What is Chronic Fatigue Syndrome? How is it Treated?

Chronic Fatigue Syndrome (CFS) is a complicated disorder characterized by extreme fatigue that is not explained through diagnostic testing or a pre-existing medical condition.  CFS is also known as Myalgic Encephalomyelitis (ME), chronic fatigue and immune dysfunction syndrome (CFIDS) and by other names. It can be a complex and debilitating chronic illness with a serious impact on one’s quality of life. Fatigue specific to CFS may worsen with physical or mental activity, but doesn’t improve after sleeping or resting.

Chronic Fatigue

WHAT ARE THE SYMPTOMS OF CFS? The most common symptoms of Chronic Fatigue Syndrome or Myalgic Encephalomyelitis  (ME/CFS) include post-exertional malaise (PEM).  PEM is characterized by a state of exhaustion due to sleep that is not relieved by bedrest or sleep.  This unrefreshing sleep leads to trouble concentrating or mental fatigue, joint and muscle pain, with worsening symptoms typically lasting for six months or more.

Chronic Fatigue Primary symptoms include:

  1. Increased malaise (extreme exhaustion and sickness) following physical activity or mental exertion
  2. Problems with sleep
  3. Difficulties with memory and concentration
  4. Persistent muscle pain
  5. Joint pain (without redness or swelling)
  6. Headache
  7. Tender lymph nodes in the neck or armpit
  8. Sore throat

Other secondary symptoms may include:

  1. Brain fog or trouble concentrating
  2. Difficulty maintaining an upright position
  3. Dizziness, balance problems or fainting
  4. Allergies or sensitivities to foods, odors, chemicals, medications, or noise
  5. Irritable bowel syndrome
  6. Low grade fever or low body temperature
  7. Numbness, tingling, or burning sensations in the face, hands, or feet
  8. Chills and night sweats
  9. Visual disturbances (sensitivity to light, blurring, eye pain)
  10. Depression or mood problems (irritability, mood swings, anxiety, panic attacks)

Chronic Fatigue SyndromeA person with CFS feels completely exhausted to the point of being unable to function. This extreme tiredness makes it hard to do the daily tasks that most of us do without thinking — like dressing, bathing, holding a book, putting away dishes, or eating, and therefore might experience depression. Sleep or rest does not make the tiredness go away. It can be made worse by walking,  light exercising, carrying on a conversation or even thinking or problem-solving. Chronic Fatigue Syndrome can happen gradually and worsen over time, or it may occur unexpectedly and suddenly.  The extreme tiredness may come and go, over many years.  In some cases the CFS symptoms never goes away. CFS symptoms must remain for at least six months before a diagnosis can be made by a trusted physician.

Experts estimate that at least one million Americans have CFS, and of these cases, 20% are undiagnosed. Statistics show that in the United States, approximately 75-420 people have CFS per 100,000 people.  In Australia,  o.3% or 30 per 1,000 people have CFS. Women are four times as likely as men to develop Chronic Fatigue Syndrome and people age 40 – 59 are more likely to be diagnosed, than children. People of all ages can get CFS, although studies suggest that CFS occurs more often in adolescents than in children under twelve years of age. CFS occurs in all ethnic groups, cultures, and countries around the world. Statistics show that it is more Tired womancommon in lower-income than in higher-income persons, however this is not significant. CFS is sometimes seen in members of the same family. Researchers are determining whether this might be because of a genetic link.  People who are overweight and inactive are more likely to develop CFS. There is no definite cause of CFS.  Epstein-Barr virus or human herpes virus-6 (HHV-6) might be a contributing factor, however, no specific virus has been identified as the cause.  It is thought that it might be caused by inflammation in the nervous system and a faulty immune system response. Age, previous illnesses, stress, genetics, and environmental factors listed above, may also play a significant role in the development of Chronic Fatigue Syndrome.   People with Chronic Fatigue Syndrome often report that the onset of symptoms occurred after a time of great stress, such as the loss of a loved one or major surgery. More research is needed to determine the cause.

