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Dr Sharma Diagnostics

Chronic Fatigue Syndrome (CFS) and Tatt – Tired All the Time

Chronic Fatigue Syndrome (CFS), often interchanged, although not necessarily accurately, as myalgic encephalomyelitis (ME) and post-viral fatigue syndrome, has been recognized by the medical profession in the UK since the mid-1990s. Other countries have been a little bit more open, but a percentage of doctors still doubt that this syndrome exists and training in the underlying theories is still scant. In fact, it was only in 2002 that it received official status as a condition.

For a CFS diagnosis to be made the patients symptoms must include fatigue or lethargy and this must be causing a 50% loss of physical and social function for at least six months. Four of the following symptoms must also be present:

  • Physical:sore throat, persistent infections, swollen and/or sore lymph nodes, headaches and pain in muscles or joints.

  • Psychological depression:impaired memory or concentration, excessive sleep requirement, appetite loss or gain and agitation.

CFS is essentially a ‘diagnosis of exclusion’ which means that other medical causes of the above symptoms must be investigated and eliminated (1).

Most often the symptoms worsen with the slightest exertion. It is important to differentiate this from the persistent fatigue that is felt by 20-50% of the population in association with incorrect lifestyle or stress, as this is quite separate from CFS. It may be just as debilitating, and also needs addressing, but may not have the same underlying causes. The term TATT – Tired All the Time – is now being used to describe such a situation.

Underlying Causes

For many years the orthodox world has been searching for a specific cause and the term post-viral fatigue syndrome was popular because it suggested that this condition occurred after viral infections. This is simply not always the case; CFS can occur with no previous or obvious illness preceding it.

Other theories of the causes of CFS include dormant/persistent viral infection (Epstein-Barr virus, cytomegalovirus, herpes virus, and others), food or airborne allergy leading to immune activation and reduced blood flow within the nervous system. Poisoning from environmental chemicals such as heavy metals, pesticides and other organophosphates and environmental toxins are all theorised to be the underlying cause of mitochondrial failure.

Since 2007, following published papers by doctors and scientists (2), many doctors consider CFS to be associated with dysfunction of mitochondria, small parts of cells that produce energy from sugar and oxygen and this has been further supported by a paper by Roland Staud MD, University of Florida, (Journal Pain, Feb 2015) who has shown that ATP made by mitochondria are associated in neural pathways that transmit feelings of fatigue to the brain.

This adds to a theory suggesting reduced blood flow to the neurological system that is particularly interesting. It is suggested that an infection, injury, stress or environmental factor creates an adrenaline response. This causes blood vessels to constrict and blood flow apparently to diminish. A decrease in this flow to the central nervous system leads to poor perfusion and oxygenation, in turn leading to fatigue and other symptoms. The immediate effect is to produce more adrenal response thereby increasing the problem.

Recommended investigations

ME/Chronic Fatigue Syndrome, as explained above, has many possible causes and no single specific test is very accurate. There are a range of tests that can be utilised and choosing these rather depends upon the symptoms being suffered and the possible causes as gleaned from the medical examination.

It is very important that hormonal and gut/bowel issues are addressed from an Integrated Medical (7) or Functional Medicine (8) point of view. Unexplained tiredness and many other symptoms may be relate to thyroid, sex hormones, poor digestive capabilities, food allergy/intolerance and sensitivities and very importantly bowel flora yeast overgrowth and normal flora imbalance (9).

An Adrenal function test, measuring cortisol - one of the bodies stress coping hormones, and DHEA - a precursor to many hormones and also a gauge of stress response, may be of benefit.

There are no conventionally common tests that unquestionably confirm a diagnosis of CFS. However, we can now measure the activity of mitochondria by measuring compounds produced in the process of making cellular energy ATP and ADP (2)

Measuring the nutrients needed for energy production is important particularly:

Co Q 10
Vitamins B3 and B12

Zinc is also vital, not only in energy production, but also as an important detoxifier.

Importantly we can now isolate compounds that are attached to mitochondria’s active energy producing areas, the translocator sites, and also look at what is attached to cell DNA (these attachments are called adducts). Such information guides us to how intensively we need to detoxify and remove toxins from an individual’s environment.

