Beyond Fatigue

Exploring the Roots of Chronic Fatigue, Fibromyalgia, and Other Syndromes

Fatigue is one of the primary complaints that doctors hear from their patients, day after day, week after week. Not only is it a symptom of many health conditions, it is also a result of lifestyle factors such as poor diet, dehydration, high stress and too little sleep.

Thus, it is not surprising that reporting fatigue as a symptom often sends both practitioners and their patients on a scavenger hunt for a diagnosis, especially when fatigue occurs in conjunction with other generalized symptoms such as pain, trouble sleeping and “brain fog.”

But chronic fatigue is very real, as is chronic fatigue syndrome (CFS). Just ask the more than one million American adults (approximately 80% of which are women) that the Centers for Disease Control and Prevention (CDC) now believe may be affected by CFS. Add to that over five million adults (as reported by the CDC in 2005) who may suffer from chronic fatigue associated with fibromyalgia syndrome (FMS). And the millions more that have symptoms of chronic fatigue but do not quite meet the CDC guidelines for a CFS diagnosis. (See “What’s in a Name?”)

As of 2013, Dr. Jacob Teitelbaum, who specializes in the treatment of both CFS and FMS, estimated that the combined incidence of CFS and FMS is in the range of 12 to 24 million Americans. That statistic represents a lot of lost productivity, both socially and economically, not to mention a severe hampering of personal quality of life.

Why So Much Fatigue?

In The Fatigue and Fibromyalgia Solution, Dr. Teitelbaum explains that a modern day “perfect storm” of energy-draining circumstances has created an epidemic of fatigue. First and foremost, he points out that the average American consumes a high-calorie, low-nutrient diet. We are “both obese and malnourished, for the first time in human history.” Dr. Teitelbaum continues “Dozens of nutrients are critical for our energy-producing machinery, and without these, fats and other calories cannot be converted into energy. This leaves people both overweight and exhausted.”

The second energy drain is sleep deficiency, says Dr. Teitelbaum. With the advent of electricity, light bulbs, television and computers that keep us awake after dark, the average night’s sleep has been reduced from over nine hours per night to under seven hours per night. We are pushing our bodies to do more, with less sleep. In addition, “restless leg syndrome and sleep apnea are also much more common in people with CFS/FMS,” according to Dr. Teitelbaum, further diminishing good solid sleep.

An overburdened immune system is the third factor contributing to Dr. Teitelbaum’s “perfect storm” scenario. Our ancestors did not have to deal with the abundance of environmental toxins that now exist, and which constantly bombard our immune system. Any “foreign invader” triggers the immune system to respond, gradually depleting our adrenal glands, potentially to the point of exhaustion.

Compounding both the nutritional deficiencies and a burdened immune system is poor digestion or absorption due to the use of antibiotics and acid blockers, “leaky gut” due to candida overgrowth, and other gastrointestinal flora imbalances. Dr. Teitelbaum recognizes hormone imbalances or deficiencies as another major factor contributing to the fatigue epidemic. He notes that increased stress not only exhausts our adrenal glands, but also suppresses the hypothalamus, which is the hormone control center. “In CFS/FMS, hormone problems are widespread,” according to Dr. Teitelbaum, even when the lab test results come back “normal,” as they often do. (See “But My Hormone Lab Test Results are ‘Normal’…”)

The “perfect storm” is a combination of factors that can lead to a major “energy crisis” throughout the body, causing the hypothalamus to eventually shut down, which Dr. Teitelbaum calls the biological equivalent of the circuit breaker “blowing a fuse.”

How Do You “Cure” Fatigue?

Considerable research over the past 50 years supports a theory that acquired mitochondrial dysfunction (as opposed to inherited or genetic mitochondrial dysfunction) may be an underlying cause of not only CFS and FMS, but also a wide range of seemingly unrelated disorders including but not limited to diabetes, Parkinson’s disease, coronary artery disease, Alzheimer’s disease, migraine headaches, epilepsy and hepatitis C, as well as mental disorders such as bipolar disease and schizophrenia.

As you might remember from biology class, mitochondria are the “power supply” part of the cell that turns fuel into energy. The mitochondria convert nutrients into energy so that the various cells in the body can do their jobs.

