What is Chronic Fatigue Syndrome?

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Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that lasts for at least six months and that can’t be fully explained by an underlying medical condition. The fatigue worsens with physical or mental activity but doesn’t improve with rest.

Other characteristic symptoms include:

• Sleep that isn’t refreshing
• Difficulties with memory, focus, and concentration
• Dizziness that worsens with moving from lying down or sitting to standing

This condition is also known as myalgic encephalomyelitis (ME). Sometimes it’s abbreviated as ME/CFS. The most recent term proposed is systemic exertional intolerance disease (SEID).

The cause of chronic fatigue syndrome is unknown, although there are many theories — ranging from viral infections to psychological stress. Some experts believe chronic fatigue syndrome might be triggered by a combination of factors.

There’s no single test to confirm a diagnosis of chronic fatigue syndrome. You may need a variety of medical tests to rule out other health problems that have similar symptoms. Treatment for chronic fatigue syndrome focuses on improving symptoms.

Symptoms

Symptoms of chronic fatigue syndrome can vary from person to person, and the severity of symptoms can fluctuate from day to day. Signs and symptoms may include:

• Fatigue
• Problems with memory or concentration
• Sore throat
• Headaches
• Enlarged lymph nodes in your neck or armpits
• Unexplained muscle or joint pain
• Dizziness that worsens with moving from lying down or sitting to standing
• Unrefreshing sleep
• Extreme exhaustion after physical or mental exercise
• Chronic Insomnia

Physical Symptoms

• muscle pain
• frequent headaches
• multi-joint pain without redness or swelling
• frequent sore throat
• tender and swollen lymph nodes in your neck and armpits

Causes

The cause of chronic fatigue syndrome is still unknown. Some people may be born with a predisposition for the disorder, which is then triggered by a combination of factors. Potential triggers include:

• Viral infections. Because some people develop chronic fatigue syndrome after having a viral infection, researchers question whether some viruses might trigger the disorder. Suspicious viruses include the Epstein-Barr virus, and human herpesvirus 6. No conclusive link has yet been found.
• Immune system problems. The immune systems of people who have chronic fatigue syndrome appear to be impaired slightly, but it’s unclear if this impairment is enough to actually cause the disorder.
• Hormonal imbalances. People who have chronic fatigue syndrome also sometimes experience abnormal blood levels of hormones produced in the hypothalamus, pituitary glands, or adrenal glands. However, the significance of these abnormalities is still unknown.
• Physical or emotional trauma. Some people report that they experienced an injury, surgery, or significant emotional stress shortly before their symptoms began.

Risk factors

Factors that may increase your risk of chronic fatigue syndrome include:

• Age. Chronic fatigue syndrome can occur at any age, but it most commonly affects young to middle-aged adults.
• Sex. Women are diagnosed with chronic fatigue syndrome much more often than men, but it may be that women are simply more likely to report their symptoms to a doctor.

Complications

Possible complications of chronic fatigue syndrome include:

• Lifestyle restrictions
• Increased work absences
• Social isolation
• Depression

Diagnosis

There’s no single test to confirm a diagnosis of chronic fatigue syndrome. Symptoms can mimic those of many other health problems, including:

• Sleep disorders. Chronic fatigue can be caused by sleep disorders. A sleep study can determine if your rest is being disturbed by disorders such as obstructive sleep apnea, restless legs syndrome, or insomnia.
• Medical problems. Fatigue is a common symptom in several medical conditions, such as anemia, diabetes, and an underactive thyroid (hypothyroidism). Lab tests can check your blood for evidence of some of the top suspects.
• Mental health issues. Fatigue is also a symptom of a variety of mental health problems, such as depression and anxiety. A counselor can help determine if one of these problems is causing your fatigue.

It’s also common for people who have chronic fatigue syndrome to also have other health problems at the same time, such as sleep disorders, irritable bowel syndrome, fibromyalgia, depression, or anxiety.

