Triggering Events for ME/CFS

Triggering events for ME/CFS fall broadly into five groups and commonly overlap.

1. 1. Biological threat (viral infection, bacterial infection, parasite, fungal exposure) or combination of biological threats
   2. Chemical exposure (i.e. VOC exposure on the job, heavy metal exposure, pesticide exposure)
   3. Physical trauma (head injury, brain surgery, sports injury, etc.)
   4. Psychological stress (loss of loved one, extreme work stress in months prior, divorce)
   5. Extreme exercise (3+ hours high-intensity exercise per day with minimal recovery period)

It is common for multiple threats to converge within a year. Acute HHV-4, also known as Epstein-Barr Virus (EBV), infectious mononucleosis, and glandular fever is a common viral precursor to ME/CFS, though does not represent the majority of cases.

There have been multiple documented viral outbreaks (and in some cases a combination of a virus and mycotoxin exposure) linked to ME/CFS, but no one pathogen or combination is a main cause. 

It is not the threat that is the signature of the disease, rather it’s the body’s continued failed response to it.

Onset of ME/CFS

The onset can be immediate or occur gradually over weeks, months, or longer.

Someone with multiple risk factors (including prior long-term mold exposure, recently experienced loss) can have routine radiation to remove a benign tumor and have immediately entered the hypometabolic state associated with the syndrome. Another can contract a viral illness, experience up-and-down flu-like symptoms for a couple months while exposed to environmental toxins and other stress, and eventually get “stuck” in the neuroinflammatory and hypometabolic state associated with the syndrome. These represent real cases.

Early warning signs of Myalgic Encephalomyelitis

If a person has:

• • Not fully recovered from an infection or injury after a month
  • Is having up-and-down flu-like symptoms
  • Is experiencing profound fatigue not explained by lifestyle factors that gets worse with exertion

…these are early signs of Myalgic Encephalomyelitis and they should have other immune and fatigue-related conditions ruled out (lymphoma, HIV, hepatitis, depression, allergies, sleep apnea, Crohn’s, hypothyroidism, anemia, etc.). Conditions like these can of course also pre-exist in someone with ME/CFS.

Hypothyroidism and anemia, which can cause or contribute to profound fatigue, do not tend to also cause flu-like inflammatory symptoms and post-exertional “crashes” that significantly reduce one’s capacity the following day (and can take multiple days, weeks, or longer to recover from) like in ME/CFS.

Post-viral fatigue from a flu-like illness, is often a precursor to ME/CFS, though most recover before it becomes chronic. This is the time where early medical intervention can be very helpful (i.e. for health professionals to investigate healing blockers and prescribe rest and time off work).

People who present with the early signs of ME/CFS will ideally have pathogenic drivers, nutritional deficiencies, and toxic exposures thoroughly investigated.

Most, but not all, people with ME/CFS experience cognitive problems (brain fog, trouble remembering words) that can range from mild to severe which get worse with exertion or other environmental stress.

A significant portion of people with ME/CFS experience blood flow issues, including difficulty going from lying to standing. Many people with ME/CFS develop post-onset digestive issues and report new food sensitivities.

Common Symptoms of ME/CFS

• Post-exertional “crashes,” commonly with a delayed onset of 2 to 48 hours
• Reduced baseline energy levels, which can range from mild to very severe
• Nonrestorative sleep
• Fluctuating flu-like symptoms
• Swollen lymph nodes (neck, underarms, etc.)
• Brain fog, trouble recollecting words, difficulty processing information that gets worse with exertion and/or other environmental stressors
• Orthostatic intolerance, heart palpitations

I’ve chosen to hide other symptoms associated with ME/CFS for people recovering who prefer not to focus on them. The main issue is the body’s dysfunctional response mechanisms rather than the symptoms themselves.

Potential Risk Factors

People with ME/CFS will usually have multiple, but not all, risk factors. Potential risk factors fall generally into three categories:

1. 1. 1. Lowered immune strength to mitigate the threat(s)
      2. Prior hits to the autonomic nervous system to prime a maladaptive stress response to threat(s)
      3. Environmental stressors blocking the body from overcoming the threat(s)

Potential risk factors include: 

• Lack of rest during onset of illness or injury.
• People with prior hits to the brain’s limbic system are hypothesized to be at greater risk. Potential risk factors include, but are not limited to:
  • • History of brain concussion, whiplash, or brain injury
    • History of childhood trauma (‘big T’ trauma or multiple ‘little t’ traumas) with coping strategies that create stress on the nervous system
    • An extreme inflammatory reaction to a brain injury or a pathogen that crosses the blood-brain barrier
    • History of long-term prolonged mental or emotional stress
    • History of major mental stress or emotional trauma, particularly in the 6 months leading up to onset and when combined with other stressors (physical, emotional, environmental, biological, etc.)
    • History of major physical trauma, particularly when combined with a succession of stressful events 
    • History of major surgery with anesthesia
    • Prior long-term exposure to environmental toxins (mycotoxins from mold, pesticides, heavy metals, etc.), which can cause brain inflammation (some people do not react, some do)
    • Carbon monoxide poisoning
    • Extreme exercise (3+ hours per day of high-intensity exercise with minimal recovery period) in the months leading up to onset
• Mycotoxins from mold (most commonly from water-damaged buildings and yard work) can weaken the immune system’s ability to overcome a threat. 
• Other environmental toxins (which can be an initial trigger themselves) can burden the body when it’s trying to heal from an illness or injury such as:
  • • Volatile organic compounds
    • Endocrine disruptors
    • Heavy metal exposure
• People with compromised immune systems and lowered immunity have an increased susceptibility to chronic illnesses. Potential risk factors include, but are not limited to:
  • • History of long-term use of antibiotics
    • History of parasites
    • Low white blood cell count
    • Low natural killer cell activity 
    • Heart condition
    • Low Vitamin D levels (also a sign of chronic illness)
    • Gastrointestinal dysbiosis (also a sign of chronic illness)
• People with blocked nerve pathways, positional spinal cord compression, and mechanical spinal cord irritation are hypothesized to be at greater risk for ME/CFS, which is a type of neurological disorder. Here are some examples:
  • • Craniocervical instability
    • Injured Vagus nerve
    • Scoliosis 
    • Long-term history of compressed spinal cord due to poor posture (ie working hunched at a computer for many hours every day)
• Overexertion and overstimulation in the early phase of an illness or injury can add stress to the body and delay its ability to heal.