Chronic Fatigue Syndrome - The Invisible Illness


Chronic fatigue Syndrome (CFS) is a difficult, frustrating condition with no definitve diagnostic tests or visible signs. Find out more about holistic medical and naturopathic management in this blog,...

One of the hardest and most frustrating health challenges is where you know something is not right, but nobody can tell you what is actually wrong.

This is often the reality experienced by people with chronic fatigue syndrome (CFS) as most symptoms are invisible to others and this can make it very hard for other people to understand.

Additionally, there are no conclusive diagnostic tests to confirm CFS. Thus many doctors think the illness does not really exist. So how do you know if CFS is the cause of your exhaustion and feeling unwell?

What is chronic fatigue syndrome (CFS)?

It is estimated that approximately 17 million people worldwide are affected by CFS. Young adults are more commonly affected, with a peak age of onset between 20-40 years.  Women are 2-4 times more likely than men to be diagnosed.

The main symptom is fatigue that is consistent and intense enough to reduce normal daily activities by at least 50% for a minimum of six months.

Other symptoms associated with CFS include headaches, sore throat, non-refreshing sleep, post-exertional fatigue, impaired memory, attention or concentration, muscle pain, and tender neck or armpit glands.

These symptoms may come and go or they may last for weeks, months or years. Symptoms can also vary widely from person to person. Recent longitudinal studies suggest that some people affected by CFS improve with time but that most remain functionally impaired for several years.

Contributors to CFS development

Infection and immune dysfunction

CFS can start suddenly and seems that it is often initiated by an infection, for example glandular fever due to Epstein-Barr virus (EBV), herpes viruses, Candida albicans and parasitic agents or another immunological involvement. According to the research, viral infections seem to be the most common cause. There is also increasing evidence that CFS may have an autoimmune component.


The condition of the immune system and its ability to function optimally can be impaired or effected by exposure to insults such as lipopolysaccharides from bacteria, moulds, candida, lyme and metabolic toxins.  A 2013 study showed a correlation in the detection of mycotoxins (mould) in patients with CFS, as well as an overlapping of symptoms occurring between CFS and multiple chemical sensitivity syndrome (MCS).

Digestive problems

If there is a problem with the digestive system (e.g. gut fermentation, lack of stomach acid or digestive enzymes, or pancreatic insufficiency) energy production will be impaired resulting in fatigue.

Mitochondrial dysfunction and oxidative stress

Mitochondria can be thought of as little batteries inside your cells. Mitochondrial dysfunction is directly related to fatigue and, therefore, is considered a fundamental factor in the syndrome. This is due to the mitochondria’s role in generating energy by oxidative metabolism in the form of adenosine triphosphate (ATP). This ATP is then hydrolysed to adenosine diphosphate (ADP) which releases energy to produce muscle contractions and nerve impulses. Outside of energy production, some of the primary functions of the mitochondria include cellular defence and immunity. These processes can therefore be compromised in CFS and are associated with oxidative stress, infection and chronic immune system activation.

Stress & mood disorders

Depression is common in CFS and can be one of the major causes of chronic fatigue. Associated with a disturbance of central nervous system functions, studies have shown abnormal function of the hypothalamic-pituitary- adrenocortical (HPA) axis. It can, however,  be difficult to determine whether the depression or the chronic fatigue came first.

7 nutrients that can assist in managing CFS

Let’s look at some popular nutritional supplements that can assist in managing CFS. For the most part, the nutrients discussed below are antioxidant and mitochondrial nutrients as the mitochondria are a major source of cellular reactive oxygen species (ROS) production and the metabolic efficiency of mitochondria is closely related to the degree of free radical production. Herbal medicines, food choices, spinal health and good sleep hygiene are also important and have been discussed in earlier blogs.

Co-enzyme Q10 (CoQ10)

Co-enzyme Q10 is a key mitochondrial nutrient for energy synthesis and regulation, and production of ATP. It also has significant antioxidant properties and is shown to be deficient in CFS.  As a result of chronic disease, including CFS, oxidative damage to mitochondrial membranes impairs mitochondrial function.

Alpha-lipoic acid

A fundamental nutrient in the mitochondria, alpha-lipoic acid is a cofactor for several mitochondrial enzymes. It assists in energy production, is a potent antioxidant and anti-inflammatory agent, and has the ability to increase cellular glutathione antioxidant levels and improve cognitive function.

Vitamins C and E

Vitamin C provides antioxidant and immune support, and vitamin C therapy has been shown to reduce antibody levels of EBV, as well supporting adrenal health. Vitamin E contributes to mitochondrial membrane integrity and protects against mitochondrial membrane lipid peroxidation. It is an important mitochondrial antioxidant, which is further regenerated by vitamin C.


CFS could be caused by deficiencies in a variety of nutrients, including carnitine. L-carnitine has a number of important functions regarding the maintenance of mitochondrial health and impaired mitochondrial function has been implicated in the pathogenesis of CFS.


An underlying magnesium deficiency can result in chronic fatigue and the symptoms similar to those of CFS. Magnesium is involved in the synthesis of ATP as well as contributing to the maintenance of cell and mitochondria membrane integrity. Magnesium has also been shown to assist pain management, as well as being an essential cofactor in enzymes of energy metabolism, hormone and neurotransmitter production and as a muscle tissue relaxant.

B vitamins

The benefits of a combination of all the B vitamins have been observed in individuals with CFS and include increased cellular energy production and mitochondrial function, neurotransmitter and hormonal balance, and methylation support. Additionally, the supplementation of a B vitamin complex positively interacts with omega-3s (fish oils) in supporting the prevention of cognitive decline, a feature which often presents in CFS. Most people do better with activated and / or methylated B vitamins.

Fish oil

Essential fatty acids (EFAs) have been shown to improve fatigue in CFS patients. They are a major component of cell and mitochondria membranes. Supplementing with EFAs may improve the clinical picture and membrane phospholipid profile of CFS patients.

Please note that these nutrients are only general examples which have been found to benefit some people with CFS. However, if you have been diagnosed with CFS, please consult a healthcare professional about the best approach to managing your symptoms.

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