Chronic Fatigue

Paul L. Reller L.Ac. / Last Updated: August 03, 2017


Information Resources and Links to Studies

  1. A 2007 article from Johns Hopkins University School of Medicine, Division of Infectious Diseases, suggested that the chronic fatigue syndrome frequently called Chronic Lyme's Disease was not a syndrome of prolonged infection with spirochetes, but rather a syndrome of complex neuroendocrine immune dysfunction that should be called post-Lyme Disease Syndrome to guide a more appropriate treatment protocol. These experts suggested that prolonged antibiotic use was perhaps a cause, within a set of causes, of the syndromes of chronic fatigue, musculoskeletal pain and neurocognitive dysfunction that is frequently seen:
  2. A 2010 statement by the American Lyme Disease Foundation suggests that the use of a prolonged antibiotic regimen to treat so-called "Chronic Lyme Disease" is not based on scientific evidence and has been shown to be harmful and without benefit:
  3. A 2010 study in Great Britain found that a single short course of antibiotics cured Lyme disease in early stages in about 95% of cases, with only about 5% requiring a second course. No clear cases of chronic Lyme disease were found in the study. The symptoms of early Lyme disease are a moving red rash, sometimes seen with a central irregular spot and a red circle around it (Erythema migrans), seen in 91% of cases, systemic symptoms of ache and fatique in 62%, headaches in 31%, joint pain or joint inflammation in 28%, peripheral neuropathies with nerve root inflammation (radiculitis) in 11%, and cranial nerve palsies (usually facial paralysis, often misdiagnosed as Bell's Palsy) in 4.6%:
  4. The U.S. Dept. of Health and Human Services / National Institutes of Health outline the studies of long-term oral and intravenous antibiotic therapy for patients with a confirmed Lyme disease, which show limited or no benefits with a high percentage of serious adverse health effects:
  5. A 2010 study by DePaul University Center for Community Research found that only 40% of medical textbooks even mention Chronic Fatique Syndrome, and of these, content related to CFS was presented on only 0.09% of pages. Of the 129,527 pages of medical information reviewed, only 116 pages had information on chronic fatique syndromes, suggesting that Medical Doctors have virtually no medical training in this field:
  6. A 2013 article in the Journal of the American Medical Association outlines the findings that statin drugs often produce fatigue:
  7. A 2009 study at the Maes Clinic, Antwerp, Belgium, found that one mechanism by which statin drugs produce chronic fatigue, besides the negative effects on muscle function, is the inhibition of CoQ10, which plays a key role in Chronic Fatigue Syndrome, or Myalgic Encephalmyelitis, causing both fatigue and autonomic and neurocognitive symptoms:
  8. A 2010 study showed that a decrease in mitochondrial production of ATP is an integral factor in Chronic Fatigue Syndrome, with a shift to utilization of a lactate energy metabolism explaining both fatigue and central nervous system dysfunction:
  9. A 2012 study at the Weill Medical College or Cornell University, New York, New York, U.S.A., found that both Chronic Fatigue Syndrome (CFS/ME) and Major Depressive Disorder (MDD) showed markers of oxidative stress, namely increased ventricular lactate, and decreased glutathione metabolism (GSH):
  10. A 2009 randomized controlled human clinical study of CFS/ME at Oxford University showed that a large percentage of cases involved a Mitochondrial Syndrome and accumulation of blood lactic acid, and that the degree of mitochondrial dysfunction correlated with severity of disease. This study showed that a test of 5 factors of ATP profile, which measured the the availability of ATP in neutrophils, the fraction complexed with magnesium, the efficiency of oxidative phosphorylation, and the transfer efficiencies of ADP into the mitochondria and ATP into the cytosol was very useful in diagnosing CFS/ME and distinguishing the Mitochondrial Syndrome:
  11. A 2006 study showed significant benefits from taking D-ribose supplement:
  12. A 2009 synopsis of mitochondrial disorders by experts at the Columbia University Medical Center, in New York, New York, U.S.A. shows that the genetic mutations that are linked are extremely varied, and that treatment options in standard medicine are very limited, with symptom alleviation, and radical and inconsistent pharmacological interventions that are experimental. Obviously, the integration of Complementary Medicine here is needed:
  13. A 2012 review of emerging evidence concerning mitochondrial diseases, by experts at the Newcastle University Institute of Genetic Medicine, in the UK, and Vanderbilt University in Nashville, Tennessee, U.S.A. shows that while serious mitochondrial diseases are thought to be rare, affecting more than 1 in 10,000, mild mitochondrial disease, or mutation, is seen in about 1 in 200 in the population, with epigenetic causes tied to environmental factors involved. Oxidative stress, or the accumulation of reactive oxygen species in cases of disease, injury or stress is also involved. The need for a holistic approach to both prevention and treatment is apparent:
