A Functional Medicine Approach to Chronic Fatigue Syndrome

Excessive tiredness or exhaustion is one of the most widely voiced issues in patients around the world ⁠— including Hong Kong, where 10.7% of Hong Kong adults are reportedly experiencing chronic fatigue. While feeling tired can be usual, it could also be the first signs your body communicates of more serious underlying health problems. 

Whether you're looking for solutions to fatigue or trying to understand different treatments, here’s a brief guide to how a functional medicine practitioner may approach chronic fatigue syndrome. 

What is Chronic Fatigue Syndrome? 

Chronic fatigue syndrome (or CFS) is an illness commonly characterised by the feeling of extreme tiredness. It can affect anyone, but research has shown it to be more common in women than in men. Other symptoms can include:

• Exhaustion
• Sleeping problems
• Muscle pain
• Concentration issues
• Headache/dizziness
• Sore throat

The exact cause of CFS is widely unknown, but through a Functional Medicine approach, we treat and diagnose chronic-fatigue by examining the five most common root causes. 

Five common causes of fatigue

#1. Gut health

Many fatigue patients suffer from gut problems like irritable bowel syndrome (IBS) and leaky gut syndrome, so it’s one of the first and most important areas that we initially examine in patients. 

A leaky gut is when the lining of the intestine doesn’t form a proper barrier, and so partially digested foods can “leak” through the intestinal wall. When it enters the bloodstream, it can cause widespread inflammation, intolerances and ultimately, fatigue. 

Several factors can contribute to an unpleasant gut, such as food allergies, intolerances, abnormal bacteria & parasites and small intestine bacterial overgrowth (bacteria imbalance in the stomach).

In Functional Medicine, a practitioner will carry out tests to identify any gut parasites and then find the correct treatment plans. Plans to treat the gut may include a therapeutic diet, treatment of infections, anti fungal medicines and probiotic supplementation. In recent years, Human Microbiota Transplant has become a treatment option for patients with IBS and other bowel symptoms. One important area we test patients for is allergies and intolerances to mould and yeast, as Hong Kong’s warm and humid weather manifests the perfect breeding grounds. 

#2. Nutritional intake

The next area we look at is your nutrition, including your absorption of vitamins and minerals. One of the most common contributors to fatigue is often iron deficiency, where the body lacks enough red blood cells to circulate oxygen. Unfortunately, some adults are poor at absorbing iron from their current diets, in which case infusions may be necessary. 

Other essential minerals are Magnesium, Zinc and Selenium. Magnesium is used in several steps of energy production and is also necessary for healthy nerve and muscle function. Zinc and Selenium is the mineral in 300 enzymes in the body, and are both crucial for immunity and healing. Correcting these deficiencies involves prescribing supplements over a 3 to 6 month period. 

Vitamins such as Vitamin D and B12 are also crucial for proper immunity, energy production and cognitive function. Many patients complain of “brain fog”, where they lack memory or mental clarity, so increasing your vitamin intake can help.

#3. Chronic infections

Many patients with fatigue have also reported increased levels of inflammation in their body, leading to pain and symptoms of Fibromyalgia, a disorder characterised by widespread musculoskeletal pain (some patients may also test for arthritis).

The FM approach would be to look into chronic infections such as Epstein Barr Virus (that causes Glandular Fever/Mono) and Lyme Disease (an infectious disease caused by the bite of a tick). Treatment of these infections, allergies and intolerances would be to give anti-inflammatory supplements that will lower the levels of inflammation and hopefully, improve the quality of life. 

#4. Environment

Exposure to environmental toxins is a usual contributor to fatigue. Using sophisticated testing, we’ve analysed hundreds of patients with fatigue and found that most have increased levels of toxins. Toxic environments can have several effects:

• Can directly block energy metabolism.
• Stimulate the immune system and cause allergies/intolerances.
• Can damage cells and disturb metabolic functioning (as the body uses up Glutathione, the main antioxidant in the body, to remove toxins and increases levels of oxidation)

Cutting back on exposure to toxins and taking supplements to support the body’s detoxification systems can help in removing the toxins and control the issue. 

#5. Hormones

Several hormones can also contribute to fatigue. For example, proper functioning of the thyroid is vital for regulating vital bodily functions like breathing, heart rate and muscle strength. The two main hormones the thyroid releases are Triiodothyronine (T3) and Thyroxine (T4); any deficiency in these hormones can contribute to fatigue. 

Chronic stress can also overwhelm the adrenal gland, crucial in producing and distributing hormones like Mineralocorticoids, Glucocorticoids and Testosterone into the bloodstream. These hormones are necessary for maintaining your salt levels, regulating your metabolism and your blood pressure. Low levels can lead to fatigue. 

An FM practitioner will assess your body functions and hormone levels before treatment. In sex hormone functions, a practitioner may use bio-identical HRT to restore levels to normal. 

Treatment of fatigue and next steps

Diagnosing and managing CFS can be challenging as there could be many underlying causes. You can see briefly that through an FM approach, practitioners often look for and test for these five common issues.

The next stage would be through a holistic and personalised approach treatment. Treatment plans of CFS usually take several months to implement, and no patients have the same treatment plans as each case needs to be carefully evaluated to determine the best course of action. 

If you’re living with CFS, it’s essential to work with your doctor to create a plan that meets your needs. You can consult with our experts at OT&P today to help create a tailored plan for your fatigue symptoms.