Chronic Fatigue Syndrome (CFS) and Fibromyalgia: One Diagnosis or Two? | HMG
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Chronic Fatigue Syndrome (CFS) and Fibromyalgia: One Diagnosis or Two?

Chronic Fatigue Syndrome (CFS) and Fibromyalgia: One Diagnosis or Two?

Imagine waking up every morning feeling weak and fatigued with no hope of relief as the day goes on. Furthermore, no matter what medications your doctor prescribes, be it antidepressants, muscle relaxers, or sleep aids, there doesn’t seem to be any improvement. For many with chronic fatigue syndrome (CFS) and fibromyalgia this is their reality.

Originally Posted April 2017
Updated June 2019

One of the primary difficulties of chronic fatigue syndrome and fibromyalgia is locating and resolving each of the numerous malfunctions associated with them. Every case is unique and has its own challenges. Treatment of both conditions require an individualized multi-system approach that is structured around each patients’ specific needs. Without better understanding of the causes, symptoms and treatments for CFS and fibromyalgia the likelihood of resolving them can be slim.

A Debilitating Duo

Many aspects are shared between CFS and fibromyalgia. This is likely because the systems most impacted by these conditions are highly integrated with one another. CFS is caused primarily by pituitary malfunction that has a significant impact on hormone regulation. Widespread hormone disruption can cause a multitude of problems throughout the body. Similarly, fibromyalgia is instigated by dysfunction in the hypothalamus, which influences the nervous system and plays a critical role in hormone regulation.

Frequently, when one system is impacted the other is affected as well. For this reason, even though CFS and fibromyalgia are individual conditions, up to 70% of patients who suffer from one disorder also has the other. Despite these conditions having clear associations with specific systems there are many contributing conditions and malfunctioning elements that can promote CFS and fibromyalgia difficulties. Common contributors of these two conditions include:

  • Mitochondrial malfunction
  • Hormonal deficiencies (cortisol, thyroid, etc.)
  • Irregular immune response
  • Neurotoxins
  • Infections and viruses
  • Reduced natural killer cell function
  • Various chronic diseases

Learn more about fibromyalgia here.

Symptoms of CFS/Fibromyalgia

Because there are many contributing issues associated with CFS and fibromyalgia the symptoms are often widespread and diverse. Furthermore, the way symptoms manifest themselves is often misconstrued as resulting from commonly occurring disorders or lifestyle habits. This makes diagnosis difficult and can complicate treatment. Symptoms of both conditions may appear in patients who only have one of the two disorders. Commonly occurring symptoms include:

  • Long-lasting fatigue
  • Muscle and joint pain or weakness
  • Tenderness and sensitivity
  • Headaches
  • Insomnia
  • Flu-like symptoms
  • Weight gain
  • Sore throat
  • Digestive difficulties
  • Inhibited cognitive function
  • Poor memory
  • Easily fatigued after minor exertion
  • Low thyroid hormone
  • Adrenal deficiency
  • Reduced growth hormone

More specific and impactful consequences of CFS and fibromyalgia are hypothalamic, pituitary, immune system and coagulation dysfunction. CFS alone promotes a notably deceptive dysfunction. The disorder may cause an increase in abnormal RNase-L enzyme. In standard form, this enzyme aids in breaking down infectious cells. However, when this enzyme is overactive it can harm the cell’s own RNA, thereby damaging cell protein coding and function. This can cause immunity to weaken and be incapable of effectively removing infectious agents. Weakening the body’s defenses allows for harmful bacteria and infectious agents to remain in the system for extended periods.

Learn more about symptoms of fibromyalgia here.

The above issues and conditions coupled with various other symptoms that result from CFS and fibromyalgia culminate with rippling disorder and malfunction throughout the body. Unfortunately, the crux of the issue frequently goes undiagnosed or undertreated due to lack of awareness and inadequate testing for CFS and fibromyalgia.

