Experts identify a number of causes of chronic fatigue:
Chronic Illness - Disruption of the immune system causes chronic illnesses that drain vitality and lead to chronic fatigue.
Psychological disorders - depression and stress caused by various factors affect the nervous system and cause fatigue.
Wrong lifestyle - lack of sleep, general overexertion, lack of sunlight.
Eating disorders - fasting or overeating, poor-quality food leads to a feeling of fatigue;
Environmental factors - the risk of chronic fatigue syndrome is higher in those people who live in megacities, since a polluted environment affects the general condition of the body.
Infections and Viruses - There is a theory that the ingestion of various viruses can cause chronic fatigue syndrome.
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Etiology and pathogenesis
Until now, they remain unknown. A large role is given to the deficiency of macro- and micronutrients, food allergies, excessive physical and mental stress, viral infection.
The most persuasive at present is the infectious or viral theory. According to this theory, the Epstein-Barr virus, cytomegalovirus, herpesvirus type 6, Coxsackie virus, hepatitis C, enterovirus, and retrovirus can serve as trigger factors for CFS. The debut of CFS is often associated with an acute flu-like illness. Data on the high frequency of detection of herpes viruses and signs of their reactivation are also convincing. The possibility of the existence of a still unidentified virus (most likely from the group of herpes viruses) that causes CFS is not completely ruled out, while other known viruses (EBV, CMV, HHV-6, etc.) may play a secondary role, reactivating against the background of disorders of the immune status and supporting them.
Numerous data indicate that both quantitative and functional immunological disorders are observed in CFS. Among the objective indicators, they describe a decrease in IgG due primarily to G1 and G3 classes, the number of lymphocytes with the CD3 and CD4 phenotype, natural killer cells, an increase in the level of circulating complexes and antiviral antibodies of various types, an increase in β-endorphin, interleukin-1 and interferon, and also tumor necrosis factor. In most patients with CFS, a decrease in the number and / or a decrease in the function of natural killer cells was found. Thus, it is believed that changes in the phenotype of immunocompetent cells and dysfunction of natural killer cells are a common manifestation of CFS.
According to some authors, CFS is a consequence of only psychiatric pathology: somatized disorders, "major" or atypical depression.
In some works, the following are discussed as factors of pathogenesis:
1. The increased formation of lactic acid in response to exercise, 2.disruption of oxygen transport to tissues, 3. decrease in the number of mitochondria and their dysfunction in patients with CFS.
The symptoms of CFS and fibromyalgia are thought to be, at least in part, due to impaired cellular metabolism. As a result of studies of patients with CFS, a clear relationship has been established between the level of L-carnitine in the blood plasma and the risk of developing CFS. It was revealed that the degree of L-carnitine deficiency is directly related to the severity of the symptoms of CFS. That is, the less L-carnitine (and its esters) is contained in a person's blood plasma, the lower his performance and the worse his health.
Scientists also believe that CFS may be caused by changes in the balance of bacteria in the gut. According to Columbia University, 90% of people with CFS develop irritable bowel syndrome. And 80% of them have an abnormally high content of the following seven intestinal bacteria: Faecalibacterium, Roseburia, Dorea, Coprococcus, Clostridium, Ruminococcus, Coprobacillus.
However, despite all the identified disorders in CFS, its pathogenesis is still unclear.
Treatment
An integrated approach is the main principle of the treatment of CFS. One of the important conditions of treatment is also the observance of the protective regime and constant contact of the patient with the attending physician.
The treatment program for chronic fatigue syndrome includes:
1. normalization of rest and physical activity;
2. unloading and dietary therapy;
3. general or segmental massage in conjunction with hydrotherapy and physiotherapy exercises;
4. autogenous training or other active methods of normalizing the psycho-emotional background, psychotherapy;
5. other aids (daytime tranquilizers, enterosorbents, antihistamines in the presence of allergies);
6. elimination of chronic diseases associated with insufficient oxygen supply to the body (chronic rhinitis or nasal congestion, etc.).
Many patients cannot fully recover from CFS even with treatment. Some management strategies are proposed to mitigate the consequences of the presence of CFS. All kinds of drug treatment methods, various medical therapies, complementary and alternative medicine are taken into account. Systematic observation has shown that patients with CFS are less susceptible to the placebo effect and have less effect on them than patients with other diseases. CFS is associated with chemical sensitivity, and some patients often respond to a small fraction of the therapeutic dose that is normal in other conditions. Several immunomodulatory agents have been used in a number of recent clinical trials: Staphypan Berna staphylococcal vaccine, lactic acid bacteria,kuibitang and intravenous immunoglobulin. For example, according to recent evidence, antidepressants appear to have beneficial effects in increasing the activity of natural killer cells (NK cells) in depressed patients.
