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

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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]

https://www.thepaleomom.com/adrenal-fatigue-pt-1/

(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]

 Chronic fatigue

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]

https://i1.wp.com/home.cc.umanitoba.ca/~berczii/images/Stress%20curve%20and%20phases%203.jpg?resize=521%2C249&ssl=1

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.

http://img00.deviantart.net/6f43/i/2005/064/f/8/__suggest_a_title___picture_by_manaxmomo.jpgAll 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.

https://i2.wp.com/blogs.bmj.com/bjsm/files/2014/04/athlete-fatigue.jpg?resize=415%2C209Assuming 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

https://i1.wp.com/cdn.hercampus.com/s3fs-public/2015/10/22/destress.jpg?resize=454%2C308

  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.

Viola Brugnatelli

Viola Brugnatelli is a Neuroscientist specialised in Cannabinoid circuitry & GPCRs signalling. Her academy and research training let her gain extensive experience on medical cannabis and terpenes both from preclinical as well as clinical perspective.
In her vision, collective human knowledge behold the power for overall improvement of life, thus, it should be accessible and shareable.
Viola is Founder of the science online magazine Nature Going Smart, and works as a consultant for companies & individual patients, as a speaker at seminars and workshops and as a lecturer in a CME course on Medical Cannabis in Italy, at the University of Padua.

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16 Responses

  1. anton mayer says:

    I did not like this article because it promotes unproven and poorly supported ideas of CFS.

    The US National Academy of Medicine carried out a review on the scientific evidence on CFS and concluded that it was a complex systemic disease (contrary to this article where it is described as psychosocial and lifestyle related disorder):
    Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness
    http://www.nationalacademies.org/hmd/Reports/2015/ME-CFS.aspx

    Subtle HPA axis abnormalities may be present but are just one of many abnormalities, and can’t explain the level of disability (mean cortisol levels are within the normal range).

    There is no effective treatment for CFS. Claims of psychotherapy and exercise being effective treatments were recently shown to be based on a flawed interpretation of data:
    Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy? A critical commentary and preliminary re-analysis of the PACE trial
    http://www.tandfonline.com/doi/abs/10.1080/21641846.2017.1259724?journalCode=rftg20

    Latest research is pointing towards CFS being hypometabolic disease, with impairment of cellular energy production:

    1. Metabolic profiling indicates impaired pyruvate dehydrogenase function in myalgic encephalopathy/chronic fatigue syndrome
    http://insight.jci.org/articles/view/89376

    2. Metabolic features of chronic fatigue syndrome
    http://www.pnas.org/content/113/37/E5472.full

    In summary, all the major ideas on CFS in this article are poorly supported or even contradicted by the literature.

  2. Thanks for your comments Anton.

    The body’s stress system has significant effects on multiple body systems including the immune system, HPA axis, autonomic nervous system, digestion and metabolism, and this is very well supported in the scientific literature.

    Pyruvate dehydrogenase is known to be inhibited by TNF-a [1], which tends to be increased in CFS [2] and is released by the brain during psychological stress [3].

    Multiple studies confirm that CBT and GET are moderately effective treatments for CFS, although recovery is rare. This is perhaps due to dubious etiologies purported by the proponents of these treatments (deconditioning and false illness beliefs), which seem unlikely to be central to CFS and are not supported by the literature. A case study by Friedberg [4] found that recovery was associated with replacing stressful activities with stress-reducing activities, even though the step count was similar for both. This implies that stressful activity may contribute to CFS, whereas non-stressful activity may aid in recovery.

    While resting cortisol tends to be in the normal range for CFS, multiple studies show that HPA axis response to stress is abnormal in CFS patients [5]. Whether this is sufficient to cause the symptoms is unclear. It may be that the abnormal HPA axis is a downstream symptom, and that the main fatigue is generated in the brain itself. Brain imaging studies point to abnormal activation of brain regions involved in activating the motor cortex [6], and these brain regions are also involved in generating fatigue during exercise in healthy people [7].

    More research is desperately needed in order to pin down the cause of CFS and develop an effective treatment.

