Everyone gets tired. But not everyone gets chronic fatigue syndrome (CFS). People with this disease aren’t just tired. They’re constantly exhausted, not just for a few days but day in and day out for six months or longer.
And the fatigue is only the beginning. Many people with CFS also have flulike symptoms, such as sore throat, painful lymph nodes and aching muscles. Others have problems concentrating and bouts of confusion and forgetfulness. And many people with CFS have no tolerance for exercise: Imagine a woman who used to run several miles a day being so exhausted by a walk around the block that she stays in bed for the next couple of days. That’s CFS.
While children and older people aren’t immune, CFS is most common in younger adults. “About 90 percent of my CFS patients are between ages 25 and 50,” says Paul Cheney, M.D., a CFS specialist and director of the Cheney Clinic in Charlotte, North Carolina.
Once it hits, CFS is hard to get rid of. Doctors don’t know what causes CFS or how to cure it. And while many people recover on their own within a year or two, some never fully recover.
The Illness behind the Headlines
While CFS has probably been around for a long time, it wasn’t until the mid-1980s that a mysterious flulike illness that hit mostly young professional women made headlines. Nicknamed the yuppie flu, it was often written off as burnout or depression. Many people who had CFS looked so healthy that they were told that their symptoms were “all in their heads.”
Today most doctors are familiar with CFS, but they still have a hard time diagnosing it. Symptoms vary widely from person to person and often resemble the flu, mononucleosis or depression. And because no one knows what causes CFS, medical science has not yet developed a definitive test that can prove whether a person has it. In the 1980s, some researchers believed CFS, like mononucleosis, was caused by the Epstein-Barr virus; while that theory has been rejected, some experts still suspect that a virus may play a role.
These days, most experts consider CFS an immune activation (autoimmune) disorder similar in some respects to lupus and rheumatoid arthritis. In immune activation disorders, the immune system is so cranked up to defend the body against invaders that it actually attacks the body’s own tissues. Doctors also see a high incidence of allergies among people with CFS, another sign that their immune systems tend to overreact.
CFS resembles other immune activation disorders in another way: A disproportionate share of people with CFS—probably around 75 percent—are women, says Dr. Cheney. “It could be that women’s immune systems are just stronger than men’s,” he says. “This is an advantage early in life, when girl infants die less often of infections than boys do. But that strong immune system makes a woman more likely to suffer from immune activation disorders in adulthood.”
Like most aspects of this mysterious disease, the reasons that women are more susceptible are subject to much debate. But one thing doctors do agree on is that CFS isn’t all in the patient’s head. Today CFS is widely regarded as a physical illness, not a mental one.
Getting the Big Picture
No one knows for sure how many people have CFS. The Centers for Disease Control and Prevention (CDC) in Atlanta estimates that 100,000 to 250,000 Americans have seen their doctors for it. But since the CDC uses a very strict definition of the disease in gathering these statistics—unless an individual has the right number and combination of symptoms, the case isn’t reported as CFS—many researchers believe the disease is far more common than the figures indicate.
A study of 3,400 nurses from around the country found that while only 11 met the CDC criteria, 23 believed they had CFS. “We chose nurses because presumably they would be more familiar with CFS than the general population and better able to judge whether they have it,” says Leonard Jason, Ph.D., professor of psychology at DePaul University in Chicago, who conducted the study.
In another study of the general population, 0.2 percent were found to have CFS. Based on these results, Dr. Jason estimates that about 387,000 American adults have CFS.
While no one has found a cure for CFS, dietary changes and nutritional supplements can help to strengthen the immune system, improve energy levels and ease some of the symptoms of CFS, says Allan Magaziner, D.O., director of the Magaziner Medical Center in Cherry Hill, New Jersey. Dr. Magaziner has been treating people with CFS for more than ten years.
“Of course, taking a supplement isn’t going to cure CFS,” he cautions. “People need to understand that they also have to eat right, exercise appropriately and work with a physician who’s knowledgeable about CFS.”