Chronic Fatigue SymptomsHOW DOES THE DOCTOR DIAGNOSE CFS? A diagnosis of CFS may take many years to determine and can be frustrating or wearing for those suffering from CFS.  Laboratory tests currently are not used.  Sometimes CFS can be misdiagnosed because many Chronic Fatigue Syndrome symptoms can be side effects of medical treatments or can also be symptoms of other illnesses.  Therefore, doctors will prescribe blood and urine tests, and possibly brain MRIs to rule out other illnesses and medical conditions.  All adult cases of CFS are determined by the “Fukuda criteria” from the 1994 Centers for Disease Control and Prevention (CDC) definition.  Children with CFS are determined by a pediatric case definition of CFS.  A qualified doctor will make a diagnosis of CFS after questioning a patient about their physical and mental health, conducting a physical exam, and ordering urine and blood tests to rule-out other medical conditions.  The doctor will diagnose a patient as having CFS, only if that person has been extremely tired for six months or more and laboratory test results do not offer a medical solution, and if the patient has four out of the 8 primary symptoms of CFS listed above. In addition to having four out of the eight primary symptoms determined by the Centers for Disease Control and Prevention (listed above under “Primary symptoms”), the patient must  also have unexplained, persistent or relapsing chronic fatigue that is:

  1. New or definite onset (has not been lifelong)
  2. Not the result of ongoing exertion
  3. Not substantially alleviated by rest
  4. Results in substantial reduction in previous levels of occupational, educational, social, or personal activities.

Doctors must rule out other diseases and chronic illnesses that have similar symptoms. The following diseases and syndromes are often mistaken for Chronic Fatigue Syndrome:

  1. Drug dependence
  2. Infections
  3. Muscle or nerve diseases (such as multiple sclerosis)
  4. Endocrine diseases (such as hypothyroidism)
  5. Psychiatric or psychological illnesses, particularly depression
  6. Tumors
  7. Fibromyalgia
  8. Lyme disease
  9. Gulf War syndrome
  10. Gluten intolerance
  11. Post-polio syndrome
  12. Vitamin B12 deficiency
  13. Multiple chemical sensitivities
  14. Other immune or autoimmune disorders
  15. Heart, kidney or liver diseases

Chronic fatigue syndrome (ME/CFS) and fibromyalgia (FMS)are alike in many ways. In fact, it is not uncommon for a person to have both fibromyalgia and CFS. Some experts believe that fibromyalgia and CFS are in fact the same disorder. According to the Arthritis Foundation, research shows that 50 to 70 percent of people have both disorders. When diagnosing CFS or fibromyalgia, one primary difference, is determining which symptom is worst – pain or fatigue. The diagnosis could also be influenced by whether your primary care physician or practitioner is more familiar with the American College of Rheumatology’s criteria for FMS or the CDC’s guidelines for ME/CFS. Some researchers have discovered a few significant differences. ME/CFS seems to begin after a person experiences flu-like symptoms, so some believe that chronic fatigued syndrome may be linked to a virus, and those with CFS often have chronic immune system challenges, as if their bodies are fighting an infection, while fibromyalgia patients do not always have this. CFS patients sometimes have low-grade fever and sore throat, while FMS criteria does not require this for a diagnosis. Fibromyalgia is frequently is rooted in a physical or emotional trauma and the pain of FMS often gets better with massage and heat, while the pain of ME/CFS may not necessarily respond favorably to these treatments. However, despite these few differences, many agree that the two diagnoses have multiple similar symptoms and might indeed be the same disorder.

The National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) are funding CFS research studies on Chronic Fatigue Syndrome in order to determine treatments and cures.  The following treatments have been found to be effective Over-the-counter pain relievers such as Aleve, Advil, or Motrin, can be beneficial in reducing pain, such as body aches, headaches, and muscle and joint pain. Non-drowsy antihistamines can help with allergy symptoms, such as sneezing, runny nose, sore throat, nose and watering or itching eyes.  Prescription medications like doxepin or amitriptyline can help improve sleep. Yoga poseComplementary or alternative treatments, such as massage, acupuncture, chiropractic care, yoga, stretching, meditation, Tai Chi, Reiki,  biofeedback, or self-hypnosis can be helpful in treating stress-related symptoms or pain. Many alternative treatments, dietary supplements, and herbal remedies can be effective in alleviating CFS symptoms.  Neti Pots are a nonprescription solution for chronic allergy and sinusitis problems and recommended for use by most all healthcare practitioners. Herbal remedies such as honey and lemon tea, steam tent, valerian root, grapefruit seed extract, ginger, echinacea,  vitamin C supplements, and others. Talk to your doctor, nutritionist, or trusted health-care practitioner in order to determine which treatment is best for you.

Lifestyle changes can be effective in treating CFS.  A nutritionist or primary care doctor can make suggestions regarding a healthy diet.  A journal can be a helpful tool. Write down what you do each day, noting times when you feel particularly tired. Then, determine which activities are most fatiguing to you.  Stop doing things that seem to trigger your tiredness, or do less.  If basic tasks are overwhelming, such as dressing or eating, find ways to modify these tasks or break them into smaller steps.  occupational therapist

An occupational therapist or physical therapist can be helpful in recommending assistive devices (such as modified appliances or tools) if you are unable to achieve basic daily life skills.  The occupational therapist can help you with setting goals, and choosing alternative approaches to completing tasks at home and at work and making progress in managing your pain and fatigue. You might also need to change your working or resting environment and even move to another location that is more supportive and comfortable for you. CFS affects mental, emotional, or physical energy, so these modifications in behaviors must include all areas of fatigue.


