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Causes of Chronic Fatigue

• Is Chronic Stress the root cause of Chronic Fatigue Syndrome?

There is currently no proven cause of chronic fatigue.

I will attempt to make the case that chronic stress is the main cause of CFS.

There are researchers that believe chronic stress is the cause of chronic fatigue syndrome.

I will also try to make the case that Chronic Fatigue Syndrome has other names. i.e....it is really the same thing as other conditions.

Let's start with a survey of visitors to this site. The results are summarized in the table below:

The first question is straight from the CDC website (Center for Decease Control).

Fatigue after exertion is at the top of the CDC list of primary symptoms of CFS⁵, and 81.4% of people surveyed on this site answered yes to that question.

Note: See Spreadsheet of Survey for detailed survey results.

Stuck in Stress for Years?

The 2nd question in the table above asked people if they were jumpy, which is an indication their nervous system was prone to being stuck in a state of stress, and for years before becoming sick.

An exaggerated startle response is a sign of having a dominant sympathetic nervous system.

Note: The Sympathetic Nervous System is the part of your nervous system that is more active during stress. It increases your heart rate, increases your breathing rate, decreases your reaction time, dilates your pupils, tells your liver to make glucose for energy, and more.

During Fight or Flight, your sympathetic nervous system is completely dominant.

They had a key sign of sympathetic dominance years before experiencing the main symptom for Chronic Fatigue Syndrome (post exertion fatigue).

They were essentially on the edge of Fight or Flight at all times. Their nervous system was never relaxed. Never in a state of homeostasis.

I believe this is stage 2 of the General Adaptation Syndrome, during which you are wired ... but not yet tired.

Other than the above survey, let's see if there are other hints that stress is the cause of CFS.

Conventional Medicine Stance

A 2012 article published in the medical journal American Family Physician sums up the current understanding of conventional medicine.

  The etiology (cause) of chronic fatigue syndrome is unclear, is likely complex, and may involve dysfunction of the immune or adrenal systems, an association with certain genetic markers, or a history of childhood trauma.²

Let's see if we can link these to chronic stress.

Immune System and Stress

Immune system issues are a major component of CFS. And ...Stress affects your immune system.

A 2014 article published in the medical journal Brain, Behavior, and Immunity stated the following:

  Stress can either enhance or suppress immune functions depending on a variety of factors such as duration of stressful condition. Chronic stress has been demonstrated to exert a significant suppressive effect on immune function.⁶

Another study published in 2014 found that the stress of training causes elite athletes to have reduced output of the thymus gland, which is an important gland for immune system function⁸.

Because stress has such a negative impact on your immune system, chronic stress was even found to be more likely to cause cancer than smoking¹⁹.

Stress could be the reason Chronic Fatigue subjects have immune system issues.

Childhood Trauma

Is chronic stress the connection between childhood trauma and CFS?

The following is a quote from a 2009 article published in Archives of General Psychiatry:

  Our results confirm childhood trauma as an important risk factor of CFS. In addition, neuroendocrine dysfunction, a hallmark feature of CFS, appears to be associated with childhood trauma.¹²

Those who have experienced childhood trauma are more wired. They are are more likely to experience increased vigilance.

One study found that childhood trauma results in an increased startle response.

  Increased startle may be a bio-marker of stress responsiveness that can be a persevering consequence of early trauma exposure during childhood.²¹

i.e.....childhood trauma results in sympathetic dominance, even in adulthood.

Even as adults, these people were stuck in a state of stress due to childhood trauma.

Is being stuck in a state of stress the connection between childhood trauma and CFS?

Researchers Consider Stress

• Some researchers belief stress is a cause of chronic fatigue syndrome.

Dr. Kenny de Meirleir is a professor of physiology and internal medicine at the University of Brussels, in Belgium. He is a prominent CFS researcher.

In the quote below, he mentions stress as a potential cause.

  In some people it is stress plus exposure to heavy metals. In other cases people may have had a long-standing stress plus a viral infection which wasn't treated properly.¹¹

Heavy metals are discussed elsewhere on this site. Chronic Stress reduces your bodies ability to remove toxins. Eventually, the accumulated toxins start to create their own problems. The toxins become an additional stressor.

