New Understanding of Chronic Fatigue Can Pave Way to Better Treatment
Imagine feeling dead-tired—drained of every drop of energy. On top of this, you feel as if you’ve come down with an infection. Your throat is sore, your body aches, and your memory and ability to concentrate are shot.
For the 1 million to 2.5 million Americans who suffer with chronic fatigue syndrome, this is daily life. People with this condition find exercise nearly impossible, even a minor stress can be devastating, and they may sleep for more than 12 hours a night yet still never overcome the overwhelming sense of exhaustion.
Chronic fatigue syndrome is a complex condition that has gained a number of names over the years—Epstein-Barr syndrome, chronic mononucleosis syndrome, and myalgic encephalopathy, just to name a few. In the 1980s, it was dubbed “yuppie flu” because it seemed to favor type A professionals who worked too hard for too long and burned themselves out.
The problem with most names for this condition is that they often don’t include everybody who suffers with it. The latest term—systemic exertion intolerance disease (SEID)—strives to be more accurate and inclusive.
A committee convened by the Institute of Medicine (IOM) unveiled the new name in a report last year along with a new set of diagnostic criteria to identify the disease.
According to the report, the new name “captures a central characteristic of the disease: the fact that exertion of any sort—physical, cognitive, or emotional—can adversely affect patients in many organ systems and in many aspects of their lives.”
Up until the last few years, many doctors doubted the disorder existed at all, suggesting that the feeling of unshakable fatigue people experienced was merely just in the minds of the sufferers.
In the not-so-distant past, chronic fatigue was considered to be a psychosomatic syndrome more worthy of ridicule than serious investigation. In 1999, the Centers for Disease Control disclosed it had taken funds allocated to study chronic fatigue syndrome and moved the money to other projects deemed more worthwhile.
But times are changing. Recent research has concluded that chronic fatigue syndrome does indeed have a physical cause, and most medical professionals now acknowledge that the condition is real.
However, a stigma remains. The IOM report finds that fewer than one-third of medical school curricula discuss the disorder, while many health professionals remain skeptical about the seriousness of the condition. The report states that some doctors still “mistake it for a mental health condition, or consider it a figment of the patient’s imagination.”
Because of the confusion, many doctors are still hesitant to identify chronic fatigue. Even when they do, conventional treatment options are limited. Recovery is slow, and setbacks are common.
Epoch Times talked to naturopath Dr. Chad Larson to understand what causes chronic fatigue, why it’s so difficult to diagnose, and how to treat it holistically.
Dr. Chad Larson is a naturopath, chiropractor, nutritionist, and strength-and-conditioning specialist practicing in California. He is also a clinical consultant to Cyrex Laboratories, a clinical immunology laboratory specializing in functional immunology and autoimmunity.
Epoch Times: What is it like to have chronic fatigue?
Dr. Chad Larson: People with this condition can exert themselves in ways that may seem trivial to healthy individuals, but they get incapacitating fatigue. This is fatigue to the level where they’re not just tired and unmotivated, but they can’t move. They’re stuck on the couch or bed. It’s very debilitating.
Oftentimes flu-like symptoms such as sore throat, tender lymph nodes, and a chronic low-grade headache accompany the condition. It’s a multi-systemic condition, meaning that it could affect the brain and neurotransmitters, the adrenal hormones, the immune system, and the gastro-intestinal system. Another common symptom is chronic low- grade muscle and joint pain.
Fatigue is the common thread, but there can be a variety of symptoms that manifest from person to person.
Epoch Times: I’ve read that because the condition is so complicated, some doctors are reluctant to identify it. What makes it so difficult to diagnose?
Dr. Larson: It can vary dramatically from person to person. Some have high titers [a measure of amount of antibodies in the blood] for Epstein Barr virus (EBV), also known as mono. Some people say, “I felt this way ever since I got mono.” Yet some don’t have EBV at all.
There was research earlier on where they looked at a bunch of different viruses in connection to chronic fatigue: EBV, cytomegalovirus, human herpes virus type 6 (HHV6), and Lyme disease. But some have a virus, and some don’t.
The problem with chronic fatigue is that it’s not as black-and-white as we would like to see it clinically. We want to see a cause and effect relationship, but this doesn’t seem to fit with chronic fatigue.
There is no perfect lab test for it. There’s not even a perfect set of clinical criteria to diagnose it. I think sometimes it ends up as a diagnosis of exclusion. You look at the set criteria, you rule out a bunch of other stuff, and then there’s chronic fatigue syndrome.
Epoch Times: Cornell University just released a study suggesting that they now have the tools to identify chronic fatigue from gut bacteria. How does our emerging knowledge of the microbiome help us understand this disease?
