The Hidden Truth About Chronic Fatigue That Doctors Never Tell You

0:01 i'd like to welcome everybody to today's presentation on chronic fatigue syndrome this is the 2025 version and we will be talking about how to help people live their richest and most meaningful life even if they have CFS i'm your host Dr donnisee Snipes in this presentation I'm going to describe CFS because you may not even be familiar with exactly what it is we'll explore other similar diagnosis that may have that may overlap with CFS we'll review the prevalence and impacts of CFS and persistent fatigue and identify current evidence-based treatments for CFS and persistent fatigue why am I separating those because there are a lot

0:48 of things that cause persistent fatigue that are not chronic fatigue syndrome doesn't mean that that fatigue is any less debilitating and if it's caused by something else something that may have a treatment then obviously we want to make sure people are being adequately seen by a specialist to help them differentially diagnose what's going on and address anything they can about two million Americans have chronic fatigue syndrome and it's twice as likely in women as in men they think that there is a connection in women between the uh gonatal hormones between

1:35 estrogen and the sensitivity to developing or the propensity to developing CFS there's also a theory out there that women are experience violence and are victims more often than men therefore their stress response may already be disregulated and which lowers the immune system so when they are exposed to whatever causes CFS and they think it's a virus then they are more likely to get it ultimately how it happens not as important as diagnosing it and figure out figuring out how to help people live their rich and meaningful life approximately 40% let that

2:23 sink in for a minute almost half approximately 40% of healthy community dwelling adults so this isn't people that are in hospitals this isn't people who are in um ALFs or nursing homes or anything like that community dwelling adults in the US Japan and the U uk report chronic fatigue wow so this is not something that is uncommon therefore it is something that we should be screening for with every patient that walks into our offices we should be screening for this and we should not underscore absolutely should not automatically assume that that fatigue is due to

3:13 uh depression there are a lot of things that can cause that fatigue now ongoing fatigue itself often causes people to feel hopeless and helpless and depressed but the depression may not be the only thing causing the fatigue so we need to look at that whole birectional thing in a survey of 20 2,323 people with chronic fatigue 7% had chronic fatigue syndrome which is why I said not everybody who has chronic fatigue has CFS but uh 7% do means the other 93% have another cause of their CFS or I'm sorry have another cause of their chronic fatigue which

4:02 may be very very treatable what is the criteria for chronic fatigue syndrome unfortunately still to this day chronic fatigue syndrome tends to be what they call a diagnosis of exclusion that means that you've ruled out everything else and this is what you're left with criteria number one severe fatigue lasting longer than 6 months and present more than 50% of the time now of course we need to take into consideration the things that are going on in the person's life if they just are recovering from open heart surgery yeah they're going to get winded easier they're going to get fatigued easier if they're grieving they may experience a lot more fatigue

4:49 uh so we want to be cognizant of what's going on holistically with the person but the severe fatigue longer than six months more than 50% of the time so they can have some good days just because they have a good day doesn't mean that they don't have CFS they have to have the presence of at least four of the following symptoms post-exertional fatigue this includes mental exertion and a lot of people don't think of mental exertion as exhausting but if you've ever sat in a classroom or done really intensive cognitive work for you know a few hours you know you feel like

5:34 you ran a mile or a marathon depending on how long you were doing it and so people can go to work and work all day long and just really try or even work a half day and come home and they're just they're done they're they're past exhausted and we want to recognize this the person post-exertional fatigue is somebody experiencing fatigue greater than what one would expect for the amount of effort that they output and part of that's also going to have to do with the person's level of conditioning if they have been you know relatively inactive for a long time and then suddenly they get a full-time

6:23 job and they're on their feet for four six hours a day yeah they're going to feel like you know they got hit by a truck when they get home sometimes they're going to be plum exhausted it's all on a continuum for this person in their condition does this seem like their fatigue is more than what would be expected and I try to avoid the word excessive because that implies that they are maybe making it up or exaggerating it's not excessive we want to look at look at e exertion or um exhaustion that is more than what we would expect um based on what the what's going on with them and it's important when we have this discussion that we make sure they understand we're hearing them we

7:14 are not minimizing their level of fatigue we are trying to understand where on the continuum it falls they have unrefreshing sleep they may sleep 8 10 12 hours and they wake up and they're ready to go back to bed again a lot of things can cause that and we're going to talk about that today muscle pain pretty self-explanatory when we don't move around a lot we can tend to get achy but people with CFS tend to have a lot of just muscle pain and kind of everywhere that is not attributable to exercise or straining something polyarthragia having arthritis having problems in your joints pain in your joints sore throat tender lymph nodes headaches and impaired memory

