Originally published in

The Official Journal of
The American Naturopathic Medical Association &
The American Association of Nutritional Consultants and the
Townsend Letter for Doctors and Patients

Chronic Fatigue Assessment and Intervention: The Result of 101 Cases

Robert Thiel, Ph.D., Naturopath Director of Research http://www.healthresearch.com

Dr. Thiel runs a clinic in Grover Beach, County of San Luis Obispo, California.

Dr. Thiel runs a clinic in Grover Beach, County of San Luis Obispo, California. 

Thiel, R.J. Chronic Fatigue Assessment and Intervention: The Result of 101 Cases. ANMA & AANC Journal 1 (3): 17-19, 1996
Thiel, R.J. Chronic Fatigue Assessment and Intervention: The Result of 101 Cases. Towsend Letter 174: 70-71, 1998

Abstract: The purpose of this trial was to measure how often individualized nutrition-based interventions could benefit people with complaints of chronic fatigue within 60 days. Of the 101 participants, 88.12% of participants reported improvement within 30 days and 99.01% reported improvement within 60 days; P< 0.0001.

Most natural health professionals see people with chronic fatigue on a regular basis. Additionally, fatigue appears to be the number one complaint that even medical doctors hear [1]. Chronic fatigue has been defined as persistant or relapsing debilitating fatigue for at least 6 months with symptoms of abrupt onset, low grade fevers, arthralgias, myalgias, post-exertional fatigue, neurophyscological complaints, and sleep disturbances [2]. Glandular malfunction, hypotension, infections, allergies, and various nutritional deficiencies have been speculated as potential causes of chronic fatigue [2-8]. Some researchers have speculated that chronic fatigue syndrome is not a discrete disease with a specific cause but is instead a clinical condition involving multiple factors [2,8].

This report includes the results of a clinical trial involving 101 people with long-term (chronic) fatigue. The intention of this trial was to measure how often individualized recommendations could benefit people with complaints of chronic fatigue within 60 days as well as to measure some of the types of factors that were present in the chronically fatigued population.

Adults were eligible for inclusion in this trial if they resided in California, agreed to follow the recommended intervention, agreed to provide (and did provide) feedback, signed a consent agreement, and indicated they suffered from fatigue, CFS, fibromyalgia, tiredness, low energy, or similar problems for a period of at least 3 months. 108 people met these criteria, but seven later failed to provide the necessary feedback (nor did they participate for the length of the trial), thus this trial only includes the results of the 101 actual participants. Of the 101 participants, 90 of them had complaints of fatigue for 6 months or more. The ages of participants ranged from 18 to 82; the mean age of the participants was 47.8 years. 27 of the participants were males and 74 of the participants were females.

After completing the selection documentation, all subjects were interviewed for approximately 45 minutes. All subjects were then assessed using Reflex Nutrition Assessment (RNA). RNA is a non-invasive technique used to assess nutrition status by observing the response of muscles under externally provided human-force (it is similar to other forms of muscle testing [9]). Performing RNA normally consists of performing two assessments. The first assessment is to determine if a reflex indicates a nutritional need (by observing a reduction in muscular strength) and the second is to determine which nutritional intervention can help fit that need (by observing an increase in muscular strength). Many have reported success in using it and similar techniques [9-11].

The reflex points assessed for this trial included adrenal, blood, heart, hemoglobin, hypoglycemia/other (checked at the pancreas or other digestive reflexes), parasite, staph, strep, thyroid, viral, and yeast (checked at the umbilicus) [9]. It should be noted that having a problem indicated by any of these reflexes does not necessarily mean that they would be confirmed by any type of allopathic diagnosis.

Participants who appeared to have (through the interview process combined with reflex assessment) hypoglycemia were given a dietary plan to follow which essentially recommended increasing consumption of lower glycemic food while decreasing consumption of high glycemic foods: high glycemic foods include sucrose, alchohol, and other refined carbohydrates; lower glycemic foods include fruits, whole grains, nuts, animal products, and vegetables [12]. Participants who had reflex problems were advised to consume an average of three tablets (per day) of one nutritional supplement for each fatigue-related reflex concern. Although the actual supplements varied, generally bovine glandulars were for adrenal reflex, iron with synergists for blood, fortified heart glandular with l-carnitine for heart, tillandsia and b vitamins for hemoglobin, chromium GTF with synergists for hypoglycemia, vitamin A with herbs for parasite, bovine thymus glandular for staph, fortified herbal-glandular for strep, bovine thyroid glandular for thyroid, fortified herbs for viral, and fortified herbs with probiotic factors for yeast (specific products used were those that reflex checked as best).

Subjects were interviewed at approximately 30 day intervals to determine any change in energy level or fatigue.