  14. A 2015 study at the Griffiths University School of Medicine, in Australia, noted for the first time that various markers for immune dysregulation were seen in various subgroups of patients with CFS/ME, with IL-1beta reduced and RANTES elevated in moderate cases, and IL-7 and IL-8 significantly higher in severe cases compared to healthy subjects. Interferon gamma was also increased more in severe cases than moderate cases, implying that an array of chronic viral and bacterial LPS low-grade infections were involved. Obviously, the treatment needs both immune support therapies and clearing of a variety of potential low-grade infections. CIM/TCM is an ideal specialty to provide this care:
  15. A 2016 randomized controlled human study at Cornell University in the United States found that nearly all patients diagnosed with Chronic Fatigue Syndrome had lowered variety of gut bacteria in stool samples and evidence of chronic low-grade systemic bacterial infection with lipopolysaccharide endotoxins evident. In fact, 83 percent of the patients in the trial, could be diagnosed with these markers, and inclusion of complement therapies to restore the gut Microbiome, clear chronic low-grade bacterial infection, and resolve the superantigen response, could improve outcomes significantly:
  16. A 2014 meta-review of all high quality Randomized Controlled Human Clinical Trials (RCTs) of the various treatment protocols in Traditional Chinese Medicine (CIM/TCM) for Chronic Fatigue Syndrome (CFS/ME), published on the 6 main medical databases, by experts at the Beijing University of Chinese Medicine, Hebei University in Baoding, China, and UiT The Arctic University of Norway, found that TCM treatments are proven effective to alleviate fatigue in CFS/ME. The treatments studied involved Chinese herbal medicine, acupuncture, Qi gong, moxibustion and physiotherapy, and all of these are studied separately, but can be combined for greater effect in short clinical courses:
  17. A systematic meta-review of the comorbidity between CFS/ME and TMD (temporomandibular disorders), commonly called TMJ, by experts at Newcastle University and the National Health Service, in the United Kingdom, showed that 21-32 percent of patients diagnosed with Chronic Fatigue Syndrome reported a comorbid TMD, showing how physiotherapy and myofascial release could be valuable in the holistic treatment protocol:
  18. A 2014 study at the Korea Institute of Oriental Medicine, in Daejeon, South Korea, showed that the herb Psoralea corylifolia seed (Bu gu zhi) show much neuroprotective effect against toxicity that causes mitochondrial dysfunction:
  19. A 2014 study at China Medical University, and Asia University, in Taiwan, reviewed the top candidates for herbal treatment of mitochondrial disease, finding significant benefits from picrasidine and acerosisn, form Picrasma quassioides and Vitex negundo:
  20. A 2001 study showed significant benefits from taking a chemical antiviral related to D-ribose to reduce Epstein-Barr viral load:
  21. A 2006 study showed significant benefits from taking a common Chinese herb, licorice root, or Gan cao, in limiting EBV reproduction; the study demonstrates how herbs may have effects limited effects, but taken together in the proper formula, may have a complete synergistic therapeutic effect:
  22. A 2015 study at the Assam Medical College, in Assam, India, found that an alcohol tincture of Cassia seed (Jue ming zi) signficantly reduced symptoms of induced chronic fatigue syndrome in laboratory animals, as well as reducing malondialdehyde toxicity and catalase levels:
  23. A 2006 study showed significant benefits from the practice of external Qigong therapy in the treatment of Chronic Fatigue Syndrome:
  24. A 2013 study at the University of Hong Kong, Hong Kong, China, Centre for Behavioral Health, randomized 157 patients diagnosed with Chronic Fatigue Syndrome to either 5 weeks of Qigong training or a waiting list, as there is no placebo Qigong therapy. The conclusions, based on standard tests of fatigue, depression and anxiety, were that Qigong may by effective in reducing both chronic fatigue and depression for patient diagnosed with Chronic Fatigue Syndrome. A prior 2012 study also showed measurable improvement on telomerase activity, needed to preserve the ends of DNA strands, which is linked to improvement in chronic fatigue:
  25. A 2008 study showed that abnormal or defective adaptive responses to various metabolic stressors, especially oxidative stress, was integral to the easy physical and mental fatigue seen in CFS, and that adaptive regulatory proteins may be overexpressed in this disease due to a variety of stressors and poor adaptogenic mechanisms:
