Original post for Naturopath & the City HERE
Anyone who experiences Chronic Fatigue Syndrome (CFS), now known as Myalgic Encephalomyelitis (ME), understands that this condition is so much more than fatigue. For years, this population of people have been excluded, ridiculed as hypochondriacs and denied the medical and financial assistance they need. What’s more, many ME sufferers have had to fight for their own healthcare needs, at times having other medical conditions undiagnosed and left feeling frustrated and hopeless.
With the new integrative medical paradigm (Medical Doctors and Naturopathic Doctors working together), this doesn’t have to be the case!
ME affects approximately 500,000 people in Canada, this number increasing as the diagnosis is becoming more accepted and understood. In the USA, this number is believed to be upwards of 2.5 million people, a very large number given the small amount of research, awareness and social fundraising campaigns.
So how do you know if you have chronic fatigue syndrome (aka myalgic encephalomyelitis)?
ME is characterized as serious, pathological and debilitating fatigue that has been ongoing at least 6 months. It is not the result of ongoing exertion, not alleviated by rest and it reduces quality of life and functional capacity. ME also includes many of the common symptoms:
- Impairment of short and long term memory or concentration (aka brain fog)
- Sore throat
- Headaches of new type, pattern or severity
- Extreme joint and muscle pain, without redness or swelling
- Painful lymph nodes
- Post exertional malaise greater than 24hrs
- Unrefreshing sleep and sleep issues (trouble falling asleep or staying asleep)
The onset of ME is often sudden onset, many times in people who were very high functioning, even type A personalities. The onset can take many forms, but in a large number of patients will follow an acute infection or trauma (physical or emotional).
(For more information for doctors and family see this ME Primer. )
Current treatment guidelines
There are no current pharmaceutical recommendations for ME. Despite this, it is quite common for patients with ME to be offered antidepressants, stimulants (such as modafinil or methylphenidate) and sleep aids (examples include clonazepam, temazepam, lorazepam, zopiclone etc)
Naturopathic approaches
As ME is a chronic systemic illness that affects the entirety of ones life, Naturopathic Doctors will ask questions about different areas of your health, looking for common ailments that could be contributing to your fatigue.
Some of the most common issues making ME worse include:
- Digestive system issues. Bloating, flatulence, stomach pain, constipation and diarrhea can be signs that your digestive system isn’t working well. It could be due to having an imbalance of bad bacteria (called dysbiosis), low stomach acid, food sensitivities, ‘leaky gut’, allergies, medication side effects etc.
- Nutrient deficiencies. This often goes hand-in-hand with digestive issues as you can’t break down food properly, or absorb it. Often times with ME eating a well balanced diet is also a challenge because food prep is energy consuming! Iron (ferritin), B12 and Vitamin D are very common deficiencies that can be tested for.
- Immune system issues and chronic infections. Infections can linger! Often times without us even knowing it. This is especially true of mono (EBV) aka the ‘kissing disease’ virus. When our immune systems are constantly running and active it is like leaving the proverbial energy tap on, it can drain us.
- Hormone imbalances. Stress, menstrual cycle changes, weight changes, anxiety, depression, acne- these can all be a sign of hormone imbalances. Other hormone imbalances include blood sugar dysregulation (Do you get angry when you go without food for a few hours? Feel light headed, shaky?) and thyroid issues. These can all cause ‘silent stress’ and significant fatigue.
- Another hormone that is critical to chronic fatigue is cortisol. Cortisol gets a bad rap because it is our ‘stress hormone’, produced when we are running from bears, in a fight with our friends or have any number of the issues listed above. Cortisol should be highest in the morning and decrease throughout the day to allow someone to sleep at night. This higher morning cortisol is actually what wakes us up in the morning, and helps us to have energy and mental clarity throughout the day. Studies have shown that people with ME often have a very low morning cortisol level, and sometimes high nighttime cortisol. Therefore you can’t wake up, or fall asleep at night!
- Energy production issues. In each of our cells we have an energy powerhouse, providing us with everything we need to function in our day to day lives, these little gems are known as the mitochondria. In order to make energy from our food in the mitochondria MANY steps have to occur. At each of these steps there can be a block, essentially a locked door, therefore slowing down how much energy we can make and use. Often times in ME there are many doors closed, or blocks in the road.
- System overload! Exposure to chemicals, fragrances, molds and other toxins requires the energy intensive process of filtering and eliminating them from your system. Genetically, some people are better at this than others. If you happen to have a sluggish processing system toxins can build up and things work on over drive, causing more fatigue, brain fog and systemic issues.
So now what to do about it?
