Chronic fatigue syndrome may be linked to bowel

Chronic fatigue syndrome can be a devastating medical condition.

Theories abound as to the cause, including chronic viral and bacterial infections, weakened immune system, endocrine abnormalities and even psychosocial connections (it's all in your head). The exact number of Americans affected by CFS is unknown, but there are estimates of between three and 3,000 cases of CFS per 100,000 people in the U.S., which translates to 3,000 to 3 million people affected.

Although the exact cause has not been determined, there is ample evidence that CFS may be related to another chronic medical condition involving the bowel, leaky gut syndrome.

CFS usually starts after flu-like illness or a period of chronic stress. It is generally defined as having at least four of the following symptoms: profound exhaustion after exercise, impaired memory/concentration, unrefreshing sleep, muscle/joint pain, headaches, tender lymph nodes and recurring sore throat without obvious infection.

CFS patients often have symptoms of irritable bowel (in my experience 100 percent), new onset food allergies and chemical sensitivities, and low blood pressure with dizziness when standing up too quickly. No medications seem to be effective and the success of many nontraditional medicine therapies is limited. CFS shares many symptoms with chronic infections, but a causal association with viral infections and Lyme disease is inconsistent. However, the symptoms of CFS do closely mimic the common symptoms of leaky gut syndrome.

Leaky gut syndrome is a condition where the bowel literally becomes “leaky” and toxins can be introduced into the blood stream in high concentrations. These toxins often come from bacteria and yeast and can affect many organ systems. LGS is related to chronic poor food selection, medications especially antibiotics and stress.

It is related to a condition called bacterial dysbiosis, where “bad” bacteria colonize the bowel and, in some cases, can result in life-threatening illnesses. Symptoms of LGS include fatigue, muscle and joint pain, insomnia, headaches, changes in memory and irritable bowel symptoms.

In a recent medical publication (BMC Medicine, 2010), the correlation between CFS and chronic inflammation associated with LGS was examined. This paper explored the research on CFS and concluded that a chronic inflammatory state may be one of the foundation stones of CFS. They also suggested that a “leaky” gut would be a likely source for the regular introduction of pro-inflammatory and toxic compounds into the body. These compounds can damage DNA and inhibit energy production resulting in fatigue, muscle weakness and pain, and changes in memory and cognition.

Many of these pro-inflammatory and toxic compounds may be related to many of the symptoms of both CFS and LGS. Therefore, a reasonable argument can be made that the root cause of CFS may originate in the bowels.

Although there are no specific tests for CFS, LGS can be measured by a simple urine test. Treatment for LGS focuses on select supplements, food choices and other simple lifestyle changes. In my personal experience, many people with CFS can get significantly better with lifestyle changes including improving bowel function.

• Patrick B. Massey, M.D., Ph.D is medical director for complementary and alternative medicine for the Alexian Brothers Hospital Network.