"Chronic Fatigue Syndrome" By Allen Weiss, MD, MBA, President and CEO

Dr. ALlen Weiss, MD, MBA, FACP, FACR

April 1, 2009 - Chronic Fatigue Syndrome (CFS) is an ill-defined disorder characterized by severe tiredness; it is becoming more and more prevalent in the world today. Most everyone is tired after exercise, stress, or a medical illness, but when the fatigue lasts for over six months, is disabling and unrelieved by rest then there is more than just the garden variety of benign fatigue.

Although there is still uncertainty as to the cause of Chronic Fatigue Syndrome (CFS), reports of small clusters of people simultaneously coming down with the symptoms have been shared for almost eighty years. Women are twice as likely to be afflicted as men, and overall about four people in 1000 have the symptoms of exhaustion, muscle and joint pain, difficulty concentrating, depression, and poor immune response. The CDC—Centers for Disease Control and Prevention in Atlanta—estimates one million Americans have CFS, with approximately 80% of those afflicted being undiagnosed.

Unfortunately, there is no definitive test except to exclude all other debilitating and infectious or inflammatory illnesses that may cause fatigue: thyroid disease, depression, anxiety, arthritis, viral illnesses, cancer, heart or lung disease, mononucleosis, lupus, Lyme disease, multiple sclerosis, and fibromyalgia.

Interestingly, CFS usually starts suddenly after a flu-like illness. This fact gives credence to an infectious cause although no virus or bacteria has ever been isolated. Prior to having CFS, a person is healthy with good exercise tolerance and normal mental health. CFS starts abruptly, is associated with persistent fatigue unrelieved by rest, lasts six months or longer, impairs memory, causes unrefreshed sleep, headaches and swollen glands, along with joint and muscle pain.

People afflicted with CFS have a wide range of responses, from normal activity to being totally incapacitated and bed ridden. About half the people with CFS are unable to be gainfully employed so that economic stress adds to physical disability.

There are many theories about how CFS causes its symptoms including viruses, genetic predispositions, endocrinological (glandular) dysfunctions, and immune alterations. The bottom line is that no one is sure and the symptoms may be caused by a variety of diseases.

Many different treatments have been tried including diets, exercise, physical therapy, behavioral therapy, antidepressants, analgesics, as well as complementary and alternative medicine. Randomized controlled trials are very difficult to do because the treated group is so obviously different from the control group.

The prognosis is variable. Many people have gradual improvement over time, while others suffer disabling symptoms for the rest of their lives. There is also a certain stigma assigned to these victims since the symptoms are so vague. Without a definitive diagnostic tool or objective physical findings, many people feel uncomfortable giving or receiving the label of Chronic Fatigue Syndrome.

CFS is another example of a “new” disease which is finding its way into modern society. This condition may have been around for a long time but now, with this new description, many more people are identified as having the disease.


Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.