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What Is Chronic Fatigue Syndrome (CFS) and How To Diagnose it?


  1. What Is Chronic Fatigue Syndrome (CFS)?
  2. Confirming the Diagnosis of Severe Chronic Fatigue Syndrome
  3. Do Epstein-Barr Antibody Tests Diagnose Chronic Fatigue Syndrome?
  4. Myalgic Encephalomyelitis (ME) versus Chronic Fatigue Syndrome (CFS)
  5. Dr. Podell is Among the Nation’s Leading CFS Doctors
  6. Links to Useful Chronic Fatigue Syndrome Websites

Chronic Fatigue Syndrome is a physical illness. Typically, very modest degrees of physical or mental exertion cause severe fatigue. This increased fatigue can often last for a full day or more. The federal government’s Centers for Disease Control and Prevention (CDC) has adopted and published working criteria for the diagnosis of CFS.

What Is Chronic Fatigue Syndrome (CFS)?

To diagnose CFS, the CDC Criteria requires the presence of persistent or relapsing fatigue lasting six months or more. Chronic fatigue must be severe enough to cause a marked decrease of physical activity. (Therefore, by definition, CFS can be diagnosed only when chronic fatigue symptoms are at least moderately severe.) Unlike “normal” fatigue, CFS related fatigue does not resolve by just getting rest.

Nation’s leading doctor for Chronic Fatigue Syndrome and Epstein-Barr

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The CFS patient must also meet at least four of these eight “minor criteria”:

  1. Impaired memory or concentration
  2. Frequent sore throat
  3. Painful/tender lymph nodes especially in the neck or armpit areas
  4. Muscle pain
  5. Pain in multiple joints but typically without major joint swelling
  6. A new pattern of headaches
  7. Unrefreshing sleep
  8. Post-exertional malaise (PEM) lasting 24 hours or more. (Many CFS doctors view PEM as an absolute requirement.)

Chronic Fatigue Syndrome can set on gradually over many months; but many or most cases begin suddenly with a viral or “flu-like” illness.

Contact Dr. Podell today if you have question about chronic fatigue syndrome symptoms.

Confirming the Diagnosis of Severe Chronic Fatigue Syndrome

Dozens of common ailments can cause fatigue. Therefore, a main focus of our two hour long new-patient visit is to identify any alternative diagnoses and/or co-occurring contributors to your illness. To help with this, we ask new patients to complete our very detailed case history questionnaire and submit it for us to review before your first visit. Also, please submit, any lab reports, or bring copies to your visit.

The following co-occurring or “co-morbid” health problems are much more common among Chronic Fatigue Syndrome patients than among the general population: Fibromyalgia, non-restorative sleep, “brain fog”, increased vulnerability to medication side effects, irritable bowel syndrome, irritable bladder, migraine headaches, low blood pressure, anxiety disorders and others. Psychological depression can co-occur with CFS as it can among persons with any severe chronic illness. Recognizing and treating these co-morbid conditions helps support the body’s natural ability to heal.

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Do Epstein-Barr Antibody Tests Diagnose Chronic Fatigue Syndrome?

Antibody tests for Epstein-Barr Virus (EBV), HHV-6 or other viruses can be useful, but only to a limited degree. Certain patterns such as high IgM type antibodies or very high levels of IgG antibodies increase the doctor’s suspicion for Chronic Fatigue Syndrome. The problem is that about 90% of Americans test positive for Epstein-Barr Virus but are perfectly healthy. A large proportion of our population also tests positive for HHV-6. So, while EBV or HHV-6 antibodies might shift the odds for or against a CFS diagnosis, by themselves, antibody testing is rarely conclusive. The diagnostic criteria for CFS and Myalgic Encephalomyelitis (ME) require the presence of a specific clinical pattern—whether or not antibody levels are high.

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Myalgic Encephalomyelitis (ME) versus Chronic Fatigue Syndrome (CFS)

A “brain fog” is a symptom of myalgic encephalomyelitis

Image: lightwise/123RF Stock Photo

The Canadian Consensus panel prefer to use the term Myalgic Encephalomyelitis (ME) instead of Chronic Fatigue Syndrome (CFS). Their diagnostic criteria are similar to the Center for Disease Control Criteria for CFS. But, as stated in their overview there are important differences.

ME requires the presence of “brain fog” or other neurological symptoms, whereas the CDC counts cognitive difficulties as an optional or “minor criterion”. But, CDC does not require that cognitive difficulties be present. Similarly, the Canadian ME Criteria requires that there be post-exertional malaise (PEM), and significant degrees of muscle pain. Again, for the CDC, these symptoms are optional.

What does Myalgic encephalomyelitis mean in plain English?

Myalgic refers to muscle pain; encephalomyelitis means inflammation within the brain and spinal cord. As a Chronic Fatigue Syndrome doctor I find the Canadian Criteria for ME useful; but for ease of reading this essay, I will continue to use the terms Chronic Fatigue Syndrome and CFS.

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Dr. Podell is Among the Nation’s Leading CFS Doctors

Dr. Podell serves on an expert panel on CFS/ME for the Center for Disease Control. Other Chronic Fatigue Syndrome physicians on the committee include: Lucinda Bateman, M.D. (Utah), Nancy Klimas, M.D.(Florida), Andy Kogelnik, M.D. (California), Charles Lapp, M.D. (N.C), Benjamin Natelson, M.D. (NY), and Daniel Peterson M.D. (Nevada).

Dr. Podell is a CFS and ME doctor

Image: United States maps on Wikipedia

Dr. Podell has specialized in Chronic Fatigue Syndrome and Fibromyalgia for more than 20 years. He serves as clinical professor for New Jersey’s Robert Wood Johnson Medical School. Dr. Podell was a principal investigator in the FDA approved phase III trial of Ampligen, an experimental drug for CFS. The New Jersey Chronic Fatigue Syndrome Association has given Dr. Podell their Medical Achievement Award. Dr. Podell is also a medical expert on social security and private insurance disability as it relates to Chronic Fatigue Syndrome and Fibromyalgia.

Philosophy: We seek to combine the best of standard drug therapies with holistic support for the body’s natural healing systems. Our model for treating Chronic Fatigue Syndrome (CFS) goes by several names, including “holistic”, “healing”, “natural”, “integrative”, “alternative”, “and complementary”. Whichever name we use, scientific research suggests that combining standard medical treatments AND holistic support for chronic fatigue is more effective than just either one alone.

Contact Dr. Podell, one of the nation’s leading chronic fatigue doctor , today if you have more questions.

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The CDC website contains much information about Chronic Fatigue Syndrome (CFS).

The Solve ME/CFS Initiative is the leading charitable organization dedicated to myalgic encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS).

The New Jersey ME/CFS Association is the patient support group for New Jersey.

Phoenix Rising is an excellent patient support group. They survey the literature and often interview expert clinicians and researchers.

Prohealth.com tracks relevant research findings on Chronic Fatigue Syndrome and Fibromyalgia in great detail. They also sell nutritional supplements.

Please also view these pages on our website:

Fibromyalgia Diagnosis page: The majority of patients with severe CFS/ME also suffer from Fibromyalgia.

Reversing 8 vicious cycles page: Being ill with Chronic Fatigue Syndrome, Fibromyalgia or any other chronic illness can set off multiple vicious cycles. This page helps to identify and reverse these vicious cycles.

Breakthrough Research page: These articles focus on important research advances.