Conditions:
Chronic Fatigue Syndrome
Related Terms
•
Myalgic Encephalomyelitis, Post-Viral Fatigue Syndrome
Principal Proposed Treatments
•
· There are no well-established natural treatments for chronic fatigue syndrome.
Other Proposed Treatments
•
Essential Fatty Acids (GLA and Fish Oil), NADH, Carnitine, Echinacea, Ginseng, Beta-Carotene, DHEA, Licorice, Multivitamin and Mineral Supplementation
Chronic fatigue syndrome (CFS) has been a subject of controversy for many years. Medical authorities were once quite skeptical regarding whether it even existed. However, in 1988, the Centers for Disease Control officially recognized CFS. Today, CFS is defined essentially as follows: Unexplained, persistent, or relapsing fatigue with a definite beginning; it is not the result of exertion; it is not relieved by rest; and it results in significant reduction of activities.
In addition, at least four of the following symptoms persist or recur for 6 or more consecutive months of the illness:
- Impairment in short-term memory or concentration
- Sore throat
- Tender lymph nodes in the neck or armpits
- Muscle pain
- Pain in many joints, without redness or swelling
- Headache of new pattern or severity
- Unrefreshing sleep
- Malaise following exercise, that lasts for more than 24 hours
Frequently, symptoms of CFS follow a viral infection; some individuals with CFS describe their symptoms as a flu that never goes away.
The cause (or causes) of CFS remains unknown. Because its symptoms somewhat resemble those of mononucleosis (caused by the Epstein-Barr virus), for a time the disease was called "Chronic Epstein-Barr Syndrome." However, further investigation disclosed that evidence of past or current Epstein-Barr infection is no more common in individuals with CFS than in the general population. Nonetheless, this erroneous and misleading term still crops up in literature on CFS.
Other syndromes with a similar pattern of symptoms to CFS include fibromyalgia, multiple chemical sensitivities, and food allergies; some consider these conditions to be closely related to each other, but there is no real evidence to support this hypothesis.
There is no dramatically effective treatment for CFS. Antidepressants (such as Prozac and Zoloft) may improve energy and mood; older antidepressants (such as amitriptyline) may improve sleep; antihistamines and decongestants can help allergic symptoms that frequently occur in CFS; and nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen) may help pain. Careful attention to lifestyle issues, such as exercise level and use of caffeine, may also offer benefit.
Other approaches to CFS that have been tried include magnesium injections,1,2,3 corticosteroid treatment,4–9 and the antidepressant fluoxetine combined with graded exercise.10–13
For a time, researchers expressed some excitement over initial findings that deliberately raising blood pressure might help individuals with CFS. However, a double-blind placebo-controlled study of 25 people given a 6-week course of fludrocortisone and increased dietary sodium to raise blood pressure found no improvement in CFS symptoms.14
Proposed Treatments for Chronic Fatigue Syndrome
There are some promising natural treatments for CFS, but the scientific evidence for them is not yet strong.
EssentialFatty Acids
In a double-blind placebo-controlled study, 63 people were given either a combination of essential fatty acids, containing evening primrose oil (a source of GLA) and fish oil, or liquid paraffin placebo over a 3-month period.15 At 1 and 3 months, participants in the treatment group reported significant improvement in CFS symptoms as compared to the placebo group. The researchers also found that at the beginning of the study many participants had abnormal essential fatty acid levels, and these improved with treatment.
However, in 1999, researchers tried to replicate this study with 50 other people, using more precise means of measuring CFS symptoms.16 The results showed no difference between individuals given essential fatty acids and those given placebo (sunflower oil). These researchers also found no difference in fatty acid levels between individuals with CFS and individuals without CFS who served as controls.
NADH (Nicotinamide Adenine Dinucleotide)
NADH is a naturally occurring chemical that plays a significant role in cellular energy production. NADH supplements have been tried in hopes they might improve energy levels in athletes and in individuals with chronic fatigue.
A double-blind placebo-controlled crossover trialthat followed 26 people given 10 mg of NADH for a 4-week period showed some improvement in symptoms during NADH treatment as compared to the period of placebo treatment (31% versus 8%).17 However, larger studies will have to be performed to actually prove a benefit with this supplement.
Carnitine
Carnitine is a substance the body uses to convert fatty acids to energy. Early studies reported decreased carnitine levels in people with CFS.18 Based on these, an unblinded crossover trial (8 weeks with each treatment, and a 2-week "washout" period in between) enrolled 30 individuals with CFS to evaluate the potential benefits of carnitine supplements.19 The results suggest potential benefit with this supplement.
However, this study was severely flawed. One problem was that, rather than using a placebo group for comparison purposes, researchers chose to investigate the antiviral drug amantadine. This drug has no proven efficacy in CFS, and it caused so many side effects that more than half of the participants dropped out during the period they were taking amantadine. This high dropout rate makes statistical interpretation of the results unreliable. In addition, the lack of blinding in the study also impairs the trustworthiness of the results.
Other Herbs and Supplements
A test tube study of echinacea and ginseng found that both increased cellular immune function in cells taken from people with CFS.20 However, many herbs and supplements can cause measurable changes in immune function, and such observations do not prove that there will be an actual benefit in people with the disease.
Both beta-carotene and DHEA have also been suggested as treatments for CFS, but the evidence that they work is highly preliminary.21,22,23
Based on the theory mentioned above that CFS might be related to low blood pressure, the herb licorice has been recommended for CFS by some herbalists. Licorice raises blood pressure (and causes other potentially harmful effects) when taken in high doses for a long time. However, there is no evidence that it works for CFS, and other treatments to raise blood pressure have proven ineffective for CFS.24
Although some authorities have suggested that CFS might be caused by deficiencies of multiple vitamins and minerals, a double-blind placebo-controlled study of 42 people found no significant improvement in CFS symptoms when a vitamin-mineral supplement was given 4 times daily after meals for 3 months.25
View References
Last reviewed March 2002 by Medical Review Board
Back to Top
