Chronic fatigue syndrome (CFS)
What Causes Chronic Fatigue Syndrome?
While there's no clear answer yet about what triggers chronic fatigue syndrome, CFS researchers are looking at a number of promising leads.
By Madeline R. Vann, MPH
Medically Reviewed by Lindsey Marcellin, MD, MPH
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The cause of chronic fatigue syndrome (CFS) is a big question mark for both doctors and patients. In fact, current research speaks to the complexity of chronic fatigue: Is it a response to a virus or viruses, the result of the interplay between stress and fatigue, or both.
Infections as Possible Causes of Chronic Fatigue
CFS is sometimes thought of as “post-viral fatigue.” This is partly because many people report flu-like symptoms or a bout of mononucleosis before they experience chronic fatigue.
For many years, CFS was linked to Epstein-Barr virus (EBV) because people with CFS often tested positive for the virus. However, EBV is a very common virus and is also found in many people who do not have CFS. Other viruses, such as herpes and hepatitis viruses, have also been offered as possible causes of chronic fatigue syndrome.
Most recently, a virus called XMRV has been strongly linked with CFS. According to the results of blood comparisons between people with CFS and people without the syndrome, those with chronic fatigue are much more likely to have XMRV than their peers. XMRV is a type of virus called a retrovirus, and retroviruses can trigger other viruses in your body, like EBV or herpes, that were previously dormant, which may be a contributing factor in CFS.
Child Abuse as a Cause of Chronic Fatigue
Early childhood trauma, such as emotional, sexual, or physical abuse, could increase the risk of developing chronic fatigue syndrome in some people. A comparison of personal histories and health data from 113 people with CFS and 124 without CFS found that those who had experienced childhood abuse were six times more likely to be in the CFS group.
In theory, early abuse can permanently alter the way your body responds to stress, possibly increasing your risk of developing CFS. However, many people who have CFS have no history of childhood abuse.
Stress as a Cause of Chronic Fatigue
Stress and fatigue go hand in hand. Intuitively, we know stress is draining, but data suggest that people with chronic fatigue syndrome respond to stress differently than those who do not have CFS.
For example, people with CFS often have lower amounts of the stress hormone cortisol in their saliva, which may mean that their bodies are not effectively fighting the effects of stress.
But cortisol is only a small part of the neural and hormonal chemical flow involved in the body’s response to stress, which may be different for people who have CFS. This chemical response comes under the umbrella of the hypothalamic-pituitary-adrenal axis (HPA), which refers to glands in the brain and other parts of the body that play a role in stress response. The role of genetics in the HPA is being studied as a possible key to unlocking the CFS mystery.
Immune Dysfunction as a Cause of Chronic Fatigue
Researchers have theorized that chronic fatigue syndrome may be the result of an abnormal immune response. This is partly because people with CFS have higher levels of cytokines — chemicals that the body produces as part of an immune response — than their people who don't have chronic fatigue.
Some studies have shown that giving someone higher than normal levels of cytokines can cause fatigue. A recent analysis of changes at the genetic level in patients with CFS supports the idea that altered immune response plays a role in the disease. However, people with CFS do not appear to be more susceptible to other kinds of infections than people who don't have CFS.
Nutrition and Chronic Fatigue
According to the U.S. Centers for Disease Control and Prevention, it's unlikely that a nutritional deficiency is the cause of chronic fatigue syndrome. However, many people with CFS have strong reactions to certain additives in foods and could benefit from removing those foods from their diets.
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