GASTROINTESTINAL PROBLEMS AND CHRONIC FATIGUE SYNDROME

Many persons with chronic fatigue syndrome (CFS) report gastrointestinal problems, including nausea, abdominal cramping, constipation, diarrhea and/or alternating constipation and diarrhea. When these symptoms are present concurrently, they meet the diagnostic criteria for irritable bowel syndrome (IBS).

IBS is not an inflammatory disease, such as ulcerative colitis, and therefore does not produce serious, long-term effects. It is, however, a painful disorder that can limit activities when symptoms are severe. The cause of IBS is unknown, but is thought to be triggered by food sensitivities and/or stress. A first line of treatment consists of diet modification after determining problem-causing foods.

Problem foods can often be determined by following an elimination diet. An elimination, or challenge diet, is used to identify foods and food additives that may be causing symptoms. When symptoms subside for at least 48 hours, then foods can be reintroduced into the diet slowly, one at a time every several days, to observe for reappearance of symptoms. The diet begins by eliminating numerous foods, including (but not limited to):

• dairy products
• gluten (this includes foods containing wheat, oats, rye, barley and other grains)
• red meats, lunch meat, hot dogs other processed meats
• alcohol
• caffeine
• citrus fruits and drinks, other fruit drinks, strawberries and dried fruit
• chocolate
• MSG, food colors and dyes

Multiple treatment options for IBS are available and include several types of medications: antidiarrheals, antispasmodics, fiber supplements, acid suppressors, antidepressants and a relatively new medication (Zelnorm) for people with chronic constipation as their primary bowel symptom. Stress management, either alone in combined with SSRI antidepressants, has been shown to be helpful for a number of people. Alternative therapies, such as yoga, tai chi or acupuncture, have been reported to relieve symptoms for some persons.

Weight loss can be a side effect of any gastrointestinal (GI) disorder, as the person avoids eating to decrease GI symptoms. When the diet is severely restricted, without attention to nutritional needs, the person can become malnourished. Large meals often make symptoms worse and for that reason eating several small meals throughout the day can be helpful. A conversation with one's primary health care provider is important to help control symptoms. And a visit with a registered dietitian to learn how to meet nutritional needs and manage symptoms can be beneficial.

Weight gain is reported as an unfavorable outcome of CFS for a significant number of people with the illness. This appears, in most cases, to be the result of decreased activity rather than increased calorie intake and it may be accelerated by changes in metabolism and brain chemistry brought on by the illness. Other factors have been implicated, such as thyroid dysfunction and medication side effects. Antidepressants and steroids are particularly problematic. Researchers have begun looking into physical exercise and its effect on CFS. Finding ways to comfortably increase activity within the capabilities of the person with CFS is a challenge for the individual, as well as care providers. A consult with a rehabilitation specialist, such as a physical or occupational therapist, may provide a highly personalized activity plan that is achievable and improves function.

Dietary supplements that are intended for weight loss or weight gain have been known to cause GI symptoms in some people, particularly diarrhea. These need to be taken with care to prevent a worsening of symptoms. And many other nutritional supplements, purchased over-the-counter, may come with fantastic claims for symptom relief or a cure, but may not be well studied or tested and need to be taken with caution. It is also wise that a person consult their physician, pharmacist or dietitian before consuming these products.

Gastrointestinal symptoms are frequently reported in children with CFS and may signal the onset of the illness. Parents will want to be alert for other symptoms that may indicate a diagnosis of CFS.