Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a debilitating and complex disorder characterized by profound fatigue that is not improved by bed rest and may be worsened by physical, emotional or mental stress. Patients report various nonspecific symptoms, including weakness, chemical sensitivities, allergies, poor immune function, muscle pain, impaired memory and/or mental concentration, insomnia, and post-exertional fatigue lasting more than 24 hours. In some cases, CFS can persist for years. The cause, or causes, of CFS have not been identified and no specific diagnostic tests are available. Moreover, since many illnesses have incapacitating fatigue as a symptom, care must be taken to exclude other known and often treatable conditions before a diagnosis of CFS is made.

Diagnostic Criteria for Chronic Fatigue Syndrome

Major Criteria:

1. new onset of fatigue causing 50% reduction in activity for at least six months

2. exclusion of other illnesses that can cause fatigue

Minor Criteria:

1. presence of eight of 11 symptoms, or

2. presence of six of 11 symptoms and two of three signs:


1. mild fever

2. recurrent sore throat

3. painful lymph nodes

4. muscle weakness

5. muscle pain

6. migratory joint pain

7. prolonged fatigue after exercise

8. recurrent headaches

9. neurological or psychological complaints, such as:

• depression

• excessive irritability

• forgetfulness

• sensitivity to bright light

• confusion

• inability to concentrate

10. sleep disturbances

11. sudden onset of symptom complex


1. low-grade fever

2. non-exudative pharyngitis (sore throat)

3. tender lymph nodes

Similar Medical ConditionsA number of illnesses have been described that have a similar spectrum of symptoms to CFS. These include fibromyalgia syndrome, myalgic encephalomyelitis, neurasthenia, multiple chemical sensitivities, and chronic mononucleosis. Although these illnesses may present with a primary symptom other than fatigue, chronic fatigue is commonly associated with all of them.

Other Conditions That May Cause Similar Symptoms

In addition, there are a large number of clinically defined, frequently treatable illnesses that can result in fatigue. Diagnosis of any of these conditions would exclude a definition of CFS unless the condition has been treated sufficiently and no longer explains the fatigue and other symptoms. These include hypothyroidism, sleep apnea and narcolepsy, major depressive disorders, chronic mononucleosis, bipolar affective disorders, schizophrenia, eating disorders, cancer, autoimmune disease, hormonal disorders*, subacute infections, obesity, alcohol or substance abuse, and reactions to prescribed medications.

Other Commonly Observed Symptoms in CFS

In addition to the eight primary defining symptoms of CFS, a number of other symptoms have been reported by some CFS patients. The frequencies of occurrence of these symptoms vary from 20% to 50% among CFS patients. They include abdominal pain, alcohol intolerance, bloating, chest pain, chronic cough, diarrhea, dizziness, dry eyes or mouth, earaches, irregular heartbeat, jaw pain, morning stiffness, nausea, night sweats, psychological problems (depression, irritability, anxiety, panic attacks), shortness of breath, skin sensations, tingling sensations, and weight loss.

Possible Causes of CFS

Due to weakened immunity, individuals with chronic fatigue have terrible problems with energy as well as reoccurring bouts with the flu, colds, sinusitis, and other immune problems. As with so many complex chronic illnesses, CFS may be aggravated by a wide variety of environmental and physiological challenges. Food allergies, environmental sensitivities (odors), heavy metal toxicity (mercury, aluminum, etc.), yeast overgrowth, parasites, and vitamin/mineral deficiencies can all contribute to CFS.


The cause, or causes, of CFS remain unknown despite a vigorous search. While a single cause for CFS may yet be identified, another possibility is that CFS represents a common endpoint of disease resulting from multiple precipitating causes. As such, it should not be assumed that any of the possible causes listed below has been formally excluded, or that these largely unrelated possible causes are mutually exclusive. Conditions that have been proposed to trigger the development of CFS include virus infection or other transient traumatic conditions, stress, and toxins.

General Theories

Unfortunately, some physicians believe that CFS is a component of a psychological disorder or a symptom of other problems, similar to anemia and high blood pressure. Indeed, no primary cause has been found that explains all cases of CFS. A number of experts believe that CFS is caused by a combination of conditions that overwhelm the person’s stress coping abilities. These conditions or triggers may include the following:

• Genetic factors.

• Brain abnormalities or inability of the self-regulating mechanisms.

• A hyper-reactive immune system.

• Viral, bacterial, fungal, mycoplasma or other infectious agents.