Heal your gut!
70-80% of our immune systems reside in our gut! The health of your gut, therefore, has a huge impact on inflammation, energy production, digestion and nutrient absorption! Some simple ways to address gut health can be to eliminate food triggers and add in healing foods.
Elimination diets are the gold standard for finding food sensitivities that could be aggravating your digestive system, immune system, fatigue and causing a whole host of other problems. More information can be found here.
Bone broth is one of my favorite healing foods! Bone broth is chocked full of nutrients, minerals, gelatin and collagen. When added to your daily routine bone broth can help correct deficiencies and heal your gut. Here is a great recipe.
Fermented foods are a great way to help add more good “bugs” into your diet. Fermented foods include kimchi, kefir, kombucha, homemade yogurt and live sauerkraut. For many people adding a small portion of fermented foods each day can be helpful in the long term. On the other hand though, some patients with ME actually have an overgrowth of bacteria in their intestines. These people will feel worse with fermented foods and probiotics and should not take them until there bacteria have been balanced under the care of a healthcare practitioner.
Eat regularly! It is very important to fuel yourself well, and often. Changes in our blood sugar can add to fatigue and brain fog, making them worse. It is critically important to add protein rich foods and snacks between meals when hungry!
Lifestyle: Pacing + Patience = Progress.
Pace yourself – may be one of the most annoying phrases in the human language. If todays culture ‘allowed’, valued and accepted us pacing ourselves the world would be far less sick in my opinion! None the less, it is important to see where your energy is going, and make sure that it is not being overused unnecessarily. Activity pacing assessments are often done in an NDs office and help to bring awareness to all of the things we do in a day and help to optimize time, rest periods and sleeping hours.
Sleep. The most healing hours of sleep we get occur between 11pm and 6am. Many NDs will only count hours of sleep during this window. Example: If you sleep from 3am to 12pm, we would say you are getting 3hrs of sleep! Now sleep is not something that comes easily to many patients, in fact sleep aids are quite common. Winding down before bed is critical, not staring at a TV screen, not being in bright lights, all of these things help our sleep hormone, melatonin to increase. In some patients melatonin supplementation can be quite helpful as well (it should be used under the care of a doctor if you are on medications). Magnesium at night can also be calming for many people. Whether that is from an Epsom salt bath or a magnesium supplement is up to you. Note that it is important to consider the type of magnesium and dosage when taking a supplement as some forms of magnesium are not as readily available to your body than others – consult a licensed naturopathic doctor to figure out which type of magnesium is right for you.
Stress less (and get herbal support). Stress, whether mental emotional, or physical, takes a HUGE toll on our bodies, minds, energy levels and relationships. Stress is something that is hard to avoid, and even revered to some extent in the western cultures. The goal is to cope with it. Cognitive Behavioural Therapy (CBT) has been shown to help ME patients in a number of research studies. So has attending support groups. Talking it out and creating a community are critical components to living well with chronic disease and should be strongly considered!
Herbal formulas and supplements can also be helpful in this, as they help in adapting to our stress response. These ‘adaptogens’ as they are called, include some of my favourite herbs such as: withania, lavender, passionflower, astragalus, eleutherococcus and rhodiola. Be cautious as these little plants can be powerful and interact with other supplements or medications, so be sure to ask a trusted naturopathic doctor or medical professional for advice if you are currently taking any.
Targeted supplementation
There are TONS of energy support supplements on the market. It is a huge industry that makes a lot of money. Many of these supplements are formulated well, but many others are not. In ME it is highly recommended to avoid supplements with stimulating herbs, such as panax ginseng, caffeine, coca, and also to avoid supplements with licorice. Licorice root can be a very powerful tool to a naturopathic doctor, but it should not be used in ME without a health care practitioner’s advice.
Do you remember the little energy powerhouse we spoke about earlier? The mitochondria? Well some of the components of the energy production chain are also available for supplementation. Things like L-carnitine (which carries fat into the cell to be used as energy) and CoQ10 (which shuttles energy to the production house), are some of the popular ones. If you have been told you have a mitochondrial issue, then these supplements might be helpful.
Overall, there is so much HOPE for chronic fatigue & myalgia encephalomyelitis. It takes a comprehensive approach to healthcare, a healthcare team, along with patience and self love, but there is HOPE!
Be empowered, be inspired and be well.
Disclaimer: there is not one single approach to address ME, in fact, most patients need very individualized treatment plans to address their personal circumstances. The information in this article is intended to be helpful and informative. It is not intended to diagnose or treat, nor is it to replace the personalized approach required from a licensed naturopathic doctor or medical professional.
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