Stress reduces bile production. Bile is needed to eliminate toxins from the liver. Stress also reduces glutathione and vitamin C, which results in slower removal of heavy metals and other toxins. (See Copper & Adrenal Fatigue for more information.)

From surveys taken by the author of Chronic Fatigue Syndrome: A Treatment Guide, 25% of people with chronic fatigue report than they have a metallic taste in their mouth.¹.

Stress and heavy metals continue to increase in our lives and environment. A 2014 report by the Chinese government found that 20% of the soil is now contaminated with heavy metals¹⁷.

Is the combination of increased stress and heavy metals the reason that Chronic Fatigue seemed to appear in the 20th century?

Refusal to accept Stress

• Many refuse to accept chronic stress as a cause of CFS

The idea that stress leads to eventual exhaustion is not exactly breaking news..... but old news is not always accepted news.

In the 1930's, Dr. Hans Selye exposed to rats to various stressors. Regardless of the source of stress, the rats went through the same pattern every time.

He named the pattern the General Adaptation Syndrome, because we adapt to elevated stress, at least for a while.

Stage 3, the last stage of the General Adaptation Syndrome, is actually called Exhaustion. That's right ... that last stage actually has the same name as the primary symptom of CFS!

Although the General Adaptation Syndrome is still in medical textbooks today, the concept that stress leads to eventual exhaustion never gained wide acceptance. This is despite years of testing proving that it does.

There is certainly resistance to accept stress as a cause of chronic fatigue. Below is a quote from the book Chronic Fatigue Syndrome: A Treatment Guide:

  The reason a little distraction or a vacation does not bring a complete restoration of body and mind is because CFS/ ME is not a stress-induced illness.¹

With all due respect .....that is like saying Bullets must not be bad for you because immediately after you stop shooting people, they still seem unwell

Like bullets .... the damage of stress remains long after obvious external stressors are removed.

Plus ... people with a dominant sympathetic nervous system are constantly in a state of stress, even when on vacation. They are never relaxed.

You can only see something when you look in it's direction. And many people refuse to look in the direction of stress as a potential cause of CFS.

Adrenal Fatigue in Alternative Medicine

• More and more, sick people are researching Adrenal Fatigue instead of Chronic Fatigue

Many people give up on conventional medicine. After your family doctor (primary care giver) and specialists are unable to find anything wrong, you continue to look for options.

People often turn to Naturopathic Doctors, or other practitioners of alternative medicine. The term Adrenal Fatigue has been steadily growing in alternative medicine.

Although the name Adrenal Fatigue is not a great name, at least there is an understanding that it is a chronic stress illness.

The chart below shows the number of Google searches for Chronic Fatigue vs Adrenal Fatigue. It is a 10-year trend, ending in October 2014.

The number of searches for Chronic Fatigue has been trending down, while the number of searches for Adrenal Fatigue is steadily increasing.

Sick people are researching Adrenal Fatigue more and more, and Chronic Fatigue less and less.

However, even once people understand that they have a condition caused by chronic stress, they can remain sick for many years.

It is very difficult to unwind the damage done by years of chronic stress.

I believe that Chronic Fatigue Syndrome is the exact same condition that Alternative Practitioners call Adrenal Fatigue.

CFS: The Search for a Virus

Researchers continue searching for a virus as a root cause of chronic fatigue syndrome.

In the 1980's, Epstein-Barr virus was thought to be the culprit. In fact, it was even called "Chronic Epstein-Barr" by some.

In 2009, a private research organization announced it had discovered the virus that was the cause of CFS, the XMRV retrovirus.

It gained a lot of press coverage¹³, and provided hope for many sufferers. Hope for vindication that it is a real illness, and that a target for treatment had been discovered.

However, their results could not be duplicated in several independent studies^14,15,16. The hunt is still on for a virus as the cause of CFS.

To date, they have not found a virus that is the cause of chronic fatigue.

CFS: What about Outbreaks?

There are many people that end up with chronic fatigue after catching a flu or cold. They catch a cold or flu, but they never recover.

And there have even been outbreaks of Chronic Fatigue, where groups of people caught a cold or flu, but some of the people never recovered.

