Eat a balanced, healthy diet. Eat whole grains, vegetables, and low-fat meats. Avoid stimulants such as caffeine, alcohol, and nicotine, and cut back on animal fats, salt, and sweeteners. Listen to your body, and avoid foods that you find difficult to digest. Eat simple meals that do not mix many different foods.
Get enough mental and physical rest and relaxation.
Learn to pace yourself to avoid physical, intellectual, and emotional stress. Get regular exercise at a level that does not cause more fatigue.
Stress makes your symptoms worse, and may lead to a relapse. Reduce stress in your life as much as possible, and avoid exertion beyond your limits. You may need to change plans or stop an activity if you begin to feel fatigued. Regular, aerobic exercise such as walking improves symptoms. Setting up a regular daily routine will help you avoid the common mistake of doing too much when you feel better, which often leads to a relapse of symptoms. This is known as “push-crash.”
Your doctor is the best source of information on the drug treatment choices available to you.
Follow a carefully designed exercise program. Patients with CFS usually cannot tolerate their previous amount of activity. However, you should be as active as possible without becoming overtired. Limited exercise, as prescribed by a doctor or a physical therapist, is important for maintaining muscle tone. Exercise that does not increase body heat too much or only slightly increases your heart rate is best, such as walking and light weight training.
Get emotional and psychological support to help you cope with the effects of CFS. CFS often causes great emotional distress. It affects your ability to earn a living and to take care of other people, which may result in a loss of self-esteem. You may need to give up many activities you formerly enjoyed. CFS changes your relationships with family and friends, who may not understand or accept your illness, and may fail to give you enough support. Employers may also not realize the nature of your disorder.
You may want to seek therapy or counseling. An approach called “cognitive behavior therapy” can help ease distress by teaching you how to cope better with the changes in your life and the people with whom you interact. Family therapy can help you express your needs more clearly, and reduce the negative effect of CFS on your family.
You may find it useful to join a local support group. Meeting other people with CFS may be helpful. A good support group includes both newcomers and people who have had CFS for a longer time. The group should make you feel comfortable. The leader should be kind and encourage all members to speak.
However, not everyone finds a support group useful. For some people, the group only increases their stress.
Many patients report that dietary supplements and herbs have relieved their symptoms. However, these claims have not been confirmed by scientific research Table 02.
Table 2. Dietary Supplements and Herbs for CFS
Type of remedy Name Symptoms treated Side effects Hormones DHEA (dehydroepiandrosterone) Low energy, poor concentration Rapid heartbeat, nervousness Melatonin Poor sleep Nervousness, headaches, early menstrual periods in women Vitamins Vitamin A Tendency to infection Overdose: appetite loss, irritability, itching, headaches, mouth ulcers Vitamin B complex Low energy level, premenstrual syndrome, poor sleep, depression None Vitamin B12 injections Low energy, poor concentration Allergic reactions to solution, sometimes rashes Vitamin C Poor blood flow, low immune function Some patients cannot tolerate Coenzymes Coenzyme Q10 Fatigue Few, but may cause nervousness and insomnia NADH Low energy, poor concentration Minor: gas, loss of appetite, indigestion Amino acids Various, depending on symptoms Fatigue, poor concentration, digestive problems Various, depending on which amino acid is taken Minerals Magnesium Pain, muscle weakness, lack of stamina High doses: diarrhea Zinc Low immune function, sore throat, other flu-like symptoms High doses: serious stomach and intestinal problems Bioflavonoid Quercetin Asthma, allergies High doses: diarrhea Essential fatty acid Evening primrose oil Low energy, skin problems, mood swings Rare: headache, digestive discomfort Herbs, such as echinacea, Gingko biloba, and chamomile Various, depending on symptoms Useful for those sensitive to drugs or as a supplement to other therapy Various, depending on the herb and patient's other medicines; can be serious
The effectiveness of herbal remedies has not been proven by scientific research
Supplements that many patients have found to be helpful include hormones and vitamins. Some doctors and patients say that the hormone DHEA has given them more energy, made their minds clearer, and boosted their immune systems. Other patients have had side effects including rapid heartbeat and nervousness. Some very ill patients who took DHEA have had relapses. DHEA may be suitable for people with mild illness.
