Chronic fatigue syndrome

Tired of being tired

Chronic fatigue syndrome, or CFS, is not one disease (researchers are at odds about what actually brings it on) but rather an often mystifying collection of symptoms, including extreme fatigue, flu-like aches and pains, and trouble with concentration and memory. Though these discomforts are common to many aliments, what differentiates CFS is a sudden onset of severe symptoms which persist for more than six months and are so pronounced as to prevent people with the syndrome from participating in normal activities.

While the symptoms of CFS have been noted by physicians since the 1860s, it was only in 1988 that doctors at U.S. government's Centers for Disease Control and Prevention first recognized CFS by drafting a medical definition of this elusive condition. Since then, many thousands of Americans have been diagnosed with CFS, with white middle class women accounting for at least two-thirds of diagnoses. CFS is also more common in young adults; one study found that the average age of the appearance of symptoms was age 30.

Because the cause of CFS is unknown, treatment focuses on relieving the pain and discomfort of physical symptoms. As the duration of the illness wears on, many people develop psychological side effects, including depression or other mood disorders.

Synonyms and Abbreviations

  • Chronic fatigue and immune dysfunction syndrome
  • Chronic Epstein-Barr syndrome
  • Yuppie flu
  • CFS
  • CFIDS

What's going on

CFS makes regular work and recreational activities impossible. In some cases, people with CFS are too listless and weak even to get out of bed. Others report that if they increase activity levels even temporarily their symptoms worsen for hours or days afterwards.

The development of CFS varies considerably. While some people find it goes away after a period of months or years; for others, symptoms continue or worsen with time. Most people do eventually recover, however, though some only partially, continuing to experience intermittent periods of weakness and fatigue.

How Common Is CFS?

The CDC estimates that as many as half a million people in the United States have CFS. In one study of people who were receiving treatment, 98% of patients were white and 85% were female. Other studies, however, have suggested that while CFS is more often diagnosed and treated in white, middle-class women, it is actually experienced by people of both genders and all racial and ethnic groups.

Established Causes

CFS has no known cause.

Theoretical Causes

Despite an aggressive effort to pinpoint the origins of CFS, the cause or causes are still unknown. At first, researchers speculated that the Epstein-Barr virus was to blame (hence the early nickname Epstein-Barr syndrome). But researchers have largely rejected the theory that any single virus is at fault and speculate that CFS might be triggered by a complex interaction of multiple factors.

In addition to the viral theory, other possible causes under investigation include a dysfunction of the immune system, weakness in the central nervous system, disturbances in the body's automatic regulation of blood pressure and pulse, a nutritional deficiency, or some combination of the above factors.

Risk Factors

People with a history of allergies are more likely than others develop CFS.

Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.

Symptoms and Diagnosis

The principal symptoms of chronic fatigue syndrome are:

  • Debilitating exhaustion
  • Substantial impairment in short-term memory or concentration
  • Flu-like symptoms, including a mild fever, sore throat, headaches, joint or muscle pain, and tender lymph nodes
  • Fatigue after exertion that lasts more than 24 hours
  • Unrefreshing sleep

Other physical symptoms (experienced by 20% to 50% of people with CFS) include:

People with CFS often suffer psychological symptoms. These include:

How CFS Is Diagnosed

Your doctor will first take a detailed medical history and give you a physical exam. Because some of the symptoms of CFS are psychological, he or she will also ask you questions about your state of mind (called a "mental status examination"). Then, in order to rule out other causes, your physician will have your urine and blood tested for other diseases that could be triggering your fatigue. If your doctor is unable to identify another cause for your symptoms, he or she will begin to consider CFS.

CFS was defined in 1994 by the Centers for Disease Control. Your symptoms must have had begun at a specific time, usually developing over a period of hours or days and they must have lasted for more than six months. They must also leave you without enough energy to go about your normal activities. Your doctor will want to know if you have at least four ongoing physical symptoms, such as muscle pain, sore throat, headaches, tender lymph notes, a low-grade fever, or unrestful sleep.

Conditions That May Be Mistaken for CFS

CFS is notoriously hard to diagnose and is often confused with several other illnesses, including fibromyalgia. Other conditions that share features with chronic fatigue syndrome include:

  • Autoimmune diseases
  • Lyme disease
  • Diseases associated with HIV
  • Psychiatric disorders
  • Chronic inflammatory disease
  • Neuromuscular disease
  • Endocrine disorders (hypothyroidism, Addison's disease, Cushing's disease)
  • Drug addiction
  • Exposure to toxins
  • Anemia
  • Chronic active hepatitis
  • Anorexia nervosa
  •  

Treatment Overview: Care, Not Cure

Until the cause or causes of CFS are found, treatment is limited to alleviating symptoms with the hope of allowing people with CFS to return to their normal activities. Lifestyle modifications, including exercise, diet, and stress reduction, are important elements of treatment. Some flu-like aches and pains can be treated effectively with over-the-counter analgesics. Other treatments involve medication or therapy for the mood disorders that often accompany CFS.

Drug Therapy

In addition to over the counter pain medications, your doctor may try a number of prescription drug therapies to help alleviate your symptoms. Because people with CFS seem to be particularly sensitive to medications, you'll probably be given low doses at first.