The majority of patients report some preceding moderate to serious physical (eg, a chronic viral infection) or emotional event (eg, episode of depression). Some experts theorize that such events alone or in combination coupled in people with certain neurological and genetic abnormalities may overwhelm the person’s ability regulate their own homeostatic self-regulating systems.

Dysfunction of the Hypothalamus-Pituitary-Adrenal Axis

Researchers investigating CFS are looking at the abnormalities in the brain system known as the hypothalamus-pituitary-adrenal axis. This system produces or regulates hormones and brain chemicals that control important functions, including sleep, response to stress, and depression. This is our self-regulating, homeostatic system. Stress Hormone


A number of studies on CFS patients have observed deficiencies in cortisol levels, a stress hormone produced in the hypothalamus. Deficiencies may be the reason why CFS patients have an impaired and weaker response to psychological or physical stresses (such as infection or exercise).

Abnormalities in Neurotransmitters

Other research has reported that some patients with CFS have abnormally high levels of serotonin, a neurotransmitter (chemical messenger in the brain). Such elevated levels in the brain are associated with fatigue. Yet another study reported that deficiencies in dopamine and norepinephrine, other important neurotransmitters, may play a role in CFS.


Because most of the features of CFS resemble those of a lingering viral illness, many researchers have focused on the possibility that a virus or some other infectious agent causes the syndrome in some cases.

Here is what the Centers for Disease (CDC) Control has to say about Infectious Agents.“Due in part to its similarity to chronic mononucleosis, CFS was initially thought to be caused by a virus infection, most probably Epstein-Barr virus (EBV). It now seems clear that CFS cannot be caused exclusively by EBV or by any single recognized infectious disease agent. No firm association between infection with any known human pathogen and CFS has been established. CDC’s four-city surveillance study found no association between CFS and infection by a wide variety of human pathogens, including EBV, human retroviruses, human herpesvirus 6, enteroviruses, rubella, Candida albicans, and more recently bornaviruses and Mycoplasma. Taken together, these studies suggest that among identified human pathogens, there appears to be no causal relationship for CFS. However, the possibility remains that CFS may have multiple causes leading to a common endpoint, in which case some viruses or other infectious agents might have a contributory role for a subset of CFS cases.” When researchers find no consistent elevations of EBV antibody levels, they conclude that viruses do not play a role in CFS. “This is like firefighters who ignore the billowing smoke on the horizon, responding only to the blaze, the discovery of which inevitably follows.”

I, like many other specialists, do believe there is an infectious agent or agents involved in CFS. Whether this is a latent or acute viral, bacterial, fungal, or mycoplasma, or a combination of these, which is interacting with and compromising the immune system, is the question?

There are three basic theories for infection-related causes of CFS

Some researchers suggest that chronic fatigue syndrome might be the result of a virus or bacteria that infects the body, causes immune abnormalities, and is then eliminated. It leaves behind a damaged immune system, however, that continues to cause flu-like symptoms even in the absence of the virus. The flu-like symptoms are most pronounced when the person is under stress. The evidence for CFS having a viral cause is not based on hard evidence but on various observations that suggest an association, such as the following:

• In up to 80% of cases, chronic fatigue syndrome starts suddenly with a flu-like condition.

• In the US, outbreaks of CFS occurring within the same household, workplace, and community have been reported (but most have not been confirmed by the Centers for Disease Control).

• A large British study of people with both diagnosed CFS and idiopathic chronic fatigue also found no evidence of infection as a direct cause of either condition, but found that previous infections may play some role.

• Although no specific virus has been identified as a single cause, CFS patients typically have elevated levels of antibodies to many viruses that cause fatigue and other CFS symptoms, including Lyme disease, candida (“yeast infection”), herpesvirus type 6 (HHV-6), human T cell lymphotropic virus (HTLV), Epstein-Barr, measles, coxsackie B, cytomegalovirus, or parvovirus.

• In one study, some patients, particularly those with severe CFS symptoms, had higher-than-normal numbers of infection-fighting white blood cells known as CD8 killer T cells, which launch attacks on invading viruses and other disease-causing microorganisms. These same people had lower-than-normal levels of another white blood cell known as the suppressor T cell, which helps to shut down the immune response once the invading organisms have been killed. In such cases, the immune system becomes persistently overactive and produces fatigue, muscle aches, and other symptoms of CFS.