The interview process suggested that nearly all participants could remember some stress, trauma, illness, or event (or combination of factors) that proceeded their bout with fatigue. Reflex assessment revealed that some participants had problems with as many as five fatigue-related reflexes. This trial found that the average participant had problems with 2.0 fatigue-related reflexes. The following table demonstrates the frequency:

Table 1. Frequency by Reflex

Thyroid 57.4%
Adrenal 33.7%
Hypoglycemia 29.7%
Hemoglobin 24.8%
Heart 15.8%
Blood 10.9%
Yeast 8.9%
Strep 5.9%
Staph 5.0%
Parasite 5.0%
Viral 2.0%

88.12% of participants reported improvement within 30 days. 99.01% reported improvement within 60 days; the P value of this result was less than .0001. This trial did not attempt to quantify the degree of improvement.

Every participant who reported having fibromylagia (all of whom were female) had problems with adrenal and heart reflexes; some had other reflex concerns as well.

In this trial, gender did not appear to play any significant role in determining improvement.

This trial confirms that a variety of factors can contribute to fatigue. Low thyroid function [5], nutritionally related heart concerns [7], adrenal issues [2], parasites [4], infections [2], diet [6,13], and nutrient deficiencies [6,8] have all been shown to play some role in chronic fatigue.

The high incidence of thyroid reflex involvement (57.4%) may be consistant with a medical study which found that 61% of people with chronic fatigue syndrome ate little, if any, salt or highly salted foods [7]. Consumption of iodized salt is the main way that most Americans receive iodine [14] (the other way is eat foods which naturally contain organic iodine such as sea vegetables [15]). The only known need for iodine in the human body is to support the thyroid gland for the production of its hormones [14].

The relatively low incidence of viral reflex involvement is not surprising. It is consistant with the findings of other researchers who have found that viruses appear to be present in only a very small percentage of people who are chronically fatigued [8,16].

Dr. Demitrack (M.D.) has hypothesized that acute infection, stress, physchiatric illness, and other factors which existed before chronic fatigue is manifested, appear to ultimately converge into a final common biological pathway that is then known as chronic fatigue [2]. This hypothesis is consistant with the findings of this report. It is believed that it is the combination of seemingly unrelated factors which has frustrated many people with energy complaints.

Although this trial was restricted to California residents, it is believed that similar results could be obtained by properly trained researchers in other areas.

[1] Kroenke, Kurt. Interviewing the patient with chronic fatigue syndrome. Infectious Disease News: 2, Oct 1991
[2] Demitrack, Mark. Chronic fatigue syndrome: A disease of the hypothalmic-pituitary-adrenal axis? Annals of Medicine 26: 1-3, 1994
[3] Defreitas, E. et al. Evidence of retrovirus in patients with chronic fatigue immunity deficiency sydrome. CFIDS Chronicle: 1, Sep 1990
[4] Galland, Leo. Giardia lamblia infection as a cause of chronic fatigue. Journal of Nutritional Medicine 1: 27-30, 1990
[5] Lathan, Robert. Chronic fatigue? Consider hypothyroidism. The Physician and Sports Medicine 19 (10): 67-70, Oct 1991
[6] Lapp, Charles and Cheney, R. Chronic fatigue syndrome: Self care manual, February 1991. The CFIDS Chronicle Physician's Forum 1 (1): 14-17, Mar 1991
[7] Bou-Holaigah, Issam. The relationship between neurally mediated hypotension and the chronic fatigue syndrome. Journal of the American Medical Association 274 (12): 961-967, Sept 1995
[8] Williams, David. Chronic fatigue syndrome: The search for a cookbook solution instead of eliminating a true problem? Alternatives for the Health Conscious Individual 6 (6): 41-46, December 1995
[9] Thiel, Robert J. Serious Nutrition for Health Care Professionals. Arroyo Grande (CA): California Health Group, 1995
[10] Burr-Madsen, Angela. Body Polarity Reflex Analysis and the Nutritional Connection. Carson City: Thoth, Inc., 1992
[11] Rosen, Marc S. and Williams, Louisa. The research status of applied kinesiology, part II: An annotated bibliography of applied kinesiological research. In: A.K. Review, Vol. 1, No. 2: 34-47, 1991
[12] Jenkins, D.J. et al. Glycemic index of foods: A physiological basis for carbohydrate exchange. American Journal of Clinical Nutrition 34: 362-366, 1981
[13] Bondy P. and Felig P. Disorders of Carbohydrate Metabolism: 221-340. In: Duncan's Diseases of Metabolism. Phil.: W.B. Saunders, 1974
[14] Clugston, Graeme A. and Hetzel, Basil S. Iodine: 252-263. In: Modern Nutrition in Health and Disease, 8th ed. Phil.: Lea & Flebinger, 1993
[15] Jensen, Bernard. The Chemistry of Man, Vol II. Escondido: Bernard Jensen, 1983
[16] Buchwald, Dedra. Chronic fatigue and the chronic fatigue syndrome: Prevalance in the Pacific Northwest health care system. Annals of Internal Medicine 123 (2): 81-88, July 15, 1995

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For additional information check out http://www.healthresearch.com. This research is for doctors and other health care professionals. Thiel is not a medical doctor. None of this research is medical advice, nor should it be construed as medical advice; nor is any of this information specific for any individual.

Copyright 1996/1999/2000 by Robert Thiel, Ph.D., Naturopath All rights reserved.