Dr. Larson: There are a few developments that we’re watching that I think will add to this story quite a bit. One is definitely the human microbiome. The other is the effect on the brain, and its involvement in chronic fatigue.
There are a lot of great studies being done right now because we’ve learned a lot about how the human microbiome influences everything in the body. If you count the cells in our body, we’re a heck of a lot more bacteria than we are human cells.
If you count genes, we’re a heck of a lot more bacteria than human genes. Anyway you measure it, we’re more bacteria than human. Laboratory science has evolved to the point where we can appreciate these affects.
There’s an estimated 5 to 10 pounds of bacteria just in our gut. At any given time, this bacteria can be in a healthy or unhealthy balance.
Some of the bacteria that tips the bacteria into the unhealthy range is the gram negative bacteria. These produce an endotoxin called lipopolysaccharides (LPS). This has been well-documented to break down the integrity of the gut barrier. This barrier system separates our internal environment from the external environment.
We need a barrier system so the outside world can’t get into our internal organs and, most importantly, our circulation. This barrier system helps differentiate friend from foe.
But in some cases, LPS builds up and breaks down the integrity of the gut barrier. When LPS gets into the circulation, it is a major inducer of inflammation and immune activation. When LPS gets into circulation, it has also been well-documented that it goes up through the blood-brain barrier, breaks down that barrier system, and also induces inflammation and immune activation in the brain.
This is one connection between all the symptoms we’ve been talking about with chronic fatigue and the gut microbiome. Another connection just starting to emerge in the research shows that some of these bacterial components are also getting into the brain through the vagus nerve. The vagus nerve is one of our 12 cranial nerves. It’s a direct extension of the brain to the gut.
Epoch Times: When doctors talk about fatigue, they often refer to the adrenal glands. How do the adrenals fit into the chronic fatigue equation?
Dr. Larson: The adrenal glands respond to different types of stress: mental or emotional stress (when people say, “I feel stressed out”) and biochemical stress (food allergies and sensitivities, and blood sugar imbalances). There’s also physical stress (unresolved injuries, chronic headache, or neck pain).
These could all trigger an adrenal response, which typically generates a release of cortisol, which is like a natural anti-inflammatory. When cortisol goes up, our pain usually goes down. It also helps with blood sugar balance.
But when adrenals respond to a chronic stress situation, cortisol can go too high. This can affect the hippocampus, which can lead to mental and emotional issues.
If the adrenals get overworked, cortisol levels can drop. If it’s too high or too low, it can affect the overall functioning of the system with regards to inflammation and blood sugar balance.
That’s in the adrenal cortex, the outside of the adrenal gland. The inside of the gland is called the adrenal medulla. This produces adrenaline. If too much adrenaline is produced, that can send a person into anxiety or alternating anxiety and depression.
For a variety of factors, what happens in the adrenal gland can definitely lead to sleep disturbances, which is often a symptom of chronic fatigue.
Epoch Times: Talk about treatment. What is the conventional treatment for chronic fatigue, and what do you recommend?
Dr. Larson: It depends on the chief symptoms the patient has. Oftentimes, depression is a key thing that threads throughout people with chronic fatigue, so they’re often treated with antidepressants.
In some cases, these can be very helpful, but I always want to dig to the next level down and figure out a way to influence their system so that their neurotransmitters are balanced, and they don’t have depression. If we just treat the symptoms of chronic fatigue, it may not get to the underlying cause of what the condition is manifesting.
My treatments are based on what the key symptoms are for a particular patient. I’m not a conventional medical doctor. I’m licensed to prescribe medication, but I’d rather not. But for providers who are more pharmaceutical-based, antidepressants are probably their main treatment.
I see multiple things to consider. People with chronic fatigue often have things like food sensitivities, leaky gut, bacterial infections, and imbalanced gut bacteria. For me, gut health is really the centerpiece for treating it, and this can vary quite a bit from person to person.
Especially in my kind of medicine, we don’t treat the condition, we treat the human. And that’s where there is going to be a lot of individuality.
First, we have to see if they’re anemic. If someone has low iron, B12, or folic acid, the number one symptom is going to be fatigue. And fixing it can be as easy as giving somebody iron or B12. Anemia really means that oxygen is not getting to the brain. If oxygen can’t get to the brain, they’re going to be fatigued.
There are other lifestyle factors that need to be considered like caffeine and alcohol. We want to dramatically reduce or eliminate these because they can influence a person’s energy.
We also have to practice good sleep habits. When someone has fatigue as one of their list of concerns in the initial consultation, the first question always has to be poor sleep. If they have poor sleep, of course they’re going to be fatigued during the day.
