Chronic Fatigue Syndrome (CFS) or ME is a complex nervous system and immune system disorder.

It involves the cell powerhouses (the mitochondria) and gut health, including gut wall integrity (see the leaky gut/leaky brain hypothesis), and is slightly different for everyone. Triggers range from an acutely stressful event and extreme physical stress on the body to the aftermath of an acute viral infection (such as Long Covid.)

Specialized immune cells in the brain called microglia, which are involved with upregulating the brain-immune axis in brain inflammation and form the first line of defense of the blood-brain barrier, may also become dysfunctional as part of CFS.  

Some things that may improve how the microglia work and reduce neuroinflammation include medications such as cannabinoids, LDN (low dose naltrexone), therapeutic psychedelics in a medical context, and a ketogenic diet. 


The Resilience Medicine Approach to Chronic Fatigue Syndrome (CFS) or ME

There is no single cure for CFS/ME, but rather, the treatment should be tailored to the patient. So, the Resilience Medicine approach often involves functional medicine testing to further customize the plan for each person but even without these advanced tests, there is a lot you can do on your own to help healing.

Diet
Supplements
Medication
mind-body
BioData + Habit Tracking

Diet

  • The Resilience Medicine diet principles
  • A healthy ketogenic style diet high in healthy fats may help mitochondrial function and help reduce fatigue and inflammation but can be hard to stick to
  • Eliminate all caffeine and alcohol due to their effect on mitochondria (especially alcohol which is a mitochondria toxin)

Supplements

Many people living with CSF/ME find nutraceuticals and botanical supplements can help, including:

  • Liposomal glutathione
  • Lions Mane and other medicinal mushrooms for stress and cognition support
  • High Absorption Magnesium
  • Vitamin D 3
  • CBD, cannabinoids, and terpenes from the cannabis plant, including alpha-pinene, beta-caryophyllene, and myrcene.
  • D ribose 5 grams for three weeks
  • Acetyl L carnitine
  • Liposomal CoQ10
  • Mg/potassium aspartate
  • NAC
  • Herbal sleep support
  • Thyroid and adrenal support with botanicals first (ashwagandha, medicinal mushroom blend, schizandra, licorice root (avoid if high blood pressure))
  • Energy support with ginseng family of herbs, cordyceps

Cannabinoids & Medication

Medications can also help, particularly:

  • Medical cannabis especially chemovars that are energising and have a high CBd:THC rato, THCA oil, starting with very low doses
  • Full spectrum hemp CBD which contains a micro-amount of THC (unless THC free) may also help
  • LDN (low dose naltrexone)
  • Stimulant medications for severe fatigue to improve function (not a first-line treatment)
  • Consideration of medications to treat other symptoms, e.g. treat restless legs syndrome if present, depression, insomnia, pain (if also has fibromyalgia)
  • Melatonin
  • Faecal transplants
  • therapeutic psychedelics (research phase currently although many years of use outside the medical model with very good anecdotal recoveries although exact doses and plant compounds used varies widely and not legally available in most countries for this indication currently)
  • Immunotherapy agents (research phase)

Mind-body Tools

Many forms of relaxation practices can help decrease brain and body hyperarousal and help expand the energy envelope and decrease the ‘tired but wired feeling.’ People can also suffer from a lack of deep restorative sleep and difficulty resting and achieving a sense of calm. These may include:

  • PMR-progressive muscular relaxation-good if also have fibromyalgia and body pain/tension
  • Breath focused mini-meditation minutes throughout the day, focusing on a longer exhale than inhale and experimenting with a few seconds of holding the breath at the top of the inhale. This can help check in with energy levels and avoid overexertion.
  • Yoga Nidra recordings whilst lying down
  • Spending time in nature when possible
  • Altered states experiences with a guide. Many people anecdotally have found these to be helpful in their healing and regaining energy levels and function, e.g. holotropic breathwork, alpha-theta neurofeedback, therapeutic psychedelics (where legal)

Apps, BioData and Habit Tracking:

  • You can track your fatigue and related symptoms in the app and see any interventions and resilience tips you have started and if they are helping over time.

Dr. Dani’s Summary:

CFS/ME is a group of diseases that are very complex but very real and definitely not ‘all in your mind’ as sadly many patients have been told before they get to me. Many times people have been trying what until this year was the recommended approach of ‘graded exercise therapy’ which rarely improves peoples disease and often makes them feel worse on top of making them feel they are ‘not trying hard enough or made to feel like they are crazy or exaggerating how bad they feel. It’s pretty disheartening and many people lose hope of getting better. This is a neuro-immune disorder and that is how I treat it.

Cannabinoids have been a lifesaver for my patients with CFS/ME and often the first thing they have tried that has improved their symptoms, function, and quality of life after trying dozens of medications, natural things and every treatment under the sun for years. When they start to feel better and have a bit more energy, starting to work on the gut health and often, leaky gut, adding a simple rejuvenating recorded meditation to listen to each day while relaxing and some targeted supplements can completely transform their daily life over 6-12 months. That may sound like a long time but to most people who have lived with CFS for years it feels like no time at all. Long Covid sufferers have many similar symptoms to CFS/ME and chronic Lyme and these disorders likely share many immune mechanisms or similarities and a similar approach offers great promise since no drugs have helped thus far.