Fatigue, Chronic Fatigue Syndrome, & ME: the Functional Medicine approach

How you can feel better with a Functional Medicine approach to Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is a debilitating and complex disorder that is characterised by extreme fatigue that cannot be explained by any underlying medical condition, and which is not improved by rest.

Another name used for a similar condition is Myalgic Encephalomyelitis (ME).  ME was a diagnosis first used in the UK, and CFS (later becoming ME / CFS) was first used in the USA. 

Functional Medicine approach to Chronic Fatigue Syndrome and ME blog flyer, with blue mitochondria

Most healthcare systems and healthcare professionals are now referring to both of these conditions as ‘ME/CFS’.

It’s important to note too, that there are experts that believe that ME and chronic fatigue syndrome are in fact unique (albeit, similar) conditions. 

This may mean that in future we develop different treatment protocols for each ME and CFS.

Table of Contents

In this article, we are primarily focusing on chronic fatigue syndrome, and with the understanding that many people may have received a diagnosis of ‘ME / CFS’ from their doctor, we will also refer to chronic fatigue syndrome as ‘ME/CFS ‘.

Chronic fatigue syndrome (ME / CFS), can make it extremely difficult to carry out everyday activities and can sadly lead to severely compromised quality of life.

Diagnosis can take many years, resulting in a huge amount of frustration for people with ME / CFS symptoms, and their families.

Those with ME / CFS often report numerous other symptoms, such as:

As with many complex chronic health conditions, the triggers of ME / CFS are multi-factorial and are unique to the individual.

While there is no cure for ME / CFS, a Functional Medicine approach to chronic fatigue syndrome can help to make the symptoms less severe, reduce the frequency of the symptoms, and significantly improve overall quality of life.

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What is Chronic Fatigue Syndrome?

Most people have experienced being overtired and overworked at some point in their lives.

Such cases of temporary fatigue often have a specific cause that can be easily identified. 

And once changes are implemented, the tiredness improves.

When the exhaustion lasts longer, and is not relieved by rest and sleep, it may be a sign of a more complex scenario.

Fatigue is a state of constant tiredness that develops over longer periods of time.

Chronic fatigue is felt as a long period of reduced energy levels, lack of motivation, and reduced concentration.

And it can impact you emotionally, as well as impacting your psychological well-being.

Unexplained tiredness called ‘tired all the time’ (TATT) is one of the most common reasons why people reach out to their General Practitioner / Physician (GP) (1).

A GP will look at the following causes of tiredness:

Unlike tiredness, long-term exhaustion that is not relieved upon rest and that cannot be explained by any other underlying cause is called Chronic fatigue syndrome (CFS)

ME / CFS can affect anyone of any age, but is more common in women than men.

Many are diagnosed between the ages of 20 to 40 years.

An estimated 250,000 people are suffering from ME / CFS in the UK (2), and between 17 and 24 million people worldwide (3).

ME / CFS is a chronic neurological condition that causes symptoms affecting many body systems, but especially the immune and nervous systems.

Other symptoms can include (4):

The severity of this illness may vary; some cases may be mild, involving taking days off work, and some can be much more severe, where even the smallest of daily tasks such as brushing teeth can be very difficult to perform.

What’s the conventional medicine approach to ME/CFS?

There are are no specific lab tests that lead directly to an ME / CFS diagnosis. 

As symptoms can be similar to other diseases, other causes of chronic fatigue are ruled out first, before a ME / CFS diagnosis is considered.

Evaluation of ME / CFS requires a thorough review of each case and is based on symptoms, prior history, physical examination findings, and review of laboratory test results.

Frustratingly, although symptoms of ME / CFS can be debilitating, often, conventional standard laboratory test results are ‘normal’.

The diagnostic criteria for ME / CFS is as follows:

Blood tests will be performed, as well as some serological tests if there is history of infection.

There is no cure for ME / CFS, and conventional medicine concentrates only on managing the symptoms.

Focusing on managing the symptoms unfortunately does not have much success, and people struggle with ME/CFS indefinitely.

The symptoms that are causing the most disruption are often the first to be addressed.

These symptoms may be addressed with prescription or over-the counter medications (e.g. for pain, nausea or depression), and some complementary therapies may be recommended by your physician such as counselling, graded exercise therapy (GET), acupuncture, cognitive behavioural therapy (CBT) and treatment for causes of sleep issues such as ‘sleep apnoea’.

What are the root causes of ME/CFS?

ME / CFS is a multifactorial disease with many different underlying contributing factors or causes.

While there is no single known causative factor for chronic fatigue syndrome, there are a number of proposed imbalances or risk factors, that are believed to contribute to the development of chronic fatigue.  

These factors can be different for each person, and therefore understanding the health history, risk factors, genetic predispositions etc, is vital in identifying the unique causal factors.

With a Functional Medicine approach to chronic fatigue syndrome, we also look to functional testing to help pinpoint areas of dysfunction.  

Here are some of the factors we consider:

Gut health

Gastrointestinal issues are very often an issue for people suffering from ME / CFS. 