Lack of Testing for CFS/Fibromyalgia

One of the hurdles in resolving CFS and fibromyalgia is recognizing its presence. No standardized testing is currently done for these chronic conditions. Instead, the disorders are overlooked or undertreated with a focus on resolving individual symptoms rather than the underlying problem. Unfortunately, many prescriptions, such as antidepressants and pain medications, frequently cause CFS and Fibromyalgia symptoms to ultimately worsen.

Proper Treatment for CFS/Fibromyalgia

Properly treating both CFS and fibromyalgia requires that the vicious cycle of system abnormalities is dealt with. The best way to accomplish this is by utilizing a multi-system approach that is specifically designed for each individual case. Treatments may occur in different orders and aspects may be addressed simultaneously. It is critical to approach treatment with a mindset of resolving contributing conditions and underlying disorders through to completion.

There are multiple components to consider when implementing a multi-system approach. The initial concern is to treat any pain and sleep disrupting symptoms that may be present. Usually this is done by prescribing sleep aids and pain medications for short period to allow for easier diagnosis and treatment of other disorders. It is important that medication be prescribed short term and is not relied on as the ultimate solution. Unfortunately, many practitioners are satisfied with only treating these symptoms through medications that are actually detrimental when they are used long term and are the sole method of treatment.

Optimizing mitochondrial function is another important aspect of overall treatment. A cell’s mitochondria are its primary source of energy. Hormone deficiencies, toxins and infections can all harm mitochondria. Furthermore, CFS and fibromyalgia inherently cause mitochondrial poisoning that inhibits their functionality. Treatment may include nutrient supplementation through oral or intravenous methods. Resolving infectious elements found elsewhere in the body is also important. Without bolstering the immune system and removing infectious agents, harmful bacteria and viruses will likely remain in the system.

Hormonal dysfunction is closely associated with pituitary and hypothalamic disorders. It is important to optimize not only hormone levels but also function. Hormones that commonly need intervention include:

  • Thyroid
  • Growth hormone
  • Testosterone
  • Aldosterone
  • Cortisol
  • DHEA
  • Estradiol
  • Progesterone

Moving Forward with CFS/Fibromyalgia

The goal in treating CFS and fibromyalgia should always be to not only resolve symptoms but also optimize system functionality. This result is best achieved through a multi-system approach that confronts the numerous elements that contribute to these debilitating conditions. Through greater awareness and proper treatment there is hope of solving these conditions and restoring quality of life.

At Holtorf Medical Group, our physicians are trained to utilize cutting-edge testing and innovative treatments to uncover and address the underlying cause of CFS and fibromyalgia. If you are experiencing symptoms of CFS/fibromyalgia, but aren’t getting the treatment you need, call us at 877-508-1177 to see how we can help you!


1. Kent Holtorf, MD. “A Confounding Condition.”
2. Kent Holtorf, MD. “Chronic Fatigue Syndrome and Fibromyalgia; Now Treatable Diseases.”
3. Kent Holtorf, MD. “Cycle of Dysfunction in CFS/FM.”
4. Kent Holtorf, MD. “Diagnosis and Treatment of Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM).” Journal of Chronic Fatigue Syndrome, Vol. 14:3 (pub) 2008.
5. Kent Holtorf, MD. “Are All Chronic Fatigue Syndrome and Fibromyalgia Patients Low Thyroid?”
6.Kent Holtorf, MD.“Growth Hormone Treatment of FM and CFS.”
7. Kent Holtorf, MD. “Hypercoagulable State and Chronic Fatigue Syndrome and Fibromyalgia.”
8. Kent Holtorf, MD. “Infectious Causes of Chronic Fatigue Syndrome.”
9. Kent Holtorf, MD. “Kent Holtorf, M.D. on Treating Chronic Fatigue Syndrome & Fibromyalgia.”
10. Kent Holtorf, MD. “New Standard for the Treatment of Chronic Fatigue Syndrome and Fibromyalgia.”

Chronic Fatigue Syndrome (CFS) and Fibromyalgia: One Diagnosis or Two? was last modified: June 6th, 2019 by Holtorf Medical Group

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