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Chronic Fatigue Syndrome

Dr. Heidi Fritz
17 August 2016

Chronic Fatigue Syndrome - Naturopathic Perspectives

by: Heidi Fritz, MA, ND

Bolton Naturopathic Clinic
64 King St W, Bolton, Ontario L7E 1C7

Chronic Fatigue Syndrome - Naturopathic Perspectives Introduction

Chronic fatigue syndrome (CFS) is a chronic condition that can be difficult to diagnose and treat. It is a condition where extreme fatigue cannot be explained by any medical condition. It can get worse with mental or physical activity, but does not usually get better with rest.[1] Other associated symptoms include loss of memory or concentration, muscle pain that is unexplained, headaches, poor sleep, and generally extreme exhaustion. CFS is one of many conditions that are not adequately (at least by the average patient’s standards) managed by the conventional medical care system. Naturopathic doctors routinely see patients who are unsatisfied with their medical care, and so it is common for patients with CFS to be in this group. Fortunately, naturopathic medicine can provide numerous natural treatment options that can help with the symptoms of CFS. After providing some background information, we will discuss a number of potential treatment options.

The causes of CFS are unknown. There are many theories as to the contributing factors of CFS, while many think that it could be a combination of causes. Some potential causes include (but have not been proven, nor have they been shown consistently):

  1. Infections, particularly viral infections. Some people appear to develop CFS shortly after having a viral infection, or sometimes years after having a virus like Epstein-Barr virus.
  2. Immune system deficiencies. There may be an association between autoimmune conditions and CFS.
  3. Hormonal problems. Lab tests sometimes reveal hormones outside of the normal range. These can include thyroid hormones, sex hormones, or stress hormones. It is difficult to say if these are necessarily a contributing factor, though, because sometimes the condition itself can lead to these kinds of problems.
  4. Nutritional deficiencies. A lack of macronutrients, vitamins, or minerals is sometimes affiliated with cases of CFS.

CFS symptoms need to last for six months or longer to establish a diagnosis. There appears to be a low prevalence in the general population (< 0.1%).[2] It is possible that a number of cases of CFS are misdiagnosed or take a significant amount of time before the diagnosis is made. It is important that these patients who generally already feel like the medical system is not taking care of them be nurtured and listened to.

Conventional Treatments

Although there is no cure or specific medications that are exclusively used for CFS, there are a number of conventional treatment options available. The first option we’ll discuss—and certainly one of the most highly regarded treatments—is cognitive behavioural therapy (CBT). Some studies have shown that, when compared to other psychological therapies (like relaxation, counseling, educational support), CBT is superior. Patients with CFS experience less symptoms of fatigue after treatment.[3] It should be noted that not all studies show the same results, and the evidence base is limited and contains some inconsistencies. However, the risks of CBT are minimal, and thus it’s likely worth a shot.

CBT is a practical form of psychotherapy. It helps those with health conditions develop skills and strategies for becoming and staying healthy. It helps people examine how they analyze situations and problems, and how they perceive their problems. It is structured and usually consists of a specific number of sessions. It is extremely goal-oriented. The big complaint about CBT is that it does not directly address any of the underlying symptoms; it only acts to change the perspective and attitudes about them. However, even knowing that, it appears that patients with CFS have symptom improvement.


Another form of therapy used in conventional medicine is exercise therapy. Exercise therapy can be part of a broader treatment approach, rather than a monotherapy. Exercise therapy is commonly used in patients with chronic mental health conditions (like depression or schizophrenia), as it has documented positive effects on mood and wellbeing. It can help alleviate symptoms of fatigue in those with CFS, but beware because you don’t want to cause worsening of symptoms or worsening exhaustion. We suggest using exercise therapy on a trial basis, and only at a pace that is comfortable for the individual. Oftentimes, patients with CFS want to push themselves harder than their body would allow, and it causes more problems. Exercise therapy can therefore be a useful adjunct when used with judicious oversight.

Natural Treatment Options Source

With CFS, there may be a certain degree of trial and error with supplemental treatment options. Not every supplement will work for everyone. A good treatment protocol will involve the goal of minimizing inflammation and inflammatory processes. An elimination diet or an IgG food allergy test followed by the elimination of highly reactive foods can be of benefit to many patients.

Foods to commonly eliminate or reduce include red meat and processed foods, which often contain proinflammatory ingredients. Foods to commonly introduce include fish, which contain essential fatty acids which perform anti-inflammatory functions in the body.

In terms of supplements, one that is commonly considered is coenzyme Q10 (CoQ10). CoQ10 helps to provide energy to cells by supporting mitochondrial function. Similarly, malic acid or magnesium malate are used to promote energy production, and have been shown to ameliorate symptoms of fatigue and help with recovery time. Some patients with CFS have been shown to have low levels of malic acid.

Another important supplement to consider is B‑complex vitamins. B vitamins include vitamin B12, which is important for brain function. Many of the B vitamins are essential for muscle function and for energy production.

l‑Carninite is the last supplement we will discuss. l‑Carninite is a supplement that is used to support muscle function and, like CoQ10, it helps with energy production in the mitochondria.

In addition to diet and supplements, other natural therapies have shown promise. An acupuncture protocol can be quite helpful for many CFS patients. Acupuncture can help with some of the physical symptoms of CFS such as the muscle complaints, but it can also help with stress that is commonly seen in these patients. It can help to provide the foundation for a trusting therapeutic relationship. Hydrotherapy is another natural therapy that CFS patients report experiencing benefit. In particular, constitutional hydrotherapy treatments which involve having the patient lie down and wrapped under a blanket with alternations of hot and cold have had patients reporting benefit.


CFS is a very difficult condition to live with. Depending on its severity, it can cause tremendous detriments to a person’s quality of life. It can be difficult to diagnose, and it can take a long time to diagnose. These problems are compounded by the fact that the conventional medical care system does not have a cure or a reliable way to help patients.

Many patients report being unsatisfied with the medical care they receive. They feel as though they are not being listened to, and that the standard treatments are only being used to reduce their discomfort, rather than actually deal with the underlying problem. That being said, CBT and exercise therapy are two conventional approaches that have shown benefit. Even though they don’t target the underlying symptoms, there are studies showing that patients report improvement in their symptoms after courses of these treatments.

Naturopathic doctors are able to offer a number of alternative natural therapies to CFS patients. Diets that promote anti-inflammatory conditions and reduce proinflammatory states are helpful. Supplements that promote or support energy production are very commonly used. They include CoQ10, magnesium malate, and l‑carninite. B vitamins are also useful due to the broad range of functions they support. B12 in particular is good for cognitive health.

Naturopathic doctors also routinely provide therapies like acupuncture and hydrotherapy. Both of these are whole-body therapies that can used on their own or in conjunction with other treatments. Patients report feeling supported and listened to when utilizing these treatments. No matter what treatment plan is selected, it is imperative that patients with CFS are well-cared for and that their goals are prioritized appropriately.