Nutritional Considerations in Chronic Fatigue Syndrome

Townsend Letter for Doctors and Patients,  Nov, 2001  by John W. Cartmell

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As a massage therapy specialist, I've had a number of clients diagnosed with Chronic Fatigue Syndrome (CFS). Chronic Fatigue Syndrome is associated with long-term problems of fatigue or exhaustion inconsistent with the amount of physical exertion, which persist for 6 months or more. It generally does not respond to rest and often results in extreme debilitation. Symptoms may include problems with concentration, reading or comprehension, blurred vision or pain in the eyes, and increased sensitivity to temperatures, odors, foods, or allergies. Symptoms of chest pain, irregular heart beat, digestive problems, muscle twitching or cramps are also common.

The causes of CFS are not well understood nor is the disease well defined; it's sometimes referred to as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS). Like many diseases, CFS may have more than one cause. Fatigue problems can be caused by toxicity from industrial chemicals or prescribed medications, or result from chronic infection, trauma injury or excessive stress. An imbalance in thyroid, pituitary or adrenal hormones can cause chronic fatigue, as can a dietary insufficiency or imbalance.

Virtually any disease can be caused or made worse if the diet is inadequate to support health. When I developed symptoms of CFS in 1994, I began to explore the possible link between CFS and sub-optimal nutrition. I eventually discovered a basic dietary imbalance that, when corrected, solved my 5-year problems of chronic fatigue.

Sodium is an essential nutrient for fluid balance. The actual amount of sodium required per day is unknown, but the recommended amount for adults varies from a minimum of 200 milligrams to an upper limit of 3,000 milligrams; approximately the amount of sodium in 1-1/4 teaspoon (7.6 grams) of salt. [1,3] The mean daily intake of salt for Americans is around 10 grams per day; approximately 3 grams occurring naturally in foods, another 3 grams from processed foods and 4 grams added during meals. [1,2] Using one-fourth to one-half teaspoon of added salt per day is generally regarded as reasonable and safe. The highest sources of sodium in the diet are salt, animal protein, processed foods and chemically softened water. A diet chronically high in water and potassium, and low in animal protein, processed foods or added salt can potentially lead to sodium depletion. [1,4]

Symptoms of low blood sodium (hyponatremia) include extreme debilitating fatigue, aching skeletal muscles, abnormally high blood pH, chronic low blood pressure, orthostatic tachycardia, cardiac arrhythmias and profuse sweating upon minimal exertion. [1,4] Hyponatremia in competitive sports is a growing concern, and in noncompetitive sports such as desert hiking, cases have skyrocketed in the last decade. [6] Mild to moderate hyponatremia can often be corrected by simply increasing dietary sodium. [6] More severe cases may require a restriction of water, and/or the administration of corticosteroids to support adrenal function. [4]

The volume and composition of body fluids are controlled by water ingestion and excretion, acid-base reactions and electrolytes (salts). These mechanisms are closely interrelated and imbalances are typically multiple disturbances. [4] Electrolytes such as sodium play essential roles in maintaining proper fluid pH, ionic balance (osmolarity), and fluid pressure. If you disrupt the electrolytic balance, then the body's physiology in general can become disturbed.

Adrenal hormones, "aldosterone" and "cortisone," regulate fluid balance and nutrient levels. Aldosterone controls blood sodium and potassium levels. If potassium levels become too high, aldosterone is secreted causing the kidneys to excrete more potassium and retain more sodium. Low sodium can also stimulate the secretion of aldosterone. [1-4] A diet chronically high in potassium or low in sodium can stress the adrenals. [1] Excess potassium is also a natural diuretic and causes some loss of sodium. Foods highest in potassium include whole fruits and vegetables and their juices. [1]

Cortisol stimulates the breakdown of proteins and fats, and provides for the conversion of some amino acids into glucose as needed (gluconeogenesis). If the diet is deficient in protein, or if digestion of protein is inadequate, extra cortisol must be produced to break down muscle tissue for needed amino acids. This extra demand on the adrenals could conceivably lead to adrenal fatigue and cortisol deficiency with impaired gluconeogenesis, decreased glycogen production, hypoglycemia and a decrease in metabolism. [2-4] Neuromuscular functions might also decrease, as well as resistance to infections, inflammations and/or stress. [3,4] The decreased resistance to stress and disease could increase susceptibility to infections of Epstein Barr or other viruses. In this respect, Epstein Barr, common in people with CFS, may be more an opportunistic infection and a symptom of immune system weakness, rather than a direct cause of CFS. Insufficient dietary protein or impaired protein digestion, coupled with an excess of cortisol production and breakdown of muscle tissue, could be a factor in the cause of Fibromyalgia, a soft tissue condition often seen in people with CFS.