Chronic Fatigue

Chronic Fatigue

Overview of Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS) is a disorder characterized by overwhelming physical and mental exhaustion. For most people, physical and mental exertion naturally causes some feelings of tiredness, varying with the level of intensity of that exertion. Resting and sleeping can help the mind and body recover, however, and perform well once again. Sufferers of CFS never feel relief following resting, so instead, their fatigue continues to worsen. Gradually, these symptoms of chronic fatigue can become debilitating, preventing the patient from exerting themselves at all.


For a long time, CFS was unaccepted by the medical community. CFS was brushed off with terms such as the "yuppie flu" and "shirker syndrome," implying that the symptoms were inventing or imagining the symptoms. CFS is now recognized by the medical health profession and there is now federally funded research to help better understand the underlying causes of the disease to improve the diagnosis, relieve the symptoms, increase the potential for recovery, and potentially prevent the development of CFS.

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Symptoms of Chronic Fatigue Syndrome

Chronic Fatigue Syndrome is somewhat difficult to diagnose, as there is no specific medical test or diagnostic marker related to it. Instead, it is defined by a collection of physical symptoms.

CFS initially presents itself with the onset of persistent fatigue. The onset of CFS is usually sudden and often follows a flu-like illness or acute stress. As much as a person rests and tries to recover from this fatigue, however, they never feel better. As a result, feelings of exhaustion force them to become less active.

In addition to the chronic fatigue, there are several other factors that must be present in order for a medical diagnosis of CFS to be made. The patient may also develop headaches that either feel different or are significantly more severe than normal. Concentration and memory may be noticeably impaired. Patients with CFS may also feel malaise following any physical or mental exertion. Physical ailments associated with CFS include joint pain (arthalgia), muscle pain (myalgia), frequent sore throats, and tender lymph nodes. Patients with CFS find that sleep is unrefreshing, and despite trying to rest and sleep more, none of their symptoms are relieved.

If any of the conditions above can be associated with other medical conditions, the diagnosis is not CFS. Instead, CFS tends to be the diagnosis for when other concrete causes, such as mononucleosis, sleep disorders, Lyme disease, or conditions that may cause similar symptoms cannot be found.

Risk Factors of Chronic Fatigue Syndrome

Because of the extreme feelings of fatigue, CFS usually reduces physical activity significantly. Any exertion, physical or mental, can induce overwhelming exhaustion, making it impossible for a person to cope with the everyday demands of life. Sufferers of CFS may find themselves unemployed, as they no longer have the energy to complete their jobs effectively. If a person completely succumbs to CFS, they may begin living an unhealthy, sedentary lifestyle, which can lead to numerous health issues, such as obesity and heart disease.

CFS can also have emotional consequences as people cope with their symptoms, particularly their sudden inability to perform the physical and mental tasks they used to be able to do. Because the diagnosis of CFS has been controversial, patients may also suffer from depression if they do not find acceptance of their illness at work or within their social circles.

Causes of Chronic Fatigue Syndrome

The cause of CFS is unknown, though it is thought that there are both physiological and psychological factors at play. Physiological factors include immune dysfunction, which allows the body to harbor chronic viral or bacterial infections. Hormones are tightly linked to mood and physical energy levels, so hormonal imbalances may also contribute to CFS. The development of CFS may also be hereditary.

The phenomenon of oxidative stress is also an avenue that CFS researchers are exploring. Oxidative stress is a chemical imbalance induced when the body is unable to detoxify itself of reactive oxygen, such as free radicals, which can cause damage to DNA, proteins, and lipids, which are the building blocks of all our cells. Such an imbalance could cause a slow destruction of our cells. Oxidative stress is involved in numerous other diseases and disorders, including Alzheimer’s disease, Parkinson’s disease, atherosclerosis, and heart disease.

Psychological problems, such as depression and other mood disorders, also seem to coincide in patients with CFS, though the link is unclear. There may also be neurological patterns that contribute to the symptoms of CFS. In one model of the illness, for example, it is thought that the patient’s interpretation of the symptoms helps to perpetuate the symptoms. If the patient has overly intense emotional reactions to their symptoms, the physiological response that accompanies the emotional response may intensify the symptoms, initiating a cycle of chronic pain.

