What Causes Chronic Fatigue Syndrome? — Part V: A Functional Medicine Approach

Mark Volmer
Apr 27, 2018 · 6 min read

Note: This is the final article in an ongoing series. Make sure to check out the previous articles before starting with this one!

What Causes Chronic Fatigue Syndrome? — Part I: Understanding Fatigue
What Causes Chronic Fatigue Syndrome? — Part II: The Epstein-Barr Virus & Other Infections
What Causes Chronic Fatigue Syndrome? — Part III: Genetics
What Causes Chronic Fatigue Syndrome? — Part IV: Hormones

Has conventional medicine got chronic fatigue all wrong? Learn how functional medicine may offer the best treatment outcomes for those suffering from chronic fatigue syndrome.

Has your doctor told you that chronic fatigue is all in your head? Maybe she prescribed you antidepressants and sent you on your way?

Unfortunately, there are still a lot of doctors that abide by the adage that chronic fatigue syndrome is a psychiatric illness. Those who believe chronic fatigue is “all in one’s head” ignore the information I present in this series. They ignore that infections, genetics, the nervous system, and hormones all contribute to chronic fatigue syndrome.

It’s unfortunate that some practitioners brush chronic fatigue off as a mental disorder. I’ve not met a single patient whose fatigue was cured by antidepressant drugs. And I doubt I ever will.

Can conventional medicine cure chronic fatigue?

Think back to your last doctor visit. How long were you visiting your doctor for? Recent reports suggest that your visit would be between 12–15 minutes. 2–3 minutes of the visit would be initial greetings and pleasantries. 5 minutes is spent on your most pressing concern and only 1 minute is spent on each secondary concern(s). (1)

As I’ve outlined in this series of posts, chronic fatigue syndrome is incredibly complex. You’ll likely have multiple secondary complaints in addition to fatigue. These could be genetic, infectious, hormonal, or nervous system related. Or, (more likely) it’s a combination of all the above. As I’m sure you know, these systems are all connected and interrelated. Addressing just one will not bring about a solution. 1 minute per concern is not nearly enough time understand the functioning of each system and create a treatment plan that addresses chronic fatigue properly.

This is why conventional medicine will never solve chronic fatigue syndrome.

With only ten minutes to diagnose and treat a disease as complex and multi-faceted as chronic fatigue syndrome, it’s no wonder most doctors prescribe antidepressants. If I only spent ten minutes with you, I’d likely do the same. There’s simply not enough time to do a deep dive into the root cause of chronic fatigue syndrome in ten minutes.

Antidepressants have been shown to raise serotonin levels in the brain. But they’ve been poorly studied in the context of chronic fatigue syndrome. The studies that did explore the link between antidepressant use and chronic fatigue found that they were no more beneficial than a placebo. (2, 3) These studies also neglected to mention the negative effects associated with coming off of antidepressants.

Pharmaceuticals are prescribed to address your main symptom. They do not look at the underlying disease process that is causing the symptom. Functional medicine looks beyond your symptoms to uncover your root cause of chronic fatigue syndrome.

How does functional medicine address chronic fatigue syndrome?

Functional medicine looks beyond your symptoms. A functional medicine practitioner may treat three patients with chronic fatigue syndrome in three different ways. This occurs because fatigue is the symptom, not the cause of the illness. In the first patient, her fatigue may be caused by an undiagnosed celiac disease. The second may have a gut infection causing her fatigue. The third patient could have mercury toxicity.

Each of the above patients requires vastly different treatment plans. The solution for the first patient is a gluten-free diet. The second patient’s treatment may involve herbs or antibiotics to treat the gut infection and plenty of specific probiotics to ensure the infection doesn’t return. The third patient requires something called chelation therapy — a process of removing heavy metals from the body. Three cases of chronic fatigue. Three different treatments. This is the difference between treating the individual (functional medicine) vs treating the disease (conventional medicine).

Functional medicine moves past a patient’s symptoms and looks at the disease process that is maintaining the illness. In the case of chronic fatigue, there are 4 areas worth exploring:

  1. Diet
  2. Gut health
  3. HPA axis
  4. Infection(s) & toxicity


Do you know the common symptom among undiagnosed celiac disease patients?

It’s fatigue. Many studies have shown the connection between undiagnosed celiac disease and fibromyalgia/chronic fatigue syndrome. (4, 5, 6) This shows the link between food and fatigue. Frequently consuming a food that you are allergic or sensitive to will decrease energy levels.

