The following column is the first of a series of questions and answers that will discuss chronic fatigue syndrome and fibromyalgia (CFS/FMS). They will review what these illnesses are, what causes them, what they feel like, testing, and how to get well. By the end of the series, despite the answers being kept fairly simple and straightforward, you'll be one of the world's experts on understanding CFS/FMS -- and how to make it go away!
Q: What are chronic fatigue syndrome and fibromyalgia?
A: A syndrome is a group of symptoms that commonly occur together and characterize a specific disease process. In CFS/fibromyalgia, these symptoms include fatigue; diffuse achiness (if fibromyalgia is present), poor sleep, brain fog, increased thirst, weight gain, bowel disorders, poor libido, and frequent infections. These are but a few of the more common symptoms! There are many more, and these will be discussed in an upcoming question. One does not need to have all of the above symptoms to have CFS/fibromyalgia. Even three or four of these, in the absence of another known cause, are adequate.
Q: How can multiple different triggers cause the same syndrome?
A: If there are number of problems that can cause a malfunction in the same part of the body, these can all cause similar syndromes. This is a case in CFS/fibromyalgia. As I'll discuss later, there are many things that can trigger this process. Once the process is set in motion however, it becomes self-sustaining. In CFS/fibromyalgia, the problems trigger a cascade effect where, like a stack of dominoes that gets pushed over, one problems triggers the next, which triggers the next and so on. To get well, one needs to see which systems have been affected in any given individual, and look to see if the initial trigger is still active. Then these all need to be treated simultaneously. To date, we have found over 50 common problems that cause the persistence of these syndromes. The average person with CFS/FMS has five to seven of these processes. The good news is that almost all these processes can be effectively treated. To get well, however, it is (as I noted above) important to treat them all simultaneously. Determining which ones are active in any given individual however, is a complex process. In my office, it takes an average of four to seven hours of my undivided time and attention and an extensive series of lab tests for a new patient visit -- and that's despite my having effectively treated over 2000 patients with these syndromes!
Despite the many triggers that can cause these syndromes, most patients seem to have dysfunction or suppression of a master gland in the brain called the hypothalamus. This gland controls sleep, your hormonal system, temperature regulation, and the autonomic nervous system (e.g. -- blood pressure, blood flow, and movement of food through your bowel). This is why you can’t sleep, you have low temperature, you gain weight, and (because poor sleep causes immune dysfunction) you are prone to multiple and recurrent infections. The hypothalamic dysfunction by itself can therefore, cause most of the symptoms we listed above! I suspect that problems with the "energy furnaces" in your cells (called the mitochondria) often cause the hypothalamic suppression.
The questions and answers that will follow in subsequent columns will give you a clearer understanding of what is causing your illness and how to make it go away.