Myalgic encephalomyelitis (ME), also called chronic fatigue syndrome (CFS), is a disorder characterized by long-lasting and unexplained fatigue. It can severely affect an individual’s day-to-day function. The disorder is more common in women than men and is found in all age groups.
Causes of chronic fatigue syndrome are not well understood
The causes of ME/CFS are not yet well understood. The disorder affects multiple body systems and the symptoms often worsen after an individual exerts physical effort. ME/CFS has been associated with malfunction of the immune, endocrine, and autonomic nervous systems. However, the underlying mechanisms are not yet clear.
Symptoms of ME/CFS include fatigue lasting more than six months, pain, non-refreshing sleep, fever, and generally impaired function. Patients with ME/CFS may experience a general malaise or feel generally unwell. Some patients also suffer from orthostatic intolerance, which causes symptoms such as lightheadedness or changes in heart rate upon standing.
The prevalence of ME/CFS in the Western world is about 0.5%, although it is suspected that many patients have not yet been diagnosed. Current treatment options are aimed at alleviating some of the symptoms of ME/CFS.
Diagnosing chronic fatigue syndrome
There is no direct test for diagnosing ME/CFS, and it can be difficult to diagnose as the symptoms of ME/CFS may be explained by other health conditions. Many health conditions can cause fatigue, and other potential causes should be ruled out. As the cause of ME/CFS is unknown, the diagnosis involves a number of tests and observations.
Patients with ME/CFS usually have normal laboratory results, but these can be used to asses other causes of fatigue. An electrocardiograph (ECG) might be used to test heart function. Sleep studies (polysomnograms), exercise tests, and other body imaging tests may also be used.
Research is ongoing to develop better diagnostic tools for ME/CFS and a better understanding of how the condition works in the body.
There is currently no cure for ME/CFS. The current treatment options include both medication and lifestyle changes, which aim to manage the symptoms.
Below, we will discuss four natural ways to address chronic fatigue treatment.
Four natural treatment options for chronic fatigue syndrome
1. Healthy balanced diet
Patients with ME/CFS may experience nutritional deficiencies if they are unable to prepare balanced meals. Balanced meals include a variety of foods from the recommended basic food groups. Those with ME/CFS should focus on receiving sufficient protein, fruits, and vegetables. Because individuals may have limited energy for shopping and cooking, convenient and easy-to-prepare meals are preferred.
Multivitamins may also be helpful for individuals who are unable to maintain a balanced food intake. Those with orthostatic intolerance may benefit from adding salt to meals.
Nutritional requirements vary between patients depending on age, sex, and overall health. Patients should focus on maintaining a reasonable body weight. While diet-based therapies are a popular alternative treatment as they give the patient some feeling of control, there are no specific diet therapies that have any evidence for treating ME/CFS.
2. Improve sleep quality
Lack of sleep often makes the symptoms of ME/CFS worse and can contribute to headaches, pain, daytime sleepiness, and overall function.
Many factors affect sleep quality in the general population such as pressures at work, lifestyle habits, social pressures, nighttime routine, and daily activity level. Symptoms of insufficient sleep include daytime fatigue, changes in mood, and pain among others.
Non-restorative sleep is a very common symptom in patients with chronic fatigue syndrome. Non-restorative sleep is defined as not feeling refreshed upon waking, despite having slept a sufficient number of hours. This may be caused by low levels of deep sleep, known as delta sleep. Sleep quality can be improved with changes to sleeping habits and environment.
Patients should have a quiet and comfortable environment for sleeping and should gradually reduce activity level before bed. They should also aim to follow a regular sleep and wake schedule. Relaxation techniques such as breathing and meditation exercises can also be helpful. Excessive alcohol, caffeine, and tobacco consumption can also impact sleep quality.
Patients may be referred to a sleep study (polysomnogram) if symptoms persist or if the patient experiences sleep apnea, restless leg syndrome, or other abnormalities. Patients may also be referred to a sleep specialist who can test for sleep disorders.
