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September 15, 2011 at 8:41 AMComments: 14 Faves: 0

7 Possible Causes of Chronic Fatigue Syndrome

By Dr. Jeff Chamberlain, MD More Blogs by This Author

Those with Chronic Fatigue Syndrome (CFS) bear the unfortunate burden of a condition that though severely debilitating, has no real outward signs and no certain cause. Many are harassed by friends and family that think they are simply depressed or lazy, or that it’s all in their head.  Some look at them and think “They don’t look sick to me!” 

It’s certainly a condition with a lot of confusion around it.

However, I’d like to make it clear that despite uncertainty, CFS is a real condition. A lot of research effort has gone and is going into discovering the possible causes of chronic fatigue.  Though there are no certainties today, there are 7 potential causes that are receiving a lot of attention.

1. Viral Illness and Chronic Fatigue

The idea that a virus may be the cause of chronic fatigue syndrome has some intense interest in the medical community.  Proposed viral causes include:

  • Epstein Barr Virus,
  • Retroviruses,
  • HHV-6  (human herpesvirus type 6),
  • Enteroviruses,
  • Coxsakie B virus,
  • Ross river virus,
  • Borna disease,
  • XMRV (xenotropic murine leukemia virus-related virus )and
  • MLV (murine leukemia virus).

However, none of these have enough evidence linking them to CFS to convince researchers any are the cause at this point.

2. Immune Deficiency and Chronic Fatigue

Researchers have found some small immune differences in patients with CFS, however, the differences are not substantial enough to be thought a significant cause.

3. Endocrine Metabolic-Dysfunction and Chronic Fatigue

Similar to those with fibromyalgia, the following signs of endocrine or metabolic abnormalities have been found:

  • Low Serum Cortisol and Corticotrophin-Releasing Hormone Levels – Can cause fatigue, weakness, low appetite, diarrhea, weight loss, dizziness associated with low blood pressure and reproductive effects.
  • Increased Serotoninergic Activity - Can cause increased heart rate, shivering, sweating, dilated pupils, tremors or twitching, high blood pressure and fever. 
  • Enhanced Serum Levels of Insulin-Like Growth Factor –  Can cause low blood sugar levels, nausea, hunger, nervousness, cold clammy skin, rapid heartbeat, numbness of the fingertips or lips, trembling, mood changes, confusion, weakness, blurred vision or dizziness, difficulty walking or talking, fatigue, weight gain and other effects on the metabolism.

However, because these findings are not unique to CFS, being shared by people with fibromyalgia and some syndromes with atypical depressive features, it is felt some other factors must come into play.

4. Neurally-Mediated Hypotension (The Fainting Reflex) and Chronic Fatigue  

A few studies show an overwhelming majority of patients with CFS have neurally mediated hypotension, a condition which causes blood pressure to drop inappropriately causing dizziness, nausea and fainting. However, these studies were not placebo controlled, blinded or randomized, so the role of neurally-mediated hypotension remains uncertain.

5. Depression and Chronic Fatigue

Depressions link to CFS is a topic of intense debate.  People with CFS are understandably up in arms as they have long been battling the idea that they are just depressed and that the physical weakness and fatigue they experience is “all in their heads”. With studies showing 2 out of every 3 paitients meet depression criteria however, there is a clear link between depression and CFS. Yet, whether this is a cause or an effect of CFS remains to be seen.

6. Sleep Dysfunction and Chronic Fatigue

The results of one small study showed that people with CFS had significantly different polysomnographic findings (results from a machine which monitors  brain waves, eye movements, muscular/skeletal movement and heart rhythm during sleep) than a control group after a night’s sleep.

Compared with the control, CFS paitients had less rapid eye movement (indicating deep, restorative sleep), lower sleep efficiency and less time sleeping overall. To make things even more interesting, these finding could not be linked to any known sleep disorders or fibromyalgia.

