To be given a diagnosis of chronic fatigue syndrome, a patient must satisfy two criteria:
1. Clinically evaluated, unexplained, persistent or relapsing chronic fatigue that is:
•Of new or definite onset – it has not been lifelong
•Is not the result of ongoing exertion; is not substantially alleviated by rest; and results in substantial reduction in previous levels of occupational, educational, social, or personal activities
2. Concurrent occurrence of four or more of the following symptoms, all of which must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue:
•Self-reported impairment in short-term memory or concentration, severe enough to cause substantial reduction in previous levels of occupational, educational, social, or personal activities
•Sore throat
•Tender cervical (neck) or axillary (armpit) lymph nodes
•Muscle pain
•Multi-joint pain without swelling or redness
•Headaches of a new type, pattern, or severity
•Unrefreshing sleep
•Post-exertional malaise lasting more than 24 hours
The symptoms must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue.
Fibromyalgia used to be diagnosed by applying firm pressure to specific areas of your body, 
called tender points. At least 11 of these 18 spots had to test positive for tenderness to diagnose fibromyalgia. But tenderness comes and goes, so now it is just a clinical diagnosis. Doctors will attempt to rule out other conditions like rheumatic diseases.
called tender points. At least 11 of these 18 spots had to test positive for tenderness to diagnose fibromyalgia. But tenderness comes and goes, so now it is just a clinical diagnosis. Doctors will attempt to rule out other conditions like rheumatic diseases.CFS has been described as the flu that never goes away. A simple bout of mental or physical activity can trigger flu-like symptoms in patients with lasting effects. Fibromyalgia is fatiguing, and some people start off with fatigue and the fibromyalgia follows.
In some patients, there are associated intestinal symptoms such as poor digestion, feeling like food just sits in the stomach, bloating after eating, diarrhea or alternating diarrhea and constipation, irritable bowel syndrome, or leaky gut syndrome. Sometimes the onset of fatigue or intestinal symptoms follows an intestinal illness, often after a trip to a foreign country or several rounds of antibiotics.
Family history can be insightful. For example, some women note that “everyone in my family has low thyroid function, but my laboratory tests are always normal.” In person after person, I find that the individual has low thyroid function, but the laboratory evaluation isn’t catching it.
Fatigue By Any Other Name
In our experience, the events surrounding the onset of fatigue are important. Sometimes symptoms begin with a cold or flu from which the person never really recovers. This is suggestive of a viral component. With some patients, we’ve found the onset of fatigue coincided with a car accident injury that never healed properly. Some women experience unending fatigue after the birth of a child which could be hormonal or indicative of a lack of EPA and DHA. For others, after a stressful life event, we’ve solved the problem by balancing their hormones.
There is no FDA-approved medication for these illnesses. Undoing the cycle of inflammation is a big part of the answer. Also, hormone balancing is in the mix.
To help patients with chronic fatigue, we assess the underlying causes:•What you eat
•Digestion problems
•Hormone imbalances
•Sleep disturbances
•Infections
•Toxic substances, including heavy metals, that interfere with normal functioning
•In some cases, an underlying coagulation disorder
If only one problem is addressed, we have not seen symptoms improve as dramatically as when all of the factors are addressed simultaneously. A number of pieces of this puzzle need to be addressed –you can’t do just one piece of it and expect your problems to be over.
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References:
•Annals of Internal Medicine 121 (14 December 1994)
•From Fatigued to Fantastic by Jacob Teitelbaum, MD