Several investigators have reported lower numbers of natural killer cells or decreased natural killer cell activity among CFS patients compared with healthy controls, but others have found no differences between patients and controls.

T-cell activation markers have also been reported to have differential expression in groups of CFS patients compared with controls, but again, not all investigators have consistently observed these differences. One intriguing hypothesis is that various triggering events, such as stress or a viral infection, may lead to the chronic expression of cytokines and then to CFS.

Administration of some cytokines in therapeutic doses is known to cause fatigue, but no characteristic pattern of chronic cytokine secretion has ever been identified in CFS patients. In addition, some investigators have noted clinical improvement in patients with continued high levels of circulating cytokines; if a causal relationship exists between cytokines and CFS, it is likely to be complex. Finally, several studies have shown that CFS patients are more likely to have a history of allergies than are healthy controls. Allergy could be one predisposing factor for CFS, but it cannot be the only one, since not all CFS patients have it.

Some of the Immune Disorders Associated with CFS are Listed Below:

• Elevated levels of antibodies to various viruses.

• Altered helper/suppressor T-cell ratio.

• Decreased Natural Killer (NK) cells or activity.

• Decreased levels of circulating immune complexes.

• Low or elevated antibody levels.

• Increased cytokine levels.

• Increased or decreased interferon levels.

• Fibromyalgia and multiple chemical sensitivities.

The History of CFS

Epstein – Barr virus (EBV), OriginThere have been several studies that have focused on identifying an infectious agent as the cause of CFS. The Epstein-Barr virus (EBV) has received a lot of attention over the last two decades.

In 1985, reports were published in the Annals of Internal Medicine about a mysterious severe viral epidemic the gripped the Lake Tahoe region in California. Initially, CFS was presumed to be caused by the Epstein – Barr virus because research at the National Institutes of Health confirmed the presence of elevated levels of antibodies against EBV in afflicted people. As times passed, EBV was deemed to be one of many viruses associated with CFS. But is CFS caused by these viruses? Or, do the viruses only show themselves once CFS manifests itself? EBV is a member of the Herpes group of viruses, which include Herpes Simplex Types 1 and 2, Varicella zoster virus, Cytomegalovirus, and Psuedorabies virus. A common aspect of these viruses is their ability to establish lifelong latent infection after the initial infection. This latent infection is kept in check by a healthy immune system.

We know that EBV causes the debilitating disease of teenhood, “Infectious Mononucleosis”, or in lay parlance ‘Mono’ (sometimes called ‘the kissing disease’). But not everyone who carries this virus develops “Mono.” In fact, over 90% of Americans have been exposed to EBV by age 20. Some of these individuals develop infectious mononucleosis; others simply experience flu-like symptoms for a few days, but most show no symptoms at all.

CFS and Immune DysfunctionEBV and the Herpes group of viruses can produce chronic lifelong infections. Most individuals have been exposed to one of these viruses and build immunity to them. Persons with a compromised immune system are susceptible to latent infections including EBV. The infection itself can compromise the immune system. Elevated EBV antibodies to the Herpes-group of viruses (Cytomegalovirus, Herpes 6, etc.,) measles, and other viruses have been observed in patients suspected of having CFS and who also display elevated EBV antibody levels. There is little argument that a disturbed immune system plays a central role in CFS, A variety of immune system abnormalities have been observed in EBV cases. The most consistent abnormality is a decreased number of or activity of natural killer (NK) cells. Natural killer cells are used to destroy cells that are infected with cancerous or viral toxins.

As with so many complex chronic illnesses, CFS may be caused and aggravated by a wide variety of environmental and physiological challenges. Food allergies, environmental sensitivities, heavy metal toxicity, yeast overgrowth, intestinal dysbiosis, parasites, and vitamin/mineral deficiencies can all contribute to CFS. These disorders must be found and eliminated with a systematic protocol based on correcting causes and not merely covering up symptoms.

Traditional Drug TherapyPharmacologic therapy is directed toward the relief of specific symptoms experienced by the individual patient. Patients with CFS appear particularly sensitive to many medications, especially those that affect the central nervous system. Thus, the usual treatment strategy is to begin with very low doses and to gradually increase dosage as necessary and as tolerated. It is important to remember that use of any drug for symptom relief should be attempted only if an underlying cause for the symptom in question has not been found. The best example is use of a sleep-enhancing medication for non-restorative sleep. Although the patient may state that they sleep better, the sleep disorder remains obscured and thus treatment of the sleep disorder not given. It is also important to remember that all medications can cause untoward side effects, which may lead to new symptoms.

