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Judging from the large amount of exhausted patients I see, chronic fatigue syndrome (CFS) is a very common medical issue.

Yet interestingly, health-care providers can't seem to agree on what CFS is, what causes it, how to diagnose it-- or even whether it exists at all. Many medical physicians also think that CFS is strictly a psychological problem and automatically prescribe antidepressants.

In my opinion, all this bickering about the CFS label is beside the point. The facts: Millions of Americans suffer from fatigue and need medical assistance. To complicate matters further, CFS is not a singular condition with a single source or a simple fix. Instead, it is the manifestation of one or more underlying health problems, like infections, hormone imbalances or numerous other problems. The goal of treatment is not just to mask the symptoms-- it is to determine the root cause or causes in an individual patient and then recommend the appropriate healing treatments.

Diagnosis requires a thorough physical exam, complete personal and family histories, diet and lifestyle analyses and various lab tests. I am pleased that about 90% of my CFS patients say their symptoms improve significantly or disappear completely after treatment.

If you recognize your symptoms and medical history in any of the following cases, talk to a holistic doctor. He/she can order diagnostic tests, advise you on suitable therapies, recommend particular dosages, and notify you to possible side effects.

Note: Some remedies below need a prescription, and others are offered over the counter (OTC) in health-food stores. Talk to a holistic doctor prior to using any of these therapies, especially if you take medication, to make sure that the treatments are suitable and safe for you.


Persistent infection is an often-missed cause of CFS. Examples:

Various viruses. In some cases viruses that typically die off within weeks instead linger on, compromising the immune system and compromising energy production.

Clues: Fatigue that began after the patient had flulike symptoms and a blood test that reveals low levels of disease-fighting white blood cells. Normally, your white blood cell count increases during an acute infection, but it may drop below normal when infection lingers on. Research at Stanford University supports the concept that viruses can trigger CFS.

Evidence: Investigators gave 25 CFS patients the antiviral prescription drug valganciclovir (Valcyte), and in 21 of the patients, fatigue was considerably relieved. However, such drugs can cause severe side effects, including vision problems and seizures. Instead, I suggest using natural therapies that enhance the immune system, including the herbs lomatium root and echinacea, thymus extract, oral or intravenous vitamin C, the mineral selenium, and homeopathic nosodes (remedies made from viruses or other pathogens that stimulate the immune response like vaccines do).

Herpes viruses. The Epstein-Barr virus (which causes mononucleosis) and human herpesvirus 6 (which causes roseola, a disease that might include a skin rash and fever) can trigger CFS. Both are identified with blood tests that measure antibody levels. Scientists believe that herpes viruses are not removed from the body, but rather stay inactive until the immune system is weakened-- at which time the virus replicates. To strengthen immunity, inhibit viral replication and boost energy production, I prescribe the immune-boosting herbs and homeopathic remedies mentioned earlier.

Hepatitis. When an exhausted patient also has yellowish skin, unexplained weight loss, an enlarged liver and/or elevated liver enzymes, I order blood tests to check for hepatitis, an inflammatory liver disease. Among the hepatitis viruses, types B and C are most likely to trigger CFS. Treatment includes herbs that support liver function, such as milk thistle and schizandra, and immune-boosting selenium and alpha lipoic acid, which are antioxidants (nutrients that neutralize damaging particles called free radicals). For extreme hepatitis, prescription antiviral pharmaceuticals also might be required.

Bacterial infections. When the normal balance of friendly bacteria in the gut is disturbed-- for example, because of a high-sugar diet or use of antibiotics-- harmful bacteria multiply in the digestive tract. This can overtax the immune system and trigger chronic fatigue. A stool test can verify the diagnosis. Bacteria also may linger in the body when a dental root canal fails to heal. This is verified with an X-ray and/or culture. Treatment involves antibacterial supplements, such as goldenseal, oregano oil and colloidal silver. Depending on the infection, antibiotic medications may be appropriate.


Fatigue is a typical symptom of various cardiovascular problems that impair circulation and restrict the oxygen available to the brain and muscles.

Congestive heart failure. This occurs when the heart can not pump enough blood to fulfill the body's requirements. Symptoms consist of chest pain, heart palpitations and swollen ankles. In such a situation, I refer the patient to a cardiologist for tests-- for instance, an electrocardiogram (ECG), which detects and records the heart's electrical activity-- and appropriate medical treatment. Complementary treatments include supplements that improve energy production within heart cells or increase blood flow to the heart. Best: Coenzyme Q10 (CoQ10) ... the amino acid derivative L-carnitine ... herbal hawthorn extract ... the mineral magnesium ... and the sugar D-ribose.

Chronic hypotension (low blood pressure). Repeated blood pressure readings below 90/60 mmHg indicate hypotension. Other symptoms consist of fatigue, dizziness or fainting, rapid, shallow breathing, cool clammy skin, pallor, blurred vision, nausea, excessive thirst, difficulty focusing, and/or depression. To raise blood volume and therefore increase blood pressure, I recommend that patients ingest 2,400 mg to 3,400 mg of sodium daily and drink at least 64 ounces of water daily. Beneficial: Herbal supplements that improve circulation, such as gotu kola and Pycnogenol (maritime pine bark extract).

