Holistic Chronic Fatigue Syndrome (CFS) Treatment

Resilience Medicine is a Holistic and Integrative Approach to medicine. In this article you will learn about the Resilience Medicine treatment approach to Chronic Fatigue Syndrome (CFS).

Holistic Chronic Fatigue Syndrome (CFS) Treatment Overview

Intro to Holistic CFS/ME Treatment

Chronic Fatigue Syndrome, or ME, is a complex nervous system and immune system disorder, or group of disorders. 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 including covid-19 or vector-borne illness.

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 as well as extreme cognitive disturbance (ie brain-fog) and mood changes alongside very unrefreshed sleep despite feeling exhausted.

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

Chronic Illness & CFS/ME

It is often known as an ‘invisible’ illness because when you are not in a major flare and fully bed-bound, many people cannot see the disabling symptoms and may think that you are well.  Most people including most doctors do not understand the illness experience with CFS/ME and its often devastating effects on quality of life and the ability to do ‘normal’ everyday things. 

Many people with CFS/ME have other diagnoses too, such as pain conditions, fibromyalgia, depression, sleep issues (feeling tired but wired) ,anxiety, problems with their digestive system, issues like MCAS, POTS and women’s health conditions. Without treating these symptoms and underlying factors together holistically, it is very difficult to get control over the core CFS symptoms because they all affect each other and share some underlying mechanisms in the brain, gut and immune system.

Symptoms can become confusing to tease apart as time goes on, especially since standard specialists only treat symptoms in their area and rarely consider cross-field research.  This often leads to multiple ineffective or high side effect drugs to treat each symptom and fragmented care.  This leads to more exhaustion.

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 break this cycle.

The Integrative Medicine Understanding of What Causes CFS

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.  Some experts believe that an ‘endocannabinoid deficiency syndrome’ is involved.

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.

The Resilience Medicine Toolkit for CFS

The Resilience Medicine Holistic approach to treating CFS/ME spectrum illnesses includes considering cannabinoid (cannabis-based) medicines, mindbody approaches, diet and microbiome, prescribed combinations of supplements, nutraceuticals & medications, and creating a resilience environment.  These things when stacked together result in a synergistic effect, where the overall result is bigger than the the sum of each part

In the clinic, we also use functional medicine tests and approaches to further personalise treatment based on biomarkers, gut markers and genomics in some cases.  These categories were chosen based on Dr Dani’s 15 years of experience using this holistic treatment framework with her patients.

It’s also worth remembering that even if you have tried some of these things before on your own, it is often getting the right combination of things done at the right time that makes the biggest difference.

It can be very overwhelming and confusing trying to navigate all of the pieces of a holistic treatment plan on your own.  Having expert guidance and a system to measure your progress helps remove this confusion and overwhelm and makes sure you are on the best treatment path, since CFS/ME is a group of illnesses and is not the same for everyone.

This is a new way of thinking about CFS/ME treatment and medicine in general that goes beyond a ‘disease management’ system but aims to enhance quality of life, energy, mood and reduce the total brain and body stress burden to create more resilience in the system to get well and stay well.

Cannabinoids for CFS/ME

Medical cannabis is a legal medicine in the UK, now available on private prescription from a specialist doctor.  Medical cannabis 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.  Unlike many other medications used in CFS, medical cannabis is usually well-tolerated and can often effectively treat clusters of symptoms that many patients with CFS/ME experience using a single medicine. 

Medical Cannabis can help patients who have failed other approaches to get a quick win in terms of symptom relief and starting off a positive neurological ‘cascade’ which makes you able to engage with other aspects of a holistic treatment plan when you have more ‘bandwidth’ again.

Most patients see a significant improvement within the first month of therapy 

One reason medical cannabis may be effective in treating CFS and the associated symptom is that it works on endocannabinoid system (ECS) dysregulation, as well as other neuroregulatory and inflammation pathways.  Cannabinoids have neuroprotective properties and prescription preparations containing even a ‘microdose’ of THC can work as an effective chronic pain reliever, a symptom many CFS patients suffer with too.

