Chronic Fatigue Syndrome: learn how the mind-body method works

What is Chronic Fatigue Syndrome?

Being tired all the time is a relatively common aspect of modern life. However, when the fatigue is profound and disabling and lasts longer than 6 months, it is termed Chronic Fatigue Syndrome (CFS). Other common symptoms of CFS include unrefreshing sleep, joint/muscle pain, post-exertion malaise, anxiety, depression, hypersensitivity to light/sound, gastrointestinal symptoms, and a dysfunctional immune system. [1]

Although there is disagreement among scientists and doctors about the causes of CFS, research has shown that the HPA axis – the body’s stress system – is implicated. [2]

(We describe what the HPA axis is and how it works within our mind-body system here)

In healthy people the brain releases stress hormones such as cortisol in a circadian pattern throughout the day, under the influence of the “body clock”, and these hormones increase during periods of physical or mental stress. In CFS, however, this response is blunted, resulting in fatigue and intolerance to stress.

Research also shows that most CFS patients report experiencing a period of chronic physical or psychological stress in the year prior to developing CFS. [3]

Burned out Stress System

Research has shown that stress results in initial high levels of stress hormones such as cortisol, but long-term chronic stress sometimes leads to low levels of stress hormones.

This was first demonstrated by Hans Selye in the 1950s. Selye found that “When subjected to any type of stress (whether physical, psychological or viral), the adrenal glands initially increased in size in order to produce more cortisol. However, prolonged stress eventually caused the adrenal glands to shrink, resulting in ability to cope with the stress, and eventually resulting in death”. [4]

Image courtesy of Istvan Berczi DVM, PhD

Subsequent research in humans and animals has confirmed this adrenal exhaustion, or burnout, from chronic stress.

However, contrary to the theory of “adrenal fatigue”, it is suggested that the problem is not with the adrenal glands themselves. Rather, it is centrally mediated by the hypothalamus in the brain, that is deliberately reducing the stress hormones, and it appears to be a protection mechanism to defend the body from the effects of long-term chronic stress.

Whether or not chronic stress leads to adrenal exhaustion depends on the nature of the threat, the time since onset, and the person’s response to the situation. Cortisol output tends to be elevated initially, and then tends to reduce as time passes. [5]

What Causes Burnout or CFS?

Although the main switch to release stress hormones is located the hypothalamus in the brain, there are many inputs from various parts of the brain which act to increase the output of stress hormones, and some of which decrease them.

All types of stressors – whether viral, physical or emotional – have similar effects on the body’s stress system. [6] Emotional stressors have an additional effect: these activate specific circuits in the brain that suppress the stress hormones in response to negative emotions. This has been demonstrated in experiments on mice, and it is presumed that this circuit also operates in humans. [7]

Emotional Brain

As well as affecting hormone levels, it is also thought that chronic stress and negative emotions can directly affect the motor cortex and sensory cortex in the brain, resulting in fatigue, paralysis and pain. Brain imaging studies have shown that the parts of the brain involved in fatigue are also involved in processing emotions, registering pain, empathy towards other people’s pain, and awareness of the body. [8]

These brain areas have also been shown to have abnormal activation in CFS, and have been given the name “central governor”.

Central Governor

Sports science researcher Tim Noakes has spent over 30 years investigating the phenomenon of “central fatigue”, which is the limiting factor in the performance of athletes.

Contrary to popular opinion, the limit to sports performance is not due to the availability of energy, or muscle fatigue. Rather, the brain deliberately limits performance by generating the sensation of fatigue in order to protect the body from death and injury.

Noakes calls this brain region the “central governor”, although it is based on an earlier idea introduced by Archibald Hill in 1924. The central governor monitors various physical and psychological inputs – such as rate of heat accumulation, position within the race, motivation, emotions, hydration and energy reserves – when deciding when to put the brakes on performance.

Assuming that the athlete is in top physical form, psychological factors are the most important in improving performance, resulting in the central governor allowing a small amount of extra speed or endurance. The negative aspect of this is that it can sometimes result in injury of death (which is what the central governor is trying to avoid in the first place). Essentially all athletes suffer from extreme psychosomatic fatigue during a race.[9]

Cost-benefit Analysis

Studies on rats have shown that there are circuits in the brain which perform an unconscious “cost-benefit analysis” when deciding whether or not to proceed with behaviour. The brain analyses the predicted rewards and potential risks associated with the task.

