Submitted by John Stump, DC, PhD, EdD
John Stump is the clinic director at the Integrative Medicine Centre. A consultant and partner in Sportec International, a Fairhope, AL, based sport and fitness consulting company. He is also a National Faculty member of the United States Sports Academy
The year of the Olympics is a special time for athletes everywhere. Health care professionals find it difficult to recognize a case of Chronic Fatigue of a former college track athlete who persisted on despite her infirmity to qualify for the Olympics. The patient had an acute onset of symptoms not consistent with any condition but general fatigue. Blood studies and additional tests indicated a fatigue syndrome consistent with that of Chronic Fatigue Syndrome. She was placed on a specific nutritional program for four months and shortly afterward was back to long distance running.
Chronic Fatigue Syndrome, sometimes called CFS, is a condition that makes one feel so tired that he/she is unable to do all of the normal, daily activities. It is a debilitating and multifaceted disorder characterized by profound fatigue not improved by bed rest and may be worsened by physical or mental activity. Symptoms affect several body systems and may include weakness, muscle pain, impaired memory and/or mental concentration, as well as insomnia that can result in reduced participation in daily activities. There are other symptoms too, but
being excessively fatigued for at least six months is the primary alarm (CDC, n.d.; Dellwo, 2013).
The cause or causes of CFS have not been identified and no specific diagnostic tests are available. Therefore, in order to be diagnosed with CFS, a patient must satisfy a minimum of two criteria:
- Have severe chronic fatigue for at least six months or longer with no other known medical conditions (whose manifestation includes fatigue) excluded by clinical diagnosis; and
- Concurrently have four or more of the following symptoms:
- Post-exertion malaise
- Impaired memory or concentration
- Un-refreshing sleep
- Muscle pain
- Multi-joint pain without redness or swelling
- Tender cervical or auxiliary lymph nodes
- Sore throat
The symptoms must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue (CDC, n.d.; Dellwo, 2013).
On the adapted Visual Analysis Scale (VAS) used (Eustice, 2009) for fatigue and modified for this investigation, the patient said, “it would be a 9 or 10 most of the time, even upon getting up in the mornings I do not feel rested.”
Many people improve in six months to a year with the correct treatment protocol and do not have a relapse. Some people continue to have severe fatigue and other symptoms for many years before their body is able to return to normal. The disease is not well understood and some experts even believe CFS and Fibromyalgia are one and the same condition. However, most experts now believe that CFS is a separate illness with its own set of symptoms (Chaitow, 2001). It is likely a number of factors or triggers came together to cause this CFS case.
Symptoms of the syndrome
Extreme tiredness and extreme fatigue was the main symptom:
- Exhausted all or much of the time.
- Problems sleeping; wake up feeling tired and not rested.
- Hard to think clearly, to concentrate, and to remember things.
- Headaches, muscle and joint pain, and tender glands in the neck and armpits.
- Symptoms flare-up after mental, emotional, or physical activity that used to be no problem to cope with.
- Depression common and seems to make other symptoms worse.
Since no specific tests are available practitioners diagnose CFS only by ruling out other possible causes of the fatigue (Chaitow, 2001; Dellwo, 2013). Many health problems can cause fatigue and most people with fatigue have something other than CFS to which it can be attributed. There was nothing apparent in her life that had changed that would have caused this fatigue. After nearly nine months under care of her family physician (an Internist) without any progress she chose to select a sports chiropractor specializing in nutrition. A second blood study was done since her family doctor had only ordered a CBC (complete blood count) and reported, “Everything within normal limits.” This time the new CBC, thyroid and metabolic panel, urine sample, Ragland’s test, trace mineral analysis (Wilson, 1998), and muscle tests were all analyzed.
In addition, a food journal of every two weeks was to be completed by the patient. These were all analyzed and a CFS diagnosis was confirmed. However, several factors were involved with making the diagnosis.
- The blood test showed hypothyroid function – low thyroid hormone output production. Her TSH score was 15.02 far above the laboratory “normal” reference range and her Free T4 (thyroxine) test was abnormally low.
- Ragland’s test was border-line the three times it was done, alerting the researchers to an Adrenal involvement.
- Her zinc was low, as well as her iron and B12. Her blood sugar was out of balance, on the high side, (although still within a normal reference range by the laboratory test standards), her manual differential or detailed white blood cell count was not optimum, including her Bands tests which were elevated.
