Chronic Fatigue Syndrome: Understanding Myalgic Encephalomyelitis /CFS, Causes, Symptoms and Treatment

Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis (ME/CFS), is a complex, long-term illness affecting several bodily functions. It is a serious medical condition characterized by persistent and unexplained fatigue that does not improve with rest. It is more than just feeling tired after physical or mental exertion; the fatigue experienced by individuals with CFS is often overwhelming and severely impacts daily activities, work, and the overall quality of life. While studies have found chronic fatigue syndrome affects almost 2.5 million Americans, In India the extent of the condition is still to be analyzed although researchers believe it is mostly women who are affected. One study involving 3000 women found how 12% were suffering from ME/CFS.
Chronic Fatigue Syndrome: What is it?

Chronic fatigue syndrome  first gained medical attention in the eighties and nineties. Despite of extensive research in the subject, it remains a challenging condition in terms of diagnosis and treatment. Chronic Fatigue Syndrome is not like your normal tiredness, it is a chronic or permanent feeling of tiredness where the term “myalgic encephalomyelitis” emphasizes the involvement of muscle pain (myalgia) and inflammation of the brain and spinal cord (encephalomyelitis). It is the involvement of these factors that has led to the disease being also named “myalgic encephalomyelitis” or ME which is why chronic fatigue syndrome is known today as CFS/ME.

Symptoms of CFS/ME

The symptoms of CFS/ME extend beyond just fatigue and often include cognitive difficulties, brain fog, sleep disturbances, muscle and joint pain, headaches, and sensitivity to sensory inputs.

  • Severe Fatigue: The most common symptom of CFS is persistent fatigue that lasts for at least six months or longer. The feeling of constant tiredness is not relieved by rest and is not due to other underlying medical conditions.


  • Post-Exertional Malaise (PEM): One of the defining characteristics of CFS is post-exertional malaise or (PEM). In PEM, minor physical or mental activity worsens the symptoms of ME/CFS leading to a crash with symptoms lasting for days or even weeks. Symptoms usually manifest within 12 hours and patients have described it as a horrible type of flu, or “having my life force drained out of me.” With PEM, every other symptom such as thinking or sleeping, sore throat, headaches, dizziness, and brain fog just get worse. For People with ME/CFS, even an activity like brushing one’s teeth can cause PEM.


  • Cognitive Difficulties: CFS is often accompanied by cognitive impairments, commonly referred to as “brain fog.” Individuals may experience problems with memory, concentration, attention, poor mental reflexes, and the inability to think clearly.


  • Sleep Disturbances: There is a marked relation between CFS and sleep. Chronic fatigue syndrome often causes insomnia, and poor quality of sleep. People with CFS often need to take naps during the day and sleep longer than others. Poor deep sleep, unrefreshing sleep, and difficulties falling asleep or staying asleep are all symptoms of ME/CFS
  • Muscle and Joint Pain: In chronic fatigue syndrome, the muscle and joint pain are similar to musculoskeletal pain caused by fibromyalgia. It is one of the main symptoms of CFS felt all over the body. Pain in CFS can be managed by a variety of strategies.


  • Orthostatic Intolerance: A condition where those with CFS might just feel dizzy or faint when standing or sitting upright. Patients might even experience blurred vision and spots.

Other Possible Symptoms of Chronic Fatigue Syndrome

  • Headaches,
  • Sore throat,
  • Tender lymph nodes,
  • Sensitivity to light and noise
  • Gastrointestinal issues
  • Sore throat
  • Irritable Bowel Syndrome
  • Breath Shortness
  • Irregular heartbeat
  • Low grade fever
  • Depression

The Causes of Chronic Fatigue Syndrome

While there are several theories, the causes of  ME/CFS, is still unknown. Most experts feel it could be triggered by a combination of factors. However, extensive research in the arena of myalgic encephalomyelitis/chronic fatigue syndrome is now exploring the possibility of various conditions that put people at risk of ME/CFS.

Infections: Due to the flu like symptoms associated with ME/CFS, researchers feel that certain infections could trigger the ME/CFS. Infections like Epstein-Barr virus, Ross River virus, or Coxiella burnetti are also risk factors of ME/CFS although that is not the case in every patient of ME/CFS.

Immune dysfunction: Research feels that changes in the immune system and its response to stress or infection could also cause chronic fatigue syndrome. Autoimmune diseases especially exhibit symptoms like ME/CFS, where women have been commonly found to be afflicted by both conditions. However, tissue damage has never been found in those with ME/CFS.

Stress: Medical research is exploring the possibility between an imbalance of the stress hormones corticotrophin-releasing hormone (CRH), cortisol, and others which might put people at risk of ME/CFS.

Genetics: Genetics could contribute to ME/CFS where members of the same family have sometimes been found suffering from the same condition. The factor of  genetics and ME/CFS is currently the subject of the world’s largest study DecodeME, underway at the University of Edinburgh, UK.

