Part 1: Chronic Fatigue Syndrome - What is it & what causes it?
Are you constantly feeling exhausted, despite getting enough bed rest? Do you struggle to stay focused and alert even when doing things you love? If your answer to the question is yes, it is time to consider that you might not be just tired. You may be one of the millions of people worldwide who suffer from Chronic Fatigue Syndrome (CFS), a highly misunderstood and often overlooked condition.
This debilitating condition can leave you feeling drained, both physically and mentally, and can have a profound impact on your quality of life. But don't despair! With the right treatment and support, it is highly possible to manage the symptoms of CFS and regain control of your life.
What is Chronic Fatigue Syndrome (CFS)?
Chronic Fatigue Syndrome (CFS) is also known as myalgic encephalomyelitis (ME) which is a complex multisystem disease characterised by overwhelming fatigue, cognitive dysfunction and sleep problems which can affect activity of daily living.
There are three core symptoms to diagnose CFS:
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Significantly reduced ability to do usual daily activities. This comes along with fatigue and must last six months or longer. The fatigue level can be severe, not relieved by rest or sleep and is not caused by unusually exhausting activity.
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Post-exertional malaise (PEM), which means the exacerbation of existing symptoms and reduction in function after minimal physical or mental activity. Many refer to this as a “crash” or “payback”. While this may vary among individuals, most of those affected by CFS will find themselves experiencing atypical exhaustion after any physical or mental activity that caused no problems before the condition.
For example, simple activities such as taking a short stroll in the park, getting coffee with a friend, or finishing this article- which many of us take for granted- have now become either impossible or would take an enormous toll on their energy levels. The onset of PEM may be postponed, creating difficulty in predicting the level of physical activities that can be tolerated per day. The symptoms typically get worse 12 to 48 hours after the activity and can take days or even weeks to recover. Sometimes patients can be house-bound or even completely bed-bound during crashes. -
Sleep problems. You may not feel better or refreshed, even after a full night of sleep. Some people can have problems falling asleep or staying asleep.
Besides these three core symptoms, one of the following two symptoms is required for a diagnosis of ME/CFS:
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Cognitive impairment - Problems with thinking, memory or executive functions. Most patients have trouble thinking, remembering things, and focusing on details which they often described as “brain fog” because they feel “stuck in a fog” and not able to think clearly.
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Orthostatic intolerance - Worsening of symptoms upon maintaining upright posture when standing or sitting. The symptoms include lightheaded, dizziness, weak, or fainting while standing or sitting up. Some may have vision changes like blurring or seeing spots. These symptoms can be improved by lying down or elevating the feet.
Other common symptoms include:
- Muscle and joint pain
- Headaches
- Sore throat, swollen and tender lymph nodes
- Sensitivity to light, sound, and odour
- Digestive issues such as constipation, diarrhea, and nausea
Given that CFS is a multifaceted illness that impacts different body systems, it is not surprising that there is a constellation of symptoms associated with it. However, it is crucial to acknowledge that not all individuals with CFS will encounter the same symptoms, and one does not necessarily need to experience all of them to receive a diagnosis of CFS.
What causes Chronic Fatigue Syndrome (CFS)?
You might have heard many refer to CFS as the disease of a fast-paced 21st century as it is commonly associated with stress. However, the unfortunate truth is we don’t know what causes CFS- at least not yet. CFS affects individuals of all ages, genders, ethnicities, and socioeconomic backgrounds. Noteworthily, a majority of individuals affected by the disease, approximately 75-80%, are female and mostly affect the age group between 40 and 70.
For some individuals, CFS may be caused abruptly by an infection, toxic exposure, immunisation, anaesthetic, or physical trauma like a car accident. On the other hand, in some people, CFS can gradually develop over an extended period of months or even years and some speculate this could be due to prolonged stress, weakened immune system, and hormonal imbalances. Despite the uncertainties, what we do know is that CFS is a physical illness with biological causes, it is not a result of lack of fitness or poor mental health.
This article is written by Ke Feng, Bpharm(Hons) DOC2US,
reviewed by Dr. Lee Siew Ling, MD (DOC2US)
References:
- Better Health Channel. (2022). Chronic Fatigue Syndrome (CFS). Retrieved from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chronic-fatigue-syndrome-cfs
- HealthDirect. (2022). Myalgic Encephalomyelitis (ME) / chronic fatigue syndrome (CFS). Retrieved from https://www.healthdirect.gov.nau/chronic-fatigue-syndrome-cfs-me
- Centres for Disease Control and Prevention. (2023). Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome. Retrieved from https://www.cdc.gov/me-cfs/index.html
- Sapra, A. (2022). Chronic Fatigue Syndrome. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK557676/#!po=98.4043
