Introduction to the Holistic Treatment of Chronic Fatigue

The Resilience Medicine Approach to the treatment of Chronic Fatigue with holistic, integrative and cannabinoid medicine.

Introduction

Chronic Fatigue Syndrome, or ME, is a complex nervous system and immune system disorder, or group of disorders since CFS is slightly different for each person. There is no drug to cure or effectively treat the causes of CFS, which is why an evidence-based holistic approach is essential to getting better.

The initial symptoms can have triggers ranging from an acute stressful event, extreme physical stress on the body or after an acute viral infection or vector-borne illness.

Specialized immune cells in the brain called microglia, which are involved with upregulating the brain-immune axis and in brain inflammation and form the first line of defense of the blood-brain barrier can also become dysfunctional as part of CFS. Results of MRI imaging studies show there may also be widespread changes in the autonomic nervous system functioning as well as abnormal functional connectivity of brain neural networks involved.

Sometimes, people can also experience symptoms of other conditions with a lot of overlap, such as MCAS which can cause lots of triggers for fatigue with eating.

There are also many conditions that may be mistaken for CFS or co-exist with it, such as some vector-borne infections and connective tissue disorders like Ehlers Danlos Syndrome and even mycotoxin exposure and mould related illness.

A holistic approach can dramatically improve quality of life and fatigue, brain fog, anxiety and other symptoms so you can return to life again and in many cases, get into full long-term remission.

In this article you are going to learn about each of these holistic approaches, how to use them for your healing journey as well as the latest research evidence & explore a case study for CFS/ME to help remove the confusion and help provide a path to healing.

Chronic Fatigue Symptoms: The Invisible Battle, Recognising the Signs

Chronic fatigue syndrome (CFS) is a complex and often misunderstood condition that affects a significant number of people in the UK. It is essential to recognise the symptoms in order to seek appropriate treatment and support. Key indicators of CFS are not limited to the following but can include:

Persistent exhaustion
Post exercise malaise (PEM)
Muscle and joint pain
Headaches
Sore throat and tender lymph nodes
Cognitive difficulties including severe brain fog
Sleep disturbances
Sensitivity to light and noise
Mood changes
Feeling ‘tired but wired’

What Causes Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

The exact mechanisms are multifactorial and still not completely understood, but likely involve multiple genes and epigenetic changes after some kind of environmental trigger, inflammation, infection, and environmental factors. A main regulatory balancing system in the brain and body, which controls functions like energy balance, stress response and immune function called the endocannabinoid system (ECS) can also become dysfunctional and unbalanced in CFS. The ECS involvement may explain why medical Cannabis helps.

The Chronic Illness Experience & CFS

Many patients with CFS have other diagnoses too, such as fibromyalgia, depression, sleep issues, and anxiety, problems with their digestive system and severe food intolerances, disrupted sleep (feeling ‘tired but wired’) and issues like MCAS. Without treating these symptoms together holistically and recognizing that they are connected, it is very difficult to get control over any of them. They all affect each other and share underlying mechanisms in the brain, gut and immune systems.

The common experience of patients with CFS is a deterioration in their overall quality of life and ability to do ‘normal’ things from going for walks to seeing friends and going to work, due to a vicious cycle of physical fatigue on top of cognitive & mental fatigue symptoms, brain fog, and unpredictable mood crashes.

This means it’s really hard to do the things like seeing friends or exercising because doing anything can leave you completely exhausted for days afterwards, unable to function at all. Most people with CFS are very sensitive to medications and side effects and standard medications are just not effective. This can lead to losing hope of feeling better and becoming more disabled and isolated over time. A holistic approach addresses and helps breaks this cycle.

Navigating the Diagnosis of Chronic Fatigue Syndrome

The process of diagnosing chronic fatigue syndrome (CFS) can be intricate, as there is no definitive blood or imaging test to confirm its presence.

Initially, doctors will assess the individual for common symptoms such as persistent exhaustion, cognitive difficulties, and sleep disturbances. If CFS is suspected, they may perform blood tests, urine tests, and other examinations to rule out alternative explanations for the symptoms.

