Chronic fatigue syndrome is a malady distinguished by severe tiredness. It is an extremely challenging condition for doctors and patients.
Chronic fatigue syndrome (also known as myalgic encephalomyelitis) is a real, complicated, and challenging disease. Patients with this disease experience profound tiredness and extreme fatigue that does not go away with rest and is not explainable by any other medical condition.
Currently, the exact cause of the disease remains unknown. Some theories suggest a viral infection as the underlying cause, while others propose psychological stress as the primary cause. Yet, most experts agree that chronic fatigue syndrome results from the interaction of multiple factors.
According to the most recent statistics, chronic fatigue syndrome affects between 800.000 to 2.5 million persons in the United States alone. Chronic fatigue syndrome patients experience a decrease in productivity as well as a high medical bill. Experts estimate that chronic fatigue syndrome causes an economic burden of around 24 billion dollars annually.
The disease is more common in women than in men and tends to affect individuals over the age of 30, although pediatric cases are not unheard of. Over 80% of individuals with chronic fatigue syndrome are not diagnosed; this means that the disease might be more frequent than we initially thought.
In this article, a doctor will explain all you need to know about this condition, from its symptoms to the treatment. Besides, there will be answers to some of the most common questions asked. Continue reading to get pearls on this topic directly from an MD.
Is chronic fatigue syndrome an autoimmune condition?
Currently, the exact causes, triggers, and mechanisms underlying the condition are still unknown. Some studies show certain immunological abnormalities such as T cell and NK cell dysfunction as well as the presence of certain autoantibodies common in autoimmune diseases like lupus.
Nevertheless, up to this day, there simply isn’t sufficient evidence to label chronic fatigue syndrome as a full flagged autoimmune disease like rheumatoid arthritis, for example.
What triggers chronic fatigue syndrome?
The earliest descriptions of chronic fatigue syndrome explained the disease as a complication of Epstein Barr virus infection, the virus responsible for mononucleosis. After a chronic fatigue syndrome outbreak in London, British doctors gave it the name myalgic encephalomyelitis. However, this is an inaccurate name because there is no evidence that encephalomyelitis occurs in patients with the disease.
Although the viral theory has not been discarded, nowadays, most experts agree that there are many factors involved. Evidence suggests that some people are born with a genetic predisposition towards the disease. After exposure to certain triggers, genetically predisposed individuals will suffer from the disease.
Some potential triggers include:
- A weakened immune system: Chronic fatigue syndrome is associated with an immune system malfunction. Several studies have shown that patients with chronic fatigue syndrome have autoantibodies in autoimmune disorders like lupus, rheumatoid arthritis, scleroderma, and Hashimoto Thyroiditis. Furthermore, these patients exhibit impaired lymphocytes at a laboratory level. However, the importance of these immunologic findings remains unclear.
- Hormonal Imbalance: Myalgic encephalitis patients also have an abnormal blood level of certain hormones involved in many different body processes. Again, scientists remain uncertain of the meaning of these findings.
- Physical or psychological trauma: Many patients recall a traumatic event before the beginning of symptoms. These events can be physical such as major surgery or a car accident, or psychological, such as the death of a loved one, a divorce, or getting fired. Because of this, chronic fatigue syndrome is often mistaken for major depression.
- Viral infection: Many patients begin symptoms after having a viral infection or other infectious diseases. Several viruses are associated with the disease, particularly Epstein Barr virus and Herpesvirus. Some bacterial infections, as certain types of pneumonia, may be involved as well.
Who is at risk of chronic fatigue syndrome?
Everybody is at risk of suffering chronic fatigue syndrome; though, some persons have a higher risk than others. Women, for example, are four times more likely than men to develop chronic fatigue syndrome. Age plays an important role as well; people in their 40s and 50s have a higher risk of suffering the disease than any other age group.
What are the symptoms of chronic fatigue syndrome?
