The remainder of this chapter discusses problems that arise in these systems-problems in which fatigue is a significant symptom.

The Immune System

Chronic Fatigue Syndrome (CFS)
One of the most publicized causes of fatigue today, chronic fatigue syndrome (CFS) has been diagnosed in 3 million Americans. It is thought that millions more are affected by this severe and dis-abling problem but are undiagnosed.

Women predominate among persons affected with CFS: 70 per-cent of the cases are female. Fatigue is the most prevalent symp-tom, occurring in almost all the afflicted. The onset of fatigue is often sudden, and many women can pinpoint when it started. The fatigue is so severe that even minor exertion, such as a short walk or light housework, can be debilitating. The loss of physical stamina and endurance is pronounced in women with CFS. Many women with CFS curtail their activities and take naps during the day or sleep more hours at night. Interestingly, increased bed rest doesn't improve the energy level of afflicted. CFS occurs with a whole range of other symptoms, including headaches, low-grade fever, swollen lymph nodes, sore throat, depression, poor ability to concentrate and decreased mental acuity, muscle and joint aches and pains, allergies, digestive complaints, weight loss, and skin rashes.

For many women, mental and emotional symptoms seem to predominate. Short-term memory may be diminished. Women with CFS often have trouble remembering specific names or places, or doing complex mental work, such as bookkeeping, administra-tive tasks, or teaching. Thus, women with CFS may have great difficulty performing functions that demand intellectual skills.

Medical researchers have found no causative agent for CFS. The most widely accepted hypothesis is that a virus or a group of viruses is involved, although this has not been definitely proven. Most of the attention has focused on the herpes family of viruses as the causative agents. These include the Epstein-Barr virus (EBV), herpes simplex viruses (genital and oral), and cytomegalo-virus (CMV). Some researchers have suggested that the causative agents may be Candida albicans, a retrovirus that is in the same family as the AIDS virus, or parasites. Some physicians even propose a mixed infectious cause, with several pathogens causing symptoms simultaneously. A wide variety of environmental and lifestyle factors may also contribute to CFS by stressing the immune system. Many of my CFS patients report extreme and prolonged emotional stress, anxiety, and depression, and a history of poor nutritional habits predating the onset of CFS. Environmen-tal pollutants and contaminants may also play a role in weakening the body and allowing CFS to develop.

The length of the illness varies. One-third of CFS patients recover fairly quickly, regaining their health within a few months. Another third of CFS patients take two years to recover, while the other third remain ill after two years. I have seen patients in my practice for whom CFS has been a long-term and extremely debilitating condition. These women had tried many drugs and natural treatment regimens. In treating women with CFS, I have had wonderful success with a variety of supportive techniques, primarily in the self help or lifestyle area. I describe these techniques fully in the following chapters.

Candida Infections
Although commonly referred to as a yeast, Candida albicans is actually a parasitic fungus that only resembles a yeast. Found most commonly in the large intestine and esophagus, candida is a normal inhabitant of the digestive tract and usually lives in bal-ance with friendly bacteria that help the digestive system function optimally. When the balance between the bacteria and the fungi is upset, candida may proliferate, infecting tissues of the digestive tract, vagina, and mouth. The toxins released by the fungi weaken the immune system, allowing candida to penetrate throughout the body and spread to other systems, such as the bladder and respiratory system.

Women with candida infections in the vagina (candida vagini-tis) often have a thick vaginal discharge, redness, itching, and burning. Women with digestive symptoms of candida may have heartburn, bloating, gas, abdominal pain, constipation, and diarrhea. Candida infection of the mouth is called thrush and most commonly afflicts infants and children. Thrush presents with white lesions inside the mouth and on the tongue. In the most severe cases, candida can travel through the bloodstream to invade every organ system in the body. This type of blood poisoning is called candida septicemia and is usually seen only in seriously ill patients, such as people with AIDS or terminal cancer.