  1. Chronic Fatigue and Immune Dysfunction Syndrome Association of America, Phone: 704-365-2343 http://solvecfs.org/
  2. Chronic Fatigue Syndrome, Center for Disease Control, Chronic Fatigue Syndrome Advisory Committee, HHS, Phone: 202-690-7650 http://www.cdc.gov/cfs/
  3. International Association for CFS/ME Phone: 847-258-7248 http://www.iacfsme.org/
  4. National CFIDS Foundation, Phone: 781-449-3535 http://www.ncf-net.org/
  5. National Chronic Fatigue Syndrome and Fibromyalgia Association, Phone: 816-737-1343
  6. The Trans-NIH Working Group on Chronic Fatigue Syndrome, Phone: 301-402-1770


  1. Evangard B, Schacterie R.S., Komaroff A. L. (Nov 1999). “Chronic fatigue syndrome: new insights and old ignorance”. Journal of Internal Medicine 246 (5): 455–469.
  2. Santhouse A, Hotopf M, David AS. Chronic fatigue syndrome. BMJ. 2010;340:c738
  3. Guideline 53: Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy). London: National Institute for Health and Clinical Excellence. 2007.
  4. Afari N, Buchwald D (2003). “Chronic fatigue syndrome: a review”. Am J Psychiatr 160 (2): 221–36
  5. “Chronic Fatigue Syndrome (CFS), Symptoms”. Centers for Disease Control and Prevention. 2012-05-14. Retrieved 2012-09-23
  6. “Chronic Fatigue Syndrome Basic Facts”. Centers for Disease Control and Prevention. May 9, 2006. Retrieved 2008-02-07
  7. Carruthers BM, Jain AK, De Meirleir KL, Peterson DL, Klimas NG, et al. (2003). “Myalgic encephalomyalitis/chronic fatigue syndrome: Clinical working definition, diagnostic and treatment protocols” (PDF). Journal of Chronic Fatigue Syndrome 11 (1): 7–97
  8. Edmonds M, McGuire H, Price J (2004). “Exercise therapy for chronic fatigue syndrome”. In Price, Jonathan R. Cochrane Database Syst Rev (3): CD003200.


Jean E. DartThis article is written by Jean Voice Dart, M.S. Special Education from Illinois State University. Jean is a published author and has written hundreds of health articles as well as hosting a local television program, “Making Miracles Happen.” She is a Registered Music Therapist, Sound Therapist, and Master Level Energetic Teacher, and is the Executive Director, founder and Health and Wellness Educator of the Monterey Bay Holistic Alliance. The Monterey Bay Holistic Alliance is a registered 501 (c) 3 nonprofit health and wellness education organization. For more information about the Monterey Bay Holistic Alliance contact us or visit our website at www.montereybayholistic.com.

Disclaimer:The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)3 organization and does not endorse any particular products or practices. We exist as an educational organization dedicated to providing free access to health education resources, products and services. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. The statements about organizations, practitioners, methods of treatment, and products listed on this website are not meant to diagnose, treat, cure, or prevent any disease. This information is intended for educational purposes only. The MBHA strongly recommends that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition.

Can Vitamin D Help Improve Muscle Strength and Fatigue?

What does Vitamin D have to do with muscle development and functionality?  Can taking vitamin D supplements help improve muscle strength? Recent research shows that vitamin D can be effective in improving muscle strength and reducing muscle fatigue.

Vitamin D - Powerful Healer

Current research shows that vitamin D can strengthen muscles and reduce fatigue. Vitamin D deficiency is a worldwide problem.

HOW DOES THE BODY RECEIVE AND USE VITAMIN D? Vitamin D is a fat-soluble vitamin.  It is produced in the body using the energy we receive from sunlight, and also found in some foods such as milk, salmon or cod liver oil and other fish, and vitamin-fortified foods, such as cereals.  Vitamin D and calcium are important for good bone health and vitamin D helps the body absorb calcium and protect older adults from osteoporosis. Muscles need vitamin D in order to move and nerves need it to carry messages between the brain and  every part of the body, and vitamin D helps our immune system fight off invading bacteria and viruses.


Man exhausted books

A vitamin D deficiency results in muscle weakness and atrophy, bone loss, and fatigue.

