Chronic fatigue syndrome (CFS) is a devastating disorder that is poorly understood, yet it impacts millions of people around the globe.
Doctors estimate that around 90% of CFS cases go undiagnosed. The syndrome is complex and has a constellation of broad, non-specific symptoms. Typically, CFS is diagnosed after all other potential causes are ruled out. Symptoms can be debilitating as they persist over extended periods and can include the following:
- Feelings of extreme fatigue
- Muscle pain and joint pain
- Headaches and migraines
- Gastrointestinal issues
- Post-exertional malaise (PEM) – tiredness with exertion
- Inability to perform normal activities
- Swollen glands
- Trouble sleeping
- Trouble concentrating (brain fog)
- Food sensitivities
Several other conditions frequently co-occur with CFS, such as fibromyalgia. Fibromyalgia affects 2-8% of the population and is characterized by widespread pain and stiffness throughout the body, fatigue, headaches, and sleep disruption. Other conditions associated with CFS include:
- Irritable bowel syndrome (IBS)
- Multiple chemical sensitivities
- Temporomandibular disorder
- Chronic pelvic pain
What causes chronic fatigue syndrome?
The causes and risk factors associated with CFS are not fully understood. CFS may be triggered by several factors in genetically predisposed individuals. Suspected risk factors and triggers for CFS symptoms include:
- Metabolic disturbances
- Dysregulated immune system
- Autoimmunity
- Infection
- Stress
These factors may play a role in triggering the inflammatory processes that are associated with CFS. Recent research points to the involvement of the microbiome and inflammatory cascade.
These studies suggest that the source of the inflammatory response is dysbiosis which leads to increased gut permeability (leaky gut). A leaky gut allows toxins and bacteria to leave the intestine and enter the blood and lymphatic vessels, maintaining a chronic inflammatory environment that can trigger autoimmunity and immune dysfunction.
The chronic dysregulation of the immune system exacerbates dysregulation of the hypothalamus-pituitary-adrenal axis (HPA) in the brain via the inflammatory cascade. This impacts normal mitochondrial function and the energy production pathways.
Hypothesis 1: The inflammatory processes lead to energy production dysfunction
The HPA axis is a complex set of hormonal interactions that produce cortisol and manages the body’s natural response to stressors. Cortisol plays critical roles throughout the body during stress, including the initiation or modulation of the immune response.
During an infection, the immune cells release pro-inflammatory signaling molecules called cytokines. Cytokines signal to surrounding cells that there is a threat that needs to be eradicated. TNF-α and Interleukins (IL) are two types of cytokines commonly released in an inflammatory environment. TNF-α is a key mediator of inflammation released during a wide range of immune threats. Many pharmaceutical therapies target this cytokine. Dysregulation of the TNF-α cytokine is associated with autoimmunity. Interleukins are a large group of cytokines released during an inflammatory event and possess both pro- and anti-inflammatory properties.
Cytokines such as TNF-α can stimulate the HPA axis and enhance cortisol levels, which in turn inhibits further production of cytokines. This feedback loop is critical to returning the immune system to homeostasis and preventing tissue damage caused by an aberrant response. In the setting of continual leaky gut and chronic inflammation, enhanced and prolonged cytokine production is an ongoing problem.
Chronic dysregulation and TNF-α production may perpetuate the HPA cycle and result in the continual production of cortisol. Cortisol dysfunction could then lead to unchecked cytokine production. Prolonged cytokine production can weaken the intestinal barrier, thus exacerbating a leaky gut condition. These processes trigger the downward spiral to chronic inflammation and are prominent in the case of chronic fatigue.
Hypothesis 2: The inflammatory processes related to higher cytokine signaling in CFS
Studies show that cytokines such as TNF-α and IL-2 are significantly higher in patients with CFS compared to individuals without CFS. Overall, a balance of both the immune system and HPA axis is necessary for the immune system to respond appropriately to an infection/immune challenge and the immune response to return to a level of homeostasis.
This hypothesis suggests that long-term dysregulation of the HPA axis results in malfunctions in metabolic pathways. Metabolism defects and mitochondrial dysfunction results in greater oxidative stress. Oxidative stress occurs when a cell produces more damaging reactive oxygen species (ROS) than its antioxidant system can block. This imbalance contributes to the pathology of CFS, especially the symptoms of post-exertional malaise (PEM).
Is there a cure for chronic fatigue syndrome?
There is no cure for chronic fatigue syndrome. Doctors focus on symptom management, which does not provide full relief for many patients with CFS. However, many people with CFS find relief from Maca.
Maca is a medicinal root vegetable that grows in the high altitudes of the Andes in Peru. Peruvians have used maca for thousands of years to build strength and resilience to stress and to balance endocrine function. The maca root has different colors, which give them different properties. They may be used short- or long-term to help balance the nervous system.
How maca helps autoimmunity and chronic fatigue syndrome
Clinically, maca has properties that could treat both some of the symptoms that impact individuals with CFS and more importantly, some of the underlying defects that lead to the symptoms. As mentioned above, patients with CFS also had higher levels of pro-inflammatory cytokines and hypocortisolism. In one study, maca treatment regulated components of the HPA axis. Another study showed that maca treatment suppressed the production of inflammatory cytokines including TNF-α and IL-2.
Maca contains macamides which are fatty acid amides or oleamides. These fatty acid derivatives affect anti-inflammation through many different pathways. In a laboratory with animals, oleamides inhibited the production of TNF-α, IL-1ß, and IL6, thereby reducing swelling of the paws. Non-steroidal anti-inflammatory drugs (NSAIDs) similarly inhibit COX2 function. Oleamides also acted in an anti-inflammatory capacity by suppressing ROS and ultimately protecting against sepsis-induced intestinal injury in rats.
Phytosterols also contribute to the anti-inflammatory properties of maca. For example, stigmasterol suppresses TNF-alpha and reduces macrophage recruitment, and beta-sitosterol is proposed as a chemo-preventative drug for colon carcinogenesis. Extracts from maca reduce fatigue by reducing muscle damage in mice.
Maca has long been believed to improve low energy, which is one of the main symptoms of CFS. Dysfunctional metabolism may exacerbate the symptoms of CFS, which could explain the low energy levels and brain fog associated with the disorder. Studies suggest that maca can improve mitochondrial function and metabolism. In addition, some studies suggest a role for maca in improving cognitive function and physical endurance.
These studies point to the potential that maca has as a complementary therapy for patients with chronic fatigue syndrome. Treatment with maca of both symptoms (low energy, depression, cognitive impairment) as well as underlying dysregulated mechanisms (oxidative stress, pro-inflammatory cytokine production, HPA axis dysregulation) may give CFS patients much needed relief.