| Food Factors When it comes to battling chronic fatigue syndrome (CFS), supplements are only part of the picture. Medical experts agree that the overall quality of your diet also makes a big difference in how you feel. Here are a few dietary changes that might prove helpful. Go easy on sugar. "Eating too much refined sugar weakens the immune system and may inhibit the ability of white blood cells to stay active," says Allan Magaziner, D.O., director of the Magaziner Medical Center in Cherry Hill, New Jersey. "Both of those factors play roles in CFS." Some research suggests that people with CFS are deficient in an enzyme needed to metabolize sugar, says Paul Cheney, M.D., a CFS specialist and director of the Cheney Clinic in Charlotte, North Carolina. The result is a buildup of lactic acid in the bloodstream, which can lead to muscle pain, vascular headaches and neuropsychiatric disorders such as panic attacks, all of which are associated with CFS. "We recommend avoiding sugar as much as possible, but if you're going to have an indiscretion, have dessert after a meal instead of eating something sweet on an empty stomach," says Dr. Cheney. "That slows down the absorption of the sugar, so you don't get a sharp elevation in lactic acid." Don't depend on caffeine. When you're exhausted all of the time, there's a great temptation to depend on caffeine to make you more alert. "But it's also important to avoid or cut back on foods that may cause loss of minerals. Caffeine is one example," says Dr. Magaziner. Trim the fat. By now just about everyone has gotten the message that a low-fat diet is essential for overall health. This advice takes on new importance for the person with CFS, since fatty foods are difficult to digest and can cause a general sluggish feeling, the last thing a person with CFS needs. "There's also some evidence that too much fat in the diet can have an adverse effect on immunity," says Dr. Magaziner. Eat healthy. The optimum diet for a person with CFS is the same as for anyone who's aiming for optimum health: high in fiber and complex carbohydrates, with lots of fruits, vegetables, beans and whole grains. Dr. Magaziner also tells people with CFS to avoid processed foods, which are often full of additives, preservatives and artificial colorings and flavorings. Get tested for food allergies. People with CFS are particularly prone to food allergies and often improve significantly when the allergies are detected and treated, says Dr. Cheney. "It seems to be a combination of difficulty digesting protein and increased gut permeability," he says. In other words, he explains, often the intestines of a person with CFS absorb substances from foods that would pass right through the digestive tract in a healthy person. Dr. Cheney treats the problem with enzymes to improve protein digestion and, in extreme cases, by eliminating the foods that cause the most problems. "Generally speaking, red meat, wheat and dairy seem to be the most problematic," says Dr. Cheney. If you suspect that food allergies are making your symptoms worse, discuss the problem with your physician. |
Muscling Up with Magnesium
Some people with CFS have benefited from taking supplements of magnesium, a mineral that is involved in the cells’ energy production.
One British study found that people with CFS had below-normal blood levels of magnesium. After receiving injections of magnesium, 80 percent reported improvement in their symptoms.
But even if their blood tests don’t show magnesium deficiencies, people can still benefit from extra doses of the mineral, according to Dr. Cheney. “Their blood levels of magnesium may be normal, but that doesn’t tell the whole story,” he says. “Magnesium, like potassium, is pumped into the cell, so normally there’s a higher concentration inside the cell than there is in the blood. And that pump mechanism may not work very well in people with CFS, so their magnesium levels can be normal in the blood and low in the cell.”
Dr. Magaziner also finds that most people with CFS notice improvement in their symptoms after starting magnesium supplements. “It doesn’t work for everyone,” he says. “But many of my patients find it eases their muscle aches and makes them feel less fatigued.”
This is probably because people with CFS have enzyme deficiencies that hamper the cells’ ability to convert food into energy, according to Dr. Cheney. And extra magnesium improves enzyme function, which results in greater energy production on the cellular level.
If you’re interested in trying magnesium, Dr. Magaziner recommends starting with 500 milligrams a day. “This level is perfectly safe, although occasionally a person will develop loose bowels or diarrhea,” he says. “If that happens, I would simply reduce the dose to the point where the diarrhea goes away.” If you have heart or kidney problems, however, you should check with your doctor before taking magnesium supplements.
Dr. Cheney recommends a chelated form of magnesium called magnesium glycinate. “It’s rapidly absorbed in the gastrointestinal tract, so it doesn’t cause digestive problems,” he explains. “And it tends to be drawn into the cell, where it’s needed.”
And because taking more magnesium increases the body’s need for calcium, Dr. Magaziner suggests taking calcium supplements as well. “I usually recommend taking them in a two-to-one ratio—1,000 milligrams of calcium if you’re taking 500 milligrams of magnesium,” he advises.
A Boost from B-Complex
The B-complex vitamins help support the adrenal glands, which are among the major organs in the body connected with stress, says Dr. Magaziner. “B vitamins also support the central nervous system, to help us cope with stress in general,” he explains. “We lose a lot of B vitamins when we’re stressed, so we need to replenish them.” These nutrients are also involved in energy production, which makes them essential for people with CFS.
Dr. Magaziner recommends a supplement containing the entire B-complex. thiamin, pantothenic acid and vitamins B6 and B12 are especially important for people with CFS, he says.
