Have you been avoiding even moderately demanding physical activity because you feel exhausted for no apparent reason? Are you having pains–muscular or joint or both–and feeling severely sleep deprived? If it’s a straight “yes” to all these questions, it’s about time you consulted a doctor. You could be suffering from myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).
What Is Chronic Fatigue Syndrome Or ME/CFS?
Once derided as “yuppie disease” or “yuppie flu”, chronic fatigue syndrome has finally been accepted by the medical fraternity as a real illness after 30 years of debates and studies. CFS is a debilitating condition which is neurological in nature. Affecting 0.2-0.7 percent population in the Western countries1, it is found to occur four times more likely in women than men.2
What Causes It?
ME/CFS was a tough nut to crack for a long time with no apparent cause found making the prognosis very difficult. Moreover, it had innumerable symptoms that were good enough to confuse the doctors. Many CFS patients were told they were suffering from diseases that seemed like CFS, like fibromyalgia, and had started on treatment only to realize much later that they were misdiagnosed. Later research have come out with many possible causes like:
Hypotension
A series of studies conducted by John Hopkins University has found neurally mediated hypotension, where the communication between the brain and heart is abnormal, to be a cause of chronic fatigue syndrome. While activities like sitting or standing require the brain to send the message to the heart to pump more blood, in this kind of hypotension, blood pools into the feet and the blood pressure falls making the patient feel dizzy, sometimes faint even.3
Hormonal Imbalances
Another possible cause is found to be the abnormality of the hypothalamus-pituitary-adrenal or HPA axis. Studies have found some patients of CFS to have higher levels of the neurotransmitter serotonin, lower levels of dopamine (a neurotransmitter associated with reward) or imbalances between the neurotransmitters norepinephrine and dopamine. Some CFS patients have very low levels of cortisol, the stress hormone, which could explain why CFS patients respond poorly to stress. Another explanation is the disturbance of the circadian clock, a group of nerve cells that determine the sleep-wake cycle.4
A Weakened Immune System
Immunity too seems to play an important part in CFS. A host of immune system related issues like impaired lymphocyte responses to mitogen has been found in CFS patients.5
Hereditary
Could CFS be hereditary? Apparently, yes! Lead scientists at the University of South Florida’s Morsani College of Medicine published an article in the Journal of Medical Virology suggesting that a common virus, Human Herpesvirus 6 (HHV-6), is the possible cause of some CFS cases. This HHV-6 genome can be inherited from parent to child, a condition called CIHHV-6 or “chromosomally integrated HHV-6”. Moreover, around 0.8 percent of the U.S. and U.K. population is CIHHV6 positive, thus carrying a copy of HHV-6 in each cell.6
Infections
Many bacterial and viral infections can be co-conspirators in CFS cases. CFS could be the result of a chronic infection or these infections can occur alongside CFS. The most common virus associated with the syndrome is HHV-6 virus. Mycoplasmal infections and infections of Chlamydia pneumoniae are not rare either.7
The latest research has found Parainfluenza Virus-5 that causes multiple sclerosis and epilepsy as a cause of chronic fatigue immune dysfunction syndrome (CFIDS).8
Is it contagious? It may come as a surprise to you but CFS can actually be contagious. No, you won’t contract the disease by merely being in the company of the infected but a blood transfusion from the sufferer is a sure shot way to get it.9
What Are The Symptoms?
There are many symptoms of the disease most of which could be confused with many other diseases of similar nature. The primary symptom is extreme fatigue after any activity often referred to as “payback” or “crash” and is very similar to the flu. This response could be immediate or delayed, sometimes even after 24 hours. It could sustain, depending on the difficulty of the activity, for weeks and even months.10
Other symptoms include non-restorative sleep, cognitive impairment, mood swings and irritability, inflammation of the lymph nodes, aches and pains like joint pain, sore throat, and severe headache. It could even lead to complete organ system shutdown.11
All Symptoms Do Not Point To CFS
Having said that, chronic, unexplained fatigue could be the result of any undiagnosed or untreated medical condition like hypothyroidism, sleep apnea, and narcolepsy, or can happen even as a side effect of medications.
Any previous medical condition like hepatitis B or C which has not been treated properly could result in unexplained fatigue. Any major depressive disorder with psychotic or melancholic features like bipolar disorder or schizophrenia or any neurodegenerative disorders like dementia and even delusional diseases like anorexia nervosa or bulimia nervosa could result in chronic fatigue. Even alcohol abuse or severe obesity could show signs of chronic fatigue.12
You need to rule out these possibilities or inform your medical practitioner about your personal and medical history for an accurate diagnosis.
How Can It Be Treated?
A variety of treatments has been suggested to cure chronic fatigue syndrome. Studies, however, have found that while full recovery is not very common and is limited to only about 4 percent cases, marked improvement in a span of four years has been observed in 39 percent of the population.13
But before any treatment modality is reached, it is important to have a proper diagnosis. The diagnosis calls for a proper evaluation complete with history, physical examination and laboratory testing of urine, blood, thyroid function, etc. If CFS is diagnosed, it is important that the patient be tested and treated for comorbidities like sleeplessness, depression, pain, etc.14 Patients are also advised to undergo activity management, sleep management, and relaxation techniques.15
Therapy And Exercise
In a study done to determine the best treatment option for CFS, 2801 participants were studied in 44 trials. Studies were grouped into 6 categories including behavioral category, immunological category, etc. The study results showed cognitive behavioral therapy and graded exercise therapy to be very effective.16 Interestingly, a follow-up study on the participants reiterated the findings.17
Drugs
There are no specific drugs for the condition but medication is often used to relieve certain symptoms. Painkillers can be taken for aches and pains, antidepressants for depression, etc.18
Complementary And Alternative Therapies
Since CFS has many symptoms that can completely bog down the sufferer, certain natural therapies done in addition to mainstream treatment can be helpful.
Diet And Supplements
Eating healthy by avoiding refined foods, sugar, stimulants like caffeine and alcohol and switching to wholesome foods like whole grains, vegetables, and fruits, essential fatty acids are recommended. Studies have shown the effectiveness of having regular supplements to manage the condition.19 Some supplements recommended include magnesium, omega-3 fatty acids, NADH, DHEA, vitamin B12 and D, beta-carotene, melatonin, and L-carnitine. Certain traditional herbs like ginseng and echinacea for better immunity are advised, too.
Homeopathy, Acupuncture, Chiropractic
Homeopathy is found to be moderately effective in alleviating the symptoms of chronic fatigue syndrome.20 Some medicines suggested include Arsenicum for restlessness and fatigue accompanied by chills and burning pains that are worse at night, Gelsemium for mental exhaustion, Pulsatilla for moodiness and Sulphur against fatigue.21
In studies conducted in China, acupuncture with moxibustion is found to be very effective in CFS treatment. All studies showed response rates ranging from 78.95 percent to 100 percent.22
Certain therapeutic massages and chiropractic manipulation of the spine may be useful in treating the disease though there aren’t any substantial evidence to prove it.
Chronic Fatigue Syndrome is a debilitating condition but it is not so bad that you feel it is the end of everything. Though 100 percent cure may not be possible, the symptoms can be successfully managed and the patient can resume normal life within a few years of regular treatment.
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