Chronic Fatigue Syndrome 

What Is Chronic Syndrome Fatigue?

[dropcap]C[/dropcap]hronic fatigue syndrome is a debilitating illness characterized by persistent or relapsing overwhelming and incapacitating fatigue not relieved by rest, having a definite onset and often accompanied by numerous symptoms involving various body systems.

This disorder has a pattern of symptom remission and relapse that often follows a fever-producing illness, although it may go away spontaneously with proper diet, avoidance of alcohol, adequate  nutrition, and sufficient rest balanced with activity.

Chronic fatigue syndrome is not life-threatening, although symptoms may be overwhelming at times.

Q: How is the diagnosis made of chronic fatigue syndrome?

A: Since there is no lab marker for chronic fatigue syndrome, diagnosis is made on symptoms present for 6 or more consecutive months. Criteria and symptoms are listed below.

The cause of chronic fatigue syndrome remains unclear despite a vigorous search according to the Center for Disease Control (CDC). While a single cause for chronic fatigue syndrome may yet be identified, another possibility is that chronic fatigue syndrome has multiple causes. Conditions that have been studied to determine if they cause or trigger the development of chronic fatigue syndrome include infections, immune disorders, stress, trauma, and toxins.

Who is Affected in the General Population? According to the CDC, the mean age of chronic fatigue syndrome patients at the onset of illness was 30 years, and the mean duration of illness at the time of the interview was 6.7 years. In four selected cities, the age-, sex-, and race-adjusted prevalences of chronic fatigue syndrome for the 4-year surveillance period ranged from 4.0 to 8.7 persons per 100,000 population.

What Is Chronic Syndrome Fatigue In Celiac Disease and/or Gluten Sensitivity?

• Relationship between chronic fatigue syndrome and celiac disease. Chronic fatigue syndrome is an associated inflammatory disorder of celiac disease.

• Relationship between chronic fatigue syndrome and cytokines. Celiac disease may be involved in chronic fatigue syndrome symptom presentation and oxidation via cytokine induction.¹ Cytokines are chemical messengers that enable cells of the immune system to interact with each other. In this respect, the omega fatty acids in fish oil and primrose oil are shown to reduce cytokines that produce inflammation, and they have anti-viral properties, too.

• Relationship between chronic fatigue syndrome and diagnosis. Celiac disease should be included in the differential diagnosis of chronic fatigue syndrome.²,³ 

• Relationship between chronic fatigue syndrome and symptom presentation. Presentations to rheumatology services are not uncommon with symptoms including fatigue, weakness, non-specific arthralgia, muscle cramps, and myalgia. A good argument therefore exists for screening for celiac disease when patients present with what may seem initially to be chronic fatigue syndrome (CFS), using combined serological testing. Such screening for celiac disease is included in the recently published NICE guidance on the management of CFS.⁴

• Relationship between chronic fatigue and stress. Psychological stress is produced in celiac disease both by the effects of gluten and by insufficiency of many nutrients. Such stress activates multiple physiological processes aimed at maintaining balance within the body. However, these physiological processes also have the capacity to influence the composition of microbial communities in the digestive tract, and research now indicates that exposure to stressful stimuli leads to gut dysbiosis.⁵ Importantly, dysbiosis in turn worsens fatigue.

How Prevalent is Chronic Fatigue Syndrome In Celiac Disease and/or Gluten Sensitivity?

There is a high prevalence of serum markers of celiac disease in patients with chronic fatigue syndrome (2%).⁶ This means that 2 persons out of 100 with chronic fatigue syndrome have celiac disease.

What Are The Symptoms Of Chronic Fatigue Syndrome?

Symptoms vary from person to person in type, number, and severity but need to meet the below criteria: 

1. The individual has had severe chronic fatigue for 6 or more consecutive months and the fatigue is not due to ongoing exertion or other medical conditions associated with fatigue (these other conditions need to be ruled out by a doctor after diagnostic tests have been conducted)
2. The fatigue significantly interferes with daily activities and work
3. The individual concurrently has 4 or more of the following 8 symptoms:

• Impaired short-term memory or decreased concentration severe enough to substantially reduce occupational, educational, social, or personal activities.
• Recurrent sore throats.
• Tender cervical or axillary lymph nodes in the neck or armpit.
• Muscle pain.
• Multijoint pain without joint swelling or redness.
• Headaches of a new type, pattern, or severity.
• Unrefreshing sleep.
• Post-exertional malaise lasting more than 24 hours.

