Chronic fatigue and fibromyalgia

I recently attended a most informative and exciting seminar on the drivers of chronic fatigue syndrome (CFS) and fibromyalgia. Some of the findings I think you will agree are fascinating.

A leaky gut creates fatigue
There is strong evidence to suggest that a very common and important factor contributing to chronic pain and fatigue disorders is a dysfunctional gut. Gastrointestinal disturbances are common in CFS, with a high incidence of intestinal permeability, “IBS” and small intestinal bacterial overgrowth (SIBO). In CFS, it has been found that there are exaggerated systemic antibody responses against commensal bacteria (normal flora bacteria). When there is a loss of intestinal barrier function (leaky gut), due to gut inflammation, commensal bacteria are able to enter the submucosa to interact with the immune system. The resulting antibodies can react with nerve cells and have been shown to correlate with symptoms such as fatigue, cognitive dysfunction and a flu-like “feeling of infection”.

Leaky gut repair
There is light at the end of the gastrointestinal tunnel! The same researchers who discovered the leaky gut and CFS connection have also
developed and tested the treatment-leaky gut repair. And many of you will have undertaken this with me at some stage. Particular supplements such a glutamine, licorice root, aloe vera, zinc and curcumin all have a lovely restorative action on a small intestine which has become unreasonably permeable.

In this study, 41 CFS patients were placed on a “leaky gut diet”.
Gluten and dairy free in combination with L-Glutamine, zinc and n-acetyl cysteine. In some cases where deficiencies of carnitine, Coenzyme Q10 and lipoic acid were discovered, these were also prescribed. In cases of acute inflammation, curcumin and quercitin were also added.

The results achieved were impressive. Using the Fibrofatigue scale, symptom scores at baseline averaged 38.8 and after an average of 12 months treatment, the score was 7.3. Measures of inflammatory antibodies (IgA and IgM) were also decreased after treatment.

Exercise therapy
One of the factors which keep patients with fibromyalgia and CFS locked into a cycle of chronic pain is lack of exercise. Of course, anyone with fatigue and pain will be averse to exercise, and for those with severe chronic fatigue, the slightest increase in activity can cause exacerbations and make bed rest mandatory for hours afterwards.

However, the enforced sedentary lifestyle is in itself an inflammatory and oxidative stressor which has the ability to worsen the pain and fatigue overtime. “Deconditioning” of the muscles is common, whereby a lack of daily use results in impaired blood supply, and reduced mitochondria numbers (energy producing cells), and low levels of ATP (cellular energy).

Exercise is something not to aim for when you are better, but should be seen as a tool and therapy to aid recovery. Trials demonstrate that both in CFS and fibromyalgia exercise increased function, decreased symptomology and improved mood and energy. Exercise improves circulation and oxygenation, reduces pain and improves muscular energetics.