Prescription MedicationsNonsteroidal anti-inflammatory drugs: These drugs can be used to relieve pain in CFS patients. Some are available as over-the-counter medications.


Low-dose tricyclic antidepressants: Tricyclic agents may be prescribed for CFS patients to improve sleep and to relieve mild, generalized pain. Examples include doxepin (Adapin, Sinequan), amitriptyline (Elavil, Etrafon, Limbitrol, Triavil), desipramine (Norpramin), and nortriptyline (Pamelor).

Other antidepressants: Newer antidepressants have been used to treat depression in CFS patients, although non-depressed CFS patients receiving treatment with serotonin reuptake inhibitors have been found by some health care providers to benefit from this treatment as well or better than depressed patients. Examples of antidepressants used to treat patients with CFS include serotonin reuptake inhibitors, such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil); venlafaxine (Effexor); trazodone (Desyrel); and bupropion (Wellbutrin). A number of adverse reactions, varying with the specific drug, may be experienced, but include agitation, sleep disturbances, and increased fatigue.

Anxiolytic agents: Anxiolytic agents may be used to treat symptoms of anxiety in CFS patients. Examples include alprazolam (Xanax) and lorazepam (Ativan). Clonazepam (Klonopin) is another member of this family of drugs that is used to control exaggerated nervous systems problems such as vertigo, burning or exaggerated tenderness in the skin, and “nervous” limb movements, may also be useful. However, they should not be used in the general treatment of CFS. Common adverse reactions include sedation, amnesia, and symptoms accompanying acute withdrawal (insomnia, abdominal and muscle cramps, vomiting, sweating, tremors, and convulsions).

Stimulants: Fatigue by itself is not a good indication for symptomatic therapy. However, if the fatigue represents lethargy or daytime sleepiness, treatment may be indicated. Trials of a wakefulness agent, modofanil (Provigil), have been completed, but the results have not yet been published. In a small group of patients with excessive sleepiness, the drug decreased symptoms compared with placebo. This drug is currently indicated only with the diagnoses of narcolepsy and excess daytime sleepiness when identified by the proper sleep studies.

Antihypotensive/antitachycardia therapy: CFS does not respond to treatment with antihypotensive or antitachycardic drugs and general use of such medications may be harmful. However, such medications may be useful in specific circumstances. For example, fludrocortisone (Florinef) has been prescribed for CFS patients who have had a positive tilt table test. However controlled studies have not found Florinef alone effective in the general treatment of CFS patients. Beta blockers such as atenolol (Tenormin) have also been prescribed for patients with orthostatic hypotension. Midodrine (Proamatine), an agent that directly increases blood pressure, may be useful in selected patients identified by an abnormal tilt test. Increased salt and water intake is also recommended for these patients but should be done only under supervision of a health care provider. Adverse reactions include elevated blood pressure and fluid retention.

Experimental Drugs and Treatments


Ampligen is a synthetic nucleic acid product that was designed to stimulate the production of interferons, a family of immune response modifiers that are also known to have antiviral activity. Although it may not directly induce interferon, reports of double-blinded, placebo-controlled studies of CFS patients documented modest improvements in cognition and performance among Ampligen recipients compared with the placebo group. These preliminary results will need to be confirmed by further study. The Food and Drug Administration (FDA) does not approve Ampligen for widespread use, and the administration of this drug in CFS patients should be considered experimental. Ampligen is not widely available, is costly, and is generally not reimbursable through insurance programs. Finally, although most recipients of Ampligen tolerated the drug well, adverse reactions, such as liver damage, were reported and are still incompletely characterized.

Gamma globulinGamma globulin is pooled human immune globulin and contains antibody molecules directed against a broad range of common infectious agents. Gamma globulin is ordinarily used as a means for passively immunizing persons whose immune system has been compromised, or who have been exposed to an agent that might cause more serious disease in the absence of immune globulin. Gamma globulin is not effective in the treatment of CFS. Serious adverse reactions are uncommon, although in rare instances gamma globulin may initiate anaphylactic shock.

Corticosteroids Controlled studies of corticosteroids have been conducted because some patients with CFS had a slight decrease in urinary cortisol levels. Some benefits were noted in patients treated with low dose hydrocortisone but the effects disappeared after one month. High dose replacement therapy had some benefit but was complicated by attendant adrenal suppression.