- The erythrocyte sedimentation rate was also slightly high giving an indication of possible inflammation in the body.
- The Trace Mineral Analysis (hair analysis) showed high calcium, low magnesium, low potassium, and low sodium. Zinc and iron were both low and the remainder of the minerals were within normal range. Finding of the potassium and sodium were indicative of a Thyroid/Adrenal imbalance with the thyroid being in a hypothyroid state and the Adrenal in a hyper-adrenal state. The calcium being high indicated it was not being utilized in the normal metabolic pathway. Her magnesium being low indicated the muscles were not getting sufficient nutrients to provide needed energy for running and physical activity (Teitelbaum,1995; Wilson, 1998).
- Her urine tests were negative.
Since there is no specific treatment protocol for CFS many of its symptoms must be treated individually. Each of the deficiencies could be addressed naturally and relatively quickly with her cooperation. The tests were certainly reason enough to consider nutrition as a starting point (Eck, 2014; Teitelbaum, 1995; Wilson, 1998). As a result of the researchers’ findings a letter was written to her Internist/GP to explain the intentions in the change of her diet, exercise, sleep, and eating schedule. Our patient was cognizant and informed that a short period of trial and error may be necessary, because no single combination of nutrients works for everyone (Mateljan, 2007; Rosenberg, 1974). In this case, enough athletes had presented with similar loss of energy and fatigue to indicate the direction of treatment (Mateljan, 2007; Pitchford; 1993; Rosenberg, 1974). Better sleep habits were another change that had to be made. She was instructed to go to bed by 8 PM for two weeks then 9 PM afterward. This was a real positive change. Getting regular sleep and gentle exercise can be a problem due to the fatigue factor but in her case she was started with a brief session of 15 minutes of meditation and 15 minutes of Tai Qi each day and the sessions were increased each week by five minutes each. Probably the most important factor of all was diet and lifestyle (Eck, 2014, Rosenberg, 1974). The researchers continued making slight changes each week, especially with supplementation, exercise, and food.
She had gotten into the habit of staying up late, not eating breakfast (just a cup of coffee), and catching an early lunch with the gang at a local grill then going from work to the Pub for a few beers.
She had gotten caught in a cycle of frustration, anger, and depression at not being able to do her Olympic training. The group she was hanging around with at the office was not athletes but weekenders; heavy drinkers that watched athletics and talked about what they used to do. She soon realized the difference and the group with which she wanted to be involved.
Again, it can be pointed out, scientists do not know what causes CFS or Fibromyalgia for that matter. Yet, some people develop CFS after having a viral or bacterial infection, such as the flu, some after a trauma, such as a sports or car accident (Dellwo, 2013; Eck, 2014) but there is no evidence to prove either link in this case. Other theories point to the immune system, the nervous system, muscular system, glands, hormones, and family history. But again, there was not enough evidence to prove any of these connections conclusively (Dellwo, 2013; Eck, 2014).
The athlete reported having a training ‘incident’ but not a real accident a few years prior. She hurt her lower back that restricted her workouts for about 6-8 weeks but nothing requiring imaging, radiographs, scans, or a special visit with the family doctor. The CFS symptoms however, did begin a few months after the incident but she never made the connection.
With the multiplicity of symptoms and the various components it is apparent the individual ability to function normally became sabotaged, due to a cellular toxic overload causing further mental, physical and emotional stress, and fatigue (Mateljan, 2007). When the brain is stressed and fatigued it cannot transmit normal nervous system responses and the entire body suffers fatigue and the neurochemical or neurotoxic response becomes unstable and unpredictable (Pitchford, 1993; Rosenberg, 1974). This is where intervention from a practitioner trained in nutritionmay be consulted. This type of expertise is needed when the digestive and nervous system do not respond normally, the biological breakdown of the required nutritional components and the individual begins to develop deficiencies (Bittman, 2014; Pitchford,1993). This was the point where the researchers found the athlete. She was beginning to hit the depression and fatigue skids daily for over six months and could not seem to climb out.
At this point, the researchers recommended the special holistic program previously mentioned; diet, Tai Qi, etc. Here it must be pointed out, this nutritional program will challenge the body systems including the brain to regenerate and rejuvenate those synapses in the brain that will allow the organs to receive a more clear and unconditional response (Bittman, 2014; Pitchford, 1993).
