Were we to make a “Top three most important elements for a healthy living” list, rest would be on it, together with a nutritious diet and plenty of physical exercise. While most people acknowledge its role, they often tend to overlook it. The reasons are numerous and depend on one’s age and daily habits, but seem to cause similar damage in any situation.

Fatigue is mainly caused by lack of proper sleep. Data made public in 2004 showed that about forty million Americans suffered from no less than seventy sleeping disorders. Twenty percent of them complained about general tiredness, while forty per cent registered low energy levels during the day which in turn caused stress and low productivity. You might wonder what could be worse than feeling tired all day long. Chronic fatigue is the answer you are looking for. With more than one million Americans suffering from it, and other several million all over the world receiving a positive diagnosis, the Chronic Fatigue Syndrome is easily one of the most serious medical conditions that affect today’s society.

What is Chronic Fatigue Syndrome?

cmf_girl_cartoon_300x414Chronic Fatigue Syndrome(CFS) is a disorder characterized by long-term fatigue that has neither an underlying condition nor an exact cause of the occurrence. It first came to public attention in the 1980s when groups of people have started reporting unusual symptoms which were placed under the umbrella-term of “Neurasthenia” soon afterward. The disorder was named Chronic Fatigue Syndrome only after the mid-1990s when specialists have realized they deal with an actual disease and not people’s imagination. If beneficial in other cases, bed rest might prove to be rather inefficient in patients suffering from CFS.

The condition affects people of all ages, but children, teenagers and young adults recover the fastest if helped in time. CFS is also known as Myalgic Encephalomyelitis(ME) and Systemic Exertion Intolerance Disease (SEID). The two notions are more common among specialists, with the latter being introduced to the general public through a report by the United States Institute of Medicine in 2015. Still, people with CFS have started using them as well to highlight the condition’s severity and the fact that it is not a symptom but a disease in itself. Doctors can hardly diagnose it. The disorder has an array of symptoms which are similar to those of other illnesses that have little to no connection with it. Aside from the overwhelming tiredness, they include muscle pain, sore throat or severe headaches. Currently, about twenty-five percent of the diagnosed people can perform daily tasks without being very affected; another twenty-five percent show little signs of improvement after receiving medical treatment, while half of the patients have confessed to suffering from a moderate form that impedes them from going to work. CFS is a treatable medical condition, although not entirely. Patients might show signs of relapse even after taking prescribed medication.

Causes

Current studies show no exact cause that triggers the occurrence of Chronic Fatigue Syndrome. However, there are some theories according to which CFS might be influenced either by infections, low immunity or biochemical abnormalities. We have explained some of them below.

  1. Viral or Other Infections

Few studies show that the onset of CFS is associated with infections. Still, most cases follow this pattern where a patient develops the disorder soon after having a viral infection. While there is little clinic evidence in regards to this theory, people who suffer from CFS do register increased levels of pro-inflammatory cytokines which might cause cell abnormality. Specialists have studied numerous types of infections in order to relate them to CFS occurrence. Even so, the majority of results are either unclear or unreliable so it would not be safe to assume infections are the disorder’s underlying cause. Rather, they weaken the immune system of an otherwise healthy individual by decreasing the number of natural killer cells. Thus, infections are no more than an element that worsens the condition. Under no circumstances should they be regarded as more influential, given the conclusions of present-day studies. We have listed other infections that might be linked to CFS below. Some of them are backed by cases reported by patients who became infected and noticed signs of CFS soon afterward.

  • Epstein-Barr virus infection
  • Enterovirus infection
  • German measles
  • Human herpes virus six infection
  • Coxiella burnetii virus
  1. Hormonal Imbalance

Women are more prone to suffering from CFS than men. In most cases, the patient is a female around thirty or forty years of age who registers abnormal hormonal levels either due to stress or menopause. Studies suggest that a decreased production of cortisol together with imbalances at the degree of hypothalamus and pituitary gland are associated with higher risks of CFS. Cortisol is the hormone responsible for stimulating glucose synthesis. A reduced cortisol quantity is linked to stress, inflammation and a weaker musculoskeletal system.  Usually, women who suffer from CFS have lower cortisol levels and show signs of depression which is related to numerous disorders, CFS included. Interestingly, Mark Demitrack, a United States researcher conducting studies on patients with CFS, has developed a theory according to which the adrenal glands(the ones that produce cortisol) are not responsible for the disorder and might have little connection to it. After numerous tests, Demitrack has reached the conclusion that the fault lays in the way a patient’s nervous system controls them. Their mechanism of action in healthy individuals is the following:

  • The hypothalamus produces corticotropin- releasing factor (CRF), an amino-acid peptide associated with stress response
  • CRF then stimulates the pituitary gland to synthesize adrenocorticotropin hormone which in turn influences the production of cortisol by the adrenal glands

However, people with CFS show a hormonal deficit in each of the three glands, and the responsible appears to be a poorly-functioning hypothalamus. Furthermore, Mark Demitrack has discovered anomalies in the interaction between hormone-producing glands and the immune system which might lead to fatigue and higher sensitivity to various medical disorders.[1]

  1. Weakened Immune System

Experts regard Chronic Fatigue Syndrome as a combination of viral, endocrine and immune dysfunctions. There is evidence, albeit little, that associates a weakened immune system to more chances of developing CFS symptoms. However, the low immune function is not directly linked to the disorder’s occurrence. In healthy individuals, when an infection occurs, the body releases antibodies to fight against harmful cells. However, CFS patients register an increase in chemokine levels that stimulate the production of pro-inflammatory cells which in turn might cause CFS. There is insufficient information in regards to whether this factor actually triggers CFS or merely sustains its development.

