Dr. Stephen Kaufman                                                                                      

Denver, CO.                                                                                                   

(303) 756-9567


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Fatigue The following paper is an in-depth discussion of various types of fatigue.



Note: 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.

There 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

Many 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.

(1)      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

On 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 conundrum.

Occasionally, 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.

If the illness was not preceded by a viral infection, then anti-infective measures may not be effective and other methodologies should be emphasized.

(2)      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.

Supplements which may help a person combat their craving for sweets include l-glutamine, chromium, and the B vitamins, especially B1 and pantothenic acid.8,9

High refined carbohydrate intake may also perpetuate a patient's lowered resistance to infection, especially candida infection.8,10

(3)      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 reaction.

(4)      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.

Although 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

5) 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 extremely helpful.

5)       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.

(6)      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.

(7)      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 symptomatic improvement.1

(8)      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 frequent colds.

(9)      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.

(10)    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.


Some 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.

(11)    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.

Physical 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.

(12)    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.

(13)    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.


(14)    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.


It 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.

(This 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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2.Whitaker, Julian. M.D. Dr. Whitaker’s Guide to Natural Healing. Primapress.1995.                                                                                           

3.Center for Disease Control. The facts about chronic fatigue syndrome.1995.                                                                                    

  4.Murray, Michael. N.D. Encyclopedia of Natural Medicine. Prima press.1991.                                                                                                    

  5.Lee, Royal . D.D.S. Therapeutic Foods Manual and Product Bulletin. 1950.                                                                                                        

 6.Murray, Michael. N.D. Healing Power of Herbs. Prima press.1995.     7.Werbach,Melvyn, M.D. and Murray, Michael. N.D. Botanical Influences on Illness. Third Line Press.1994.                                                   

8. Atkins , Robert. M.D. Dr. Catkins’ Health Revolution. Bantam.1990. 

9.Davis, Adelle. Let’s Get Well. Signet.1970.           

10.Crook,William.M.D. The Yeast Connection. Professional books.1985.                                                                                              

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12.Phillpott, William. M.D. Brain Allergies. 1980.                         

13.Wright, Jonathon. M.D. Dr. Wright’s Guide to Healing with Nutrition.Keats.1984.                                                    

14.Werbach,Melvyn. M.D. Nutritional Influences on Illness. Keats. 1993.                                                                                                          

15.Carper, Jean. Food: Your Best Medicine. Harper books.1993. 

16.Hendler, Sheldon. The Doctor's Vitamin and Mineral Encyclopedia. Proteus. 1990                                                                  

17.Dean, Ward M.D. and Morganthaler,John. Smart Drugs and Nutrients. Vol. 1 and 2. Health Freedom,1993.                                  

8.Pelton, Ross. pH D. Mind Food and Smart Pills. Doubleday, 1989. 

19.Newbold, H. L. M.D. Meganutrients for Your Nerves. Berkeley Books.1975                                                                                                

20.Pearson, D. , Shaw, S. Life Extension: A Practical Scientific Approach.WarnerBooks,1982.                                                            

21.Barnes, Broda. Hypothyroidism, the Unsuspected Illness. 1979. 

22.Shealy, C.Norman. M.D., Ph.D. Miracles Do Happen. Element Books. 1995.


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