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Part 2: Understanding the Symptoms: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

In this post, I review the literature on the pathophysiology specific to CFS/ME to look at what’s going on at the cellular level – why do patients have particular symptom clusters? Even though FM has its own diagnostic criteria, recall from last week’s post that the pain experienced in CFS/ME patients can sometimes meet the criteria for FM. The conditions are often found together, so although I focus on CFS/ME, it may be relevant for FM patients too.

Etiology – How does it all start?

Short answer: it’s unknown. It’s been estimated that in 50-80% of ME/CFS patients there was a precipitating infection, whether it was viral, bacterial, or parasitic. Instead of recovering, they get progressively worse. For FM, onset of symptoms can be usually traced back to a physical or emotional trauma.

But – many people get infections and/or experience trauma and recover just fine. Why not them? It’s been proposed that it’s a combination of factors that lead to the development of disease: nutritional status, types of gut bugs living in the gut, stress levels, genetic predisposition, environmental factors, strength of initial infection, etc.

Review of Literature

Immune System in Disarray

To put simply, the immune system doesn’t function normally, being over-active in some areas or situations, and under-active in others. For specifics:

-Increase in T-Helper 2 immune cells – resulting in hyper-reactivity of the immune system making patients more likely to be sensitive to food, chemicals, medications, etc.

-Low Natural Killer cells – these are a part of our innate immune system that float around and protect us from infection – so patients are more vulnerable to infection.

-High levels of Cytokines – As an over-simplification, consider cytokines as things secreted by immune cells that cause inflammation.

-They’ve noticed a pattern with ME/CFS patients: those with a new diagnosis had more variation in the types of cytokines secreted, whereas those who’ve been ill longer had less variation.

Post-Exertional Malaise = worsening of symptoms or inability to function after physical or mental exertion that had previously never been an issue prior to diagnosis. It can take days, weeks, or even months to recover. Here are the different hypotheses/findings:

-Muscles have impaired oxygen uptake and increased lactic acid production

-Mitochondrial dysfunction - There’s an impairment in generating energy (ATP) which is necessary for the functioning of every cell in the body.