Yoga Therapy for Chronic Fatigue Syndrome

Sep 27th, 2017

By Dr. Yogananth Andiappan
Co- Author Dr. Anjhana Priya

Most of us would have gone through this common yet underestimated condition called “Fatigue”, which literally means “lack of energy”. Seemingly simple, but it could be a sign of a dangerous underlying disease. Epidemiologic estimates indicate that up to 4 million people in the United States meet the Centers for Disease Control and Prevention (CDC) criteria for the diagnosis of CFS, and that 85% of US citizens with CFS remain undiagnosed. The disorder affects individuals of all racial, ethnic, and socioeconomic backgrounds with no difference in prevalence between rural, urban, or metropolitan populations. It is at least as common among African Americans and Hispanics as in whites. CFS strikes 3 to 5 times more women than men, with incidence in females peaking between the ages of 40 and 59 years. Children and adolescents can be afflicted with the disorder, but incidence in younger populations is less common.

A recent CDC-sponsored, population-based study in Georgia provides evidence that CFS is 6 to 10 times more common than previously estimated and is a significant public health problem in the United States.Evidence-based estimates by the CDC also indicate that CFS has severe economic impact in the United States. The disorder results in a $9 billion annual loss in productivity, not including medical costs or disability benefits, and results in a $20,000 annual loss in wages and income per family.

The nature of CFS is that it “waxes and wanes,” following a cyclical pattern of improvement alternating with unpredictable relapses of variable severity. The percentage of people who recover from CFS is unknown, although preliminary estimates are that at least partial recovery is possible in 40% to 60% of patients. Delays in CFS diagnosis and treatment may lead to a more complicated course of illness and poorer prognosis for recovery.

According to Griffith Health Institute Australia, Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is most commonly characterized by fatigue lasting more than 6 months accompanied by symptoms such as muscle and joint pain, sore throat, tender lymph nodes, and cognitive difficulties. It is not relieved by rest and results in a substantial reduction in the patient’s activity levels prior to onset.

Studies on the prevalence of this condition have been available since 1990. While most reports have come from the United States and Europe, increasing estimates are emerging from Asia and developing countries, such as Nigeria. Prevalence varies from as low as 0.2% to as high as 6.41%. A previous review suggested that the inconsistency is more likely due to differences in study design rather than true differences in prevalence. Prior to epidemiological surveys, prevalence was suggested based on clinical reviews of patients in tertiary care. The first studies to use prospective sampling methods were based on physician referrals. Studies gradually began to directly screen samples from primary care clinics, and the wider community, through questionnaires and structured interviews. In contrast, larger population based studies first screen medical databases for potential cases.

In a study conducted by CDC, USA, a random digit-dialing survey and clinical examination to estimate the prevalence of CFS in the general population of Wichita, Kan, and a 1-year follow-up telephone interview and clinical examination to estimate the incidence of CFS was done. The survey included 33 997 households representing 90 316 residents. This report focuses on 7162 respondents aged 18 to 69 years. Fatigued (n = 3528) and randomly selected nonfatigued (n = 3634) respondents completed telephone questionnaires concerning fatigue, other symptoms, and medical history. The clinical examination included the Diagnostic Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, laboratory testing, and a physical examination.

Chronic fatigue syndrome constitutes a major public health problem. Longitudinal follow-up of this cohort will be used to further evaluate the natural history of this illness.


Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that can’t be explained by any underlying medical condition. The fatigue may worsen with physical or mental activity, but doesn’t improve with rest.

Chronic fatigue syndrome has also been called myalgic encephalomyelitis (ME) and, more recently, systemic exertion intolerance disease (SEID). Although CFS/ME and SEID share the same major symptom of chronic fatigue, there is variation between the definitions of these disorders. The symptom of chronic fatigue also may arise from more than one underlying condition.

The cause of chronic fatigue syndrome is unknown, although there are many theories — ranging from viral infections to psychological stress. Some experts believe chronic fatigue syndrome might be triggered by a combination of factors.

There’s no single test to confirm a diagnosis of chronic fatigue syndrome. You may need a variety of medical tests to rule out other health problems that have similar symptoms. Treatment for chronic fatigue syndrome focuses on symptom relief.

