Judging from the great number of exhausted patients I see, chronic fatigue syndrome (CFS) is an extremely common medical problem.

Yet surprisingly, health-care providers can’t seem to agree on what CFS is, what causes it, how to diagnose it — or even whether it exists at all. Many medical doctors even believe that CFS is strictly a psychological problem and automatically prescribe antidepressants.

In my opinion, all this arguing about the CFS label is beside the point. The facts: Millions of Americans suffer from fatigue and need medical help. To complicate matters further, CFS is not a single disease with a sole cause or a simple cure. Rather, it is the manifestation of one or more underlying health problems, such as infections, hormone imbalances or numerous other conditions. The goal of treatment is not simply to mask the symptoms — it is to identify the root cause or causes in an individual patient and then recommend the appropriate healing therapies.

Diagnosis requires a thorough physical exam, complete personal and family histories, diet and lifestyle analyses and various laboratory tests. I am gratified that about 90% of my CFS patients say their symptoms improve significantly or disappear completely after treatment.

If you recognize your symptoms and medical history in any of the following scenarios, consult a holistic doctor. He/she can order diagnostic tests… advise you on appropriate therapies… recommend specific dosages… and alert you to possible side effects.

Note: Some remedies below require a prescription, and others are sold over the counter (OTC) in health-food stores. Talk to a holistic doctor before using any of these therapies, especially if you take medication, to ensure that the treatments are appropriate and safe for you.


Persistent infection is an often-missed cause of CFS. Examples…

Various viruses. Sometimes viruses that normally die off within weeks instead linger on, weakening the immune system and compromising energy production.

Clues: Fatigue that began after the patient had flulike symptoms… and a blood test that shows low levels of disease-fighting white blood cells. Typically, your white blood cell count rises during an acute infection, but it may fall below normal when infection drags on. Research at Stanford University supports the idea that viruses can trigger CFS.

Evidence: Investigators gave 25 CFS patients the antiviral prescription drug valganciclovir (Valcyte), and in 21 of the patients, fatigue was significantly relieved. However, such medications can cause serious side effects, including vision problems and seizures. Instead, I recommend using natural therapies that strengthen the immune system, including the herbs lomatium root and echinacea… thymus extract… oral or intravenous vitamin C… the mineral selenium… and homeopathic nosodes (remedies made from viruses or other pathogens that stimulate the immune response much as vaccines do).

Herpes viruses. The Epstein-Barr virus (which causes mononucleosis) and human herpes virus 6 (which causes roseola, a disease that may involve a skin rash and fever) can bring on CFS. Both are detected with blood tests that measure antibody levels. Scientists believe that herpes viruses are not eradicated from the body, but instead remain dormant until the immune system is compromised — at which time the virus replicates. To strengthen immunity, inhibit viral replication and improve energy production, I prescribe the immune-boosting herbs and homeopathic remedies mentioned above.

Hepatitis. When an exhausted patient also has yellowish skin, unexplained weight loss, an enlarged liver and/or elevated liver enzymes, I order blood tests to check for hepatitis, an inflammatory liver disease. Among the hepatitis viruses, types B and C are most likely to trigger CFS. Treatment includes herbs that support liver function, such as milk thistle and schizandra… and immune-boosting selenium and alpha lipoic acid, which are antioxidants (nutrients that neutralize harmful molecules called free radicals). For severe hepatitis, prescription antiviral pharmaceuticals also may be warranted.

Bacterial infections. When the normal balance of friendly bacteria in the gut is disturbed — for instance, due to a high-sugar diet or use of antibiotics — harmful bacteria proliferate in the digestive tract. This can overtax the immune system and lead to chronic fatigue. A stool test can confirm the diagnosis. Bacteria also may linger in the body when a dental root canal fails to heal. This is confirmed with an X-ray and/or culture. Treatment includes antibacterial supplements, such as goldenseal, oregano oil and colloidal silver. Depending on the infection, antibiotic drugs may be appropriate.


Fatigue is a common symptom of various cardiovascular conditions that impair circulation and limit the oxygen available to the brain and muscles.

Congestive heart failure. This occurs when the heart cannot pump enough blood to meet the body’s needs. Symptoms include chest pain, heart palpitations and swollen ankles. In such a case, I refer the patient to a cardiologist for tests — for instance, an electrocardiogram (ECG), which detects and records the heart’s electrical activity — and appropriate medical treatment. Complementary therapies include supplements that increase energy production within heart cells or boost blood flow to the heart. Best: Coenzyme Q10 (CoQ10)… the amino acid derivative L-carnitine… herbal hawthorn extract… the mineral magnesium… and the sugar D-ribose.

Chronic hypotension (low blood pressure). Repeated blood pressure readings below 90/60 mmHg indicate hypotension. Other symptoms include fatigue, dizziness or fainting… rapid, shallow breathing… cold clammy skin… pallor… blurred vision… nausea… excessive thirst… trouble concentrating… and/or depression. To increase blood volume and thereby raise blood pressure, I recommend that patients ingest 2,400 mg to 3,400 mg of sodium daily and drink at least 64 ounces of water daily. Helpful: Herbal supplements that improve circulation, such as gotu kola and Pycnogenol (maritime pine bark extract).

