Dr. Stephen Kaufman
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Fatigue The following paper is an in-depth discussion of various
types of fatigue.
SYNDROMES: DIFFERENT MANIFESTATIONS AND NUTRITIONAL TREATMENT
c.1996. Stephen J. Kaufman, D.C.
The contents of this paper are not intended to be used in the diagnosis
or treatment of disease but are for educational purposes only.
Individuals should not attempt self treatment but should discuss
possible therapeutic options with their own doctor, preferably one who
is nutritionally well-informed.
is a specialty within the chiropractic profession known as applied
kinesiology. By utilizing in-depth history, examination and treatment of
gland and organ functioning, it is possible to greatly improve
metabolism in chronic fatigue syndromes. Many of the symptoms, including
fatigue, headaches, sore throat, joint and muscle pain, insomnia,
digestive disorders, and even cognitive impairment can be substantially
helped. This is done with physical treatments which include many
different types of acupressure, spinal and cranial manipulation, trigger
point and myofascial therapy, and aided by nutrition.1
individuals suffer from severe fatigue with various other accompanying
symptoms. Depending upon these other symptoms, treatment may progress
along different lines. It is possible to have several patients meeting
the CDC diagnostic criteria for Chronic Fatigue syndrome show very
different symptom presentations. Proper treatment for one patient may
even worsen another. It has been argued that only 10% of the patients
presenting with chronic fatigue actually have Chronic Fatigue Syndrome 2.
Even within a group of patients who meet the C.D.C. criteria for CFS 3
there is a wide variability in terms of severity of disease and response
to treatment. The term "Chronic Fatigue Syndromes"
may be more appropriate, with the term "Chronic Fatigue Immune
Deficiency Syndrome" being reserved for those patients showing more
pronounced signs of viral infection (such as swollen lymph nodes),
immune disorders, and neuropsychological deficits. Following are some of
the main areas to examine, along with current nutritional treatments.
Sudden onset, especially following a viral infection or flu.
Patients with this history are more likely to have a syndrome of
infectious origin and treatment may be directed towards anti-infectious
measures and immune system support, such as vitamin C, beta carotene,4
thymus extract,5 calcium lactate,5 L.E.M.,
U.D.G., golden seal,6 echinacea,6 astragalus
formulas, and adrenal tissue extract.5 Some of these patients
continue to get frequent colds and respiratory infections which can
often be avoided with adequate nutritional supplementation, including
Chinese herbal compounds such as Yin Chao, Gan Mao Lin, and turmeric,
and vitamins A, C, B complex, etc. Chronic sinus and bronchial
conditions can also be effectively addressed with botanical
preparations, including bromelain.7
the other hand, the patient may give no history of their illness being
preceded by a flu. There may be a sudden emotional trauma in the
history, however, and this may need to be addressed. An ongoing
emotional trauma would tend to shift the diagnosis more towards
depression than Chronic Fatigue Syndrome; this is sometimes a diagnostic
the onset was sudden but followed a severe physical trauma such as an
auto accident. This may indicate neuromusculoskeletal damage to the
spinal column. Chiropractors and osteopaths frequently help such cases.
the illness was not preceded by a viral infection, then anti-infective
measures may not be effective and other methodologies should be
Hypoglycemia. Many people with Chronic Fatigue Syndromes are
hyper -sensitive to sugar intake and improve considerably when sources
of sugar, glucose, honey, dextrose, maple syrup, dates, fruit juices,
soda, etc. are removed from their diet. Fatigue, sleep disturbances,
severe emotional reactions such as anxiety and depression, headaches,
brain fog and spaciness, weakness, exercise intolerance, multiple muscle
and joint pains, and digestive disturbances are frequently
brought on by excessive sugar intake (including juice, dried fruit, and
fruit), and may improve greatly when sugar is restricted. 8,,9 Whether
a person's blood sugar is actually low or they have a food sensitivity
reaction to sugar is a question of semantics.