8:05 or concentration well guess what if you've got unrefreshing sleep you're going to have impaired memory and concentration so I would expect those things to go together imagine if you have never had CFS which I'm hoping you haven't because it is a really devastating condition to have to try to figure out how to li live with in a uh less than adaptable world but thinking about having pain exhaustion not getting enough sleep don't feel like no matter what you do you fe feeling like you don't have the energy to get out of bed think about how that's going to impact your mood

8:53 think about the grief as you can't do the things that you had dreamed of doing you had wanted to do think about the guilt when you just don't you truly do not have the energy to get out of bed and go to your kids' recital or make dinner tonight let alone not even getting out of the house just getting up and making dinner the prospect is just overwhelming you don't have the energy it's important as we talk about these things today to remember that the effects of chronic fatigue are birectional so somebody can have chronic fatigue syndrome and have these symptoms and those symptoms are likely going to impact their every aspect of their life which is going

9:43 to further exacerbate their chronic fatigue so P stands for physical people with chronic fatigue have exhaustion sleep difficulties deconditioning because they just don't have the energy it's not that they're being lazy they don't have the energy pain and stiffness now they do have I think most of us have probably seen the ad for that little um seated pedal exercise machine that has a motor to it um I don't know how much that actually does if the motor's doing all the work to help with conditioning but it certainly can help with reducing stiffness for people who have difficulty

10:28 moving and and again the one with the motor is actually ideal for somebody with chronic fatigue because you don't have to use the motor you can slow it down or whatever but for a lot of people with CFS they don't have the energy to sit there and pedal for any period of time and keeping the blood moving keeping the joints mobile is really important adolescent chronic fatigue syndrome is associated with altered autonomic cardiovascular control which means they have difficulty controlling their blood pressure heart rate and pulse or blood pressure and and heart rate um it's characterized by enhanced sympathetic stress and attenuated parasympathetic the uh dig rest and

11:18 digest doesn't kick in so excessive stress not enough relaxation uh nervous system activity and we've talked about this in other videos in relation to postural orthostatic tacocardia syndrome people with POTS when they stand up their heart rate goes up their blood pressure goes up i mean way up um in response to standing they're not doing anything unusual they're not standing with a 40 lb rucks sack on them they're just standing up and when your body responds like that it takes a lot of energy so people with POTS often struggle with exhaustion on top of everything else

12:06 in addition to imbalanced sympathetic and parasympathetic nervous system activity uh the person may have prior to developing these symptoms had an episode of mono or Epstein bar virus and this is where they started believing that CFS may be related to a viral infection interestingly enough though most people with POTS particularly um and adolescent CFS often have normal cytoine levels so the inflammation level in their body isn't more than what is expected which

12:52 is why for so long doctors said oh it doesn't exist because we can't see the inflammation well it's there so we need to understand the symptoms and try to figure out what else might be going on interpersonally people with CFS experience isolation and withdrawal because they don't have the energy and a lot of people since it's what we call an invisible disability a lot of people may not understand or they may think that the person is overreacting or milking it um and that can cause a lot of resentment guilt grief and and just simply relational changes if you used to go to the gym with somebody or go hiking with somebody you can't do that now and if they don't want to do

13:41 something else with you then that relationship may start to dwindle people's relationship with themselves their self-esteem their self-concept changes as they start recognizing their new normal and recognizing that there are some things that they thought they were going to be able to do that they are not actually going to be able to do now and that involves a grieving process the the loss the death of their vision of their rich and meaningful life and that's one of the places we can help people step in and say "Okay well maybe you can't do this the way you thought you were going to let's look at are there any modifications we can make let's look at what other things are

14:30 important in your rich and meaningful life that you can still do albeit with modifications." helping people become aware of what CFS is and educate their their loved ones their friends their co-workers and their employers is also really important and as clinicians we can advocate for them um obviously release of information blah blah blah but we can also just go out and do public presentations and say "Hey this is what CFS is the person's not making it up it is a very challenging condition emotionally the person with CFS often struggles with depression anxiety anger and grief due to the severity of their chronic fatigue syndrome you know more severity more grief

15:24 more helplessness more anger uh uncertainty if they have more flares than someone else then they may have more um emotional distress as a result because it is more disruptive to their life the ambiguity of what's causing it can also be very frustrating it's like okay there's something wrong with me you've got to be able to fix it but we don't know how to do that yet and that can be exasperating for somebody with CFS especially because it often seems to come on kind of out of nowhere it's like they had a virus and then they got better but they were never quite the same again uh and then the chronicity in patients uh and they called me CFS me stands for myal myalgic

