By Dr. Mercola
Chronic Fatigue Syndrome (CFS), sometimes also referred to as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), has only been recognized by the US Centers for Disease Control and Prevention (CDC) since 1988.
Fortunately, most doctors have now abandoned their view that CFS is just something "in your head," and no longer view it as a psychological disorder.
On February 10, 2015, the Institute of Medicine released a landmark report1 containing recommendations for CFS, including the suggestion to change the name from Chronic Fatigue Syndrome to Systemic Exertion Intolerance Disease (SEID).
That name has not yet been formally adopted by world and federal health agencies, but you may end up seeing it more in the future.
Signs and Symptoms of Chronic Fatigue Syndrome
According to the Solve ME/CFS Initiative2 (SMCI), about 1 million Americans suffer from CFS, and the syndrome disproportionally strikes more women than men.
Symptoms characteristic of CFS include the following. As you would expect, these symptoms correlate with many other diseases and conditions, making a correct diagnosis notoriously difficult to obtain.
Since there's no known cure for CFS, all treatments are currently directed at relieving these symptoms.
Extreme fatigue and weakness, difficulty maintaining upright posture, dizziness, balance problems, and fainting Post-exertional malaise, lasting 24 hours or longer Muscle and joint aches and pains Sore throat, swollen glands, and periodic fevers and chills Chronic headaches Numbness and tingling of the extremities Brain fog, cognitive dysfunction, and/or lack of concentration Insomnia, and/or unrefreshing sleep, night sweats Visual disturbances (blurring, light sensitivity, and eye pain) Gastrointestinal disturbances Allergies and sensitivities to foods, odors, chemicals, and medications Irritability, depression, and mood swings
The Benefits of Talk Therapy and Exercise for Chronic Fatigue Sufferers
In 2011, a large randomized trial known as the PACE trial5 determined that cognitive behavioral therapy (talk therapy) and graded exercise therapy could effectively treat CFS.
Although high-intensity exercises are typically recommended for healthy individuals, that would not be wise for those with CFS. I believe gentle walking, gradually building up to 1 to 2 hours a day could have profoundly beneficial results.
Results showed that at 52 weeks, compared to those who received no other intervention except medical advice about how to manage their symptoms (such as insomnia and pain), those who received talk therapy or graded exercise therapy had significantly lower mean fatigue scores.
Patients receiving talk therapy or graded exercise therapy also scored higher on physical function tests compared to those who only received general medical advice.
According to lead author Professor Peter White:
"While there is still room for improvement, this is a real step forward in informing patients with CFS/ME which treatments can help to improve their health and ability to lead a more normal life."
The British research team has now published a follow-up study6 on the PACE trial, in which they found that these two treatments do indeed have long-lasting benefits.
In fact, the improvements patients achieved after one year of talk therapy (in which patients are taught how their thinking can affect their symptoms) or graded exercise (where patients gradually increase the amount of exercise they're able to perform) remained stable even 2.5 years after the original treatment.
Three Important Nutrients for Boosting Energy
While researchers are still struggling to understand the mechanisms causing the wide ranging symptoms of chronic fatigue syndrome, it seems clear that impaired immune system function and/or some sort of mitochondrial dysfunction is involved. The American Healthcare Foundation7 suggests CFS is best classified as a post-viral or post-infectious syndrome. A number of infectious organisms have indeed been linked to CFS, although definitive evidence that the condition is caused by a lingering infection is still slim.
Despite such uncertainties, supporting healthy energy synthesis and mitochondrial function through nutrition may be quite helpful for alleviating some of the symptoms. Remember that damaging free radicals are produced by excess electrons.
So it's also important to minimize the production of excessive electrons in the mitochondria, as they will generate free radicals that can further damage energy production.The key to reducing mitochondrial damage is to limit free radical generation, and this is most effectively done by calorie restriction or intermittent fasting.
Avoiding eating too close to bedtime is part and parcel of this, as eating right before you're about to go to sleep will ultimately promote the premature destruction of your mitochondria. I will review the mechanics of this in a section below. But first, let's take a look at three nutrients that may be of particular importance for supporting cellular energy production and protecting your mitochondria:
- Ubiquinol (the reduced form of CoQ10; one of the strongest lipid-soluble antioxidants known that is produced within your own body)
- D-ribose (a core building block of ATP)
- Glutathione (one of your body's most important antioxidants and a natural detox agent)
The Energy Boosting Properties of Ubiquinol
Coenzyme Q10 (CoQ10) is used for energy production by every cell in your body, and is therefore vital for good health, high-energy levels, longevity, and general quality of life. It also helps protect against cellular damage from free radicals.
Ubiquinol is the reduced form of CoQ10 – the effective form your body naturally uses to transfer free electrons. Research shows that the reduced form is better for your health in a number of ways, primarily due to its superior bioavailability if you're over 25. If you're under 25 years old, your body is typically capable of converting CoQ10 to the reduced form fairly well, and the additional expense of purchasing the reduced form is unnecessary. However, if you're older, your body becomes increasingly challenged to convert the oxidized CoQ10 to ubiquinol.
