I just had an online appointment with a doctor who specializes in functional medicine and has worked with many patients with Chronic Fatigue Syndrome (CFS).
His overall explanation of CFS is very similar to what I have arrived at as a likely explanation, based on my own experience.
It’s a mainly physical illness, triggered or caused by stress. And this stress is often a combination of physical and psychological stress and can come from a variety of sources. Since a viral infection often precedes CFS, I assume this plays a central role as well. Perhaps the body’s reaction to the stress of the viral infection, combined with other stress, triggers the illness.
When I initially got CFS at age fifteen, I suspect the sources of stress were several. I likely had a low-grade chronic Epstein-Barr infection (I had mononucleosis a few months earlier), combined with usual teenage stress (towards the high end of the scale), combined with my first and last party where I drank alcohol. The three together may have been enough to trigger the CFS.
When the CFS worsened a couple of decades later, the sources of stress were serious and long-lasting pneumonia, a marriage that didn’t feel right, perhaps combined with mold in the house.
And when it worsened further some years later, it was immediately following a two-week period where my presence was required daily at a study, and that involved a long travel time.
In general, my condition worsens when the following stressors are present: Physical exertion, psychological exertion, life stress, cold and/or wet weather, and poor diet. I imagine other stressors like pollution, food quality, and so on also play a role.
What’s the remedy? The doctor suggested a combination of healthy oils, adaptogens, probiotics, and vitamins and minerals. This is not so different from what others in the field recommend.
The doctor suggested a pathway as well, involving cortisol, adrenals, etc. Any ideas we currently have about these pathways are, by necessity, simplistic and I mainly leave those explorations to others. I am more interested in the possible causes, what maintains or worsens the illness, and the possible remedies.
A note on mechanisms: There are no agreed-upon mechanisms from CFS. There are some typical patterns in what goes before the illness and what worsens and stabilizes it. There are some findings, usually from single unreplicated studies. There are several suggested mechanisms and biological elements of the illness. And that’s about it, and that’s one reason I hold it all very lightly. Even if or when they get a better idea of the mechanism, it’s important to remember that modern science – including medical science – is in its infancy. They only have small pieces of a much larger and more complex puzzle. And the content of science, by its nature, changes over time. What’s held as (provisional) truth today will be outdated and obsolete in a year, or a decade, or a century. All of it is provisional. It’s the best guess based on what we know today. And it’s all a small piece of a much larger puzzle.