Chronic Fatigue Syndrome


Chronic Fatigue Syndrome CFS Introduction

:fatigue.gif All of us are familiar with being tired after a period of over exertion, or perhaps a bout of the flu. But for some, the tiredness is not alleviated and becomes a condition that begins to affect activities of daily living. Many don’t understand that their lack of energy is not optimal, and many times, consider their energy-output normal. The majority of individuals often disregard the symptoms of chronic fatigue, attributing indicators to over working and lack of sleep. While these are many times valid explanations, fatigue that persists must be investigated.

Fatigue can affect all people. Regardless of age, gender, or socioeconomic class, there are a multitude of reasons why someone may experience low energy over prolonged periods of time.

It may be caused by endocrine disturbances, such as hypothyroidism, premenstrual syndrome, or Addison’s disease; Attributed to sleep disturbances, such as sleep apnea or insomnia; Emotional imbalances, like depression; Conditions with immune involvement, such as a viral illness; Blood loss or inadequate blood cell production stemming from anemia: Or perhaps, the fatigue may be caused by something more obvious, like periods of high stress or inadequate nutritional intake.

Whatever the reasoning, chronic fatigue is paralleled with many chronic diseases, including certain forms of cancer. While most fatigue is due to an unhealthy lifestyle choice, the fact remains that this condition may be associated with a more serious underlying condition. If a clear reason cannot be determined and treated, a more thorough evaluation must be completed by specialized tests and procedures.

Chronic Fatigue Symptoms

Because chronic fatigue may be due to other reasons besides lifestyle choices or an underlying medical condition, those suffering from this condition will likely have other signs and symptoms. It is very important to seek medical attention if symptoms of fatigue do not resolve after being addressed, or if the cause remains unclear.

Common signs and symptoms:

  • Depression
  • Apathy
  • Falling asleep during the day at inappropriate times (work, driving, etc.)
  • Weakness
  • Tiredness
  • Chronic pain

Fatigue Statistics

Truly accurate statistics regarding fatigue are difficult to come by, as nearly every person from their early teens through the oldest ages experience fatigue in varying degrees. As mentioned earlier, fatigue is more often a symptom of an underlying disorder and is therefore difficult to classify.

  • About 422 per 100,000 persons in the United States suffer from chronic fatigue syndrome, an extreme form of fatigue. This translates into about 800,000 people nationwide. [1]
  • CFS is three times more common in women than men and does not discern between people; regardless of gender, race, age, or socioeconomic background.
  • Most of the reported cases are Caucasian, and the average age of onset is 30 years. [2]
  • 90% of those with CFS have not been diagnosed and thus are not receiving proper care for their condition. [3]

Fatigue Treatment

Once the underlying cause of chronic fatigue has been identified, treatment is focused on addressing the cause of attributable symptoms, and by improving one’s quality of life. Depending on the manifestation of low energy and the underlying cause, medications such as NSAIDs for pain management, anti-depressants and anti-anxiety medications for mood stabilization, stimulants for excessive daytime sleepiness, and antibiotics for diagnosed infections could be helpful in managing these more centralized symptoms. Physical activity and psychological counseling may also be employed to help those suffering from fatigue.

Supplements helpful for Fatigue

Iron For some women, a heavy menstrual period or irregular menstrual bleeding can lead to an iron deficiency anemia, which in turn manifests as low energy. In addition, there are other reasons that a person may have decreased iron stores. For example, bleeding due to trauma, inadequate intake of iron, and poor absorption can all lead to iron deficiency. Even athletes can become deficient in iron due to unique physiological processes. Because one of iron’s functions is to transport oxygen, a decrease in the delivery of oxygen to tissues may resemble fatigue. In a study examining the relationship between iron and energetic efficiency, it was concluded that deficiency can cause a decrease in aerobic capacity and energetic efficiency. The dietary supplementation of iron can help to rectify this problem. [4]

Magnesium Magnesium is the most prevalent positive mineral in the body and maintains several important uses. It is involved in over 300 enzymatic reactions in the body, including the formation of cyclic AMP, which is an intermediate in the production of cellular energy. [5] The brain, heart, liver and kidneys have the highest percentages of magnesium of all organs, and provide support for the vital role of magnesium-based energy production for various metabolic processes.