  26. A 2012 study at Yichun College, in China, found that acupuncture stimulation in laboratory studies significantly modulated measures of cellular and oxidative stress in relation to fatigue, with super oxide dismutase (SOD) and glutathione metabolism upregulated to clear and detoxify cells, and malonaldehyde, a known cause of chronic fatigue associated with various stressors, such as candidiasis and environmental toxins, downregulated in serum, compared to a control and model group. Such studies demonstrate the potential for acupuncture to help resolve chronic fatigue syndrome within a comprehensive treatment strategy:
  27. A 2015 randomized controlled study at the Korea Institute of Oriental Medicine of 4 weeks of acupuncture in the treatment of Chronic Fatigue Syndrome showed that this therapy provided significant benefits:
  28. A 2014 randomized controlled study of the effects of acupuncture stimulation on inflammatory markers of Chronic Fatigue Syndrome in China found that manual stimulation at just 3 points, DU20, DU4 and ST36, daily for 14 days, resulted in sustained modulation of interferon-gamma (IFN-gamma) and interleukin-4 (IL-4), inhibiting excess circulating levels in laboratory animals with induced Chronic Fatigue Syndrome:
  29. A 2015 controlled human clinical trial of acupuncture in the treatment of Chronic Fatigue Syndrome, with a less biased and more practical study design, by experts at the Korea Institute of Oriental Medicine, Kyung Hee University, Dongshin University, and Semyung University, all in Daejeon, South Korea, found that standard acupuncture treatment for 4 weeks involving 10 sessions improved fatigue symptoms for these patients:
  30. A 2008 study at the University of Oxford, in the United Kingdom, concluded that a short course of Cognitive Behavioral Therapy performed post-treatment in the care of patients with Chronic Fatigue Syndrome is effective in reducing symptoms:
  31. A 2011 meta-review of published scientific studies of Complementary Medicine by the University of Tromse, Norway, demonstrated the problems with evidence-based recommendations, as these researchers could only find 26 small studies published in the West related to CAM therapies and Chronic Fatigue Syndrome. Evidence of benefit existed for tuina, massage and qigong, integral parts of Traditional Chinese Medicine, but insufficient evidence was available for a variety of other therapies, including acupuncture and herbal medicine, showing neither a denial or affirmation of benefit. The study researchers also acknowledged the problems with randomized controlled human trials of Complementary Medicine, citing study bias and lack of funding, with small study size, as significant problems in confirming these treatments with standard criteria designed for pharmaceutical studies:
  32. A 2014 multicenter meta-review of all published studies of acupuncture to treat Chronic Fatigue Syndrome, by The Arctic University of Norway in conjunction with the Beijing University of Chinese Medicine, and Hebei University, in China, found that 23 randomized controlled human clinical trials of high quality, with 1776 participants, showed that standard measures of fatigue were significantly improved by these protocols. The researchers of course noted that larger and better designed clinical trials need to be developed to fully explore this effectiveness, and that standard medicine has, as of 2014, no curative treatments:
  33. A 2010 study at the First Affiliated Hospital of Guangzhou University, in China, showed that in a controlled randomized human clinical trial of acupuncture and herbal injection into acupuncture points, that both of these methods showed significantly reduced measures of fatigue in patients with Chronic Fatigue Syndrome compared to controls :
  34. A 2010 study at Beijing University of Chinese Medicine, in China, found that electroacupuncture at SP6 and ST40, and DU20 and DU26, significantly benefited expression of CA 3 hippocampus expression and cell function in laboratory studies:
  35. A 2013 study at the University of Hong Kong, Hong Kong, China, found in a randomized controlled human clinical trial that a course of 8 acupuncture treatments produced significant improvement in physical and mental fatigue, as well as quality of life measurements, for patients with Chronic Fatigue Syndrome. The real acupuncture treatment significantly outperformed the sham acupuncture therapy, which also produced significant improvements :
  36. A 2011 study at the Second Military Medical University, in Shanghai, China, found that eleutherosides in the Chinese herb Siberian Ginseng (Eleutherococcus senticosus) may help alleviate both physical and mental fatigue with an array of adaptogenic responses. These herbal effects included reduction of excess triglycerides, improvement of fat utilization metabolism, decrease in accumulation of BUN (blood urea nitrogen), and reduction of lactic acid accumulation in muscle by increase of LDH (lactic dehydrogenase). There are over 40 active chemicals in Siberian Ginseng, though, and many of these have been studied and shown to benefit the nervous system, immune system, and endocrine system:
