CFS/ME: Psychological Condition or Metabolic Dysfunction?

Chronic fatigue syndrome (CFS), also known as Myalgic Encephalomyelitis (ME), affects approximately 250,000 people in the UK (Coghlan, 2017). Women are 2-4 times more likely to be affected than men and prevalence ranges between 0.2% and 2.6% of the population. However, varying definitions and classifications of ME/CFS have impacted on reporting and diagnosis of the condition.

According to Emerge Australia (2017), the primary symptom is “Overwhelming post-exertional malaise as a result of minimal cognitive, emotional or physical effort. This exhaustion may occur immediately after activity or be delayed by hours or days.” Fluge and colleagues (2016) suggest the “hallmark symptoms including postexertional malaise and poor recovery.” There may also be a number of concurrent symptoms, but these vary between individuals.

If you don’t know anything about CFS, it is a very contentious issue.

“Some have argued that CFS is a psychological condition, best treated with cognitive behavioural therapy.” (Coghlan, 2017, p.10).

“Metabolic dysfunction is a plausible contributing factor.” (Fluge et al., 2016)

There is research now suggesting that CFS could, in many cases, be due to people losing their ability to fully exploit carbohydrate sugars to generate energy.

To compensate, their cells rely on lower-yielding fuels, such as amino acids and fats, and build up lactate, a painful by-product. This would explain both the shortness of energy and why even mild exercise can be exhausting and painful.

Øystein Fluge (Haukeland University Hospital in Bergen, Norway), and his colleagues have studied amino acids in 200 people with, and 102 without, CFS. They found abnormally low levels of the types of amino acid that can be used as a fuel source in the blood of women with CFS. These shortfalls were not seen in men with CFS, but that could be because men tend to extract amino acids for energy from muscles, instead of blood.

Fluge et al. (2017) state “These findings are in agreement with the clinical disease presentation of ME/CFS, with inadequate ATP generation by oxidative phosphorylation and excessive lactate generation upon exertion.”


Coghlan, A. (2017) Metabolism Linked to Chronic Fatigue. New Scientist. 18 February 2017.

Emerge Australia:

Fluge, Ø., Mella, O., Bruland, O., Risa, K., Drystad, S.E., Alme, K., Rekeland, I.G., Sapkota, D., Røsland, G.V., Fosså, A., Ktoridou-Valen, I., Lunde, S., Sørland, K., Lien, K., Herder, I., Thürmer, H., Gotaas, M.E., Baranowska, K.A., Bohnen, L.M.L.J., Schäfer, C., McCann, A., Sommerfelt, K., Helgeland, L., Uleland, P.M., Dahl, O. & Tronstad, K.J. (2016) Metabolic Profiling Indicates Impaired Pyruvate Dehydrogenase Function in Myalgic Encephalopathy/Chronic Fatigue Syndrome. JCI Insight. 1(21):e89376. doi:10.1172/jci.insight.89376.


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