Chronic Fatigue Syndrome (CFS)

Constantly tired and exhausted

Fatigue syndrome, also known as chronic fatigue syndrome (CFS), can have a variety of causes. What they all have in common is a latent chronic underlying inflammation.

Chronic inflammation, also persistent latent inflammation, causes markedly increased energy consumption in the body. The energy consumption can be measured in kilojoules or kilocalories and is directly proportional to the increase in the degree of inflammation.

In a cross-sectional study, patients who had complained of chronic fatigue syndrome over a long period had elevated blood concentrations of 17 cytokines. The publication in the Proceedings of the National Academy of Sciences (2017; doi: 10.1073/pnas.1710519114) supports the hypothesis of an immunological genesis of the disease.

Since the usual inflammation markers BSG (blood sedimentation rate) and CRP (C-reactive protein) by far cannot indicate all inflammation, the possibility of latent underlying chronic inflammation should also be examined by determining the TH1/TH2 balance (TH1 measures the pro-inflammatory T-cells, TH2 the anti-inflammatory B-cells) and, in particular, also the revealing interleukin 6, which makes it possible to assess the degree of inflammation accurately. In some cases, further clarification of inflammation is required by determining fibrinogen, D-dimer, alpha-2-macroglobulin, interleukin 8, Lp-Pla2, MDA-LDL (oxidized cholesterol) and nitrotyrosine (nitrosative stress?). The cytokines leptin and resistin, which signal the fill state of fat cells, also appear to be good indicators of chronic fatigue syndromes.

Inflammation in the jaw and tooth area have considerable clinical significance for the entire body. Conventional X-rays used by dentists can only detect such inflammation in more advanced stages. DVT (Digital Volume Tomography), which enables a three-dimensional representation of the jaw and tooth area, is now much more conclusive. The safest and most reliable method today is fine layer CT of the upper and lower jaw. This, however, requires a specially trained radiologist who has the necessary, highly specialized expertise.

We can also confirm or disprove the existence of latent underlying inflammation in the jaw/tooth area (which incidentally occur frequently) by measuring Interleukin 5 (also called RANTES). As a precaution, this measurement is combined with an LTT (lymphocyte transformation test) for thioether and mercaptan (both are decay products of dead proteins in the jaw/tooth area).

Another important manifestation of chronic fatigue syndrome can be adrenal insufficiency.

The adrenal gland can be divided into the adrenal cortex and adrenal medulla, and it is an essential organ for our stress and performance control system. It produces the stress and performance hormones cortisol, adrenalin and noradrenalin (see section on hormones). The adrenal gland also regulates blood pressure and the salt content of the blood with the help of the adrenal cortex hormones aldosterone and cortisol. The stress hormone cortisol regulates sugar balance with the hormones insulin and glucagon. The adrenalin released from the adrenal medulla causes an increase in blood pressure via its function in the blood vessels. A hyperactive adrenal gland can thus very easily lead to high blood pressure, a hypoactive adrenal gland, and, on the other hand, to low blood pressure levels with dizziness, optical blackouts, feelings of weakness, occasional palpitations and a permanent feeling of exhaustion.

Cortisol regulates energy turnover in almost every cell of the body and influences blood sugar, protein metabolism, the immune system, and bone metabolism. Hyperfunction can lead to elevated blood sugar levels, hunger, insomnia, muscle weakness, infection, and bone loss (osteoporosis). Hypofunction leads to low blood sugar levels, sodium deficiency, nausea, often considerable fatigue and exhaustion, rapid chills and freezing, and occasionally muscle, joint and bone pain.

The adrenal cortex produces not only cortisol and aldosterone but also the hormone precursor dehydroepiandrosterone (DHEA), of which the natural production decreases considerably at the latest from the age of 50. DHEA is a precursor for male and female sex hormones (testosterone and estrogen) that give us vitality, strength, initiative, and energy. A DHEA deficiency in adrenal hypofunction is accompanied by dry skin, loss of libido and a general loss of energy. DHEA administered as a natural substance can often effectively increase energy.

The significance of minimal hepatic encephalopathy (MHE) is often severely underestimated. It is a subtype of hepatic encephalopathy (HE) with a high prevalence (22 to 74 %) among patients with liver dysfunction. MHE is defined as HE without obvious neurological symptoms but with clear cognitive deficits in psychometric tests.

MHE impairs the quality of life and ability to work of affected patients, in spite of its minor symptoms. It impairs driving ability and is associated with an increased rate of traffic accidents. In addition, these patients experience increased falls and progression to episodic HE. The most important pathophysiological cause of MHE is a malfunction of brain cells (astrocytes) caused by hyperammonemia (to ammonia). Psychometric tests are used to diagnose the disease as a reference.