Tests for metal, chemical and environmental pollution need to be considered and a look at the home and work environment explored to rule out mould, water contamination and household contamination by cleaning compounds(6).

Any stressful event, be it physical, psychological – professional personal or social, can trigger CFS/TATT, but generally it occurs in those who are poisoned, deficient or who have already a weakened energy or constitution. The Eastern philosophies believe in an energy store (the Chinese call it Qi) which can be depleted by life’s events or habits.

Specific dysfunction of the pituitary gland or the parts of the nervous system that produce serotonin have been found in some cases but not in all. The Hypothalamic-Pituitary- Adrenal (HPA) axis is a controlling mechanism for stress response and is frequently associated with CFS(3).

There is a higher rate of CFS in those working in jobs that have exposure to chemicals such as pesticides and recreational drugs, but also in those who over exercise (4), under sleep or have poor diets.

General Advice

  • Rule out any other cause for your symptoms by visiting your GP initially.
  • Do not push your body beyond its limits. Unlike when trying to get fit, working beyond your body’s endurance only makes the condition worse.
  • Remember that the condition is both physical and physiological due to the chemical changes that occur in the neurological system. Advice should be sought both from a medical practitioner and psychological specialists such as Neurolinguistic programmers, counsellors or meditation teachers.
  • Review your lifestyle, stresses and habits and endeavour to remove any contributing factors such as cigarette smoking, drug taking and lack of exercise.
  • Consider an initial detoxification programme and remember that you may feel an exacerbation of your symptoms as your body starts to repair.
  • Consider getting the tests mentioned above through an experienced doctor or senior complementary health professional.


  • Ensure that your diet is suitable for yourself. Test for food allergy/intolerance through blood test or Bioresonance techniques.


  • Take the following supplements in divided doses with breakfast and a late afternoon snack (not with your evening meal): magnesium, Co Q 10, a multi-B complex and Vitamin C. Consider zinc – best taken before bed
  • Maximum recommended doses of adrenal extract and thymus gland extract could be taken.
  • The amino acid L-carnitine can be of benefit in reducing fatigue.
  • Folic acid may be beneficial along with Vitamin B 12
  • Glutathione should be taken for it’s detoxification and anti-oxidant benefits


  • Homeopathy can be most effective, depending on your symptoms, and referral to your preferred homeopathic manual or a session with a homeopath to choose a remedy for the symptoms and your constitution is an excellent first step.

Herbal/natural extracts

  • Amongst the repertory of herbs which may be of benefit to CFS sufferers, Echinacea and Astragalus can help boost the immune system, while Ginkgo can aid the circulation of blood to the brain and Glycyrrhiza can help give support to the adrenal glands. Ginseng and liquorice may be supplemented with some success.
  • Coriolus, a mushroom, has been researched for its effects on Natural Killer cells which have been shown to be low in some CFS studies (5).

Prescription of any herbal treatment is best carried out by a qualified practitioner.


  • In some patients, low-dose hydrocortisone reduces fatigue levels in the short-term but longer-term studies are still required.
  • A majority of patients are prescribed antidepressants, and as many as 60% of these improve. Whether there is an improvement because the patient feels less depressed or because of an actual therapeutic benefit, is still in doubt.
  • Not strictly orthodox, but a derivative of a morphine (heroin) antagonist, called Naltrexone, is undergoing research in relation to conditions that effect the nervous system. Low Dose Naltrexone is only prescribed by those physicians with training or experience in this area.

Dr R Sharma


  1. A Clinical Case Definition and Guidelines for Medical Practitioners An Overview of the Canadian Consensus Document Bruce M. Carruthers Marjorie I. van de Sande
  2. Int J Clin Exp Med (2009) 2, 1-16 Chronic fatigue syndrome and mitochondrial dysfunction Sarah Myhill, Norman E. Booth, John McLaren-Howard
  3. Gabb J at al Psychosom Med. 2002 Nov-Dec;64(6):951-62.
  4. Derman W et al, Journal of Sports Sciences Volume 15, Issue 3, 1997
  5. Ojo-Amaize EA, et al Clin Infect Dis. 1994 Jan;18 Suppl 1:S157-9.
  6. William Vayda (Originally Published this article in ‘Australian Wellbeing No. 33, 1989)
  7. Weil, Andrew

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