  37. A 2011 report the Second Military Medical University, in Shanghai, China, found that many scientific studies of the diverse array of chemicals in Siberian Ginseng, also called Eleutherococcus senticosus, Acanthopanax senticosus, and Ci wu jia, confirm a wide array of adaptogenic effects. These include anti-stress, antiulcer, anti-irradiation, anticancer, anti-inflammatory, and hepatoprotective activities:
  38. A 2009 study showed that defective adaptive responses to metabolic stressors, such as oxidative stress, are seen in study of CFS patients, and that defective immune responses, with cytokines overexpressed after exertion, such as IL-6 and TNF-alpha, as well as a reduced ascorbic acid metabolism:
  39. A 2008 study at the University of Texas Houston Medical School found that a combination of Goldenseal (Hydrastis) and Astragalus (Huang Qi) has immunomodulatory effects on the innate immune system (macrophage response) reducing the pro-inflammatory excesses of IL-6, TNF-alpha, IL-10, and IL-12 is a dose-dependent manner. Overexpression of IL-6 and TNF-alpha are seen in CFS/EM.:
  40. A 2006 review of standard research databases found that a number of commonly used herbs in professional herbalism have demonstrated effects on multiple immune modulators, or cytokines, that are proven to be at the core of underlying causes of chronic diseases, including Chronic Fatigue Syndromes / Encephalomyelitis:
  41. A 2010 review of standard research databases found that a number of commonly used herbal formulas in professional herbalism have demonstrated effects on multiple immune modulators, or cytokines, with TCM (Traditional Chinese Medicine) providing the majority of these formulas in common use:
  42. Scientific study of herbal phytochemistry is prolific in China, and this is an example of the quality of scientific proof identifying objectively the effects of specific herbal chemicals on human immune cytokines
  43. A 2010 study at the Institute of Health Sciences Joint Immunology Laboratory in Shanghai, China, found that an herbal chemical, berberine, from many Chinese herbs, including Coptis chinensis, or Huang lian, was effective in treating encephalomyelitis:
  44. A 2011 study at the University of South Australia noted that the fatty acid and carnitine homeostasis was altered and could be a notable contributor to Chronic Fatigue Syndrome pathology. Supplementation with an omega-3 fatty acid combined with carnitine (krill oil, acetyl-L-carnitine and P5P), may provide significant benefits in a holistic protocol:
  45. A 2012 study at Punjab University in Chandigarh, India, found that probiotic therapy with Lactobacillus acidophyllus improved symptoms of fatigue and produced significant objective measures of improvement in animals induced with Chronic Fatigue Syndrome. Lowered TNF-alpha, and oxido-nitrosative stress in the CNS, as well as resolution of spleen hypertrophy and thymus hypotrophy were noted:
  46. Scientific study of viral and retroviral infection in CFS patients in 2010 at Academy of Sciences Bethesda research facility found that a group of retroviruses are found in prevalence in CFS patients that could be tied to the pathophysiology of the disease:
  47. A 2014 multicenter study in Korea, at 5 University Schools of Medicine and Pharmacy, and the National Institute, showed that the main chemical in the Chinese herb Cordyceps (Dong chong Xia cao) is proven to significantly inhibit Epstein-Barr Virus (EBV), a hallmark of Chronic Fatigue Syndrome, as well as many other viruses, microbial infections and inflammatory mediators involved:
  48. Scientific review of the pathophysiology of CFS continues to provide a diverse array of evidence that is often different in different studies. Groups such as this on at the University of Groningen, in the Netherlands, have realized that the problem is the persistence in identifying a unifying single etiology, or cause, for allopathic medicine, instead of focusing on the diverse array of causes that differ from one individual to the next. This supports the holistic focus of TCM and Complementary Medicine:
  49. A more comprehensive report on the diagnosis, pathology and treatment of Chronic Fatigue Syndrome / Myalgic Encephalomyelitis (brain stem inflammation affecting the muscle system), with a presentation of the comprehensive Canadian ME/CFS Guidelines, was presented in 2003 in the Journal of Chronic Fatigue Syndrome :
  50. In contrast to the Canadian Guidelines on ME/CFS, the U.S. Centers for Disease Control and Prevention (CDC) focus on potential causes, but in 2013 still do not have any unifying set of causes, instead emphasizing the probability that multiple casuses and underlying health conditions may cause or trigger the development of this complex disorder:
  51. A 2015 study at Johns Hopkins Medical College and DePaul University, in the United States, showed that patients with Postural Orthostatic Tachycardia Syndrome experienced chronic fatigue syndrome when the syndrome became more severe, further obscuring the differential diagnosis and assessment in CFS/ME: