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Encephalomyelitis myalgica
The exhaustion does not lift with rest and worsens after exertion — which is why pacing is central.
Also known as: myalgic encephalomyelitis · chronic fatigue syndrome · systemic exertion intolerance disease
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A serious, long-lasting illness with profound exhaustion that rest does not relieve. Its hallmark is post-exertional malaise (PEM): even small physical or mental effort can trigger a major crash hours or days later. ME/CFS is a recognised physical illness (ICD-10 G93.3) — not imagined, not laziness, not depression. Its causes are not fully understood; it often begins after an infection. There is no curative treatment, but managing one’s energy well can make a real difference.
The most important lever: stay within your energy limits and avoid overexertion to prevent crashes.
Pushing progressive exercise against the body can worsen ME/CFS — the goal is to adapt, not to push through.
Sleep, pain and circulation can each be treated, even if the illness itself remains.
Being taken seriously is a huge relief. Exchange with others affected and everyday accommodations help.
Estimates run at two to four in a thousand people; women are affected more often. Several years pass on average before the diagnosis. The exertion intolerance typically shows only twelve to forty-eight hours afterwards — which is why it is missed for so long.
There is no drug for the illness itself — what can be treated separately is treated: sleep, pain, circulation when upright, irritable bowel. The most important point is not a medicine but the limit of exertion: activity above one’s own threshold triggers a worsening that arrives hours to days later and lasts days to weeks. That is why a graded exercise programme does not mean the same thing here as in other states of exhaustion.
The decisive feature: delayed, often overwhelming crash after exertion. Distinguishes ME/CFS from ordinary tiredness.
No recovery even after long sleep.
Thinking as if through fog, word-finding and memory trouble.
Dizziness, palpitations or light-headedness on standing (orthostatic intolerance).
No value proves ME/CFS. These values look for the treatable explanations — the thyroid comes first among them.
Belongs to the basic workup of lasting tiredness, especially with a diet low in meat or long use of stomach medicines.
Coeliac disease can show itself with tiredness almost alone. The value only holds while gluten is still being eaten.
A lack causes exhaustion, problems concentrating, low mood and forgetfulness — and it is one of the few causes that can be found and put right with a single blood draw.
Low values are common with low mood. Whether correcting it lifts the mood is not settled; that it makes sense in winter at our latitudes is.
The nerves cover their energy needs through thiamine. It runs short with alcohol, after stomach operations, with long-lasting vomiting and under water tablets.
An empty store causes tiredness, lack of drive and problems concentrating long before any anaemia becomes visible. In women of childbearing age the most common single reason.
Here both count: a lack harms the nerves, and too high an intake over months harms them as well. Supplements therefore belong taken in a dose that has a reason.
Studied in small trials together with NADH over 8–12 weeks, 200–300 mg a day. The reported differences are small, and none of these studies was large enough for a firm statement.
An open study at 5 g three times a day over 3 weeks reported more energy — without a control group. That is the state of things: much reported experience, little comparison.
Often injected in ME/CFS. A real deficiency belongs found and replaced; beyond that no benefit is shown. Once the doses begin the blood value says nothing.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.
No hormone finding proves ME/CFS. What is described is an on average flatter daily course of the stress axis — that is an observation across groups and is no test for the individual.
This axis holds salt and blood volume. It explains why salt and how much one drinks matter so much when upright, and why long standing worsens the complaints.
Stands for the regulation of the circulation on standing up. A racing heart and light-headedness when upright are among the commonest companions and can be tackled specifically.
The giver of the day-night rhythm. A shifted or reversed rhythm worsens everything else — which is why light in the morning counts for more than it sounds.
With any long-lasting exhaustion the thyroid is checked, because it makes the same picture and is treatable. A low T3 with a normal TSH is usually a consequence and not a cause.
Many also have a POTS picture. Then 2–3 litres of fluid, more salt and smaller meals help — not with high blood pressure or kidney disease.
With exertion intolerance the preparing itself can trigger a crash. Pre-cooked food, frozen items and simple meals are not carelessness here but energy management.
Studied as a way of living with the illness, not as a treatment of its cause — the difference matters to those affected.
Often taken together with other mitochondrial nutrients; the studies are small.
A deficiency causes the same complaints and is treatable — which is why it is measured.
Listed values: 465 · 660 · 787 · 2127 · 10000 Hz