What Is Chronic Fatigue Syndrome?

Excerpted from
From Fatigued to Fantastic!: A Proven Program to Regain Vibrant Health, Based on a New Scientific Study Showing Effective Treatment for Chronic Fatigue and Fibromyalgia
By Jacob Teitelbaum, M.D.

What Causes CFIDS

People who suffer from CFIDS/FMS usually have a combination of several different problems. The exact combination varies from individual to individual. There are dozens of major underlying factors, with individual people displaying an average of five to six factors each.7 It is important to look for and treat all of the factors simultaneously. CFIDS/FMS are unusual in that each separate problem can trigger other problems. Because of this, it is rare to have only one single underlying problem by the time a person seeks medical help.

To use an analogy, a person with a chronic fatigue state is like an automobile with a dead battery that short-circuited the starter. If we only charge the battery, the car will not run. If we only repair the starter, the car will not run. However, if we both charge the battery and repair the starter, the car will be fine. In the same way, if we treat all of a CFIDS/FMS patient's problems simultaneously, the person will feel well!

Some Common Patterns of Chronic Fatigue Syndrome

Many common subsets and patterns are seen in severe chronic fatigue states. They include infections (what I call the drop-dead flu), disrupted sleep, and hormonal problems, including what I call the autoimmune triad.

Infections - The Drop-Dead Flu

The most notorious pattern seen in severe chronic fatigue states is one in which a person who is feeling fine suddenly comes down with a brutal flu-like illness that never goes away. The sudden onset of the illness after an infection is a mark of this classic pattern. In most of these CFIDS patients, an underlying viral or other infection is suspected. These infections can suppress the hypothalamus, located in the brain. Hypothalamic dysfunction is common in chronic fatigue states.

What happens when the hypothalamus is injured? The hypothalamus is the body's master gland. It controls most of the other glands, including the adrenal, ovarian, testicular, and thyroid glands. If the hypothalamus is suppressed, the individual will often have a subtle but disabling decrease in the functioning of several of these glands. However, a person can experience fatigue and flulike symptoms from suppression of the adrenal glands alone.

For most people, the suppression of the hypothalamus ends when the flu is over. Dr. William Jefferies, a retired endocrinologist and assistant professor of medicine at Case Western Reserve University, has theorized that people who remain chronically ill after an infection have long-term, sometimes permanent, hypothalamic suppression. He has found that treating such patients with adrenal hormone (in doses that are normal for the body) can safely bring about marked improvement. My research supports his findings.

What happens if the adrenal gland no longer functions properly? In severe cases, people have gone into shock and died from even minor stresses, such as dental work. In most cases, however, the suppression is less severe. Dr. Jefferies discusses adrenal suppression in his excellent 1996 monograph, Safe Uses of Cortisol. He explained that the flu causes suppression of adrenocorticotropic hormone (ACTH), which is the hormone that causes the adrenal gland to make adrenal hormone. If the adrenal gland is suppressed-that is, if the adrenal gland does not make sufficient adrenal hormone-a variety of fatigue symptoms result. When Dr. Jefferies gave fatigue and flu patients low doses of adrenal hormone, the flulike symptoms often improved markedly.

Even though a gland is underactive, a blood test can often (I believe mistakenly) suggest that the gland is technically normal, albeit in the low range (more on this in later chapters). This is why patients are often told that their thyroid or adrenal glands are healthy when indeed they are not. Because of this, doctors must know how to correctly interpret blood tests and how to identify subclinical hormonal deficiencies.

The drop-dead flu also causes many people to develop poor immunity, facilitating repeated bladder, respiratory, or sinus infections. I have found that patients who then take repeated courses of antibiotics for any reason often end up with an overgrowth of yeast in the bowel. Bowel parasites and other infections are also common in CFIDS patients. Some of these infections can sneak up on you slowly. Suppressed hypothalamic function from chronic infections can then trigger disordered sleep.

Poor Sleep

Fibromyalgia is basically a sleep disorder associated with shortened, achy muscles that have multiple tender knots. Trying to sleep on the tender knots is like trying to sleep on marbles. In addition, the day/night cycle is confused, leading the brain to be wide awake and thinking, "Its morning!" just about the time one goes to bed. Because of this, people with fibromyalgia have trouble staying in the deep, restorative stages of sleep (stages 3 and 4) that recharge their batteries. Instead, these people stay in the light sleep stages (stages 1, 2, and REM) and often wake up repeatedly during the night. Some of us joke that there's an invisible alarm clock set for 3:00 to 4:00 A.M. that can be heard only by people with fibromyalgia! They finally fall fast asleep just before the alarm clock is set to ring. In essence, fibromyalgia sufferers may not have slept effectively for several years. When normal sleep patterns are restored, they feel much better. Please note, however, that most sleeping pills-especially benzodiazepines, such as diazepam (better known by its brand name, Valium), triazolam (Halcion), and flurazepam (Dalmane)-actually worsen deep sleep.

I suspect that poor sleep further suppresses the hypothalamus. Poor sleep can then cause immune suppression, with secondary bowel infections. The bowel infections seen in chronic fatigue can cause decreased absorption of nutrients and may prompt increased nutritional needs, which in turn can lead to vitamin and mineral deficiencies. The hormonal and nutritional deficiencies cause the fibromyalgia to persist, and the fatigue cycle thus continues.

Many people enter the fatigue cycle directly through disrupted sleep. Fibromyalgia can be triggered by anything that suppresses the hypothalamus, disrupts sleep, or causes tight muscles. These include a trauma, such as an accident; a parasitic or other infection; chronic emotional or physical stress; hormonal imbalances; and/or recent childbirth. It can also be triggered by a number of other problems, such as an anatomic problem (for example, having legs of different lengths) or temporomandibular joint (TMJ) syndrome, which is characterized by tenderness and clicking in the jaw.