Chronic Fatigue Syndrome: Understanding a Complex Condition

Written By Indre Cepliauskaite
Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis, is a complex, often misunderstood condition causing severe, long-lasting exhaustion not relieved by rest. Even light activity can trigger days of worsening symptoms.

Its cause remains unknown, though research points to a combination of factors such as viral infections, immune dysregulation, mitochondrial dysfunction, and hormonal or neurological imbalances. With no single diagnostic test, many people spend years seeking answers and often feel misunderstood or dismissed along the way.

In the UK, around 0.6% of the population — approximately 390,000 people — may be living with CFS, with women affected nearly four times more often than men.

Experiences vary widely: for some, symptoms are manageable; for others, they can be profoundly disabling. Common complaints include muscle pain, poor concentration, unrefreshing sleep, and a persistent sense of feeling “flu-like.”

Supporting Recovery 

Although there’s no one-size-fits-all solution, evidence-based strategies can make a meaningful difference in supporting recovery and wellbeing.

Massage and Lymphatic Support

A recent review of 32 clinical studies involving 2,594 people with CFS found that massage therapy can significantly reduce both physical and mental fatigue. Other research also suggests it may help to ease muscle pain, reduce inflammation and support more restorative sleep.

Manual lymphatic drainage may also be beneficial for people with CFS, as it helps to improve lymphatic flow, boost circulation and support the body’s natural balance. In a study of 20 people with Long COVID, participants received weekly Perrin Technique sessions over nine to ten weeks, along with daily self-massage and gentle mobility exercises. Around 80% reported noticeable improvements in fatigue.

Sleep Hygiene

Sleep is one of the most powerful tools for healing, yet many people with CFS describe waking unrefreshed, no matter how long they sleep. Poor-quality sleep is closely linked to hormonal and nervous system imbalance, particularly dysregulation of the HPA axis and immune system.

Helpful strategies include:

  • Establish a Consistent Sleep Routine: Go to bed and wake up at the same time every day to regulate your internal clock and improve sleep onset. Aim for 8-9 hours of sleep during the hours of darkness.

  • Limit Daytime Naps: Avoid naps after 3 pm.

  • Morning Light Exposure: Spend time in natural sunlight in the morning. Use a SAD light therapy in winter to help regulate sleep patterns.

  • Optimise Sleep Environment: Ensure the bedroom is dark using sleep masks or blackout curtains to promote melatonin production.

  • Create a Relaxing Bedtime Ritual: Engage in calming activities like reading or gentle stretching before bed to signal that it's time to wind down.

  • Manage Restlessness: If unable to sleep, leave the bedroom and do a quiet activity (e.g., reading, soft music) until feeling sleepy. Avoid screens.

Nutrition for Energy

Nutrition plays a key role in supporting mitochondrial function, reducing inflammation, and stabilising blood sugar levels — all essential in managing fatigue.

The Ketogenic Diet

The ketogenic diet is a high-fat, moderate-protein, low-carbohydrate approach that shifts the body’s main energy source from glucose to fat, producing ketone bodies as an efficient fuel. This shift may help support mitochondrial health, stabilise energy, and reduce oxidative stress — key issues in CFS.

Many people notice improvements simply by reducing processed and sugary foods, which helps calm inflammation. Because the ketogenic diet can be restrictive, it should always be personalised and professionally guided to remain balanced and sustainable.

Intermittent Fasting

Intermittent fasting (IF) alternates periods of eating and fasting — for example, the 16:8 pattern, where meals are eaten within an eight-hour window. This rhythm can improve metabolic flexibility, enhance mitochondrial function, and reduce oxidative stress and inflammation.

As with any dietary change, IF should be introduced gradually and with professional guidance, especially for those with adrenal or blood sugar imbalances.

A Multidisciplinary, Individual Approach

Because CFS is multifactorial, management needs to be individualized. The aim isn’t to “push through” fatigue, but to work with the body, supporting its natural rhythms and recovery processes. With patience, understanding, and consistent care, many people can stabilise their symptoms and gradually improve their quality of life.

References

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• Bateman, L., Staines, D., & Marshall-Gradisnik, S. (2021). Neuroinflammation and cognitive impairment in chronic fatigue syndrome: Evidence from imaging and biomarkers. Frontiers in Neurology, 12, 643–659.

• Bjørklund, G., Maes, M., & Dadar, M. (2019). Mitochondrial dysfunction and oxidative stress in chronic fatigue syndrome. Pharmacological Research, 150, 104–118.

• Castro-Marrero, J., Cordero, M. D., & Saez-Francas, N. (2015). Mitochondrial dysfunction and therapeutic strategies in chronic fatigue syndrome. Antioxidants & Redox Signaling, 22(8), 680–692.

• Craig, C. L. (2015). Nutritional approaches in managing mitochondrial dysfunction and fatigue syndromes. Integrative Medicine, 14(6), 40–49.

• Field, R., Pourkazemi, F., & Rooney, K. (2021). The ketogenic diet and chronic musculoskeletal pain: Clinical implications. Journal of Pain Research, 14, 2103–2112.

• Fleming, J. (2024). Epidemiological patterns of chronic fatigue syndrome in the United Kingdom. British Journal of General Practice, 74(740), e105–e112.

• Friedberg, F., Sunnquist, M., & Nacul, L. (2019). Multidisciplinary management of chronic fatigue syndrome: Evidence and clinical strategies. Fatigue: Biomedicine, Health & Behavior, 7(1), 1–13.

• Heald, A., Peters, M., & Perrin, R. (2022). Manual lymphatic drainage and fatigue improvement in post-viral syndromes: A pilot study on Long COVID. Complementary Therapies in Medicine, 64, 102774.

• IACFS/ME. (2014). Primer for clinical practitioners: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). International Association for CFS/ME.

• Jackson, M. L., & Bruck, D. (2012). Sleep disturbances and fatigue in chronic fatigue syndrome: Implications for the HPA axis. Sleep Medicine Reviews, 16(3), 247–257.

• Jordan, J., Smith, T., & Davies, K. (2019). Systemic inflammation reduction through intermittent fasting: Clinical insights. Nutrients, 11(8), 1850.

• Li, Y., Zhang, X., & Wu, H. (2024). Massage therapy for chronic fatigue syndrome: A meta analysis of randomised controlled trials. Journal of Integrative Medicine, 22(2), 111–123.

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• Nacul, L., Lacerda, E., & Campion, P. (2011). The epidemiology of chronic fatigue syndrome in the UK. BMC Medicine, 9, 91.

• Sapra, A., & Bhandari, P. (2023). Chronic fatigue syndrome: Overview and current understanding. StatPearls Publishing.

Indre Cepliauskaite