16:18 encphylitis or CFS and so CFS is what we typically uh refer to it as but it's important to understand that when people have distress guess what that's that sympathetic nervous system triggering and the parasympathetic nervous system getting weaker the sympathetic nervous system triggers increases inflammation increases the chances of a a flare of the CFS it can make it a lot worse it can impair sleep it can impair um you know relationships which is going to increase stress increase inflammation worsen CFS symptoms people with uh CFS have difficulty concentrating and difficulty

17:06 with their memory okay and we're going to talk about interventions in I think starting on the next slide but I do want to highlight the fact that a lot of that is due to the inflammation and the lack of restful quality sleep when we don't clear out the adenazine in our brain uh through quality sleep we feel sluggish the next day we have more difficulty controlling our thoughts and preventing negative ruminations all of which increases stress when we're stressed we are in fight or flight not think clearly not learn things we are trying to survive and one would expect that concentration memory attention all those executive functionings would probably be worse what do we do

17:58 encourage people to mitigate this write things down if you're not if you're trying to remember something it takes energy the person with CFS that's the one thing that they ain't got so encourage them to write it down so they don't have to remember encourage them to use push notifications as much as possible encourage them to create a concentration environment learning environment whatever it is they need for if they're doing school work or at work that removes as many distractions as possible so they're not using energy trying to block out the extraneous stuff it takes more energy if you're having to work to focus than if you don't have to work as

18:45 hard it it affects the person environmentally because people with CFS often cannot work uh some can work part-time some uh can't work at all there are very few with a with milder cases of CFS that can work uh uh full-time but that is the exception not the rule therefore housing becomes and and financial situations become much more tenuous which is stressful you see the connection here um it can become more difficult to access good nutrition because it's expensive and medical services the inability unfortunately in our society to work a full-time job definitely

19:35 negatively impacts a lot of people's environment and the when you think of Maslo's hierarchy what's the bottom those biological needs housing uh shelter food water medical care and those become more difficult to access loss of connection with one's personal meaning and purpose is the spiritual effect and I refer to spirituality in a much broader term we're not talking about religion but we're talking about a person's sense of a lack of connection with the world it's like the world's going on without me i'm just sitting here and I can't I don't even have the energy to get up causes and consequences of chronic fatigue syndrome something we don't know exactly know what

20:25 in all cases but something causes dysfunction in the nervous endocrine and immune systems and which one comes first doesn't really matter because they all impact each other when your immune system is overactive or underactive it's a stressor when your endocrine system your your hormones are imbalanced it's a stressor when your nervous system is imbalanced when the stress response is way stronger than the relaxation response then the stress response stays turned on a lot longer because you can't balance it out we can help people work on strengthening their vag nerve

21:10 we can help people work on strengthening their nervous system and reducing unnecessary sources of stress and minimizing inevitable stress when the person's nervous system starts to balance out cortisol will be more effective the endocrine system will balance out somewhat um assuming there's not an underlying pathology in in the endocrine system and the immune system tends to chill out a little bit and and we've seen this in people with uh autoimmune disorders when they get stressed their immune system you know kicks into overdrive and when they're not stressed they can typically manage their symptoms so helping people heal their nervous system is one of our key jobs

21:58 and as that autonomic nervous system heals a lot of things will start to balance again again it may not be a complete reversal but it will help it will help a lot in terms of gonatal hormone imbalances in chronic fatigue syndrome and when I talk about gonatal hormones I'm talking about uh testosterone uh estrogen progesterone DHEA excess corticotropin releasing hormone estrogen follicle stimulating hormone and luteinizing hormone are often present in women with CFS so they have high levels of a lot of these hormones it's important to understand though we've talked

22:46 about Goldilocks and too little is bad and too much is bad exposure for too long is bad or too short of a time is bad and when it comes to estrogen short-term increases in estrogen showed a decrease in something called the serotonin re-uptake transporter and that is the um enzyme that breaks down serotonin so it can be re-uptaken uh so a shortterm increase in estrogen isn't bad it's actually beneficial and can help people have a little more energy and feel a little bit brighter long-term exposure more than 28 days caused an increase in serotonin re-uptake

