What is chronic fatigue syndrome?
Chronic fatigue syndrome (CFS) involves unexplained, persistent fatigue that is not caused by excessive exertion, does not improve with rest, and substantially limits work, social and personal activities.
The diagnostic criteria described here require at least 4 of the following symptoms to have been present for at least six consecutive months:
1. Problems with memory and concentration
2. Sore throat
3. Tender and swollen lymph nodes in the neck and armpits
4. Muscle aches
5. Joint pain without swelling or redness
6. Headache
7. Unrefreshing sleep
8. Sleep disorders (insomnia and/or sleep disturbances)
9. Feeling unwell after exertion for more than 24 hours
Initial treatment
There is no single solution for chronic fatigue. It calls for a comprehensive approach. The following are the general measures used in this practice.
| Foods to include | Foods to avoid | |
| Fruit | Fresh and frozen, without added sugars; fresh fruit juices without added sugars | Oranges and orange juice |
| Vegetables | Fresh, raw, steamed, fried, grilled | Sweetcorn, tomatoes |
| Starch | Rice, oatmeal, millet, quinoa, amaranth, teff, tapioca, buckwheat, potatoes | Wheat, maize, barley, spelt, kamut and rye (gluten-containing products) |
| Cereal products | Products based on rice, oats, buckwheat, millet, potato flour, tapioca, arrowroot, amaranth or quinoa | All products based on wheat, spelt, kamut, rye or barley |
| Legumes and vegetable proteins | All legumes (e.g. peas, lentils), except soya beans | Tofu, tempeh, soya beans, soya milk and other soya products |
| Nuts and seeds | Almonds, cashews, walnuts, Brazil nuts, sesame seeds and sesame paste, sunflower seeds, pumpkin seeds and nut butters (except peanut butter) | Peanuts and peanut butter |
| Meat and fish | Fish, chicken, turkey, game, lamb, fresh or frozen | Beef, pork, veal, processed meats, tinned meat, eggs and shellfish |
| Dairy products and milk substitutes | Rice milk, almond milk, oat milk, coconut milk | Milk, cheese, cream, yoghurt, butter, ice cream, soya milk, quark and cottage cheese |
| Fats | Cold-pressed olive, flaxseed, canola, safflower, sunflower, sesame, walnut or almond oil | Margarine, solid cooking fats, hydrogenated oils (in ready-made foods, biscuits and commercially produced pastries), mayonnaise and prepared salads |
| Drinks | Water, herbal tea, mineral water | Soft drinks, alcohol, coffee, tea, cocoa |
| Herbs and spices | All spices, except those in the column opposite, with a preference for cinnamon, cumin, dill, garlic, ginger, carob, oregano, parsley, rosemary, tarragon, thyme, turmeric | Ketchup, mustard, soya sauce, all prepared sauces |
| Sweeteners | Brown rice syrup, fruit-based sweeteners, molasses, stevia, tagatose | All refined sugar and products containing sugar, honey, maple and corn syrup |
Deficiencies in the following nutrients are commonly seen in this practice in patients with chronic fatigue and fibromyalgia. Supplements may be tried to assess whether symptoms improve; they are also used here to support the immune system. The amounts below are daily doses.
– Coenzyme Q10: 200 mg
– Acetylcarnitine: 2 x 1000 mg
– Ribose powder: 3 x 5 g (an energy source for the muscles)
– Vitamin B12: 1–2 mg as a tablet dissolved under the tongue. In patients with chronic fatigue, I often see marked vitamin B12 deficiency, which I prefer to treat with injections. I aim for optimal blood levels rather than the minimum reference level. The dose I administer is 10 mg of hydroxocobalamin per week.
– Magnesium: 400 mg
– Ginseng: 300-500 mg
– Rhodiola: 500 to 1000 mg.
– Silymarin: 300 mg, sulforaphane: 50-100 mg, lipoic acid: 400–600 mg (to support liver detoxification).
– Iodine: 250 micrograms + L-tyrosine: 500 mg (both nutrients are needed to produce the thyroid hormone thyroxine, or T4).
– Vitamin D3: 2000–5000 IU per day (more in winter than in summer, provided you spend plenty of time outdoors in sunlight during summer).
– Sleep at least eight hours every day
– Exercise for at least 30 minutes every day, at your own pace
– Do relaxation exercises daily (meditation or other)
– Ensure that your blood pressure is at least 110/70 mmHg
– Avoid amalgam fillings in your mouth
– Support a healthy gut microbiome (with additional probiotics if necessary)
A comprehensive approach
CFS requires a multifactorial approach. A detailed medical history, comprehensive blood testing and a 24-hour urine collection are central to the assessment.
The following issues are assessed and addressed where necessary:
