Chronic Fatigue Syndrome (CFS)

I am old, Gandalf. I don't look it, but I am beginning to feel it in my heart of hearts. Well-preserved indeed! Why, I feel all thin, sort of stretched, if you know what I mean: like butter that has been scraped over too much bread. That can't be right. I need a change, or something.

 J.R.R. Tolkien, The Lord of the Rings

The cause of Chronic Fatigue Syndrome (CFS) is unknown, but it is characterised by severe, chronic fatigue of six months or longer that is not explicable by other known medical conditions. It is usually accompanied by some combination of four or more other symptoms (see below) that have also lasted for six months or more and coincide with the period of fatigue.


Chronic fatigue syndrome signs and symptoms, plus the main symptom (fatigue)  that gives the condition its name: -


  • Dizziness

  • Enlarged and tender lymph nodes in your neck or armpits

  • Extreme exhaustion lasting more than 24 hours after physical or mental                                                                                                  exercise

  • Fatigue - persistent physical and mental fatigue (exhaustion) which is not                                                                                  relieved with sleep or rest

  • Headache of a new type, pattern or severity

  • Impaired short term memory or concentration

  • Limits on your usual activities which become seriously curtailed

  • Loss of memory or concentration

  • Muscle pain without explanation

  • Pain movement - going from one joint or area to another without swelling or redness

  • Pain that moves from one joint to another without swelling or redness

  • Psychological difficulties such as depression, irritability, anxiety and even panic attacks

  • Sensitivity or intolerance to light, loud noise, alcohol, and certain foods

  • Sore throat

  • Stomach pain and other problems similar to irritable bowel syndrome, such as bloating, constipation, diarrhoea and nausea

  • Sore throat 

  • Sweating

  • Unrefreshing sleep



Chronic fatigue syndrome (CFS) and adrenal fatigue are not the same, but adrenal function is likely to be implicated in CFS.


A period of physical or emotional stress commonly precedes the onset of CFS. In my own case within one week I had lost my partner, my business, my finances, and my home, my social network,  but it doesn't have to be as exaggerated as that.


People with CFS have been found to produce lower levels of the adrenal stress hormone, cortisol, than do healthy people. Although low cortisol does not seem to cause CFS, and raising cortisol levels does not eliminate it, adrenal fatigue, and its concomitant low production of cortisol and a number of other regulatory hormones, may help predispose a person to its onset or exacerbate the symptoms.


When there is a longer than normal recovery period from CFS, with decreased stamina and pronounced morning tiredness, adrenal fatigue is likely contributing to the symptom picture, no matter the cause of the illness.


Approaches to treatment


Providing adequate support for healthy adrenal function is an important contributing factor in facilitating full recovery from CFS and the maintenance of health and vitality.


If you feel you may have CFS you may find your general practitioner ill-informed and quite dismissive of your symptoms. One doctor told me, "It may well be CFS but it's difficult to diagnose and more difficult to treat."  Not much hope there then. And none of that is any longer true! It is simply an example of the challenges faced by a doctor when confronted by a mystery illness.


Your role may well be to inform and educate your medical practitioner.