23:31 transporter which led to reduced serotonin because the more cert we have the quicker it breaks down the serotonin in the syninnapse so it doesn't give the serotonin as much time to do its job low serotonin leads to sleep changes unrestful sleep fatigue and increased pain low serotonin impacts the availability of oxytocin which is an anti-inflammatory and helps regulate the autonomic nervous system it affects the availability of estrogen in the body um and it affects the availability of dopamine and our natural painkillers which we call indogenous

24:17 opioids uh which is why people with depression who have low serotonin experience a lot of these things there is a neurochemical basis resolution of fatigue and decrease of inflammatory mediators in patients with chronic fatigue syndrome often occurs after the discontinuation of hormone therapy that doesn't mean that hormone therapy is bad it means if the hormones are pushing the person to having too much then it can be bad we want to have the person where it's just right it's not too low not too high additionally insufficient DHEA which helps make gonatal hormones can also

25:04 contribute to these problems if you don't have the precursors you can't make the final product there is a clear relationship between sleep disorders and chronic fatigue syndrome there's also a clear relationship between sleep disorders and inflammation and sleep disorders and diabetes but those are other presentations we'll talk about identifying sleep disorders in our patients when they come in for their intake is important that can mean fragmented sleep are they having difficulty getting to sleep difficulty staying staying asleep etc are they having other issues that are fragmenting their sleep like they have to get up and pee eight times a night um or they are

25:54 sleeping in a room where there's something that's waking them up whether it's a dog or a spouse or whatever um or their sleep is becoming fragmented because of sleep apnea sleep apneoa is associated with increased likelihood of chronic fatigue syndrome as well as an increased likelihood of diabetes because chronic um because sleep apnea is stressful on the body when you quit breathing the body kind of freaks out makes sense which increases stress hormones which also increases blood sugar so every time the person quits breathing they have a blood sugar spike that's not good for your insulin resistance chronic fatigue syndromes are also related to dysfunction in the

26:46 autonomic nervous system and the hypothalamic pituitary adrenal axis we've talked about this a lot already so I'm not going to belabor it suffice it to say that increased stress or trauma whether it be prenatally in childhood during adolescence or right now increases the risk of chronic fatigue syndrome as the person's autonomic nervous system becomes disregulated as the sympathetic nervous system becomes overly powerful then cortisol starts to lose its ability to do what it does so well which is reduce inflammation and we start to see inflammation creep up and all kinds of neurochemical and hormonal changes in the body that are not changes that we want

27:40 helping people reduce their stress is essential helping them feel safe and empowered is essential somebody with CFS may not have the energy let's be brutally honest they may not have the energy to do a bunch of trauma work uh they may explore EMDR on a good day but that again is going to take a lot of energy and one of the things that we can do as therapists when we're seeing somebody who's struggling with CFS we want to help them build their reserves trauma's been there it'll still be there six months from now a year from now let's help the person get to the place where they feel safe they feel empowered they feel like they have an increased quality of life

28:29 unless of course they're just hellbent on working on their trauma then of course we're not going to um negate or disempower them emotionally and cognitively perfectionism self-sacrificial tendencies so kind of codependency unhelpful beliefs about emotions thinking that being angry is bad being anxious is bad um and perceived stress may present to a greater extent preorbidly in people with CFS so people who tend to be perfectionistic anxious insecurely attached are at a much higher risk of developing CFS exclusion remember I said this was a diagnosis of exclusion

29:20 and I'm sure I missed some but these are some of the common things that guess what we can screen for in our intake sleep apnea anemia now we're not going to be able to tell about anemia but we can encourage people to go to the doctor and get a blood test to identify their nutritional status and their hormonal status which takes us to malnutrition if they have anemia they've got some level of malnutrition that'll show up in a blood test that's something a doctor can handle you know relatively simply cardiovascular issues whether it is really bad cardiovascular conditioning or some sort of congestive heart failure if the person is exhausted because of cardiovascular

30:09 issues that's something that can be addressed in most cases pots postural orthostatic tacocardia syndrome it's exhausting y'all know my daughter has it and I've watched how absolutely wrecked she can be when her POTS is flaring up because it takes so much energy just to stand up just to move around just to stay upright hypothyroid when we get stressed we are much more likely to trigger an endocrine reaction in our body um if the stress is chronic that can lead to hypothyroid and if you watch the videos I have on the uh impact of trauma on the body uh I go into

