Chronic Fatigue Syndrome (Chronic Fatigue and Immuno-Deficiency Syndrome, CFIDS) and Fibromyalgia (FM) are illnesses that often coexist and affect millions of Americans. Symptoms vary but commonly include severe fatigue, sleep disturbances, cognitive problems commonly called brain fog, muscle pain and multiple infections. CFIDS and FM often seem to begin after an infection or a severe shock (physical or emotional), and the symptoms are very similar. The difference seems to be that for some people the fatigue element is the most dominant while for others the muscular pain symptoms are more severe.
The medical literature is now clear that these are legitimate diseases and individuals with CFIDS/FM have measurable hypothalamic, pituitary, immune and often thyroid dysfunction. The hormonal dysfunction results in multiple deficiencies that are often not detected with standard blood tests. Neurotransmitter abnormalities and nutrient deficiencies have also been shown to occur with CFIDS/FM.
Due to their complexity, these conditions often have been inadequately treated, partly due to the intensive evaluation and follow-up that is required, which can not be addressed in a short office visit. When multifaceted treatment addresses the entire spectrum of these diseases, truly remarkable success can be obtained. Treatment needs to be individualized, ultimately each patient should have a maintenance program with the minimal medications and supplements that are necessary to remain symptom-free.
Treatment for infections and enhancement of immune function is key. Komaroff et al. of Brigham and Women’s Hospital, Harvard Medical School, have concluded that CFIDS “is an illness characterized by activation of the immune system, various abnormalities of several hypothalamic-pituitary axes, and reactivation of certain infectious agents.” Multiple infections either may cause or contribute to CFIDS/FM. Immunological defects may underlie CFIDS/FM, and if a poor immune system is not addressed, successful eradication of the organisms is not likely. Also, if an infective organism produces neurotoxins, these substances can remain in the body and continue to cause symptoms long after the infection is gone.
Hormone balance is essential for optimal therapeutic outcomes. Therapy should be individualized with multiple hormonal deficiencies addressed concurrently to assure successful treatment. Studies have reported that there is an altered hypothalamic-pituitary-adrenal axis (HPA axis) in CFIDS/FM, leading to altered function that is often overlooked when interpreting standard blood tests.
Adrenal insufficiency is very common in patients with CFIDS/FM, and is often the cause of serious fatigue. Sophisticated tests are required for an accurate diagnosis. Proper supplementation can often have profound effects. However, if only the adrenal deficiency is treated without addressing deficiencies of other hormones, results will be disappointing. And, if poor adrenal function is missed, it can mean the difference between treatment success and failure.