Kutapressin is a crude extract from pig’s liver. It is not readily available and there is no scientific evidence that it has any value in the treatment of CFS patients. Kutapressin can elicit allergic reactions.


Unpublished reports of malformations at the base of the skull (Chiari malformations) as being causative of CFS have been circulated, and surgical intervention has been suggested in some of those unsubstantiated reports. Surgical intervention is not recommended at this time.

While prescription drugs may offer some relief from the symptoms associated with CFS, potential side effects are often more problematic than the illness itself.

Potential Dangers Associated with Prescription Drug Therapy

NSAIDs causes 10,000-20,000 Deaths a YearA person taking NSAIDS is seven times more likely to be hospitalized for gastrointestinal adverse effects. The FDA estimates that 200,000 cases of gastric bleeding occur annually and that this leads to 10,000 to 20,000 deaths each year.5

Studies also show that neither drug (Celebrex ) alleviated pain any better than the older medicines. And the drugs cost close to $3 a pill; over-the-counter pain relievers, in contrast, cost pennies a dose.

Benzodiazepines (Tranquilizers) Medications – Xanax, Klonopin, Ativan, Restoril, Busbar, Tranxene, Serax, Librium, Tegretol, Valium, Trileptal, Seraquel, Risperdal, and Symbax.

Side effects associated with these medications include sleep disturbances (poor sleep), seizures, neuropsychiatric disturbances (mania, depression, suicide, etc.) tinnitus (ringing in the ears), transient memory loss (amnesia), dizziness, agitation (anxiety), disorientation, hypo-tension (low blood pressure), nausea, edema (fluid retention), ataxia (muscular in-coordination), tremors, sexual dysfunction (decreased desire and performance), asthenia (weakness), somnolence (prolonged drowsiness or a trance-like condition that may continue for a number of days), and headaches. The big problem with these medications is that they are loaded with side-effects that cause further health problems (depression, fatigue, memory loss, “fibro fog’” etc.) yet don’t promote deep, restorative sleep.

Stimulants – Adderall, Concerta, Cylert, EtcStimulants such as Adderall (amphetamine), Concerta (methylphenidate), Cylert (pemoline), Dexedrine (dextroamphetamine sulfate), Focalin (dexmethylphenidate HCL), Metadate (methylphenidate), and Ritalin (methylphenidate) are use to increase adrenalin. They can be very helpful in increasing a person’s energy. But you may remember the saying “speed kills.” With the exception of Provigil, these medications are nothing more than various forms of amphetamines (“speed”). These drugs are incredibly hard on the adrenal glands. Long-term use can cause adrenal fatigue or burnout at least and full blown Addison’s Disease (adrenal failure) at worst.

Potential Side effects include: insomnia (big problem), Tourette’s syndrome (movement disorder consisting of grimaces, ticks, and involuntary outbursts), nervousness, unstable mood (anxiety, mania, depression, irritability, aggression, etc) tachycardia (rapid heartbeat), hypertension (high blood pressure), tics (abnormal muscle movements), psychosis (abnormal behavior), headaches, seizures, visual disturbances, anorexia (unwanted weight loss), aplastic anemia (arrested development of bone marrow), liver dysfunction, and blood dyscrasias (disease).

Antidepressants – Prozac, Zoloft, Celexa, Paxil, Etc.Selective Serotonin Re-Uptake Inhibitors (SSRIs). SSRIs work by increasing the brain’s use of the neurotransmitter serotonin. Serotonin deficiency is linked to depression, lowered pain tolerance, poor sleep, and mental fatigue. All SSRIs are partially or wholly broken down in the liver. This can create liver dysfunction in some patients, so patients with a sluggish liver should be cautious in taking these medications. Examples of SSRIs include Zoloft (sertraline), Paxil (paroxetine HCL), Celexa (citalopram), Prozac (fluoxetine), Luvox (fluvoxamine), etc.

Common side effects include headache, muscle pain, chest pain, anxiety, nervousness, sleeplessness, drowsiness, weakness, changes in sex drive, tremors, dry mouth, irritated stomach, loss of appetite, dizziness, nausea, rash, itching, weight gain, diarrhea, impotence, hair loss, dry skin, chest pain, bronchitis, abnormal heart beat, twitching, anemia, low blood sugar, and low thyroid.