These could be IBS symptoms, increased intestinal permeability (‘leaky gut syndrome’), malabsorption, inflammation originating from the digestive system, increased food sensitivities, gas, bloating, or abdominal pain.

Advanced stool testing can help pinpoint the reasons for symptoms, that can then be improved with a Functional Medicine approach.

Symptoms connected to the digestive system have far reaching consequences, for example digestive system imbalances can contribute to tiredness, brain fog, headaches, joint pain or mood changes.

Chronic infections

ME / CFS has been linked to several chronic infections, particularly to Epstein Barr Virus (EBV) which causes glandular fever, also known as infectious mononucleosis (or ‘mono’), human herpes virus-6, and the bacterium Borrelia burgdorferi, which causes Lyme’s disease. 

Immune system

A number of immune system imbalances can exist in ME / CFS.

These include as increased inflammatory cytokine and abnormalities in Natural Killer (NK) cells.

It is proposed that low-grade chronic inflammation is a driver of ME / CFS and can reduce the efficiency of the energy producing factories in our cells (the mitochondria).

Nutritional status

Assessing nutrient intake through diet, as well as the absorption of these nutrients in the intestinal system, is very important. 

Nutrient insufficiencies can compromise energy production at a cellular level.

For example, sub-optimal levels of iron, magnesium, zinc and selenium can negatively impact immunity, cognitive function, nervous system health and muscle function.

Environmental factors

Environmental chemicals, such as phthalates and pesticides, and heavy metals, such as arsenic, lead and mercury, can impact how your mitochondria and liver function.

People suffering from ME / CFS tend to be more sensitive to environmental chemicals and toxins, and the ability to detoxify these compounds may be reduced, resulting in an increased toxic load in the body.

This accumulation of toxins can be harmful to cellular function and can impair the structure and function of the mitochondria.

Toxins can also stimulate the immune system, causing inflammation, oxidative stress and immune system dysregulation.

These immune system imbalances can also lead to increased allergies or intolerances.

There is a growing body of evidence indicating a link between ME / CFS and mould exposure.  

Mould releases mycotoxins which can be measured in humans, through urinary tests.

People who have spent time in water-damaged buildings may be at risk of mould exposure and fatigue that is caused by mycotoxins.

A study published in 2013, found mycotoxins present in 93% of chronic fatigue patients (5).


Imbalances in the hormones produced by the adrenal and thyroid glands can contribute to ME / CFS.

Adrenal hormones regulate our sleep cycle and our response to stress.  

Too high, or too low, levels of cortisol can contribute to tiredness and fatigue. 

Comprehensive adrenal hormone testing over a 24 hour period, in chronic fatigue patients, can provide an extremely insightful, and helps to design an effective protocol to rebalance adrenal hormones.

An underactive thyroid can also contribute to fatigue. 

Even subclinical low thyroid function, which is not often flagged by conventional testing, can contribute to fatigue.


As we’ve mentioned, the mitochondria are the energy producing factories inside our cells.

They turn calories into cellular energy (ATP).

There are many reasons why our mitochondria may not be producing optimal levels of energy, for example:

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Functional testing in chronic fatigue syndrome / ME

While some tests may have been performed by your doctor, assessing common areas such as white blood cells, red blood cells, liver enzymes, inflammatory markers, thyroid hormones, advanced functional testing can provide a deeper layer of understanding.

Functional testing in chronic fatigue syndrome can help by pinpointing imbalances in function, or in systems.

This means we can get closer to understanding ‘why’ you have developed chronic fatigue syndrome, and therefore ‘how’ we can help you optimise function, so that symptoms can improve.

At Coho Health, testing recommendations are made after a full case review at the initial consultation.

The tests recommended are those that we believe will be the most beneficial in your case and provide the most meaningful data, so that we can help you to feel better as soon as possible.

Examples of functional tests that we may consider for chronic fatigue syndrome / ME:

As you can see, there’s a wide range of testing that we consider.

This is why it’s really important to consult a professional who can perform an in depth assessment of your unique health history, and make the right recommendation for you.

The Functional Medicine approach to chronic fatigue syndrome & ME

Treatment options for chronic fatigue syndrome are lacking in the conventional medicine model, and unfortunately the underlying imbalances in each case may not have been identified.

A personalised Functional Medicine approach to chronic fatigue syndrome is crucial in helping in ME / CFS, so we can better understand their unique causative factors, drivers of their condition, and how to address the imbalances identified.

We are often asked about estimated timeframes within which clients should expect to see improvements.

As with all cases, how long it takes is highly dependent on:

In order to set realistic expectations, our general guideline is that it could take a few months before improvements are noticeable.

Every protocol designed by Coho Health practitioners, is unique. There are no two protocols that are the same, and this is especially true when applying a Functional Medicine approach to chronic fatigue syndrome.

It’s this 100% individualised approach for each client helps to achieve the best clinical outcomes.

In a Functional Medicine approach to chronic fatigue syndrome there are many areas that are considered and an assessment of all body systems is performed. 

