Chronic Fatigue Syndrome

Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS), is a severe, complex, acquired illness with numerous symptoms related mainly to the dysfunction of the brain, immune and endocrine systems.

The causes of ME/CFS are not yet clearly defined, however, onset most frequently follows an acute viral infection. ME/CFS may also be triggered by physical trauma, such as major surgery or a serious accident or exposure to chemicals, pollutants, heavy metals or immunization. In some cases symptoms occur within days or weeks of a triggering event while other people experience a gradual onset of the illness. It affects people of all ages and ethnic groups and the illness will last for at least six months (three months is common for children).

SYMPTOMS
The main symptoms of ME/CFS are as follows:
• Persistent or recurring, unexplained mental and physical fatigue that substantially reduces normal activity levels.
• Post-exertional malaise. Following physical and mental exertion there is a worsening of symptoms that may be delayed 24 hours or more and recovery after activity is slow.
• Dysfunctional sleep. Unrefreshing sleep, inability to fall asleep, excessive sleep, frequent awakenings, restless legs, and abnormal sleep rhythms.
• Pain. Burning, aching and shooting pain in muscles and/or joints, headaches of a new type and severity, widespread tenderness.
• Cognitive problems, e.g. brain 'fog'; problems with processing and recalling information; difficulty with finding the right word, reading, writing, mathematics and short-term memory; losing track of things; forgetting names; disorientation; inability to concentrate on more than one thing; trouble with decision-making; perceptual and sensory disturbances.
The person will have at least three of these five main symptoms, which will always include fatigue and cognitive problems.
Other symptoms may include:
• Light-headedness on standing
• Disturbance of balance and clumsiness
• Sensitivity to light, touch and sound
• Nausea and/or gastrointestinal and urinary problems
• Sore throat and/or tender lymph node
• New sensitivities to foods, medications and/or chemicals
• Intolerance to temperature changes; e.g. sweating and feverishness and/or cold extremities
• Marked weight change-anorexia or abnormal appetite
• A worsening of symptoms with stressors, e.g. new infection, travel, anaesthetic.

TREATMENT OPTIONS
Consult your Doctor for an accurate diagnosis and treatment. There is no known cure for ME/CFS as yet, however there is much that can be done to improve quality of life. Recovery rates vary in individuals. People diagnosed with the condition can generally expect to be unwell for some years. Early diagnosis may lessen the impact of the illness. The outcome is often better for children than adults.
Inform yourself as much as possible about ME/CFS and pace your physical and mental activities throughout the day. Rest as needed and be aware of how any new medication or therapy is affecting you.
Practices such as yoga promote good body mechanics and improve balance. Ask your Doctor about sleep hygiene practices that may help to improve sleep quality. Any treatments or self-help techniques must address the underlying biological factors of your illness. Some alternative therapies such as massage, hydrotherapy and acupuncture can have remedial benefits. Always consult your Doctor before trying any new therapy.

Useful information on the condition can be found in the Canadian Consensus document - A Clinical Case Definition and Guidelines for Medical Practitioners. This is available on http://www.mecfs.org.au/information.html You may wish to show this to your Doctor.

DIET HINTS
• Eat a balanced, nutritious diet of fresh food and eat meals at regular times.
• Adequate daily intake of fluids is essential. Try to drink 8 glasses of water each day.
• Your diet should include fresh vegetables and carbohydrates with a low glycaemic index such as pasta, legumes (except broad beans) and wholegrain breads and cereals. Low fat protein e.g. lean meat, chicken, fish etc, is recommended along with small amounts of healthy fats from nuts and seeds, fish and vegetable oils.
• Avoid highly refined foods such as cakes, pastries, confectionary and sugary drinks. Limit additives and processed foods. Avoid alcohol and caffeine.
• Avoid foods that are not well tolerated i.e. foods which cause bloating, nausea, diarrhoea or constipation.
• Your Doctor may refer you to a Dietician for specialist advice.

VITAMINS/MINERALS/HERBS
Use supplements only after first checking with your doctor. Nutritional supplements may only be of value if your dietary intake is inadequate and one multivitamin is often sufficient.
• Valerian, calcium and magnesium salts, or aromatherapy can be useful for sleep disturbance. Only those without chemical sensitivities should try aromatherapy.
• St John's Wort may be effective in mild depression but should not be used for marked depression or taken with other antidepressants.
• Lavender and thyme essential oils may be helpful for relieving anxiety.
• Echinacea is traditionally used for infectious conditions and is thought to stimulate the immune system.
• Wild oregano and olive leaf extract may also have antiviral effects.
• Panax ginseng and Siberian ginseng are herbs thought to increase stamina, reduce mental fatigue, support the adrenal glands and improve mood.
• Zinc is important for thymus gland function (involved in immune system regulation) as well as cellular immunity. It is also important in viral infections.
• Vitamin C and bioflavonoids are thought to have an anti-viral activity and enhance white cell function. Vitamin C may also aid recovery from viral infection and support the adrenal glands.
• Selenium and Coenzyme Q10 are antioxidants important in energy production.
• Magnesium and potassium may improve symptoms of muscular weakness, fatigue, nervous depletion and adrenal gland function.
• B group vitamins may improve fatigue and symptoms of nervous debility.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints and consider taking the supplements in this topic.
2. Ask your Pharmacist if your medication may be contributing to your symptoms.
3. Avoid stress and have adequate rest and relaxation.
4. Quit smoking. Ask your MedAux Pharmacist for advice. Smoking places a burden on your general health and may contribute to fatigue.
5. Avoid drinks containing caffeine such as coffee, tea, energy drinks and cola. Caffeine may interfere with energy levels.

REFERENCE SOURCES
• Canadian Consensus document - A Clinical Case Definition and Guidelines for Medical Practitioners. 2003
•South Australian ME/CFS Management Guidelines for General Practitioners.
Both of these are available at http://www.mecfs.org.au/information.html