Chronic Fatigue Syndrome (CFS)

What Is CFS?

Chronic Fatigue Syndrome a neurologic problem - possibly of immune dysfunction origin- is also called Myalgic Encephalomyelitis (ME). The first documentation about this was in the late 1800s, but it hasn't been officially recognized until the last few decades. It has often been misdiagnosed as a psychological disorder consisting of extreme fatigue (lasting at least six months) because diagnostic testing, labs, and physical exams are elusive. One thing is certain: Ongoing and persistent fatigue, which often interferes with normal daily functioning, is always the common denominator.

While CFS is a lifelong problem that can affect a person of any sex, race, or age, however, it more commonly occurs in the adolescent to 30-year age range. According to the CDC, in 2024, there were an estimated 3.3 million reported cases of this in the US.

Yawning from fatigue

Chronic Fatigue Syndrome: Symptoms

Cognitive and Neurological

• Difficulty falling asleep or staying asleep

• Intense or vivid dreams

• Restless legs syndrome

• Non-restorative sleep despite a full night’s rest

• Memory issues

• Trouble finding words

• Poor concentration

• Headaches

• Postural problems (e.g., lightheadedness or dizziness when standing)

  
  

Physical Symptoms

• Muscle or joint pain

• Small, tender lymph nodes (especially in the armpits or neck)

• Temperature regulation issues (feeling too hot or too cold)

• Recurrent sore throats

• Fatigue after exertion or exercise

• Appetite changes or nausea

• Shortness of breath

• Palpitations

• Irritable bowel-type symptoms

• Chronic constipation

• Diarrhea

CFS is often accompanied by anxiety or depression, or both and can be confused with depression. Symptoms may actually worsen with emotional, mental and physical stress. 

Diagnostic Criteria

The CDC outlines the following criteria for chronic fatigue syndrome.

Core Symptoms (All required)

• Fatigue lasting 6+ months with a significant drop in activity

• Post-exertional malaise (worsening symptoms after mental or physical effort)

• Unrefreshing sleep, even with adequate rest

  
  

Additional Symptoms (At least one required)

• Cognitive difficulties (e.g., memory issues, trouble concentrating, word-finding problems)

• Orthostatic intolerance (e.g., dizziness, lightheadedness, rapid heartbeat when upright)

  
  

Diagnostic Notes

• Symptoms must be moderate to severe and occur at least 50% of the time

• Other medical conditions must be ruled out

Chronic Fatigue Syndrome: Causes

What causes chronic fatigue syndrome? There are various theories about this. In some cases, it may be inherited genetics. It may be attributable to physical or emotional trauma. There may be a problem with metabolism. Or, it may be a result of an earlier infection - post-infectious etiology (especially viral). The latter seems a good possibility given the aftermath of certain viruses (i.e., post-COVID neurologic alterations), but biological markers have been elusive. The "good" news is that researchers have finally discovered, through MRIs, changes in brain structure in those with chronic fatigue syndrome. They have also noted changes in the cerebrospinal fluid  Hopefully, this will lead to a breakthrough in the diagnosis of CFS, but more studies are still needed.

Chronic Fatigue Syndrome: Treatment and Approaches

Unfortunately, at this point in time, there is no cure for chronic fatigue syndrome. The treatment is supportive: aimed at controlling the problems that contribute to chronic fatigue as well as the signs and symptoms like insomnia, concentration problems, fatigue, pain, bowel problems, lightheadedness, and others.

Fatigue: Pacing (finding and sticking to your limits), low-dose aripiprazole (increases dopamine, which increases pleasure, motivation, and attention), anti-inflammatory diets, stimulants (may increase tachycardia of postural problems and also cause energy that leads to an eventual crash or significant drop in energy/increase in fatigue).

Many of the symptoms discussed above have dedicated pages on this site. If you would like to know more about treatments and remedies for some of these things, please see the links below. 

• ​Sleep: See Sleep Disorders

• Pain: See Body Aches and Pain

• Constipation, Diarrhea, Nausea: See Stomach Problems

• Postural Hypotension or Tachycardia:​ Increase fluids, support stockings, and sometimes medication​

• Mental Health

-Depression: Treatment and Approaches to Depression

-Anxiety: See Treatment and Approaches to Anxiety

• Exercise Intolerance: Extra rest before activities, pacing (finding and sticking to your individual limits)

Natural Remedies: An article in Mayo Clinic Proceedings also mentions possible remedies and over-the-counter approaches

• CoQ10 (may help with fatigue and pain)

• Nicotinamide adenine dinucleotide (reduced form) - NAD+ - This is a natural substance synthesized by our body (now available as a supplement). It essentially helps convert your food to energy.

• Omega-3 fatty acids, such as EPA or DHA, for minor cognitive impairment and neurologic disease

• Quercetin immunologic or anti-inflammatory properties

• Curcumin may also be helpful for inflammatory processes and pain.

• Valerian

Vitamin and mineral deficiencies should also be addressed.

There are also fibromyalgia specialists, specialty clinics, and some pain clinics that focus holistically on all aspects of chronic fatigue syndrome.

If you suspect you have chronic fatigue, it's essential to consult your primary care provider. They can evaluate your symptoms and order any necessary tests to rule out other potential causes. Your healthcare provider can treat and refer you accordingly.