30:58 great detail about that but just suffice it for now to recognize that stress will cause changes in thyroid hormone availability and gonatal hormone availability severe obesity when people have a lot of atapost tissue fat it increases the estrogen levels and we've talked earlier about how too much estrogen estrogen dominance too much estrogen for too long actually reduces the availability of serotonin lyme disease and diabetes are other physical issues that we need to sort of rule out we also want to recognize chronic fatigue syndrome can occur concurrently with these

31:44 things just because somebody has POTS doesn't mean they don't also have CFS we But once we get the POTS under control then if the CFS remains we can start addressing that hypothyroid we know that hypothyroid looks a lot like depression and when people have hypothyroid and and fatigue and they get exhausted easily it's frustrating and it's going to cause stress and it's going to impact every piece of their life as that stress goes up they become their their immune system becomes less effective if you will and they become more at risk for developing CFS so it is a birectional thing

32:32 interpersonally interpersonal stress relationship stressors that we talked about uh they can be exhausting it doesn't mean you have chronic fatigue if you're living with somebody who has a uncontrolled mental health issue if you're in a conflictual relationship if you work in a place that is just toxic as all get out you're going to be exhausted it's stressful does it make you more at risk for getting CFS yes um but it also uh can in and of itself cause chronic fatigue when you're laying down at night and you're replaying all those conversations or done me wrongs in your head relationships can be stressful and exhausting insecure attachment is a source of interpersonal

33:23 stress but I wanted to highlight it on its own when people don't feel safe and loved in their relationships when people don't feel like they can count on somebody to support them then it creates a lot of anxiety and as we get older as we become adults we have multiple somebodyies that we believe we can rely on and that's wonderful up however if we don't believe we're worthy of love if we don't believe we can trust other people then there's always a level of anxiety there's always a fear of abandonment that increases stress increases inflammation increases the likelihood of CFS and in somebody with CFS it worsens their symptoms addressing attachment is

34:15 something we can do in in treatment and it's not something as exhausting as maybe addressing the trauma that caused that attachment uh attachment issue we can help people focus on in what way are you safe and empowered in your relationships now what relationships do you have that are important to you let's look at how they may be safe how they may be the pneummonic I use for secure attachment is cares how they're consistent attentive uh consistent attentive responsive encouraging and safe let's look at those no most relationships aren't perfect so we want to help

35:02 people look at the positives in the relationship and acknowledge the ne the negatives or things that may need a little bit of work emotionally and cognitively people may have depression and depression looks like chronic fatigue syndrome a lot of times um and chronic depression uh can co-occur with chronic fatigue syndrome bipolar disorder increases people's risk of chronic fatigue syndrome but we need to evaluate you know and with bipolar the depressive episodes don't usually last for six months or more uh so we need to look at the duration of how long are these episodes lasting anxiety anger both of those are exhausting that anxiety and anger are our stress

35:55 responses and when we feel stressed when our stress our sympathetic nervous system sympathetic nervous system is triggered we're using a whole lot of energy and when people feel chronically anxious or chronically angry chronically guilty uh chronically resentful it uses a whole lot of energy and it's exhausting people who are negative tend to be a lot more tired trauma as I mentioned earlier can cause people to develop something called hypocortisolism which happens as I described earlier when the stress response is on for too long cortisol becomes ineffective and reduces its ability to suppress inflammation which affects the entire system and they call

36:48 that hypocortisolism grief it's exhausting many people when they're grieving they don't sleep well they may experience more pain aches and pains they're not sleeping well uh they have difficulty concentrating it overlaps like completely with CFS so we need to evaluate is this person grieving or is it CFS or is it both and and and a lot of people with CFS have a lot that they're grieving birectionally environmentally too much noise too much light overly strong smells not feeling safe all of these things co can cause stress and exhaustion if you're in an environment that

37:36 is overstimulating a lot of times you'll come home and you're just like "Oh my gosh you know finally some relief but I'm exhausted because I've been fending off all that over stimulation all day long and as I mentioned earlier sleep disruptors we do need to check people's sleep hygiene and there's sleep habits to make sure that there's not something going on besides like apnea that may be keeping them up i've mentioned before that you know I have animals i live on a farm i'll I let the cats sleep in the bedroom and sometimes they have a overly active night like they did last night and they were up and down and they were playing with each other they got

38:22 the zooies at 2:00 in the morning and I'm like y'all I got to work tomorrow but that doesn't happen on with regularity and if it does happen like tonight they ain't sleeping in the bedroom because I know I need to get a good night's sleep recognizing what is important in reducing stress and maintaining your sleep and your circadian rhythms in terms of treatment stress management and when I talk about stress I'm not just talking about emotional stress i'm talking about any source of stress on the body you're in pain it's stressful you didn't get enough sleep your body thinks it's a stressor you're malnourished your body registers that as a stressor all of those

39:09 things are going to require more energy they're going to trigger the sympathetic nervous system and they may impair your body's ability to make and balance the hormones and neurotransmitters you need to live your rich and meaningful life we want to help people manage these stressors so they can reeregulate that autonomic nervous system and re restore the anti-inflammatory effects of cortisol and allow their body to reeregulate all of those symptoms we've talked before in other videos about the different um axes we've got in our nervous system we have the hypothalamic pituitary adrenal axis which is the stress response we have the hypothalamic pituitary gonatal axis and we have

40:00 the hypothalamic pituitary thyroid axis not sure exactly why they decided to separate all three of them but they all three work together and when one gets out of whack like this the adrenal axis it brings its buddies along with them and then the gonatal axis and the thyroid axis get out of whack so strengthening that parasympathe parasympathetic nervous system and reducing unnecessary stress of all types is essential physically help people improve their sleep address circadian rhythm issues uh remember circadian rhythms regulate our hormones it regulates our enzymes it regulates everything not just our sleep circadian rhythms are regulated by light levels light means be

40:51 awake dark means go to sleep it's regulated by temperature warm means be awake cold means go to sleep and hibernate and our activity levels when you are engaged in activities uh you are more likely especially activities with other people you are more likely to keep that uh awake signal going which is why it's helpful to have a sleep routine where you do the same couple of things each night before bed eat dinner take a bath read a book go to sleep so your body starts getting primed as soon as you start eating dinner it's like "Oh I know what comes next we're going to get to go to bed pretty soon." We want to help people reduce inflammation as much as possible through uh good

41:41 nutrition and stress reduction and we want to pe help people balance their autonomic nervous system interpersonally we want to help them develop secure attachment with their self and others learning how to be consistent attentive responsive encouraging and safe which means unconditional positive regard with themselves first how can I be accepting of myself and with others we want to also help them work on disability acceptance cfs may never go away for them so how can we help them as Hayes says in acceptance and commitment therapy how can we help them live in the and I have CFS and I'm going to do this i have CFS and I can do this helping people develop

42:33 their emotional quotient or emotional intelligence whatever phrase you like and distress tolerance skills are really important in terms of working with this people need to be able to do what I call I use the pneummonic idea identify the feeling they're having anxious angry grieving curious whatever it is identify the feeling if it's a stressful feeling have skills distress tolerance skills to help them downregulate get into their wise mind get out of fight or flight and into their wise mind explore the trigger or the cause of the feeling using the facts in this context at this time or Fitcat so I identified my feeling i downregulated so I could think more clearly about

43:25 what's going on now what the heck did happen what triggered my anxiety right now and is it actually an issue and then address the feeling figure out what I need to do whether I need to do something to address the trigger or I need to recognize that it wasn't a big deal it was just triggering a memory or maybe it was something in in the present that made me feel a little bit unsafe but it's not worth my energy to address those are kind of our options and so identify the feeling I downregulate D explore the trigger or cause e and address the feeling a idea cognitively helping

44:14 people address their dis cognitive distortions and most of your cognitive distortions personalization all or nothing thinking jumping to conclusions emotional reasoning you list them off most of them can be addressed by looking at the facts in this context at this time looking at the probability versus the possibility anything's possible but what is the probability that this worst thing is going to happen finding exceptions when you think everything's going wrong finding exceptions to that or when you think somebody never does something find exceptions and find alternate explanations and this is a big one for uh jumping to conclusions as well as personalization

45:02 what are three other reasons why this might be happening besides what you what you're afraid it is besides this conclusion that you jump to or besides the fact that you think it's about you environmentally helping people achieve safe stable housing and adjust the environment both at home and at work or wherever they spend most of their time to be compatible with their senses compatible light levels noise levels temperature levels um smells all of those things when they are either too little or too great but especially too great trigger that stress response so we need to help

45:50 people figure out how can I modify my environment so I feel comfortable so I'm not overwhelmed or overstimulated and help them spiritually define their rich and meaningful life and create connectedness with how they're using their energy and so they can see how it's helping them move toward the things people and experiences that are important to them exercise and reconditioning now a lot of people get upset when I say this but movement is essential exercise doesn't mean going to the gym exercise may mean getting out of bed and walking over to the chair and sitting down and sitting up straight for a few minutes each day start off start with what you can do