A functional medicine practitioner will take a thorough look at your diet. There may be removals of some foods and additions of others. Remember, no two cases are identical. Generalizations like “a ketogenic diet is best for those with fatigue” don’t hold weight. You need to uncover the best diet for you. Functional medicine can help you do so.

Gut health

Recent research has shown that those with chronic fatigue syndrome have imbalanced flora in their digestive tract. (7, 8) These studies showed that those with chronic fatigue syndrome lacked diversity in the bacterial cultures of their digestive tract. Additionally, those with CFS showed higher levels of inflammatory or “bad” bacteria and lower levels of beneficial or “good” bacteria. Another study showed how improving a leaky gut increased patients energy levels. (9) These studies further confirm the increased association between CFS and irritable bowel syndrome (IBS).

Functional medicine considers gut health paramount to overall health. A well-trained functional medicine practitioner will thoroughly examine the health of your gut. Treatments can be aimed towards removal of pathogens (parasites, yeasts, protozoa, or bacteria) or the addition of beneficial bacteria by way of dietary changes or probiotics.

HPA axis

The HPA axis stands for the hypothalamic-pituitary-adrenal axis. You may be more familiar with the HPA axis if it is framed as adrenal fatigue. Adrenal fatigue is the colloquial term for HPA axis dysfunction. The HPA axis is your body’s stress response system. Whenever your body is stressed, the HPA axis is what helps you maintain homeostasis.

Cortisol is the hormone that most concerns those of adrenal fatigue or HPA axis health. Studies have shown that those suffering from chronic fatigue syndrome have altered cortisol levels and responses. (10, 11, 12) The balancing of cortisol can have a profound effect on energy levels. It is hypothesized that many chronic fatigue patients also have adrenal fatigue.

Functional medicine will examine the health of the HPA axis and recommend diet, vitamin, and lifestyle strategies to best balance cortisol levels. To learn more about the HPA axis, click here.

Infections & toxicity

It has been proposed that those with chronic fatigue syndrome poorly tolerate mercury and other heavy metals. (13, 14) Think of those with CFS as the canaries in the coal mine. They are the hyper-responders. For the average member of the population, small amounts of mercury or other heavy metals will not cause symptoms. For those with chronic fatigue, even small amounts of heavy metals can cause symptoms.

Other studies show that those with chronic fatigue have elevated immune and inflammatory markers. (15, 16) It is hypothesized that chronic fatigue could come about from a chronic infection like the Ebstein-Barr virus. Other studies believe chronic fatigue to be a symptom of chronic Lyme infection. (17, 18)

An experienced functional medicine will run the most up-to-date laboratory test to clearly identify the infectious or toxic burden. This is essential for the proper treatment of chronic fatigue syndrome.

Functional medicine and chronic fatigue syndrome

The strength of functional medicine does not come by fancy testing for dietary sensitivities, gut health, hormone levels, or toxic burdens (though that does help!). If used independently, like in conventional testing, the benefits of lab testing are minimal. The strength of functional medicine is the way in which a well-trained practitioner views the body.

Functional medicine practitioners view the body as an interconnected whole. They are aware that if you alter one system through treatment, it will have a ripple effect on other body systems. This is the perspective that brings functional medicine its strength.

A thorough functional medicine exam will involve testing for the four most common causes of chronic fatigue:

  1. Diet/food
  2. Gut
  3. HPA axis
  4. Infections/toxicity

Treatment should always be in the above order. It’s best to think of them as a pyramid. Food or diet is the base of the treatment. The other categories all build upon dietary health. If mercury toxicity is causing fatigue, before you can safely remove the metal from the body, you will want to ensure you have a healthy diet, gut, and HPA axis. your body will need support from each area in order to successfully remove the metal.

Want to know more about what causes chronic fatigue syndrome?

Check out the links below for more info.

What Causes Chronic Fatigue Syndrome? — Part I: Understanding Fatigue
What Causes Chronic Fatigue Syndrome? — Part II: The Epstein-Barr Virus & Other Infections
What Causes Chronic Fatigue Syndrome? — Part III: Genetics
What Causes Chronic Fatigue Syndrome? — Part IV: Hormones

Want to know more than your doctor about chronic fatigue and fibromyalgia?

Check out all my writings here!

Originally published at Fatigue to Flourish.

Mark Volmer

Written by

I help those with fatigue naturally reclaim their energy and share their gifts with the world.

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