The weakening of the immune system caused by the over-growth of candida has been linked to many symptoms other than those of active infection. These include chronic fatigue, lethargy, poor ability to concentrate, depression, visual changes, pain and swelling in joints, nasal congestion, sore throats, and muscle weakness. Candida infections are more common in diabetics and have been linked to the prolonged use of antibiotics, cortisone, or birth control pills. Diets that include large amounts of bread, alcoholic drinks, candy, cookies, fruit juice, and other foods with high sugar or yeast content promote the growth of candida.

Because candida is present in most people, a candida infection is difficult to diagnose. Women with candida vaginitis may be diagnosed by identifying the organisms on a slide. However, for women who may have candida in other organ systems and tissues, the most definitive diagnostic test may be their response to a sugar- and yeast-free diet, as well as their response to the appropri-ate medication. See the self help section of this book for more infor-mation on effective medical and self help treatment for candida.

Allergies
Allergies occur when the body's immune system overreacts to harmless substances. Normally, the immune system is on the alert for invaders such as viruses, bacteria, and other organisms that cause disease. The immune system's job is to identify these invaders and destroy them before they cause illness. In allergic people, this system begins to react to other substances-typically pollens, molds, or foods such as milk or wheat (called allergens). Sometimes allergic reactions are easily diagnosed, because the symptoms occur immediately after the encounter with the allergen. Immediate allergic symptoms include wheezing, itching and tearing of the eyes, nasal congestion, and hives. Some allergic reactions are delayed; they may occur hours or days after expo-sure to the allergen. Delayed symptoms include joint aches and pains, eczema, and fatigue and depression. The person affected may be unaware that an allergy is causing her symptoms. Fatigue is a very common symptom of an allergic reaction; it can accom-pany an allergy to foods or to chemical or environmental triggers.

Allergies are very common; approximately 24 million Ameri-cans (10 percent of the population) suffer from allergies. As much as $1 billion is spent each year in the medical treatment of aller-gies, while an additional $1 billion is lost in time away from work and allergy-related disability compensation.

Several tests are available for diagnosing allergies; they are not always accurate and can be expensive. Physicians don't agree on the usefulness or accuracy of the different types of tests. The most traditional type has been skin testing: A minute amount of allergen is placed on or within the skin, and the physician then observes whether an allergic reaction takes place (commonly a red swelling or itching and tenderness). Any reactions take place within a day or two. Traditional allergists consider blood tests, such as the RAST test (radio allergosorbent test) and the FICA (food immune complex assay), to be more controversial. These tests detect rises in the specific IgE antibodies; a rise reflects the body's immune response to different allergens. My experience with RAST testing finds that it may be inaccurate or not correlate well with actual clinical symptoms. It is also less sensitive than skin testing.

Some holistic physicians test for food allergies by doing sub-lingual provocative tests. In this test, a food extract is placed under the tongue to see whether it elicits a reaction. Neutralizing antidotes are then administered to the patient to reduce or eliminate symptoms. This test is not used by traditional allergists, who consider it to be ineffective. Another way to test for food sensitivities is simply to eliminate suspected food allergens. First, the patient fasts, taking only distilled water for several days. Then she reintroduces foods one at a time. If the patient is allergic to a specific food, a reaction will occur after she adds that food to her diet.

Treatment for allergy usually includes avoiding the offending substance, if possible, or using over-the-counter and prescription medication and desensitization shots. Managing stress and following a low-stress elimination diet may also be very helpful in treating and preventing allergies. It is also important to rotate foods and choose from a wide variety of high-nutrient food.

The dietary principles discussed in this book are very helpful for women with allergies.

Endocrine or Glandular System

Premenstrual Syndrome
Premenstrual syndrome (PMS) is one of the most common problems affecting women during their reproductive years (from the teens to the early fifties). PMS affects between one-third and one half of all American women between the ages of 20 and 50- in other words, as many as 10 to 14 million women. There is no single cause of PMS; medical researchers now believe that various hormonal and chemical imbalances can trigger PMS symptoms. The symptoms usually begin 10 to 14 days before the onset of the menstrual period and become progressively worse until the onset of menstruation or, for some women, several days after the onset. This means that millions of women spend half of each month of their adult lives feeling sick.