You can get the B-complex vitamins in most 6 and 50 micrograms of vitamin B12. He also recommends taking a separate B-complex supplement whenever you’re under stress. Higher doses of vitamin B12, given through injection by a physician, can also be helpful in cases of enzyme deficiency, says Dr. Cheney. Injected B12 doses may be 1,000 times higher than the normal daily dose.
| Fighting Back with Coenzyme Q10 Coenzyme Q10 sounds like something that might be prescribed in sick bay on Star Trek. But for those doing daily battle with chronic fatigue syndrome (CFS), they just might hear about it from their doctors, according to Paul Cheney, M.D., a CFS specialist and director of the Cheney Clinic in Charlotte, North Carolina. Coenzyme Q10 is available in supplement form in drugstores and health food stores. This little-known nutrient isn't exactly a vitamin, although its chemical makeup is similar to that of vitamins E and K. Experts believe that like vitamin K, coenzyme Q10 can be manufactured by the body, though it's also found in soybeans, vegetable oils and many meats. Like vitamins C and E and beta-carotene, coenzyme Q10 is a member of the antioxidant family, a group of nutrients that protect your body's tissues from everyday wear and tear by disarming destructive free radicals. Free radicals are unstable molecules that wreak havoc at the cellular level by stealing electrons from your body's healthy molecules to balance themselves. Besides being a potent antioxidant, coenzyme Q10 has an important function in energy production: It reacts with another enzyme to let cells convert protein, fat and carbohydrates into energy. While people with CFS aren't deficient in coenzyme Q10, they seem to have functional shortages of the enzyme it reacts with, explains Dr. Cheney. Taking extra coenzyme Q10 prompts the body to improve the function of this partner enzyme. And the better the partner enzyme works, the better the body's ability to convert food into energy. Dr. Cheney prescribes large doses of coenzyme Q10 for his patients, who are under his close medical supervision. For people with CFS who'd like to try coenzyme Q10 on their own, he recommends a daily dose of 200 milligrams, taken in divided doses under the tongue. And since this nutrient is fat-soluble, it should be taken with a little bit of fat or oil (although some supplements are in an oil base, similar to vitamin E capsules). |
Arm Yourself with Antioxidants
Also helpful in treating CFS are the so-called antioxidant nutrients, which include vitamin C, vitamin E, beta-carotene and the mineral selenium.
These nutrients form a veritable SWAT team that helps defend your cells against free radicals, unstable molecules that occur naturally in the body and that are also produced by bad habits such as smoking, sunbathing and drinking alcohol. Free radicals steal electrons from your body’s healthy molecules to balance themselves, damaging cells in the process. Antioxidants neutralize free radicals by offering their own electrons, protecting healthy molecules from harm.
“Antioxidants protect the body from deterioration, degeneration and environmental stresses,” says Dr. Magaziner. “And since many people with CFS are unusually sensitive to environmental factors such as household chemicals, food additives and artificial fragrances, taking antioxidants makes sense.”
Damage from free radicals is such an important factor in CFS that some researchers consider CFS a free radical–generated disease, says Dr. Cheney. “I don’t think it’s caused by free radical damage, but that seems to be one of the factors that maintains it,” he says.
To help bolster the immune system and improve stamina, both doctors recommend an antioxidant-complex supplement, available in most drugstores and health food stores. Because dosage varies widely from brand to brand, read the label to make sure you’re getting at least 500 milligrams of vitamin C, 25,000 international units of beta-carotene, 400 international units of vitamin E and 50 micrograms of selenium.
People with CFS may also want to try a vitamin C supplement in the form of ester-C, says Dr. Cheney. “Ester-C is much more bioavailable than regular vitamin C,” he explains. “Your body absorbs twice as much. People with CFS can take 2,000 milligrams of ester-C twice a day; it’s very safe.” Taking more than 1,200 milligrams of vitamin C can cause diarrhea in some people, however, so it’s a good idea to check with your doctor before exceeding that amount. Ester-C is available in health food stores.
| Prescriptions for Healing Nutrients can play roles in treating chronic fatigue syndrome. Here's what some doctors recommend. Nutrient Daily Amount
Antioxidant-complex supplement containing . . .
Beta-carotene 25,000 international units Selenium 50 micrograms Vitamin C 500 milligrams Vitamin E 400 international units
B-complex supplement containing . . .
Pantothenic acid 50 milligrams thiamin 50 milligrams Vitamin B6 50 milligrams Vitamin B12 50 micrograms Calcium 1,000 milligrams (2 milligrams for every 1 milligram of magnesium) Magnesium 500 milligrams (magnesium glycinate) Vitamin C 4,000 milligrams (ester-C), taken as
2 divided doses
MEDICAL ALERT: If you have been diagnosed with chronic fatigue syndrome, you should be under a doctor's care. If you are taking anticoagulants, you should not take vitamin E supplements. If you have heart or kidney problems, you should always check with your doctor before taking magnesium supplements. Doses of vitamin C in excess of 1,200 milligrams a day can cause diarrhea in some people, so it's a good idea to check with your doctor before taking more than that amount. |
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