Additionally, complementary methods such as neurophysiological testing and imaging are available. Recent randomized controlled trials have shown that treatment with lactulose or rifaximin improves the quality of life of patients with MHE. Rifaximin also improves the driving ability of those affected when using a driving simulator. A combination of both drugs also safeguards against the recurrence of episodic HE for a period of up to six months. Some dietary supplements have also improved cognitive deficits in smaller studies.

The causes of Chronic Fatigue Syndrome remain to be clarified:

  1. Chronic latent, underlying viral infections, led by Epstein-Barr virus, possibly also cytomegaly, rare dengue, adeno, parvo, Bornaviruses, Coxsackie viruses
  2. Chronic latent, underlying bacterial infections, led by the Borrelia group, often accompanied simultaneously by typical co-infections such as Rickettsia, Brucella, Coxiella, Bartonella, Anaplasma/Ehrlichia. Toxoplasmas can also contribute as protozoa.
  3. Chronic latent yeast and/or mold infections as an expression of intestinal dysbiosis (abnormal intestinal flora)
  4. A very wide range of yet-to-be-tested environmental pollutants  which have a lasting immunosuppressive effect
  5. Vitamin deficiency, in particular vitamins D, B3, B6, B12, and vitamin C
  6. Trace element deficiency, especially iron (ferritin), selenium and iodine
  7. Hormonal disorders, especially the thyroid gland! Also the adrenal gland (cortex and marrow) with the question of "adrenal fatigue." In very rare cases Addison's disease should be investigated.
  8. COMT deficiency results in reduced adrenaline breakdown, which leads to hyperactivity and overachievement, and excessive consumption of resources leads to exhaustion syndrome after some time.
  9. Permanent radiation exposure from Wi-Fi to radar to radiation as part of cancer therapy
  10. Cancers, in particular with the symptom of unexplained weight loss
  11. Very rarely congenital immunodeficiencies
  12. Depression (also hidden, so-called larviated depression) in different variants and manifestations should be clarified as a (co-)cause.
  13. Selective demyelination of parasympathetic nerve pathways in the central nervous system, as observed in ME/CFS, leads to an impairment of the body's ability to regenerate and is a central factor in the development and worsening of CFS symptoms.

One of the distinctive features of ME/CFS is the so-called selective demyelination (see *1). This means that the protective myelin sheath, which normally surrounds our nerve pathways, is particularly damaged in the central nervous system. This primarily affects the parasympathetic nerve pathways. The parasympathetic nervous system is a part of our nervous system responsible for recovery and regeneration in the body. It plays a crucial role in the healing and repair of our body.

When this protective myelin sheath is damaged, the body can no longer regenerate properly. This leads to people with ME/CFS often feeling perpetually tired and exhausted, as their body does not get the necessary rest and recovery.

Our Approach

In our practice, we offer treatments that specifically target this problem. Through procedures such as apheresis and/or immunoadsorption, we can remove the faulty antibodies responsible for the destruction of the myelin sheath from the blood. These treatment methods help restore the function of the parasympathetic nervous system by freeing the body from these harmful antibodies.

In addition to treating the antibodies, it is important to strengthen the mitochondria. The mitochondria are powerhouses in our cells responsible for energy production. A thorough examination of the various causes of mitochondrial weakening (various inflammations, various environmental toxins) and a corresponding causal therapy should be an integral part of any treatment plan.

A holistic approach to the examination and treatment of ME/CFS is, in our experience, essential to provide the best possible support and relief of ME/CFS symptoms. Our treatment methods aim to restore the body's own regulation and regeneration capabilities.

We believe that a holistic view and treatment of ME/CFS is important to provide the best possible support and relief for the affected patients. Our treatment methods aim to support the body in its own ability to regenerate and help it heal itself.


Chronic Fatigue Syndrome (CFS) can have significant overlaps with Multiple Chemical Sensitivity Syndrome (MCS). Please also read the background of MCS and the Therapy section on Hormone Regulation carefully.

*1) Catalytic Antibodies May Contribute to Demyelination in Myalgic Encephalomyelitis/Chronic Fatigue SyndromeMichael Anthony Jensen, Miranda Lee Dafoe, Julie Wilhelmy, Layla Cervantes, Anna N Okumu, Lucas Kipp, Mohsen Nemat-Gorgani, and Ronald Wayne Davis Biochemistry Article ASAP, DOI: 10.1021/acs.biochem.3c00433

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