Most of my patients present to me wanting help with their mental health, particularly anxiety. But as a naturopath trained to uncover the unique root causes beneath someone’s symptoms, I end up helping with all sorts of connected issues, from gut, to thyroid to hormones and more. Two similar and often overlapping conditions that can manifest with anxiety (and depression) are fibromyalgia (FM) and Chronic Fatigue Syndrome (CFS).

These poor patients are going through A LOT…both experience symptoms such as pain, fatigue, sleep disturbances, exercise intolerance, cognitive difficulties and general unwellness, whereas FM is characterised by severe widespread muscle pain and CFS often has severe fatigue, brain fog, lymph node swelling and sore throat. What’s worse, is the exact causes of these illnesses are not known, and effective treatment can be even more elusive.  In fact, 80% of those suffering from CFS and FM are given the wrong diagnosis for YEARS…it’s a long time to suffer without knowing what’s going on, let alone being treated effectively! This can leave patients feeling hopeless and also misunderstood, as loved ones and health practitioners alike may dismiss these symptoms as “all in their head”.

3 Core Defects in FM & CFS and The Vicious Circle

While science hasn’t elucidated exactly what’s going on in these conditions yet, it has become clear that there are 3 core defects at the heart of both, and effective symptom management must target these.

Mitochondrial Dysfunction

The mitochondria are the energy producing “mini-organs” of your cells, and nearly every symptom of CFS and FM can be traced back to these little guys not behaving properly. I won’t get into the biochemistry of it, but suffice to say, instead of producing energy as they should, the mitochondria end up going haywire biochemically speaking, and producing oxidative stress and inflammation instead. In fact, in both CFS and CM patients, muscle biopsies show loads of ragged red fibres – damaged mitochondria – which is the hallmark of mitochondrial diseases.

 Oxidative Stress

So, the mitochondria instead of producing energy produce oxidative stress which further damages the DNA of the cells as well as causes oxidation to the fatty cell membranes (imagine your cell walls going “off” like expired milk or rusting like an old nail!)…This then interferes with normal cell signalling which can cause catastrophic effects on cellular communication leading to all sorts of symptoms depending on the type of cell affected – eg a neuron may no longer respond to serotonin causing mood issues, or a muscle cell may trigger auto-immunity from the immune system.

This then becomes a vicious circle – the more damaged the mitochondria, the more oxidative stress is generated and the more oxidative stress, the more damaged the mitochondria become!

This oxidative stress also activates inflammation in the body, further contributing to mood, pain, cognitive and somatic symptoms.

Ischaemia

Ischaemia, or poor blood supply to the tissues, is another defect in CFS and FM, as the oxidative stress damages arterial walls and compromises circulation. In FM, this reduced blood flow in the muscles can contribute to pain and tenderness and in CFS it doesn’t always manifest in the muscles but it often does in the brain resulting in severe cognitive dysfunction such as confusion, brain fog, the inability to concentrate and fatigue.

Precipitating, Triggering and Maintaining Factors in FM and CFS

So why do certain people succumb to these chronic, lingering illnesses that are essentially biochemical disasters, and struggle so hard just to reclaim some basic health, wellbeing and energy?

When we dig into the stories of these patients there is often a trigger – a point where symptoms started or steadily got worse…in FM or CFS it could be a significant life-stress or emotional upheaval or in CFS there is often an underlying  viral infection such as Epstein-Barr or Ross River Virus. For many, there are hidden gut infections they may not know about.

But again, not everyone who has a life-stress or viral infection succumbs to these chronic complications…which is why precipitating factors are important to examine. These patients may be sensitive, been chronically unwell as children or had a difficult childhood or past trauma. Others are at the other end of the spectrum -Type A personalities accustomed to working 60 hour weeks, partying and exercising hard and pushing their bodies to their limit with no problem – until it crashes and won’t “co-operate” anymore.

Maintianing Factors

Contributing to the ongoing unwellness can be the “maintaining factors” which can vary from person to perosn. In those with viral infections, the immune system is constantly battling to keep the virus at bay. From the gut, the immune system may be constantly battling infections like SIBO or having to deal with the constant fallout of food intolerances or leaky gut syndrome. And for our stressed and crashed patients, the severe history of stress can alter the HPA axis and even thyroid, further degrading their energy stores and resilience to stress.

A Holistic Approach

Getting relief for some of these debilitating symptoms can be frustrating for practitioners and patients alike, with so many underlying factors, it can be hard to know where to begin, and several areas may need targeted support, from the gut to the immune system to the adrenals or thyroid.

However, the key to getting the most leverage in terms of relieving pain and ftaigue as quickly as possible is to target the 3 areas mentioned above: oxidative stress, mitochondrial dysfunction and ischaemia. Certain nutrients and antioxodants have shown promise in clinical trials in breaking this cycle of cellular energy dysfunction, such as CoQ10, N-Acetyl Cysteine, D-Ribose, Magnesium and L-Carnitine to name a few.

Once we can “win” back some energy by disrupting this vicious cycle and reduce pain and brain fog, it’s then much easier to address some of those triggering and maintaining factors that still need to be dealt with so that we’re not just applying a “band-aid” solution. Healing leaky gut, removing food intolerances and gut infections, supporting the adrenals and the immune system and well as working on repairing the cell membranes and mitochondria are 2nd tier treatment aims.

We also can’t underestimate the power of the mind/body connection in healing, and lifestyle interventions like stress reduction, mindfulness, gratitude, rest and healthy boundaries in relationships can be particularly helpful.

It’s important to have realistic expectations with treatment goals and symptom resolution, it definitely takes time to address these different factors, and as each individual is unique, it can feel a bit like finding the missing pieces of a cryptic puzzle. Thankfully though, with time and dedication, symptoms and quality of life can improve with each step, if not all at once, and more and more research is on it’s way in terms of the causes and possible treatments for these chronic conditions.

If you’d like help getting to the bottom of your FM or CFS, you can shcedule a free 30 min consultation here.

In the comments below, I’d love to hear from you! Have you struggled with these conditions? Have you found something that has helped you that you’d like to share?