Burnout Syndrome (Chronic Fatigue) – is defined as debilitating fatigue and associated symptoms lasting at least 6 months. Even though the Centers for Disease Control officially recognized Burnout Syndrome in 1988, it remains a controversial issue.
Centers for Disease Control defines Burnout Syndrome as: clinically evaluated, unexplained, persistent or relapsing fatigue that is: of new or definite onset, not a result of ongoing exertion, not alleviated by rest and results in a substantial reduction in previous levels of occupational, social, or personal activity.
Four or more of the following symptoms that persist or recur during 6 or more consecutive months of illness and that do not exceed the fatigue:
- self-reported impairment of short-term memory or concentration;
- sore throat;
- tender lymph nodes;
- muscle pain;
- multi-joint pain without swelling or redness;
- headaches of a new type, pattern, or severity;
- unrefreshing and/or interrupted sleep.
- pain is almost universal in chronic fatigue;
- secondary infections, including Candida and viral infections;
- cognitive impairment, including short-term memory loss, difficulty concentrating, word searching, and math problems;
- digestive disturbances, such as chronic constipation or diarrhea;
- night sweats or spontaneous daytime sweats, unaccompanied by fever;
- headaches, migraines;
- weakness (paresis), muscle fatigue and pain (fibromyalgia);
- premenstrual syndrome;
- sleep disorders, including excessive sleep (hypersomnia), light sleep or an inability to sleep for more than an hour (hyposomnia), disturbing nightmares;
- a period of 1-3 hours after awakening during which they are too exhausted to get out of bed (dysania);
- vision and eye problems, including sensitivity to light (photophobia), dry eyes, tunnel vision, night blindness and difficulty focusing.
- complete blood count with differential;
- chemistry panel;
- erythrocyte sedimentation rate;
- thyroid tests;
- adrenal tests;
- HIV serology;
- viral infections tests (Epstein-Barr virus, Human herpes virus 6, etc.);
- immune system tests (cell counts, elevated interferon alpha, T cell activation, etc.);
- functional assessments of the adrenal gland;
- assessments of oxidative stress;
- homocysteine levels;
- C-reactive protein;
- toxin analysis, including heavy metals, pesticides, and organic chemicals.
Causes of Burnout Syndrome:
- immune system activation, particularly by viruses;
- oxidative stress, glutathione deficiency;
- endocrine dysfunction, including adrenal fatigue, thyroid deficiency and hypothalamic-pituitary axis abnormalities;
- neurotransmitter deficiencies;
- drug-induced fatigue.
The Immune System:
The immune system – is a complex system of cells and chemical messengers that work together to keep the body clear of pathogenic infections. The components specifically involved in viral immunity include:
- antigens (viruses) attach to T-helper cells which secrete a variety of chemical messengers (including interferon and interleukin-2) that activate NK cells, macrophages, cytotoxic T cells, and memory B cells;
- interferon is a group of glycoproteins that activate macrophages to form Natural Killer (NK) cells;
- NK cells lyse (split apart) cells that contain viruses;
- interleukin-2 stimulates proliferation of B and T cytotoxic cells;
- cytotoxic T cells are formed to attack specific antigens (viruses).
Viruses that “fool” the Immune System:
There are two different types of T-helper cells which defend against different organisms:
- T-helper 1 cells target intracellular pathogens (organisms that invade cells), such as viruses.
- T-helper 2 cells target organisms that are found outside of cells (T-helper 2 cells are involved in humoral or antibody-mediated immunity and are triggered by interleukin-10 which is stimulated by bacteria, parasites, toxins, and allergens).
Cytokine profiles and functions of T helper cells
T helper 1
-Activates cytotoxic cells
-Inhibits Th2 cells
T helper 2
|-Interleukin-4, 5, 6, and 10||
-Activation and maturation of B cells
-Inhibits Th1 cells
Several nutritional supplements, including essential fatty acids, vitamin A, vitamin E, DHEA
and melatonin, have been found to have beneficial effects of the Th1:Th2 ratio !!
!!! Breaking the infection-inflammation cycle !!!
Breaking the chain of inflammation caused by chronic viral infections would require a three-part
- First, the underlying viral infection should be addressed with antiviral supplements (such as ginseng, echinacea and lactoferrin) and those that shift the Th1:Th2 ratio (such as essential fatty acids and vitamin E).
- Second, inflammation should be reduced with anti-inflammatory agents (such as essential fatty acids and curcumin).
- Third, the nitric oxide system should be supported with supplements such as arginine, vitamin B2 (riboflavin), vitamin B3 (niacin), and folate.
Supplements that Support the Immune System:
- Ginseng and Echinacea.
- Essential Fatty Acids.
- Vitamin E.
- Vitamin A.
- Whey Protein.
- DHEA and Melatonin.
Free radical damage (oxidative stress) is probably the most significant cause of biologic aging. Free radicals are unstable molecules that damage cells and are implicated in most diseases associated with aging. Antioxidants are the bodies natural defense against free radical-induced cell damage. Recent studies have shown that oxidative stress plays a role in the development of burnout syndrome.
Antioxidant Therapy for Burnout Syndrome:
- Glutathione and N-Acetil Cysteine.
- Coenzyme Q10.
Natural Supplements to support Adrenal Function:
Supplements That Support Neurotransmitter Function:
The following types of drugs are associated with side effects of chronic fatigue syndrome:
- muscle relaxants;
- immune agents;
- Ginseng (500 mg twice a day) has been found to enhance NK function in CFS patients. Ginseng is commonly used to help increase energy levels.
- Echincea (500 mg twice a day) supports the immune system and has been found to enhance NK function in CFS patients.
- Essential fatty acids may be of benefit in chronic fatigue.
- Acetyl-L-carnitine (1000 to 2000 mg a day), Vitamin E (400 IU a day), and NADH (5 mg 2 times a day) support fat metabolism and may increase energy.
- Whey protein should be considered as a source of amino acids and to enhance immunity and boost glutathione levels.
- Lactoferrin (300 mg three times daily) has been shown to have significant antiviral properties and may be useful in chronic fatigue syndrome.
- Glutathione (500 mg per day), and its precursors Glutamine (one gram per day) and N-Acetyl Cysteine (500 mg per day) are important antioxidants. Glutamine should not be taken at night as it may cause insomnia.
- Vitamin B6, B12, folic acid (800 mcg per day) and trimethylglycine should be considered if homocysteine levels are elevated. SAMe (200 to 800 mg a day), a methyl donor, may be beneficial for symptoms of depression.
- Coenzyme Q10 (100 mg 3 times a day) may be helpful in CFS for increased energy.
- DHEA and melatonin can be considered based on appropriate lab testing.
- Licorice (250 mg three times a day) may help with fatigue, particularly when it’s related to adrenal insufficiency. Care should be taken as high doses of licorice may increase blood pressure.
- The amino acids phenylalanine or tyrosine, taken in daily doses of 1500 mg, will help to boost levels of brain hormones and neurotransmitters.
- Magnesium may be deficient in 80% of all Americans and may be of particular importance in chronic fatigue. Everyone should consider supplementing with 500 mg of magnesium daily. Up to 3 grams of magnesium may be taken. Doseage should be reduced if an unwanted laxative effect occurs.
- Few, if any, supplements contain sodium due to its adverse effect on blood pressure. Substituting sea salt for sodium chloride (common table salt) may be beneficial for those not on a sodium-restricted diet.
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