Chronic Fatigue Syndrome

Dr. Weyrich's Naturopathic Functional Medicine Notebook

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Overview

Chronic fatigue syndrome is a functional diagnosis, for which conventional medicine has identified no causative mechanism. Among the theories that have been advanced, mitochondrial dysfunction and neurotoxins produced by dysbiotic Clostridia spp., yeasts, and fungi appear most credible.

Etiology

Evidence suggesting that dysbiosis is associated with chronic fatigue syndrome includes the following:

Elevated urinary levels of 3-hydroxyphenyl-3-hydroxypropionic acid (HPHPA) and other markers of dysbiotic overgrowth with Clostridia spp. are common in chronic fatigue syndrome [GP].
Elevated urinary levels of tartaric acid and other markers of dysbiotic overgrowth with yeasts and fungi are associated with chronic fatigue syndrome [Shaw2008].
However, note that hypothyroidism is associated with Functional Immune Deficiency, so addressing hypothyroidism may help clear the dysbiosis.

Another often-overlooked cause of chronic fatigue is sleep apnea.

Diagnosis

Symptom picture:

Decreased concentration and short-term memory
Headaches
Muscle and joint pain without inflammation
Tender lymph nodes
Sore throat
Unrefreshing sleep
Post-exertional malaise lasting 24 hours or longer

Note that most of the above are also commonly seen in hypothyroidism [Starr2005, pg 148], although other authors attribute these symptoms to overgrowth of Candida [Crook; Starr2005, pg 150].

Diagnostic Testing:

Organic Acid Test (elevated markers for gut dysbiosis).
Basal Body Temperature (depressed if hypothyroid or mitochondrial dysfunction)
Heavy metal urinalysis with provocation (possible cause of mitochondrial dysfunction).

Differential Diagnosis

Vitamin B12 deficiency [stuart2006].

Treatment

Treat hypothyroid if present.
Supplement CoQ10, acetly-L-Carnitine, and D-Ribose.
Heavy metal chelation if indicated.
Treat dysbiosis if present.
Supplement with malic acid if Organic Acid Test shows that urine tartaric acid is elevated [Russell1995].
Supplement with magnesium (why?) [Shaw2008].
Low doses of adrenal hormones may be beneficial [MckJefferies2004; Starr2005, pg 151].

Pathophysiology

Elevated levels of tartaric acid (3-hydroxymalic acid or 2,3-hydroxy-succinic acid) are associated with chronic fatigue syndrome. Tartaric acid is an analog of the Krebs cycle intermediate malic acid that inhibits the Krebs cycle enzyme fumarase that converts fumaric acid to malic acid [Shaw2008] [Russell1995].

ICD-9 Codes

ICD9-Code	Description	Comments

References

Unless specifically noted above, references used in the construction of this web page include the following:

[FDM] Lecture notes from Functional Medicine University.

[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.

[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.

Crook William G. Chronic Fatigue Syndrome: The Yeast Connection. [Cited by Starr2005].

[Guyton2000] Aurthur C. Guyton & John E. Hall. Textbook of Medical Physiology, Tenth Edition. Philadelphia: W. B. Saunders (2000).

[MckJefferies2004] McK. Jefferies William. Safe Uses of Cortisol, Third Edition. Springfield, IL: Charles C Thomas Publisher (2004).

[Russell1995] Russell IJ, Michalek JE, Flechas JD, Abraham GE. Treatment of fibromyalgia syndrome with Super Malic: a randomized, double blind, placebo controlled, crossover pilot study. J Rheumatol. 1995 May;22(5):953-8.

[Shaw2008] Shaw W. Biological Treatments for Autism & PDD, Third Edition. (2008).

[Starr2005] Mark Starr. Hypothyroidism Type 2: The Epidemic. Columbia, MO: Mark Starr Trust (2005).

[Stuart2006] J.J. Stuart & S.M. Pacholok. Could it be B12? An Epidemic of Misdiagnoses. Sanger, CA: Quill Driver Books/Word Dancer Press (2006).

Copyright © 2007-2010 Dr. Weyrich (Naturopathic Medical license number 07-1008). The information on this site is for educational purposes only. It is not intended to diagnose, treat or cure any disease or illness. The statements on this website have not been evaluated by the Food and Drug Administration.

This web page is http://www.DrWeyrich.com/disorders/chronic_fatigue.html - Phone Dr. Weyrich at (480) 423-6952