Are you tired all the time? Feeling mentally foggy all the time? Sleep just doesn’t feel as good as it used to? Well, you’re not alone. Up to 2.5 million Americans have similar symptoms, and as many as 1/4 are homebound or bedridden (1). These symptoms are some of the few that describe systemic exertion intolerance disease (chronic fatigue syndrome); however, little is understood about the issue. Several individuals have asked me about this topic recently, so I thought I would do my best to shed light on this tired topic. So let’s take a look at what we know and don’t know about recognizing and treating the enigmatic epidemic.
What Is It Exactly?
Let’s start out with talking about what a syndrome is. It is a set of medical signs and symptoms that are correlated with each other. This is different from a disease which is a health condition that has a clearly defined reason behind it. So, to be diagnosed with chronic fatigue syndrome, you need to meet the following criteria (2):
Diagnosis requires that the patient have the following 3 symptoms:
1. A substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest AND
2. Postexertional malaise(a) AND
3. Unrefreshing sleep(a)
At least 1 of the 2 following manifestations is also required:
1. Cognitive impairment(a) OR
2. Orthostatic intolerance
a. Frequency and severity of symptoms should be assessed. The diagnosis of systemic exertion intolerance disease (myalgic encephalomyelitis/chronic fatigue syndrome) should be questioned if patients do not have these symptoms at least half of the time with moderate, substantial, or severe intensity.
In other words, substantial reductions or impairments in the ability to engage in pre-illness activities, unrefreshing sleep, post-exertional malaise (general feeling of not being healthy or happy), and either cognitive impairment or orthostatic intolerance.
Orthostatic intolerance: hypotension, and symptoms, such as lightheadedness, that occur when upright and are relieved by sitting down (3).
What It’s Not
Chronic fatigue syndrome is not just the feeling of being tired all the time. If sleep is an issue because you drink a gallon of coffee a day, well then the problem is your nutrition. See the article Woman Who Drinks 6 Cups Of Coffee Per Day Trying To Cut Down On Blue Light At Bedtime for more details. The fact that you’re tired all the time is more than likely self-sabotage in one form or another. You could be anxious about work, nervous that your newborn isn’t breathing because she hasn’t made a noise in over 2 minutes, or jacked up on Mountain Dew. So, don’t go rushing to your doctor because you read this and realized that you’re tired during your work days after you eat lunch!
Chronic fatigue syndrome also is not adrenal fatigue syndrome. Although the reported symptoms are similar, the fact of the matter is that adrenal fatigue DOES NOT EXIST (4)!!! It is a made up disease, developed by quacks, that’s used to sell people supplements/treatments that they don’t need. The real issue probably has more to do with cortisol control, and by trying to treat adrenal fatigue, you are simply prolonging the diagnosis of the real problem.
Chronic fatigue also is not leaky gut syndrome. Because leaky gut syndrome also DOES NOT EXIST (5)!!! Yes, the permeability of the intestines can be altered. However, there is a complex but dynamic association between mucosal permeability and immune system homeostasis. In other words, things in the gut happen for a reason, they’re not always good or bad, and we don’t know enough one way or another to say what exactly is going on. To be clear, leaky gut syndrome also doesn’t not exist either. But there is no use treating a sick leprechaun with fairy dust in the real world.
It has been brought to my attention that the research I cited in this portion of the blog post has been called into question. It seems that the use of cognitive behavioral therapy is not a valid treatment. Instead of deleting this portion of the post, I am striking it out for transparency.
As of right now, there seems to be no gold standard for the treatment of chronic fatigue. However, if you suspect that you have some of the signs or symptoms, please speak with your doctor. You could be mistaking your symptoms ask chronic fatigue when they could be symptoms of a more serious issue such as thyroid dysfunction. Should a treatment become available, I will be sure to update this blog post.
1. Marshall, R., Paul, L., & Wood, L. (2011). The search for pain relief in people with chronic fatigue syndrome: a descriptive study. Physiotherapy theory and practice, 27(5), 373-383.
2. Clayton, E. W. (2015). Beyond myalgic encephalomyelitis/chronic fatigue syndrome: an IOM report on redefining an illness. Jama, 313(11), 1101-1102.
3. Stewart, J. M. (2013). Common syndromes of orthostatic intolerance. Pediatrics, 131(5), 968-980.
4. Cadegiani, F. A., & Kater, C. E. (2016). Adrenal fatigue does not exist: a systematic review. BMC endocrine disorders, 16(1), 48.
5. Ahmad, R., Sorrell, M. F., Batra, S. K., Dhawan, P., & Singh, A. B. (2017). Gut permeability and mucosal inflammation: bad, good or context dependent. Mucosal Immunology, 10(2), 307-317.