Chronic fatigue syndrome (CFS) is a complex condition characterized by extreme fatigue that lasts for more than 6 months, doesn’t improve with bed rest, and is not due to an underlying medical condition. The Mayo Clinic states that a diagnosis of CFS can be made if the patient has the above symptoms, and at least four of the following symptoms:
- Unrefreshing sleep
- Post-exercise malaise that lasts more than 24 hours
- Impaired memory or concentration
- Muscle pain
- Jointpain without swelling or redness
- Tender lymph nodes in neck or armpit areas
- Frequent or recurringsore throat
- Headache of a new type, pattern or severity
Conditions that could cause fatigue must be ruled out before a CFS diagnosis can be made. These include anemia, thyroid problems, and cancer. Mental health issues could also causefatigue.
Causes and risk factors
The cause of CFS has not been identified, and it’s possible that CFS could be due to many different factors.
Infections, inflammation, and immune system
Viruses or bacteria could be a cause of CFS, but there isn’t one pathogen that has been confirmed to be the causative agent. The bacteria Coxiella burnetti, Epstein-Barr virus, and Ross River virus can cause a condition that meets the criteria for CFS in about 10% of cases. The CDC reports that people with severe symptoms after infection were more likely to later develop CFS symptoms, compared to those with mild symptoms.
Some patients with CDF have excessive inflammation, and higher levels of inflammatory proteins such as TNF-alpha. A small study has shown that patients with CFS have higher levels of neuroinflammation compared to healthy controls.
Some patients have different T-cell activation markers than healthy controls, but not all research shows this.
Heart and circulatory issues
Some patients with CFS have reduced blood circulation, and a recent study also shows impaired peripheral pulse characteristics on orthostasis (when a patient stands). Patients with CFS can have orthostatic hypotension, which is very low blood pressure, weakness, or faintness after moving from a sitting position to a standing position. People with postural orthostatic tachycardia will have a dip in blood pressure when they stand.
Graded exercise can be used to treat CFS. Start slowly by walking for a minute, then gradually progress to longer exercise times. This will help ease some of the symptoms of CFS.
Cognitive behavioral therapy (CBT) can help reduce fatigue symptoms and significant improvement from CFS after CBT is possible.
Although antidepressants could be prescribed, these can cause serious side effects. Safer alternatives, such as exercise, CBT, and some supplements should be tried first.
Having enough magnesium, iron, and vitamin B12 are essential to prevent fatigue. Panax ginseng, from 1 to 2g per day can help lower fatigue.
A recent study showed that French oak wood extract (Robuvit), 200 mg/day, significantly improved most CFS symptoms after 3 and 6 months, as compared to the control group who didn’t use the extract. The French oak wood extract group showed a significant decrease in oxidative stress, but there was no significant change in the control group.
CFS is a multifactorial disease and there are many treatment options available. A balanced approach with exercise, CBT, good nutrition, and specific supplements is the best way to treat it.