Chronic Fatigue Syndrome
• Myalgic Encephalomyelitis, Post-viral Fatigue Syndrome
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 (CDC) 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
There is no dramatically effective treatment for CFS.
For a time, researchers expressed some excitement over initial findings that deliberately raising blood pressure might help individuals with CFS. However, a
Proposed Natural Treatments
There are some promising natural treatments for CFS, but the scientific evidence for them is not yet strong.
Essential Fatty 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
However, in 1999, researchers tried to replicate this study with 50 other people, using more precise means of measuring CFS symptoms.
Nicotinamide Adenine Dinucleotide (NADH)
Nicotinamide adenine dinucleotide (NADH) is a naturally occurring chemical that plays a significant role in cellular energy production.
A double-blind, placebo-controlled crossover trial that 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%).
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
Other Herbs and Supplements
A double-blind, placebo-controlled study available only in the form of a press release (at the time of this writing) reportedly found dark chocolate helpful for CFS.
A test tube study of
Based on the theory mentioned above that CFS might be related to low blood pressure, the herb
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
A fairly substantial (96-participant) double-blind, placebo-controlled study failed to find
A special bran extract marketed for enhancing immunity failed to prove more effective than placebo for CFS symptoms (although placebo was quite effective).
People with CFS may at times attribute their symptoms to chemical exposures, thereby relating chronic fatigue syndrome to another loosely defined condition known as multiple chemical sensitivities, or MCS. One study evaluated people with chronic fatigue syndrome who believed that certain chemical triggers affected their mental function, causing mental sluggishness and confusion.
10. Deale A, Chalder T, Wessely S. Commentary on: randomised, double-blind, placebo-controlled trial of fluoxetine and graded exercise for chronic fatigue syndrome. Br J Psychiatry . 1998;172:491-492.
11. Wearden AJ, Morriss RK, Mullis R, et al. Randomised, double-blind, placebo-controlled treatment trial of fluoxetine and graded exercise for chronic fatigue syndrome. Br J Psychiatry . 1998;172:485-490.
16. Warren G, McKendrick M, Peet M. The role of essential fatty acids in chronic fatigue syndrome. A case-controlled study of red-cell membrane essential fatty acids (EFA) and a placebo-controlled treatment study with high dose of EFA. Acta Neurol Scand . 1999;99:112-116.
20. See DM, Broumand N, Sahl L, et al. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency patients. Immunopharmacology . 1997;35:229-235.
26. Brouwers FM, Van Der Werf S, Bleijenberg G, et al. The effect of a polynutrient supplement on fatigue and physical activity of patients with chronic fatigue syndrome: a double-blind randomized controlled trial. QJM. 2002;95:677-683.
29. Williams G, Waterhouse J, Mugarza J, et al. Therapy of circadian rhythm disorders in chronic fatigue syndrome: no symptomatic improvement with melatonin or phototherapy. Eur J Clin Invest . 2002;32:831-837.
30. Smith S, Sullivan K. Examining the influence of biological and psychological factors on cognitive performance in chronic fatigue syndrome: a randomized, double-blind, placebo-controlled, crossover study. Int J Behav Med . 2003;10:162-173.
31. McDermott C, Richards SC, Thomas PW, et al. A placebo-controlled, double-blind, randomized controlled trial of a natural killer cell stimulant (BioBran MGN-3) in chronic fatigue syndrome. QJM. 2006 Jun 29 [Epub ahead of print].
33. Health Benefits of Chocolate Revealed. Hull and East Yorkshire Hospitals NHS Trust website. Available at: http://www.hey.nhs.uk/pdf/media/chocolate.pdf . Accessed December 21, 2006.
Last reviewed April 2009 by EBSCO CAM Review Board
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