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Chronic Fatigue Syndrome

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Fatigue is a common complaint among patients and can involve the feeling of generalized weakness, the inability to be active without becoming fatigued, and/or mental fatigue. Chronic fatigue is defined as experiencing fatigue for more than six months whereas chronic fatigue syndrome (CFS) is defined as persistent, medically unexplained, disabling fatigue that is accompanied by at least four other specific symptoms. The causes of fatigue/CFS are often multifactorial, but poor nutrition has a major role in its development.

  • Overview
  • Action Plan
  • Ask The Doctor


Chronic fatigue and CFS are more common in women than men. Chronic fatigue is a common complaint seen in primary care offices. One study revealed that 24% of patients identified fatigue has a “major problem.” CFS is not as common but may affect up to 2.6% of patients.1 Fatigue in the workplace costs employers $130 billion annually in health-related lost productive time.2

Chronic fatigue syndrome is defined as persistent fatigue for more than six months that is not caused by exertion, does not improve with rest, and is not attributable to other medical conditions. It is accompanied by four or more of the following symptoms:

  • Sore throat
  • Tender lymph nodes in the neck or armpit
  • Headaches
  • Joint pains
  • Muscle pains
  • Impairment of short-term memory or concentration
  • Poor sleep quality
  • Post-exertion fatigue lasting more than 24 hours

Chronic fatigue is often accompanied by other diseases. It is associated with or can be caused by:

  • Poor nutrition lacking in micronutrients
  • Sedentary lifestyle
  • Stress
  • Mood disorders such as depression or anxiety
  • Medications such as antidepressants or antihypertensives
  • Chronic diseases such as diabetes, hypothyroidism, liver or kidney disease, COPD or heart failure
  • Anemia
  • Cancers
  • Infections such as mononucleosis, HIV
  • Auto-immune diseases such as rheumatoid arthritis
  • Allergies
  • Sleep apnea
  • Fibromyalgia
  • Chronic fatigue syndrome

Chronic fatigue syndrome is a diagnosis of exclusion when the cause of fatigue cannot be determined. Although likely due to multiple causes, such as chronic infections and immune dysfunction, one of the major contributors to CFS is poor nutrition. Lack of sufficient micronutrients, which inhibits the body’s ability to detoxify ingested toxins, contributes to the development of CFS. A Nutritarian diet has relieved many patients’ CFS symptoms.

  1. Ranjith G. Epidemiology of chronic fatigue syndrome. Occup Med (Lond) 2005, 55:13-19.
  2. Ricci JA, Chee E, Lorandeau AL, Berger J. Fatigue in the U.S. workforce: prevalence and implications for lost productive work time. J Occup Environ Med 2007, 49:1-10.

Action Plan


  • A Nutritarian diet will supply adequate micronutrients to build up vitamin, mineral, and phytochemical stores and aid in the detoxification of toxins. Toxins are either ingested or inhaled from the environment or made by the body as by-products of metabolism. Nutrients are needed to drive detoxification reactions that help rid the body of these toxins. Leafy greens, colored vegetables, beans, fruits, nuts, and seeds will provide the micronutrients needed for detox. Attention to adequate plant protein and a high plant protein to animal protein ratio is helpful to aid detoxification. Hemp seeds, sunflower seeds, Mediterranean pine nuts, and the liberal use of beans and greens have been helpful for many patients.
  • Food sensitivities may contribute to fatigue. An elimination diet may be necessary to see if symptoms improve with avoidance of the most allergenic foods (e.g. gluten, dairy, corn, soy, peanuts)


Graded-exercise therapy can aid in recovery from CFS. Home exercises can be performed five times a week, starting with a 5 minute session. This can gradually be increased as tolerated.1

Vitamin D

Low vitamin D levels may be associated with CFS and should be supplemented to bring blood levels to 30 ng/ml. Blood work to check ferritin, iron, B12, MMA (methylmalonic acid), and Vitamin D 25 hydroxy can be helpful.2 Omega-3 levels should be optimized with DHA/EPA supplementation, and zinc supplementation can also be helpful for some patients, as increased zinc requirement is common in chronic fatigue.3

Find additional help

ONLINE: All members of can search the Ask the Doctor archives for discussions on this topic. Platinum and Diamond members can connect with Dr. Fuhrman by posting questions in the forum. Not a member? Join now.

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  1. Van Cauwenbergh D, De Kooning M, Ickmans K, Nijs J. How to exercise people with chronic fatigue syndrome: evidence-based practice guidelines. Eur J Clin Invest 2012, 42:1136-1144.
  2. Berkovitz S, Ambler G, Jenkins M, Thurgood S. Serum 25-hydroxy vitamin D levels in chronic fatigue syndrome: a retrospective survey. Int J Vitam Nutr Res 2009, 79:250-254.
  3. Maes M, Mihaylova I, De Ruyter M. Lower serum zinc in Chronic Fatigue Syndrome (CFS): relationships to immune dysfunctions and relevance for the oxidative stress status in CFS. J Affect Disord 2006, 90:141-147.

Ask The Doctor

The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)


Recent bloodwork revealed that my vitamin D level is 13. I currently take two Osteo-Sun and also have been exposing my face to the sun for 15 minutes a day, three times a week. I practice yoga regularly and have done so for quite some time. Recently, my endurance level has been compromised and I feel nauseous and dizzy. Overall, I’m very fatigued. Could a vitamin D deficiency cause such a result?


Yes, Vitamin D deficiency can cause fatigue and muscle cramps.

Sun on your hands and face will not be sufficient. Make sure you are taking my Women’s Daily Formula which contains 2000 IU of D3 in addition to three Osteo-Sun. Some people require more Vitamin D than others. Recheck this level in 3 months, and check if your level is between 30 and 45 so further adjustments can be made if needed.


I am currently suffering from chronic fatigue. I have read some literature that warns against a high intake of carbohydrates, as it may exhaust the adrenals. Do you have any advice for me?


Chronic fatigue is caused by many different factors such as infection, nutritional deficiencies, hormone imbalances, lifestyle factors such as poor diet, sedentary lifestyle, and stress. It is the high intake of refined carbohydrates that is detrimental (soda, white flour, bread, pastries, etc.). Beans, vegetables, fruits, and nuts/seeds are rich in complex carbohydrates that are healthful in general and healing and restorative to adrenal function.