Chronic Fatigue Syndrome: A Functional Medicine Approach


Chronic Fatigue Syndrome (CFS) is a multi-factorial condition that requires a holistic and thorough approach to treatment.

What Are The Symptoms Of Chronic Fatigue Syndrome?

Typical symptoms include post-exertional fatigue, memory or concentration problems, muscle pain, joint pain, headaches, sore throat, painful swollen lymph nodes and sleep disturbance. Digestive symptoms such as bloating and bowel irregularities are also common.

A statistic from a ‘2020 Health’ report stated that:

The total cost to the UK economy of CFS in 2014/15 was at least £3.3 billion

In this article I want to cover some of the underlying causes of this condition.

I also recently recorded this webinar which goes through the numerous underlying causes of chronic fatigue:

Can Gut Issues Cause Chronic Fatigue Syndrome?

In analogy with “the atopic march” in allergic diseases, we suggest “a dysbiotic march” in IBS; initiated by extensive use of antibiotics during childhood, often before school age. Various abdominal complaints including IBS may develop soon thereafter, while systemic symptom like CFS, fibromyalgia and ME may appear years late.

Dysbiosis (imbalances in our gut bacteria) have been associated with CFS. This may contribute to low grade inflammation which has been associated with CFS. Previous causes of antibiotics, other medications such as PPI’s, a poor diet (high in sugar in low in vegetables and phytonutrients), chronic stress can call contribute to imbalances in our gut bacteria.

Research has also found lower microbiome diversity in patients with CFS.

Leaky Gut And Chronic Fatigue

Leaky gut has been associated with CFS. Leaky gut is a condition when the lining of our digestive system becomes excessively permeable allowing bacterial remnants and undigested food particles into our circulation where they can trigger a chronic immune response and low level inflammation.

Click here for a research paper discussing this connection.

SIBO And Chronic Fatigue

While there isn’t much research investigating SIBO in CFS we can make a strong assumption these two conditions are correlated. SIBO can cause inflammation, leaky gut and nutrient deficiencies which may all contribute to a CFS. One paper did find that:

77% of participants with CFS had SIBO.

SIBO stands for ‘small intestine bacterial overgrowth’.

Click here for my blog post introducing  SIBO, and click here, for a study demonstrating this link.


Mitochondrial Dysfunction Causes Chronic Fatigue Syndrome

Recent reports point toward a central metabolic defect in CFS, which affects aerobic energy production in mitochondria, leading to a diminished production of ATP and excessive lactate generation upon exertion.

You may find this book, click here, helpful.

Can A Viral Infection Cause Chronic Fatigue Syndrome?

Viral infections have been associated with CFS.

In conclusion, this study using both serological and PCR-based techniques for distinguishing between active and latent infection showed high rate of active EBV infection among patients with ME/CFS indicating that at least in a subset of cases, EBV is important factor for the development of disease.

The most frequently discussed virus to be associated with CFS is the Epstein-Barr Virus. A great book on this topic is The Epstein Barr Virus Solution by Dr. Kines: click here.

Other viruses discussed in the research include the Ross River virus, enterovirus, harper complex viruses (HHV-6A & 6B) and Parvovirus B19.

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Can Mycotoxins Cause Chronic Fatigue Syndrome?

Mycotoxins can contribute to CFS and this has also been discussed in the research.

My next blog post in this series will explore how to recover from CFS including information on diet and chronic fatigue, supplements such as probiotics and CFS, sleep, exercise and journalling.


  • Is SIBO A Real Condition? Click here.
  • Rasa et al., (2018) Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome, J Transl Med 16:268 (click here)
  • Proal A and Marshall T (2018) Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in the Era of the Human Microbiome: Persistent Pathogens Drive Chronic Symptoms by Interfering With Host Metabolism, Gene Expression, and Immunity. Front. Pediatr. 6:373 (click here)
  • Sepúlveda N, Carneiro J, Lacerda E and Nacul L (2019) Myalgic Encephalomyelitis/Chronic Fatigue Syndrome as a Hyper-Regulated Immune System Driven by an Interplay Between Regulatory T Cells and Chronic Human Herpesvirus Infections. Front. Immunol. 10:2684 (click here)
  • Normalization of leaky gut in chronic fatigue syndrome (CFS) is accompanied by a clinical improvement: effects of age, duration of illness and the translocation of LPS from gram-negative bacteria (click here)
  • Inflammatory and oxidative and nitrosative stress pathways underpinning chronic fatigue, somatization and psychosomatic symptoms (click here)
  • Gut Microbiota, Bacterial Translocation, and Interactions with Diet: Pathophysiological Links between Major Depressive Disorder and Non-Communicable Medical Comorbidities (click here)
  • Myalgic Encephalomyelitis/CFS in the Era of the Human Microbiome: Persistent Pathogens Drive Chronic Symptoms by Interfering With Host Metabolism, Gene Expression, and Immunity (click here)
  • Cytomegalovirus, Epstein-Barr virus, and human herpesvirus-6 infections in patients with myalgic еncephalomyelitis/chronic fatigue syndrome (click here)
  • From IBS to ME – The dysbiotic march hypothesis (click here)
  • Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Not Due to Anti-mitochondrial Antibodies (click here)


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