Other currently discussed hypotheses include nutritional deficiency, low blood pressure, depression, traumas, genetics or brain abnormalities.[2]

Who is affected by CFS?

Statistics show that no less than one million Americans, 250.000 people in the United Kingdom and millions of other people suffer from CFS at the present moment. Furthermore, an increasing number of individuals show distinct symptoms, but have yet to be positively diagnosed. Chronic Fatigue Syndrome can affect anyone, regardless of age, sex and ethnicity. Even so, there are some groups that are more susceptible to develop it than others:

  • People living in the United States(there is limited data in regards to this group)
  • Women around the age of thirty or forty
  • People between the ages of forty and sixty
  • Individuals with a family history of CFS
  • Individuals who suffer from depression or went through traumatic experiences

CFS Symptoms

cfs_chronic_fatique_syndrome_low_energy_223x300Similarly to other medical conditions, CFS has a well-established set of symptoms. Some of them are specific for CFS while others are met in patients who suffer from different disorders. According to the United States Centers for Disease Control and Prevention, one should present the following symptoms in order to receive a CFS diagnosis:

  • Fatigue that persists for more than six consecutive months, cannot be helped by bed rest and has no connection to other disorders
  • An impossibility to perform daily tasks, be they minor, due to general tiredness and low energy levels
  • Depression, stress, and irritability
  • Decreased concentration and poor short-term memory
  • Insomnia
  • Mental and physical exhaustion due to unrefreshing sleep
  • Severe headaches
  • Muscular and joint pain
  • Sore throat
  • Tender lymph nodes
  • Increased heart rate and breathing issues
  • Sensitivity to light, noise or high and low temperature
  • Nausea, bloating, diarrhea or constipation
  • Gynecological problems
  • Night sweats
  • Weight loss or gain

Numerous illnesses that have no connection to CFS mimic its manifestation. Likewise, certain medications might cause side effects similar to the disorder’s symptoms. Always make sure to consult with a doctor to rule out the possibility of diseases such as chronic hepatitis, diabetes, lupus or Lyme disease.

Also, there are some medical conditions possibly triggered by the disorder that a CFS patient might suffer from. They include:

  • chronic pelvic pain
  • chronic headaches
  • cognitive problems
  • eating disorders
  • fibromyalgia
  • irritable bowel syndrome
  • interstitial cystitis
  • multiple chemical sensitivity
  • temporomandibular disorder

[3]

Complications

In the majority of situations, patients initially, report flu-like symptoms. Specialists assume that this element combined with a family history of CFS and possible traumatic events lead to Chronic Fatigue Syndrome’s development. What started as a mild physical condition is bound to become a disease that affects millions of people from across the globe. As cases differ in accordance to the individual’s health status, so does the disorder’s manifestation as follows:

  • mild: the patient can move, take care of himself and can go to school or work if he reduces other activities as to avoid exhaustion
  • moderate: the patient will is likely to spend most of his time inside the house and reduce activity to a minimum
  • severe: the individual is bedbound and cannot perform any action without someone else’s help

People suffering from Chronic Fatigue Syndrome require mental support from those around them. Sadly, there is a widespread misconception among people with little information on the subject according to which CFS patients are lazy and use the disorder to avoid physical work. As in the case of people suffering from anxiety and depression, those with CFS might be inclined to force themselves perform tasks as to avoid critics. This usually leads to symptom aggravation and relapse.

Diagnosis

Because there is no scientifically confirmed cause for CFS, there is no test for it either. When doctors perform tests on possible patients, they do so only as a means to eliminate other medical conditions that might be similar in symptomatology. Eating disorders, side effects due to medication abuse or depression are among the first diseases the specialist must exclude to reach a CFS diagnosis. The general physician will first require the patient a detailed history of past diseases to make sure they did not recidivate. Blood and urine tests, as well as imaging scans, will be performed to rule out other conditions such as irritable bowel syndrome, fibromyalgia or anemia. Also, the GP will carefully inspect symptoms which first appeared six months before the patient’s consultation. Three criteria must be met for the GP to offer a CFS diagnosis:

  1. persistent fatigue which first appeared six months before the patient’s consultation
  2. physical exhaustion that interferes with daily activity
  3. the patient presents four of the following seven symptoms: general discomfort, poor quality sleep, decreased focus, muscle and joint pain, severe headaches, sore throat and tender lymph nodes.

