Saul Marcus, ND - Naturopathic Doctor

257 West 39th street, 10th floor - New York, NY 10001

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Chronic Fatigue Syndrome - Naturopathic Perspective

Official criteria

There are no official objective lab tests or symptoms which in an of themselves are definitive of Chronic Fatigue Syndrome (CFS). According to the CDC, a CFS diagnosis requires the following 3 criteria. []

  1. The individual has had severe chronic fatigue for 6 or more consecutive months that is not due to ongoing exertion or other medical conditions associated with fatigue (these other conditions need to be ruled out by a doctor after diagnostic tests have been conducted)
  2. The fatigue significantly interferes with daily activities and work
  3. The individual concurrently has 4 or more of the following 8 symptoms:
    • post-exertion malaise lasting more than 24 hours
    • unrefreshing sleep
    • significant impairment of short-term memory or concentration
    • muscle pain
    • pain in the joints without swelling or redness
    • headaches of a new type, pattern, or severity
    • tender lymph nodes in the neck or armpit
    • a sore throat that is frequent or recurring

These symptoms should have persisted or recurred during 6 or more consecutive months of illness and they cannot have first appeared before the fatigue.

CFS Diagnosis - what does it mean?

Many people feel tired. CFS however implies something more. This isn't the more normal fatigue after having a a long day at work or school. The person with CFS may not even be able to go to work, or school. This is truly severe fatigue that put's people's lives on hold.

The CFS diagnosis is by definition a short-hand term used to describe the above symptoms. It essentially means that someone is very tired, and conventional medicine doesn't know why. There are additional symptoms which are general signs of either inflammation or chronic infection.

Is CFS a "real" disease?

Chronic Fatigue Syndrome is real in so far as people truly are suffering with symptoms. Part of the confusion is from the way conventional medicine understands illness.

First doctors may assume that if nothing is found on their lab tests then the patient must be healthy. While conventional lab tests have their use, they are not a universal way to determine how "health" someone in. In fact, conventional blood work looks at a fairly narrow range of markers. So it's entirely possible for someone to feel terribly sick, yet all of their labs are "normal."

The second assumption is of linear cause and effect. This is the belief that every illness has a single cause and treatment. For example, measles is a specific illness, with specific symptoms, caused by a specific microbe.

But Chronic Fatigue Syndrome doesn't fit this model. Not every CFS case has the same cause. So yes, CFS is real in so far as patients are suffering with real symptoms. However, CFS is not a distinct disease entity that has a common cause in every patient , which can be identified by a common lab test. That is why it is called a "syndrome" instead of a "disease."

Newer research is proving that more advanced labs tests can find objective proof of CFS. However, this just shows that people with CFS do have something going on. It's not necessarily leading to treatment [add in links].

Finally, even though CFS is clearly real to all patients and experienced practitioners, due to cultural factors many may still dismiss it as not real. After all, someone laying in bed all day with terrible fatigue which can not be found on lab tests, doesn't fit in well with a "pull yourself up by your bootstraps," culture. This mind set needs to change, as it causes far more harm than good. No, someone with CFS can not just pull themselves together and get over it.

Is it important to have a CFS diagnosis?

Medically speaking, the purpose of a diagnosis is to identify what is going on, and then prescribe and appropriate treatment. While a CFS diagnosis may be useful for insurance forms, from a strictly medical perspective it's almost worthless. A CFS diagnosis in no way identifies the cause of illness, nor leads to proper treatment. Therefore, when it comes to actual treatment the debate over whether or not the have it, or if it's "real," is nothing more than a distraction away from the real questions. That being - what is causing these patients to feel so tired and what can be done about it.


Patient talking to doctor

What is conventional medicine not looking at:

Top 10 triggers of Chronic Fatigue

The following are possible triggers for chronic fatigue that are either often ignored or poorly treated in conventional medicine:

  1. Chronic infection such as Epstein Barr, Cytomegalovirus (or other viruses) and tick borne illness such as Lyme disease. It is essential to look at the overall state of the immune system. Often someone who is chronically ill with and underactive immune system will think they can't have any infection because they never get sick. This may in fact be a sign of low vitality - their body doesn't have enough energy to even produce symptoms.

  2. Parasitic infection. Can include worms or single cell parasites such as Entameba histolytica. Often overlooked and difficult to diagnose.

  3. Food allergies - especially to Gluten which many more people are becoming aware of the past few years.

  4. Dental foci. Infections in the mouth or toxicity from past dental work.

  5. Candida or chronic fungus/yeast infection.

  6. Toxicity in general - such as to heavy metals, plastics or other industrial chemicals we are all exposed to daily.

  7. Side effects of prescription drugs. This may include psychiatric drugs.

  8. Insomnia - of which there are many causes. Treatment must be individualized.

  9. Emotional stress.

  10. Hormonal imbalances related to thyroid hormone, estrogen, cortisol and blood sugar. If hormones are off, careful consideration must be given to why. Trying to force hormones back to normal with drugs or supplements may not work. Instead an underlining causal factor must be fixed.

  11. Anemia - often missed by MDs.

  12. Poor diet, nutrient deficiencies.

Go to the page on assessment for a sample case history