A proposal for explaining progression from light/moderate to severe chronic fatigue, by Anna Dorothea Höck in ES Journal of Nutritional Health vol 1, no.2 Jun 11 2020


Research abstract:


Chronic mild to moderate fatigue is also called chronic idiopathic fatigue. Physicians at best consider psychotherapy for treatment. But most physicians do not view this condition as a real disease.

In contrast, debilitating chronic severe disease has been termed chronic fatigue syndrome (CFS), or if more severe, myalgic encephalopathy (CFS/ME). Meanwhile published metabolic aberrations in CFS/ME suggest estimating these diseases no longer as mere psychiatric diseases. The metabolic results inspire to further exploration of cell stress response mechanisms, which are summarized in this paper.

Interestingly, cell stress responses were tightly linked to vitamin D3 – mediated effects, such as homeostatic regulation of metabolism, energy and redox balance, as well as defense against pathogens and toxins. Specific personality traits, prevalence of indoor activities, latitude and climate predispose to vitamin D3 deficiency, which is supposed to represent a missing link for a comprehensive model of disease progression from mild chronic fatigue to most severe forms.

By diagnosing vitamin D deficiency in early stages of chronic fatigue, the progression to severe and debilitating chronic fatigue may be prevented. In more severe stages of chronic fatigue, such as CFS/ME, resistance against mere vitamin D replenishment seems to be the rule. Some causal mechanisms for this resistance and potential treatment options are shown.


Scientific insight to the biomolecular mechanisms of cell homeostasis helps to understand and treat all clinically manifestations associated with different stages of chronic fatigue.


Excerpt from conclusion:

Physicians could be stimulated to revise their treatment regimens by omitting all interventions which induce further redox stress and xenobiotic burden. The drug
and chemical intolerances of CFS/ME patients call for only minor dosages of pain and psychoactive substances. Instead, restoration of effective VDR activity should be
targeted. This is assumed to stabilize a SIRT1/Nrf2-driven stress response.

This might be achieved by plant based diets and/or supplementations, such as those recommended by Naviaux et al. [8], and Xiao W 2018 [31], 8/10 including all B vitamins, and by supplements of vitamin D3 and minerals, which include calcium and magnesium,
in particular. Phosphate deficiency through long-standing vitamin D deficiency should be considered as well.

Due to presumed vitamin D3 resistance and to distinct genomic and translational vitamin D3 responses, personalized high doses such as 250 mcg cholecalciferol and up to 2400 mg calcium per day should be applied [57,58]. Careful clinical observations should clarify the potential reversibility of very severe and long-standing CFS/ME stages. In any case, any sort of stressful challenge, such as xenobiotics, drugs, nutrient additions, microwaves, and psychosocial stress, should be avoided as much as possible.

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