Once other conditions have been excluded, and symptoms persist for at least four months, a diagnosis of CFS may be considered. Once diagnosed, functional medicine testing can play a role in the holistic treatment of underlying factors in CFS, since everyone’s illness is unique and what is needed for one person to get better may be slightly different than the next.

The Resilience Medicine Toolkit for Chronic Fatigue

The Resilience Medicine Holistic approach incorporates ‘Power Plant’s such as cannabinoid (cannabis-based) medicines, specific mindbody techniques, therapeutic diets, prescribed combinations of nutraceuticals & medications where needed, and creating a resilience environment using evidence-based and evidence-informed interventions personalized to you.

Medical Cannabis

Medical cannabis is a legal medicine in the UK and is now available on private prescription from a specialist doctor.

Medical cannabis is a whole class of medications rather than a single medication. They are whole plant medicines which contain over 100 active cannabinoid compounds, which are thought to work together to deliver the medicinal effects although the main cannabinoids used for dosage currently are CBD and THC. The different strains or chemovars, can produce different therapeutic effects, making it a highly personalized medicine.

Medical Cannabis can often help patients those who have failed other approaches, to get a quick win in terms of symptom relief and starting of a positive neurological ‘cascade’ leaving them more able to engage with other aspects of a holistic treatment plan.

Most patients see a significant improvement within the first month of therapy across multiple symptom clusters including improved mood, fatigue, stress, pain, sleep and mental function.

Medical Cannabis by prescription is different to the hemp CBD you can buy in the UK as a health supplement. Hemp cbd oil non-medical products do not contain any measurable THC. Even the small amounts of THC in prescription medical cannabis can make a huge difference to the therapeutic effects.

How Medical Cannabis works in CFS/ME

Medical cannabis can be helpful in CFS for treating clusters of symptoms together with a single medicine. It is very well-tolerated in most cases, even when other medications were not.
Medical cannabis may help with fatigue as well as sleep disturbance, anxiety, mood, IBS-like symptoms, headaches and other comorbid symptoms like restless legs that can come alongside CFS.

Medical Cannabis works on endocannabinoid system (ECS) dysregulation as well as our serotonin system and also decreases inflammation pathways,

It is neuroprotective and an excellent chronic pain reliever as well as mitochondrial protective (where our cells make energy) when used correctly. All of these mechanisms are involved in the symptoms CFS patients experience that dramatically disrupt life.

One theory is that CFS is actually a type of ‘endocannabinoid deficiency syndrome’ and that by using plant cannabinoids in the right doses and ratios to help restore balance, the syndrome is corrected.

For different times of day and different effects, medical cannabis treatments should be tailored, factoring in things like the need for uplifting medicine during the day that will help fatigue & mental function and then calming medicine at nighttime to support restorative sleep, based on minor cannabinoid and terpene profile and the mode of delivery into the body so it is most effective at each time of the day.

Dr Gordon is the most experienced cannabinoid medicine physician in the UK, has trained the first UK specialist physicians in the prescribing of medical cannabis and has treated thousands of patients with medical cannabis first in Canada and in the past few years in the UK since it has become legal. She uses a more holistic individualized approach to cannabinoid therapy rather than just THC and CBD content alone, due to her unique background in Integrative & botanical medicine in addition to her conventional medical training as a physician.

Therapeutic Diets for CFS/ME

Although CFS is not a nutritional illness as it’s core cause, certain types of diets can have a huge influence and improve symptoms such as fatigue, brain fog, anxiety, sleep disturbance and other symptoms by working on multiple inflammation pathways, neuro-immune modulation, gut-brain axis and microbiome function just to name a few.

For example, a modified ketogenic diet may improve symptoms for some people, but may not be suitable for everyone.

Others may respond better to a different therapeutic diet, such as a low histamine diet or doing an elimination diet, based on things like symptom cluster profile, gut and blood biomarkers and other individual factors which are assessed & taken into account as part of your treatment plan.

Therapeutic diets for CFS are not one-size fits all.