These integrative management procedures allowed the body the proper fuel to each cell and tissue while the biochemical and biomechanical repair and rejuvenation occurred with the body systems. Thus, allowing the patient the physical and mental ability to utilize the boost in adrenal and thyroid balance to occur provided by the added nutritional support (Standard Process-MediHerb, 2013).
The supplements utilized by this clinical team is one of the oldest and most stable organic food farms in North America and backed by 100 years of research and service to the healing arts professions (Standard Process-MediHerb, 2013).
The stresses and strains of life take a toll on the body even if in good general health as was the athlete. When they (athletes) are afflicted with CFS, it is even worse because the athletes are used to a body and mind that responds quickly when under demand. Whole foods and phytochemicals can help the corrective process by providing sound natural nutritional support during those highs and lows that the body will experience during repair and recuperation; also restoring normal energy to the body while repairing the cellular matrix that has begun to erode in most individual cases (Bittman, 2014; Pitchford, 1993; Standard Process-MediHerb, 2013).
The researchers followed this protocol for six months to see if the CFS patient responded favorably. There were chances that it may take longer to get total remission depending on the systems affected. First, there was a most important 10-day detoxification, consuming only fresh fruit and vegetables; no alcohol, tobacco, sugar, white foods (excessively processed), or drugs.
Second, drink only fresh, clean water and herb tea. After the 10 days, fish protein was added to the diet and the following regiment of supplements would be followed for 30 days before any additional changes.
There were other supplements added and some subtracted; it is a continual rebuilding process during the months of managing a case of CFS with an athlete. The above list is a basic example given of what the athlete had a need for (deficiencies) in the blood; hair analysis, and her Ragland’s kept improving each time it was taken. These will change as the body requirements shift. The body condition may require more than these nutritional elements to get past the pain and inflammation involved in the muscles (Bittman, 2014; Pitchford, 1993, Standard Process-MediHerb, 2013). If that occurs, referral to a specialist may be necessary for a few weeks to help manage the pain and inflammation. However, this is unusual.
In many cases there has to be a simultaneous management of the athlete’s pain problems while getting the nutritional elements built-up in the individual. The pain must be cared for and treated. In this approach research has found integrative health care to be very efficient. While traditional Chiropractic is a natural healing arts tool it may not be the only technique to use with a case such as this due to the pain and fatigue factor. Acupuncture, Laser therapy, Massage, and the muscle techniques such as Applied Kinesiology (Cuthbert, 2013) and Active Release Technique (ART) may be considered as a starting point for pain treatment. As the athlete progresses with the muscle pain on the VAS scale from a 9-10 down to a 7-8 any of the healing arts techniques then could be employed.
This combination of integrative care is used for the next several months until the pain level decreases to a 4-5 level on the VAS and Nutritional Risk Screening (NRS) (Kondrup, 2002) before most can be managed by nutrition alone.
There is no doubt Chronic Fatigue Syndrome, after years of pharmaceutical management, can cause doubt and frustration. For years medicine even refuted the existence of the condition and CFS was placed with Fibromyalgia, as a medical mystery (Dellwo, 2012, 2013). However, after admitting success by numerous physical medicine specialists, chiropractors, acupuncturists, and others; the medical profession now invites help with management of such cases.
The discussed case is that of a 32 year old, female athlete (long distance and marathoner), who had been suffering with CFS for over six months and came in for consult and treatment. First, an athlete rarely complains with fatigue. Second, in this case she had changed living and work locations, and third, researchers were later told of the breakup with her boyfriend. Lastly, there was a drastic change in eating pattern. She went from a good eater to a fast food junkie, much more alcohol and a poor sleep pattern emerged after moving and breaking up with her boyfriend.
Within five months after changing several lifestyle habits along with the diet, she was able to climb back out of the hole she had dug for herself, moving to a new job and friends in Atlanta. She felt like working out again and got back into a regular healthy exercise, sleep and dietary regime. Although missing her Olympic opportunity, she was pleased to get back to a normal life.
The outline given in this article is a good basic beginning for the successful management of a case of Chronic Fatigue Syndrome. The author feels a CFS case cannot be successfully managed without a sound nutrition program as a foundation.
I wish to thank the Standard Process-MediHerb Company of Palmyra, WI for providing an inexhaustible amount of educational and research material for this article.
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