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.  The wrong preparation or dose can worsen fatigue, which is why having an expert to guide you is so important.

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 is the foremost expert in cannabinoids for chronic fatigue spectrum illnesses in the UK, speaking widely and internationally on the topic.  She has treated thousands of patients with medical cannabis first in Canada and in the past few years in the UK since it became legal. She uses a more holistic individualized approach to cannabinoid therapy, due to her expertise in Integrative & botanical medicine in addition to her conventional medical training as a physician.  

Hemp CBD oil wellness supplement products available over the counter at health shops are not the same as medical cannabis.  They do not contain any measurable THC.  CBD hemp supplements are generally not effective for chronic fatigue syndrome/ME and similar conditions for most people, although there are a few case reports of benefit.

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.

In some cases, trauma can play a role in worsening of CFS/ME and impede progress to healing.  If this is suspected, specific trauma-focused therapies including compassion focused therapy and attachment based EMDR with handheld devices used during the session may be included in your holistic plan.

Neuromodulation devices that stimulate the vagus nerve and regulate the autonomic nervous system dysfunction in CFS/ME may also be recommended and can be used at home and monitored by the doctor to track progress.  These devices have a growing body of evidence to support their use in CFS/ME and similar conditions.

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.

Graded Exercise Therapy

Some people find graded exercise makes them worse and that CBT, often used alongside graded exercise, is not helpful.  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 alongside a holistic treatment protocol to support energy.

Diet and Microbiome 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 does not suit 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.  Increasing plant polyphenols and antioxidants is also a good idea.

Changes in the microbiome and gut biomarkers can be seen via dietary change and can affect neurotransmitter function and causes of fatigue via the brain-gut axis.   This is rarely considered as part of ‘standard’ medical care for CFS/ME despite the large and growing body of evidence in this area.

Choosing the best diet approach is based on things like symptom cluster profile, gut and blood biomarkers and other individual factors which are assessed & taken into account.

Medications for Chronic Fatigue Syndrome (CFS)

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

Many patients find that these standard medication & therapy options do not work well or have intolerable side effects.  Medical cannabis is generally still well tolerated in these cases, so as a medication it is quite unique.

Supplements & Nutraceuticals 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 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

Resilience Environment for CFS

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.  

Using an air purifier in the rooms where you spend most of your time and adding more indoor plants are easy ways to improve the indoor environment if you have chronic fatigue.

Supporting circadian rhythms by using blue-blocking glasses and smart bulbs for the evening and bright light in the am hours may also be helpful. 

Infrared saunas in small controlled timed doses may help with recovery but it must be done at the right point in recovery, otherwise it can create a crash and it may not be suitable if you have POTS.  It is best done only after recommended by a physician who understands your case specifically.

Functional Testing for CFS/ME

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. 

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.

Measuring Quality of Life in CFS/ME

One of the challenges of doing multiple things together is how to know what is working and how to keep track of everything without becoming overwhelmed.  This is where a system for measuring and tracking becomes so important. 

We use a simple resilience and quality of life score metric that you can track in a simple app, including measurements of fatigue, stress, mood, and mental clarity and pain.   This helps you track the different aspects of how you are feeling as you go on your healing journey.

Validated rating scales for fatigue, such as the FSS and sleep assessments can also be useful.  

We track these metrics with you over time and put you in charge of your data with easy to read data so both you and your medical team can see what’s working and tweak the plan over time.

Case Study for CFS/ME

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 step

Successfully treating chronic fatigue syndrome or ME and similar illnesses including post-viral fatigue and long covid can be difficult and confusing to navigate on your own but you can start feeling better and stay well using a holistic approach to this complex condition.

Dr. Dani has helped thousands of patients with difficult to treat chronic illness conditions including many hundreds of people with CFS/ME over the past 15 years using this approach, first in North America where it is more developed and now in the UK. 

Using a specific, personalized holistic approach to CFS/ME can dramatically improve your quality of life even if you have failed multiple treatments in the past. 

To take the next step in your journey, book an initial consultation with our expert physicians.