Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (Epstein Barr)

Chronic fatigue syndrome (CFS) is the most common name  used to specify a medical disorder or group of disorders generally defined by persistent fatigue accompanied by other specific symptoms for a minimum of six months, not due to ongoing exertion, not substantially relieved by rest, nor caused by other medical conditions.  The disorder may also be referred to as myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS), or several other terms.  Although classified by the World Health Organization under Diseases of the nervous system, the etiology (cause or origin) of CFS is unknown, and multiple psychological and physiological factors may contribute to the development and maintenance of symptoms.  There is no diagnostic laboratory test or biomarker for CFS

Fatigue is a common symptom in many illnesses, but CFS is comparatively rare.  Estimates of CFS prevalence vary widely,  from 7 to 3,000 cases of CFS for every 100,000 adults,  but national health organizations have estimated more than 1 million Americans and approximately a quarter of a million people in the UK have CFS.  CFS occurs more often in women than men, and is less prevalent among children and adolescents.  The “quality of life” is particularly disturbed in chronic fatigue syndrome

There is agreement on the genuine threat to health, happiness and productivity posed by CFS, but various physicians' groups, researchers and patient advocates promote different nomenclature, diagnostic criteria, etiologic hypotheses and treatments, resulting in controversy about many aspectsof the disorder.  The name CFS itself is controversial as many patients and advocacy groups, as well as some experts, want the name changed as they believe that it stigmatizes by not conveying the seriousness of the illness.


The majority of CFS cases start suddenly, usually accompanied by a "flu-like illness"  while a significant proportion of cases begin within several months of severe adverse stress.  An Australian prospective study found that after infection by viral and non-viral pathogens, a sub-set of individuals met the criteria for CFS, with the researchers concluding that "post-infective fatigue syndrome is a valid illness model for investigating one pathophysiological pathway to CFS".  However, accurate prevalence and exact roles of infection and stress in the development of CFS are currently unknown.


The most commonly used diagnostic criteria and definition of CFS for research and clinical purposes were published by the United States Centers for Disease Control and Prevention (CDC).  The CDC definition of CFS requires the following two criteria be fulfilled:

  1.   A new onset (not lifelong) of unexplained, persistent fatigue unrelated to exertion and not substantially relieved by rest, that causes a significant reduction in previous activity levels.
  2.   Four or more of the following symptoms that last six months or longer:


  • Impaired memory or concentration
  • Post-exertional malaise, where physical or mental exertions bring on "extreme, prolonged exhaustion and sickness"
  • Unrefreshing sleep
  • Muscle pain (myalgia)
  • Pain in multiple joints (arthralgia)
  • Headaches of a new kind or greater severity
  • Sore throat, frequent or recurring
  • Tender lymph nodes (cervical or axillary)
  • Other common symptoms include:
  • Irritable bowel, abdominal pain, nausea, diarrhea or bloating
  • Chills and night sweats
  • Brain fog
  • Chest pain
  • Shortness of breath
  • Chronic cough
  • Visual disturbances (blurring, sensitivity to light, eye pain or dry eyes)
  • Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise
  • Difficulty maintaining upright position (orthostatic instability, irregular heartbeat, dizziness, balance problems or fainting)
  • Psychological problems (depression, irritability, mood swings, anxiety, panic attacks)

The CDC recommends that persons with symptoms resembling those of CFS consult a physician to rule out several treatable illnesses:  Lyme disease,  sleep  disorders,  depression, alcohol/substance abuse, diabetes, hypothyroidism, mononucleosis (mono), lupus, multiple sclerosis (MS) ,chronic hepatitis and various malignancies.   Medications can also cause side effects that mimic symptoms of CFS.

Who Gets Chronic Fatigue Syndrome?

Few studies address this question.  Studies  show  that seventy  to eighty  percent of CFS patients are women, although some researchers say that these are normal figures for any immune-related illness.  Some studies indicate that CFS is less common among lower income people and minorities, but critics point out that the average CFS patient sees so very many doctors before they can get a diagnosis, that only those with great access to medical care get counted in such studies, thus giving a bias with regards to income and race.