which may help a person combat their craving for sweets include
l-glutamine, chromium, and the B vitamins, especially B1 and pantothenic
refined carbohydrate intake may also perpetuate a patient's lowered
resistance to infection, especially candida infection.8,10
Yeast infection. Many patients with yeast overgrowth or
candidiasis present symptoms of Chronic Fatigue Syndrome. If candida is
a prominent factor, the patient will also tend to have digestive
problems such as bloating or diarrhea, urinary or vaginal infections,
and a history of extensive antibiotic, birth control pills, and/or
steroid usage.10,11 Treatment in this case would emphasize
anti-fungal measures such as caprylic acid, undecyanic acid, oregano,
thyme or peppermint oil, pau darco, paramycocidin (citrus seed extract),
echinacea, golden seal, strong acidophilus preparations, tannic acid
products, etc.2,4,6,7,8,10,11,12 Treatment must also include
a low sugar, low mold, low yeast, diet. 8,10,11 Sugar in the
intestinal tract encourages the growth of yeast, and the presence of
yeast and molds in food may produce a cross-sensitivity allergic
Food allergies. Many patients may have sensitivities to various
foods which cause severe fatigue as well as some of the other symptoms
of CFS such as headaches, severe lack of concentration,
neuropsychological complaints, sore throat (pharyngitis), muscle
weakness and joint pain.8,12,13 In my experience eliminating
suspected food allergens will produce at least some symptomatic
improvement in most patients. Food allergies can be determined by blood
tests such as R.A.S.T. and cytotoxic testing, kinesiology or simply
eliminating all suspected foods, and then reintroducing them one at a
time. A strong symptom or reaction may indicate a food sensitivity. Any
food or spice or seasoning agent can be allergy provoking, and it may
take some extended detective work and a lot of patience to determine all
of a patient's allergens. The most common food allergens are wheat,
milk, eggs, coffee corn, chocolate, yeast, sugar, and citrus but again, any
food or seasoning may be a culprit.
avoidance is usually best, some patients can reduce their sensitivity
reactions to foods by the use of certain supplements. Digestive aids
such as hydrochloric acid, pancreatic enzymes, plant enzymes, and
bromelain may more completely break down a substance in the intestinal
tract so it doesn't produce an allergic reaction. Vitamin C, quercetin,
bromelain, and pantothenic acid may have anti-inflammatory effects and
reduce allergic reactions.8
Chemical and environmental sensitivities, and heavy metal toxicity.
Patients may also be environmentally sensitive ,i.e. they are allergic
to chemicals, perfumes, odors, cleaning agents, etc. in their
environment. These patients may require strict avoidance of chemical
exposure, and high intake of certain nutrients such as vitamin C,
quercetin, enzymes, alkalinizing salts, selenium, Vitamin E, etc. to
reduce allergic reactions.4,8,10,12 Detoxification programs
such as enemas and fasting, and chelating nutrients such as methionine,
chlorophyll, and pectin , used under a doctor’s supervision may be
Chronic digestive disorders and malabsorption syndromes. Patients
with candida overgrowth frequently have bloating or other digestive
problems and may require anti-candida measures. Low hydrochloric acid
levels are a special concern in patients with fatigue and digestive
problems since they may have trouble properly absorbing many nutrients,
especially iron, protein, zinc, calcium, magnesium and other minerals.5,13,14
Hydrochloric acid supplementation with betaine hydrochloride may be very
helpful and should be considered, but may not be indicated in patients
with any signs of an ulcer or gastritis. They should seek knowledgeable
medical advice first.
Anemia. Most physicians will readily run a complete blood count
in any case of fatigue to rule out anemia. However some common types of
anemia may not show up on a routine C.B.C. A total serum iron may reveal
low levels of iron even in the presence of a normal hematocrit. A serum
vitamin B12 level may reveal low levels of B12 in the presence of a
normal MCV. Either of these can cause fatigue. B12 levels may be very
difficult to raise with oral supplementation alone, and B12 injections
may be required. Supplemental iron may be required, but should be
obtained form a non-constipating source. As mentioned above,
hydrochloric acid tablets may be required to insure absorption of iron
and other minerals.