Here are some of the areas that your practitioner will consider:


Nutrition factors to consider include removing any allergens, addressing food sensitivities, inflammatory foods, and improving blood sugar balance and nutrient status.

These requirements are unique to each individual.

Nutritional supplements

In thinking about how nutritional supplements can help, we assess micronutrient intake / levels and can introduce some supplements to help improve any deficiencies quickly (such as vitamin B12, Coenzyme Q10, magnesium, vitamin D, zinc, and omega 3 fatty acids).

Lifestyle interventions

The main lifestyle considerations in our Functional Medicine approach to chronic fatigue syndrome / ME are to help support stress reduction and ensure the reduction of exposure to environmental toxins.

Thyroid and adrenal hormones

Hormonal imbalances can be an important factor in supporting chronic fatigue syndrome.

In our Functional Medicine approach, any hormonal imbalances are assessed, especially supporting the hypothalamus-pituitary-adrenal (HPA) hormone axis, and thyroid hormones.

Chronic infections

Chronic infections can also be an important factor.

Understanding if any chronic infections are part of your health picture, taking steps to address any underlying infection, and supporting the immune system, can form an essential part of our chronic fatigue syndrome strategy.

Mitochondrial function

The mitochondria are your cellular energy generating units.

We assess mitochondrial function and energy production, and optimise that function through nutrition and lifestyle factors.

We also assess and eliminate factors that can be hindering mitochondrial function.

Detoxification pathways

In chronic fatigue syndrome, we always consider your toxin load, your ability and capacity and detoxify, as well as ensuring that the health of your detoxification pathways is optimal.

Gastrointestinal health

Gastrointestinal health is always a super important aspect of health, and that’s also the case in chronic fatigue syndrome / ME.

Assessing gastrointestinal function, the microbiome, gut pathogens, and optimising gut health to support optimal nutrient absorption, reduced inflammation, and good intestinal barrier function, forms part of our Functional Medicine approach to chronic fatigue syndrome / ME.

Immune system

In chronic fatigue syndrome, we want to understand the levels of immune cells being produced, if the immune response is heightened, and if there is low-grade systemic inflammation or oxidative stress.

This can then help us to design a protocol that supports healthy immune responses.

The above is not a comprehensive list of factors we consider, but hopefully provides an indication of the areas we would explore and how that ultimately leads to improvements in health.

Hypothalamus-Pituitary-Adrenal (HPA) axis dysfunction & chronic fatigue syndrome

Hypothalamus-Pituitary-Adrenal (HPA) axis dysfunction, which is admittedly a bit of a mouthful, has historically been referred to ‘Adrenal Fatigue’. 

We wont go into the long story of why ‘adrenal fatigue’ is a controversial term right now (we’ll save that for a separate article).

But let’s just say that while ‘adrenal fatigue’ has become a popular term, it should be more properly referred to as HPA axis dysfunction, which better describes what is going wrong.

It’s useful to note, however, that neither HPA axis dysfunction or ‘adrenal fatigue’ are accepted diagnoses in the conventional medical field, and your doctor will probably roll their eyes if you start talking about your fatigued adrenal glands or your dysfunctional HPA axis.

Within conventional medicine, the only available testing for HPA axis problems is designed to identify Addison’s Disease (which is a primary adrenal insufficiency where the adrenal glands do not produce enough cortisol or aldosterone), or Cushing’s syndrome (where the body makes too much cortisol).

These are two extreme conditions, at both ends of a spectrum of adrenal dysfunction. 

There are then degrees of HPA axis dysfunction, that are not regarded as medical conditions, but can alter the immune system, energy systems, mood, physical strength, and ability to fight infections.

HPA axis dysfunction manifests differently in people, making it difficult to recognise, but it’s linked to imbalances in many body systems, and is triggered by long-term physical, emotional or mental stress.

This is important because chronic stress in itself can alter immune function and increase inflammatory cytokines that have the potential to hinder mitochondrial function (and therefore energy production).

HPA axis dysfunction can present in different ways.

Assessing cortisol (and DHEA) levels over a 24 hour period can help to identify where an imbalance may be.

Imbalances in these hormones can then be supported through: 

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The wrap...

The symptoms of chronic fatigue syndrome are often severe, and significantly impair quality of life.

Yet, sadly, there is no single cure, or prescription medicine, that can reverse these life changing symptoms.

We know that many of the ME / CFS clients we’ve had the pleasure to work with over the years have spent a significant length of time searching for answers on their own, but have been left feeling frustrated and hopeless, wondering if they will just have to learn to live with their symptoms for the rest of their lives. 

This is also what many people suffering from ME / CFS have heard from their doctors – that the best that can be done is learning how best to live with their symptoms.

We don’t think that’s good enough.

And we know from our years of experience of working with people who are suffering from chronic fatigue syndrome, that there is more that can be done.

Your symptoms, and your quality of life, can better with the support of a whole-body, root-cause, evidence-based approach.

If you think we can help you, don’t hesitate to book your free 15 minute discovery call now, or use the contact form below to send us message.

We’d love to hear from you.

To your optimised, healthy future,

Aga & the Coho Health team

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