Neurally mediated hypotension. With this type of low blood pressure, people become dizzy only after standing or sitting for a prolonged time, and may feel nauseated if they do not lie down. Possible cause: When the adrenal glands (which secrete stress hormones) do not function well, the resulting hormone imbalance may interfere with the nerves’ signals between the heart and brain, impairing the body’s ability to maintain equilibrium.

Test: Blood pressure is taken when the patient is lying down and again when standing up. Blood pressure that remains the same or drops (instead of increasing upon standing, as is normal) indicates neurally mediated hypotension. Treatment includes the previously mentioned hypotension therapies, increased rest and the remedies for adrenal fatigue described below.


When hormones are out of balance, fatigue is common. If you are diagnosed with a hormone deficiency and hormone therapy is recommended, ask your doctor about bioidentical hormones. Unlike synthetic hormone drugs, bioidentical hormones have the same molecular structure as those produced by the human body. As a precaution, I advise that all hormone therapies — even OTC — be used under a doctor’s guidance.

Adrenal fatigue (AF). In stressful situations, the adrenal glands produce the hormones cortisol and dehydroepiandrosterone (DHEA). With AF, this mechanism is overwhelmed by prolonged physical or emotional stress, and these hormones become depleted. Because cortisol and DHEA are vital to energy production, blood sugar control and the anti-inflammatory response, AF can cause unremitting fatigue. Additional symptoms include mood swings, low libido, poor concentration and memory, light-headedness, low back pain, slow recovery from illness, salt and/or sugar cravings, and inability to lose or gain weight despite calorie reduction or increase. Saliva, urine and blood tests can detect low levels of cortisol and DHEA.

To balance hormone levels, I advise taking midday naps and sleeping eight to nine hours each night… exercising in moderation (not to exhaustion)… and controlling blood glucose by avoiding simple carbohydrates (such as those in sugary foods, white bread and pasta). To hasten adrenal cell healing, I recommend the herbs ashwagandha, licorice root and rhodiolarosea… adrenal glandular extract (a supplement derived from cow or pig adrenal tissue)… vitamin C… a B-vitamin complex… and, in severe cases, bioidentical cortisol and/or DHEA replacement.

Estrogen and/or progesterone deficiency. A woman’s production of these hormones naturally decreases at menopause — but if levels drop too low, she may experience fatigue along with menopausal symptoms, such as severe hot flashes. Lab tests reveal these deficiencies. If levels are only slightly low, homeopathic remedies and/or the herbs black cohosh and maca root may restore hormone balance. For significant deficiencies, bioidentical hormone therapy can be considered.

Low testosterone. This is common among men, especially those over age 60. Obesity, diabetes and high blood pressure increase the risk for testosterone deficiency. Symptoms include fatigue, reduced muscle mass, weight gain and joint pain. The condition is diagnosed using blood tests that measure levels of “free” testosterone (the amount not bound to protein and therefore available to interact with cells), and treated with bioidentical testosterone replacement.

Growth hormone deficiency. Symptoms, which usually appear after age 65, include fatigue, reduced muscle mass and strength, loss of skin elasticity and increased abdominal fat. If a blood test for insulin growth factor 1 confirms the deficiency, I prescribe injections of growth hormone.

Hypothyroidism (thyroid hormone deficiency). In addition to fatigue, hypothyroidism patients typically have unexplained weight gain… low body temperature, cold hands and feet, and frequent chills… dry skin… constipation… and/or depression. The most accurate blood test measures the free levels of the thyroid hormones T3 and T4. Treatment includes supplements that support normal thyroid function, such as iodine… the herbs bladderwrack and ashwagandha… and thyroid glandular extract (derived from the thyroid glands of various animals). In moderate or severe cases, I also prescribe thyroid hormone replacement that includes T3.

There is no reason to accept chronic fatigue as an immutable fate. With the appropriate diagnosis and treatment, the mystery of CFS can be solved.


To identify and treat the root cause of an individual’s chronic fatigue, doctors must take into account all accompanying symptoms. If you experience fatigue and…

  • Mood swings, memory problems and/or low back pain, the cause may be adrenal fatigue.
  • A history of root canal problems, the cause may be bacterial infection.
  • Chest pain and/or heart palpitations, the cause may be congestive heart failure.
  • Yellow skin and/or unexplained weight loss, the cause may be hepatitis.
  • Hot flashes, weight gain and/or reduced muscle mass, the cause may be hormone deficiency.
  • Dizziness, nausea and/or clammy skin, the cause may be hypotension (abnormally low blood pressure).
  • Low body temperature, weight gain and/or dry skin, the cause may be hypothyroidism.
  • Flulike symptoms or mononucleosis, the cause may be a viral infection.