Neurally mediated hypotension. With this form of low blood pressure, individuals get dizzy only after standing or sitting for a prolonged time, and may feel nauseated if they do not lie down. Potential cause: When the adrenal glands (which secrete stress hormones) do not function well, the resulting hormone imbalance may disrupt the nerves' signals between the heart and brain, hindering the body's ability to keep equilibrium.

Test: Blood pressure is taken when the patient is lying down and once again when standing up. Blood pressure that stays the same or drops (rather than increasing upon standing, as is normal) indicates neurally mediated hypotension. Treatment includes the previously mentioned hypotension treatments, increased rest and the treatments for adrenal fatigue described below.


When hormones are out of balance, fatigue is common. If you are diagnosed with a hormone deficiency and hormone treatment is advised, ask your doctor about bioidentical hormones. Unlike synthetic hormone medications, bioidentical hormones have the same molecular structure as those produced by the human body. As a precaution, I advise that all hormone therapies-- even OTC-- be used under a doctor's instruction.

Adrenal fatigue (AF). In stressful circumstances, the adrenal glands make the hormones cortisol and dehydroepiandrosterone (DHEA). With AF, this mechanism is overwhelmed by prolonged physical or emotional stress, and these hormones become exhausted. Because cortisol and DHEA are critical to energy production, blood sugar control and the anti-inflammatory response, AF can cause continuous fatigue. Additional symptoms include mood swings, low libido, poor focus and memory, light-headedness, low back pain, slow recovery from illness, salt and/or sugar cravings, and inability to lose or gain weight even with calorie reduction or increase. Saliva, urine and blood tests can detect low levels of cortisol and DHEA.

To balance hormone levels, I advise taking midday naps and sleeping eight to nine hours each night, working out in moderation (not to exhaustion), and managing blood glucose by avoiding simple carbs (such as those in sugary foods, white bread and pasta). To speed up adrenal cell healing, I recommend the herbs ashwagandha, licorice root and rhodiolarosea, adrenal glandular extract (a supplement taken from cow or pig adrenal tissue), vitamin C, a B-vitamin complex, and, in serious cases, bioidentical cortisol and/or DHEA replacement.

Estrogen and/or progesterone deficiency. A woman's production of these hormones naturally decreases at menopause-- but if levels drop too low, she may experience fatigue in addition to menopausal symptoms, like severe hot flashes. Lab tests reveal these deficiencies. If levels are only a little low, homeopathic treatments and/or the herbs black cohosh and maca root may restore hormone balance. For major deficiencies, bioidentical hormone therapy can be considered.

Low testosterone. This is common among men, particularly those over age 60. Obesity, diabetes and high blood pressure increase the risk for testosterone deficiency. Symptoms include fatigue, decreased muscle mass, weight gain and joint pain. The disorder is diagnosed using blood tests that measure levels of "free" testosterone (the amount not bound to protein and therefore available to engage with cells), and treated with bioidentical testosterone replacement.

Growth hormone deficiency. Symptoms, which usually show up after age 65, include fatigue, decreased muscle mass and strength, loss of skin elasticity and increased abdominal fat. If a blood test for insulin growth factor 1 verifies the deficiency, I prescribe injections of growth hormone.

Hypothyroidism (thyroid hormone deficiency). Along with fatigue, hypothyroidism patients usually have unexplained weight gain, low body temperature, cool hands and feet, and frequent chills, dry skin, constipation, and/or depression. The most accurate blood test measures the free levels of the thyroid hormones T3 and T4. Treatment includes supplements that support regular thyroid function, such as iodine, the herbs bladderwrack and ashwagandha, and thyroid glandular extract (taken from the thyroid glands of various animals). In mild or extreme cases, I also prescribe thyroid hormone replacement that includes T3.

There is no reason to accept chronic fatigue as an immutable fate. With the proper diagnosis and treatment, the mystery of CFS can be solved.


To identify and treat the root cause of a person's chronic fatigue, physicians have to take into account all accompanying symptoms. If you experience fatigue and:

  • Mood swings, memory problems and/or low back pain, the cause may be adrenal fatigue.
  • A history of root canal problems, the cause may be bacterial infection.
  • Chest pain and/or heart palpitations, the cause might be congestive heart failure.
  • Yellow skin and/or unexplained weight loss, the cause may be hepatitis.
  • Hot flashes, weight gain and/or reduced muscle mass, the cause might be hormone deficiency.
  • Dizziness, nausea and/or clammy skin, the cause might be hypotension (unusually low blood pressure).
  • Low body temperature, weight gain and/or dry skin, the cause might be hypothyroidism.
  • Flulike symptoms or mononucleosis, the cause might be a viral infection.