus extract at breakfast and again at lunch.

3. Enercel: has been used successfully as administered by Enerpuncture