Tricyclic Antidepressants – Elavil, Pamelor, Doxepin, EtcTricyclic antidepressants block the re-uptake of the hormones serotonin and norepinephrine. This produces a sedative effect. They also reduce the effects of the hormone acetylcholine. Like other antidepressant medications, these drugs are processed by the liver and can cause liver toxicity. Common side effects include sedation, confusion, blurred vision, muscle spasms or tremors, dry mouth, convulsions, constipation, difficulty in urinating, and sensitivity to light. Examples of tricyclic antidepressants include Pamelor (nortriptyline) and Elavil (amitriptyline).

Integrative Medicine

Integrating natural therapies with a judicious amount of prescription drugs (only when natural fail) is the best approach. An integrative approach that combines the judicious use of prescription drugs and nutritional therapy offers the best chance of reducing the symptoms associated with CFS.

Nutritional Therapies

Several nutrients have been found to be deficient in CFS patients, including B vitamins, antioxidants, vitamin C, magnesium, sodium, zinc, L-tryptophan, L-carnitine, CoQ10, and essential fatty acids.


Essential Fatty Acids

There are several interesting interrelationships between EFA metabolism and viral infections. EFAs have direct antiviral effects and are lethal at surprising low concentrations to many viruses. The antiviral activity of human mother’s milk seems to be largely attributable to its EFA content. Interferon is dependant on EFAs and in their absence will be compromised. Viral infections lower the blood levels EFAs. This has been confirmed in the case of the Epstein Barr Virus (EBV). Of particular interest was the observation that at 8 and 12 months, those who have recovered from EBV showed normal or near normal EFA blood levels. In contrast, those who were still clinically ill from Epstein-Barr show persistently low EFA levels. This study and others like it are one of the reasons the CFS/Fibromyalgia Formula contains 2,000mg of essential fatty acids.


Magnesium participates in energy metabolism and is involved in over 350 enzymatic processes. depend on magnesium for activation. A randomized, double-blind, placebo-controlled study was conducted of patients with CFS who were found to have low magnesium levels. In the clinical trial, 32 CFS patients received either placebo or intramuscular magnesium sulfate every week for six weeks. Patients treated with magnesium reported improved energy levels, better emotional state, and less pain.

Malic Acid and Magnesium

A combination of magnesium and malic acid has also been recommended for treatment of chronic fatigue and fibromyalgia. Reports from clinical experience using 300-600 mg. of elemental magnesium and 1200-1400 mg. of malic acid indicate that about 40% of the patients show some type of benefit. Adenosine Triphosphate (ATP) ATP, adenosine triphosphate, is the substance which stores the energy created when the body burns carbohydrates and fats in the Krebs cycle. When the body needs energy (as, for example, in muscular contraction), ATP is broken down into ADP (adenosine diphosphate) and immediate energy is released. ATP is the universal energy molecule for the body in the same way that electricity is the universal energy source for a computer.

Magnesium, Potassium and Aspartic Acid Low levels of magnesium have been noted in many CFS patients. Magnesium is required for ATP synthesis and is a cofactor of more than 300 enzymatic reactions involving energy metabloism. Its primary site of action is within the cell. It also enhances transport of potassium into the cells.

Malaise is probably the most common symptom of chronic potassium deficiency and muscular weakness is almost always noted. Aspartic acid is converted intracellularly into oxaloacetate, an important substrate in the energy- producing Krebs cycle, and is also a carrier molecule for the transport of potassium and magnesium into the cell. In the potassium and magnesium aspartate studies of the ’60s, a beneficial effect was usually noted after 4-5 days, but sometimes 10 days were required. Dosage was generally one gram of each salt daily (250 mg. with each meal and at bedtime). Patients usually continued treatment for 4-6 weeks. In most cases, fatigue did not return after treatment was discontinued. Optimal levels of magnesium and malic acid are found in a comprehensive multivitamin/mineral formula (Essential Therapeutics CFS/Fibromyalgia Formula) I developed for my CFS and fibromyalgia patients.


In one study of 20 female patients with CFS (who required bed rest following mild exercise), 80 percent were deficient in CoQ10. After three months of CoQ10 supplementation (100 mg/day), the exercise tolerance of the CFS patients more than doubled: 90 percent had reduction or disappearance of clinical symptoms, and 85 percent had decreased post-exercise fatigue.

