Chronic Fatigue Syndrome: At Last a Biological Insight Into the Disease

It’s a condition that blights the lives of possibly as many as four million Americans, but the medical community still knows relatively little about Chronic Fatigue Syndrome (CFS) and whether it is purely psychological or at its heart can be traced to a physical cause.

Now, new research published in Science Advances, sees doctors identify key differences in the immune systems not just of people who have CFS, but also differences between those who are newly diagnosed and those who have had the condition for a number of years.

The Columbia University researchers identified a group of molecules, including the cytokine molecule in particular, that appears to be present in much higher quantities for CFS sufferers. These molecules are involved in the body’s immune response to infections, with cytokine previously linked to the fatigue caused by the Epstein Barr Virus. That’s not to say that CFS is linked to that same virus, but rather that there may be “biomarkers,” things that we can look for in a person’s body, to better identify if they have CFS. As diagnosis of CFS can be very difficult, that prospect alone is something that is encouraging.

But What is Chronic Fatigue Syndrome?

That’s a good question. There is still no firm diagnostic criteria for CFS or myalgic encephalomyelitis (ME) as it is sometimes known (for clarity, we’ll stick with CFS). In general, people may first present to their doctors saying that they are unable to do the things in their daily routine that before they became ill were effortless or required very little exertion. That sense of fatigue can also be characterized by the fact that even with bed rest the physical and mental feeling of being exhausted doesn’t go away. At its worst, CFS can leave people bedridden and unable to perform anything but the most simple of tasks like dressing themselves.

While currently there are no standardized diagnostic frameworks, the Centers for Disease Control notes that a CFS diagnosis usually hinges on three main criteria:

  • The patient should have suffered from chronic fatigue for more than six months with no other medical causes of fatigue being present.
  • The fatigue should significantly impact day to day life–for instance, many people with CFS find that holding down a job can be difficult.
  • The patient should have four or more of the following symptoms: needing to recover after exertion for more than 24 hours, finding sleep does not reinvigorate, significant memory and cognitive “fuzz” or impairment, muscle pain as well as joint pain and swelling and redness, headaches, tender lymph nodes, and/or a persistently sore throat.

Those symptoms must have been present for more than six months to be counted as part of this diagnosis.

There are a number of other symptoms that might accompany CFS, and you can find out more here.

Recently, the Institute of Medicine proposed a new name and definition for CFS. They want to call it “systemic exertion intolerance disease.” This may sound long-winded but it is an attempt by the institute to put the focus on CFS’ key facet: the so-called post exertion malaise that nearly all patients experience. The change in name has caused some upset however among those who are keen to look at CFS ‘biological underpinnings because they say that, yet again, the disease is being framed almost exclusively as a psychological disorder when the research seems to be saying that CFS is more complicated than that.

Who Develops Chronic Fatigue Syndrome?

Technically, and per our understanding at this moment in time, it seems that anyone can develop CFS but there are certain factors that makes a person more likely to develop the disease. Women are around four more times likely to suffer than men, and CFS usually strikes adults over 40 rather than younger people and children, and even among children who do develop the condition it is usually adolescents that will present with CFS and not those under 10. There appears to be no racial predisposition to CFS, meaning that all races seem as likely to develop it as the others.

As evidenced above, it has long been thought that there is an underlying biological cause to CFS and as such there could be a genetic link which makes it more likely to be passed on from parents to children, but the research on that is still relatively small and we can’t yet draw firm conclusions as to the precise risks.

What is the Treatment for Chronic Fatigue Syndrome?

There is no cure for CFS and, as you may have gathered from the fact that CFS can present with such varied symptoms, treating those symptoms can require multiple approaches. This can be frustrating for sufferers who may have to wait a long time before they find a treatment program that can help them.

As such, news that researchers have potentially been able to identify certain biomarkers that could underpin the illness is welcome for people living with CFS because it means that for new patients a quicker diagnosis may be possible in the relatively near future, and ultimately this finding could finally point a way to a more exacting treatment that could help people with CFS manage their condition more easily.

Photo credit: Thinkstock.


Emily J.
Emily J1 years ago

Thanks for sharing, very interesting article!

Emily J.
Emily J1 years ago

Please sign this petition, this young woman's human rights are being violated and she's being denied appropriate medical care for her ME

Siyus Copetallus
Siyus Copetallus2 years ago

Thank you for sharing!

Phoebe B.
Phoebe B2 years ago

Thank you for this article - the more this misunderstood illness is in the news, the better.

Here is a link to the comprehensive new report from the U.S. Institute of Medicine that debunks inaccurate outdated information:

Because the symptom "chronic fatigue" is a symptom shared by many other illnesses, the proposed new name Systemic Exertion Intolerance Disease (SEID) is especially welcome because it reflects the unique reality of ME/Chronic Fatigue Syndrome.

The cardinal symptom Post-Exertion-Malaise (PEM) means that over-exertion leads to a whole-system collapse that can last for days or even weeks. This bears no resemblance to a healthy person's tiredness that's relieved by a good night's sleep.

Aerobic exercise, activity and exertion improve normal healthy people; but these things severely worsen people who have the debilitating multi-system illness ME/CFS.

It is crucial to understand this, because ME/CFS patients can manage this chronic illness by being aware of their own unique energy envelope and staying within it. Every patient can design their movement/activity/rest routines with this in mind, and maintain stability as much as is possible for them.

Though this so-far incurable illness significantly curtails their previous activities, they can slowly rebuild as much health as is possible and deal with the challenge of forming a new kind of satisfying life.

Ree O.
Ree O3 years ago

It's good to know that there is in fact proof it is a biological/physical illness and hopefully now people can be diagnosed more quickly and, as it is now recognised as a physical illness, the public may treat those with CFS as having an illness. Mind you, with most invisible illnesses, this may not change.

Gerald L.
Gerald L3 years ago

Nikki D; so many MD's prescribe Anti-Depressants labelling the patient as depressed.

Nikki Davey
Nikki Davey3 years ago

Like so many conditions where there is not an option for drug companies to profit, there is very little meaningful research into treatment.

ERIKA S3 years ago


Danuta Watola
Danuta W3 years ago

Thanks for sharing!