Fatigue is one of the most frequent symptoms that brings a patient to the doctor. The causes are numerous and, in fact, it can accompany almost any illness. The presence of fatigue is, however, an important indicator of serious disease. In 1979 Dr. Cuyler Hammond's report on the 20 year long Cancer Prevention Study, which surveyed over a million Americans, found that a positive answer to the question "do you fatigue easily?" was predictive of a higher death rate from disease, including cancer, than any other question!
Chronic fatigue Syndrome (CFS) is not a new disease; however in the past few years it has seemingly increased in frequency and severity. After a large number of cases were reported in 1984 at Incline Village, Nevada, the National Institute of Health assigned a full time researcher. When calls for information went over 1000 per month, Center for Disease Control launched a million dollar investigation and assigned a hot-line number (404-332-4555).
A national conference was held in San Francisco in mid-1989 and a formal definition of CFS was accepted by CDC, giving it new disease status. This includes 11 symptoms and 3 physical signs but essentially it is defined as newly occurring persistent or relapsing fatigue that reduces activity below 50 percent of normal for at least six months. Flu-like symptoms, including fever, sore throat, painful lymph nodes and muscle weakness and pain, as well as headache, insomnia, irritability and mood depression also occur. The consensus was that CSF is a disease, possibly reflects a new organism or virus and occurs in about 5 percent of patients with fatigue.
The diagnosis of fatigue syndrome is only the latest in a long list of labels to denote this common symptom. In the late 19th Century and until the 1940's it was called neurasthenia, a French word that translates literally, weak nerves. This term was removed from the manual of psychiatric diagnosis only a decade ago and replaced by the diagnosis, depression. Hypochondriasis is another label traditionally offered in explanation of those who suffer chronic fatigue. Faced with a disabling condition and no apparent diagnosis, the doctor of the past was commonly tempted to resort to a psychologic diagnosis.
Doctor’s offices are now equipped to diagnose viruses and so doctors are more likely to consider
viruses in puzzling cases. Epstein Barr, Herpes and Cytomegalo viruses have all been researched but found to be present no more in fatigue patients than the rest of us. So strongly does the CSF case profile fit the syndrome of viral illness, including sore throat and swollen lymph nodes in many cases, that UCSF virologist Jay Levy suggests that it is "a new agent, not readily recoverable or we would have found it."
Patients seem to identify with the concept of "stress." In a survey of almost 300 fatigue patients in San Francisco, over half blamed stress. This is unlikely to be the cause though it can evidently aggravate the syndrome of disabling fatigue. When present stressful circumstances are obvious; however, stress is an ever-present part of life and we are designed to adapt and become stronger thereby—and we do if we are not first sick, toxic or depleted.
In this regard, a survey by Dr. Carol Jessop, of 1100 CSF patients, 80 percent reported recurrent infections as children, acne as adolescents and chronic bowel problems, hives, headaches and anxiety attacks. Over 90 percent had high cholesterol levels. This certainly points to pre-existing illness, depletion and toxicity. She also reported recovery in about 60 percent after treatment with a sugar free diet and ketoconazole (Nizoral) for presumed yeast infection (Candida).
This intriguing finding has persuaded many that Candida is a cause of CSF and that the removal of dietary sugars removes the favorite food of the yeast organism so that it will be less likely to relapse after drug treatment. The high frequency of responders to Nizoral has encouraged many doctors to prescribe this sometimes dangerous drug on presumptive evidence, ie. no actual identification of yeast organisms. This has generated a very heated controversy, not yet resolved.