Thymus Extract Supplements

Thymus extracts have proven to be one of the best immune-boosting agents for treating CFS. A recent study published in the Journal of Nutritional and Environmental Medicine showed that patients taking a patented thymus extract, obtained dramatic improvements in their CFS symptoms. The increase in their immune function, as demonstrated by blood tests, resulted in myriad benefits: a 47% improvement in sleep quality, a 43% reduction in food sensitivities, a 53% reduction in chemical sensitivities, a 47% improvement in short-term memory, a 79% improvement in depression symptoms, and a 100% improvement in panic disorder symptoms.

A substantial amount of clinical data now supports the effectiveness of using thymus extracts. They may well provide the answer to chronic viral infections and low immune function. Double-blind studies reveal not only that orally administrated thymus extracts are able to effectively eliminate infection, but also that treatment over the course of a year significantly reduced the number of respiratory infections and significantly improved numerous immune parameters. Thymus glandular extracts are able to raise T-cell numbers when needed but will lower T-cell numbers when an autoimmune disease is present. This balancing act is the big advantage that glandular extracts and many natural herbs have over prescription, synthetic drugs.

Thymus glandular extracts (like other glandular extracts) are able to raise T-cells when needed but will lower T-cells when an autoimmune disease is present. This balancing act is the big advantage glandular extracts, and many natural herbs, have over prescription (synthetic) drugs. I put the majority of my CFS patients on thymus glandular supplements.

Other Immune Boosting Supplements

• Astragalus membranaceus, a Chinese herbal, is used to treat a wide variety of viral infections. Clinical studies in China have even shown it to be effective (with ongoing use) against the common cold. Research in animals has revealed that it apparently works by stimulating NK cells and T-cells. Astragalus appears particularly useful in cases where the immune system has been damaged by chemicals or radiation.

• Echinacea (purple coneflower) is one of the most popular herbal medicines in the United States and Europe. In 1994, German physicians prescribed echinacea more than 2.5 million times. There are over 200 journal articles written about echinacea. This herb, from the sunflower family, can be grown in your garden and is thought to stimulate the immune system by increasing the production of and activity of white blood cells, especially NK cells. Persons with autoimmune illnesses such as multiple sclerosis, lupus, or tuberculosis should not take echinacea. A typical dose is up to 900 mg. three times daily. Some physicians suggest discontinuing use after two–three weeks, then restarting as needed after one week.

• Goldenseal (Hydrastis canadensis) is a perennial herb native to eastern North America, and it has shown itself to be a potent immune stimulator. It increases the blood flow to the spleen and the number and activity of macrophages. A typical dose is 250–500 mg. one–three times daily.Goldenseal is in my viral formula.

Immune Function Protocol

1. Poor sleep results in suppressed NK cell activity and poor immune function. More about sleep disorders and solutions.

2. Restoring optimal adrenal function often reduces many of the symptoms associate with CFS including fatigue, poor stress coping abilities and poor immune function.

I’ve noted that almost all of patient’s with CFS have adrenal fatigue. This may or may not show up on blood or salivary tests. However, the majority of my CFS patient’s respond favorably to therapies, which help boost and restore optimal adrenal function including the use of adrenal cortex glandular, vitamin, mineral, and DHEA supplementation. An article in the Journal of Affective Disorders concluded that CFS may be associated with low cortisol levels and increased serotonin function.

Adrenal fatigue is known to cause many of the same problems associated with CFS and FMS:

• hypoglycemia (low blood sugar)

• hypotension(low blood pressure)

• neural mediated hypotension (become dizzy when stand up)

• fatigue

• decreased mental acuity

• low body temperature (a sign of low thyroid function)

• decreased metabolism

• a compromised immune system

• decreased sense of well-being (depression)

• weight loss

• hyperpigmentation (excess skin color changes)

• loss of scalp hair

• excess facial or body hair

• vitiligo (changes in skin color)

• auricular calcification (little calcium deposits in the ear lobe)

• GI disturbances

• nausea

• vomiting

• constipation

• abdominal pain

• diarrhea

• crave salty foods

• muscle or joint pains

Individuals with FMS and CFS who suffer from adrenal fatigue (99%) will find that their stress coping abilities are shot. They don’t handle stress very well. They will try to avoid stressful situations. Stress will make their symptoms worse and cause them to have flare-ups. If they have a day when they feel good they may over do it (clean the house, paint the playroom, grocery shopping, etc.). Then they usually crash the next day. Therefore, restoring proper adrenal function is a crucial step in peeling away the layers of dysfunction associated with FMS and CFS. I believe that adrenal fatigue is a major contributory factor to the symptoms associated with FMS and CFS.