Cells harvest the energy stored in food through a multi-step biochemical process called cellular respiration. In simple terms, cells burn food in the presence of oxygen to produce a “high-energy” molecule called adenosine triphosphate (ATP), the primary energy “currency” in the body. The chemical energy stored in ATP molecules is used to drive various metabolic processes such as biosynthesis and cell division.

If the mitochondria are not healthy or are damaged by toxins from infections, heavy metals, pollutants and solvents, the energy supply suffers, the cells don’t function properly, and fatigue sets in at all levels—from the cellular level on up.

But My Hormone Lab Test Results are “Normal”…

Dr. Teitelbaum shares a humorous but useful analogy to explain what “normal” means when referring to lab test results. He likens it to a “shoe problem” where the normal range for adult shoes might be size 5 to size 13, and a “shoe doctor” could randomly assign you a shoe anywhere within that range and consider it a good fit, no matter what size your foot actually is.

You might then tell your shoe doctor that the shoe just doesn’t feel right, and he’d tell you that you’re fine because you are within the “normal” range (perhaps leading you to believe that “it’s all in your head”).

But hormone levels, just like shoes, are not “one size fits all,” admonishes Dr. Teitelbaum. Being within the “normal” range may not be “normal” for you. When trying to optimize hormone levels, it is important to know your baseline, and whether your lab results are up or down from that baseline. Working with a practitioner—and a reliable lab—to establish your baseline and monitor hormone levels is well worth the effort.

Damaged mitochondria require additional energy to “heal” or repair, adding to the mitochondrial dysfunction and further compounding the energy crisis. In this way, “mitochondrial dysfunction can result in a feed forward process, whereby mitochondrial damage causes additional damage,” according to an article in Experimental and Molecular Pathology.

Protocols Supporting Mitochondrial Function

Dr. Sarah Myhill, a leading authority on CFS and FMS in the United Kingdom, has had considerable success treating her patients with a protocol based on improving mitochondrial function. This protocol essentially involves:

  1. Eating a Stone Age diet (similar to a Paleo diet).
  2. Taking nutritional supplements, including CoQ10, acetyl-L-carnitine, D-ribose, magnesium and niacinamide (Vitamin B3).
  3. Getting a good night’s sleep on a regular basis.
  4. Achieving a balance between work, exercise and rest.

Dr. Teitelbaum’s S.H.I.N.E. protocol, which also promotes healthy mitochondria, purports to have a remarkable success rate of over 80% among his patients. His approach is similar to Dr. Myhill’s, but it also includes specific attention to hormone balance. The S.H.I.N.E. protocol involves:

  1. Sleep, with the goal of eight to nine hours of solid, deep sleep per night.
  2. Hormones, with the goal of optimizing the adrenals (cortisol and DHEA), thyroid (T3 and T4), testosterone, estrogens and progesterone, using bioidentical supplements as needed. Dr. Teitelbaum also notes that vitamin D, which is actually a hormone, is “critical for regulating immune function.” A vitamin D deficiency can trigger autoimmune illness and increase the risk of infection, also contributing to reduced energy.
  3. Immune Support, with the goal of clearing the body of yeast, candida and fungal infections that can lead to a “leaky gut,” and adding probiotics to keep the gut healthy. Dr. Teitelbaum suggests that anyone with CFS should also be checked for bowel parasites and viral infections that can affect the gastrointestinal tract.
  4. Nutrients, with the goal of optimizing the body’s healing powers by eating a healthy diet of whole foods, avoiding processed foods and sugar, taking vitamin supplements and fish oil. Dr. Teitelbaum recommends D-ribose, CoQ10 and acetyl-L-carnitine to “jump start” the mitochondrial energy production.
  5. Exercise, as able, with the goal of reconditioning, so that the body of someone with CFS or FMS can gradually make the energy needed to do conditioning exercise.

The S.H.I.N.E. protocol is described in further detail in an easy-to-read, “do it yourself” manner in The Fatigue and Fibromyalgia Solution: The Essential Guide to Overcoming Chronic Fatigue and Fibromyalgia, Made Easy! There is a chapter devoted to each of the five areas, complete with questionnaires and worksheets to guide patients through the protocol.

