Health and Environmental Illness

Resources about environmental illness and non-drug treatments

Chronic Fatigue Syndrome (ME/CFS)

Chronic Fatigue Syndrome, more properly called Myalgic Encephalomyelitis or Myalgic Encephalopathy, is a serious illness. It is not a joke.

Its hallmark is "post-exertional malaise."

I was excited to find a doctor's carefully observed description of his own post-exertional malaise. It may give you some sense of how disabling post-exertional malaise is.

I see a pattern of symptoms, which I call post-exertional debility (PED), that occur following physical or cognitive exertion. This pattern is specific and vastly different from any post-exertional experience I had as an athlete, surgery resident or while practicing surgery.

Dr. Larry Baldwin on Post-Exertional Debility in ME/CFS

He is also correct in saying that the pattern of symptoms is individual; most of us, however, call it a "crash" and know what we mean.

Dr. Leonard A. Jason, PhD, says, "Patients with CFS are more functionally impaired than those suffering from type II diabetes mellitus, congestive heart failure, multiple sclerosis, and end-stage renal disease." Live Chat Q&A with Chronic Fatigue Syndrome Research and Policy Leader Dr. Leonard A. Jason, Ph.D. (, August 14, 2007)

At the November 3, 2006 press conference of the CDC and the CFIDS Association of America, Dr. Anthony Komaroff, MD, spoke about the neurological, immune, and energy metabolism abnormalities of chronic fatigue syndrome patients. "There are now over 4,000 published studies that show underlying biological abnormalities in patients with this illness," he said. "It's not an illness that people can simply imagine that they have and it's not a psychological illness."


ME/CFS is not a vague or poorly defined complaint. It is well defined by the Canadian Clinical Case Definition.

Clinical Working Case Definition of ME/CFS from the Canadian Expert Consensus Document

More on ME/CFS Definition and Description  Updated 1/29/2017

Post-Exertional Malaise

The Canadian case definition requires "post-exertional malaise and/or fatigue" for diagnosis.

There is an inappropriate loss of physical and mental stamina, rapid muscular and cognitive fatiguability, post-exertional malaise and/or fatigue and/or pain and a tendency for other associated symptoms within the patient's cluster of symptoms to worsen. There is a pathologically slow recovery period--usually 24 hours or longer.

The earlier Ramsay Definition describes the phenomenon as "muscle fatiguability."

Even after a minor degree of physical effort, three or more days may elapse before full muscle power is restored. This feature is unique and is the "sheet anchor" of diagnosis. In moderate cases there may be normal muscle power in remission.

Maryann Spurgin (Myalgic Encephalomyelitis Society of America) adds, in Founding Principles and M.E. Society Definitional Framework--Discussion:

What all patients must have, at least according to both of these definitional frameworks, is an abnormal muscle metabolism -- a delayed or impaired recovery of muscle function after exercise, which patients experience as paralytic muscle weakness and pain, not "fatigue."

ME/CFS Exercise Studies  Updated 6/17/2017

Immune Dysfunction

ME/CFS Immune Dysfunction  Updated 1/29/2017

Cardiac Insufficiency

ME/CFS Cardiac Issues  Updated 6/15/2017

Mitochondrial Dysfunction

Dr. Sarah Myhill, MD states, "Chronic fatigue syndrome is the symptom caused by mitochondrial failure." The mitochondrion is the structure in a biological cell that supplies energy to the cell. Mitochondrial dysfunction can affect every cell of the body, including the cells of the heart. (See Mitochondrial Dysfunction)

CFS - The Central Cause: Mitochondrial Failure
By Dr. Sarah Myhill, MD

Nitric Oxide / Peroxynitrite Cycle

The ultimate source of the mitochondrial dysfunction may be the upregulation of the nitric oxide / peroxynitrite cycle, according to the theory developed by Dr. Martin Pall, PhD. (See Neural Sensitization Protocol)

Research Approaches

Open Medicine Foundation End ME/CFS Project  Updated 3/22/2017

Research Articles
Phoenix Rising

The Pathogens in Chronic Fatigue Syndrome
Phoenix Rising

Orthostatic Intolerance: The Research
Phoenix Rising

Q&A Session With Cort Johnson, Phoenix Rising Founder & ME/CFS/FM Sleuth, March 21, 2008

Organizations and Information Sites

ME/CFS Information Sites  Updated 10/14/2018

Updated 3/13/2020