Dr. Weyrich's Naturopathic Functional Medicine Notebook is a collection of information on topics of interest to Dr. Weyrich that may be of interest to the world wide audience. Due to limitations of time, not all information that Dr. Weyrich knows or would like to further research is published here. Dr. Weyrich welcomes financial contributions to support specific research topics, as well as copies of non-free access journal articles for him to review on a topic. Constructive criticism is also welcome.


Overview of Chronic Fatigue Syndrome (CFS)

Chronic fatigue syndrome is a functional diagnosis, for which conventional medicine has identified no causative mechanism; its cause may be multifactorial, with multiple contributing factors.

Although chronic fatigue syndrome and fibromyalgia appear to share many of the same symptoms and causative factors, they appear to be distinct disorders with different treatments. Hence, careful differential diagnosis based on history, signs, and symptoms is necessary for effective treatment [Liptan2016].

It is also possible that a patient may present with diagnoses of both fibromyalgia and chronic fatigue syndrome.

Complimentary and alternative treatments for chronic fatigue syndrome that are considered below include:

  • Immune System Balancing
  • Low Dose Naltrexone
  • Neuro-Gen High Performance Neuromodulation (HPN)
  • Neurotransmitter Balancing

Etiology of Chronic Fatigue Syndrome (CFS)

Among the theories that have been advanced, mitochondrial dysfunction and neurotoxins produced by dysbiotic Clostridia spp., yeasts, and fungi appear most credible.

Evidence suggesting that dysbiosis is associated with chronic fatigue syndrome includes the following:

  • Elevated urinary levels of 3-hydroxyphenyl-3-hydroxypropionic acid (HPHPA) and other markers of dysbiotic overgrowth with Clostridia spp. are common in chronic fatigue syndrome [GP].
  • Elevated urinary levels of tartaric acid and other markers of dysbiotic overgrowth with yeasts and fungi are associated with chronic fatigue syndrome [Shaw2008].
  • However, note that hypothyroidism is associated with Functional Immune Deficiency, so addressing hypothyroidism may help clear the dysbiosis.

Another often-overlooked cause of chronic fatigue is sleep apnea.


Diagnosis of Chronic Fatigue Syndrome (CFS)

Symptom picture:
  • Decreased concentration and short-term memory
  • Headaches
  • Muscle and joint pain without inflammation
  • Tender lymph nodes
  • Sore throat
  • Unrefreshing sleep
  • Post-exertional malaise lasting 24 hours or longer
Note that most of the above are also commonly seen in hypothyroidism [Starr2005, pg 148], although other authors attribute these symptoms to overgrowth of Candida [Crook], [Starr2005, pg 150].

Diagnostic Testing:


Differential Diagnosis of Chronic Fatigue Syndrome (CFS)

  • Vitamin B12 deficiency [Pacholok2011].
  • Copper toxicity can cause fatigue and exhaustion; this may especially be a problem in "red-rock" areas of Arizona, where the soil/water may be high in copper.

Treatment of Chronic Fatigue Syndrome (CFS)

Please see conventional, complimentary and alternative medical treatments for important background information regarding the different types of medical treatments discussed below.

Naturopathic, Complimentary and Alternative Treatments

  • Treat hypothyroid if present.
  • Supplement CoQ10, acetyl-L-Carnitine, D-Ribose, alpha-Lipoic Acid (tx: mitochondrial dysfunction).
  • Heavy metal chelation if indicated.
  • Treat dysbiosis if present.
  • Supplement with malic acid if Organic Acid Test shows that urine tartaric acid is elevated [Russell1995].
  • Supplement with magnesium (why?) [Shaw2008].
  • Low doses of adrenal hormones may be beneficial [MckJefferies2004], [Starr2005, pg 151].

Immune System Balancing

[McCulley2018, pp 35, 89, 219-222] reports that chronic fatigue syndrome is a TH2-dominant autoimmune disorder. However, [McCulley2018, pg 180] also reports states that chronic fatigue syndrome is not an autoimmune disease because there are no antibodies.

Dr. Weyrich has considerable interest in this topic, but has not treated any cases of chronic fatigue syndrome with Immune System Balancing.

Please see What is Immune System Balancing? for more information.

Low Dose Naltrexone (LDN)

According to the Low Dose Naltrexone home page [LDN], LDN has been seen to benefit chronic fatigue syndrome, which is considered to be an autoimmune disease. [LDN] reports that all patients with autoimmune processes who were treated by the late Dr. Bihari [Bihari2003] using LDN "have experienced a halt in progression of their illness. In many patients there was a marked remission in signs and symptoms of the disease." Dr. Bihari suggests a 50% to 70% overall response rate [Bihari2003].

Dr. Weyrich has been trained in the use of Low Dose Naltrexone (LDN). However, Dr. Weyrich has not treated any cases of Chronic Fatigue Syndrome with LDN.

Please see What is Low Dose Naltrexone? for more information.

Neuro-Gen High Performance Neuromodulation (HPN)

HPN has been reported to be useful for treating chronic fatigue syndrome [Snook]. Dr. Weyrich has been trained in the use of Neuro-Gen High Performance Neuromodulation system by it's inventor, Corey Snook. However, Dr. Weyrich has not treated any cases of chronic fatigue syndrome with this technique.

Please see What is Neuro-Gen High Performance Neuromodulation? for more information.

Neurotransmitter Balancing

Neuro Research [Hinz2015] reports that chronic fatigue can be benefited by balancing neurotransmitter levels in the body.

Dr. Weyrich has been trained in neurotransmitter balancing protocols, but has not treated chronic fatigue using this technique.

Please see What is Neurotransmitter Balancing? for more information.


Pathophysiology of Chronic Fatigue Syndrome (CFS)

Elevated levels of tartaric acid (3-hydroxymalic acid or 2,3-hydroxy-succinic acid) are associated with chronic fatigue syndrome. Tartaric acid is an analog of the Krebs cycle intermediate malic acid that inhibits the Krebs cycle enzyme fumarase that converts fumaric acid to malic acid [Shaw2008] [Russell1995].

References for Chronic Fatigue Syndrome (CFS)