Diagnosing Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Currently there are no tests to diagnose myalgia encephalomyelitis or chronic fatigue syndrome, but common guidelines have been established to help doctors diagnose the condition. Doctors rely more on a complete medical history of a patient and will recommend various blood tests to rule out other conditions like liver, kidney, and thyroid issues. Questionnaires considering a patient’s current status, activity, lifestyle, and sleep patterns can also support a diagnosis. To make an assumed diagnosis of ME/CFS, doctors mostly rely on the Canadian Consensus Criteria, which is a set of three strict criteria to diagnose ME/CSF.

The three main criteria to diagnose chronic fatigue syndrome

  1. Chronic fatigue of 6 months or longer unresponsive to rest with no known clinically diagnosed conditions
  2. The fatigue impacts quality of life, activities, and work
  3. A patient has 4 or more of the following:
  • Short term memory impairment
  • Sore throat
  • Tender lymph nodes
  • Muscle pain
  • Multi join pain with swelling/redness
  • Uncommon headaches
  • post-exertional malaise lasting more than 24 hours

The Difference Between Adrenal Fatigue and Chronic Fatigue Syndrome

Adrenal fatigue is a term used to describe a variety of symptoms as a result of adrenal gland dysfunction. The adrenal glands are two little glands sitting on top of the kidneys, their job is to produce cortisol, the stress hormone that regulates stress. However, adrenal fatigue though recognized by naturopaths is not recognized by the allopathic medical community.

source: The amino company

Endocrinologists do not consider the validity of adrenal fatigue attributing it to factors such as poor sleep, chronic stress, mental health issues, and various medical conditions. Such conditions can lead to a state of adrenal dysfunction. Thus ME/CFS can cause adrenal fatigue but adrenal fatigue cannot cause CFS. This is the main difference between adrenal fatigue and chronic fatigue syndrome

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Treatment

There is no cure for ME/CFS and doctors will focus mostly on pain management and symptom relief, addressing the most disturbing symptoms first to help improve one’s quality of life. Treatments are often individualized and may include the following.

Pain Management

Medications such as ibuprofen, or naproxen sodium are usually prescribed for pain, but if these don’t help, then stronger prescription drugs are considered. Medications for fibromyalgia can also help such as pregabalin, duloxetine, amitriptyline, or gabapentin.


Prioritizing sleep is important in CFS, but since it is easier said than done, sleep medication can be considered such as Zolpidem. Practicing good sleep hygiene by sleeping at the right time every night, and ensuring you get 7-8 hours sleep will benefit your condition.

Lifestyle Changes

  • Stress Management: Chronic fatigue symptoms can be triggered by emotional stress making it difficult to maintain a daily routine. There are several ways to manage stress such as meditation, yoga, and mindfulness. Engaging in pleasurable activity, going for walks outdoors, and balancing activity with adequate rest is the key to manage CFS. Rest even on days with no symptoms prevents crashes in future.


  • Activity: Adjust your physical routines to use less energy than others. For example, sit on a high chair when washing dishes, or clothes. Use a wheel chair or electric cart in a grocery store, and practicing low energy hobbies like reading and watching movies is helpful. Controlled and gradual increases in physical activity under guidance can be considered to improve physical function.


  • Nutrition: A balanced diet and adequate hydration can contribute to overall well-being. Consume a diet low in sugar, refined carbs, saturated fats, and processed foods. Instead opt for foods rich in monounsaturated and polyunsaturated fats. A balanced diet with good carbs for energy, lean protein, healthy grains, fruits, and vegetables is always beneficial to boost your body’s fighting mechanism. A CFS friendly diet will provide huge support in preventing symptoms from getting worse. Stay well hydrated and avoid caffeine.

Psychological support

CBT (Cognitive Behavioral Therapy) can help individuals develop coping strategies for managing the cognitive and emotional challenges associated with CFS. Moreover, therapy and counselling will provide emotional support to reduce the emotional impact of the condition. Family support can contribute much to people suffering from the condition.

Medications and Supplements

People suffering with ME/CFS can benefit from supplements such as co-enzymes nicotinamide adenine dinucleotide (NADH) and NAD+, CoQ10, L-Carnitine, magnesium (Mg glycinate, MG malate, Mg Threonate), B-vitamins, Omega-3ftty acids, melatonin, and probiotics. Pain relievers, antidepressants, and other medications may be used to manage specific symptoms; however, these should only be prescribed by a doctor. Never self-medicate.


Chronic Fatigue Syndrome is a complex condition displaying multifaceted symptoms that significantly affects the lives of people experiencing it. Extensive research is being carried out to help medical professionals get a better understanding of the disease, but until there is no conclusive diagnosis and treatment, the best way is effective and committed management.