Adrenal insufficiency. Chronic fatigue frequently has its roots
in mild to moderate adrenal insufficiency. Adrenal hypofunction has been
described for many years as consisting of fatigue, joint pains,
especially knee and low back, headaches, tendencies towards allergies
and frequent respiratory infections, and possible sleep difficulties. 5
Treatment may consist of adrenal glandular extracts, DMAE, herbal
compounds such as licorice and ginseng, and high doses of pantothenic
acid and vitamin C. 2,4,5,6,7,14,17,19,22(Licorice should be
used cautiously for a period no longer than six weeks, and blood
pressure monitored, since its use may elevate blood
pressure.)Additionally, there are numerous reflex points which, when
treated by chiropractic applied kinesiologists, seem to give good
Hypothyroidism. Even though a patient's blood tests for thyroid
function fall into the normal range, he or she still may be hypothyroid.21
Possibly the thyroid simulating hormone is elevated, indicating that the
body is artificially raising low thyroid hormone levels. One currently
used test is measuring axillary temperature (under the armpit), first
thing in the morning before arising. A normal temperature is 97.8° to
98.2°. Many patients show a lower body temperature, and may be helped
by a course of natural thyroid medication. Supplementation with
ribonucleic acid , iodine ,or essential fatty acids such as flax seed
oil may also be considered. Thyroid syndromes may involve a patient who
feels cold all the time or has cold hands and feet, coarse or dry skin,
and has a lot of hair falling out. They may also be susceptible to
Depression. Many patients with CFS may be depressed, and many
depressed patients are very fatigued. It is sometimes very difficult to
differentiate diagnostically between the two, especially since
pharmaceutical anti-depressants (SSRI's such as Prozac) may also aid CFS
symptoms. Sometimes depression is situational and related to life's
external events; this is usually obvious and may call for emotional
support or psychotherapy. Endogenous or biochemical depression, even
when it occurs due to difficult events in one's life, will frequently
respond to herbal or nutritional supplements. These include the amino
acids l-phenylalanine, tyrosine, acetyl-l-carnitine, and SAMe (S-adenosyl
methionine), vitamins C, B1, B2, niacin, folic acid, B6, B12, Omega 3
essential fatty acids as found in flax seed oil, evening primrose oil,
garum amoricum, melatonin, DMAE, DHEA, selenium, small doses of
elemental lithium, rubidium, and botanical preparations such as ginseng,
St. John's Wort, ginkgo biloba, forskohlii extract, ashwaghanda, kava
extract, vincomine, buplureum, etc.2,4,6,7,8,9,13,14,15,16,17,18,19,20
(Phenylalanine may elevate blood pressure in patients susceptible to
hypertension, so its use should be carefully monitored.) A diet high in
sugar, and ,paradoxically, a diet too low in complex carbohydrates may
exacerbate or even cause depression. 13Regular exposure to
sunlight of at least an hour a day and regular aerobic exercise are
medically accepted treatments for depression, and some studies show them
to be as effective as anti-depressant medications. (Just like your
mother used to say). There are numerous physical techniques used in
applied kinesiology that have a marked anti-depressive effect.
Fatigue, insomnia, and sleep disturbances . It is important to
determine a patient's sleep pattern in CFS. Some patients sleep a great
deal, nine to twelve hours a night. These patients may profit from
natural stimulants such as adrenal extract, large doses of various B
vitamins, especially folic acid, B12, niacin, pantothenic acid, and B1,
vitamin C, panax ginseng, Siberian ginseng, magnesium and potassium
aspartate, evening primrose oil, pau darco, DMAE, pyroglutamate, green
tea, 1-glutamine, gotu kola, co-enzyme Q10, malic acid, etc. I have
routinely found that chiropractic manipulation is useful in stimulating
the sympathetic nervous system in patients who sleep excessively,
enabling them to regain a normal sleep pattern. Patients frequently
decrease their need from 12 to 8 or 9 hours of sleep as the quality of
sleep improves. Attention is also given to stimulating acupressure
reflexes for the adrenal, thyroid, and pituitary glands, and removing
restrictions and enhancing circulation.
patients, however, have insomnia and do not get adequate sleep. This may
be due to many factors, including consumption of caffeine (including
cola and chocolate) or nicotine, high sugar intake, noisy sleep
environment, nocturnal urination, worry, late night violent television,
etc. Many patients just can not sleep well; they either have trouble
falling asleep, or wake up after several hours and cannot get back to
sleep. They are consequently very fatigued due to lack of sleep. These
patients should not be treated with stimulants as they may worsen the
existing sleep pattern and make it more difficult to sleep. Supplements
taken at bedtime to deepen sleep include 5 Hydroxytryptophan,
niacinamide, kava root extract, melatonin, calcium, magnesium, potassium
e.g. Liquid K, inoositol, schizandra, valerian, and other herbal
preparations. Frequently, improving a patient's sleep patterns and
deepening their rest will enhance and restore their energy, and improve
their mood. Giving them stimulants may interfere with this process. I
feel it is imperative to ascertain a patient's sleep pattern and correct
it, if it is inadequate.