The formal definition of chronic fatigue syndrome is as follows: “A disorder characterized by unexplained extreme fatigue lasting for six months or longer“. The fatigue in this illness also worsens with exertion (post exertional malaise) and does not improve with rest. This severe fatigue interferes with daily activities and can lead to difficulties in work, school, and interpersonal relationships.
Other characteristic symptoms include
- Chronic insomnia
- Unrefreshing sleep
- Incapacity to concentrate
- Memory loss
- Orthostatic intolerance: Feeling dizzy or light-headed with positional changes
- Muscle pain or muscle aches
- Joint pain
- Tender lymph nodes, particularly in the neck and armpits
- Frequent sore throat episodes
In most cases, chronic fatigue syndrome symptoms often come in cycles. Patients go into long periods of severe tiredness and then start feeling better (remission), and after a few months or years, they start experiencing symptoms again (relapse).
How is chronic fatigue syndrome diagnosed?
Chronic fatigue syndrome diagnosis represents a formidable challenge for the physician. There isn’t any specific imaging test or blood test that can aid in CFS diagnosis. Also, the fact that CFS is so vague and unspecific further complicates the diagnosis.
Many CFS patients do not consider themselves to be ill and attribute their symptoms to exhaustion. Because many of these patients do not appear ill or have significant physical exam findings or routine laboratory testing, many doctors overlook the disease. It is no wonder that around 80% of patients do not have an adequate diagnosis.
In the end, chronic fatigue syndrome is a diagnosis of exclusion. This means that the only way to diagnose it is by ruling out other possible causes with similar symptoms.
The most critical element that helps distinguish chronic fatigue syndrome from other potential causes of fatigue is the presence of cognitive dysfunction, such as lack of concentration and short and long-term memory difficulties, and sleep problems.
Many different diseases can cause similar symptoms as CFS. Doctors can rule out most of them through laboratory testing, imaging studies accompanied by an excellent medical history and physical exam.
Some important differential diagnoses for chronic fatigue syndrome include the following:
- HIV infection and AIDS
- Thyroid gland disorders
- Lyme disease
- Restless leg syndrome
- Polymyalgia rheumatica
- Multiple sclerosis
- Celiac disease
- Obstructive sleep apnea
- Postural tachycardia syndrome
- Rehabilitation and Fibromyalgia
- Orthostatic hypotension
- Diabetes Mellitus
- Adrenal disease
- Sleep disorder
Although chronic fatigue syndrome is an organic disease, it can often be mistaken for a psychiatric condition, particularly major depressive disorder. Side effects of certain legal and illegal drugs can also be mistaken for chronic fatigue syndrome. Antihistamines and alcohol are classic examples.
How is chronic fatigue syndrome treated?
Currently, there isn’t any official or specific treatment for chronic fatigue syndrome. During the last decades, researchers have made several different clinical trials with many drugs without success. Antiviral drugs, antibiotics, glucocorticoids, vitamins, mineral supplements, chelating agents, liver extracts, and antidepressant drugs have all failed to produce remission.
Some studies recommend psychological therapy, specifically cognitive behavioral therapy, and effective treatment against CFS symptoms. However, several organizations, including the CDC, do not recommend cognitive behavioral therapy due to insufficient evidence of its success.
Activity management (pacing) helps many CFS patients manage post exercise malaise symptoms, thus improving their quality of life. It involves keeping a daily record of your routine and activities and getting to know your limitations in order to balance rest and activity in a way that prevents post exercise malaise symptoms.
How can I manage symptoms?
Although there isn’t a pharmacologic treatment currently leading to complete remission, some drugs can help manage some of the symptoms and complications of the disease. Some examples include:
- Pain killers: Pain killers can help with the headaches and muscle aches that come with CFS. In many cases, over the counter, drugs such as ibuprofen and naproxen are effective. Over-the-counter medications fail to produce any significant effect that patients may be getting from other sources, such as tricyclic antidepressants like amitriptyline or analgesics such as pregabalin and gabapentin.
- Drugs for orthostatic intolerance: Feeling light headed with sudden movements is a common symptom.
- Drugs like droxidopa activate your adrenergic syndrome, fighting off orthostatic hypotension.
