There are several comorbidities patients with CFS also suffer. Commonly, fibromyalgia is found in individuals with CFS⁵. Fibromyalgia affects 2-8% of the population and is characterised by widespread pain and stiffness throughout the body, fatigue, headaches, and sleep problems^1,6. Other comorbidities often associated with CFS include⁵:

• Irritable bowel syndrome (IBS)
• Chronic pelvic pain
• Multiple chemical sensitivities
• Temporomandibular disorder

The causes and risk factors associated with CFS are not fully understood. CFS is thought to be triggered by a combination of several factors in genetically predisposed individuals⁴. Suspected risk factors and triggers for CFS symptoms include^1,4,7:

• Infection
• Stress
• Metabolic disturbances
• Dysregulated immune system
• Autoimmunity

Several, or all, of the above risk factors, may be involved in initiating the inflammatory processes that are associated with CFS. Recent research has begun to shed more light on the progression of the condition with a consensus now pointing towards the involvement of the microbiome and inflammatory cascade (read more here).

In summary, studies of patients with chronic fatigue have proposed that a source of primary inflammation initiates an imbalance of the gut microbiota and eventually leads to increased gut permeability (leaky gut) and dysbiosis.^7a A leaky gut allows toxins and bacteria to leave the intestine and enter the blood and lymphatic vessels, maintaining a chronic inflammatory environment that can trigger autoimmunity and immune dysfunction. Finally, the continual dysregulation of the immune system perpetuates dysregulation of the hypothalamus-pituitary-adrenal axis (HPA) in the brain via the inflammatory cascade. This in-turn affects the energy production pathways and normal mitochondrial function (Scheme 1)

Scheme 1. The inflammatory processes leading to dysfunction of energy production.

The HPA axis is a complex set of hormonal interactions that produces cortisol and manages the body’s natural response to stressors. Cortisol plays critical roles throughout the body during stress, including the initiation or modulation of the immune response. During an infection, pro-inflammatory signalling molecules called cytokines are released by immune cells. Cytokines signal to surrounding cells that there is a threat that needs to be eradicated (Scheme 2). TNF-α and Interleukins (IL) are two types of cytokines commonly released in an inflammatory environment. TNF-α is a key mediator of inflammation released during a wide range of immune threats and therefore is a therapeutic target with many current pharmaceutical approaches. Dysregulation of the TNF-α cytokine is associated with autoimmunity, where the body attacks its healthy cells. Interleukins are a large group of cytokines released during an inflammatory event and possess both pro- and anti-inflammatory properties.

Cytokines such as TNF-α can stimulate the HPA axis and enhance cortisol levels, which in turn inhibit further production of cytokines^8. This type of feedback loop is critical to return the immune system to homeostasis and prevent tissue damage caused by an aberrant response. In the setting of continual leaky gut and chronic inflammation, enhanced and prolonged cytokine production would be an ongoing issue. In this dysregulated environment, continued TNF-α production might perpetuate the HPA cycle and continually produce cortisol (Scheme 2). It is known that following chronic production of cortisol, cortisol dysfunction occurs due to several mechanisms^9. Cortisol dysfunction could then lead to unchecked cytokine production. Prolonged cytokine production can also weaken the intestinal barrier, which would exacerbate the primary leaky gut issue and ultimately, the associated symptoms¹⁰. These processes are known as the downward spiral to chronic inflammation and are prominent in the case of chronic fatigue.

Scheme 2. The inflammatory processes related to the gut and increased cytokine signalling in CFS.

Importantly, it has been shown that cytokines such as TNF-α and IL-2 are significantly higher in patients with CFS compared to control patients¹¹. Hypocortisolism (adrenal fatigue), or the insufficient production of cortisol, was also associated with CFS in adolescent patients¹². Overall, a balance of both the immune system and HPA axis is needed for the ability of 1) the immune system to respond appropriately to an infection/immune challenge and 2) the immune response to return to a level of homeostasis to keep the body in a healthy equilibrium.

In the proposed model of events that lead to CFS symptoms, long-term dysregulation of the HPA axis results in malfunctions in metabolic pathways. Mitochondrial dysfunction and metabolism defects, in turn, lead to enhanced oxidative stress¹³. Oxidative stress occurs when a cell produces more damaging reactive oxygen species (ROS) than its antioxidant system can block. This imbalance and resultant oxidative stress contribute to the pathology of CFS, in particular the symptoms of post-exertional malaise (PEM)¹³.

Currently, there is no cure for CFS, and treatment involves only treating the symptoms¹. Unfortunately for some, treating the symptoms does not provide sufficient relief. There is a desperate need for treatment options that can repair the underlying issues of dysregulation, rather than mask the symptoms alone.

Maca is a medicinal root vegetable that grows above 4000m in the Andes of Peru. Traditionally maca is taken in Peru at all stages of life to build strength and resilience to stress and to balance endocrine function. The Inca believe that maca is a sacred feminine plant spirit that grows in the most extreme conditions (4000m + in altitude) and endures such extreme climatic stresses but thrives under them. She (la maca – feminine) is the food of your brain and her gift to you when you respect her is all her strength and resilience to stress. Furthermore her different colours have different properties and are used long-term or acutely to return balance to an out of balanced nervous system.

Red maca is believed to nourish the internal and black the external. In additional to daily consumption of boiled maca roots, the shamans and healers will look at your body’s constitution and see what energies are lacking before using red and black maca in high doses to treat symptoms via maceration of the roots. In essence, they will see which symptoms are dominant on any given day and treat with the colour that corresponds to return balance to the body. These ancient principals are the foundations of treating all chronic inflammatory conditions.

The three colours of maca used traditionally to manage chronic health problems in Peru