Biological, genetic, infectious, and psychological mechanisms have been proposed, but the cause is not understood. The fatigue of CFS is not due to ongoing exertion, is not much relieved by rest, and is not due to any other medical condition. Diagnosis is based on a person’s signs and symptoms.

Evidence suggests that cognitive behavioral therapy and a gradual increase in activity suited to individual capacity can be beneficial in some cases. In a systematic review of exercise therapy, no evidence of serious adverse effects was found; however, data was insufficient to form a conclusion. Tentative evidence supports the use of the medication rintatolimod. The evidence, however, has been deemed insufficient for approval for this use in the United States.

Most cases of CFS are mild or moderate, but up to one in four people with CFS have severe symptoms. These are defined as follows:

  • mild – you’re able to care for yourself, but may need days off work to rest
  • moderate – you may have reduced mobility, and your symptoms can vary; you may also have disturbed sleep patterns and need to sleep in the afternoon
  • severe – you’re able to carry out minimal daily tasks, such as brushing your teeth, but have significantly reduced mobility, and may also have difficulty concentrating

It’s not known exactly what causes CFS. Various theories have been suggested, including:

  • a viral or bacterial infection
  • problems with the immune system
  • an imbalance of hormones
  • psychiatric problems, such as stress and emotional trauma

Some people are thought to be more susceptible to the condition because of their genes, as the condition is more common in some families.

More research is needed to confirm exactly what causes the condition.

The symptoms of CFS vary from person to person and based on the severity of the condition. The most common symptom is fatigue that is severe enough to interfere with your daily activities. For CFS to be diagnosed, fatigue must last for at least six months and must not be curable with bed rest, and you must have at least four other symptoms as well.

Other symptoms of CFS may include:

  • loss of memory or concentration
  • feeling unrefreshed after a night’s sleep
  • chronic insomnia (and other sleep disorders)
  • muscle pain
  • frequent headaches
  • multijoint pain without redness or swelling
  • frequent sore throat
  • tender lymph nodes in your neck and armpits

People are sometimes affected by CFS in cycles, with periods of feeling worse and then better again. Symptoms may sometimes even disappear completely (remission). However, it’s still possible for them to come back again later (relapse). The cycle of remission and relapse can make it difficult to manage your symptoms.

CFS as per Doshic Theory

In Ayurveda, chronic fatigue syndrome – or bala kshaya – is believed to be caused by a buildup of toxins, resulting in a disconnect between mind, body and spirit. Treatment is holistic, and includes meditation, diet, massage, breathing techniques and herbal therapies. Naturally, it’s an intelligent decision to minimize your toxic burden – as a top priority – along with incorporating immune-supportive therapies.

Once you remove toxic threats, try a cleansing diet, followed by “pancha karma” – a more extensive detoxification process involving massage oils and herbal therapies. The third stage normally consists of rejuvinative herbal therapy to help restore energy and vitality.

The imbalance of any three energies (vata, pitta and kapha) results in health complications. The main reason of chronic fatigue is aggravation of vatadosha that generates negativity at physical and mental levels. It affects nervous system that causes weakness of nervous system and it may create hypersensitivity that results in pain and tenderness. It may leads to mental disorders like cognitive disorders and disturbances in sleep. It may be due to accumulation of ama (toxins) that results in disconnection of mind, body and spirit.

When it comes to the cause of these conditions, there are several important factors to mention. The first, as with all pathologies, is compromised digestion. When our Agni (digestion) is not working well and has become imbalanced, Ama (undigested food waste/toxin) is formed. Once it is present, Ama causes further digestive problems such as bloating, pain, gas, constipation or diarrhoea and also moves from the gut into the channels of circulation causing obstructions. This impedes the flow of nutrients, wastes and hormones around the body and hampers the metabolism of healthy tissues.

The second factor is the aggravation of Vata and Pitta doshas. This occurs due to various causative factors. Along with the Ama that is produced, Vata and Pitta dosha also become imbalanced and begin to exert their influence on the tissues of the body, contributing to pain, stiffness, fatigue and many of the other symptoms that are associated with CFS and Fibromyalgia.

