Pattern of recovery

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In recovering from chronic fatigue syndrome there are several stages to be gone through. CFS is just a symptom with many causes and as one starts to identify and correct those causes, one starts to see improvements clinically. Often there are many causes and one has to put in place several of the necessary interventions to start to see clinical changes. The mitochondrial function tests, tests of antioxidant status, diets, sleep regimes and so on all help to give pointers as to what is and is not important. Putting all this package in place requires major lifestyle changes, considerable self-discipline, ability to tolerate all these interventions and the necessary amount of support to make it all happen. The commonest problems I run into are people not tolerating the supplements, getting dreadful withdrawal symptoms because of the diet or because of detox reactions, or simply being unable to put the changes in place for financial, social or work pressure reasons. All these things need tackling as separate issues. But the pattern of changes is usually similar.

The first stage - windows of improvement

One starts to see windows of time when one feels better (but cannot do more). These may just be a few hours initially or a day or two. At this stage do not be tempted to do more activity – that will just postpone your recovery and complicate things. The trouble is the very personality that gets people in to CFS does not help them get out of it. They have a little devil on their shoulder that beats them up every time they try to rest!

The second stage - feel fine doing nothing

The sufferer must feel completely well whilst doing absolutely nothing. The reason why it is so important to get to this stage is because that is the best test of how the body is functioning. The blood test for a cell free DNA is a measure of tissue damage and this potentially is a disease amplifying process. The reason for this is that when there is lots of cellular debris swilling around the body, the immune system makes antibodies against it and this has the potential to set up either allergies or possibly autoimmunity. When there is lots of immune activity there is excessive production of free radicals and this puts an extra stress on the antioxidant system. The bottom line is that feeling ill puts a great stress on the body, energy is expended uselessly in coping with this stress and the whole business of recovery is further delayed.

The third stage - feel fine doing nothing every day!

is arrived at when one feels absolutely fine doing absolutely nothing (and of course this never really happens in true life because life has a habit of getting in the way) AND this level of wellness is maintained for some days or even better weeks. That is to say one’s level of well being becomes established, more robust and less susceptible to the fluctuations of every day life. Suddenly one starts to have a future and one’s horizons pick up! Then one can move into

The fourth stage - graded activity programme

Carefully start a very gradual graded activity programme. The deal is that one is allowed to increase one’s activity, which may be mental or physical on the grounds that one feels fine the next day. I do not mind people feeling tired at the end of the day, that is physiological and helps one to have a good night’s sleep. However, if the fatigue is delayed so one wakes up the next morning feeling exhausted as a result of the previous day’s exertions then you have overdone things and one has to pull back. This explains why there is no standard activity programme to follow because however much one can or cannot do depends entirely on how you feel. I suppose one way around this would be to do daily blood tests for cell free DNA, but this would be rather impractical!

So long as one continues to feel well and does not get delayed fatigue then the graded activity programme can be continued.

However, during all this time it is very important to hold the whole regime of diet, sleep, supplements, pacing, detoxing, or whatever in place.

Fifth stage - additional exercises to restore numbers of mitochondria

Once one gets to a stage when one feels well all the time and activity levels are acceptable, then you can start to do exercises to increase numbers of mitochondria and so improve cardiovascular fitness. The standard exercises for people who are otherwise well are given in Exercise - the right sort. The same principles apply to CFSs but the starting point is much lower. First see Exercise - the right sort in Chronic Fatigue Syndrome. Then See Exercises – the big four which take 12 minutes to do!.

Sixth stage - balance up the regime with lifestyle

Relax the regime. Actually as we age we all get a chronic fatigue syndrome. It is pretty obvious why this is the case, energy levels are dictated by mitochondrial performance, the ageing process is dictated by mitochondrial performance and the very interventions I recommend to treat chronic fatigue syndrome all slow the normal ageing process. So as we age we can stay just as fit and just as well, but we have to work much harder at it. So the level of supplementation and lifestyle changes one ends up doing depends very much on the individual. Magnesium injections are a real nuisance, but once mitochondrial function is restored, usually they are no longer necessary. Simply taking magnesium by mouth, in the bath or whatever is sufficient to do the job.


Again once antioxidant status is restored then the need for B12 injections is very much reduced, but again there is no doubt that some people feel a lot better for the odd B12 jab, it has no known toxicity and I am happy for people to continue with these in the long term. Indeed because as we age our ability to absorb micronutrients, particularly B12 declines, whilst because we become less efficient biochemically, our requirement for these micronutrients increases, you could argue that everybody over the age of say 60 would benefit from regular B12 injections. You might think that this is evolutionary nonsense since primitive man did not need B12 injections, but then on the other hand by the age of 60 most of us are on the evolutionary scrap heap when evolutionary rules do not apply!

Long term

Not only do the lifestyle changes, nutritional supplements, sleep, detox regimes and so on help to get rid of chronic fatigue syndrome, but these are all the interventions I use in the prevention and treatment of cancer, heart disease and other degenerative conditions such as Alzheimer’s, arthritis, organ failures etc. Therefore, I can say with confidence to my CFS patients that once they get on the regimes, not only should they improve, but their best years could be ahead of them and their risk of developing these diseases associated with the ageing process is substantially reduced.

When things go wrong

What commonly stops or slows the recovery process are:

  • Not pacing properly – most people feel a bit better and over-do things. The clue here is delayed reactions – feel OK at the end of the day but awful the next. I don’t just mean physical pacing but also mental and emotional pacing!
  • Letting the regime slip with respect to diet, supplements, sleep
  • Viral infection
  • Allergy – some people just do not tolerate the regimes of supplements. In this case, stop everything and reintroduce slowly one at a time. See Allergy - not just avoidance
  • Addiction withdrawal – a very common problem! The big problem is sugar and carbohydrate. Indeed many addictions are mediated through blood sugar levels. See Hypoglycaemia - the full story
  • Detoxification reactions – all the various methods of detoxification can mobilised chemicals from fatty area into the blood stream where they cause an acute poisoning. See Detoxification reactions
  • Un-noticed poisoning eg pet flea treatments, new paint, carpets, windows, new wash powders etc etc
  • Missed diagnoses – there may be another cause of the fatigue which has not been thought of!

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