7. Genetics and Chronic Fatigue

CFS has been linked to certain genes dealing with immune and stress response.  Findings suggest that trouble managing stress may be linked to the development of CFS.

Though we cannot know  which of these factors, if any, are the real cause of Chronic Fatigue Syndrome today, new findings and continued studies bring great hope to the 1% of the population living with CFS and to the doctors awaiting better, more focused, CFS specific treatments to provide their patients with.

Stay Healthy,

Dr. Jeff M.D.


Gluckman, MD, Stephen J. "Clinical Features and Diagnosis of Chronic Fatigue Syndrome." UpToDate. Web. 14 Sept. 2011.

"What Are The Effects Of Low Cortisol Levels? | LIVESTRONG.COM." LIVESTRONG.COM - Lose Weight & Get Fit with Diet, Nutrition & Fitness Tools. Web. 14 Sept. 2011.

Staff, Mayo Clinic. "Low Blood Pressure (hypotension): Causes -" Mayo Clinic. Web. 14 Sept. 2011.

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  • Lots of interesting information here!

    Number 3 in particular, noting the hormonal differences, should make it clear to people that there really is something go on physically with CFS. The symptoms those changes can cause make a lot of sense!

  • My daughter became ill in 1997 at age 11. She withdrew from school in 1999 at age 13.
    In the years since she saw Doctors from Maryland to California and all points in between.
    Neurologists, gastroenterologists, cardiologists, immune specialists etc. etc.
    Noone could find out what was wrong so they said she had CFS/FM. When at age 19 she had a stroke they could not explain why this would happen. Since her stroke she has had several TIA's. Once again, noone could find a cause. Then in April of 2010 we finally figured it out ourselves after spending tens of thousands of dollars on umpteen specialists.
    My daughter has chronic neuro Lyme disease with many co-infections.
    She was tested many times over the years for Lyme disease. Each time the blood test came back negative. Doctors said "we don't know what is wrong but we know it is not Lyme".
    They were ALL wrong. Last year we finally found out that the blood test is not at all reliable. Also many Lyme patients never have a bulls eye rash. Many never even recall having ever been bitten by a tick. Our diagnosis was confirmed using a symptom based checklist provided online. Search for Dr. Burrascano and his 2008 report. Also watch the documentary "Under Our Skin" for more information. There are many websites devoted to Lyme disease and it's treatment. Sadly, the medical community are not aware of this.
    They continue to rely on a faulty blood test which tells them their patients do not have Lyme when in fact they do. My daughter has been on antibiotics targeting the Lyme bacteria for over a year now. We are slowly seeing some improvement in her symptoms. At 25 she lives at home and is disabled. She has many neurological problems and feels strongly that if we had not diagnosed this disease ourselves, that she would have died from it.
    We wasted 13 years of not having treatment because we relied on the Doctors and specialists who never did diagnose her condition. My daughter does have CFS. She also has FM.
    She also has a near nonexistent immune system with wbc count of 2.2 and natural killer cell count of 24. Despite the gravity of her illness she actually looks "fine" and many Doctors dismissed her illness and suggested she was depressed. They suggested that she had "school phobia". Even when her blood work obviously showed that something was seriously wrong they dismissed us and offered anti-depressants. There is one blood test that can indicate whether someone possibly has Lyme. It is called a CD-57 and it measures the natural killer cells. If you are below a certain number then you may have Lyme or one of the many co-infections of Lyme disease. If your number is in a higher bracket then you may have just CFS and not Lyme.
    Please download the symptom checklist for Dr. Burrascano and ask your Doctor to go over it with you if you have been diagnosed with CFS or FM. Also ask for the CD-57 test to be run. Do not waste 13 years like we did blindly listening to a medical community that relied on a useless blood test.

  • Catherine, thank you for sharing your story. I'm sorry you and your family had to go through that - you have been through quite the ordeal! I have a friend who has Lyme disease, and she often talks about how this disease is often misunderstood. I would be interested to see that documentary.

