Chronic Fatigue Syndrome

Chronic, persistent or relapsing debilitating fatigue or easily fatigued, that does not resolve with bed rest and that is severe enough to reduce or impair average daily activity below 50% of premorbid activity level. Associated symptoms: mild fever, sore throat, painful lymph nodes, muscle weakness, myalgia headaches, arthralgia, neuropsychological complaints, sleep disturbances.

International CFS Study Group Definition of Chronic Fatigue Syndrome

  1. Clinically evaluated, unexplained persistent or relapsing chronic fatigue that:

is of new or definite onset (has not been lifelong).

is not the result of ongoing exertion.

is not substantially alleviated by rest.

results in substantial reduction in previous levels of occupational, educational, social, or personal activities.

  1. The concurrent occurrence of four or more of the following symptoms, all of which must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue:

self-reported impairment in short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social, or personal activities sore throat tender cervical or axillary lymph nodes muscle pain multi-joint pain without joint swelling or redness headaches of a new type, pattern, or severity unrefreshing sleep post-exertional malaise lasting more than 24 hours.

Suspected Etiologies for Chronic Fatigue Syndrome: Viral infections and the post-viral fatigue syndrome, Fibromyalgia, Neurally-mediated hypotension, psychogenic biological dysfunction, low natural killer cell syndrome.

Factors Suspected of Promoting Chronic Fatigue Syndrome: Hypoxemia, endocrine dysfunction, immune dysfunction, stress-related dysfunction, somatoform disorder, marginal nutritional deficiencies, intestinal hyperpermeability. overgrowth of pathogenic intestinal flora (dysbiosis), food and chemical sensitivities, chemical toxicity, heavy metal toxicity.


Fatigue: The degree may be mild, being able to perform at work or home but easily fatigued from it; or it may be intense, causing patients to give up their jobs and greatly curtailing other activities. Sometimes they may be bedridden, and slight activities such as housecleaning or going for a walk may necessitate a recovery period of 2-3 days. Usually more strenuous exertion and exercising are impossible. Frequently, though, patients have alternating periods of fatigue and normalcy. The disease usually begins gradually, with the fatigue slowly growing until it becomes overwhelming.

Lab Findings

While laboratory diagnosis of this condition used to be prohibitively expensive and inadequate, some labs now provide reasonably priced comprehensive panels showing titers of different causative agents, usually Epstein-Barr virus, Cytomegalovirus, toxoplasmosis, Candida. Subtyping of antigens allows accurate diagnosis of present, chronic, active or inactive infections, but severity of symptoms do not always correlate with the lab findings. Some patients with extremely high titers for a particular agent may be symptom-free while others with low titers may be extremely symptomatic. Many see decreased WBC count, increased lymphs or atypical lymphs on peripheral smear.

Naturopathic Approach

A naturopathic approach to treating someone with chronic fatigue, starts with asking the right questions to put together the puzzle of what may be the underlying cause(s) of their chronic fatigue. Multiple lab tests are ordered to find objective data as to the underlying cause(s) and together with the subjective findings an individualized clinical nutrition plan is put together along with the implementation of lifestyle changes to bring health and energy back into the body.