However, a good starting point is removing ‘free’ sugars, preservatives and artificial colorants, processed foods and gluten grains for a trial period and increasing vegetables, cold pressed plant oils and healthy fats such as small wild fish and organic animal protein alongside whole gluten-free grains.

Mindbody Medicine for CFS/ME

Mindbody practices help to actually change the brain structure and function in multiple ways, turn down the volume on stress, anxiety and help our brains become more resilient.

Certain practices have been shown to reduce fatigue in chronic fatigue syndrome and related illnesses. For example, specific Mindfulness practices have been shown to improve fatigue, quality of life, anxiety, depression and physical functioning in chronic fatigue patients.

Techniques to activate the Relaxation Response, based on Dr Gordon’s experience studying these techniques at Harvard University with Dr Benson can also be very beneficial for the anxiety component and the ‘tired but wired’ issue many patients have.

The use of a tailored energy envelope ‘energy points’ system incorporating mindfulness can also help to slowly but steadily increase the amount of energy that can be used without crashes.

Creating a tailored mindbody practice to suit you best at each stage of the healing journey and making it easy and unburdensome is important to making it effective, since many patients may have tried some of these things previously on their own and not noticed an improvement.

If there is a history of trauma, trauma therapy can also play a role in removing sources of persistent stress and fatigue in the nervous system that can contribute to the illness.

Supplements for CFS/ME

Supplements including nutraceuticals, botanical extracts, medicinal fungi, adaptogens and minerals can all be helpful and ideally should be tailored to each person. Navigating supplements on your own can you be daunting and often ineffective in many cases due to the complexity of this area for CFS/ME and the huge selection of supplements online of varying quality.

Normally many ingredients are compounded into single tablet formulas to reduce the number of pills and improve effect, using clinical grade supplements for treatment under the care of a medical practitioner although many of these ingredients can be found on their own directly online.

Each person will likely have a slightly different ‘stack’ of supplements but can include:

Stabilized liposomal Glutathione with Vitamin C-glutathione is the body’s master antioxidant and is super important for your cellular energy.
D Ribose-this is sugar that is used to help support mitochondrial function
Acetyl L carnitine-Another nutrient needed to help support mitochondrial function
Fat Soluble B complex Vitamin
Milk thistle, which has the active ingredient silymarin, can also help boost glutathione levels and prevent depletion so you can take this in addition to the liposomal glutathione to enhance further
Medicinal mushrooms – a combination of a few medicinal mushroom extracts which have immune system and energy regulating properties and normally includes cordyceps and reishi as well as possibly others such as sun blaze, chaga, maitake, shiitake. There are many cheap mushroom powders online but for this supplement it is important to choose a high quality brand backed by a solid scientific formulation, since there is such a wide variation in the cheap versions vs. more expensive brands in terms of active ingredient content and hence, effect. The dosage will vary depending on the formulation
Alpha Lipoic acid may help with pain related symptoms in CFS
Co-enzyme Q 10 in its ubiquinol form. People who suffer with chronic fatigue syndrome, for example, have been shown to have lower CoQ levels. CoQ10 is integral to energy production in our mitochondria.
Phosphatidylcholine- one of the substances that makes up the cell membranes, it also may help with fatigue
Ginsengs- American Ginseng (tired but wired) or Panax Ginseng (if just tired/exhausted). These herbs have been shown to reduce fatigue.
Pyrroloquinoline quinone (PQQ) is a functional nutrient that in animal studies has shown to help with energy and aspects of brain and mental function. Used in a mitochondrial support complex most commonly
NAD+-Injectable IV or IM or SC since taking it by mouth is not well absorbed
Other NAD+ precursors in liposomal formulations

Conventional Medications & Therapies in Chronic Fatigue Syndrome

While there is currently no specific standard medication for chronic fatigue syndrome (CFS), various medications are often trialed to help manage symptoms including:
Pain relief medications
Antidepressants
Sleep aids
Psychological therapies to help with coping although it is now recognized that graded exercise therapy and cbt do not ‘cure’ CFS. Some people find graded exercise makes them worse or that CBT is not useful for them. In the most recent research, 51% of patients could not tolerate graded exercise regimens so it is important to see a specialist who understands your case and the stage of your illness so you do worsen with inappropriate exercise advice. However, at the right stage of treatment, it is possible to regain physical conditioning using a tailored program to your needs.