    I just looked up some information about Lyme, and I was surprised to discover how relatively young it is - the cause wasn't identified until 1981! I hope that a new, more reliable test for Lyme is developed soon, so other families won't have to suffer as you have.

    Thank you again for sharing your story. I would love to hear updated on how your daughter is doing. All the best!

  • Yeah, Catherine - thanks for sharing! This is really important information for others facing a CFS diagnosis!

  • Along with Laura and Erin, I agree! Thanks for sharing your story. It's good to know the seriousness of Lyme disease because many people don't understand it. And I hope your daughter is doing well!

  • Laura
    Thank you for taking the time to comment on my post.
    I don't know if or when a reliable blood test will be available for Lyme and it's many co-infections such as bartonella like organisms, ehrlichia, babesia etc.
    Somehow this story is just not being told despite the publicity for the documentary "Under Our Skin" which aired on PBS in May. Lyme and it's co-infections are bacterial infections that can be treated with antibiotics. Anyone diagnosed with CFS/FM or even MS should find a Lyme literate Doctor and go through the symptom checklist to make sure that Lyme is not an underlying factor in their illness. In it's early stages it can be treated successfully with only 3 weeks of antibiotics. In chronic mis-diagnosed cases treatment can last for years and the patient may never fully recover. There are many alternative treatments available that we use for my daughters recovery in addition to prescribed antibiotics. If only we had not been misled for 13 years by the medical community and told by multiple Doctors that she did not have Lyme disease when she did. We cannot turn the clock back and are just focusing on her recovery which will probably take years. Bartonella can weaken cell walls leading to strokes.
    Babesia can contribute to heart attacks. Our neurologist and cardiologist cannot explain why she keeps having TIA's (transient ischaemic attacks) mini-strokes, They cannot explain why she had a major stroke at age 19 which left a large scar in the cerebellum part of her brain that is clearly visible on her MRI.
    Yet they will not even consider the possibility that bacteria are contributing to these. There is a mountain of research out there. It is up to the public to educate themselves about this epidemic that is as yet unrecognized and underreported.
    I cannot emphasize enough to anyone reading not rely on a blood test to tell you whether you have Lyme disease or not. If you have a blood test that comes back negative then ask for a CD-57 test for natural killer cells. Print out the symptom checklist to take to your Doctor. Make sure that your Doctor is knowledgeable about Lyme disease and it's many co-infections. Then if you are unfortunate enough to have Lyme disease you can access the antibiotifcs that are needed to treat it. Please do not accept your diagnosis of CFS/FM without making sure that it is not caused by Lyme disease.
    Thank you again for responding. I hope that your friend with Lyme disease knows that she is not alone.

  • Your doctors may have looked into this Catherine, but I know that extremely low blood sugar - (which Dr. Chamberlain says can result with the the high levels of insulin-like growth factor they associate with CFS and FM) can cause seizures. Perhaps her hormone and blood sugar levels should be addressed?

  • Erin,
    Thank you for replying. CFS/FM are such complicated diseases. There are so many different health issues that they cause including hypoglycemia and hormone disruptors including problems with thyroid glands and adrenal glands. My daughter has been on thyroid medication and adrenal gland support for years. She also has small frequent meals to control low blood sugar. Thankfully she has never had a seizure. We are now treating the Lyme disease that is the underlying factor in her CFS/FM. For 13 years her health became progressively worse until she became disabled. Now that she hs been having antibiotic treatment for the Lyme for the past year she is gradually becoming better although it will be a long slow road to recovery. In the past year her wbc has improved from 2.2 to 3.2. This is the first improvement in her wbc in 10 years. I believe that anyone diagnosed with CFS/FM should consult with a LLMD (Lyme Literate Medical Doctor) to make sure that their CFS/FM is not caused by Lyme bacteria. As my daughter continues to be treated for her Lyme bacteria and multiple co-infections, we are hopeful that her symptoms of CFS and FM will one day be resolved. If someone has been given a diagnosis of CFS/FM they should consider the possibility that Lyme disease could be a underlying factor in their illness. If their LLMD determines that their CFS/FM is not caused by Lyme bacteria then that is good news. If however, Lyme bacteria are an underlying cause then antibiotic treatment can be considered.

