Chronic Fatigue Syndrome

With this article, I aim to help you better understand the symptoms you are experiencing regarding Chronic Fatigue Syndrome (CFS), to participate consciously in your treatment process, and to manage your daily life in a healthier way.

What Is Chronic Fatigue Syndrome?

CFS (Myalgic Encephalomyelitis / Chronic Fatigue Syndrome), is a condition of fatigue lasting at least 6 months, not relieved by rest, and significantly limiting your physical and mental functions. This syndrome is not simply “being very tired.” It is a multifaceted medical condition in which the body’s energy production mechanisms, immune system, and nervous system are affected in a complex manner.

With this illness, you may have difficulty carrying out daily activities and may experience severe exhaustion even after minor effort. This situation often becomes difficult for your surroundings to understand; therefore, understanding the illness is important.

What Are the Symptoms?

CFS symptoms may vary from person to person. However, many of our patients show common complaints. Its main symptom is deep fatigue that does not improve with rest and lasts at least 6 months. Even mild activity may cause your symptoms to worsen for hours or days. Other symptoms include:
• Difficulty falling asleep, non-restorative sleep
• Muscle and joint pain
• Dizziness, palpitations, tendency to low blood pressure
• Difficulty concentrating and forgetfulness (brain fog)
• Sensitivity to light, sound, or multiple stimuli
• Headaches
• Digestive problems (bloating, irritable bowel, etc.)
• Extreme sensitivity to cold or heat

What Causes It?

There is no single cause of CFS; multiple factors usually play a role. One or several of the following factors may have triggered the process in you:
• Post-viral infections (such as flu-like illnesses)
• Immune system dysregulation
• Vitamin deficiencies
• Hormonal imbalances
• Autonomic nervous system dysfunctions
• Intense physical or emotional stress
• Metabolic energy production disorders
• Genetic predisposition
The fact that the exact cause is unknown does not mean recovery is impossible. Today, many of our patients achieve significant improvement in their quality of life.

How Do We Diagnose It?

There is no specific blood test or imaging method for CFS. Therefore, the diagnosis is made based on your detailed medical history, examination findings, and by excluding other possible conditions.
As Physical Medicine and Rehabilitation specialists, we:

1. Question your long-standing fatigue and its effects.
2. Evaluate post-exertional symptom worsening.
3. Examine your sleep and cognitive complaints in detail.
4. Rule out conditions such as thyroid disorders, anemia, rheumatic diseases, depression, and vitamin deficiencies.
   At the end of the diagnostic process, we offer a treatment plan, lifestyle adjustments, and rehabilitation options suitable for you.

Treatment Approaches

Since Chronic Fatigue Syndrome is a multifaceted condition, treatment requires a multidisciplinary approach. The treatment plan we provide you is shaped according to your personal symptoms, daily life conditions, and coexisting medical issues.

1. Energy Management (Pacing): One of the most effective methods.
   • We encourage you to break your daily activities into smaller parts,
   • Avoid exceeding your effort capacity,
   • Stay away from the “push–crash cycle.”
   Using your energy evenly throughout the day makes it easier to control your symptoms.
2. Graded and Controlled Exercise Programs: Exercise may be beneficial for you, but classic intense exercise models can worsen symptoms in CFS. Therefore:
   • Low-intensity, heart rate–controlled,
   • With rest intervals,
   • Designed with the supervision of a physiotherapist.
   The aim is to improve your functional capacity and strengthen the body safely.
3. Sleep Regulation: Sleep hygiene education, recommendations to regulate the circadian rhythm, and supportive treatments when necessary may be used. Regular and restorative sleep is one of the cornerstones of your recovery.
4. Pain Management: We aim to significantly reduce muscle, joint, and widespread body pain. For this, we use the following methods:
   • Manual therapy
   • Soft tissue and fascial release techniques
   • Heat/cold applications
   • TENS and other electrotherapies
5. Autonomic Nervous System Support: For patients experiencing palpitations, dizziness, or a tendency to low blood pressure, we recommend:
   • Regulating daily fluid and salt intake
   • Making positional changes gradually
   • Use of compression stockings
6. Glutathione and Vitamin Support: In Chronic Fatigue Syndrome, we frequently observe oxidative stress, changes in immune function, and impaired energy metabolism. Therefore, in some of our patients, we prefer glutathione and vitamin–mineral supplements as additional treatments.

Glutathione Support:

• Glutathione is one of the body’s most powerful antioxidants.
• It may help reduce oxidative stress, support the immune system, and regulate cellular energy production.
• It is usually administered intravenously and in scheduled intervals.
• Whether it is suitable for you is determined by evaluating your lab results and clinical condition.

Vitamin and Mineral Supplements: Some supplements stand out especially in CFS:
• Vitamin B12: Important for nervous system function and energy metabolism.
• Vitamin D: Supports immunity, muscle function, and general endurance.
• Vitamin C: A strong antioxidant supporting immune function.
• Magnesium: May benefit muscle tension, headaches, sleep quality, and the nervous system.
• Coenzyme Q10 (CoQ10): Contributes to mitochondrial energy production and may reduce fatigue.
• Omega-3 fatty acids: With anti-inflammatory effects, they support general well-being.
We plan each of these supplements with a personalized evaluation; we determine the dose, duration, and combination. I would like to emphasize the importance of using supplements under medical supervision.

1. Psychological Support
   CFS is not a psychological disease; however, living with a chronic condition may lead to emotional challenges at times. For this reason, the psychological supports listed below strengthen the treatment:
   • Stress management
   • Attention and stimulus tolerance training
   • Methods to cope with anxiety and burnout

Suggestions for Daily Life

• Plan your day and use your energy in small installments.
• Avoid unnecessary stimuli; noise, bright light, and crowded environments may worsen symptoms.
• Simplify your home and work environment as much as possible.
• Stick to your graded exercise programs.
• Eat your meals regularly and in balance; avoid blood sugar fluctuations.
• Increase your water intake.
• Plan “rest days” when you experience sudden symptom flare-ups.
• Do not compare yourself with others; find your own rhythm.
• Track your progress through small steps.

Is Recovery Possible?

We observe the following positive developments in many of our patients:
• Decrease in fatigue levels,
• Increase in exercise tolerance,
• Relief in pain,
• Improvement in sleep quality,
• Improvement in daily functioning.
In the treatment of Chronic Fatigue Syndrome, being patient, not overexerting the body, applying proper energy management, and adhering to an appropriate rehabilitation program increase success. Recovery is a personal process; however, many of our patients achieve significant quality-of-life improvement over time.

Final Words

The symptoms you experience are real and valid. Chronic Fatigue Syndrome is a condition that can be managed with professional support and the right approach. You are not alone in this process; our goal is for you to become stronger, improve your quality of life, and reach a life where you can use your energy freely.

Stay healthy…

Dr. Elif Berber, PhD
Specialist in Physical Therapy and Rehabilitation