If the task is too costly, the sensation of mental fatigue is generated, preventing the behaviour. [10]

There is an overlap in the brain regions responsible for this unconscious “cost-benefit analysis”, and the “central governor”. These areas of the brain are part of the dopamine reward system, and are involved in processing emotions, fatigue and pain, and in activating the motor cortex to produce movement.

While humans like to think that the brain is a machine which operates independently of emotions, the reality is that emotional factors are taken into account by the brain when considering how much physical and mental energy to provide.

How to Fix your Brain?

There is evidence showing abnormalities with both the stress hormones, and in the brain regions involved in the “central governor” in CFS. Whether chronic fatigue is caused by the central governor or by stress hormones, the problem appears to be within the brain, and is likely a protection mechanism that has evolved to protect the body from the negative effects of long-term chronic stressors.

This, however, doesn’t mean that CFS is a permanent, irreversible brain injury. Many people have fully recovered from CFS and live normal lives.

We know that the brain has a remarkable ability to heal, and research on CFS and PTSD patients shows that the abnormalities present in their brains are reversed after successful treatment.

Steps to Recovery

1. Remove the sources of the stress.
   Usually the chronic stress is caused by workplace or relationship stressors. Viral infections such as mononucleosis and Q-fever are also known triggers for CFS, presumably due to the effects these illnesses have on the body’s stress system (viral infections have a similar effect on the stress system to a psychological stressor).
2. Deal with negative emotions, especially feelings of shame, regret, anger and resentment, including due to the illness itself.
3. Increase positive, motivating, enjoyable activities, especially goal-oriented activities.
   These will crowd out the negative emotions, and will eventually “kick” the brain out of the negative, burned-out state.
4. Research what therapies or alternative treatments can help you.
   Your doctor may recommend sleep aids &  painkillers, however don’t forget that alternative treatments with less impact on your liver and kidneys than medication can work great at aiding you feeling energised, less moody and reduce pain.
5. Implement your therapy daily.
   Correct your diet, use essential oils, psychotherapy, mindfulness meditation, medical marijuana, and many more activities that awaken and nourish you. Make sure to not give up, listen to your body and engage in activities that give you a sense of purpose and meaning in life.

The author of this article is David J., whom successfully recovered from CFS and tells more about it on www.mind-body-health.net

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References

[1] Afari, N., & Buchwald, D. (2003). Chronic fatigue syndrome: a review. American Journal of Psychiatry, 160(2), 221-236.

[2] Papadopoulos, A. S., & Cleare, A. J. (2012). Hypothalamic.pituitary.adrenal axis dysfunction in chronic fatigue syndrome. Nature Reviews Endocrinology, 8(1), 22-32.

[3] Salit, I. E. (1997). Precipitating factors for the chronic fatigue syndrome. Journal of psychiatric research, 31(1), 59-65.

[4] Selye, H. (1950). Stress and the general adaptation syndrome. British medical journal, 1(4667), 1383.

[5] Fries, E., Hesse, J., Hellhammer, J., & Hellhammer, D. H. (2005). A new view on hypocortisolism. Psychoneuroendocrinology, 30(10), 1010-1016.

[6] Silverman, M. N., Pearce, B. D., Biron, C. A., & Miller, A. H. (2005). Immune modulation of the hypothalamic-pituitary-adrenal (HPA) axis during viral infection. Viral immunology, 18(1), 41-78.

[7] Furay, A. R., Bruestle, A. E., & Herman, J. P. (2008). The role of the forebrain glucocorticoid receptor in acute and chronic stress. Endocrinology, 149(11), 5482-5490.

[8] De Lange, F. P., Kalkman, J. S., Bleijenberg, G., Hagoort, P., vd Werf, S. P., Van der Meer, J. W., & Toni, I. (2004). Neural correlates of the chronic fatigue syndrome—an fMRI study. Brain, 127(9), 1948-1957.

[9] Noakes, T. D. O. (2012). Fatigue is a brain-derived emotion that regulates the exercise behavior to ensure the protection of whole body homeostasis. Frontiers in physiology, 3, 82.0

[10] Boksem, M. A., & Tops, M. (2008). Mental fatigue: costs and benefits. Brain research reviews, 59(1), 125-139.