- Corticosteroids like fludrocortisone promote water and salt retention, which can also help with orthostatic hypotension.
- Antidepressant drugs: Although chronic fatigue syndrome is a different disease from depression, many patients develop clinical depression due to the disease. In those cases, antidepressant treatment with drugs like fluoxetine combined with psychological therapy is a must.
How can I address sleep problems?
Managing insomnia is one of the most important factors in CFS. Sleep deprivation makes every other symptom more difficult to manage, increases the risk of depression, and can lead to a worse outcome. The sleep management plan includes elements from three main categories:
- Sleep habits: Your sleep environment is an important modifiable factor that can help with insomnia. Having a comfortable bed, going to sleep at regular hours, and having a quiet and dark environment can go a long way in helping with your insomnia. Also, avoid drinking caffeinated beverages and alcohol before going to bed. Although alcohol can make you sleepy, you won’t get a refreshing sleep after drinking.
- Medication: Selecting the right drug can be tricky because currently, there is no single medication that has proven to be effective in a majority of cases. Ideally, patients should start with over the counter medication such as diphenhydramine (Benadryl) and non-pharmacological sleep aids like passionflower and chamomile tea. Amino acids like L-theanine and L-tryptophan are the next step when all the previous alternatives have failed. Prescription medications are for cases in which all other approaches have failed. Some examples of prescription drugs include clonazepam, zolpidem, and lorazepam. Many of these drugs build up tolerance over time, becoming less effective, and some of them, like clonazepam, can induce addiction.
- Treating sleep disorders: If your sleep issues do not improve with better sleeping habits and medication, you might have a sleeping disorder like sleep apnea or restless leg syndrome. These sleep disorders are very frequent in patients with chronic fatigue syndrome. Treating them with a sleep specialist’s aid can drastically improve insomnia and the quality of your sleep.
Is exercise good for chronic fatigue syndrome?
Currently, this is a controversial subject; many experts are for it and others against it. However, the Centers for Disease Control and Prevention states that CFS should maintain a low impact physical activity routine to prevent complications. Despite this, many clinicians still maintain that exercise therapy in all its forms worsens CFS symptoms.
It also depends on the patient and his condition at the time. Chronic fatigue syndrome is a chronic illness in which symptoms continually worsen and improve over time. In patients who are very ill with severe symptoms, exercise is not an option, but patients with moderate to mild disease can benefit from small amounts of low impact exercise.
Most doctors recommend a little by little or gradual approach to exercise. In the beginning, patients should make very simple exercises; simple stretching exercises are sufficient in the early stages. The next step after stretching exercises is sub aerobic exercise. This means exercises that do not raise the heart rate in any significant way. Walking and swimming (slowly) are good sub aerobic exercises. Patients should perform sub aerobic exercises with a heart monitor to avoid going over the heart rate limit of a hundred beats per minute.
Remember that exercise in the context of chronic fatigue syndrome is not a competition, don’t try to force yourself into swimming more laps or walking more blocks each day. Listen to your body; if you force it beyond its limits, you might cause a relapse. You will have good days and bad days; your body will tell you when to exercise, when not to exercise and when is enough.
What it graded exercise therapy?
Graded exercise therapy is a daily exercise program, which basically increases the amount of exercise, just a little bit each day. Generally, it begins with active stretching and range of motion contractions and extension sessions that last for a few minutes each day. Graded exercise therapy requires that the patient follow a daily schedule until they can go back to a normal daily routine. This exercise regime must be accompanied by cognitive-behavioral psychotherapy.
Critics of graded exercise therapy point out that in a disease in which the hallmark symptom is post exertional malaise, a daily exercise program will not work out and lead the patient to relapse. Some researchers point out that it might even be dangerous to force patients into any kind of exercise regime because it can lead to cardiac problems.
A 2008 study, including thousands of patients, concluded that graded exercise therapy is one of the least successful treatments for chronic fatigue syndrome and potentially harmful. Many patients that have tried it out report having relapses and a general worsening of symptoms after beginning the program.