People who do not experience all the symptoms listed above will receive a negative CFS diagnosis. The doctor might offer the patient of a positive diagnosis for Idiopathic Chronic Fatigue, which has unknown causes. CFS does not have an exact cause either. Even so, due to some studies that indicate towards genetics, infection, and immune system dysfunctions as possible reasons which lead to it, Chronic Fatigue Syndrome is regarded as a disease caused by documented factors.[4]

Treatment

cfs_treatment_vitamin_b3_300x200There is no prescribed medication that could be used as a cure for CFS. Experts are currently conducting studies on numerous drugs with possible benefits in alleviating CFS symptoms. It is good to know that much of the medication patients use to obtain relief has not been approved by the United States Food and Drug Administration and therefore is unsafe and probably inefficient as well. Herbal and dietary supplements such as Vitamin B(3,12), Vitamin C, ginseng, Ginkgo Biloba or St. John’s wort are among the products most frequently used. Most of them have serious side effects which might cause damage in the long term. However, people prefer taking risks rather than feeling the pain which is understandable to a point but not recommendable.

The GP will want to help the patient improve at least his state of mind, as many people with CFS are depressive or do not sleep enough. The doctor usually prescribes antidepressants and sleeping pills as a temporary solution which might improve sleep and relieve pain.

Other recommended strategies that might actually help are:

  1. Cognitive behavioral therapy(CBT): in 2014, the National Institute of Health made public a report which indicated towards potential benefits of cognitive behavioral therapy in patients suffering from CFS. The report’s results were rather negative, with little efficacy rate in quality of life improvement. Still, this might have been because of an insufficient number of participants to the study, as some of those who took part did register symptom alleviation. However, numerous reviews showed that while CBT produced certain benefits, the patients were prone to relapse soon after the therapy had ended. Furthermore, there are researchers who state CBT might be efficient as long as it is combined with counseling, treatment, and other therapies. By itself, it could do more harm than good, given that the patient might accommodate with the symptoms rather than alleviate them.
  1. Exercise therapy and pacing: as in the case of cognitive-behavioral therapy, exercise therapy and pacing are two strategies used in patients with CFS that are not backed by sufficient evidence for people to regard them as truly efficient. Even so, the patient might register a betterment in time if he tries to gradually increase physical activity without forcing himself to do so. A physical therapist’s help is more than welcomed in these situations as the patient is unlikely to know what kind of exercise best fits his personal needs. Stretching for a few minutes daily is usually the first step to recovery, especially for people who have reduced activity to a minimum. The therapist will increase activity every few weeks until the patient can perform simple workouts for thirty minutes in a row. It is important to establish limits ever since the first session to decrease the risk of physical and mental exhaustion. People who find it difficult to stick to the daily routine might want to take a break more often and rest as to avoid relapse. Alternative therapies such as yoga, tai chi, acupuncture or massage can work wonder when combined with physical exercise. Meditation, hypnosis, and light therapy might be efficient in patients who show signs of depression.

While CFS is not a disorder from which people fully recuperate, most of its symptoms can be alleviated through therapy and counseling. It is true that neither CBT nor exercise therapy is backed by enough evidence for CFS patients to rely on them. Nevertheless, if a single person in one thousand might register improvement in the general condition after using them, then maybe they are not as inefficient as studies suggest.

Relapse Prevention

The one thing any patient suffering from a chronic disorder might tell you at any moment is that living with one is difficult and sometimes unbearable. Even in an era with plenty of scientific discoveries, researchers have yet to find out the treatment for many diseases that affect millions of people and cause thousands of deaths daily. Chronic Fatigue Syndrome is not the disorder to be fully cured anytime soon. Nevertheless, if you are a CFS patient, you can take care of yourself and even experience signs of recovery by following some simple pieces of advice:

  • Eat small, nutritious meals throughout the day to avoid irritable bowel syndrome-like symptoms from occurring
  • Make a sleeping program: fix an hour in the morning to wake up, as well as one to go to sleep
  • Reduce stress: Avoid people or situations that might negatively influence you, and try meditation as it has been scientifically proven to enhance mental function lead to a more positive mindset
  • Try to move and perform simple exercises that do not require much effort but can improve daily function
  • Try acupuncture and massage to relax both physically and mentally(mood swings are common among CFS patients, and can positively or negatively affect the symptoms)
  • Search for a good counselor to provide you with mental assistance or try looking for support groups in your area if that suits your needs

Conclusion

Specialists urge people with Chronic Fatigue Syndrome to try various therapies and strategies as to encourage condition improvement. Tiredness in uncomfortable but when it impedes daily activity, it becomes less of a physical state and more of a disease. Like many other chronic disorders, CFS has no exact underlying cause, does not benefit from a specific test to diagnose it nor does it have a well-established treatment that can help the patient regain general health. CFS does not equal laziness, and people who suffer from it are under no circumstances seeking for attention. The quality of life in CFS patients can easily be compromised. Moreover, many of them present signs of depression that only add to the mental pressure. If you know people that fall into this category, you might want to direct them towards a therapist or psychologist because many patients keep distance as to avoid social stigma.[5]

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