Any deficiency in magnesium can manifest as fatigue; those who maintain a high stress lifestyle are one of the groups at most risk.

Some people with fatigue have low red blood cell magnesium levels, and supplementation has shown to alleviate some symptoms. In one study, thirty-two chronic fatigue syndrome patients received an intramuscular injection of magnesium sulfate or placebo over a period of six weeks. The results showed that 12 of the 15 people who received the magnesium injection reported a significant improvement in energy levels, improved emotional state, and a decrease in pain. [6]

Vitamin C Vitamin C is involved with the production of many hormones such as dopamine, noradrenaline, and adrenaline in the nervous system. Additionally, the adrenal glands are some of the biggest energy producers in our bodies. In times of stress, the adrenals respond by producing large amounts of stress hormones. The adrenal gland contains 100 times the amount of vitamin C found in the body’s normal circulatory processes, hinting at its importance in the body’s response to stress. Vitamin C is also necessary for cellular energy production and is one of the most important antioxidants in the body.

Due to its critical role in the synthesis of adrenal hormones, supplementation with vitamin C is important in supporting adrenal function. [7] In addition, because vitamin C is important for optimal function of the immune system, it is helpful in combating a host of immune related symptoms and potential causative agents common to those with CFS and other energy-related problems. [8]

B Complex Like vitamin C, B vitamins support the adrenal gland and are important for immune function. B complex consists of 11 vitamin B factors. The whole complex functions together to perform important metabolic processes that regulate the body’s energy and consequent vitality. B vitamins are not stored in the body (they are water soluble), and are often depleted during times of stress. Fatigue and depression can be the result of such B vitamin depletion.

Some studies indicate that 70% of those with chronic fatigue demonstrated B12 deficiency, compared to about 40% of the normal population. [9] It would logically follow that individuals with fatigue would also suffer from abnormalities in B12 metabolism. Furthermore, people with fatigue have a significant response to B12 supplementation; reporting increased energy levels, improved stamina, and/or an enhanced sense of well-being.

B6, also known as pyridoxine, acts as an antioxidant and is necessary form the metabolism of amino acids, fats and carbohydrates, and is involved in about 60 enzyme systems in the body. Some research shows a connection between fatigue and low levels of B6. [10]

B5, or pantothenic acid, also contributes to energy production in the body. It participates in the production of adrenal hormones and red blood cells. Severe deficiencies of B5 can cause numbness, burning, and shooting pains in the feet, and fatigue. [11]

NADH Nicotinamide adenine dinucleotide, or NADH, is present in all living cells. It is a coenzyme made from vitamin B2, and serves an important role in enzymatic reactions. NADH stimulates the production of ATP (adenosine triphosphate), which is the energy currency of the body; and has a direct effect on energy production. [12]

A study involving 28 fatigue patients who were given NADH over a four-week period demonstrated that NADH could be helpful for those suffering from fatigue, as well as others with chronic fatigue due to other causes. [13] Furthermore, research suggests increased concentrations of NADH in the brain may boost brain chemicals vital to healthy mental functioning.

Glycyrrhiza glabra (Licorice) Licorice is an herb that has a variety of uses. It is well-known for its anti-viral properties, ability to soothe mucous membranes, anti-inflammatory constituents, and ability to provide a reduction in oxidative damage. [14] Included in its many uses is its ability to decrease the conversion of cortisol to cortisone within the body. [15] This means cortisol is ‘kept around’ longer leading to decreased fatigue. [16] Licorice is often used in combination with other herbs for this purpose, and has been applied in those with long term corticosteroid use to support the adrenal glands.

