veryone knows what it feels like to have fatigue, but anyone who has CFS can tell you this fatigue is not the normal ups and downs of everyday life. This is a real disease, not laziness or needing to get out and exercise more. The biggest problem is that there are no visual symptoms, so the patient looks fine but does not feel fine.

I've lived with this disease since June of 1987. I've been a study patient at Harborview Medical Center in Seattle, and the National Institutes of Health (NIH) in Bethesda, Maryland; I've done extensive research as well as polled hundreds of patients on varying issues of the disease; and as a Christian counselor I have had numerous clients who suffer from CFS. As an Adventist, I have a great interest in the issues of nutritional health and its connection to mental health (as well as physical), and have done extensive research into this area.

Prevalence
CFS affects between 75 and 265 people per 100,000 population. In the early 1980s mainly well-educated, well-off women in their 30s and 40s sought help.¹ Since then, however, doctors have seen the syndrome in people of all ages, races, and social and economic classes from several countries around the world.

Diagnosis
An absolute in diagnosing patients with CFS is that they have unrelenting, debilitating fatigue with an identifiable onset that lasts six months or more without the person returning to their normal level of energy. They will also have had other known medical causes excluded by clinical diagnosis. Generally, patients with CFS have at least four of the following symptoms:

• substantial impairment in short-term memory or concentration
  
• sore throat, tender lymph nodes
  
• fatigue and weakness
  
• muscle pain, multijoint pain without swelling or redness
  
• headaches of a new type, pattern, or severity
  
• unrefreshing sleep
  
• allergies, skin or chemical sensitivities, cold intolerance, irritable bowel syndrome, dizziness, or lightheadedness

Some physicians and researchers believe CFS and fibromyalgia (FM) are the same; however, some patients with CFS do not have the trigger points of FM, and some with FM do not have the debilitating fatigue of CFS. The majority, however, do seem to have both. There are also considerable overlapping symptoms with many other conditions, such as myofascial pain syndrome, etc.

What is the cause?
Although unknown, most people report a trauma (either physical or emotional) that triggers the disease and can often pinpoint the day it came on. Examples: an auto accident, a death in the family, or an illness/infection, to name a few of many.

Initially it was believed that an infection was the cause, most probably Epstein-Barr virus (EBV). It now seems clear that CFS cannot be caused exclusively by EBV or by any single recognized infectious disease agent. No firm association between infection with any known human pathogen and CFS has been established.

Is CFS a physical or emotional disease?
Many physicians have attributed CFS to depression. However, people who live with pain and illness day after day often become depressed or have periods of depression, even without a past history of any depression. In studies, the overall majority of people with CFS who experience depression find the onset after contracting the disease.

What treatments are available?
In traditional medicine, most patients are treated with nonsteroidal antiinflammatory medication, as well as generally an antidepressant. Many antidepressants in low doses are also beneficial for pain.

The Centers for Disease Control claims that "there is no published scientific evidence that CFS is caused by a nutritional deficiency." However, I have found the following elements to be beneficial for me and the majority of those I've known personally or have researched. (Note: Patients need to work closely with their health-care providers and try therapies that are safe for them.)

• Reducing my intake of simple carbohydrates is helpful not only to my energy level but also the pain.
  
• I avoid chemicals (external and internal) as much as possible in case of allergies and/or MCS (multiple chemical sensitivities).
  
• I find light exercise is beneficial, "but without causing more fatigue."
  
• I avoid Aspartame (artificial sweetener). This may exacerbate the symptoms.
  
• I suggest reducing the intake of dairy products for those with problems of IBS (irritable bowel syndrome) and allergies.
  
• I work on a positive attitude despite the difficulties. (Family and friends: Being supportive is extremely helpful in the level of patient depression. You haven't walked in their shoes except perhaps during the first few days of a case of the flu!)
  
• Diet and nutritional supplements: A healthful, well-balanced diet is essential. magnesium malate (malic acid) has helped many FM sufferers with pain, and good vitamins/minerals may provide an extra boost.²
  
• I get adequate rest.
  
• I pray. Web sites may not provide this answer, but I know that while we may not receive healing, we will receive the bounty of peace and love the Lord has for us.

What is the prognosis?
Unfortunately, the studies do not show an overwhelming majority of patients to date getting "well." However, whether it is learning to live with the disease or getting somewhat better, many patients do not remain as incapacitated as they felt during the initial disease process.

The medical community is learning new things every day. So, have hope! The cause as well as the cure may be found anytime.

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¹ See the National Institute of Allergy and Infectious Diseases Web site: www.niaid.hih.gov.
² See I. J. Russell, J. E. Michalek, J. D. Flechas, G. E. Abraham, "Treatment of Fibromyalgia Syndrome With Super Malic: A Randomized, Double-blind, Placebo-controlled, Crossover Pilot Study, Journal of Rheumatology 22, no. 5 (May 1995); 953-958.