In fact, there are so many overlapping symptoms of chronic fatigue syndrome and fibromyalgia that some researchers consider the two disorders to be different aspects of the same disease.

Diagnostic criteria

Guidelines proposed by the United States Institute of Medicine define the fatigue associated with chronic fatigue syndrome as being:

• So severe that it interferes with the ability to engage in pre-illness activities
• Of new or definite onset (not lifelong)
• Not substantially alleviated by rest
• Worsened by physical, mental, or emotional exertion

To meet the Institute of Medicine’s diagnostic criteria for chronic fatigue syndrome, a person would also need to experience at least one of these two symptoms:

• Difficulties with memory, focus, and concentration
• Dizziness that worsens with moving from lying down or sitting to standing

These symptoms must last for at least six months and occur at least half the time at moderate, substantial, or severe intensity.

Additional Notes

People who have chronic fatigue syndrome also sometimes experience abnormal blood levels of hormones produced in the hypothalamus, pituitary glands, or adrenal glands. There are a few factors that might increase one’s risk for CFS: Sex – women are diagnosed with CFS more than men. Blood proteins are also linked to this disease.

For years, chronic fatigue syndrome (CFS) has baffled both experts and patients alike. Although up to 2.5 million Americans may live with the disorder, researchers are only now starting to better understand it — and to realize that we still have a lot to learn.

Treatment

There is no cure for chronic fatigue syndrome. Treatment focuses on symptom relief. The most disruptive or disabling symptoms should be addressed first.

There’s currently no specific cure for CFS.

Each person has different symptoms and therefore may require different types of treatment to manage the disorder and relieve their symptoms.

Work with your team of healthcare providers to create the best treatment plan for you. They can go over the possible benefits and side effects of the therapies with you.

Medications

Some problems associated with chronic fatigue syndrome can be improved with either prescription or over-the-counter medications. Examples include:

• Depression. Many people with long-term health problems, such as chronic fatigue syndrome, are also depressed. Treating your depression can make it easier for you to cope with the problems associated with chronic fatigue syndrome. Low doses of some antidepressants can also help improve sleep and relieve pain.
• Orthostatic intolerance. Some people with chronic fatigue syndrome, particularly adolescents, feel faint or nauseated when they stand or sit upright. Medications to regulate blood pressure or heart rhythms may be helpful.
• Pain. If over-the-counter medications such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) don’t help enough, prescription drugs sometimes used to treat fibromyalgia might be options for you. These include pregabalin (Lyrica), duloxetine (Cymbalta), amitriptyline, or gabapentin (Neurontin).

Therapy

Many people with chronic fatigue syndrome benefit from:

• Counseling. Talking with a counselor can help build coping skills to deal with chronic illness, address limitations at work or school, and improve family dynamics. It can also be helpful for managing depression.
• Addressing sleep problems. Sleep deprivation can make other symptoms more difficult to deal with. Your doctor might suggest avoiding caffeine or changing your bedtime routine. Sleep apnea can be treated by using a machine that delivers air pressure through a mask while you sleep.
• Exercise. Aggressive exercise regimens often lead to worsened symptoms, but maintaining activities that are tolerated is important to prevent deconditioning. Exercise regimens that start at a very low intensity and increase very gradually over time may be helpful in improving long-term function.

Post-exertional malaise

People with chronic fatigue syndrome have a worsening of their symptoms after physical, mental, or emotional effort. This is called post-exertional malaise and it can last for days or weeks after the exertion.

People who experience post-exertional malaise often struggle to find a good balance between activity and rest. The goal is to remain active without overdoing it.

You may want to keep a daily diary of your activities and symptoms, so you can track how much activity is too much for you. This may help you avoid pushing too hard on the days you feel good, which can result in a “crash” where you feel much worse later.

When to see a doctor

Fatigue can be a symptom of many illnesses, such as infections or psychological disorders. In general, see your doctor if you have persistent or excessive fatigue.

