As a rheumatology practice we see several cases of chronic fatigue syndrome (CFS) and we know how debilitating it can be. Our belief to recover from CFS results from identifying the underlying cause such as a virus, illness, food induced problems, and mold and mycotoxins. By treating these underlying factors, CFS symptoms will dramatically improve.
We were encouraged that a 2018 study in a mainstream medical publication acknowledged that chronic fatigue syndrome is a result of various chronic infectious processes and that beating chronic fatigue can be achieved by bringing the correspondent infections under control.
What does CFS stand for?
Chronic fatigue syndrome (CFS) or Myalgic encephalomyelitis (ME) is a disease that causes persistent fatigue leading to the deterioration of a productive and active lifestyle causing loss of quality of life, mental peace, and happiness.
While fatigue, even persistent fatigue, can be a common symptom of many medical conditions, CFS is remarkably different from these conditions in a few key aspects.
- Severe, persistent fatigue for at least 6 months with no relief after sufficient rest
- Sudden onset that is not precipitated by any incidence
- The absence of any other fatigue producing medical condition
Each of these aspects is further explained below.
Severe, persistent fatigue for at least 6 months with no relief after sufficient rest
The fatigue associated with CFS is always of new onset meaning that it was not present to any significant degree in the past. The duration of the fatigue is prolonged and to qualify as CFS it must last more than 6 months. The fatigue is usually unexplained and cannot be attributed to any known or immediate cause.
It is not directly related to physical exertion such as exercising or gardening, but physical exertion always exacerbates it. Nor is it significantly relieved by rest unlike the usual fatigue that follows exertion.
The level of fatigue experienced is so severe that it causes significant reduction of previous activity levels, loss of employment and loss of social activities. Often times someone afflicted with CFS is incapacitated and misses out of many life experiences.
Sudden onset that is not precipitated by any incidence
One of the hallmarks of CFS is that it usually comes on suddenly with no unusual incident happening prior to onset.
- In many cases onset is preceded or accompanied by “flu-like” symptoms
- Onset of the disease can follow a prolonged period of stress either physical, mental, or both
The absence of any other fatigue producing medical condition
If the conditions listed below are present, they can also be factors relating to fatigue, and therefore, CFS is likely not an accurate diagnosis. This doesn’t mean that fatigue isn’t present, but these conditions need to be identified and treated appropriately.
These conditions are as follows:
- Chronic obstructive pulmonary disease
- End-stage renal disease (CRF)
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Multiple sclerosis
- Chronic renal failure
- Type II diabetes mellitus
- Anorexia nervosa
- Bipolar disorders
- Major depression
- Alcohol abuse
- Morbid obesity
- Substance abuse
Risk factors of Chronic Fatigue Syndrome
Though females outnumber males by 3:2 in CFS, incidence in males may be underreported. In our practice the ratio of women to men is 5:1. It is our belief that more men likely have CFS, but they do not seek help; women are much more verbal and seek help earlier of onset.
The most common age group when CFS manifests is from 50 to 69 years and it is much less prevalent amongst children and adolescents compared to adults. Blood relatives of CFS patients have been found to be more prone to develop it.
There is no lab test to verify CFS.
To make a clinical diagnosis of CFS, various diagnostic criteria have been put forward. Out of these, the most commonly used diagnostic criteria are the United States CDC criteria.
The recommendation of the CDC is that to qualify as CFS the following three criteria has to be fulfilled:
- A new onset (not lifelong) of severe fatigue for 6 consecutive months or greater duration which is unrelated to exertion, is not substantially relieved by rest, and is not a result of other medical conditions
- The fatigue causes a significant reduction of previous activity levels
- The third criteria consists of a list of eight symptoms out of which four or more symptoms have to be present for more than 6 months or more
- Impaired memory or concentration
- Postexertional malaise, where physical or mental exertions bring on “extreme, prolonged exhaustion and sickness”
- Unrefreshing sleep
- Muscle pain (myalgia)
- Pain in multiple joints (arthralgia)
- Headaches of a new kind or greater severity
- Sore throat, frequent or recurring
- Tender lymph nodes (cervical or axillary)
Decrease of cognitive functions:
- There is marked impairment and decrease of cognitive functions in a significant number of cases of CFS
- Decreased attention, memory and reaction time are impaired and the level of impairment may affect day-to-day activities
- Both simple and complex information processing faculty and its speed may be significantly affected over long periods of time
- On the other hand, patient’s perceptual abilities, motor component of speech, language, reasoning and intelligence are not significantly altered
- Extreme forgetfulness, inability to recall details quickly
How to beat CFS
While beating chronic fatigue is quite difficult to achieve; there are a number of things people can do on their own to help manage their symptoms. People can also seek professional help to deal with psychological and physical issues.
The following are various steps people can take toward beating chronic fatigue:
- Psychological assistance to help patients understand their symptoms and the disease and to discuss strategies to improve day-to-day functioning
- Physical therapy
- Healthy diet
- Sleep management techniques
- Medications to reduce pain, discomfort, fever
- Medications to treat anxiety and depression
- Maintaining active social life through various mediums of contacts
- Relaxation and stress-reduction techniques such as: Biofeedback, Deep breathing techniques, Hypnosis, Massage therapy, Meditation, Muscle relaxation techniques, Yoga
- Avoiding doing too much on days when you feel tired
- Balancing your time between activity, rest, and sleep
- Breaking big tasks into smaller, more manageable ones
- Spreading out more challenging tasks throughout the week
While these are the standard techniques that have been around for years on how to beat CFS, it is our belief, through years of diagnosing and treating hundreds of people with CFS, the single most impactful solution to beating chronic fatigue is to define the driving force behind the illness and correct it.
At our clinic, we have identified four different categories of driving forces behind CFS.
These groups are identified as:
Various chronic microbal infections such as: Borrelia burgdorferi, bartonellosis, yersiniosis, mycoplasmosis
Viral illnesses such as: Epstein Barr Virus
Heavy metals overload
Food induced problems: Celiac disease, reactions to immunogenic foods like gluten, dairy, soy, and corn, leaky gut syndrome, candida overgrowth.
Molds and mycotoxins
In our experience, usually within 3-4 months of treating the underlying cause, patients will begin to notice a big improvement in their symptoms with many feeling 70-80% better over the entire course of treatment.
While it is important to understand the traditional therapies of CFS, as they can be a helpful part of a treatment protocol; real, lasting healing can only be experienced when the driving illness is identified and addressed. Those who have been suffering with CFS without any improvement will be greatly served by getting tested for chronic microbial infections, heavy metals, gastrointestinal conditions, and mold/mycotoxins.