WHAT IS VITAMIN D DEFICIENCY? A diagnosis of vitamin D deficiency is rapidly on the rise and becoming a significant public health problem world-wide.  Fatigue is frequently found to be the cause of vitamin D deficiency. The mitochondria within the cells, take fats and sugars and make them into energy.  When the mitochondria are not working properly, people have symptoms of fatigue. Vitamin D deficiency is a well-recognized cause of fatigue and myopathy (a muscular disease resulting in muscular weakness).  Bones can become thin, brittle, or misshapen without sufficient vitamin D. Vitamin D can prevent rickets in children and osteomalacia in adults.  In the 1930’s milk was fortified with vitamin D making rickets almost unheard of in the United States, although it is still occurs occasionally.  It is difficult to get enough vitamin D from food and therefore sunlight is the primary source.  This means that elderly people who are home-bound, those who spend most of their days working inside,  or women or men who wear long robes and cover their heads for religious reasons, will most likely not receive enough vitamin D and will need supplementation. Dark-skinned and obese people, those whose wear sun-block, and those who have tinted windows are also at risk of not getting enough vitamin D. Doctors are discovering that patients with somewhat elusive or undiagnosed symptoms of fatigue and muscle weakness are suffering from a vitamin D deficiency.

Several research studies have been conducted on vitamin D. Bischoff-Ferrari  (2009)  and other researchers investigated vitamin D and its effects on preventing falls among older individuals.  They concluded, “Supplemental vitamin D in a dose of 700-1000 IU a day reduced the risk of falling among older individuals by 19% and to a similar degree as active forms of vitamin D. Doses of supplemental vitamin D of less than 700 IU or serum 25-hydroxyvitamin D concentrations of less than 60 nmol/l may not reduce the risk of falling among older individuals.”


two girls computer

More children and adults are getting less exposure to sunlight and are deficient in vitamin D.

Holick and Chen (2008) conclude that, “Vitamin D deficiency is now recognized as a pandemic.”  They state that “A circulating level of 25-hydroxyvitamin D of >75 nmol/L, or 30 ng/mL, is required to maximize vitamin D’s beneficial effects for health. In the absence of adequate sun exposure, at least 800-1000 IU vitamin D3/d may be needed to achieve this in children and adults.”   Vieth R, Bischoff-Ferrari and others (2007) in a study on dietary and lifestyle predictors with British adults, found an “urgent need”  to recommend an efficient dose of vitamin D.

The Agency for Healthcare Research and Quality (2010) summarized 165 primary articles and 11 systematic reviews that incorporated over 200 additional primary articles, in “Vitamin D and Calcium: Systematic Review of Health Outcomes.”  They concluded that “The majority of the findings concerning vitamin D, calcium, or a combination of both nutrients on the different health outcomes were inconsistent. Synthesizing a dose-response relation between intake of either vitamin D, calcium, or both nutrients and health outcomes in this heterogeneous body of literature proved challenging.

Dr. Anna Dorothea Hoeck, MD (2009), estimates that over a billion people worldwide are vitamin D deficient or insufficient and that there appears to be a correlation between vitamin D deficiency and chronic fatigue syndrome or multi-system syndromes. She states that  “Severe vitamin D deficiency with levels below 10 ng/ml (25 nm ol/L) causes severe fatigue and personality changes, depression-like symptoms, chronic sleep disorder, multiple intolerances,obvious immune dysfunctions and in the long time, multi-system symptoms and multi-system diseases”

Dr. Zahid Naeem (2010), MBBS, MCPS, DPH, FCPS, Professor, states that “Vitamin D deficiency is a global health problem. With all the medical advances of the century, vitamin D deficiency is still epidemic. Over a billion people worldwide are vitamin D deficient or insufficient. Yet no international health organization or governmental body has declared a health emergency to warn the public about the urgent need of achieving sufficient vitamin D blood levels.”

A recent research study was presented at the Society for Endocrinology annual conference in Harrogate, UK., and supported by the British Society of Paediatric Endocrinology and Diabetes (BSPED).    Dr Akash Sinha (2013), research team leader, and researchers from Newcastle University Endocrinology, GNCH, Institute of Genetic Medicine, investigated the effects of cholecalciferol therapy (vitamin D3) on skeletal mitochondrial oxidative function in symptomatic, vitamin D deficient individuals.  The researchers studied  the phosphocreatine (a compound of phosphoric acid and creatine found in vertebrate muscle) recovery time in patients with vitamin D deficiency.   Twelve patients were used in the study.  They each were diagnosed with severe vitamin D deficiency before and after treatment with vitamin D.   A non-invasive magnetic resonance scan (MRI) called phosphorus-31 magnetic resonance spectroscopy was used to measure phosphocreatine movement in response to exercise in the calf muscles of all 12 patients.  Serum assays were performed before and after cholecalciferol therapy to document serum 25OHD and bone profiles.   Ten to twelve (10-12) weeks after treatment, the researchers found phosphocreatine recovery significantly improved. After receiving vitamin D supplementation, all patients reported improvement in fatigue symptoms. According to Dr Akash Sinha research team leader,

“This is the first time a link has been shown between vitamin D status and muscle aerobic function.”