The cause of the illness is not yet known.  Current theories are looking at the possibilities of neuroendocrine dysfunction, viruses, environmental toxins, genetic predisposition, or a combination of these.  For a time it was thought that Epstein-Barr Virus (EBV), the cause of mononucleosis, might cause CFS but recent research has discounted this idea.  The illness seems to prompt a chronic immune reaction in the body, however it is not clear that this is in response to any actual infection -- this may only be a dysfunction of the immune system itself.
A recent concept  offered by Prof. Mark Demitrack is that CFS is a generalized condition which may have any of several causes .  It  is known that stress either physical or emotional,  seems to make CFS worse.

Some current research continues to investigate possible viral causes including HHV-6, other herpes viruses, enteroviruses, and retroviruses.  Additionally, co-factors (such as genetic predisposition, stress, environment, gender, age, and prior illness) appear to play an important role in the development and course of the illness.
Many medical observers have noted that CFS seems often to be "triggered" by some stressful event, but in all likelihood the condition was latent beforehand.  Some people will appear to get CFS following a viral infection, or a head injury, or surgery, excessive use of antibiotics, or some other traumatic event.  Yet it is unlikely that these events on their own could be a primary cause.

Many treatments are available.  Most seem to be of limited usefulness.  As odd as it may seem, typically the most beneficial program is for the patient to avoid stress and to get lots of rest. Stress does not merely mean unpleasant experiences, but rather any biological stressors,  physical or emotional,  which prompt a protective reaction in the body and which may alter physiologic equilibrium ("homeostasis").  Failure to avoid stress often leads to short-term and long-term set-backs which may be serious.  Many patients believe that if they had done more to avoid stress in the early phases of the illness, they would not have become nearly so disabled later on.  The correlation between stress and the progress of this illness appears to be strong.

Treatments tend to address the symptoms, since the underlying mechanism of the disease is not really understood.  Medications which are helpful are often those which have immune-modulating characteristics. CFS patients are unusually sensitive to drugs and they usually must take doses that are 1/4 or less than standard doses.  Some drugs will be a big help to some patients and little or no help to others.  And drugs that seem to work for a while may stop being effective later.


Know that it is  not you.  It takes a lot to adjust to your new, lessened capabilities, and the adjustment is made more difficult by the expectations of you and those around you who have been long accustomed to dealing with your "normal, healthy self".
Patients often find an equilibrium point at which they can function.  As in combating any chronic illness, a positive hopeful attitude is essential.
Be prepared for a possible lack of acceptance from some from whom you might expect support.  This may be a shock, but when you cannot regularly "go bowling" with the gang, or you increasingly depend on being accommodated at home or on the job, and when you have a condition that your doctor may not certify or that other people have already heard of as "that yuppie disease", then your emotional world will become quite different.

Find new sources of support.  It will be important to create a new family-and-friends support structure. 
You will need to take the time to create a new self image for yourself.

Doctors will tell you that you have Epstein Barr Chronic Fatigue when you have had the virus followed by recurrent unexplained fatigue for six months or more, plus four or more of the following symptoms:

  • sore throat
  • swollen lymph glands
  • muscle aches or pain
  • headaches
  • poor quality sleep
  • poor memory or concentration
  • post exercise malaise lasting more than 24 hours.

There may also be other symptoms like frequent infections, nausea, constipation, bloating, loose stools, rapid heart beat, tingling sensations, dizzy spells, shortness of breath, mood swings, depression and anxiety.
Epstein Barr Chronic Fatigue symptoms can fluctuate from day to day, and week to week.  Periods of feeling well are often followed by a relapse, as people try to resume normal activities or exercise.  In some cases the condition may be so severe that patients become bedridden.  There have been several reported deaths, mainly from metabolic and cardiac causes, as well as suicides.

If you think you have Epstein Barr Chronic Fatigue, it is important that you have a careful medical checkup to confirm the diagnosis.  It is essential to exclude other possible conditions like autoimmunity, low iron stores, under active thyroid, other viral, bacterial or fungal infections, gastrointestinal disorders, low blood pressure etc. that can mimic CFS.
If CFS is diagnosed, a health practitioner who offers support and hope for a recovery is vital.  You will also need understanding and help from your family, friends and work place.

The treatment for Epstein Barr Chronic Fatigue is aimed at boosting the immune system with nutrients, herbs, healthy diet, stress management, lifestyle adjustments, graded exercise, restoration of normal sleep patterns and strategies to overcome the frustration, depression and social isolation that this illness so commonly causes.

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