Treatment might include:

  • Low-dose tricyclic agents, a class of antidepressants including Adapin, Elavil, Norpramin and Pamelor, which are used to relieve generalized pain
  • Antidepressants, including Zoloft, Paxil, and Effexor, have improved energy levels for both depressed and non-depressed people with CFS
  • Nonsteroidal anti inflammatory drugs, including Naprosyn, Nuprin, Anaprox and Feldene, are used to relieve pain and fever
  • Other experimental medications are sometimes used in treatment, including Ampligen, a synthetic nucleic acid that appears to improve memory and concentration in people with CFS

Lifestyle Changes

Much of the treatment for CFS revolves around lifestyle changes and emotional support. Moderate exercise, a healthy diet, nutritional supplements, and stress-reducing activities, including relaxation exercises and changes in activities, can be helpful in boosting the immune system. Many people with CFS also turn to alternative therapies such as acupuncture or tai chi to further strengthen their immune systems.

Psychotherapy

Counseling or support groups can also help people with CFS cope with the lifestyle limitations triggered by CFS.

Activity and Diet Recommendations

Modifications to activity and diet are central to care for people with CFS. Researchers have found that while moderate exercise can boost the body's immune system, strenuous exercise can further weaken it. People with CFS benefit from gentle aerobic exercise such as walking, biking and swimming. Many people find that a day of rest is helpful before a day when they must be particularly active.

While there are many diets or dietary supplements that have been proposed for people with CFS, the value of such special diets is unclear. People with CFS should eat a balanced, healthy diet.

Supplements

  • Antioxidants: These help maintain immune function. Noted supplement advocate Andrew Weil, M.D., recommends the following daily: 1,000 to 2,000 mg of vitamin C and 25,000 IU of beta-carotene or mixed carotenoids (all members of the vitamin A family) at breakfast; 400 to 800 IU of vitamin E and 200 micrograms of selenium at lunch; and another 1,000 to 2,000 mg of vitamin C at dinner, along with a B-complex supplement.
  • Calcium and magnesium: These minerals work together in reactions involved in producing cellular energy. Try 500 mg of magnesium and 1,000 mg of calcium daily.
  • Coenzyme-Q10: This is another supplement involved in energy production. Take 100 mg to 200 mg a day.

Herbs

  • Immune boosters: Suppression of immune function often accompanies CFS. The best-known herbal immune enhancer, echinacea, is not recommended for long-term use (i.e., longer than eight weeks). But garlic and astragalus are. Follow package directions.

Preventing Chronic Fatigue Syndrome

Although there is no known preventive measure for chronic fatigue syndrome, maintaining a healthy lifestyle with proper nutrition and exercise can help alleviate the symptoms.

Self-Care Measures

The following modifications to your lifestyle can help to control the effects of chronic fatigue syndrome:

  • Maintain a healthy diet. Depending on the type of healthcare practitioner and his or her therapeutic orientation, diet advice varies from "It makes no difference" to suggesting elaborate elimination diets. Here's a prudent middle course that is inherently healthful: eat a diet based on fruits, vegetables, beans, and whole grains. Minimize your intake of high-fat meats and dairy foods. Avoid alcohol. Minimize your intake of sugar and caffeine. If you notice that diet changes seem to help, consider a medically supervised elimination diet.
  • Get some exercise. It may seem strange to recommend exercise to people who feel exhausted all the time, but gradually increasing exercise helps people with CFS feel less fatigued and more energetic. In one study, 60 CFS sufferers either did gentle stretches or aerobic exercise five days a week. Both groups started with five to 15 minutes a day and worked up to 30 minutes. After three months, eight of the 30 members (or 27%) of the stretching group said they felt "much better," but in the aerobics group, 16 of 29 members (or 55%) felt much better.
  • Seek the advice of a therapist. CFS is depressing, which aggravates the condition. Cognitive therapy, which teaches people to change how they think about life's problems, can help. In one study, British researchers taught cognitive therapy techniques to some people with CFS and relaxation techniques to others. Six months later, 19% of the relaxation group reported "substantial improvement," but in the cognitive therapy group the figure was 70%. To learn more about cognitive therapy, visit the National Assoc. of Cognitive-Behavioral Therapists website (www.nacbt.org), or at Depression.com.

Preventing Chronic Fatigue Syndrome

Although there is no known preventive measure for chronic fatigue syndrome, maintaining a healthy lifestyle with proper nutrition and exercise can help alleviate the symptoms.

Websites & Organizations

American Association for Chronic Fatigue Syndrome
c/o Harborview Medical Center
325 Ninth Avenue
Box 359780
Seattle, WA 98104
Phone: 206-521-1932
Fax: 206-521-1930
Email: info@aacfs.org

Centers for Disease Control and Prevention (CDC)
MS A15
Atlanta, GA 30333
Phone: 404-332-4555

CFS-News
Email: cfs-news@list.nih.gov

Chronic Fatigue and Immune Dysfunction Syndrome Association of America Inc.
Box 220398
Charlotte, NC 28222-0398
Phone: 800-442-3437

Consumer Health Information Research Institute
300 East Pink Hill Road
Independence, MO 64057
Phone: 816-228-4595

The Journal of Chronic Fatigue Syndrome
The Haworth Press, Inc.
10 Alice Street
Binghamton, NY 13904-1580
Phone: 607-722-5857

National Chronic Fatigue Syndrome and Fibromyalgia Association
P.O. Box 18426
Kansas City, MO 64133
Phone (24 hours): 816-313-2000
Fax: 816-524-6782

National Institute of Allergy and Infectious Diseases Resources
Building 31, Room 7A-50,
31 Center Drive MSC 2520
Bethesda, MD 20892-2520

New Jersey Chronic Fatigue Syndrome Center

Physicians with CFS/CF/FM
Registry Harborview Medical Center
325 9th Avenue, Box 359780
Seattle, WA 98104
Phone: 206-521-1932
Fax: 206-521-1930
Email: ekleyman@u.washington.edu

Sources for This Article

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