3. Resolve orthostatic intolerance
Orthostatic intolerance is a broad term that describes a number of different conditions. Patients with orthostatic intolerance have difficulty maintaining an upright posture or standing. Symptoms may cause patients to feel weak, nauseated, or lightheaded upon standing. Abnormal sweating and changes in heart rate are also common. Many patients with these symptoms have problems with regulating their blood pressure.
A clinical study in The Journal of the Autonomic Nervous System showed that 40% of study participants with ME/CFS also had orthostatic intolerance. Results of the study suggest that targeting the symptoms of orthostatic intolerance may improve CFS symptoms in these patients.
Certain lifestyle changes can improve the symptoms of orthostatic intolerance. Patients who increase water and salt intake significantly can improve the most. At least 2 litres of water should be consumed each day. Wearing tight clothing such as compression stockings and elevating the legs while sitting can also help. If symptoms persist, patients may be referred to a cardiologist for further testing.
4. Pace activities into smaller tasks
Many patients with ME/CFS benefit from balancing their activity level with rest throughout the day. Pacing involves separating larger activities into smaller tasks and resting in between tasks. Managing activity level can prevent over-exertion and improve symptoms of fatigue. Pacing helps ME/CFS patients to become aware of their limitations and use their energy more efficiently. Patients will be able to gradually stabilize and lengthen their activity level over time.
Activity pacing depends on avoiding too much activity at one time, which can lead to a crash. Instead, patients stop the task before running out of energy or becoming depleted. Regular periods of resting can help to recover energy levels. Rest periods involve anything that is restorative. This may include breathing exercises, meditation, listening to gentle music, and yoga. Sleeping is not recommended during the daytime as it may impact nighttime sleep cycles. Healthcare professionals can help patients create a plan that meets their energy needs.
Chronic fatigue syndrome is a disorder that is not well understood. The disorder affects multiple body systems and is difficult to diagnose. When diagnosing ME/CFS, physicians will aim to rule out other health conditions that can cause fatigue.
Natural treatment options for ME/CFS include healthy eating habits, better sleep hygiene, resolving orthostatic intolerance, and pacing daily activity level. Such lifestyle changes can help improve symptoms associated with ME/CFS.
References:
- CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2018 [cited 2018 Sep 28]. Chronic fatigue syndrome. Available from: http://www.e-cps.ca or http:// www.myrxtx.ca
- Roberts JR. Chronic fatigue syndrome: overview, differential diagnoses (DDx), treatment. Medscape [Internet]. 2018 [cited 28 September 2018]. Available from: https://emedicine.medscape.com/article/235980-overview
- Morris DH, Stare FJ. Unproven diet therapies in the treatment of chronic fatigue syndrome. Archives of Family Medicine. 1993 Feb;2(2):181-186.
- Broman JE, Lundh LG, Hetta J. Insufficient sleep in the general population. Clinical Neurophysiology. 1996 Jan;26(1):30-39.
- The CFIDS and Fibromyalgia Self-Help Program. Solutions for sleep [Internet]. Palo Alto; [cited 2018 September 28]. Available from: http://www.cfidsselfhelp.org/library/solutions-sleep
- Baker Heart and Diabetes Institute. Orthostatic intolerance [Internet]. Melbourne, Australia; [cited 2018 September 28]. Available from: https://baker.edu.au/health-hub/oi-research
- Schondorf R, Benoit J, Wein T, Phaneuf D. Orthostatic intolerance in the chronic fatigue syndrome. Journal of the Autonomic Nervous System. 1999 Feb 15; 75(2-3):192-201.
- Phoenix Rising. Treating orthostatic intolerance in CFS: diet [Internet]. Long Beach; 2011 Mar 6 [cited 2018 September 28]. Available from: https://phoenixrising.me/treating-cfs-chronic-fatigue-syndrome-me/problems-standing/diet-and-chronic-fatigue-syndrome-mecfs-patients-with-orthostatic-intolerance
- Action for M.E. Pacing for people with M.E. [Internet]. Bristol, UK; 2013 Dec [cited 2018 September 28]. Available from: https://www.actionforme.org.uk/uploads/pdfs/pacing-for-people-with-me-booklet.pdf
