Skip to main content

Beyond Tired: CFS/ME or Not?


Presentation Download: 

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is characterized by debilitating persistent or relapsing fatigue greater than 6-months duration, which is not alleviated by rest and not explained by medical or psychiatric conditions. This complex condition encompasses not only post-exertional malaise, but chronic pain, cognitive and/or sleep dysfunction, and an array of other immune, neurological and autonomic symptoms. With no validated test and several overlapping case definitions, the diagnosis of CFS/ME is dependent on practitioner exclusion of other medical conditions that cause chronic fatigue. With a comprehensive approach, many patients with an initial diagnosis of CFS/ME are found to have treatable conditions. Co-morbidities and co-infections must also be addressed.

Females are more predisposed to CFS/ME with precipitating or causal factors including physical/emotional trauma, acute or a chronic infection, and environmental toxins. Common exclusionary diagnoses include the following categories: anemias, autoimmune, cardiac, endocrine, gastrointestinal, infectious, malignancies, neurological, primary psychiatric disorders and substance abuse, pulmonary, and primary sleep disorders such as sleep apnea. Non-exclusionary conditions that commonly occur in association with ME/CFS include allergies and food sensitivities, fibromyalgia (FM), irritable bowel syndrome (IBS) and multiple chemical sensitivity (MCS).

A hallmark of CFS/ME is multi-organ system involvement, which points to underlying mitochondrial dysfunction. Fatigue itself must be characterized in the individual patient by peripheral (physical limitation) vs central (complex emotion). This may be differentiated via patient medical history and questionnaires, and exclusionary diagnoses ruled out via biomarker testing and physical examination. Intense diet, nutritional, antioxidant, and lifestyle modifications are first-line therapies for all underlying causes of fatigue. With regard to CFS/ME, Low Dose Naltrexone (LDN) has been shown as an important treatment adjunct with minimal side effect profile and multiple potential therapeutic targets.

Session Learning Objective: 

Participants will understand the complex criteria for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), which is dependent on the exclusion of innumerable other conditions that cause chronic fatigue. Evidence shows that a hallmark of CFS/ME is mitochondrial dysfunction and intense diet, nutritional, antioxidant, and lifestyle modifications are first-line therapies. Low Dose Naltrexone (LDN) is an important treatment adjunct for CFS/ME.

Session Outline: 
  • CFS/ME: case criteria and definitions
  • Predisposing, precipitating, and causal factors of CFS/ME
  • Medical and psychiatric CFS/ME exclusions
  • Common co-morbidities in CFS/ME
  • Clinical pearls: functional medicine testing and workup
  • Chronic fatigue is a hallmark of underlying mitochondrial dysfunction
  • Paramount fatigue treatment considerations include intense diet, nutritional/antioxidant support, and lifestyle modifications
  • Low Dose Naltrexone (LDN) is a novel treatment adjunct for CFS/ME
  • Brief CFS/ME case study: multiple therapeutic targets of LDN