Is deconditioning a thing?
Many authors suggest that the lack of exercise during a CFS relapse will lead to ¨deconditioning¨, a process that will worsen symptoms and lead to a longer recovery time. However, there is little to no evidence to support this claim. Some studies even suggest the opposite. These studies show that patients can improve their physical condition without performing any form of exercise during relapses.
Can yoga help with chronic fatigue syndrome?
Doing a yoga session poses a significant challenge for a CFS patient. It can trigger post-exertional malaise for starters. Also, constant positional changes during a session can trigger orthostatic hypotension. The cognitive dysfunction that comes with CFS makes it hard for patients to follow instructions or remember a routine. However, a yoga regimen tailored explicitly for chronic fatigue syndrome can effectively bypass all these issues.
Isometric yoga is a variant of regular yoga with dew differences that make it perfect for chronic fatigue syndrome. It is done in a stationary position (which addresses the orthostatic hypotension issue) and mainly involves flexing the muscles while maintaining the same position. Participants can flex more or less, depending on their capacities. The program includes six stationary poses done while sitting on a chair.
So far, there are very few studies on the effects of isometric yoga on the overall health of chronic fatigue syndrome patients. Yet, the few studies that exist do report improvement in life quality after a few months of yoga therapy. In the end, it is really up to you as a patient to decide whether or not to give it a try. The fact that it has worked on a few people does not mean that it will work for everyone, but it is worth the try.
Is there a special diet for chronic fatigue syndrome?
Food isn’t the cause or the cure for chronic fatigue syndrome; nevertheless, having a bad diet can compromise your overall health and worsen the CFS symptoms.
Many CFS syndrome patients gain a lot of weight during relapses because of the inactivity that comes with it. Some patients even report having more hunger than usual. Keeping a daily calorie count and avoiding processed sugars and fatty foods are particularly important for these patients.
Some lose their appetite during relapses and begin dangerously losing weight. These patients should keep having soft meals readily in hand; these meals should be easy to prepare to avoid exhaustion.
Although many websites and nutritionists claim that nutritional supplements improve CFS symptoms, there is no real evidence to support this claim. Furthermore, high doses of certain vitamins like vitamin A and B can be harmful. Except in exceptional circumstances such as pregnancy, the minerals and vitamins in your diet are more than enough to meet your nutritional necessities.
There is also not enough evidence to support the claim that certain diets such as a gluten-free diet, a paleo diet, an anti-candida diet, blood type diet does anything to improve symptoms.
What to do when a loved one has chronic fatigue syndrome?
When a loved one or family member has chronic fatigue syndrome, it can be hard for everyone in the family. The limitations that come with the disease are bound to cause a problem with the patient’s interpersonal relationships.
Some ways to support your family member with chronic fatigue syndrome include:
- Learning about the condition: Learning about the disease will help you understand what your loved one feels and let you know what to expect.
- Be flexible: Patients have bad days and good ones, and it is impossible to know which day will be bad. Be prepared for a bad day and be flexible with plans and appointments.
- Look your easy activities to do together: Do activities that accommodate the needs of your loved one, like watching movies, reading aloud, playing word games, and listening to music
- Take care of yourself: Taking care of a sick family member can be incredibly strenuous; always make sure to take some time to look after yourself.
Does chronic fatigue syndrome go away?
Unfortunately, only five percent of chronic fatigue syndrome patients experience a complete recovery. In the other 95 percent, symptoms go on and off for years. About fifty percent of patients are unable to maintain stable jobs after the beginning of symptoms.
Patients can suffer from depression, social anxiety, and isolation. Although chronic fatigue syndrome can damage a person’s life, it is not associated with higher mortality levels. In other words, they do not have more probability of dying in comparison to any other person.
Do you have symptoms of this condition?
This is a Chronic Fatigue Syndrome Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this ailment. Therefore, the tool will tell anybody who uses it their likelihood of having Chronic Fatigue Syndrome based on their symptoms and risk factors. Using this tool is free and would only take a few minutes.