Chronic fatigue syndrome (CFS) is marked by long-standing, severe and disabling fatigue usually lasting at least six months, and the fatigue is usually aggravated by minimal exertion. CFS may lead to a reduction of 50% in the ability to participate in ordinary activities.
It is estimated that 0.5-2.5% of the population may be affected by CFS, predominantly individuals aged 20-40 years. CFS is two to three times more common in women than in men.
Specific biological markers for the diagnosis of CFS do not exist and since symptoms of CFS overlap with other syndromal disorders such as fibromyalgia, depression and irritable bowel syndrome (which can also be characterised by fatigue), it has been difficult to define and classify CFS with certainty.
Criteria for Diagnosis
CFS was first recognised in 1988 and the diagnostic criteria were more recently revised by the American Centers for Disease Control and Prevention (CDC). The CDC state that the fatigue of CFS must be clinically evaluated and meet the following criteria
- Unexplained chronic fatigue of new or definite onset, not alleviated by rest (and not the result of ongoing exertion) and causing significant decrease in daily activities.
- At least four of the following eight symptoms must occur concurrently, and they must have persisted for six months duration:
- Substantial impaired short-term memory and concentration
- Sore throat
- Tender lymph nodes
- Muscle pain
- Joint pain without swelling or redness
- Headaches of a new type to the individual
- Unrefreshing sleep
- Post-exertion malaise lasting longer than 24 hours.
Diagnostic tests should be performed to exclude other fatigue-related conditions, such as untreated hypothyroidism, from the diagnosis of CFS.
In 2003, the Canadian Guidelines for defining CFS were published. This definition expands on the Australian and USA versions. It states that a single disease model for CFS will not account for every case, but there are common clusters of symptoms that permit a clinical diagnosis. The diagnostic criteria are as follows:
A patient with CFS must have been suffering the illness for at least six months with a distinct onset and must have:
- Fatigue: significant, new onset, unexplained, physical and mental, persistent, and that substantially reduces daily activity by 50%
- Post-exertion fatigue and/or malaise with a tendency for symptoms within the patient's cluster of symptoms to worsen, with a slow recovery period of 24 hours or longer
- Sleep dysfunction: unrefreshing sleep or sleep disturbance
- Pain: headaches of a new type; joint or muscle pain that is often not confined to one area
- Neurological or cognitive manifestations: two or more of the following must be present - confusion, impairment of short-term memory and concentration, disorientation, difficulty processing information (categorising or word retrieval), perceptual and sensory disturbances (e.g. inability to visually focus), ataxia, muscle weakness, or cognitive/sensory overload (e.g. photophobia), or hypersensitivity to noise or emotional overload
- At least one symptom from two of the following:
a) Autonomic manifestations: such as delayed postural hypotension, neurally-mediated hypotension, light-headedness, extreme pallor, irritable bowel syndrome, urinary bladder dysfunction, palpitations, exertional dyspnoea
b) Neuroendocrine manifestations: subnormal body temperature, sweating episodes, feverishness, cold extremities, intolerance to extremes of heat and cold, marked weight change, abnormal appetite
c) Immune manifestations: tender lymph nodes, recurrent sore throat, recurrent flu-like symptoms, new sensitivities to foods, chemicals or medications.
All other disease states that are marked by fatigue, sleep disturbance, pain and cognitive dysfunction must be excluded before CFS can be diagnosed. Certain illnesses such as irritable bowel syndrome, fibromyalgia, depression, allergies and multiple chemical sensitivities can co-exist with CFS.
It is interesting to note that approximately 75% of individuals with CFS also meet the criteria for fibromyalgia - a closely related syndrome with an emphasis on musculoskeletal pain rather than fatigue.
Proposed Pathophysiology of CFS
It is likely that multiple factors promote the development of CFS, possibly with the same factors causing, and being caused by, the syndrome. Several theories of the pathogenesis of CFS have been proposed:
- A unique pattern of infection: Epstein-Barr virus can trigger CFS and some studies suggest that CFS may proceed from Ross River virus.Inadequate evidence exists for enteroviruses, human herpes virus 6, retroviruses, candida and Lyme disease as causative factors for CFS.
- Immunological factors: several studies suggest that CFS may be due to alterations in immune function; however, total consensus on a pattern of immunological disturbance in those with CFS has not yet been reached. The most consistent abnormality is decreased activity and number of natural killer cells. Reduced lymphocyte proliferation is also common. It has been hypothesised that a continued overreaction or suppression of immune responses may be linked to CFS.
- Altered central nervous system function: neuromuscular performance in individuals with CFS is normal, suggesting that an alteration of central nervous system function may be the site of pathophysiological disturbance. Impaired hypothalamic-pituitary-adrenal (HPA) axis activation and white matter abnormalities have been shown, and neurally-mediated hypotension has been recorded. Evidence of sleep disturbance, gait and motor abnormalities, poor attention and concentration and other measures of cognitive function have been established.
- Oxidative stress: recent studies have demonstrated that oxidative stress contributes to the pathology and clinical symptoms of CFS, either as a cause or a result of the condition. Oxidative stress can be caused by an increase in the generation of reactive oxygen species, often due to dysfunction of the mitochondria, or it may be caused by a decline in the efficiency of antioxidant enzyme systems.
- Food and environmental intolerances may exacerbate or promote symptoms of CFS, as may marginal nutritional deficiencies, intestinal hyperpermeability and intestinal flora dysbiosis. Chronic exposure to industrial chemicals, insecticides and pesticides may cause an illness resembling CFS.
Psychological stress may be a predisposing factor in the development of CFS. Mood disorders may be secondary to, or independent of, CFS. Unresolved anger or guilt or other emotive factors may play a role in maintaining CFS.
The long-term outlook for people with CFS is variable. Some patients recover completely after six months to a year. Most studies report that patients seeking an extensive or holistic rehabilitation program have a better prognosis than those who do not seek treatment at all.
Nevertheless, many people may take a few years to improve, and some may never reach complete recovery. Factors associated with poorer outcomes include a long duration of illness, and those with high levels of fatigue or functional impairment and a low sense of control over their symptoms.
CFS has also been associated with low ATP production, which in turn can cause an excess of lactic acid build up, which is often the cause of the severe muscle pain often experienced by CFS sufferers.
For an effective natural CFT treatment why not try Blackmores Celloid Minerals, they can help with ATP production, cleanses the lymphatic system and balance the bodies PH, eliminating any excess acid.
PP.MP (nervous system), PC.IP (inflammation/lymphatic) & SP96 (acidosis/parasites) another great product for the immune system is an Ayurvedic treatment called Septilin.
From Blackmores Naturopathics