Eleutherococcus senticosus (Siberian Ginseng) Used and studied for many years, Siberian Ginseng has a long history in Siberia and China of increasing one’s quality of life, improving memory and appetite, and preventing infection. The medicinal effects of Siberian ginseng range from decreasing oxidative damage and stimulating the immune system, to acting as a tonic for the heart. Siberian ginseng is known as an adrenal adaptogen, meaning it reduces the extent of the body’s alarm response and can alter the way one’s body responds to stress. Adaptogenic herbs, such as ginseng, are useful in helping people in the exhaustive phase of a chronic stress response. [17] It has been shown to be equally effective in chronic infections, post-surgery care, and in those suffering from chronic pneumonia. It also is purported to assist in the improvement of energy, mood, and overall sense of well-being. [18]

Schisandra Chinensis Traditionally used in China, Schisandra is a Chinese climbing shrub, which is known as a “five-taste fruit;” acting on all organs in the Chinese medical perspective. The berries act as a tonic herb, and seem to work best in chronic conditions. Schisandra is said to strengthen the kidneys, lungs and adrenals. It is also thought tto help with anxiety, insomnia and forgetfulness caused by high levels of stress.

The effect of this herb on the central nervous system also lends itself to help those with chronic fatigue. It is stimulatory in nature and improves concentration and endurance. [19] Various studies show the increase of mental function and increased alertness, while maintaining a calm mood in those consuming the herb under times of high stress.

Rhodiola rosea Rhodiola is a plant native to arctic regions of Siberia, Scandinavia, Lapland and Alaska. Similar to Siberian ginseng, it is classified as an adaptogen, supporting the body in its resistance against certain physical, chemical, and environmental stressors. Given that it is used to increase energy, stamina, and mental capacity, recent research has investigated the efficacy of this plant as applied to modern day life stresses with interesting results. One study investigated the fatigue-fighting effects of Rhodiola on mental work capacity in a situation of background fatigue and stress (military cadets). [12] The study’s results demonstrated a significant decrease in both physical and mental fatigue in the cadets; being statistically superior when compared to the placebo group.

Another study examined students during an acute period of high stress. Over a period of several weeks, Rhodiola was given to the students as they engaged in school examinations.[20] The effect of Rhodiola’s ability to decrease stress was measured by observing mental fatigue, neuromotor tests, and physical fitness ability, before and after supplementation over a period of 20 days. Considerable improvements were observed in all categories. Currently, more studies are underway, further investigating the potential of this herb in combating mental fatigue.


[1] Online document at:

[2] Online document at:

[3] Online document at:

[4] Jere D. Haas and Thomas Brownlie, Iron Deficiency and Reduced Work Capacity: A Critical Review of the Research to Determine a Causal Relationship IV Journal of Nutrition. 2001;131:676S-690S

[5] Shils M, Olson A, Shike M. Modern Nutrition in Health and Disease. 8th ed. Philadelphia, PA: Lea and Febiger, 1994.

[6] I.M.Cox, M.J. Campbell and D. Dowson, “Red Blood Cell Magnesium and Chronic Fatigue Syndrome,” Lancet 337 (1991) 757-760

[7] Murray MM. Encyclopedia of Nutritional Supplements. Prima Publishing, Rocklin, CA. 1996, P 186

[8] McKevoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.

[9] Online document at: Online source:

[10] Heap LC, et al. Vitamin B status in patients with chronic fatigue syndrome. J R Soc Med. Apr1999;92(4):183-5.

[11] Fry PC, Fox HM, Tao HG. Metabolic response to a pantothenic acid deficient diet in humans. J Nutr Sci Vitaminol (Tokyo). 1976;22(4):339-46.

[12] Forsyth LM, Preuss HG, MacDowell AL, et al. Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann Allergy Asthma Immunol 1999;82:185-91

[13] ibid

[14] Online document at:

[15] Krahenbuhl S, Hasler F, Frey BM, et al. Kinetics and dynamics of orally administered 18 beta-glycyrrhetinic acid in humans. J Clin Endocrinol Metab 1994;78:581-5.

[16] Online document at:

[17] Wagner H, Norr H, and Winterhoff H Phytomedicine, 1, 1994: 63-76

[18] Hiai S, Yokoyama H, et al Endrocrinol Jpn, 26, 1979:661

[19] Upton R, ed. Schisandra Berry: Analytical, quality control, and therapeutic monograph. Santa Cruz, CA: American Herbal Pharmacopoeia 1999;1-25

[20] Spasov AA, Wikman GK, Mandrikov VB, Mironova IA, Neumoin VV.A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen. Phytomedicine. 2000 Apr;7(2):85-9.


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