Because no single cause has been identified, and because many other conditions produce similar symptoms, CFS can be difficult to diagnose.

There are no tests for CFS. Your doctor will have to rule out other causes of your fatigue when determining a diagnosis.

While CFS was previously a controversial diagnosis, it’s now widely accepted as a medical condition.

Home remedies and lifestyle changes

Making some lifestyle changes may help reduce your symptoms.

Limiting or eliminating your caffeine intake can help you sleep better and ease your insomnia. You should limit or avoid nicotine and alcohol too.

Try to avoid napping during the day if it’s hurting your ability to sleep at night.

Create a sleep routine. Go to bed at the same time every night and aim to wake up around the same time every day.

Alternative medicine

Acupuncture, tai chi, yoga, and massage may help relieve the pain associated with CFS. Always talk to your doctor before beginning any alternative or complementary treatments.

Natural/Herbal Remedies

Valerian

Take 600 to 900 milligrams of a valerian extract standardized to 0.4 percent valeric acids an hour before bed. The valerian helps you get a good night’s sleep, which also helps fight fatigue. To treat chronic fatigue syndrome (CFS), take the herb nightly for at least two months.

Green supplements

Products such as Emerald Green and Synergy contain powdered greens, usually in the form of grasses (such as wheat or barley grass) and green vegetables such as spinach. Many of these supplements contain the antioxidant equivalent of six or more servings of fruits and vegetables.

Although researchers haven’t studied their use in people with CFS, we find they help support the immune system and protect against the antioxidant damage that often contributes to muscle pain in people with CFS. Take one to three tablets a day or five milligrams of powdered product mixed into juice or a shake for at least three months.

Licorice extract

Some people with CFS tend to have abnormally low blood pressure. If you’re one of them, and your symptoms include mostly fatigue—not pain—this supplement may help with energy levels. The herb contains an anti-inflammatory compound that increases sodium levels in the blood, which usually leads to higher blood pressure. Take 500 milligrams, two to three times a day.

Siberian ginseng

Ginseng, considered a “tonic” herb, may help with your fatigue, especially if it’s mild. In one study, CFS patients with mild fatigue who took Siberian ginseng daily for 4 months reported less fatigue that improved faster than those who took a placebo. Those with severe fatigue, however, showed no improvement in fatigue, although they did report less depression. Take 400 to 500 milligrams of a standardized extract containing 2.24 milligrams of combined eleutherosides B and E daily.

Ginkgo

This herb may improve concentration and alertness by boosting blood flow to the brain. Because it’s an antioxidant, it may also help protect muscles from oxidative damage that contributes to muscle pain in CFS. Take 80 to 120 milligrams twice a day of a product standardized to 24 percent flavonoids and six to seven percent terpene lactones.

Coenzyme Q10

People with CFS may not produce enough adenosine triphosphate (ATP), the energy currency of the cells of the body. When levels of ATP drop too low, you feel bone tired. Coenzyme Q10 helps your body produce more ATP. It’s also an antioxidant, so it may boost your immunity and help your muscle pain.

In one study of 155 people with CFS, this supplement increased their ability to exercise—a sign they had more energy. Sixty-nine percent of those who took the supplement also reported improvements in a host of other symptoms during the 6 months they took it. Take 100 milligrams daily or 60 milligrams twice a day.

Essential fatty acids

People with CFS tend to have low levels of essential fatty acids, which are important for reducing inflammation and boosting immunity. In one study, people who were supplemented with essential fatty acids experienced fewer symptoms after eight to 12 weeks. Take either two grams of fish oil and two grams of flax oil or four grams of a combination of evening primrose oil and fish oil.

Melatonin

To help you sleep at night, take 1 to 3 milligrams of melatonin an hour before bed in lieu of or in addition to the valerian. Although there are no studies on its use for CFS, other research finds that this supplement can improve sleep-wake cycles and energy levels in shift workers and people suffering from jet lag.

Thank you for reading

Michael

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