Over time the metabolism of all the tissues is compromised and the final stage in the pathology becomes involved. Ojas (which is considered the final essence of tissue metabolism and the primary support for our immune system) is gradually depleted, causing the lingering viral or fungal infections that are often associated with CFS.

This occurs in the same way that mud or debris clogs up and obstructs a channel irrigation system in a field. If the channels are blocked and the water can’t get through then eventually the fields (where Ojas is ‘grown’) will dry up.

The things that are most depleting to Ojas however, are those of a psychological nature, such as fear, anxiety, anger, grief and trauma. They are all have opposite qualities to the qualities of Ojas and very quickly cause it to loose its nectar-like, life supporting properties. This depletion is exacerbated by many factors including eating too much dry and cold food (including processed food or too much raw food), lack of restful sleep, excessive talking and sensory stimulation, too much mass media, overly strenuous exercise, overwork, travel, excessive fasting or sudden weight loss.

Diet for CFS

Like any other disorder, the top foods to beat chronic fatigue syndrome must come from a varied diet selected from the basic food groups to ensure an adequate nutrient intake and to reach and maintain a reasonable body weight.

Grains: Carbohydrates are the main energy source for the body. Include whole grains as part of the balanced diet to keep the digestive system in good working order. Brown rice, barley, quinoa, and oatmeal are some of the healthiest whole grain options. Choose gluten-free foods and avoid processed foods and refined sugars.

Proteins: Nuts and beans are also good quality proteins but they are not as good as animal proteins. It is essential that you include variety of different proteins in your diet so that you can get all the amino acids. You may also include protein drinks, such as whey protein powders, to boost the low levels of glutathione in your weakened immune system.

Fats: Unlike the current recommendation for low fat diets, people with CFS are rather encouraged to consume healthy fats. Unhealthy fats should still be avoided. Fats help you improve poor immune function and hormonal imbalance, and also help in cognitive functioning. Moreover, fats are excellent source of energy. And the top source of fats is the extra virgin olive oil which is very rich in omega-3sAn Iranian study on neuroprotective effects of olive oil suggested that olive oil intake significantly reduced cell death and decreased memory loss, especially short term memory loss, common in CFS patients. Most studies therefore recommend the Mediterranean diet for CFS because this diet includes virgin olive oil. Papers presented in the International conference on the healthy effect of virgin olive oil also agreed that ‘The Mediterranean diet, rich in virgin olive oil, improves the major risk factors for cardiovascular disease, such as the lipoprotein profile, blood pressure, glucose metabolism’ and reduced inflammation and oxidative stress.

Fruits and Vegetables: All green vegetables are good for those suffering from CFS. Researchers have found that CFS patients had elevated levels of methemoglobin (MetHb), a marker of oxidative stress, which shows that antioxidant treatment can help reduce free radical damage in them. A diet high in fruits and vegetables can increase plasma antioxidant capacity in people with CFS. Blueberries, with the highest ORAC (oxygen radical absorbance capacity) value, have been found to have significant benefits due to their high potential antioxidant activity, neuroprotective properties, and specific ability to protect red blood cells from oxidative damage.

Yoga Therapy Chronic Fatigue Syndrome

Mental and physical fatigue can be lessened by asana practice, which rests the brain and rejuvenates the body and the mind. The practice includes inverted postures like Sirsasana, Viparata Karani and Sarvangasana; forward bending posture such as Padahasthasana, Paschimottanasana, Janu Sisasana and Adho Mukha Svanasana. Backward bending postures like Ustrasana, Chakrasana and Bhujangasana are helpful in relieving mental fatigue, which is the cause of physical dullness and laziness. In addition, twisting posture keeps the spine supple. Pranayama opens the chest and lungs and bring freedom in the diaphragm.

As the breath becomes easier, the body feels light and the mind feels fresh.

Get enough sleep each night and develop a proper sleeping routine. Eat healthy food like fruits and vegetables, early in the evening and avoid caffeine content food. Practise yoga regularly and learn the relaxation techniques. Do not push yourself beyond a limit. Work on achieving work life balance. When you are on your yoga mat, be serene in your mind and bring harmony in your heart.

The whole system of yoga is teaching to be self-centered. That is to say, to be yourself, and to keep your body, mind and the soul in a perfect balance and harmony.

Asana Journal

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