One common question is whether or not supplementing with ubiquinol may negatively affect your body's own production of it. Fortunately, several studies have shown that this is not the case. Even at very high levels of ubiquinol – upwards of thousands of milligrams a day for a considerable period of time – natural production has remained unaffected. And, even at very large doses, no adverse effects or drug interactions have ever been found or reported, so it appears to be very safe.
Interestingly, although it's a lipid (fat) soluble antioxidant, which typically means it's more difficult to absorb, ubiquinol is "peculiar" in that its rate of absorption appears to be based on your body's metabolic demand — which is great. Meaning, if you're healthy, you absorb less, and when you're ill, or struggle with chronic disease, your body will absorb more. Its absorption rate is basically self-adjusting so it becomes very difficult to take too much.
That said, since it is lipid-soluble, it is better to take it with a meal – or if not with a meal, then with some type of fat like olive oil, or coconut oil to ensure optimal bioavailability and absorption. These considerations – its profound, well-documented health benefits, along with its safety profile – makes supplementing with ubiquinol a no-brainer when you're struggling with fatigue.
Clearly, diet and exercise are the cornerstones of optimal health, but there's overwhelming evidence that ubiquinol can go a long way toward optimizing your energy levels. I have been so impressed with the recent research on ubiquinol that I have doubled my dose to 200 mg per day.
D-Ribose Helps Energy-Depleted Cells to Recover
Adenosine triphosphate (ATP) is a coenzyme used as an energy carrier in every cell of your body. It's composed of three major chemical groups, one of which is D-ribose, a five-carbon sugar. As a structural component or building block of ATP, D-ribose is involved in the energy synthesis in your cells, and research dating back to the 1970s found that giving patients supplemental D-ribose prior to, or immediately after cardiac ischemia (where a blockage in your heart's arteries causes reduced blood flow, preventing it from getting enough oxygen), allowed the heart to recover its normal cellular energy level.
When you take supplemental D-ribose, the vast majority of it — about 97 percent — is absorbed into your blood and is quickly distributed into the various tissues in your body. Once inside your cells, your body uses the D-ribose to synthesize and restore cellular energy levels. As for dosage, research suggests that just about any amount of supplemental D-ribose will help energy depleted cells to recover — even as little as 500 milligrams (mg) can be beneficial.
However, if you're struggling with chronic fatigue or other health issues, you likely need more than that. A standard dosage recommendation is 3 to 5 grams per day. Even though it is biochemically a sugar, it is not burned for fuel like other sugars but rather preserved to make ATP and parts of DNA and RNA.
The Role of Glutathione in Chronic Fatigue Syndrome
The American Healthcare Foundation8 presents a valuable summary of the benefits of glutathione in the treatment of chronic fatigue syndrome. Its primary value is its ability to promote healthy immune system function. And, while it has nothing to do with the generation of cellular energy per se, it helps eliminate toxins that can disrupt cellular energy synthesis. Its antioxidant capacity also helps prevent or reduce the pain response.
As explained by the American Healthcare Foundation:
"[Glutathione] GHS protects the mitochondria (your cell's power plant) from chemical and environmental stressors that mount free radical attacks against the cell. When your body's natural GSH antioxidant defense systems cannot protect your cells – you experience fibromyalgia and other diseases of 'pain and fatigue…'
Every day, we are exposed to toxins... and our immune system depends on GSH for their removal. The inability to facilitate such detoxification – overwhelms your immune and antioxidant defense systems – thus the cycle of persistent fatigue, musculo-skeletal pain, sleep disturbance, and cognitive and psychological abnormalities is perpetuated. The GSH enzyme system detoxifies at the cellular level...
Dr. Paul Cheney and numerous other CFS physicians have demonstrated that once your levels of GSH have returned to a level consistent to enabling proper immune system support, many patients respond with dramatic results. By providing your immune system with the 'fuel' required to function, raising GSH not only allows you to begin feeling better, but in many cases, a return to normal routines becomes possible."
Another intriguing explanation of glutathione's role in chronic fatigue can be found on the Phoenix Rising website,9 an online support group for people with CFS. The article was written by the late Rich Van Konynenburg, PhD;10 a physicist (not a medical doctor) who'd taken a personal interest in CFS and spent 15 years studying the disorder before his death in 2012.
In 2004, he proposed a biochemical model of stress-induced glutathione depletion as a cause of chronic fatigue. A few years later, he came up with a more refined hypothesis, the Glutathione Depletion-Methylation Cycle Block, which he thought was responsible for the pathogenesis of CFS. While this information is speculative, many CFS sufferers claim to have benefited from it, so I present it for your review.
