Chronic fatigue: a clinical syndrome?

Jannyn Saß 17/06/2024

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How long‑lasting fatigue develops and what you can do about it

Fatigue – everyone knows feeling tired. But when tiredness and exhaustion become a constant companion and the body's resources cannot be restored despite usual recovery strategies, this is referred to as either fatigue or Chronic Fatigue Syndrome (CFS). Sometimes it is also called Myalgic Encephalomyelitis (ME), and often both terms are combined as ME/CFS.

People who suffer from it feel tired and exhausted for no apparent reason. The pronounced lack of energy impairs everyday life and those affected often meet with incomprehension from others.

While chronic tiredness is a symptom that can occur in many different conditions, Chronic Fatigue Syndrome is a specific, severe and complex illness with a wide range of symptoms and an unclear aetiology.

While treatment of secondary chronic tiredness depends on the underlying cause, therapy for CFS aims to relieve the diverse symptoms and is usually multidisciplinary.

In this article you will learn,

what CFS means as a clinical syndrome,
which conventional medical treatment options are available, and
what naturopathic medicine recommends.

Chronic fatigue syndrome – the diagnostic criteria in conventional medicine

The diagnostic criteria for Chronic Fatigue Syndrome (CFS) or Myalgic Encephalomyelitis (ME) include several specific features. The most commonly used primary criteria come from the USA and were formulated by the Institute of Medicine (IOM) [1]:

Severe impairment in the ability to engage in activities of daily living caused by fatigue, newly onset, lasting longer than six months, not explained by exertion.
Post‑Exertional Malaise (PEM): Symptoms worsen after physical or mental exertion and last for more than 24 hours.
Non‑restorative sleep: Sleep that does not contribute to recovery and does not relieve the fatigue.

In addition to the primary criteria, the following secondary criteria may occur, at least one of which is required to diagnose CFS:

Cognitive impairments: Problems with short‑term memory or concentration.
Orthostatic intolerance: Worsening of symptoms when standing or sitting upright, improvement when lying down.

Other symptoms commonly appear as:

Pain (e.g. muscle or joint pain without swelling or redness)
Sore throat
Tender lymph nodes
Headaches of a new type, pattern or severity
Muscle soreness after exertion
Other types of sleep disturbances

To make a diagnosis of CFS/ME, the primary criteria must be met and at least one of the secondary criteria must also be present. These symptoms must furthermore be consistently present and cannot be explained by other medical or psychiatric conditions.

What are the causes? – Current state of research

The exact causes of Chronic Fatigue Syndrome (CFS) or Myalgic Encephalomyelitis (ME) are complex and not yet fully understood. Research, however, points to a combination of different factors that may contribute to the development of the illness:

1. Infections:

Viral infections such as Epstein‑Barr virus (EBV), cytomegalovirus (CMV) and human herpesvirus 6 (HHV‑6) have been linked to CFS. A study by Andrew Lloyd in Australia, for example, found that a significant percentage of patients with CFS had previously suffered an acute infection [2].
Bacterial infections, such as Q fever caused by Coxiella burnetii, can also trigger CFS.

2. Immune system dysfunction:

Dysfunction of the immune system, including abnormal B‑cell activity, has also been observed in CFS patients. Studies show that the immune system in these patients reacts in an overactive way, leading to a persistent inflammatory response and associated fatigue [3] [4].

3. Neurological and hormonal changes:

Abnormal activity in certain brain regions may influence the subjective perception of effort and fatigue. Changes in hormone regulation, particularly in the hypothalamic‑pituitary‑adrenal (HPA) axis, have also been observed [5].

4. Genetic predisposition:

Genetic factors may increase the risk of developing CFS. There is evidence that CFS occurs more frequently in some families, suggesting a hereditary component [6].

5. Physical or emotional stress:

Severe physical or emotional stress, such as traumatic events or surgery, can act as triggers for CFS. Patients often report that symptoms began after such events [7].

6. Disturbances in energy metabolism:

Some CFS patients have shown problems in converting dietary energy into usable energy. This could lead to insufficient energy supply to the cells and explain the persistent fatigue [8].

The multifactorial nature of CFS makes diagnosis and treatment particularly challenging. Ongoing research aims to better understand the exact mechanisms and to develop effective treatment approaches.

Person with a blanket over their shoulders, hand on their face.

Naturopathic treatment options

Naturopathic treatment of Chronic Fatigue Syndrome (CFS) can play a complementary role to conventional medicine and aims to improve the quality of life of those affected. As CFS is a complex and multifactorial illness, a holistic approach can be sensible. Below is an overview of naturopathic approaches in the treatment of CFS:

Nutrition and dietary supplements

1. Balanced diet:

Anti‑inflammatory diet: A diet rich in omega‑3 fatty acids (e.g. fish, flaxseed), fruit, vegetables, nuts and whole grains can help minimise inflammation in the body. [9]
Avoidance of processed foods: Sugar, refined grains and saturated fats should be reduced.

2. Dietary supplements:

Vitamin B12 and folate: May help improve energy production. In the case of vitamin B12, this is particularly supported by observed mitochondrial or transporter dysfunctions in CFS that can lead to reduced energy production. [10]
Coenzyme Q10: Supports mitochondrial function and may boost energy production.
Magnesium: May relieve muscle cramps and pain.
Omega‑3 fatty acids: Have anti‑inflammatory properties. [11]

Herbal remedies

1. Adaptogenic herbs:

Ashwagandha: May reduce stress and improve energy levels. [12]
Rhodiola rosea: May enhance physical and mental performance. [13]
Ginseng: Known for its tonic and adaptogenic effects. [14]

2. Herbs for immune modulation:

Astragalus: Traditionally used to strengthen the immune system. [15]

Astragalus: plant with pale green leaves with fine hairs on the leaf edges.

Physical therapies

Acupuncture: May help relieve pain and improve overall well‑being.
Massage: Can release muscle tension and promote circulation.
Tai Chi and Qigong: Gentle movement therapies that can reduce stress and boost energy.

Psychological approaches

Mindfulness and meditation: Can help reduce stress and anxiety and improve sleep quality.
Cognitive behavioural therapy (CBT): Can be helpful in coping with the psychological impacts of the illness.

Lifestyle adjustments

Sleep hygiene: Regular bedtimes, a relaxing evening routine and a quiet sleeping environment can improve sleep quality.
Stress management: Techniques such as deep breathing, progressive muscle relaxation and yoga can help reduce stress.
Gentle physical activity: Short, regular exercise sessions adapted to individual energy levels can help maintain physical fitness without worsening symptoms.

Conclusion

The diagnosis of CFS/ME requires a thorough medical history and clinical examination by an experienced physician or therapist. Treatment should be individually tailored, as symptoms and responses to therapies in CFS patients can vary greatly. It is important that naturopathic approaches are used in coordination with conventional medical treatments and under the guidance of an experienced healthcare provider. Naturopathic treatments may take time, and continuous application is often necessary to achieve lasting improvements.

Combining different therapeutic approaches can help alleviate the symptoms of Chronic Fatigue Syndrome and meaningfully improve personal quality of life.

Disclaimer:

This article does not replace treatment by a qualified therapist. The basis of this contribution is studies and current literature. It must not be used for self‑diagnosis or self‑treatment. Discuss any inspirations from this article with a therapist you trust if necessary.