Relevant

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, neuro- psychological complaints, sleep disturbances.

International CFS Study Group Definition of Chronic Fatigue Syndrome

I. 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.

II. 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
• postexertional 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

• HypoxemiaEndocrine dysfunctionImmune dysfunction
• Stress-related dysfunction
• Somatoform disorder
• Marginal nutritional deficienciesIntestinal hyperpermeability
• Overgrowth of pathogenic intestinal flora (dysbiosis)
• Food and chemical sensitivities
• Chemical toxicity
• Heavy metal toxicity

Symptoms

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. Other symptoms include:

• Recurrent pharyngitis HEENT lymphadenopathy
• Recurrent headaches Chronic low-grade fever
• Myalgia and/or arthralgia Inability to concentrate
• Gastrointestinal upset Emotional upset and/or depression
• The patient may have a history of allergies,

difficulty sleeping, weight loss or gain

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.

Course and Prognosis

This disorder is not well recognized by most conventional physicians, despite empirical evidence and clinical research. Conventional treatment involves suppression and/or palliation of symptoms, e.g. salicylates for fever, headaches, and myalgia. With no further diagnosis or treatment the patient is likely to have bouts of remissions and exacerbations that may develop into a constant, persistent disease. Appropriate diagnosis and treatment lead to excellent recovery rates in most sufferers who comply.

Nutrients Involved

Vitamin  B12  Note: CFS  patients generally  have B12  metabolism problems  requiring much  higher B12 supplementation.  Sublingual magnesium assessment is more indicative of magnesium status as the cells (sublingual) are increasing turnover cells with mitochondria vs. RBC have no mitochondria (CFS patients have energy production problems).

Suggested Nutritional Supplementation

• AdvaClear® and UltraClear PLUS® Advanced Bi-functional Detoxification Program (see Detoxification

section for specifics)

• EPA-DHA 720 - 2-6 capsules daily with food

EPA-DHA 720 provides 720 mg of omega-3 essential fatty acids from cold water fish per softgel-

eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)

• Mitochondrial Resuscitate - 1-2 capsules 3 times daily between meals

Mitochondrial Resuscitate is scientifically designed to provide nutritional support for healthy cellular energy

(ATP) production.

• CoQ10 ST-100TM - 1-2 softgels daily

Stabilized, Highly Absorbable Coenzyme Q10 with Natural Vitamin E and Beta-Carotene

• Intrinsi B12/Folate - 2 tablets 3 times daily with food

Intrinsi B12/Folate provides vitamin B12 and folates in combination with intrinsic factor for enhanced

absorption and assimilation

• Kre-Alkalyn - 2 capsules twice daily

pH Correct Creatine for increased muscle ATP.

Dietary Suggestions

• Modified Elimination Diet

Avoid:

• dairy
• increased fat
• red meat
• gluten
• arginine-rich foods*

*Viral protein structures are arginine rich vs. human protein structures which are lysine rich (e.g., CFS patients in general have decreased arginine by amino acid analysis possibly because of increased viral replication.)