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Is Chronic Fatigue Such a Complete Mystery?

Publication date: 13 May 2012

This week (in the UK at least) has been ME Awareness Week. ME is Myalgic Encephalomyelitis, a syndrome characterised by strong mental and physical fatigue as well as other neurological symptoms. It's also known as Chronic Fatigue Syndrome (CFS). CFS/ME is still a controversial diagnosis, as some doctors apparently don't recognise it as a real illness, or think it's really just depression. In articles about chronic fatigue you commonly read that no-one knows what causes it and there are no known cures.

And that's even amongst supporters and campaigners - see this as an example: ME Awareness Week.

But is it really true?

Actually I think behind such beliefs is a significant misconception: that chronic fatigue or ME is a single, distinct pathological entity, that is the same in everyone diagnosed. If it were, it might be reasonable to look for "the cause" (meaning a single cause).

In reality chronic fatigue is a symptom, or set of symptoms. Why should we assume that the same thing is going on in everyone with chronic fatigue? Like most other chronic illnesses, there can be multiple causal factors - even in a single individual. (Which is not to say that CFS doesn't exist.)

In speaking of causes it's important to distinguish between antecedents and mediators. In chronic fatigue, a mediating cause could be mitochondrial damage (mitochondria are the energy-producing structures in all our cells). On another level, a viral infection can be a cause in the sense of being (a variant of CFS is post-viral fatigue syndrome).

If you start from the assumption that the cause of CFS must be present in all its sufferers, well it isn't surprising it hasn't been found yet.

So we do know some of the causal factors and imbalances underlying chronic fatigue. Here are some more examples:

  • Nutrient deficiency (e.g. Iron, vitamin B12);
  • Hypothyroidism;
  • Adrenal weakness.

You might argue that if an ME sufferer has these, then it's simply a misdiagnosis. ME that can be "cured" by supplementing iron or thyroid hormone is not really ME. But what if all these causes are present at the same time? And there are other causal factors besides, such as  a compromised or permeable gut lining? Taking iron supplements isn't going to cut it.

In practice, even these individual factors are controversial because they aren't black and white. Just how slow does a thyroid have to run before it's considered (significant) 'hypothyroid'?

In my practice I see a lot of people with fatigue as their major symptom (though they may not have been diagnosed officially). And I do see them making significant improvements - though I never use the C word ("cured") myself.

I think the approach that works best is to identify (objectively as far as possible) as many of the interacting causal factors as possible, ranging from biochemical and nutritional, to physiological and hormonal, to psychological and social, and then to address them with possibly multiple therapeutic interventions. This is the way of Functional Medicine. (I think Functional Medicine has got a big future ahead of it.)

All of this is not to deny there's still an awful lot we don't understand about chronic fatigue, or that a lot more research is needed. But certainly I think the situation is not hopeless for CFS sufferers.

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