    [1] https://www.ncbi.nlm.nih.gov/pubmed/9450646
    [2] https://www.ncbi.nlm.nih.gov/pubmed/10535608
    [3] https://www.ncbi.nlm.nih.gov/pubmed/12492308
    [4] http://dx.doi.org/10.1016/S0005-7916(02)00038-1
    [5] http://dx.doi.org/10.1038/nrendo.2011.153
    [6] https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awh225
    [7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323922/

    • anton mayer says:

      I hate to be messenger of bad news, but sorry, you have not succeeded in understanding this illness while the rest of science is still fumbling about in the dark, you have only succeeded in fooling yourself.

  3. Leela Play says:

    It is so harmful to print misinformation like this. It’s like saying you can cure cancer, HIV/AIDS or MS by thinking positively and removing stress. The Institute of Medicine of the National Academy of Science recently reviewed all the research in the field and determined that ME and CFS, or Systemic Exertion Intolerance Disease (SEID) as they propose renaming it, “is a medical — not a psychiatric or psychological — illness.”[1].

    Canada Health’s guideline, and much of the ME and CFS research by the experienced biomedical researchers in the field, use what is informally called the Canadian Consensus Criteria (CCC)[2], written by a group of international experts, researchers and clinicians. This was updated in 2011 in the ME International Consensus Criteria (MEICC) [3]. Please take a look at these for a correct awareness of what the disease is and appropriate treatments are.

    Depression is not found at a higher rate than in the general populace. The CDC is currently running a multi-site longitudinal study[4]. The linked slide of the SF-36 used in the CDC Grand Rounds Feb 2016 summarizes the results , showing that “the functional status of patients is substantially impaired in comparison to healthy controls, BUT with the exception of mental health and emotional functioning, which are remarkably well preserved, given the seriousness of this disease.”

    [1] https://www.ncbi.nlm.nih.gov/pubmed/25695122
    [2a] CCC journal paper http://www.tandfonline.com/doi/abs/10.1300/J092v11n01_02
    [2b] Health Canada’s CCC Guidelines http://www.phac-aspc.gc.ca/dpg-eng.php#cfs
    [3a] MEICC journal paper https://www.ncbi.nlm.nih.gov/pubmed/21777306
    [3b] MEICC easy to read Primer derived from the MEICC http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf
    [4a] 2017 https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kwx029
    [4b] SF-36 summary chart https://www.facebook.com/122950357787779/photos/a.441844885898323.1073741825.122950357787779/1335784113171058/

    • Hello Leela, we understand your distress so I would like to point out that in no way whatsoever this article has been written trying to belittle this condition. At the contrary, this has been written with people well-being in mind, from a recovered patient of CFS.
      At the same time, I would encourage you to be respectful of whom has psychiatric and psychological illnesses, because they also happen to be “medical conditions”.
      Personally, I have met many people managing well the disorders your mention (MS, cancer and HIV) and the common thing all of them were doing was being very positive on their life and seizing the best out of it, and reducing stress. Were only these factors to ameliorate their conditions? Obviously not only, but without that key point of self-love, even a cold could be tough to go through.

      • Jen B says:

        The article clearly states how to ‘recover’ from ME/CFS, not merely ‘cope’. The comment you are replying to is not in any way ‘disrespectful’ to people suffering from psychiatric or psychological illnesses, Leela merely points out that ME is Not one of them!
        If this article was about how to ‘manage’ living with ME as you claim patients with MS etc do, that would be one thing. You’re comment is irrelevant as it is nothing to do with the claims made in the article.

        And I object to ME being lumped in with Burnout, as one of the subheadings states. The two are very different. However, with the lack of proper teaching for the last few decades, sadly Doctors will diagnose CFS where there is only burnout, which is obviously recoverable, while doing no favours to the actual ME/CFS discussion.

