Fatigue is a symptom of many conditions. Chronic fatigue syndrome (CFS) is an umbrella diagnosis used when the fatigue is chronic and no underlying cause can be identified. In other words, it is a chronic, severe form of fatigue with no known underlying cause. Typically, the fatigue worsens with mental and physical activity, but doesn’t improve with rest.

CFS is a functional disorder. This means there is no clinical test or standard biomarker for diagnosing CFS. It is diagnosed based on the persistence and commonality of a certain profile of symptoms, without any other explanation for the occurrence of these symptoms.

Use the following clickable Table of Contents to skip to your desired section:

• Symptoms of Chronic Fatigue Syndrome
• A Diagnosis of Exclusion
• Is Gluten Involved?
• What Causes Chronic Fatigue Syndrome?
• Treatment
• Nutritional Suggestions

Symptoms

The symptoms used to identify and diagnose CFS include:

• Chronic muscle and joint pain without another identifiable cause
• Foggy brain or lack of mental acuity
• Headaches
• Inability to experience restful sleep
• Mental and physical exhaustion (sometimes severe) that isn’t relieved by bed rest
• Sore throat

Additional symptoms associated with CFS include:

• Digestive distress (including symptoms similar to irritable bowel syndrome)
• Heart palpitations
• Heightened sensitivity to light, sound and smells
• Irritability
• Muscle weakness
• Respiratory distress (sometimes similar to asthma symptoms)

Experiencing several of these symptoms along with severe fatigue may lead your doctor to diagnose you with CFS.

A Diagnosis of Exclusion

Fatigue is a common symptom in many different conditions and diseases, so don’t assume you have CFS just because you experience fatigue. Because there is no single test to verify the presence of CFS, you may need to undergo a series of other tests to rule out other possible medical conditions as the root of your symptoms.

To be diagnosed with chronic fatigue symptom, a patient must experience persistent fatigue with at least four related symptoms for a standardized period of time. For adults, this period of time is six months, for children and adolescents it is three months. The exact symptoms can vary widely per individual.

Doctors often assess patients for the following conditions before diagnosing CFS:

• Bacterial or viral infections
• Cancer
• Depression
• Drug addiction
• Endocrine diseases (like hypothyroidism)
• Heart disease
• Immune or autoimmune disorders
• Kidney disease
• Liver disease
• Muscle or nerve diseases (like multiple sclerosis)

As you can see, autoimmune disorders are on this list. So doctors should consider celiac disease, which is an autoimmune disorder, as a potential origin of chronic fatigue. However, many doctors may still overlook celiac disease.

Is Gluten Involved?

Many of the symptoms of chronic fatigue syndrome overlap with undiagnosed gluten intolerance symptoms.

In my opinion, when someone presents a potential CFS diagnosis, he or she should be screened for celiac disease. If the test is negative, then a gluten challenge should be implemented to help determine if a non-celiac gluten sensitivity is present. However, many doctors still don’t consider gluten intolerance when investigating the cause of chronic fatigue, so don’t hesitate to remind them of this possibility.

For people who aren’t experiencing gluten intolerance, additional theories relating gluten to CFS can be a little controversial. Certainly, the refined grains people consume the most contain gluten, but in those cases the problem is the simple carbohydrates, not the gluten. Some evidence suggests proteins like gluten and casein have an addictive quality, which may result in withdrawal-like symptoms when you can’t consume them. However, the evidence of this, while widely reported on nutrition blogs, is largely speculative and hypothetical at this point.

(What is gluten, really? Read my lesson to make sure you understand this pesky and controversial protein composite: What Is Gluten?)

What Causes Chronic Fatigue Syndrome?

We don’t yet understand the origin of CFS. The four most common theories involve systemic inflammation, viral infections, immune disorders and hormone imbalances. While some evidence correlates each of these with CFS, there is still no conclusive link. Some current research is focused on thyroid health.

However, in either researching a cause or developing a treatment, these four possibilities should be considered.

Treatment

Treatment is oriented around treating the symptoms since there is little understanding of the underlying cause. Depending on how CFS manifests itself, different therapies will be considered. You will find much debate regarding each of these treatments, but some success has been reported with each of them:

• Acupuncture
• Anti-depressants
• Cognitive behavioral therapy
• Fluorescent-light treatments
• Graded exercise therapy
• Therapeutic massage

Everyone reacts differently, and it may depend on your particular manifestation of CFS.

Several research projects are currently measuring and refining the value of cognitive behavioral therapy. Some researchers are trying to combine cognitive behavioral therapy and graded exercise therapy to see if combining mental and physical therapies provides better results. Graded exercise therapy involves a deliberate, methodical and gradual increase of physical activity, beginning with simple, light stretches.

Nutritional Suggestions

While verifiable data is sparse on what foods and nutrients may help CFS, current claims and anecdotal evidence suggest bananas help some people. Some experts recommend supplement regimens incorporating vitamin D, vitamin B6 and vitamin B12.

Because some hypotheses involve systemic inflammation, I recommend incorporating foods containing plenty of vitamin C and quercetin, which are nutrients that combat inflammation. Citrus fruits, red onions and apples are great sources of vitamin C and quercetin. Eat the whole fruit rather than juice from the fruit to make sure you obtain the quercetin, which is most concentrated in the skin of the apple or the pith (the white stringy stuff) of the orange.

Improving your ratio of omega-3 fatty acids to omega-6 fatty acids can help reduce inflammation. This is because omega-6 fatty acids are converted to pro-inflammatory hormones and omega-3 fatty acids are converted into anti-inflammatory hormones. Most people in industrialized nations consume far too many omega-6 fatty acids and not enough omega-3 fatty acids.

Vegetable oils, like corn, soy, sunflower and safflower oils, are our primary source of omega-6s. Because so many packaged products and recipes rely on these products, we obtain far more than we need. But we do need some of it. By just eating more vegetables, nuts and seeds, you should obtain plenty of it. Reduce your reliance on packaged products to reduce omega-6s in your diet.

The main omega-3 fatty acids are alpha linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). The primary sources of these fatty acids include flaxseeds and chia seeds for ALA, or fish and fish oil for EPA and DHA. Your body converts ALA to EPA and DHA, but it is not an efficient process. While you should still obtain some ALA in your diet, to enjoy the maximum benefits of omega-3s, you should also obtain EPA and DHA directly. Fish and fish oil is typically the best dietary source of EPA and DHA, but vegans can take EPA and DHA supplements derived from algae and algal oil.

Read my lesson on chronic inflammation treatment for more anti-inflammation suggestions.

I also recommend CFS patients try chamomile and melatonin supplements in the evening to encourage better sleep. Another supplement you might try is Rhodiola rosea. It is an adaptogen herbal supplement. Unlike most adaptogens and herbal supplements, there are a couple of solid, legitimate studies supporting rhodiola’s use to combat fatigue and depression.

Most researchers agree chronic fatigue syndrome patients should avoid caffeine and minimize sugar because of their negative effect on sleep quality and energy levels. In addition, I suggest you incorporate breathing exercises and relaxation techniques into your bedtime routine to improve your sleep.

One simple breathing exercise is to close your eyes, sit-up straight, smile, then take several deep breaths in through your nose and out through your mouth. Try to pay attention to your lungs and chest expanding as you inhale, and then relaxing and softening as you exhale.

CFS can be complex and controversial to diagnose and treat. Please try to remain patient and positive as you work with your doctor to determine the best course of treatment. With attentive care and diligent treatment, you can and will feel better.