46:42 what can you do and then build on that a little bit at a time five minutes if you can sit up on your own for five minutes right now and you don't feel completely exhausted great tomorrow try 10 minutes if that goes well the next day try 15 when you reach the place where it starts triggering tiredness not exhaustion tiredness that's where you need to stop for a little while and you need to hold there so maybe it's 25 minutes after 25 minutes you need to lay back down okie dokie that's great so keep doing that 25 minutes until you realize that hey maybe I can do 30 maybe I'll try that but give yourself time take it slow and be compassionate with yourself when you have

47:34 setbacks you may be doing 25 minutes at a time for two weeks and then one day after 15 minutes you're just like I got to lay back down okay being compassionate with yourself is essential because if the person starts getting angry or pushing themselves and saying well I should be able to do 25 minutes that's what I've been doing it uses a whole lot more energy between being angry or frustrated and pushing through the body is telling them what they need to do as they move it can help build muscle and anybody who has worked with patients that are in hospitals in hospital beds in rehab uh will tell you that people need to move to prevent bed sores as well as to keep those muscles

48:26 strong muscles get weak you know you have your arm in a cast for 6 weeks it's going to get weak it's going to take a minute to build that muscle back we want to encourage people with CFS working with their physical therapist to identify a plan for reconditioning and that may mean literally laying in bed and clenching their hands like that that may be as much energy as they have right now but it's better than nothing and eventually maybe they'll get to the place where they're doing unweighted bicep curls okay great but start low and slow don't overwhelm the person don't push them to the point or they shouldn't push themselves to the point where they're exhausted

49:13 push themselves to where they think what they know they can do and then maybe a minute two minutes five minutes more than that and if it goes well great then maybe consider advancing it later being too sedentary negatively impacts circadian rhythms remember I said one of the things that impacts our circadian rhythms in addition to light and temperature is our activity levels and a lot of times in the evening when we're getting ready for bed we're winding down we're becoming more sedentary so if you're sitting laying sleeping all day long your circadian rhythms have no clue what's going on so the brain doesn't prepare to release melatonin at the right time

49:59 circadian abnormalities are a common symptom of many diseases and may aggravate several neuroscsychiatric disorders circadian rhythms negatively impact the balance of thyroid hormones gonatal hormones cortisol and our ability to get good quality sleep melatonin with a doctor's approval has been suggested for circadian rhythm regulation depressive symptoms and inflammation and caffeine reduction at least 6 hours before bed some people with CFS swear by caffeine um to help them get through the day and you know if it's working for you and it's not causing harm yes caffeine's a stressor on the body but we've got to pick

50:47 and choose our battles anti-depressants and specific agonists or drugs that increase 5HT1A receptors counteract serotonin reduction caused by inflammation inflammation causes a reduction in serotonin sa reduction in serotonin contributes to fatigue and CFS symptoms so increasing serotonin can be helpful making sure people's hormones are in balance getting those blood tests done same thing with their nutrients as counselors social workers we aren't going to be doing that but if somebody's presenting with physical symptoms like fatigue and sleep difficulties it

51:34 is really essential that they get blood work done nutritional deficiencies also can occur not only due to poor diet they don't have the energy to get up and make a healthy meal so they're just kind of eating out of bags but it can also be due to poor absorption when the intestines are inflamed or when the gut microbiome's out of whack it's not going to allow the body to absorb nutrients as effectively microbiome alterations this bacteria in the gut it can be helpful with people with CFS to help them enhance butyrate producing microbes and they can do this by adding resistant starches

52:20 like cooked and cooled potatoes or rice they eat it cooled not hot and legumes inolin which is found in chory root which you can make chory root tea it's also found in garlic oh love my garlic and leaks fructo oligosaccharides are also found in asparagus and onions these can also help increase butyrate producing microbes polyphenols that come from berries green tea apples cocoa and my favorite coffee caffic acid actually has polyphenols in it that enhance the health of the microbiome to increase the number of butyrate producing microbes galacto oligosaccharides are

53:09 found in legumes and nuts xylan is found in whole grains pairing prebiotics like resist resistant starch or any of these other things that we just talked about with probiotics like yogurt or kefir enhance butyrate levels more effectively than either alone other fatigue interventions medications commonly associated with fatigue so medications with a side effect of fatigue include seditive hypnotics anti-depressants muscle relaxants anti-hypertensives like beta blockers antihistamines statins and many antibiotics so statins yeah your cholesterol medication in

