What are chronic fatigue syndrome and fibromyalgia?
There are a couple different names for these conditions. While fatigue is a significant symptom in both conditions, there are other things going on that are contributing to the fatigue. You may have heard the term chronic fatigue syndrome (CFS) or chronic fatigue and immune dysfunction syndrome (CFIDS). These two names are describing the same condition. Fibromyalgia syndrome (FMS) is very similar to CFS and these two names are sometimes used interchangeably. You can think of them as the same thing.
I’ll be using the terms chronic fatigue syndrome (CFS) and fibromyalgia (FMS).
What does CFS feel like?
According to the Center for Disease Control (CDC), chronic fatigue syndrome looks like:
Fatigue - this has been worked up and can’t be explained. It’s persistent, is new for you and is not due to overwork. Rest doesn’t help and it is significantly impacting your life.
You also have at least 4 of these 6 symptoms, for at least 6 months:
Impaired memory or concentration
Sore throat
Tender lymph nodes in the neck or underarms
Muscle pain
Joint pain without redness or swelling
Headaches
Poor sleep that is not restful
Fatigue after exertion that lasts 24+ hours
“You may feel like you’re an 80-year-old in a 30-year-old’s body”
Chronic fatigue syndrome and fibromyalgia can have similar symptoms but fibromyalgia will also have painful, tender areas throughout the upper and lower body.
If you have unexplained, significant fatigue and at least 2 of the other symptoms on the list below, you probably have CFS. If you also have painful, tender areas then you probably have fibromyalgia.
The list below adds a few more symptoms to the CDC’s list.
Common symptoms you may feel are:
Unexplained, significant fatigue that interferes with your ability to live your life the way you want
Poor sleep
Brain fog - this can include difficulties with short term memory, concentration, and word finding
Increased thirst
Bowel disorders
Recurrent infections and sinusitis
Exhaustion after minimal exertion
Fatigue - you may feel this most or all the time and you may have periods where it gets better, but it always comes back. Your daily energy rhythm is reversed and you feel the most energy at night. Exercise makes you feel exhausted because you already can’t make enough energy and then exercise requires even more. It’s hard for your body to recover from strenuous activity.
Frequent infections - the immune system is dysfunctional in CFS so you’re more prone to infections. You may have frequent sinus, gut, bladder, vaginal or skin infections. Your digestion may be poor and you have gas, cramping, bloating, diarrhea or constipation. Knowing what to eat may be difficult because you have reactions to different foods.
Brain fog - this term can encompass symptoms like poor memory, difficulty finding words or feeling disoriented.
Achiness - CFS can have achy pain in the muscles and joints and fibromyalgia can have tender points all over the body. This body-wide pain can be caused by poor sleep, low thyroid function, infections and nutrient deficiencies.
Increased thirst - the hypothalamus is affected in CFS which decreases the production of a hormone called antidiuretic hormone (ADH). ADH keeps fluid in the body. Without ADH, your body will not retain fluid and you’ll find yourself peeing a lot. This water loss leads to you feeling thirsty all the time. You may also have dry eyes or dry mouth.
Weight gain - you may find yourself gaining weight when you haven’t changed anything about your lifestyle. This can be caused by low thyroid function, gut infections, insulin resistance, poor sleep and low levels of nutrients that help metabolism.
What does fibromyalgia feel like?
Fibromyalgia has many of the same symptoms as CFS and you can have both conditions at the same time. Those with CFS can have body aches and pain, but fibromyalgia has tender knots of pain throughout the upper and lower body. These painful points disrupt sleep and perpetuate the pain cycle by preventing your muscles from healing and regenerating.
The muscle tightness is due to a dysfunction in our mitochondria, the energy producers in all of our cells, leading to the muscles not getting the energy they require. When your muscles become tight they compensate and use the surrounding muscles instead. This puts strain on the surrounding muscles and you get pain throughout your body. Chronic pain can also cause your brain to amplify your pain sensation.
Common pain symptoms of fibromyalgia:
Painful points above and below the waist
Painful points on both the left and right sides of the body
Feeling pain down the middle of the body (ie. headache, back, chest, abdomen)
Tenderness in 11 of 18 points throughout the chest, back, hips, knees, and arms.
Fibromyalgia isn’t just about pain, it’s also very much a sleep disorder. When you’re not getting enough sleep, your body will be in pain. Our body needs to go into a deep sleep state in order to heal and the body pain is preventing that. It keeps you restless and uncomfortable all night. You may sleep 12 hours but wake up feeling like you need more. You don’t get a restful night’s sleep no matter how long you sleep.
What causes CFS and fibromyalgia?
These syndromes are the body’s response to a trigger. The hypothalamus, a gland in our brains that’s involved in regulating many of our body systems, “shuts down” and doesn’t turn back on again. It becomes dysfunctional or suppressed and your body can’t keep up with your energy needs.
When the hypothalamus is dysfunctional it can have downstream effects on the whole body. The hypothalamus controls many different body systems through hormonal regulation. It’s like the CEO of the hormonal system. It releases hormones to the pituitary gland, which release hormones to our organs like our adrenal glands and our thyroid. This explains the wide variety of symptoms in CFS that seem to be unrelated. But if you trace the problem back to the hypothalamus, it makes more sense.
Immune dysfunction - The hypothalamus can become dysfunctional due to infections. Viruses like HHV-6, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) can all cause problems with the hypothalamus. You may have yeast, parasite, or bacterial gut infections leading to intestinal permeability (aka “leaky gut”). Poor sleep can contribute to poor immunity.
Hormonal dysfunction - the hypothalamus is responsible for starting a cascade of hormones from the brain to the organs. Problems with this process can lead to problems in the thyroid, adrenals and ovaries. This can show up for you as slow metabolism, weight gain, body temperature fluctuations, frequent urination, low energy, menstrual cycle issues, hypotension and immune dysfunction.
Sleep dysfunction - temperature dysregulation, adrenal dysfunction and pain can make sleep more difficult or not restful. Poor sleep can further suppress the immune system, making you more susceptible to infections, and can decrease your metabolism.
What caused your CFS or fibromyalgia?
It can be hard to pinpoint what started the process for you and the original trigger may not even be around anymore depending on how long you’ve been dealing with the condition. One way to go about finding your trigger is to think about when it all started for you. What was happening for you? Did you have a stressful event? Travel? Sickness? Pregnancy?
If your symptoms came on suddenly your trigger may be:
A viral infection, especially if you had a “bad flu” that took a while to resolve or never really went away
Sickness that required antibiotic use
Injury or trauma
Pregnancy
Toxic exposure
Illnesses can suppress the hypothalamus and a hormone called adrenocorticotropic hormone (ACTH). Without ACTH, the adrenals don’t produce cortisol so you feel tired and have a less robust immune system. This makes you more susceptible to bladder, respiratory, sinus or gut infections.
If your symptoms came on gradually your trigger may be:
Bowel issues - you may have had a yeast infection or other gut infection
Low thyroid
Perimenopause
Chronic stress
Autoimmune disease
Sleep disruption - ie. sleep apnea, restless leg syndrome
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In health,
Dr. Jamie
Resources
Pizzorno, J. E., Murray, M. T., & Joiner-Bey, H. (2015). The Clinician's Handbook of Natural Medicine (3rd ed.). Churchill Livingstone.
Teitelbaum, J. (2007). From Fatigued to Fantastic (3rd ed.). Avery.
This website is not intended for the purpose of providing medical advice. All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.
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