Having worked with hundreds of CFS clients at my clinic there are a few foundational strategies I have found to be helpful.

Start by seeking medical advice from your doctor so that they can rule out other potential causes of your symptoms and help to make an official diagnosis. Try and seek out a doctor who is open-minded and supportive, and who fully acknowledges CFS and its physical basis as a condition.

If your GP does not fit the bill, you are perfectly within your rights to keep asking for a second or third opinion, until you are satisfied. You could either ask the receptionist at your current practice if any of the doctors there have experience of working with patients with CFS (or other complex chronic illnesses) or, if necessary, ask for a referral to another local surgery or practice.

If your memory and concentration aren’t particularly good when you attend appointments, then take a partner or friend or relative with you who may be able to help discuss your health on your behalf. If you ever need more time to discuss your concerns, book a double appointment so you have the ability to fully outline your health concerns.

One of the key strategies that I teach CFS clients is pacing to support their recovery. Pacing is an energy-management strategy that seeks to find the balance between activity and rest. It involves (for a period) living within the physical and mental limits imposed by illness and avoiding physical and mental activities that exacerbate symptoms. It also might involve incorporating scheduled rest breaks around any form of activity undertaken. 

In order to pace well, you must carefully evaluate your daily activities and get them to a level that your body can handle, without entering the ‘boom-and-bust’ pattern which frequently happens when you overexert past your activity threshold and then crash.

This involves finding your baseline (the level of activity – whether this is physical, mental, or both) that you can comfortably manage on at least three to four consecutive days, without experiencing symptoms as a result. Once you have identified your baseline, the pacing process involves dropping this back by 25% so that you are giving yourself a window of resting room so that energy levels can begin to recoup. Then, eventually and over time, you will be able to slowly start to introduce more activity into your routine again (all the while listening to your body’s feedback and if any symptoms arise as a result). This process allows my clients to progress their activity levels and get back to a way of functioning without crashing and experiencing post-exertional malaise (PEM). 

Note: I cover more detail on pacing in Chapter 15 of my book Chronic Fatigue Syndrome: Your Route to Recovery.

It is a well-known fact that what you eat has an enormous impact on the health of the body. But did you know that what you eat can influence your energy levels, immune system, digestive system, mood and so much more? In CFS, it is paramount that we work on a client’s diet and support them in finding a way of eating that supports the health of their physiological systems so that recovery can take place.

I am a firm believer in the concept of bio-individuality, which means that each person is biochemically unique with highly personal nutritional requirements. That said, there are some common threads which I do see amongst my CFS clients, which include common food intolerances and sensitivities which can often be a trigger for their symptoms (gluten, dairy, FODMAPs and histamine can be biggies here!)

In essence, I work with my clients to help them find a diet that suits their individual tolerance profiles, whilst reducing the inflammatory-burden and ensuring that their blood sugar levels remain stable throughout the day, whilst also encouraging fibre intake to help flourish their gut microbiome. I will often advocate balanced plates of food with my clients. 

Dietary diversity is also a key strategy that I advocate in my nutrition and wellness clinic. This involves rotating sources of plants (fruits, vegetables, nuts, seeds, wholegrains, legumes, herbs and spices) and trying out at least 2 new ingredients each week. The more you change up the foods that you eat, the more you give your gut a cocktail of different fibres.

Did you know that fibre feeds our gut bacteria and as a result this helps them to produce anti-inflammatory substances which can protect our health and support chronic symptoms?

So, try and experiment – buy 2 new plant-based ingredients each week and keep yourself accountable by avoiding eating the same things day in, day out. Whilst we are all creatures of habit, remember that diversity is the spice of life and will reward you threefold!

A functional test is a test that examines how well the body is functioning, and is performed by private laboratories, which you can access through a healthcare provider such as a nutritional therapist or naturopath. Most samples of these tests can be taken at home, but on occasion may require a blood draw from a nurse or phlebotomist. 

In the NHS, testing uses markers that instantly detect a disease or diagnosis, whereas functional testing measures dysfunction, using markers backed up by a large body of clinical data.

I often recommend functional testing on an individualised basis with my CFS clients, depending on presenting symptoms and case history. Some examples of the tests I run with CFS clients include:

• Adrenal testing
• Microbiome analysis
• Thyroid dysfunction
• Chronic infection testing (this includes chronic Lyme disease)
• Organic acids testing
• Genetic testing
• Toxicity testing

Once you have your lab tests interpreted by your practitioner, you will gain bespoke nutrition, lifestyle and supplemental protocols that can offer a unique roadmap to your recovery journey that is personalised to your functional health.

Note: the best functional test(s) for you will depend on your unique case and personal situation.

Whilst CFS is a physical illness, it is one that affects physiology. This means that your health and recovery can be largely influenced via the mind-body connection, and thus focussing on your mindset and your inner thoughts can play a pivotal role in moving the needle in your overall health. 

Put simply, if you are frequently firing out thoughts (sometimes you can be unaware of these thought cycles as they are commonly subconscious) that involve filtering for CFS symptoms, thinking negatively about your health and situation or spiralling when symptoms start to flare, this can result in putting your nervous system in a state of stress. The more often that your nervous system is activated in “fight-or-flight”, you impede the health of key physiological processes and this can impact energy, digestion, and so much more.

Focus your attention to relaxation strategies and mindfulness principles which will work to put your body into a healing state where recovery can take place. Examples include breathwork, meditation, journaling and speaking to a therapist who can support you in your mental health journey. Note: we have a psychology practitioner at the ARDERE clinic who is equipped to support individuals with this.

Working on belief blocks is also a crucial part of my work with CFS clients because so many clients do not believe that it is possible for them to recover, so we work on overcoming these obstacles as well.

And remember, never ever blame yourself for your situation and know that it is completely understandable to have your mindset affected when dealing with a chronic illness like CFS, because it can completely change the goalposts in your life. So be kind to yourself, practise acceptance and increased awareness whilst also fostering gratitude for all the lessons learned from your illness along the way. This can really help reframe the narrative and empower your forwards along your journey!

• 3 medications to reduce PEM crashes
• How toxins impact the nervous system
• Mitochondrial failure: the cause of CFS symptoms?