Do they have hypothyroidism? Then we have to work on that. Do they have hypoglycemia (low blood sugar)? This leads back to the adrenal glands. When a person has been under chronic stress and cortisol is low because of adrenal insufficiency, having low blood sugar is going to cause fatigue in anybody.
These are the things we have to look at right away because we can often fix the problems with pretty basic medicine.
We also have to get them moving. Difficult as it is for a person with chronic fatigue, a sedentary lifestyle is just going to seed this deeper and deeper. So we have to get them moving.
It might just be a short 15–20 minute walk daily. But as we work on these other factors—thyroid, adrenals, glucose, anemia, diet, sleep—once all that stuff is improving, then we can help to increase their exercise even more.
There is a lot of information that shows that HIIT (high-intensity interval training) is very good to help people with chronic fatigue. HIIT increases a person’s mitochondria. The mitochondria are really at the root of chronic fatigue in my mind. The mitochondria are the little engines in all the cells.
We now understand a lot more about how to keep a person’s mitochondria healthy and more importantly, how to increase the number of mitochondria in our cells.
Each cell in the human body has hundreds of mitochondria. A person with chronic fatigue may have fewer mitochondria per cell. It might take months to get people to the point where they can do high-intensity exercise, but HIIT has been shown to significantly increase the number of mitochondria per cell.
Now we’re getting down to the nitty gritty. This is the fundamental, underlying reason for their fatigue. This goes well beyond giving them an antidepressant. We’re trying to build up their cellular structures.
From a dietary standpoint, we have to get things like sugary foods, sodas, and energy drinks out because of their effect on the adrenals.
Hydration is very important too. Just a minimal amount of dehydration could cause fatigue and muscle achiness, which are some of the symptoms people with this condition suffer from. Most people don’t drink enough water. They think they do, but they don’t.
We have to make sure they have a healthy diet. Protein should be the centerpiece of an anti-fatigue diet. It doesn’t have to be animal protein, but protein is kind of the opposite of what sugary foods do.
Sugar causes blood sugar and insulin to spike and then to plummet, and that will cause fatigue. Protein is like drip-feeding for blood sugar. It creates a nice, sustained energy.
I always check people with chronic fatigue for food sensitivities, and oftentimes we find gluten or dairy is causing a problem, so we have to get those out. We also make sure they eat more vegetables.
Non-negotiables like high fructose corn syrup and partially hydrogenated trans-fats—these things need to get out of their diet completely.
A lot of this is just back to basics. Sometimes it’s the basics that people are missing.
Epoch Times: We’re all prone to these basic aspects of health. So what makes someone more susceptible to chronic fatigue?
Dr. Larson: The reason why one person might get chronic fatigue syndrome, and another person might not goes back to the microbiome. Our microbiomes vary greatly from one another. Where our genetics are 99.9 percent the same, our microbiomes are very, very different.
Now that we know how much our microbiome influences our 1/100th of a difference in our genetics, it explains why a person might get chronic fatigue syndrome, and another person might not, even when they’re in the same family.
This is where a lot of the research is going. People may have very similar genes, but it could be the microbiome that is the main differentiating factor between the two.
Epoch Times: Talk about obstacles to recovery. I’ve read that oftentimes when people make progress with their condition, they can have a dramatic setback, and climbing back up again can be really frustrating.
Dr. Larson: It is difficult to stick to a protocol like this. In my opinion, the complexity of the condition needs to be matched by the complexity of the treatment protocol. This is a complex condition that needs a complex and comprehensive treatment.
Frankly, it’s difficult for a lot of people to stick to. We can create the perfect treatment plan, but if it’s not followed, then we’re only going to see a certain percentage of improvement.
It can be somewhat socially isolating to have all these food eliminations, so people slip up on this. They might choose to have pizza and cake at a party, and it could set them back for months because it creates such an inflammatory response in their system.
That will create a cascade of immune activation and inflammatory chemicals that will carry on for weeks and weeks. That’s unfortunate that it happens, but it does.
A lot of this is lifestyle. Stress is such a big factor in chronic fatigue that people who have this adrenal component to it have to alter their lifestyle so they’re not as exposed to stress.
Of course stress is an individual thing—it’s the interpretation of stress that I’m talking about. It might get to a point where a person has a very, very low threshold of stress.
We might try to raise that threshold, so the stressors don’t have as much effect on the person, but for a while, that threshold can be pretty low, and it takes minor triggers for their body to flip over that threshold. All of a sudden, they’re in full stress response.
So certain aspects of their life just have to go away for them to totally heal. If we can’t get these things to go away, we’re not going to be able to get ahead of it.
Epoch Times: It sounds like a person in chronic fatigue recovery needs to see the long game. Even if the protocol is isolating and involved at first, it takes persistence to get over the hump.
Dr. Larson: Absolutely. It’s a marathon, not a sprint.