Cognitive Enhancement: mental clarity, lack of concentration,
mental fog, and "spaciness". This can be a terribly
frustrating symptom in CFS, and one which elicits very little sympathy
from friends. It is a common occurrence with hypoglycemia, and reducing
refined carbohydrates and more frequent feeding may help.
1,2,4,8,9,12,13,14 The patient should eat breakfast, lunch and
perhaps mid-morning and mid-afternoon snacks. This sometimes makes a
dramatic difference, if they're going too long without eating. It has
been hypothesized that candida patients have high levels of blood
aldehydes, causing increased ammonia levels. 10,11 This may
contribute to a mental fog. This may be helped by supplementation with
alpha keto glutaric acid and/or pantethine.8 Hydrochloric
acid tablets may also help, both by improving digestion and by
acidifying the patient.5 Food allergies are frequently a
factor and many patients get very spacey when eating certain unsuspected
foods.8,12,13,19 B vitamins, Vitamin C, boron, acetyl-l-carnitine,
DMAE, pyroglutamate, Kyo-Green, ribonucleic acid, choline,
phosphatidylserine , and herbal preparations such as gotu kola, ginkgo,
ginseng, and vincamine have been shown in various studies to improve
concentration, memory, mental skills, and learning aptitude. 7,9,12,14,15,16,17,18,19,20
These substances may increase circulation and oxygen to the brain
and enhance nerve function. (Some patients may have difficulty
converting the B vitamins to their active form in the body and may
require the nutrient in phosphorylated form, e.g. pyridoxal-5-phosphate
in the case of B6 ). Coenzyme Q10 and ayurvedic rasayana preparations
are other supplements that many people report improvement in mental
clarity from taking.
techniques such as cranial sacral therapy, acupressure, applied
kinesiology, chiropractic manipulation, and other muscle techniques may
improve circulation to the brain, helping to increase oxygenation and
remove toxins. Patients frequently report a marked improvement in mental
clarity after these treatments.
Exercise Tolerance. Undue fatigue after physical exertion
frequently occurs with CFS. This may be caused by a buildup of blood
lactate, and aided by high doses of thiamin 19 or Vitamin C,
and a high water intake. Obviously, patients should be encouraged to
exercise. However, the doctor needs to question athletes complaining of
fatigue. Over-training in the athlete (anywhere from 6 to 30 hours a
week) will usually cause fatigue and/or sleep disturbance. The athletic
patient needs to be cautioned about the potential damage this can do in
the long run.
Medication. There are numerous medications which can cause
fatigue as a side effect, either by prescription or self administration.
Any doctor confronted with a fatigued patient needs to know all the
medications and supplementation a patient is on. One of the side effects
of high doses of Vitamin A is extreme fatigue. The use of alcohol,
marijuana or other intoxicants may also result in excessive tiredness.
Other diseases may have severe fatigue as a symptom, especially
heart, lung, liver and all forms of cancer. A patient should always seek
proper professional help to rule these out.
is important to thoroughly consider all of the patient's symptoms in
order to administer effective treatment. A comprehensive history is
essential, although many doctors fail to do this. Chronic Fatigue
Syndrome can be a devastating disorder with a wide variation in
patients’ symptomatology . The basic concept behind nutritional
therapy is a willingness to try a wide number of nutritional remedies as
long as they are non-toxic. Persistence and perseverance on the part of
both patient and doctor may be necessary to attain any improvement. A
nutritional program closely tailored to the individual will frequently
produce substantial improvement in Chronic Fatigue Syndromes.
author has treated over 400 patients with various Chronic Fatigue
Syndromes since 1980, with nutritional and botanical therapies,
including Chinese herbs, acupuncture with and without needles, applied
kinesiology, and various chiropractic and cranial sacral therapies.
Special emphasis has been placed on the cognitive disorders present .
The majority of patients have improved considerably.
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15.Carper, Jean. Food: Your Best Medicine. Harper books.1993.
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22.Shealy, C.Norman. M.D., Ph.D. Miracles Do Happen. Element Books. 1995.
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