How Does Chronic Syndrome Fatigue Develop In Celiac Disease and/or Gluten Sensitivity?

• A number of recent studies have shown oxidative stress may be involved in the pathogenesis (development) of chronic fatigue syndrome.⁷
• The mechanism that lowers oxidative stress in the body involves anti-oxidants (vitamin E and vitamin C).
• Malabsorption of nutients that may be involved include deficiencies of carbohydrate, protein, essential fatty acids, vitamins, especially vitamin B1, vitamin C and vitamin E, and minerals iron and magnesium.

Does Chronic Syndrome Fatigue Respond To Gluten-Free Diet?

Yes. Chronic fatigue syndrome responds to gluten free diet with dietary supplementation.⁸,⁹

Avoidance of alcoholic drinks, inflammatory foods, and certain medications that exacerbate symptoms is important. See below.

6 Steps To Improve Chronic Fatigue Syndrome In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both chronic fatigue syndrome and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.¹⁰
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.¹¹
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.¹¹
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.¹¹.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.¹¹
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.¹¹
• Alcohol MUST be avoided because it often makes the symptoms of chronic fatigue syndrome worse. It also disrupts intestinal permeability causing leaky gut and this sets you up for other food intolerances.¹¹
• Caffeine. Disrupts intestinal permeability causing leaky gut.¹¹[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

 

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Certain drugs prescribed for other disorders and also non-prescription drugs used for headache or muscle pain cause deficiencies of these nutrients that make chronic fatigue syndrome worse: vitamin B1 (thiamin), vitamin C, vitamin E, iron, magnesium, and protein.

Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Calcium, Iron, Magnesium.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Calcium, Iron, Magnesium.
• Alka Seltzer®, Baking Soda deplete Magnesium, Proteins.

ANTIBIOTICS disrupt intestinal permeability.

• Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete B Vitamins, Vitamin C.
•  Tetracyclines deplete Calcium, Magnesium, Iron.

ANTI-INFLAMMATORIES disrupt intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Calcium, Magnesium, Vitamin C.
• Aspirin and Salicylates deplete Calcium,Vitamin C, Iron.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Calcium, Vitamin B1.

ANTIVIRAL AGENTS

• Foscanet depletes Calcium, Magnesium. 

CARDIOVASCULAR DRUGS

• Antihypertensives (Catapres®, Aldomet) deplete Vitamin B1.

CHOLESTEROL DRUGS

• Colestid® and Questran® deplete Iron, Vitamin E.

DIURETICS

• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete Magnesium.
• Loop Diuretics (Lasix®, Bumex®, Edecrin®) depletes Calcium, Magnesium, Vitamin B1, Vitamin C.
• Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Calcium.

FEMALE HORMONES disrupt intestinal permeability.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Vitamin C, Magnesium.
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Vitamin C, Magnesium..[/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

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The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.
• Ferrous fumarate or gluconate as prescribed for low iron following blood test for status.
• Chelated magnesium  as prescribed but do not take at same time as calcium because they compete for absorption.
• Natural vitamin C such as Ester-C as prescribed.
• Vitamin E as prescribed to correct deficiency.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration is very important in managing chronic fatigue syndrome:

Research in young men showed that mild dehydration induces adverse changes in vigilance and working memory, and increased tension/anxiety and fatigue.¹²

Research investigating how mental performance is affected by slowly progressive moderate dehydration induced by water deprivation shows that subjective ratings by subjects of mental performance changed significantly toward increased tiredness and reduced alertness, and higher levels of perceived effort and concentration necessary for test accomplishment during dehydration.¹³

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins. Because the muscle pain that develops in chronic fatigue syndrome often causes avoidance of activity,  the resulting inactivity sets up a cycle that increases intolerance to activity followed by increasing muscle pain and muscle wasting.

The best exercise regimen is low-intensity for about 5 minutes a day with a gradual progressive increase as tolerated without getting worse. A dairy of symptoms here is very helpful.

