CHRONIC FATIGUE SYNDROME
by Paul J. Dunn, MD, charter member of the American Holistic Medical Association; member of the American College of Advancement in Medicine, the American Academy of Environmental Medicine, and the Academy of Orthomolecular Medicine; and member and past president of the International Academy of Nutrition and Preventive Medicine, with private practice in holistic medicine in Oak Park, Illinois.
Chronic fatigue syndrome (CFS) is a serious, mysterious illness that during the past ten years has reached epidemic proportions. It has been variously referred to as chronic mononucleosis syndrome, chronic Epltein-Barr virus, and yuppie flu. What are its symptoms, what causes it, and what can be done about it?
The most outstanding manifestation of CFS is debilitating fatigue, often with a sudden onset and brought on by very little exertion. General malaise is common. Other symptoms include headache, depression, low-grade fever, poor concentration, gastrointestinal symptoms, allergies, muscle and joint pain, anxiety attacks, mental confusion, sleep disturbance, weight loss, and skin rash. Some chronic fatigue patients have flu-like symptoms such as chills and sore throat. Mental and emotional symptoms are common. Memory for recent events may be diminished. Comprehending spoken words may be difficult. Some patients are constantly sick while others experience periods of exacerbation and remission. Women seem more susceptible than men – or do women seek help more readily?
Causes and treatments
At this time no single causal agent has been incriminated, though it is speculated that a virus or group of viruses, such as the herpes family, is involved. This family includes the Epstein-Barr virus (EBV), the cytomegalovirus (CMV), the herpes simplex viruses (oral and genital), and the herpes virus type 6. These viruses can lie dormant inside body cells for years and then under certain conditions of immune dysfunction emerge and cause a variety of symptoms.
Other factors contributing to CFS are trace mineral imbalance, poisoning with metals such as lead, cadmium, aluminum, and mercury; hypoglycemia (low blood sugar); food and chemical sensitivities; heredity factors such a family history of diabetes or alcoholism; chronic exposure to toxins and electromagnetic radiation in the environment; psychological problems; and possible injury affecting structural balance that could lead to internal organ symptoms. Also involved might be degenerative diseases such as heart disease or cancer; disorders in thyroid function; adrenal insufficiency; reactions to drugs, anesthesia, and surgery; occult malnutrition; and autoimmunity.
Rosenbaum and Susser1 postulate that a virus invades white blood cells and disorders the immune response, possibly because of genetic susceptibility to this virus. Other environmental factors further dysregulate the immune system, reactivating latent viruses and precipitating CFS. This leads to a variety of other infections which further compromise the immune system and aggravate an already horrendous situation. They refer to this as mixed infection syndrome (MIS). The microorganisms involved in MIS are viruses and retroviruses, bacteria, yeasts, and certain parasites, with the latter two the most common.
The yeast Candida albicans causes candidiasis, which is often referred to as candida hypersensitivity syndrome (CHS) or candida-related complex (CRC). This is controversial: many in the medical profession do not agree that the condition exists. Candida is a normal inhabitant of the gastorintestinal tract, and usually it is benign. However, if the normal balance of friendly bacteria in the colon is disturbed, for example through the use of antibiotics or the ingestion of significant amounts of refined sugars, the yeast may quickly proliferate to an active state and invade other tissues and organs2 throughout the body. Other factors implicating this proliferation include low-fiber diets, achlorhydria (lack of hydrochloric acid in the stomach), certain steroids, and birth control pills. When the organism proliferates, it converts to an invasive mycelial form in which, as a fungus, it can penetrate the intestinal mucosa. Injury, severe burns, and surgery also contribute to this conversion.
Candida overgrowth may be affecting up to 20 million Americans.3 The seriousness of candida infections ranges from the commonly recognized vaginal yeast, thrush in the mouth, and various candida eczemas to the hidden infections of other organs and severe, sometimes lethal, disseminated candidiasis. When the invasive form penetrates the walls of the GI tract, the toxins it produces can escape and spread to any part of the body. Candidiasis occurs mostly in women but it is not at all unusual in men and even in children.
One might suspect candida infection if there have been recurrent vaginal yeast problems, urinary tract infections, and athlete’s foot or fungal infections of the nails; persistent bloating and gas after eating; symptoms worse on damp days or in moldy places; or a history of antibiotic treatment. Treatment consists of one of the anticandida drugs, diet management, herbs, and other methods of enhancing immune system functioning. Colonics have also been a useful adjunct.
A parasite is any organism that invades and feeds upon another. In this sense, bacteria, viruses, and fungi are all parasitic. However, there is a class of disease-causing organisms called parasites that are not viruses, bacteria, or fungi. There are hundreds of species of parasites, but four are primarily involved in CFS: Giardia lamblia (giardiasis), Entamoeba histolytica (amoebiasis), Ascaris lumbricoides or roundworm (ascariasis), and Toxoplasma gondii (toxoplasmosis). Giardiasis and amoebiasis are the two most often involved in CFS. Parasitic diseases are much more common in the tropics, but they have also been found in more temperate climates. The incidence in the United States seems to be increasing, or at least it is being suspected and diagnosed more often.
Certainly the incidence of giardiasis and amoebiasis is much higher than is usually thought. Diagnosis requires first of all a high index of suspicion by the physician. Then proper tests must be ordered, particularly a careful examination of a purged stool specimen. The tests must then by properly interpreted. Treatment consists of a combination of antiparasitic drugs and herbs, the specifics varying with the individual patient and determined by the physician. Parasitic infections can be successfully treated.
