Chronic fatigue syndrome (CFS), also known as chronic fatigue immune deficiency syndrome (CFIDS), is a disabling illness characterized by persistent fatigue accompanied by rheumatologic, cognitive, and infectious-appearing symptoms.
Fatigue is an excessive feeling of tiredness, lack of energy, or exhaustion accompanied by a stong desire to rest or sleep. Many underlying conditions can cause fatigue and it is essential to find the cause.
Idiopathic chronic fatigue is unexplained chronic fatigue that fails to meet criteria for the chronic fatigue syndrome.
Although the prevalence of chronic fatigue syndrome is not really known, the US Centers for Disease Control estimates that 200 per 100,000 persons have chronic fatigue syndrome symptoms.
It is estimated that perhaps as many as half a million persons in the United States have a CFS-like condition.
Chronic fatigue syndrome affects both genders (women more than men), and all racial, ethnic and socioeconomic groups.
The cause or causes of chronic fatigue syndrome remain unknown. It is possible that there is a single (as yet unidentified) cause for CFS or that CFS results from multiple causes. A person may have one or more causes for chronic fatigue syndrome. Conditions that have been proposed to trigger the development of chronic fatigue syndrome include viral infection, trauma, stress, and toxins.
- Infectious Agents
- Due in part to its similarity to chronic mononucleosis, chronic fatigue syndrome was initially thought to be caused by a virus infection, most probably Epstein-Barr virus (EBV).
- It now seems clear that chronic fatigue syndrome in not caused exclusively by EBV or by any single recognized infectious disease agent.
- The possibility remains that some viruses or other infectious agents and post-viral fatigue syndrome might have a role in some CFS cases.
- EBV and related viruses produce lifelong latent infections which the person’s immune system normally keeps in check. However, a compromise in a person’s immune system can lead to reactivation of the virus and recurrent or chronic infection.
- It has been proposed that chronic fatigue syndrome may be caused by an immunologic dysfunction, for example inappropriate production of cytokines (hormones produced by immune cells) or altered capacity of certain immune functions.
- A common finding is decreased NK (natural killer) cell number or function in patients with chronic fatigue syndrome.
- Some investigators have observed hallmarks of autoimmune disease in people with CFS. However, tissue damage typical of autoimmune disease has not been seen in patients with chronic fatigue syndrome.
- One hypothesis is that various triggering events, such as stress or a viral infection, may lead to the chronic expression of cytokines and then to CFS.
- Several studies have shown that chronic fatigue syndrome patients are more likely to have a history of allergies than are healthy controls. Allergy could be one predisposing factor for chronic fatigue syndrome, but it cannot be the only one, since not all CFS patients have it.
- Hypothalamic-Pituitary Adrenal (HPA) Axis
- The HPA axis is a communication in the brain between the hypothalamus and pituitary and adrenal glands. It is heavily involve din the regulation of the release of hormones.
- The central nervous system may have an important role in chronic fatigue syndrome. Physical or emotional stress, which is commonly reported as a pre-onset condition in CFS patients, activates the hypothalamic-pituitary-adrenal axis, or HPA axis, leading to increased release of cortisol and other hormones. Cortisol and corticotrophin-releasing hormone (CRH), which are also produced during the activation of the HPA axis, influence the immune system and many other body systems. Over time, the adrenal glands can “burn out” resulting in lower than normal levels of cortisol and other hormones.
- Recent studies revealed that chronic fatigue syndrome patients often produce lower levels of cortisol than do healthy controls. Cortisol suppresses inflammation and cellular immune activation, and reduced levels might relax constraints on inflammatory processes and immune cell activation.
- Neurally Mediated Hypotension (NMH)
- NMH is low blood pressure caused by nervous system control.
- Disturbances in the nervous system’s regulation of blood pressure and pulse (neurally mediated hypotension, or NMH) are common in CFS patients.
- One study found that 96% of adults with a clinical diagnosis of CFS had symptoms of neurally mediated hypotension compared with 29% of healthy controls.