  • You should really think about putting this all in a blog Catherine! This is stuff people should be aware of!

  • Catherine, your passion on this subject is truly admirable. I am so glad your daughter is starting to show signs of improvement after all these years - what a long road for you and your family.

    My friend with Lyme frequently posts links and information on her Facebook to get the word out there. Still, it seems that the vast majority of people out there are either uninformed or misinformed.

    I agree with Erin - you should consider writing all this in a blog entry. This story needs to be told!

  • I'm with Erin and Laura.

    Also, until reading your comments, I had barely any knowledge about what Lyme disease was, let alone knowing what measures a person should go to for diagnoses and treatment.

    I appreciate how open and honest you have been. It's incredible to hear your story because yours is one that others who may have gone through a similar struggle can relate to. By writing a blog about this, you could not only use it as an outlet to express what you went through, but also as a way to reach others!

  • Thank you Laura, Erin and Bri for your support and suggestions.
    This link below will take you to my daughters facebook page where there is more information if you are interested.
    It means a lot to know that you are so supportive.
    Thank you.

  • It is very unfortunate about your daughter’s medical condition. Lyme disease is an autoimmune disease that is caused by a bacteria called Borrelia Burgdorferi. Chronic Lyme disease can cause various arthritis and neurological problems.

    Borrelia Burgdorferi is carried by deer ticks. It is is epidemic in areas of the North East and northern Midwest. If you are in the forest of these areas, it is important to use insect repellent, to help prevent getting Lyme disease. Here is a link to a map that shows where deer ticks and Lyme disease are located.

    With Lyme disease, it can be difficult to separate fact from conjecture from fiction. Because Lyme Disease is a serious illness that can often present with vague symptoms, there are some people who fell into the temptation of diagnosing everyone with vague autoimmune or rheumatologic problems as having Lyme Disease.

    The two major blood tests that test for Lyme disease are not very accurate right after someone contracts the disease, but are very sensitive if someone has had Lyme disease for a while or has advanced neurologic or rheumatologic symptoms.

    Some people who are treated for Lyme disease have persistent symptoms or are slow to recover. There is currently some controversy about prolonged antibiotic use in people with persistent symptoms. Some people advocate using extremely long courses of antibiotics, in hope of treating “undetected” Borrelia Bugdorfori bacteria. At present the main stream experts on Lyme disease are against prolonged treatment with antibiotics, because: (1) to date, randomized controlled trials show that extended antibiotic use does not reduce symptoms, and (2) there are cases where the prolonged antibiotic use can cause anaphylaxis, increased incidences of C. Difficile and other medical problems. C. Difficile infections due to antibiotic use are increasingly common and can be difficult to treat. There are even cases of people at alternative Lyme treatment centers dying of C. Difficile because of the prolonged antibiotic exposure.

    If a person has Lyme disease, it is important for them to seek care from a qualified physician. For chronic Lyme disease or other autoimmune disorders, I recommend seeing a board certified Rheumatologist.

    Steere AC, McHugh G, Damle N, Sikand VK. Prospective study of serologic tests for Lyme disease. Clin Infect Dis 2008; 47:188.
    Death Due to Community-Associated Clostridium difficile in a Woman Receiving Prolonged Antibiotic Therapy for Suspected Lyme Disease

  • This is a very good post. I do, however feel like they have missed an important idea when it comes to CFS and ME. That is toxins. Toxins induce in our food, surroundings, water, and pharmaceutical drugs. My blog is beginning to document toxins in our surroundings and removal of such to reduce CFS, ME and immune hyperactive symptoms. See for more info on this. Thanks for the post. Keep up the good work. NWA

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