Researchers who have identified deficiencies in antioxidants, L-carnitine, B vitamins, and magnesium, believe that supplementation with drugs containing these substances can significantly reduce the symptoms of CFS. Magnesium regulates all processes of energy production and consumption in the body, with its chronic deficiency, fatigue, lethargy and loss of strength occur. It is even known that intracellular magnesium is 80-90% in a complex with ATP, a nucleotide that is a universal carrier and the main accumulator of energy in living cells.
From the point of view of physiology, fatigue occurs after the depletion of energy resources in the tissues and the accumulation of catabolic products. The formation of energy available to cells (ATP) occurs in the mitochondria due to the oxidation of glucose and fatty acids. In this case, energy deficiency occurs not due to a lack of substrate, but due to the limited throughput of mitochondria. The efficiency of mitochondria is largely determined by the amount of fatty acid transporter - L-carnitine. With a lack of L-carnitine, the oxidation of fatty acids in mitochondria slows down and, as a result, ATP production decreases.
A number of clinical studies have shown the efficacy of L-carnitine (and its esters) preparations for CFS. The daily dose was usually 2 g. The strongest effect occurred after 2-4 weeks of treatment. Fatigue decreased by 37-52%. In addition, such an objective cognitive parameter as concentration of attention improved.
Doctors at Stanford University have linked chronic fatigue syndrome (CFS) to variations in 17 cytokines: immune signaling proteins. The study was published in the journal Proceedings of the National Academy of Sciences.
The concentration of cytokines in the blood correlates with the severity of the disease. It turned out that inflammation directly affects chronic fatigue, the causes of which scientists have been trying to find for about 35 years. Chronic fatigue syndrome affects at least a million people in the United States, and no therapy for this disease has been invented. 75% of patients are women, and two age groups are more susceptible to the disease - adolescents from 15 to 20 years old and adults from 30 to 35 years old.
There was a lot of controversy surrounding chronic fatigue syndrome - some scientists did not even agree that this condition is a disease. Nevertheless, it was found that CFS is accompanied by an inflammatory process, therefore, patients are recommended to donate blood for further diagnosis.
The disease sometimes goes away on its own within a year, but if the condition lasts longer than five years, then according to doctors, the chances that it will suddenly disappear are extremely small.
Many people with CFS experience flu-like symptoms that are sometimes found in other diseases caused by inflammation. Sometimes people develop heart problems, mental impairments called "brain fog", diarrhea, constipation, muscle pain, and other symptoms that make chronic fatigue syndrome very difficult to diagnose.
Jose Montoya, lead author of the study, said that anti-inflammatories and immunomodulatory drugs resulted in symptomatic improvement in his first patient. This prompted the physician to investigate if inflammation could be the cause of the condition.
Montoya and colleagues analyzed blood samples from 192 patients and 392 healthy individuals. The average age of the participants in the experiment was 50 years, and the average duration of symptoms was about 10 years. The project took into account the severity of the disease and its duration. The researchers found that the level of cytokines in patients with moderate forms of CFS was lower than in the control group of respondents, while in patients with severe forms of the disease, cytokines were, on the contrary, higher. As a result, it was found that the concentration of 17 different cytokines can help track the severity of the disease, and 13 of them are anti-inflammatory. One of them, leptin, is secreted by adipose tissue and is more common in the blood of women than men. This discovery will help to understand why there are more women than men among patients with chronic fatigue syndrome.
By the way, quite recently there was an interesting case similar to an exacerbation of Chronic Fatigue Syndrome. The tourist called a rescue helicopter to the mountains, "because she was tired." Emergency workers refused to consider fatigue as a threat to life and offered the unlucky climber to shell out $ 3.5 thousand for an air taxi trip. The incident occurred in the mountainous commune of Jokmokk in northern Sweden. According to the Local publication, a married couple of amateur climbers turned to the rescue services with a complaint that the woman "has difficulties with the musculoskeletal system" and cannot move independently.
A rescue helicopter flew out to help the tourists.
And what was the surprise of the emergency services when it turned out that all the woman really complains about is fatigue. Since fatigue is not considered a serious threat to life, rescuers offered the spouses a choice: either they still go down the mountain on their own, having paid a small fine for a false call, or they pay in full for the helicopter taxi service.
Laziness was stronger than greed. Tourists gave 30 thousand crowns (more than 3.5 thousand dollars) in order not to go down the mountain on their own feet.