The Cortex

The adrenal cortex is primarily associated with response to chronic stress (infections, prolonged exertion, prolonged mental, emotional, chemical, or physical stress). The hormones of the cortex are steroids. The main steroid is cortisol. Chronic over secretion of cortisol leads to adrenal exhaustion, which accelerates the downward spiral towards chronic poor health. Once in adrenal exhaustion your body can’t release enough cortisol to keep up with the daily demands. Eventually you become deficient in cortisol and then DHEA. Chronic headaches, nausea, allergies, nagging injuries, fatigue, dizziness, hypotension, low body temperature, depression, low sex drive, chronic infections, and cold hands and feet are just some of the symptoms that occur with adrenal cortex exhaustion.

Not Enough DHEAThe adrenal cortex, when healthy, produces adequate levels of dehydroepiandrosterone (DHEA).

DHEA boosts:

• energy

• sex drive

• resistance to stress

• self-defense mechanisms (immune system)

• general well-being

and helps to raise:

• cortisol levels

• overall adrenal function

• mood

• cellular energy

• mental acuity

• muscle strength

• stamina

DHEA is notoriously low in CFS patients. Chronic stress initially causes the adrenals to release extra cortisol. Continuous stress raises cortisol to abnormally high levels. Then the adrenal glands get to where they can’t keep up with the demand for more cortisol. As the cortisol levels continue to become depleted from on going stress the body attempts to counter this by releasing more DHEA. Eventually they can’t produce enough cortisol or DHEA. Aging makes holding on to DHEA even tougher. Even in healthy individuals, DHEA levels begin to drop after the age of 30. By age 70, they are at about 20% of their peak levels.

Stress and DHEA

DHEA helps prevent the destruction of tryptophan (5HTP), which increases the production of serotonin. This helps provide added protection from chronic stress. Studies continue to show low DHEA to be a biological indicator of stress, aging, and age-related diseases including neurosis, depression, peptic ulcer, IBS, and others.

DHEA and Immune FunctionThe decrease in DHEA levels correlates with the general decline of cell-mediated immunity and increased incidence of cancer. DHEA protects the thymus gland, a major player in immune function.

I recommend a special adrenal cortex glandular supplement for all of my CFS patients.

Optimal Nutrients, EFAs, and Other FactorsOptimal levels of selenium, vitamin A, vitamin C, zinc, and other nutrients are needed to repair and maintain a healthy immune system (these nutrients should be in your vitamin/mineral formula). Zinc is an important cofactor in the manufacture, secretion, and function of thymus hormones. When zinc levels are low, T-cell numbers drop. This might explain why zinc lozenges, when used at the first sign of a cold, can reduce the number of sick days. Selenium boosts the “killer instinct” of your blood cells. One study, using 200 mcg. daily in individuals with normal blood selenium levels, resulted in a 118% increase in the ability of their white blood cells to kill tumor cells, and an 82.3% increase in NK cell activity. All of my CFS patient’s take a special multivitamin/mineral formula .I formulated the CFS/Fibromyalgia formula especially for those with CFS and Fibromyalgia.

New evidence reveals that EFAs have direct antiviral effects and are lethal at surprisingly low concentrations to many viruses. In the case of the Epstein-Barr virus, for example, a good 90% of the US population carries this virus, yet only a fraction become ill from it. One theory is that those who actually develop symptoms have below-normal levels of EFAs and their derivatives. A study investigating sufferers of the EBV particularly confirms this: Both eight and 12 months into the study, subjects who had recovered from the virus showed normal or near normal EFA blood levels. In contrast, those who were still clinically ill from the EBV showed persistently low EFA levels.

Food allergies can cause a 50% reduction in white blood cell count (lowered immune function). When the allergic food is eaten daily, the allergy can cause intestinal inflammation and destruction of white blood cells. Food allergies can also lead to leaky gut symptoms and autoimmune reactions.

All pathogenic (disease causing) intestinal, yeast, parasites, viruses or bacteria should be eliminated.

Low thyroid function is a common finding in those suffering with CFS. Hypothyroidism can lower metabolism and reduce enzyme activities associated with initiating proper immune functions. Chronic infections, especially sinus infections usually drastically improve once low thyroid is corrected.

Start taking 140-280mg of thymus gland glandular (whole or extract) twice a day. Consider being tested for and taking DHEA. Most individuals will need between 25-50mg a day. DHEA is an important hormone for boosting the immune system.