Many patients find that these standard medication & therapy options do not work well or have intolerable side effects.

Resilience Environment

Environmental factors also impact our resilience from noise and light pollution to actual air pollution and chemicals in the foods we eat. Our environment also interacts with our genes to influence how we respond to our external environment. For example, if you have the genotype for certain enzymes not working as strongly as they could, you may be more sensitive to the effects of pollutants in the environment, which can influence a wide variety of health symptoms including susceptibility to chronic fatigue triggered by an environmental factor such as after a home renovation or by working in a toxic building with chronic mould exposures. Working from a functional perspective on identifying environmental triggers and biological vulnerabilities in detoxification can help with this aspect of recovery.

Passion and Connection

The importance of social connection, bonding, and nurturing warm relationships has been increasingly recognised as a crucial aspect of managing chronic fatigue syndrome (CFS). Research shows that fostering such connections can have a positive impact on physical health, immune system function, and overall mental well-being.

Engaging in meaningful interactions with friends, family, and support groups can help individuals with CFS feel understood, validated, and less isolated. These connections can also provide emotional support and practical advice, making it easier to cope with the daily challenges posed by CFS.

One low-energy activity that has gained attention for its therapeutic benefits is spending time with animals. Animal-assisted therapy, or simply interacting with pets, has been shown to reduce stress and anxiety levels. For those living with CFS, engaging with animals can be an excellent way to maintain social connections while adhering to their ‘energy envelope’ and pacing strategies.

Pacing, a technique commonly employed by those with CFS, involves carefully managing energy expenditure to prevent symptom exacerbation. By incorporating activities like animal interaction into their daily routine, individuals with CFS can experience the benefits of social connection without overexerting themselves.

In conclusion, embracing the power of passion and connection through social bonds and interactions with animals can greatly enhance the management of chronic fatigue syndrome. By prioritising these connections, individuals living with CFS can improve their overall quality of life and better navigate the challenges posed by this complex condition.

Tests for CFS

There is no standard blood or imaging test to diagnose CFS, it is a clinical diagnosis. The first tests are usually those to rule out other causes of fatigue, such as iron deficiency, thyroid problems, other neurological conditions in some cases via imaging like MRIs of the brain and spinal cord.

Functional Medicine Testing in CFS Treatment

We can use functional medicine testing to look at factors such as mitochondrial function, genetic stress tolerance, gut microbiome and gut-brain axis function, inflammatory biomarkers, circadian rhythm dysfunction, and more, based on your specific assessment. They can help further customize your treatment based on your biochemistry and underlying drivers of illness, since CFS is a broad category and no two people are exactly alike. These tests are optional.

Case Study

Paula, 22 years old. Diagnosed with ME 4 years ago

Goal: finish her undergraduate degree & go out with her friends.

History: After a viral illness and a high-stress period, Paula developed chronic fatigue syndrome. She had been seen by a standard care ME specialist service and tried medications, graded exercise therapy and CBT without improvement.

The plan: after a thorough integrative assessment and specialized functional testing, She was started on a specific medical cannabis plan to help with her daytime fatigue and brain fog and also help regulate her light sleep. Based on the results of her tests, she was started on a specific mitochondrial energy nutraceutical and dietary protocol, brain-gut axis support based on a lack of SCFAs and other gut markers and given a recording for a restorative mindbody practice done alongside her evening medical cannabis dose.

Outcome: 6 months later, she had been able to resume her studies and could have a normal ‘uni life’ again with her peers. She was able to focus on her studies and no longer needed 3 hr daytime naps in addition to 12 hrs of sleep each night. Her energy had gone from 1/10 most days to 7-8/10 on average.

Next Steps

In summary, using a specific, evidence-based holistic approach to healing from CFS/ME can dramatically improve quality of life, energy level, cognitive function and remove the confusion and overwhelm of trying to navigate the illness on your own. To take the next step in your journey, book an initial consultation with our expert physicians.