How to Raise Your Glutathione Levels
Glutathione is poorly absorbed, so your best bet is to not take oral glutathione but to use its precursors. One good alternative is to use a high quality whey protein,11 made from organically-raised raw milk, without added sweeteners. Foods that are high in sulfur and/or selenium12 also encourage your body's production of glutathione. This includes:
Why Intermittent Fasting May Help Pain and Fatigue
Some of you may balk at the idea of calorie restriction when dealing with chronic fatigue, but there's actually compelling evidence showing it can play a significant role in correcting mitochondrial function. As noted earlier, when excessive electrons are produced in the mitochondria they create highly destructive free radicals. The best way to address this is to limit excessive electron production, as if there are fewer free electrons, they're less likely to leak out.
So how do you limit free electrons?
One of the most effective ways to do this is through calorie restriction, which in fact is the only proven method to increase lifespan in mammals. The drawback is that calorie restriction is enormously difficult to maintain over extended periods of time. Fortunately, research has shown that intermittent fasting effectively mimics calorie restriction, and it's far easier to comply with, especially if you do it daily, restricting your eating to a window of about six to eight hours, where your last meal is taken at least three hours before bedtime. Ideally, aim for as much as six hours between your last meal and your scheduled bedtime.
The Benefits of Avoiding Late-Night Eating
The rationale for avoiding late night eating is directly tied to the way your body produces energy, which I will now describe in greater detail. Your mitochondria are responsible for "burning" the fuel your body consumes and converting it into usable energy.
These tiny bacterial derivatives live inside your cell and are optimized to create energy from the food you eat and the oxygen in the air you breathe. Your cells have between 100 and 100,000 mitochondria. Your mitochondria have a series of electron transport chains that pass electrons from the reduced form of the food you eat to combine it with oxygen from the air you breathe and ultimately form water.
This process drives protons across the mitochondrial membrane, which recharges ATP (adenosine triphosphate) from ADP (adenosine diphosphate). ATP is the carrier of energy throughout your body.
A major side effect of this transfer of electrons is that some leak from the electron transport chain to react with oxygen to form the free radical superoxide. Superoxide anion, the product of a one electron reduction of oxygen, is the precursor of most reactive oxygen species and a mediator in oxidative chain reactions. These oxygen free radicals attack the lipids in your cell membranes, protein receptors, enzymes, and DNA that can prematurely kill your mitochondria.
Some free radicals are actually good and your body requires them to regulate cellular function, but problems develop when you have excessive free radical production. Sadly that is the case for the majority of the population and why most diseases, especially cancers, are acquired. There are two possible solutions to this problem:
- Increase your antioxidants, or
- Reduce mitochondrial free radical production
I believe one of the best strategies for reducing mitochondrial free radical production is to limit the amount of fuel you feed your body when it requires the least amount of energy, which is when you are sleeping. If you feed your body shortly before sleeping you will have large amounts of fuel your body simply has no need for, which will result in an increase in unnecessary energy production that results in the leakage of electrons.
These leaked electrons then combine with oxygen to form free radicals, which damage your DNA, thereby radically increasing your risk for serious disease.
In the case of CFS, they will also decrease mitochondrial energy production, which is why I believe this is one of the simplest, least expensive, and possibly most effective strategies for CFS. It is one of the reasons why I rarely eat less than three hours before going to bed and frequently it is five to six hours. A review paper13 that provides much of the experimental work for the above explanation was published in 2011, titled "Mitochondrial DNA Damage and Animal Longevity: Insights from Comparative Studies."
It may be too complex for many laypeople, but the take-home message is that since your body uses the least amount of calories when sleeping, you'll want to avoid eating close to bedtime because adding excess fuel at this time will generate excessive free radicals that will damage your tissues, accelerate aging, and contribute to chronic disease.
Addressing Chronic Fatigue Requires a Multi-Pronged Approach
Chronic fatigue syndrome is undoubtedly a challenging condition, but there is hope. A number of different lifestyle changes have been shown to increase your chances of recovery, including the ones covered in this article:
- Exercising according to your ability, with a focus on increasing the amount of exercise you can handle. Research shows that a combination of aerobic activity and strength training can improve pain and fatigue symptoms. Gentle exercise such as yoga can also be an excellent part of your exercise program – and yoga benefits the mind as well as the body.
- Supplementing with nutrients important for cellular energy synthesis, such as ubiquinol and D-ribose.
- Eating foods rich in glutathione precursors, and foods high in sulfur and/or selenium to encourage glutathione production. Also make a conscious effort to avoid toxic exposures.
- Intermittent fasting, making sure your last meal is taken three to six hours before bedtime.
- Addressing your mental outlook. In addition to talk therapy, I would recommend trying The Emotional Freedom Techniques (EFT), to help normalize your bioenergetic circuitry. Emotionally traumatic events can leave "energy blockages" for many years, which then interfere with your overall health, including immune function. There are many different techniques that can be used, but EFT is my favorite, and it's easy to learn and apply.