We are a nation of very tired people – likely attributable (at least in part) to our stressful lives, poor diets, and sedentary lifestyle. Seems everyone is tired and many suffer from overwhelming fatigue that interferes and interrupts their life in destructive ways.

The CDC defines Chronic Fatigue Syndrome (CFS) by these criteria:

1.   Have severe chronic fatigue for at least six months or longer with other known medical conditions (whose manifestation includes fatigue) excluded by clinical diagnosis; and  

2.   Concurrently have four or more of the following symptoms:

  •         post-exertional malaise
  •         impaired memory or concentration
  •         unrefreshing sleep
  •         muscle pain
  •         multi-joint pain without redness or swelling
  •         tender cervical or axillary lymph nodes
  •         sore throat
  •         headache 

The symptoms must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue.

CFS has a number of etiologies and it can be difficult to determine the exact cause. Infectious causes range from viruses, to Candida, Mycoplasma, and spirochetes. No clear culprit has been elucidated but all may play a role. Immune dysfunction is thought to play a role but no clear relationship has been established.

Cortisol and the adrenals play a big role in CFS. The role seems to be more a result of a hypothalamic pituitary axis (HPA) dysfunction/communication rather than a clear result of low cortisol. Because cortisol is essential to life and abnormal cortisol affects many other hormonal systems, it is essential to address the function of the HPA axis. Adrenal fatigue, or burnout, is actually quite common. This article explains and describes the symptoms nicely.

Nutritional deficiencies may be a contributing factor to CFS. A detailed review of the literature suggests a number of marginal nutritional deficiencies may have etiologic relevance. These include deficiencies of various B vitamins, vitamin C, magnesium, sodium, zinc, L-tryptophan, L-carnitine, coenzyme Q10, and essential fatty acids.

Whatever the etiology, CFS generally responds to balancing hormones, including thyroid, sex hormones, insulin and glucagon, and cortisol.  Following a whole foods, high protein diet, treating gut dysfunction, decreasing stress or adding coping strategies, and replacing missing nutrients along with supplements help to support optimal adrenal function. There is no single magic bullet and getting the fatigue to lift requires a commitment to a healthy lifestyle as well as utilizing traditional as well as alternative sources of healthcare.

Marsha Nunley MD
Marsha Nunley MD
I am an internist, trained and experienced in Western Medicine, who believes that illness and disease are best treated by working to discover their underlying causes. Come to me for bioidentical hormones, advice on healthy aging, and whole-body medicine.