Many physicians include vitamin supplements as part of treatment for CFS, believing that ill people need greater amounts of vitamins. They also believe that CFS patients may not absorb all the vitamins in their food.
In particular, some physicians recommend extra amounts of vitamins A, B, and C. Some patients also say that injections of vitamin B12 increases their energy and mental clarity. There are a few reports of allergic reactions to these injections.
Coenzyme Q10 is a vitamin-like substance that is often used to treat fatigue. Many patients report that it increases energy. Although it has few side effects, some patients report that it makes them nervous and causes sleep problems.
NADH, also a coenzyme, is reported to improve energy and concentration. One small research study of NADH gave some support to this claim.
Other supplements that are said to benefit people with CFS include amino acids (the building blocks of proteins); minerals, including zinc and magnesium; the bioflavonoid quercetin; the hormone melatonin; and evening primrose oil, which contains nutrients called essential fatty acids. There is no well-designed scientific evidence to support any claims of benefit from these substances.
Herbs taken in the form of teas or tinctures may help to relieve symptoms. Herbs can relieve particular symptoms, although they tend to become less effective over the long term. Herbs that are said to be helpful are astralagus, comfrey, echinacea, garlic, Ginkgo biloba, St. John’s wort, chamomile, ginger, goldenseal, gotu kola, licorice, milk thistle, uva ursi, and valerian.
Because herbs contain powerful substances, they can cause serious side effects. They can also interact with prescription drugs (for example, St. John’s wort must not be taken with prescription antidepressants, especially those called MAO inhibitors). Thus, herbs should used with caution. It is best to consult with an herbalist and a health care professional before taking herbs.
CFS patients use a wide variety of other alternative therapies to relieve symptoms. You may find that various forms of alternative medicine or supportive therapies can relieve pain, help you relax, and relieve stress. Such methods include different types of massage (acupressure, therapeutic touch, craniosacral therapy, reflexology, lymphatic drainage, Swedish massage), acupuncture, warm- or cool-water baths, chiropractic, self-hypnosis, tai chi, and yoga. For most of these therapies, you will need to find a qualified instructor or practitioner.
There is no evidence that CFS can be transmitted to an unborn child, or that the disorder will affect the baby. However, pregnant women need to be extra careful. If you are pregnant, you may find that your CFS symptoms continue unchanged. However, some pregnant women report that their symptoms disappear early in the pregnancy, and do not return until about six weeks after delivery.
You should mention your CFS to your obstetrician. The doctor may tell you to stop taking many of the drugs used to treat the CFS symptoms, or to decrease the dose until you have stopped breast-feeding.
When deciding whether to become pregnant, you and your partner should think about whether you will have the energy needed to care for a child.
Ask your doctor about precautions regarding contagious diseases and vaccines. People with CFS are more likely to have adverse reactions to vaccines, such as flu shots. You should discuss the possible risks and benefits with your doctor before deciding to have any vaccine.
The outcome of CFS varies greatly among patients. Some CFS patients recover completely, although the actual percentage of those who do is not known. Some people become well enough to return to work and resume other activities, but they still have some symptoms. Some have periods of wellness that alternate with periods of illness. Others stay more or less the same, and still others continue to get worse.
The CDC is studying the long-term outcome of CFS. Early results suggest that although you may recover at any point in the illness, your greatest chance of recovery occurs during the first five years. The CDC also finds that people whose CFS developed suddenly seem to recover nearly twice as often as those whose condition developed slowly.
Your treatments will need to change during the course of your illness. Since CFS patients are generally very sensitive to drugs, your doctor will almost always begin treatment with very small doses to reduce the chance of an adverse reaction. Depending on your response, the doctor will increase the dose if necessary.
It’s helpful to try one treatment at a time. This helps you see what works and what does not. Remember that many drugs take several weeks to show a benefit.
As your illness continues, treatments that did not work at one stage may be useful later on.
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