Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), is a complex and often misunderstood condition characterised by persistent, unexplained fatigue that doesn’t improve with rest. It’s a challenging condition for those suffering with it because historically those suffering from it have been viewed with suspicion or outright cynicism – often they are accused of making up the condition. In addition to having to deal with this stigmatising behaviour many with CFS face a difficult road back to health. There is a broad spectrum of severity of symptoms but for those who suffer with severe CFS, even something as simple as walking downstairs to the kitchen and back can leave them utterly exhausted. Many sufferers spend most of their time confined to their bed with a “normal” life feeling unobtainable. While the exact cause of CFS remains open to debate, this article will look at some of the areas that have been explored in research. This is challenging since CFS is a systemic health issue with often an array of complex symptoms and thus likely not to have a single cause. This would explain why many people suffering from CFS struggle to recover. This article will aim to give you an idea of some of the key systems affected in CFS and to look at some of the underlying mechanisms.
Functional medicine looks at CFS as a multifactorial condition, meaning that its causes could stem from various systemic dysfunctions, rather than a single, identifiable pathology. From this perspective, the body is seen as an interconnected system, and imbalances in one area could trigger a cascade of other problems, leading to chronic fatigue. Here are several mechanisms theorised to contribute to CFS based on current research:
Immune System Dysfunction
There seems little doubt that CFS is associated with immune system dysregulation. Research has indicated that individuals with ME/CFS often exhibit heightened immune responses, such as inflammation or the activation of cytokines, which are molecules that help regulate immune responses. These immune system imbalances could lead to chronic low-grade inflammation, which might be a key factor in the fatigue and pain experienced by those with CFS.
Studies from UK researchers have explored the idea that CFS may share common pathways with autoimmune conditions. In these conditions, the immune system mistakenly attacks the body’s own tissues. The dysfunction in immune signaling might impair the body’s ability to repair itself or recover from illness, contributing to the persistent fatigue.
Mitochondrial Dysfunction
The mitochondria are the powerhouses of our cells, responsible for producing energy. A number of studies have pointed to mitochondrial dysfunction as a possible cause of the overwhelming fatigue in CFS. In a functional medicine context, this is often referred to as energy dysregulation at the cellular level. Research from the UK has suggested that people with ME/CFS might have mitochondrial damage or dysfunction, leading to an inability to generate sufficient energy for normal bodily functions. This energy deficit could explain why physical or mental exertion exacerbates the symptoms of CFS.
This theory also ties into metabolic disturbances that have been observed in some patients, suggesting that the body is unable to properly utilize nutrients or oxygen to fuel cellular processes, leading to the characteristic exhaustion and muscle pain.
Neurological Dysfunction
Another theory gaining traction is that CFS involves abnormalities in the brain and nervous system, particularly in how the body perceives and processes fatigue. Dysregulation in the autonomic nervous system (ANS), which controls involuntary body functions such as heart rate and blood pressure, may be a key factor in CFS. Dysfunction in the ANS could contribute to the fluctuating energy levels and cognitive dysfunction seen in CFS patients.
Research from UK-based studies has shown that individuals with CFS often report symptoms consistent with dysautonomia, such as dizziness, lightheadedness, and an inability to regulate body temperature. The autonomic nervous system may also play a role in the “brain fog” commonly experienced in CFS, which includes symptoms like poor concentration, memory problems, and confusion.
Chronic Infections
Many sufferers with CFS report the beginning of their illness being precipitated by a period of illness. Given that most of us experience illness at various points throughout our lives, this begs the question why do some people have trouble recovering from their illnesses? It would seem to again point to their being multiple triggers.
There are some viruses and pathogens which have been commonly linked to the development of CFS. These include:
Emotional and Psychological Impact
Living with an autoimmune disease can take an emotional toll. The chronic pain, fatigue, and unpredictability of symptoms can lead to feelings of frustration, anxiety, and depression. Additionally, the impact on physical appearance—such as rashes, hair loss, or joint deformities—can affect self-esteem and body image.
Living with auto-immune conditions can be extremely challenging and lonely, especially for those who are unsure where to turn for support. If you, or someone close to you, would like to discuss the health challenges you are experiencing please get in touch here (link to contact page).
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Gut Microbiome Imbalance
The role of the gut microbiome in overall health has become a major focus of research in recent years. There is growing interest in how the gut microbiome may influence systemic inflammation and immune function. Imbalances in the gut flora could contribute to dysregulation of the immune system, which, as mentioned earlier, is a key theory in the development of CFS.
Some studies suggest that the microbiome in people with CFS may differ significantly from that of healthy individuals, particularly in relation to the diversity and balance of microbial species. Research has also indicated a potential link between gut health and neurological symptoms, supporting the idea that a dysfunctional gut-brain axis might be involved in the development of CFS.
Hormonal Imbalances
Another potential mechanism underlying CFS is hormonal dysregulation. The body’s endocrine system, which produces hormones to regulate various functions, is almost certainly disrupted in CFS patients. For instance, research has shown abnormalities in cortisol levels, which is the hormone responsible for managing stress. Chronic stress, which can be both physical and psychological, might lead to persistent high or low cortisol levels, disrupting the body’s natural rhythm and contributing to fatigue.
Additionally, thyroid dysfunction has been observed in some CFS patients, which can also lead to fatigue, weight changes, and cognitive impairments. Imbalances in sex hormones, such as estrogen and progesterone, may further exacerbate fatigue, especially in women.
Emotional Trauma as a Trigger
Emotional trauma is increasingly recognised as a potential trigger for CFS. Trauma—whether physical, emotional, or psychological—can have long-lasting effects on the body’s stress response system. Traumatic events, such as abuse, a history of chronic stress, or a significant life event, can overwhelm the body’s ability to cope, leading to systemic imbalances.
Emotional trauma may lead to dysregulation in the autonomic nervous system (ANS), contributing to symptoms of CFS like brain fog, fatigue, and dysautonomia. It can also cause long-term stress responses, affecting the immune system, hormonal balance, and the body’s ability to recover from illness or exertion. There is a growing body of research that shows a link between trauma and chronic illness. People who have experienced significant emotional or psychological trauma may be more likely to develop CFS or experience a worsening of symptoms.
Studies have noted that the chronic activation of the stress response can create a vicious cycle in which the body remains in a heightened state of alertness, further depleting energy reserves and exacerbating fatigue. Emotional trauma may also influence the gut-brain axis, further compounding the physical and psychological challenges faced by those with CFS.
Chronic Fatigue Syndrome is a multifaceted condition with complex underlying mechanisms. It is key in understanding CFS to appreciate the interplay between the immune system, metabolism, neurological function, emotional trauma, and environmental factors. Functional medicine approaches of treatment aim to address all of these interconnected factors and systems in order to direct those suffering with CFS towards healing and recovery.
If you or someone you know, has been suffering with CFS and would like any further advice please feel free to contact us here.
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