What's in a Name? Is it Chronic Fatigue? Fibromyalgia? Depression? Or something else?

Both chronic fatigue and fibromyalgia have been around for quite some time, and the fact that the medical field is still debating what to call these conditions, not to mention how to diagnose them, is telling in and of itself. We are still learning about these extremely complex syndromes with many overlapping symptoms.

Too often, well-intended people (healthcare practitioners included) suggest that those with chronic fatigue take a vacation, or a sleeping pill, or get a different job, or just “buck up” and get on with life. If only it were that easy…

The suggestion that “it’s all in your head” can create a feeling of helplessness, contributing anxiety or depression to the symptoms already associated with a fatiguerelated condition.

It is unfortunate that many CFS/FMS patients undergo therapy to address mental health and depression, with the result that antidepressants are now frequently offered as “treatment.” While some patients may “feel better” with this approach, it does not address the underlying cause(s).

Dr. Myhill notes that the ATP Profile, a multi-part lab test that measures mitochondrial function, is “an objective test of chronic fatigue syndrome which clearly shows this illness has a physical basis” that antidepressants do not address. Whatever you call it, the syndrome has physical characteristics that are very real, and not “all in your head.”


As its name implies, chronic fatigue syndrome (CFS), also sometimes called chronic fatigue and immune dysfunction syndrome (CFIDS), is a condition characterized by persistent, debilitating fatigue that does not improve with rest. But fatigue is just one aspect of this complex condition. In Canada and Europe, it is often called myalgic encephalomyelitis (ME) or myalgic encephalopathy chronic fatigue syndrome (ME-CFS) to more accurately describe the condition. For the sake of simplicity, we will use CFS to represent all variations of this complex syndrome.

The CDC’s framework for diagnosing CFS requires a combination of:

  1. Extreme, persistent fatigue that lasts longer than 6 months, coupled with
  2. Four or more of the following symptoms, also for longer than 6 months, but having started after the fatigue:
    • Severe, prolonged exhaustion after physical or mental activity
    • Unexplained muscle soreness (not from exercise or trauma)
    • Pain in multiple joints without swelling or redness
    • Sleep disturbances, or sleep without rejuvenation
    • Memory loss or impaired concentration
    • Frequent or recurring sore throat
    • Headaches of a new type or severity
    • Tender, mildly enlarged lymph nodes

In addition to these diagnostic criteria, there are numerous other generalized symptoms that can coexist in people with CFS, including numbness, anxiety, dizziness, an irregular heartbeat, allergies and chemical sensitivities.


According to Dr. Sarah Myhill, one of the leading authorities on CFS, fibromyalgia syndrome (FM or FMS) often occurs along with CFS. Fibromyalgia literally means “muscle pain.” Although the primary symptoms of FMS relate to pain, the second most common symptom is sleep disturbances and fatigue.

Dr. Teitelbaum suggests that although CFS and FMS may be two names for the same condition, a diagnosis of fibromyalgia may be more “socially acceptable.” The reason for that may have something to do with the fact that the pharmaceutical industry has been spending approximately $270 million a year on marketing FDA-approved medications for treating fibromyalgia.

  • Teitelbaum J. The Fatigue and Fibromyalgia Solution: The Essential Guide to Overcoming Chronic Fatigue and Fibromyalgia, Made Easy! New York, NY; The Penguin Group:; 2013.
  • Pieczenik SR, Neustadt J. Mitochondrial dysfunction and molecular pathways of disease. Exp Mol Pathol. 2007 Aug;83(1):84-92. doi: 10.1016/j.yexmp.2006.09.008. Epub 2007 Jan 18.
  • Myhill S, Booth NE, McLaren-Howard J. Targeting mitochondrial dysfunction in the treatment of Myalgic Encephalomyelitis /Chronic Fatigue Syndrome (ME/CFS) – a clinical audit. Int J Clin Exp Med. 2013;6(1):1-15. Epub 2012 Nov 20. 2013;6(1):1-15.
  • Kaplan M. New Study Finds High Prevalence Of Chronic Fatigue Syndrome. NCID Focus. Winter 2004; 13(1).

The information on this website is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding any condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read on this site.

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