Treatment for Chronic Fatigue Syndrome (ME/CFS)
I recently had the lovely experience (sarcasm) that many of us know so well: being dismissed by a healthcare provider. I sought 2 different general practitioners and described my ME/CFS diagnosis only to be quickly sent away and told there was nothing that could be done.
Unfortunate but not unusual, am I right?
The saddest part about this is that there are in fact things that can be done! Despite the condition still having no definitive biomarker and no approved medication, there are a whole host of treatments that are established and known to improve or stabilize the symptoms of ME/CFS.
Finding ways to manage symptoms of ME/CFS can be a challenge (understatement). While there is no one-size-fits-all solution, many benefit from lifestyle changes, dietary adjustments, and certain medications and supplements. Let’s look at some options.
Chronic Fatigue Syndrome Self-Care
Managing your daily energy levels is one of the most important steps in living with chronic fatigue syndrome. By making small changes in your routine, you can avoid the "boom-and-bust" cycle, where you feel better and do too much, only to crash later.
The first step is to avoid triggering activities as much as possible. For the most severe, this could be avoiding noise or other stimuli. Using noise-cancelling headphones and an eye mask can help reduce these inputs that provoke the nervous system response. Avoiding stress, exercise, and strenuous mental activities is also crucial.1
Pacing for ME/CFS
Pacing is key. This means balancing activity with rest, and knowing when to stop before you feel too tired. Listening to your body and spreading out tasks throughout the day can help you avoid feeling completely wiped out. Enlisting the help of others is crucial in this process. It is also extremely helpful to keep a daily symptom diary or to use an activity tracker to document activity and energy levels.1
Pacing is completely individual. Only you, and you alone, will know your energy window and the boundaries you must keep to stay within it. For those newly diagnosed, this may take a great deal of trial and error. It’s important to be patient and forgiving with yourself as you determine what is best for you.
Start by tracking your energy levels and figuring out when you're most likely to feel tired or have a crash (symptom worsening). By planning your day around these patterns, you can avoid doing too much at once. Knowing these patterns can also help you know when to ask others to step in and help out. Gentle activities like walking, stretching, or yoga can be helpful if they don’t worsen your symptoms. Performing graded increases in activity or exercise are not recommended.
Diet to Support Energy Levels
The diet also plays a role in managing chronic fatigue syndrome. The best diet for the condition is one that is anti-inflammatory. 1 Individuals must also avoid foods that trigger symptoms. Sweets, gluten, high-FODMAP foods, and high-histamine foods are frequent culprits.
Staying hydrated is also crucial. Dehydration can make fatigue and brain fog worse.
With over 10 years of experience creating nutrition plans for patients, I invite you to create your own personalized nutrition plan with me.
Supplements for Energy Production in ME/CFS
Certain supplements may help support energy production and improve symptoms in ME/CFS.
A multivitamin is a great first option. Research has shown deficiencies in B vitamins and certain minerals in those with ME/CFS. Vitamins and minerals are essential for energy production (the breakdown of our food into cellular energy) and the proper function of immune cells and mitochondria. Supplementing with omega-3 fats (EPA and DHA) may also be helpful to reduce inflammatory symptoms of the condition.2
Coenzyme Q10 (CoQ10): Known for supporting energy production at the cellular level, CoQ10 may help reduce fatigue in some people with ME/CFS. Some studies have used CoQ10 with NADH and shown improvements in subjective fatigue.3
Addressing Infections & Immune Support in ME/CFS
Some people with chronic fatigue syndrome may have underlying infections that contribute to their symptoms. Treatments that target these infections, such as antiviral therapies, could help reduce fatigue in certain cases. Some are prescribed antiviral drugs like acyclovir, valacyclovir, or rintatolimod. These medications have limited effects but may benefit some individuals.4
Alternatively, there are natural agents with antiviral properties. Monolaurin, for example, is a natural antiviral that has been studied for its ability to fight infections without harming healthy cells. High-dose, bioavailable antioxidants may also support immune defense. This includes sulforaphane, curcumin, and resveratrol.
Low-dose naltrexone is also a possible treatment option. This medication is believed to block inflammation in the nervous system (neuroinflammation), which can help alleviate symptoms of ME/CFS.1
Treating Coexisting Conditions in ME/CFS
Most ME/CFS patients have 1 or more coexisting conditions. Common examples include mast cell activation syndrome (MCAS), irritable bowel syndrome, orthostatic intolerance (POTS), or disrupted sleep. 1 There are various medications and treatments for these conditions. Proper management of coexisting conditions can go a long way in stabilizing and improving the symptoms of ME/CFS.
Table 1: from Grach SL, Seltzer J, Chon TY, Ganesh R. Diagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Mayo Clin Proc. 2023;98(10):1544-1551.
Treatment for ME/CFS
The next time a doctor tells you there are no treatments for ME/CFS, please correct them. Better yet, direct them to some continuing education on proper diagnosis and management of the condition. 1
Finding the right treatment for chronic fatigue syndrome can take time and patience. However, some medications or supplements can be trialed. Pacing and dietary changes can and do make a difference.
By focusing on small, sustainable changes, many people with ME/CFS find ways to manage their symptoms and regain some control over their daily lives.
References
1. Grach SL, Seltzer J, Chon TY, Ganesh R. Diagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Mayo Clin Proc. 2023;98(10):1544-1551. doi:10.1016/j.mayocp.2023.07.032
2. Castro-Marrero J, Zaragozá MC, Domingo JC, Martinez-Martinez A, Alegre J, von Schacky C. Low omega-3 index and polyunsaturated fatty acid status in patients with chronic fatigue syndrome/myalgic encephalomyelitis. Prostaglandins Leukot Essent Fatty Acids. 2018;139:20-24. doi:10.1016/j.plefa.2018.11.006
3. Castro-Marrero J, Sáez-Francàs N, Segundo MJ, et al. Effect of coenzyme Q10 plus nicotinamide adenine dinucleotide supplementation on maximum heart rate after exercise testing in chronic fatigue syndrome - A randomized, controlled, double-blind trial. Clin Nutr. 2016;35(4):826-834. doi:10.1016/j.clnu.2015.07.010
4. Richman S, Morris MC, Broderick G, Craddock TJA, Klimas NG, Fletcher MA. Pharmaceutical Interventions in Chronic Fatigue Syndrome: A Literature-based Commentary. Clin Ther. 2019;41(5):798-805. doi:10.1016/j.clinthera.2019.02.011