“Patients with vitamin D deficiency often experience symptoms of muscle fatigue. Our findings in a small group of patients with very low vitamin D levels show that muscle efficiency significantly improves when vitamin D status is improved.”


Kiss the sunVitamin D deficiency is becoming a world-wide problem. This may be due to our technological advances and cultural changes with more people choosing to spend long hours working and relaxing indoors. Researchers conclude that vitamin D deficiency may be the cause of multiple physical ailments with symptoms of muscle fatigue, atrophy and bone loss.  Vitamin D is not easily found in many foods, therefore many researchers and health professionals are determining that it may be necessary or urgent for people to alter their lifestyle to receive adequate doses of vitamin D from sunshine or from supplementation.  The recent study by Akash and others (2013) showed significant improvement in muscle efficiency after increasing vitamin D supplementation with patients who were vitamin D deficient. This was ground-breaking documentation.  More research, like this is needed with more subject to determine how and why this is happening and if people who are not vitamin D deficient can also benefit from using vitamin D.

Akash SA, Hollingsworth K, Ball S, and Cheetham T, Improving the vitamin D status of vitamin D deficient adults is associated with improved mitochondrial oxidative function in skeletal muscle Endocrine Abstracts (2013) 31 OC1.6, DOI:10.1530/endoabs.31.OC1.6

Bandeira F, Gris L. Vitamin D deficiency a global perspective. Arq Bras Endocrinol Metab. 2006;50/4:640–646.

Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009;339:b3692.

Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, et al. Vitamin D and calcium: a systematic review of health outcomes. Evidence Report/Technology Assessment No. 183 prepared by the Tufts Evidence-based Practice Center under Contract No. 290-2007-10055-I. AHRQ

Cranney A, Horsely T, O’Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garrity C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V. Effectiveness and Safety of Vitamin D in Relation to Bone Health Evidence Report/Technology Assessment No. 158. (Prepared by Ottawa Evidence-based Practice Center under Contract No. 290-02-0021). AHRQ Publication No. 07-E013, Rockville, MD: Agency for Healthcare Research and Quality. August 2007.

Heaney RP. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr 2003;78:912-9.

Hoeck AD, MD, Vitamin D deficiency results in chronic fatigue and multi-system symptoms
Mariawaldstr. 15.09.2009; Apr;87(4):1080S-6S.7, 50935 Cologne, Germany.

Hollick MF, Chen TC. Vitamin D deficiency a worldwide problem with health consequences. Am J Clin Nutr. 2008;87:10805–68.

Naeem Z, Vitamin D Deficiency- An Ignored Epidemic, Int J Health Sci (Qassim). Jan 2010; 4(1): V–VI.

Vitamin D: Fact Sheet for Health Professionals, Office of Dietary Supplements,  National Institutes of Health, U.S. Department of Health and Human Services

Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson-Hughes B, Garland CF, Heaney RP, et al. The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr 2007;85:649-50.

Vitamin D and Calcium: Structured Abstract. May 2010. Agency for Healthcare Research and Quality, Rockville, MD.


Jean E. Dart
This article is written by Jean Voice Dart,  M.S. Special Education from Illinois State University. Jean is a published author and has written hundreds of health articles as well as hosting a local television program, “Making Miracles Happen.”  She is a Registered Music Therapist, Sound Therapist, and Master Level Energetic Teacher, and is the Executive Director, founder and Health and Wellness Educator of the Monterey Bay Holistic Alliance.  The Monterey Bay Holistic Alliance is a registered 501 (c) 3  nonprofit health and wellness education organization.  For more information about  the Monterey Bay Holistic Alliance contact us or visit our website at www.montereybayholistic.com.

Disclaimer:The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)3 organization and does not endorse any particular products or practices. We exist as an educational organization dedicated to providing free access to health education resources, products and services. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. The statements about organizations, practitioners, methods of treatment, and products listed on this website are not meant to diagnose, treat, cure, or prevent any disease. This information is intended for educational purposes only. The MBHA strongly recommends that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition.