Do you feel tired, even when you’ve gotten plenty of sleep the night before? Does your mind feel “foggy” all day long, no matter how many cups of coffee you have? Does completing the simplest of tasks leave you feeling exhausted and sore?

While many people think that having low energy and feeling tired often is a byproduct of not getting enough sleep, it can be a more serious condition called Chronic Fatigue Syndrome.

As a Functional Medicine expert, I work with my patients on recovering from chronic fatigue issues and adrenal insufficiency on a daily basis. When these chronic fatigue issues go on and on and symptoms get more severe over time without intervention, this is when I see the phenomenon of Chronic Fatigue Syndrome occur.

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What is Chronic Fatigue Syndrome (CFS)

Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a complex illness that has yet to be fully defined, making it difficult to diagnose and treat. ¹ However, many patients are walking into clinics with the health history, signs, and symptoms of CFS only to be turned away or misdiagnosed leading them to further frustration, despair, and worsening health.

Understanding the causes of CFS and the intricate relationships and pathways inside the human body can help CFS sufferers regain their energy and take back their health.

Let’s dive into the symptoms, causes, and my Functional Medicine approach to healing from CFS naturally by addressing the root causes.

Common CFS Symptoms

Chronic Fatigue Syndrome is a disease characterized by profound fatigue, sleep abnormalities, pain, and a multitude of other symptoms that are typically made worse by exertion.  Some professionals believe CFS is closely related to Adrenal Fatigue / Adrenal Insufficiency or systemic inflammation in the body.

A diagnosis of CFS is based on distinct signs and symptoms, different from Adrenal Fatigue, specifically: experiencing chronic fatigue lasting more than 6 months that is not alleviated by rest is accompanied by¹ one more other symptoms.

In addition to the profound fatigue experienced, other serious symptoms or conditions² often accompany CFS, such as:

CFS occurs more commonly in women. The cause of this condition is currently unknown but may include environmental or genetic factors.

A good starting point to discovering if you may be suffering from CFS is to write down any health concerns you have had in the past six months.

You may find it necessary to start a health journal and document any consistent signs and symptoms or unexplained issues. Being able to look back on your journal may help you see patterns and hidden problems that you didn’t see while living through those days.

Also, reviewing your past health history and family history will be valuable and will help your functional medicine practitioner if you seek further help.

Causes of CFS

Inflammation and Leaky Gut

Inflammation is a leading cause of many illnesses, and CFS is definitely one of them.

Inflammation can come from many sources including diet, food allergies or sensitivities, infections, medications, heavy metals and environmental pollutants, mold, previous surgeries, and tooth infections.

One of the most significant sources of inflammation associated with CFS, is gut inflammation.  A leaky gut (impaired intestinal permeability), irritable bowel syndrome (IBS), or an imbalance of the gut microbiome (bacteria in your gut) activates the immune system leading to multiple symptoms associated with CFS.

These include; flu-like illnesses, abdominal pain, diarrhea or constipation, anxiety and depression, brain fog, and extreme fatigue.⁴

Infections and Autoimmunity

Infections can go undetected for many years. Underlying infections include viral, bacterial, fungal, Epstein-Barr virus (EBV), herpes simplex, parvovirus, Q fever, and Lyme disease.³

These infections can result in fever, fatigue, muscle pains, breathing issues, digestive problems, and energy levels that fluctuate in a cycle.  Infections can be difficult to track down and may not always appear as an “abnormal” finding on your lab work.

While there are tests that can certainly detect underlying infections, it’s important to take into account the person as a whole, not ignoring symptoms if a lab test comes back as normal. Several studies have pointed to evidence that CFS may be autoimmune driven and associated with metabolic disturbances including a history of frequent infections.⁶

Mitochondrial Dysfunction and Autoimmunity

Mitochondria are in every cell of the human body and are famous for being the “powerhouse of the cell”, meaning they produce most of the body’s energy.

However, newer research is showing that the mitochondria do much more than just produce energy. The mitochondria is heavily involved in many body processes and when it is not working well or is dysfunctional, it will lead to oxidative stress, free radical formation, and inflammation. Mitochondrial dysfunction shares many of the same symptoms of CFS. ⁵

HPA Axis Imbalance

The Hypothalamic-Pituitary-Adrenal (HPA) axis helps your body adapt to stress.  Stress is not always a bad thing as we need stress in order for our body to adapt and survive.

When we are in a stressful situation our body anticipates that we will eventually come out of it and go back into a state of rest and relaxation. However, many people are in a state of constant stress at home, work, in relationships, and finances among many others.

Long-term stress creates dysfunction in the HPA axis and leads to low cortisol levels, or Adrenal Fatigue, which is consistently associated with CFS.³

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Healing from CFS

While the symptoms and causes of CFS are diverse, so are the treatments. As a Functional Medicine practitioner, my goal is to address the underlying root cause of your health imbalance.

There is no one diet, supplement, or medication that fits everyone. If you feel like you have CFS or one of the underlying causes as listed above, I recommend working with a Functional Medicine practitioner. They will listen to you and help you start working towards making healthy changes and heal the body at a cellular level, instead of trying to simply treat the symptoms.

5 Strategies to Start Healing the Cellular Level

1) Reduce Inflammation Through Diet and Hydration

You can immediately begin healing your body because you have choices every day that you make that will either bring you toward or away from healing.

The most simple, but perhaps not the easiest, is choosing better foods for your body. Inflammatory foods such as refined sugar, processed foods, processed grains, dairy, artificial sweeteners and preservatives, food dyes, and synthetic chemicals can cause inflammation throughout the body, leaving you lethargic and tired.

Remember that the nutrients, or anti-nutrients, you put into your body are the resource your cells use to grow, repair, and function properly. Giving your cells what they need to regenerate and self-cleanse yields a reduction in inflammation, which often means you start feeling better.

Removing waste material from your body is just as important, so water concentration and proper hydration are key.

Start with these 3 simple steps:

1. Follow the Mediterranean or Paleo Diet, or for more severe cases begin an Elimination Diet
2. Drink at least half of your body weight in ounces of water per day
3. Add in electrolytes such as Himalayan salt, trace minerals, fermented foods, and a healthy dose of fruits, vegetables, nuts, and seeds

2) Heal the Gut

A leaky gut, or increased intestinal permeability, is a common issue that needs to be addressed. Genetic factors, the use of antibiotics, and virulent microbes can lead to inflammation and autoimmunity.⁷  

A simple test can show you whether you have leaky gut, microbiome imbalance, overgrowth of bacteria, or gut infections such as viruses, pathogens, and parasites. However, there are also many patients who have all these same symptoms but do not have a leaky gut.

It’s important to realize that leaky gut is not in everyone. That is why testing is important if you are struggling to get well. Don’t guess, test.

Here are several ways to start healing the gut:

1. Get a microbiome test and food sensitivity panel
2. Follow an Elimination Diet
3. Drink 2 cups of bone broth daily
4. Add more fiber to your diet
5. Helpful supplements: probiotics, prebiotics, glutamine, zinc, magnesium, vitamin D, Omega-3s

3) Cellular Energy and Balance

Boosting cellular energy starts with the mitochondria. While there is no one cause of mitochondrial dysfunction, it’s important to help support the body by opening the detoxification pathways (liver, kidneys, spleen, and skin) and improve the drainage of toxins through the lymphatic system.

Decreasing stress on the organs and detox pathways will free up energy resources for your mind, body, and muscles.  Improving mitochondrial function will increase cellular energy and improve fatigue symptoms.⁸  

Here are several steps you can take to support healthy mitochondria:

1. Eat enough protein for your body: 1.2 to 1.8 grams of protein per kilogram of body weight
2. Increase dietary flavonoids including berries, red cabbage, green tea, dark chocolate, onions, grapes, apples, tomatoes, lettuce, and kale
3. Helpful supplements: L-carnitine, CoQ10, fulvic and humic acids, vitamin C and E, alpha-lipoic acid, n-acetyl cysteine, milk thistle, dandelion root, and echinacea

4) Sleep and Relaxation

CFS sufferers commonly experience difficulty with their sleep. In particular, falling asleep, staying asleep, muscle spasms, restless legs, and vivid or frightening dreams.

It’s important to establish a regular bedtime routine, which includes a physical and emotional wind-down period.

While better sleep will come as you heal the underlying causes, you can promote healthy sleep with several simple tips:

1. No electronic devices or cellphones at least 1.5 hours before bed
2. Wear blue-light blocking glasses
3. Keep the room dark and cool
4. Listen to delta wave music
5. Apply Essential Oils such as lavender, sandalwood, chamomile, and valerian
6. Helpful supplements: melatonin, CBD oil, magnesium, valerian, L-theanine, and phosphatidylserine

5) Gradual Physical Fitness

As your energy improves it will become easy to over-do your workouts at first in an attempt to regain your former physique and self. Take it slow as your body is healing. Gradually increase physical fitness and exercise.

Here are several helpful tips to work up into your workouts:

1. Start a graded walking program ¼ a mile at a time on flat ground, then graduate to more hilly terrain
2. Gentle hikes and walking in nature
3. Swimming or water aerobics
4. Yoga or active stretching 

References
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038594/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370741/
3. https://pubmed.ncbi.nlm.nih.gov/25671535/
4. https://link.springer.com/article/10.1186/1743-7075-7-79
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680046/
6. https://pubmed.ncbi.nlm.nih.gov/29635081/
7. https://www.ifm.org/news-insights/ai-rise-autoimmune-disease-linked-intestinal-permeability/
8. https://www.ifm.org/news-insights/reduce-fatigue-by-addressing-mitochondrial-dysfunction/