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Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS), also known as myalgic encephalitis (ME), is a long-term illness with a wide-range of symptoms. The most common symptom is extreme tiredness. Investigations are undertaken to identify if there is a clear physical cause for fatigue, such as anaemia, diabetes mellitus and hypothyroidism. CFS/ME can only be diagnoses when other conditions have been excluded.
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Symptoms

Other features which are common include:
Difficulty with sleeping, such as insomnia, unrefreshing sleep and a disturbed sleep-wake cycle
Muscle and/or joint pain
Headaches
Sore throat
Cognitive dysfunction such as ‘brain fog’, impairment of short-term memory and difficulties with word-finding.
Symptoms are worse with exertion, which may be physical or mental
Dizzyness and/or nausea

Treatments

It is not known what causes ME/CFS, but it is likely that there are a number of different triggers.
Possible triggers include:
Viral infections such as glandular fever
Bacterial infections
A weakened immune system
Dysbiosis (imbalances in gut bacteria) and ‘leaky gut’ (increased epithelial permeability)
Hormonal imbalances
Emotional trauma and stress
Optimal management of CFS/ME involves identifying specific triggers and addressing underlying physical and psychological problems.
In addition, structured exercises programmes, such as graded exercise therapy, and cognitive behavioural therapy may be helpful.
CFS/ME may be best managed as part of a multi-disciplinary team. This may involve a GP, Functional Medicine doctor, physiotherapist and psychologist.

References

Larun, L., Brurberg, K.G., Odgaard-Jensen, J. et al. (2019) Exercise therapy for chronic fatigue syndrome (Cochrane Review). Issue 10. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
Maes M, Leunis JC. Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria. Neuro Endocrinol Lett. 2008 Dec;29(6):902-10. PMID: 19112401.
Price, J.R., Mitchell, E., Tidy, E. et al. (2008) Cognitive behaviour therapy for chronic fatigue syndrome in adults (Cochrane Review). Issue 3. John Wiley & Sons, Ltd. http://www.cochranelibrary.com [Free Full-text]
Proal A, Marshall T. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in the Era of the Human Microbiome: Persistent Pathogens Drive Chronic Symptoms by Interfering With Host Metabolism, Gene Expression, and Immunity. Front Pediatr. 2018 Dec 4;6:373. doi: 10.3389/fped.2018.00373.
Rasa S et al. Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Journal of Translational Medicine.16: 268(2018)
Sepulveda N et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome as a Hyper-Regulated Immune System Driven by an Interplay Between Regulatory T Cells and Chronic Human Herpesvirus Infections. Front. Immunol., 21 November 2019 | https://doi.org/10.3389/fimmu.2019.02684
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