INTRODUCTION
Before discussing the treatment of Chronic Fatigue Syndrome (CFS), we must have an understanding of this complex problem, within the limitations of what we know at the present time. Most everyone has now heard of this problem, even though many may still think of it as the “yuppie flu”. And most people, unfortunately, know of someone with the illness. CFS is now estimated to affect approximately three to 5 million Americans and ninety million people worldwide. Recent studies show incidence figures ranging between 37.1 in 100,000 [1] and 98 to 267 in 100,000 [2]. Various epidemiological surveys find that between 1-3% of Americans are afflicted. One study published in the Annals of Internal Medicine in 1995 went so far as to estimate that Chronic Fatigue Syndrome may affect as many as 7% of the population.[3]
The definition of this illness, as set out by the Centers for Disease Control, in Atlanta, Georgia, has succeeded in setting guidelines for diagnosis. Although there is no accepted cure offered in the orthodox medical world, at least CFS is finally being accepted as a legitimate illness. There is now much more research being done, even though this has not lead to much in the way of helpful orthodox treatment. It is possible that the drugs the medical world prescribes even make a CFS sufferer worse.
There are many current theories pertaining to possible causes of this syndrome. Perhaps part of the problem is that scientists and physicians are used to searching for a single cause, what we call the “single bullet theory”. They are looking to find a drug that will eradicate one invading organism, as if there is one cause, be it a virus, bacteria, parasite, fungus, etc. But, in the opinion of many experts and practitioners in the alternate and complementary health field, Chronic Fatigue Syndrome seems to be a myriad of problems piled high upon each other.
With this in mind, let’s look at all the various indicating factors that may be involved in CFS. There is a high percentage of Chronic Fatigue Syndrome sufferers with what we call unresolved foci in the body, such as viral infection, parasites, dysbiosis (imbalance of the bacteria in the colon) and/or candida inflammations of the bowel, and allergies to both foods and airborne substances. Many patients with CFS also have allergic or hypersensitive reactions to chemicals in the environment, heavy metal toxicity, thyroid toxicosis, and such problems as nutritional deficiencies. One or several of these problems may lead to an eventual diagnosis of Chronic Fatigue Syndrome, with the devastating fatigue, pain, and depression that this involves. It is important to use methods for diagnosing these problems, or foci, in order to unravel this syndrome. The problems may be like an onion, in layers, which need to be peeled back. With the help of herbs, homeopathic remedies, and nutritional supplementation, much of the suffering involved in CFS can be dramatically alleviated.
[1] Shepherd, CB, Myalgic Encephalomyelitis: Post-viral Fatigue Syndrome. Guidelines for the care of patients. London: Thornton and Pearson 1994
[2] Buchwald, D., Prevalence of Chronic Fatigue and Chronic Fatigue Syndrome in the Community. Paper delivered at the International Meeting on CFS. Dublin, Ireland, May 1994
[3] Buchwald, D., Umali, J et al. Chronic Fatigue Prevalence in a Pacific Northwest Health Care System, Annals of Internal Medicine 1995; 123: 2: 81(8)
CHRONIC FATIGUE SYNDROME (CFS): CDC DEFINITION
The CDC (Center for Disease Control in Atlanta, Georgia, in the USA) updated its previous working definition of CFS (Holmes, et al) in 1993. The consensus from the leading CFS researchers and clinicians is that Chronic Fatigue Syndrome is a subset of Chronic Fatigue, which of course is a broader category understood to mean prolonged fatigue. True CFS must be differentiated from prolonged fatigue.
The guidelines for evaluating CFS include a thorough medical history, physical exam, and lab tests before a diagnosis of CFS can be made. According to the CDC, clinically evaluated, unexplained chronic fatigue cases can only be classified as Chronic Fatigue Syndrome if:
1) Unexplained, persistent fatigue that is of new or definite onset (not lifelong), is not the result of ongoing exertion, is not substantially alleviated by rest, and results in substantial reduction in previous levels of occupational, education, social, or personal activities.
2) The concurrent occurrence of four or more of the following symptoms: substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern or severity; unrefreshing sleep; and post-exertional malaise lasting more than 24 hours.
3) These symptoms must have persisted or recurred during 6 or more consecutive months of illness and must not have predated the fatigue.[1]
Furthermore the CDC lists conditions that must be excluded or eliminated as a possibility before a diagnosis of CFS can be given, Therefore, the practitioner must rule out infections, metabolic disorders, endocrine disorders, and cancer. He or she must exclude any other diagnosis that may explain the presence of chronic fatigue, such as untreated hypothyroidism (lowered thyroid function), sleep apnea and narcolepsy, and iatrogenic conditions such as side effects of medication. CFS must be differentiated from diagnosable illnesses that may relapse or may not have completely resolved during treatment, such as some types of malignances, hepatitis B or C virus infection. Also major depressive disorders such as schizophrenia, dementia, bipolar affective disorder, etc, must be ruled out, as must alcohol or other substance abuse, or severe obesity.
The CDC does not condone batteries of tests other than those to exclude other medical explanations for the patient’s fatigue. Only in the setting of protocol based research is this suggested. These tests include serologic tests for Epstein Barr (once thought to be a prime indicating factor in CFS), enteroviruses, retroviruses, human herpes virus 6, Candida Albicans, tests of immunologic function, including cell population and function studies, and imaging test such as MRI and radionuclide scans.
[1] Fukuda, K et. al. The Chronic Fatigue Syndrome; A Comprehensive approach to its definition and study. Annals of Internal Medicine 1994; 18 (supp.1): 126-33
] Shepherd, CB, Myalgic Encephalomyelitis: Post-viral Fatigue Syndrome. Guidelines for the care of patients. London: Thornton and Pearson 1994
[2] Buchwald, D., Prevalence of Chronic Fatigue and Chronic Fatigue Syndrome in the Community. Paper delivered at the International Meeting on CFS. Dublin, Ireland, May 1994
[3] Buchwald, D., Umali, J et al. Chronic Fatigue Prevalence in a Pacific Northwest Health Care System, Annals of Internal Medicine 1995; 123: 2: 81(8)