CHRONIC FATIGUE SYNDROME

Chronic fatigue syndrome (CFS), previously called myalgic encephalomyelitis (ME), refers to a relentless, debilitating exhaustion that makes a short walk feel like a Himalayan trek. Because no one knows its exact cause, a cure remains elusive. Research and doctors' experience both suggest that some herbs and nutritional supplements can help ease the symptoms.

This illness begins as a flu-like cold that won't completely go away, followed by fatigue that rest won't relieve and tiredness that has nothing to do with overexertion. Other symptoms include sore throat, tender lymph nodes in the neck or armpit, muscle pain, joint pain, headaches, impaired memory and concentration, depression, anxiety and insomnia. Symptoms tend to wax and wane; just when you think.

you're getting better and attempt to get your life back, you relapse.

If you suspect you have CFS, it's important to see a doctor for a diagnosis. Some easily treatable diseases can mimic CFS symptoms or underlie a full-blown case of CFS.

LIVING WITH CFS

If you're going to conquer chronic fatigue, lifestyle adjustments are probably the most important treatment.

1. Rest, rest, rest. You're going to have to make major modifications in your schedule, especially during flare-ups. This requires flexibility and under­standing on the part of employer, spouse and children - and yourself.

2. Reduce stress. Researchers note that stress reduces immune function, resulting in many of the changes that occur in chronic fatigue syndrome. One theory is that stress-induced immune impairment could increase vulnerability for a viral infection or for reactivation of latent viruses such as herpes.

3. Exercise lightly. Although too much physical activity can trigger a relapse, too little can weaken skeletal and heart muscles, further aggravating fatigue. Pacing is critical. Studies have found that moderate amounts of aerobic exercise can significantly improve fatigue, muscle strength and overall fithess. Ask your doctor how much exercise is appropriate for you.

4. Eat wisely. Avoid nutrient-depleting junk foods and eat a varied, whole­food diet including ample protein and complex carbohydrates. Frequent, small meals every three hours or so can help maintain energy levels.

5. Avoid stimulants. Flogging your system with stimulants drains energy reserves, so it makes sense to stay away from caffeine, though it's easier said than done. Try substituting carob-coated nuts for chocolate bars, herb teas for black tea, and decaf or herbal coffee for caffeine-laden coffee.

6. Go smoke-free. Cigarette smoke, including the second-hand form (passive smoking), increases susceptibility to respiratory tract infections, reduces how much oxygen gets to your cells and generally wreaks immune­system havoc. It's a challenge you don't need.

DRUG TREATMENT

Currently, no 'magic bullet' exists; no single drug has proven significantly and consistently helpful. Non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can help relieve aching muscles and joints.

Some doctors prescribe benzodiazepine drugs such as Diazepam and Xanax when anxiety and insomnia predominate, or antidepressants when sadness is among the symptoms.

HERBAL REMEDIES

Siberian Ginseng (Eleutherococcus senticosus)

This well-known tonic supports adrenal function and bolsters resistance to stress. A German study found that taking this herb

(10 milligrams of fluid extract) three times daily for four weeks raised the number of immune cells in healthy volunteers. The two cell types that increased - T lymphocytes and natural killer cells - are often low in CFS sufferers. Typical dosage: up to nine 400- to 500-milligram capsules per day; or 20 drops of tincture up to three times per day.

Echinacea (Echinacea angustifolia, E. purpurea, E. pallida)

This popular herb has been shown to enhance immune function in people with chronic fatigue syndrome. Typical dosage: up to nine 300- to 400-milligram capsules per day; or 60 drops three times per day. Take either for two weeks, followed by a one-week break. Caution: if you're allergic to other members of the daisy family, you may be allergic to echinacea.

Astragalus (Astragalus membranaceus)

A revered overall tonic in traditional Chinese medicine, astragalus rebuilds the immune system and is antibacterial andnantiviral. It also improves stamina and is safe for long-term use. All of these qualities make it an ideal choice for chronic fatigue. Typical dosage: eight or nine 400- to 500-milligram capsules per day; or 15 to 30 drops of tincture two times per day.

Reishi (Ganoderma lucidum)

Another traditional Chinese remedy, reishi has been used as a folk medicine for thousands of years. Today, studies have confirmed that reishi protects the liver and fights allergies, inflammation and viruses. It's also an antioxidant. Furthermore, reishi helps calm anxiety and ease insomnia, and it's safe to use long-term. Typical dosage: up to five 420-milligram capsules per day; or up to three 1,000-milligram tablets up to three times per day.

Liquorice (Glycyrrhiza glabra)

This root delays the body's removal of cortisol, an adrenal hormone that tends to be low in those with chronic fatigue syndrome. The chemical glycyrrhizin produces liquorice's effect on cortisol and is responsible for its antiviral properties. This means that taking deglycyrrhizinated (DGL) liquorice won't help CFS. Donald Brown, N.D., author of Herbal Prescriptions for Better Health, starts his CFS patients on 2,000 to 3,000 milligrams of liquorice root twice daily for four to eight weeks. Caution: do not take for longer than six weeks without a doctor's supervision. Do not take if you have high blood pressure, diabetes, or a disease of the thyroid, kidney, liver or heart, or if you take diuretics (water tablets). Do not use if you're pregnant.

Lomatium (Lomatium dissectum)

This herb has a long history of use by Native Americans. Some research suggests that it is active against many types of viruses and bacteria. Because lomatium root tinctures have been associated with a temporary, full-body rash, practitioners often use an isolate - an extract into either alcohol or glycerin that is specially processed to eliminate the rash-causing resins. Typical dosage: researchers haven't come to a consensus on a dosage for lomatium, so follow the manufacturer's recommendation.

Lemon Balm (Melissa officinails)

This traditional tea herb fights several viruses, including the herpes simplex virus, which has been suspected of contributing to chronic fatigue syndrome. Typical dosage: up to nine 300- to 400-milligram capsules per day; or 1 cup of tea per day (steep 2 to 4 teaspoons of dried herb in % litre of hot water for 10 to 15 minutes).

St John's Wort (Hypericum peeforatum)

Many herbalists find that this herb, usually called upon to treat depression, improves appetite and energy levels and calms anxiety. And it's antiviral. Typical dosage: 300 milligrams of product standardised to 0.3 per cent hypericin three times per day; or 1 cup of tea per day (steep % to 1 teaspoon of dried herb in ''/, litre of hot water for 10 to 15 minutes); or 15 to 40 drops of tincture up to three times per day. Caution: do not take with prescription antidepressants or L-dopa.

Valerian (Valerian officinalis)

If sleeplessness due to anxiety is one of your symptoms, valerian can be an important herb in your chronic fatigue regimen (for more alternatives, see Insomnia, page 351). It induces sleep as reliably as strong pharmaceutical sedatives, but without causing a morning hangover, interacting with alcohol, or leading to addiction. Typical dosage: 1 cup of tea (simmer 2 teaspoons of dried, minced root in 450 millilitres of water for 10 to 15 minutes; combine with other herbs or juice if the taste or smell is off-putting); or one 150- to 300-milligram capsule standardised to 0.8 per cent valeric acid; or 300 to 400 milligrams in non-standardised capsules; or '/ to 1 teaspoon of tincture in water. Take 30 minutes before bedtime. Caution: valerian is not addictive but, if you're convinced you can't sleep without it, you could develop a psychological dependence.

In rare instances valerian stimulates instead of sedating. If this occurs, discontinue use.