Strenuous exercise should be avoided because exhaustion is shown to worsen muscle pain.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Getting outdoors even if it is just to the porch gives a change of scenery that can improve the blues that is part of chronic fatigue syndrome. Of course, getting into sunshine adds more emotional lift. Read more about Exercise and Fitness.
• Weight training builds muscle. This should be done under the direction of a therapist when muscles improve. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Chronic Syndrome Fatigue In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“High prevalence of serum markers of coeliac disease in patients.” This study investigating the prevalence of endomysial antibodies as markers of celiac disease in the blood of 100 consecutive patients with diagnosis of chronic fatigue syndrome found a rate of 2%. Neither of the two women had reported symptoms typical of celiac disease although one had constipation. Both had histories of hypothyroidism and were taking thyroid medicine (thyroxine) and were euthyroid.

Before diagnosis of celiac disease, confirmed by jejunal biopsy, both patients had received behavioral cognitive therapy which is a standard treatment for chronic fatigue syndrome. Although  improved, neither patient was symptom free at 6 months follow-up. Celiac disease should be added to the relatively short list of mandatory investigations in chronic fatigue syndrome.¹⁴

Sources:

1. Logan AC, Wong C. Chronic fatigue syndrome: oxidative stress and dietary modifications. Alternative Medicine Review : A Journal of Clinical Therapeutic. Oct 2001;6(5):450-9. [↩]
2. Logan AC, Wong C. Chronic fatigue syndrome: oxidative stress and dietary modifications. Alternative Medicine Review : A Journal of Clinical Therapeutic. Oct 2001;6(5):450-9. [↩]
3. Skowera A, Peakman M, Cleare A, Davies E, Deale A, Wessely S. High prevalence of serum markers of coeliac disease in patients with chronic fatigue syndrome. J Clin Pathol. 2001 Apr;54(4):335-6. [↩]
4. Hepburn AL. Adult coeliac disease: Rheumatic presentations are common. BMJ. 2007 Sep 29;335(7621):627. [↩]
5. Galley JD, Bailey MT. Impact of stressor exposure on the interplay between commensal microbiota and host inflammation. Gut Microbes. 2014 May 1;5(3):390-396. Epub 2014 Apr 1. [↩]
6. Skowera A, Peakman M, Cleare A, Davies E, Deale A, Wessely S. High prevalence of serum markers of coeliac disease in patients with chronic fatigue syndrome. Journal of Clinical Pathology. Apr 2001;54(40:335-6. [↩]
7. Logan AC, Wong C. Chronic fatigue syndrome: oxidative stress and dietary modifications. Alternative Medicine Review : A Journal of Clinical Therapeutic. Oct 2001;6(5):450-9. [↩]
8. Logan AC, Wong C. Chronic fatigue syndrome: oxidative stress and dietary modifications. Alternative Medicine Review: A Journal of Clinical Therapeutic. Oct 2001;6(5):450-9. [↩]
9. Siniscalchi M1, Iovino P, Tortora R, Forestiero S, Somma A, Capuano L, Franzese MD, Sabbatini F, Ciacci C. Fatigue in adult coeliac disease. Aliment Pharmacol Ther. 2005 Sep 1;22(5):489-94. [↩]
10. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
11. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩] [↩]
12. Ganio MS, Armstrong LE, Casa DJ, McDermott BP, Lee EC, Yamamoto LM, Marzano S, Lopez RM, Jimenez L, Le Bellego L, Chevillotte E, Lieberman HR. Mild dehydration impairs cognitive performance and mood of men. Br J Nutr. 2011 Nov;106(10):1535-43. doi: 10.1017/S0007114511002005. [↩]
13. Szinnai G, Schachinger H, Arnaud MJ, Linder L, Keller U. Effect of water deprivation on cognitive-motor performance in healthy men and women. Am J Physiol Regul Integr Comp Physiol. 2005 Jul;289(1):R275-80. [↩]
14. Skowera A, Peakman M, Cleare A, Davies E, Deale A, Wessely S. High prevalence of serum markers of coeliac disease in patients with chronic fatigue syndrome. J Clin Pathol. 2001 Apr;54(4):335-6. [↩]