Myalgic Encephalomyelitis (Chronic Fatigue Syndrome)

Chronic fatigue syndrome is a chronic illness characterized by symptoms such as severe fatigue, difficulty thinking clearly, and pain. Although CFS is estimated to be fairly common (some sources suggest it affects 1 in 100 people), many individuals remain undiagnosed due to the condition’s unclear cause, varying symptoms, and inadequate treatments.^[1][2]

The symptoms of CFS can be unpredictable, and may improve or get worse over time. Common symptoms include:^[3]

• Severe fatigue that doesn’t improve with rest
• Sleep disturbances
• Difficulty thinking/concentrating
• Pain
• Dizziness (especially after standing up)
• Gastrointestinal discomfort
• Postexertional malaise (i.e., The worsening of symptoms following relatively small amounts of physical or mental effort.)

There are no definitive diagnostic tests for CFS, so diagnosis is mainly centered on identifying the characteristic signs and symptoms after ruling out other possible conditions (e.g., hypothyroidism, anemia, lupus erythematosus, cancer).^[1]

There are no medical treatments that target CFS directly; they focus exclusively on managing symptoms. Not all symptoms have good treatment options (e.g., postexertional malaise), but there are medications for sleep issues (e.g., trazodone, benzodiazepines, antihistamines like Benadryl), cognitive issues (e.g., stimulants), and pain (e.g., nonsteroidal anti-inflammatory drugs, muscle relaxants, cannabis).^[1]

There are many supplements that are mechanistically compelling for CFS, but there’s very little high-quality research on this subject. Currently, the most promising supplements include magnesium, l-carnitine, and s-Adenosyl Methionine. Some supplements, such as probiotics, dark chocolate, and NADH, may improve symptoms of CFS (notably fatigue), but aren’t likely to improve the condition itself.^[4]

If individuals experience gastrointestinal discomfort, it is recommended that they avoid ultraprocessed food (although there isn’t much evidence to directly tie ultraprocessed foods to CFS) and experiment with removing potentially problematic foods (e.g., caffeine, alcohol, spicy foods, dairy, gluten).^[1]

Because mental and physical effort can worsen symptoms, it’s important for people with CFS to pace themselves. Ideally, individuals should aim to estimate their energy levels/tolerance for certain activities, and plan out their days to avoid overexertion.^[1][2]

There are many symptom-oriented options for CFS, although the degree to which they help individuals may vary. Such options include meditation/mindfulness, light therapy, behavioral changes (e.g., memory aids), physical therapy, massage, acupuncture, and neurofeedback.^[1]

The cause of CFS is still very much debated. Currently, the prevailing attitude is that CFS is fundamentally a neurological condition — individuals with CFS show subtle but distinct changes to cognition (e.g., slower information processing, reduced working memory, and poor learning). That said, CFS still lacks characteristic signs (neurological, immunological, or otherwise).^[2]