- Nutritional Deficiency
- There is no published scientific evidence that CFS is caused by a single nutritional deficiency. However, a deficiency of any nutrient can result in fatigue.
- RBC magnesium levels may be decreased in CFS patients, some of who have adequate dietary intake of magnesium.
- Vitamin B12 deficiency can cause fatigue. This is a common deficiency in people who have gastritis, take acid-blocking medication, are vegetarians, or have an autoimmune pernicious anemia.
- Other nutritional deficiencies which have been found in people with CFS include: Coenzyme Q10, L-carnitine, L-tryptophan, Folic Acid, and Zinc.
- Oxidative Stress.
- A number of recent studies have shown oxidative stress may be involved in its pathogenesis.
Factors suspected of promoting chronic fatigue syndrome:
- Hypoxemia (low levels of oxygen in the blood)
- Endocrine dysfunction
- Immune dysfunction
- Stress-related dysfunction
- Somatoform disorder (disorders with no identified organic cause)
- Marginal nutritional deficiencies
- Intestinal hyperpermeability (leaky gut syndrome)
- Overgrowth of pathogenic intestinal flora (dysbiosis)
- Food intolerances
- Chemical sensitivities
- Chemical toxicity
- Heavy metal toxicity
Here are the common chronic fatigue syndrome symptoms:
- Fatigue, generally of more than 6 months duration, which impairs daily function and is often made worse by exertion (with other known medical causes of fatigue excluded)
- Other symptoms may include:
- Enlarged, painful lymph nodes
- Sore throat
- Arthralgias (joint pain) in multiple joints without swelling or redness
- Headaches of a new type, pattern, or severity
- Abdominal pain
- Muscle pain
- Low-grade fever
- Cognitive difficulty, especially difficulty concentrating or short-term memory
- Difficulty sleeping (unrefreshing sleep)
- Post-exertional malaise lasting more than 24 hours
There is no one test to diagnose chronic fatigue syndrome.
A number of illnesses have similar symptoms to chronic fatigue syndrome and must be ruled out before the diagnosis of CFS can be used. These include, but are not limited to depression, stress, impaired liver function, environmental illness, chronic candida infection, food allergies, excessive gastrointestinal permeability, hypothyroidism, hypoglycemia, and low adrenal function.
Evaluation of possible chronic fatigue syndrome will include:
- Complete health history
- Physical Examination
- Laboratory testing (depending on symptoms may include some or all of the following):
- Complete Blood Count (CBC)
- Comprehensive Metabolic Panel (includes liver, kidney, glucose, protein and electrolyte tests)
- Erythrocyte sedimentation rate (ESR)
- Thyroid Stimulating Hormone (TSH)
- Iron studies (serum iron, transferrin saturation, ferritin)
- Antinuclear antibodies (ANA) if autoimmune disease is suspected
- Liver detoxification studies
- Food allergy testing
- Stool culture
- Testing for yeast in the digestive tract
- Testing for metabolic abnormalities (amino acids, organic acids, fatty acids)
- Testing for toxic heavy metals
- Testing for specific nutrient deficiencies
- Testing to screen for celiac disease: anti-gliadin, anti-endomysial, anti-reticulin and/or anti-tissue transglutaminase antibodies.
- Testing for mold sensitivity or allergies
- Bowel permeability testing
- Lyme Antibody Screen with Western Blot
- Testing for antibodies for Ehrlichiosis, Babesiosis, Chlamydia pneumonia, Epstein Barr Virus Panel, Herpes 1 & 2, Herpes Type 6 , CMV, Mycoplasma pneumoniae, and Parvovirus
- Carnitine (Total and Free)
- Check immune competence and function
- Other testing may be performed depending on a person’s symptoms, to rule out other possible causes of the symptoms.
The doctors at The Connecticut Center for Health are experienced in the treatment of chronic fatigue syndrome. If you have (or suspect you have) symptoms and want to learn more about natural treatments for this condition, we recommend that you contact one of our clinics for a free consultation about chronic fatigue syndrome or an appointment.