Conventional Treatment of Chronic Fatigue Syndrome

Generally, CFS is not considered to be a curable condition. Instead, most patients are taught strategies to help manage their exhaustion. Two of the most promising therapies have been cognitive behavioral therapy (CBT) and graded exercise therapy (GET).

Cognitive behavioral therapy (CBT) is a form of psychological therapy that has been shown to relieve symptoms in approximately 70% of patients. CBT aims to help a patients understand the patterns of their symptoms in order to help anticipate and manage them closely. A common component of CBT is having the patient keep a detailed diary of their symptoms and what activities may have brought them on. Here, they can examine closely the thoughts they had toward their symptoms and assumptions they may have made that influenced their behavior in response to the symptoms. CBT can also include the teaching of relaxation techniques and ways of quieting (or distracting) the mind.

Graded exercise therapy (GET) is a form of physical therapy designed to help patients cope with physical activity and increase their capacity to exercise. By carefully pacing the exercise and keeping the level of exertion below the threshold for exhaustion, the patient can gradually increase their endurance. As part of this therapy, the patient monitors their own progress to help them focus on improvements rather than the symptoms. The exercise can also help maintain cardiovascular health and keep them strong, as their physical condition could quickly worsen if they remained inactive.

There are no medications specifically prescribed to CFS patients, however some drugs have found to be beneficial for some patients. Antidepressants, in addition to treating symptoms of depression, have been found to reduce physical pain and also help CFS sufferers get a better night’s sleep. Stimulants appear to be helpful to be helpful for some patients in staying alert, but the long term benefits of such drugs for CFS are unclear. Immunotherapies and hormone treatments have also been studied, but were found to have mixed results, and are thus not recommended.

Patients Medical’s Treatment of Chronic Fatigue Syndrome

Most people find that CFS prevents them from leading a healthy, active lifestyle on their own. Their continuous exhaustion can make it extremely difficult to eat well, exercise their muscles, and take good care of themselves. Our goal is to help support a healthy future for you as you work to overcome the symptoms of CFS.

During your initial visits with us, we will take your medical history and perform some diagnostic tests in the laboratory. We find that fatigue is very often due to hormone imbalances, so we will specifically test for thyroid and adrenal gland function. If these hormones do not fall within normal range, we may recommend bio-identical hormone supplements to help re-establish balance and restore your energy. (Please see our article on bio-identical hormones for more information.)

We will also help you design a nutritional plan that will help reduce the risks of developing further complications as you slowly get the strength to begin physical activities once again. As always, we recommend a diverse diet based largely on fruits, vegetables, lean meat, and whole grains. Because oxidative stress may play a role in CFS, we will also recommend a diet rich in antioxidant foods, particularly berries, beans, artichokes, and nuts. Researchers have found that L-carnitine, a potent antioxidant contained in red meat and dairy products, has also improved recovery of CFS patients. Essential fatty acids have also been shown to improve chronic fatigue in some patients, so fish oil and oil of evening primrose may be suggested. Additional vitamin, mineral, and antioxidant supplements may also be prescribed. Herbal supplements, such as ginseng, may also help increase energy.

Maintaining physical strength is also a critical part of keeping the body healthy. Our physicians will also help you design a graded exercise therapy (GET) program tailored to your personal goals. We will help you monitor your progress as you gradually increase your physical endurance. Depending on your case, acupuncture or acupressure may be recommended to relieve muscle pains or headaches.

Begin Your Journey to Wellness with Patients Medical

Our job at Patients Medical is to listen, to connect the dots between a patient's medical history, symptoms, and their underlying causes. Patients Medical is a superb place for women and men to secure integrative and holistic health care from providers who give personalized care, partner with the patient to focus on the root cause of their illness, support their recovery, and help them maintain good health.

To make an appointment with one of our physicians, please call us at 1-212-794-8800. We look forward to hearing from you.

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