Some people believe these clusters of CFS is enough proof that CFS is contracted like a virus.

However, the outbreaks never seem to affect everyone. i.e. not everyone exposed becomes chronically sick. In fact, most people recover like they would from a normal flu.

  Why was the attack rate in the Royal Free outbreak 6% and not 100%? Why do only 8% of people with mono go on to develop CFS/ ME? ¹

I believe the reason only some people with mono develop chronic fatigue is that the mono was the last straw for these people.

i.e... they were plodding along in Stage 2 of the General Adaptation Syndrome (Adrenal Fatigue) and mono pushed them over the edge into Stage 3 Adrenal Fatigue.

The flu they caught was a large stressor, but only those previously exposed to years of chronic stress were pushed over the edge.

In a similar manner, only a portion of people exposed to a traumatic event develop Post Traumatic Stress Disorder.

For example, one study showed that the Boston Marathon Bombing caused PTSD symptoms only in people with a high stress load, either before or after the event²⁰. Only those people with the highest stress load developed PTSD.

I believe it is the same for people getting CFS after a cold or a flu. Only those who were on their way to crashing from stress were pushed over the edge by the flu, mono or cold they contracted.

The Last Straw?

• Everyone has a different Last Straw

For many people, chronic illness and exhaustion can seem to start suddenly. It seems to be linked to a specific life event.

The article The Last Straw makes the case that their exhhaustion was inevitable due to chronic stress.

The last even was simply the straw thay broke the camels back, the even that pushed them into Stage 3 of the General Adaptation Syndrome.

Summary

There are researchers that believe that chronic stress is the cause of Chronic Fatigue Syndrome.

I believe the following conditions all have the same cause, chronic stress:

• General Adaptation Syndrome (chronic stress condition discovered in the 1930's)
• Chronic Fatigue Syndrome (name created by the CDC in 1988)
• Burnout Syndrome (a term that first appears on Pubmed.com in 1982)
• Adrenal Fatigue (Term used in alternative medicine since late 1990s. Book published in 2000)
• Post Traumatic Stress Disorder (PTSD)

Note: There is evidence that total stress load has an impact on the risk of developing PTSD symptoms²⁰, either before or after a traumatic event.

It seems that these are just different names for chronic exhaustion caused by chronic stress.

Here are a few related articles:

• Burnout vs Adrenal Fatigue
• General Adaptation Syndrome

References

1. Verrillo, Erica (2012-09-14). Chronic Fatigue Syndrome: A Treatment Guide, 2nd Edition
2. Chronic fatigue syndrome: diagnosis and treatment
3. The long-term costs of traumatic stress: intertwined physical and psychological consequences
4. Childhood Trauma is Associated with Altered Cortical Arousal: Insights from an EEG Study
5. CDC: Chronic Fatigue Syndrome (CFS)
6. Essential role of IL-10/STAT3 in chronic stress-induced immune suppression.
7. Long term effects of childhood trauma on cortisol stress reactivity in adulthood and relationship to the occurrence of depression
8. Reduced thymic output in elite athletes
9. Post-traumatic stress disorder: the neurobiological impact of psychological trauma
10. Oxford Index: Cortical Arousal
11. Research Kills Theory That Chronic Fatigue Syndrome/ME is Psychosomatic
12. Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction
13. Is a Virus the Cause of Fatigue Syndrome?
14. Failure to detect the novel retrovirus XMRV in chronic fatigue syndrome
15. No evidence for XMRV in German CFS and MS patients with fatigue despite the ability of the virus to infect human blood cells in vitro
16. No association found between the detection of either xenotropic murine leukemia virus-related virus or polytropic murine leukemia virus and chronic fatigue syndrome in a blinded, multi-site, prospective study by the establishment and use of the SolveCFS BioBank
17. Report: One fifth of China's soil contaminated
18. Hans Selye and the Field of Stress Research (pdf)
19. Personality, stress and cancer: prediction and prophylaxis.
20. Media exposure and sympathetic nervous system reactivity predict ptsd symptoms after the Boston marathon bombings
21. Childhood Abuse is Associated with Increased Startle Reactivity in Adulthood