Often unrecognized bacterial conditions are also involved in MIS. These include chronic infection of the gums; Lyme disease acquired from infected ticks; peptic ulcer caused by a bacteria Heiobactor pylori; acne that is related to chronic bacterial infection; chronic cystitis, an infection of the lining of the urinary bladder; chronic prostatitis, an infection of the prostrate gland; and chronic sinusitis, which can be a hard-to-cure infection of the air sinuses. Rheumatoid arthritis is another malady that may be caused by bacteria, including the sexually transmitted chlamydia bacteria. It is essential that physicians be suspicious of these hidden bacterial infections. They need to realize how these infections compromise the immune system and lead to activation of other organisms, thus contributing to CFS.
Diagnosis here again involves careful medical history, physical examination, bacterial cultures, and other tests to rule out Lyme disease and other infections such as hepatitis and AIDS. Treatment with antibiotics may be based on specific cultural findings or on deciding empirically to do a therapeutic trial. It may be necessary to use an antibiotic in greater amounts and for a longer time than usual. Whenever antibiotics are used, they must always be accompanied by a good lactobacillus preparation to help maintain normal flora in the GI tract.
The diagnostic evaluation should be an integrated one that looks into possible causes. In my practice, after an extensive interview, I do a general physical examination and a neurological and osteopathic exam. I review a very detailed medical history form that the patient has completed before the visit. Then I discuss what I consider to be my ideal diagnostic recommendation, based on all the information available at that time. If the patient is comfortable with this ideal and it is feasible, we proceed accordingly. If some part is not feasible, we discuss it, and once a mutual agreement is reached, then testing and treatment are begun. Sometimes testing is deferred pending results of a trial lasting several months and consisting of a basic diet (see listing below), nutritional supplements, exercise, stress reduction, and other lifestyle changes.
Diagnostic protocols will vary from one physician to another, but most, in light of newer knowledge, will include tests of blood and stools for candida and other parasites, bacterial cultures, tests for obscure infections, and viral studies. Other usual procedures are a comprehensive blood profile; a five- or six-hour glucose tolerance test; hair and whole blood or packed-cell mineral analysis for trace and toxic minerals; plasma and urine amino acid levels; blood tests for food and chemical sensitivities, particularly for delayed reactions; a Heidelberg gastrogram (testing for pH levels in the GI tract); basic thyroid and adrenal studies; and other indicated studies.
If treatment based on the results of these procedures does not lead to satisfactory improvement, then more sophisticated tests of immune and brain function are indicated, for example, interferon levels, a CAT scan, and MRI. Treatment, in addition to the measures already discussed, is based on the results of this integrated evaluation.
1Rosenbaum, M., and M. Susser, Solving the Puzzle of Chronic Fatigue Syndrome, Tacoma, Washington, Life Sciences Press, 1992.
2Bland, J., "Candida albicans: an unsuspected problem," Resource Monograph, Department of Nutritional Biochemistry, University of Puget Sound, Washington, 1984.
3Truss, C.O., "The Role of Candida albicans in Human Illness," Journal of Orthomecular Psychiatry 10:228-38, 1981.
Dr. Dunn’s Basic Diet Recommendations
In general, the basic therapeutic diet should be free from simple refined carbohydrates, from high-calorie, low-nutrient fatty foods, and from highly processed foods. It should take food sensitivities into account and should be accompanied by some nutritional supplements. A good overall vitamin-mineral supplement should contain adequate amounts, especially of antioxidants, including vitamins C and E and beta carotene. Supplements should be yeast-free. If you have not been tested for food sensitivities, then you should at least eliminate the foods you crave the most (hard though that may be!). Ideally fresh fruits and vegetables should be organic (i.e. chemically less contaminated). If not, they should be washed with, for example, NutribioticTM, a biologically active grapefruit-seed extract, to decrease any toxic residue.
The following specific recommendations would be true for everyone except those with candida-related complex, who should not use fruit, fruit juice, or dairy products. Food yeasts such as found in vinegar and bread need not be eliminated unless there is a sensitivity to food yeast.
Eat a variety of complex carbohydrates, such as vegetables, sprouts, beans of various types, whole grains in cereals and breads, fruits (except for dried fruits, grapes, plumbs and bananas), nuts, and seeds. For protein eat fish, seafood, and poultry. Limit red meat (lamb, pork, veal, beef, venison, liver, rabbit) to two servings a week. Eggs boiled or poached are good; their cholesterol is not oxidized and is not harmful. Try to limit dairy products to buttermilk, yogurt, and other acidophilus-digested products. Eliminate cheeses. Pure water (not tap water), freshly squeezed vegetable juice, and herb teas are the best beverages. Pau d’Arco tea is helpful with candidiasis.
Avoid alcohol, caffeine in any form, and all refined sugars, especially as found in cake, pie, ice cream, candy and cookies. Even artificial sweeteners like Nutrasweet® have been reported to cause a variety of symptoms. White rice and white, bleached, enriched flour products are also to be avoided.
In general, undercook. Have vegetables crisp rather than soggy. Eat raw foods when palatable. Butter is better than margarine. Ghee, made by removing protein from unsalted butter, often becomes satisfactory for those sensitive to cow’s milk. Do not use excess salt. Good snacks are carrots, celery, radishes, seeds and nuts.
Other types of cooking, such as Thai and Chinese, can add interesting variety to the diet and still remain within the guidelines (but watch out for MSG). Be adventurous!
Article from NOHA NEWS, Vol. XVII, No. 2, Spring 1992, pages 2-4.