What is Chronic Fatigue Syndrome and M.E.
CFS is a very misunderstood illness, partly because it does not fit easily into any medical categories. In fact there are still some doctors who “don’t believe” in it. However there has been a lot of research into it and we now have a much better understanding of what is involved. Briefly CFS represents a dysfunctioning of the body’s response to stress, such that it remains active or hyper-sensitive over a long period of time. This leads to depletion of the adrenal glands and problems with the immune system, hormonal system, digestive system and most especially fatigue and cognitive problems – “brain fog”, difficulties concentrating and memory problems.
CFS/ME can affect anyone, male and female, young or old, and of any social class or ethnic background. It is definitely not “Yuppie Flu”. Children as young as 8 have been known to develop CFS.
It can start following a viral illness (this is more true of children), and there may be a history of repeated bouts of tonsillitis or other infections, or a history of allergies. In adults it may develop following an infection or it may result from years of chronic stress or a traumatic injury such as a car accident, or other trauma such as divorce or bereavement.
What happens when someone develops CFS/ME?
Broadly speaking there are three reasons for developing chronic fatigue syndrome.
- It may either come on quite quickly following a viral infection such as glandular fever,
- it may develop more insidiously after a period of either prolonged stress or a shorter period of very intense stress or trauma (such as the death of a partner) or
- it may result from exposure to environmental toxins.
There is some evidence that there may be a genetic basis for CFS/ME, and it does sometimes seem to “run in the family”. If you are interested in reading more about the genetic basis, please click here and for further information on genetic sub-types click here.
There is a considerable body of research summarised on ME Research UK’s website.
The HPA (Hypothalamus-Pituitary-Adrenal) Axis
The key to CFS/ME lies in a small part of the brain known as the hypothalamus. The hypothalamus controls many of the “more primitive” functions of our bodies including hunger, thirst, temperature, sex drive, etc. It is also the central controller for our hormones, working with the pituitary gland which is attached to it. The pituitary gland is the body’s master gland, producing a number of hormones including growth hormone, thyroid stimulating hormone and adrenocorticotropic hormone (ACTH). The important hormone for CFS/ME sufferers is ACTH. This hormone travels through the blood vessels to the adrenal glands where it stimulates the production of cortisol. Cortisol is one of two stress hormones produced by the adrenal glands, the other being adrenaline, which we will come to in a moment.
The pituitary gland produces its hormones in response to stimulation by the hypothalamus. However the hypothalamus also has direct effects on the body via the sympathetic nervous system. Some of the sympathetic nerves terminate in the adrenal glands where they stimulate the release of another hormone, adrenaline. Together, the sympathetic nervous system, cortisol and adrenalin act to produce the fight or flight response, which is our normal response to a stressful situation.
The Effects of Stress
So what has all this to do with CFS/ME? In those who have developed ME as a result of prolonged stress, the body will have been in fight/flight mode for a protracted period of time with serious consequences. These can include a number of disorders including irritable bowel syndrome, indigestion and heartburn and food intolerances, all of which are associated with the increased sympathetic arousal. However the tiredness, pain and cognitive problems (brain fog, memory loss, etc) appear to be due to the effects of the sympathetic nervous system on the lymphatic system. The over-activity of the sympathetic nerves, leads to slowing down of the flow of lymph through the lymphatic system, which is the body’s natural waste disposal system. Eventually back-flow in the lymphatics leads to accumulation of toxins in the brain, which cause the fatigue. Similarly toxin build-up in the muscles and joints can lead to pain and weakness.
In those people who developed CFS/ME following a viral infection, in most cases the virus does not persist. However it seems that the virus may have caused lasting damage to the immune system and/or nerve tissue. There are a number of viruses which may lead to the development of CFS/ME, including herpes virus, (including HHV4, the Epstein Barr virus which causes glandular fever or mononucleosis), enteroviruses, hepatitis and other viruses, the most implicated viruses being Coxsackie B and Human Herpes Virus 6 (HHV6). Recent studies suggested the involvement of a retrovirus the Murine Leukemia Virus (XMRV) which has crossed over from mouse to human populations, and was present in 68% of CFS/ME patients, as opposed to about 4% of healthy controls. Another study found antibodies to XMRV in 95% of CFS/ME patients. However these results have not been replicated and there is now considerable doubt about their authenticity (see for instance Blomberg et al’s article in ME Research).
In people with CFS/ME, the viral attack appears to lead to the development of an imbalance in the immune system whereby some types of cell increase in number (generally leading to an increase in the production of anti-bodies) while others decrease in number, including those which are responsible for attacking and killing pathogens. This results in increased susceptibility to infection and an inferior immune response which accounts for frequency of infections and the length of time needed for recovery.
While the initial mechanism may be different for the two groups of patients (ie the viral mechanism and the stress mechanism) the eventual outcome seems to be the same in terms of the symptoms patients experience. The body’s response to the stress of a viral infection is the same as its response to a major life event or years of constant stress. Prolonged sympathetic arousal leads to slowing of the lymphatics and the build-up of toxins in the tissues. Dr Perrin’s work has shown that there is evidence of lymphatic congestion in virtually all CFS/ME patients, and this means that the treatment is suitable for all sufferers.