        • Hello Jen, thanks for your comment.
          Are you suggesting that there are burnouts misdiagnosed as CFS?
          Because other than the author, I personally met in the past month another ex-CFS patient who also recovered going through the same steps described.
          If this is the case, that physicians erroneously diagnose CFS, it shows the complexity of the topic, and the difficulty on defining and spotting the boundaries between burnouts & CFS.
          There is substantial scientific evidence reporting the relationship between motor cortex and sensory cortex, and between emotional states and energy levels. Therefore the information reported here is meant to improve the quality of life of a person suffering from chronic fatigue/burnout.
          Hopefully some serious clinical trials will be carried out in the near future to provide reliable data. Until then, we can share what has worked for others and the rationale behind that.

        • Burnout and CFS both actually have similar symptoms and physiological abnormalities (see Leone et al. 2011 and Huibers et al. 2003). And as mentioned in the article, multiple studies have shown that CFS is associated with a dysfunctional HPA axis, and that most CFS patients suffer from chronic stress before developing CFS.

    • The difference is that with cancer and HIV we know that these illnesses are not caused or significantly influenced by chronic stress (except insomuch as reduced immunity due to stress might have a small effect on prognosis). Whereas with CFS the evidence suggests that chronic stress is a major factor in causing the illness, and the stress system is mainly affected.

      The article is not saying that CFS is purely psychological. It is a very serious and severe illness with significant physical and physiological symptoms.

  4. Dear reader, Nature Going Smart is an online science magazine with the primary purpose of promoting evidence-based natural practices that improve human (and environment) well-being. This magazine does not intend to substitute your physician nor your current medical program, it does not claim to treat your health condition, but rather encourages self-study of alternative therapeutic practices that have greatly ameliorated the quality of life of people suffering from CFS.
    Should you feel offended by this, we encourage you to add your thoughts in this comment section in a polite and constructive manner.
    The goal is that of sharing scientific knowledge as to better understand the condition. We encourage you to take part in this discussion respectfully.
    Thank you !

  5. anton mayer says:

    The article is suggesting to its readers that CFS patients can recover if they take the described steps. This is not an evidence-based claim (I’m familiar with the literature and as far as I know, no such evidence exists).

    In the World Health Organization’s International Classification of Diseases, Tenth Revision CFS is classified as disorder of the nervous system, with the code ICD G93.3. In contrast, Occupational Burnout is as classified as mental health disorder, with the code Z73.0. While there is uncertainty about many aspects of CFS, the author offers no compelling evidence that CFS and burnout are the same thing, and his personal views are contrasted by those of major US research organizations that have unanbiguously endorsed the view that this a biological illness.

    I’m sorry to say this, but this article is clearly incompatible with the stated purpose of this magazine.

    • Thanks for your feedback, Anton.
      Are you suggesting that there are burnouts misdiagnosed as CFS?
      Because other than the author, I personally met in the past month another ex-CFS patient who also recovered going through the same steps described.
      If this is the case, that physicians erroneously diagnose CFS, it shows the complexity of the topic, and the difficulty on defining and spotting the boundaries between burnouts & CFS.
      There is substantial scientific evidence reporting the relationship between motor cortex and sensory cortex, and hence between emotional states and energy levels. Therefore the information reported here can definitely improve the quality of life of a person suffering from chronic fatigue/burnout.
      Hopefully some serious clinical trials will be carried out in the near future to provide reliable data. Until then, we can share what has worked for others and the rationale behind that.

    • The steps to recovery are mostly based on the experiences of patients who have recovered. You are correct in saying that there isn’t much evidence showing effective treatments. (CBT and GET have been shown to be moderately effective, but they don’t generally result in full recovery). The article isn’t suggesting that everyone can easily recover, any more than you could give a patient with depression a set of steps to recover. Recovery is difficult.

      The use of the word burnout in the article was more aimed at describing the physical and physiological effects of burnout rather than the purely psychological symptoms of occupational burnout. However there are studies showing that occupational burnout does share the same symptoms of CFS (see Leone et al. 2011 and Huibers et al. 2003), and there is extensive research showing that chronic stress results in similar disruptions to the HPA axis, autonomic nervous system and immune system seen in CFS.

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