weeks , or even months . 35 In some cases , people may need help with their basic day-to-day activities . 4 There is an overlap between chronic fatigue syndrome and burnout . 38-40
Figure 1 . Symptoms associated with chronic fatigue syndrome
2-7 , 33 , 35
Fatigue
Absentmindedness 3
Alcohol intolerance 3 Altered gut microbiome 5
Anxiety 3 , 4
“ Brain fog ” 33
Burnout 38-40 Cardiovascular problems 6 Chronic sinusitis 3
3-6 , 33 , 37
Cognitive dysfunction
Constipation 5
Depression 3 , 4
Diarrhoea 5 Difficulty concentrating 6 , 7 Difficulty with standing still 3
Exhaustion 3
Fibromyalgia 3 Gastrointestinal dysfunction 6 Hay fever 3
Headaches 3 , 4 , 6 , 7 Hypothalamic-pituitary-adrenal ( HPA ) axis dysregulation 34
Hypothyroidism 3 Inability to multi-task 3 Intestinal discomfort 5 Intestinal dysbiosis 5 , 33 Intolerance to light 5 Intolerance to noise 3 , 5 Intolerance to physical exertion 4 Intolerance to simple conversations 5 Intolerance to specific odours or chemicals 5 Intolerance to stimulation 5 Intolerance to temperature extremes 3 , 5 Irritable bowel syndrome 3 , 5 Issues with perception 5 Joint pain 4 , 6 , 7 Low cortisol 34 Memory issues 5 , 6
Migraines 3 Multiple chemical sensitivities 3 Muscle pain 4 , 6 , 7 , 33 Musculo-skeletal pain 7
Pain 3 Postural orthos-tatic tachycardia syndrome ( POTS ) 3 Seasonal affective disorder 3 Sleep disorders 3 , 4 Sleep disturbance 7 Sore throat 6
Stress 3 , 6 Temporoman-dibular joint disorder 3 Tender lymph nodes ( lymphadenopathy ) 6 , 7
3 , 6 , 32 , 33 , 41
Un-refreshing sleep
Chronic fatigue syndrome is associated with a broad spectrum of symptoms ( Figure 1 ). There is un-refreshing sleep . 3 , 6 , 32 , 33 , 41 People with chronic fatigue syndrome spend longer time in bed . 41 They have been found to have longer sleep onset latency , longer awake time after sleep onset , reduced sleep efficiency , decreased stage 2 sleep , more stage 3 , and longer rapid eye movement sleep latency . 41
The cause , or causes , of chronic fatigue syndrome are unclear . There is no diagnostic test , validated biomarker , or clear pathophysiology of chronic fatigue syndrome at this stage . 37 A typical onset pattern of chronic fatigue syndrome is a distinct change in health , signalled by an infectious event then followed by a gradual progression to becoming consistently unwell . 3 Various infections have been associated with chronic fatigue syndrome , such as Epstein Barr virus , 3 , 4 , 6 , 7 Cytomegalovirus , 3 , 4 , 6 Candida albicans , 4 Ross River virus , 6 Enterovirus , 4 , 6 Borrelia burgdorferi , 4 Human Herpesvirus , 4 , 6 Retrovirus , 4 Borna virus , 4 Coxsackie B virus , 4 hepatitis C virus , 4 mycoplasma , 6 and Lyme disease , 6 plus other unknown viruses . The disturbances in the immune system associated with chronic fatigue syndrome may be the result of viral infection . 6 Additionally , it may lead to the reactivation of latent viruses . 6 Once reactivated , viruses may contribute to the morbidity of chronic fatigue syndrome via inflammation and immune dysregulation . 6 It is noted that people with chronic fatigue syndrome have a higher susceptibility to infections , especially of the upper respiratory tract . 33 Chronic fatigue syndrome has been identified among recovered Coronavirus 2019 ( COVID-19 ) patients as the most common symptom of long COVID . 42 A systematic review and meta-analysis on chronic fatigue syndrome among long COVID patients found that post-COVID-19 chronic fatigue affects people ’ s lives , individually , socially , and spiritually . 42
The microbiome of the gastrointestinal system plays a role in the progression of chronic fatigue syndrome . 5 The intestinal barrier integrity is essential for the absorption of nutrients and health . 43 Dysfunction of the mucosal barrier of the intestinal tract is associated with increased gut permeability and the development of multiple gastrointestinal diseases . 43 Fatigue may result from dysfunction or imbalance in the oxygen supply to muscles and the brain . 36 Muscle and brain tissue are highly dependent on oxygen . 36 During anaemia , oxygen delivery is impaired ( due to reduced haemoglobin ), leading to reduced cognitive and physical performance , and perceived fatigue and tiredness . 36 People with chronic fatigue syndrome have been found to have lower total antioxidant capacity . 34 Oxidative stress and decreased antioxidant capacity are known to disrupt the hypothalamicpituitary-adrenal ( HPA ) axis . 34 Among the broad range of symptoms , many patients report disturbances in emotional health , the most frequent of which is anxiety . 44 Stress and trauma play a role in the progression of chronic fatigue syndrome . 6 A history of childhood trauma increases the later risk of developing chronic fatigue syndrome . 7 Family and twin studies have shown a genetic component to chronic fatigue syndrome . 37
Nutritional medicine management of chronic fatigue syndrome
Optimum nutrition is the foundation for optimum health . 8 , 9 There are many pieces to the puzzle of chronic fatigue syndrome . Therefore , the management of a person with chronic fatigue syndrome is holistic in nature . The focus is on treating the whole person ( mind , body , spirit ). 8 Identifying and treating the underlying causes , background activity , and triggers 8 are very important in the management of chronic fatigue syndrome . Here we introduce the potential of vitamins , minerals , amino acids , lactoferrin , probiotics , and water , via various mechanisms of action , in managing chronic fatigue syndrome .
126 | vol29 | no3 | JATMS