53:57 addition to your blood pressure medication uh can be contributing to your fatigue again encouraging in people who can exercise getting some daily movement even if that is done from your bed even if that is moving your arms or moving your foot back and forth you know using your your calf and your shin muscles that's still exercise start with what you can do work on helping the person sustain their interpersonal relationships so they feel connected with other people these interpersonal relationships will also help increase oxytocin when they're with the person when they're talking to the person oxytocin helps regulate the nervous system the autonomic nervous system which is one

54:50 of the things we're trying to regulate and oxytocin is a powerful anti-inflammatory so you get you know double the work for your money by helping them increase that oxytocin and it's not on here but I'm going to add it uh can also be increased with animal assisted therapy because we know that petting animals actually and playing with animals being nice to animals increases our oxytocin and that is something that can be helpful unfortunately for people with chronic fatigue syndrome they may have difficulty maintaining a pet because they don't have the energy to change the litter box they don't have the energy to take the dog out therefore telling them to own

55:36 a pet is overly simplistic unless they've got somebody who can help them care for the pet um when they don't have when they're when they don't have the energy to do what needs to be done encourage people with fatigue chronic fatigue or otherwise to maintain a routine they may not be able to go back to full-time work but maintaining a routine helps set those circadian rhythms getting up about the same time each day or waking up even if you don't have the energy to get up and doing similar things opening the blinds keeping it light uh with whatever you can do in terms of circadian rhythm regulation we've talked about that sort of ad nauseium there are no

56:22 recommendations for the American associ uh from the American Association of sleep medicine for routinely effective treatments for sleep phase disorder which means you got to go see a sleep specialist if adjusting if looking at your sleep hygiene and I do have videos on improving your sleep uh if improving your sleep hygiene isn't working or isn't doing enough then getting a sleep study done can be incredibly helpful nearly half of adults experience persistent fatigue fatigue itself is caused by a variety of biocschosocial factors we can't identify just one thing that causes persistent fatigue in people chronic fatigue syndrome is present in up to 7% of adults

57:13 that have persistent fatigue there is no single known cause for chronic fatigue syndrome sorry we still aren't there yet however we recognize that nutritional immunological so your immune system autonomic your nervous system and endocrine factors your hormones have all been implicated in the development of chronic fatigue syndrome as well as in the exacerbation of symptoms we want to help people reduce stress in any piece of life current treatments we have address the presenting symptoms with the goal of improving sleep quality regulating circadian rhythms ensuring adequate nutrition balancing hormones reducing inflammation managing stress and disease

58:04 adaptation are there any questions exactly Southern girl and if you uh go back to the slide that we've got on um other conditions that may contribute to or may masquerade as CFS Lyme disease is definitely one of those time my husband was joking right before this presentation that I should be multitasking doing that too but you know I can't teach and

58:53 uh watch a video at the same time so I'm going to have to catch up next life maybe and I hear that a lot from people with chronic fatigue syndrome they're almost afraid to do anything sometimes because they feel okay right now and they're like "Well if I do this next task is it going to push me over the edge?" And good charting and I didn't talk a lot about that today so thank you for bringing that up good charting of their sleep their nutrition their energy levels what they did and for how long and for what intensity can help people start to understand a little bit more about what may be

59:44 causing their exhaustion for me for example and and I don't have CFS but I have struggled with adrenal fatigue and persistent fatigue and I know that there are certain things that I do that are not physical in nature they're cognitive but they wipe me out if I record for example if I record three or four hours worth of classes in a day I'm pretty much done for the next two days which is why I try not to do more than an hour or two a day now because that is my my threshold and I can respect the person's anxiety about what's going on

1:00:29 um and encouraging if if they were my patient or my friend I would validate their concerns and encourage them to be compassionate with themselves um sunny summer i'm not sure why the CFS um is different and and I'm not sure on on holiday if you mean like over the winter

1:01:19 months when it's cooler or when you are on vacation and you're less stressed so you have less energy going to other stressors and you have more energy that you can devote to uh being outside so without knowing a whole lot more I wouldn't be able to even fathom a guess southern girl in haling the adrenals means healing the autonomic nervous system uh check out the video I have on healing your nervous system and uh releasing stress and trauma from your body those will provide you a lot of helpful tips um that can help you move toward healing your adrenals strengthening your vagus

1:02:08 nerve strengthening your relaxation response is going to be a big part of that but there's only so much that your vag nerve can do if you're constantly stressing your nervous system out uh and I do have Southern Girl i do have It's a very old video it's a very old video but I do have one on adrenal fatigue everybody have an absolutely fabulous rest of your day and I will see you next week same time same station