What is chronic fatigue syndrome and how is it treated?

Chronic fatigue syndrome (CFS) is a health disorder characterized by prolonged fatigue that does not resolve even after prolonged rest.

The factors that promote the disorder onset are an imbalance of the emotional and mental with the lack of physical activity.

At risk are people who live in large cities, entrepreneurs, people with increased responsibility, for instance, medical workers, air traffic controllers, police officers, and so on. The predisposing factors are unfavorable environmental conditions, chronic diseases including viral infections. The major signs of the disease during flare-ups are apathy, depression, anger outbursts, aggression with partial amnesia, etc. CFS has a variable clinical picture, and it is quite problematic to identify any specific symptoms.

Nevertheless, doctors distinguish the following indicators:

- Lack of a sense of relaxation after a full night's sleep;

- Often recurring headaches for no apparent reason;

- Increased drowsiness in the daytime;

- The inability to fall asleep quickly even after intense physical labor;

- Unmotivated irritation;

- Bad mood for no reason;

- Frequent infectious diseases;

- Allergic reactions

- Decreased memory and ability to concentrate;

- Pharyngitis;

- Inflamed lymph nodes in the neck and axilla;

- Unexplainable muscle pain.

CFS is difficult to diagnose, as its manifestations are similar to those of many other diseases. The criterion for the diagnosis of CFS is chronic overwork, lasting 6 months or more, and 4-8 of the above-listed symptoms.

To date, the precise mechanisms of the disorder remain unknown. A large role is given to the deficiency of macro- and micronutrients, food allergies, excessive physical and mental stress, and viral infection.

The most convincing currently is the infectious or viral theory. According to this theory, Epstein-Barr virus, cytomegalovirus, herpes simplex virus type 6, Coxsackie virus, hepatitis C, enteroviruses, and retroviruses can serve as trigger factors for CFS. The debut of CFS is often associated with an acute flu-like illness. The data on the high detection rate of herpes viruses and signs of their reactivation are also convincing. The possibility of the existence of a still unidentified virus (most likely, from the group of herpes viruses) that causes CFS, is not completely ruled out, while other known viruses (EBV, CMV, HHV-6, etc.) can play a secondary role by reactivating against the background of violations of the immune status and supporting them.

Numerous data indicate that in CFS both quantitative and functional immunological disorders are observed.

In some works pathogenesis factors are discussed:

- Increased lactic acid formation in response to physical activity,

- Violation of oxygen transport to tissues,

- A decrease in the number of mitochondria and their dysfunction in patients with CFS.

Symptoms of CFS and fibromyalgia are believed, at least in part, to be due to impaired cellular metabolism. As a result of studies of patients with CFS, a clear link was established between the level of L-carnitine in blood plasma and the risk of CFS. It was revealed that the degree of L-carnitine deficiency is directly related to the severity of symptoms of CFS. That is, the less L-carnitine (and its esters) is contained in human blood plasma, the lower its performance and health.

Scientists also believe that the cause of CFS can be a change in the balance of bacteria in the intestine. According to Columbia University, 90% of people with CFS have irritable bowel syndrome. And 80% of them exhibit deviations in the contents of the following seven intestinal bacteria: Faecalibacterium, Roseburia, Dorea, Coprococcus, Clostridium, Ruminococcus, Coprobacillus.

Other causes of chronic fatigue syndrome:

- Chronic diseases causing a malfunction of the immune system.

- Psychological and mental disorders - frequent depressive states, a sense of anxiety and fear, regular stress. According to some authors, CFS is the result of only psychiatric pathology: somatized disorders, "major" or atypical depressions.

- Improper lifestyle - lack of sleep, prolonged overstrain, insufficient exposure to the sun and/or lack of fresh air, lack of exercise, an irrational regime of the day.

- Eating disorder - starvation/malnutrition or overeating, malnutrition (hypo/vitamin deficiency, lack of macro and micronutrients).

- Environmental factors - residents of megacities have a higher risk of chronic fatigue syndrome than others since a polluted environment affects the general condition of the body.

How is chronic fatigue treated?

The condition requires a multifaceted approach for beneficial treatment results.

First of all, a patient should be correctly diagnosed to exclude any serious conditions that require specific treatment. If there are such conditions that can result in chronic fatigue, for instance, diabetes, cancer, vascular diseases, and so on, they should be addressed first. In most cases, when the underlying diseases are taken under control, chronic fatigue also goes away.

If there are no underlying conditions, the following treatment methods are implemented:

- Normalization of sleep;

- Incorporation of physical exercises in daily routine;

- Diet (chosen based on the individual intolerance of certain products, generally healthy diet);

- Meditation, psychotherapy, and other methods of normalization of psycho-emotional background;

- Treatment of chronic diseases that may be causing insufficient oxygen supply, for instance, chronic nasal congestion;

- Use of medicines (wakefulness-promoting drugs, antihistamines, sorbents, or others based on the tests.

What stimulants can you use to cope with daytime sleepiness in chronic fatigue?

Chronic fatigue commonly is characterized by excessive daytime sleepiness and loss of productivity which is why stimulants or wakefulness-promoting drugs are advised to be used.

The majority of people around the world chose caffeine as the cure for sleepiness but it is better to opt for a more medically-justified and less harmful substances, for instance, Modafinil.

Modafinil is a drug that is designed to treat narcolepsy, i.e. unbearable daytime sleepiness caused by the violated sleep-wake cycle regulation. The medication is also prescribed for sleepiness related to sleep apnea and shift works. It is also used off-label for numerous disorders, including chronic fatigue, and also in individuals who do not suffer from any diagnosed conditions but still are sleepy during the day, find it difficult to focus, and so on.

The reason this drug is suitable for so many conditions is because it gently promotes the natural mechanisms of wakefulness promotion, rarely causes adverse effects, have a few contraindications for use, doesn’t cause addiction, and can be used for extended periods of time as it had been tested for long-term effects in people with narcolepsy who need to take stimulants throughout all of their lives.

See the comparison of adverse effects and contraindications for caffeine and Modafinil