Dr. Sarah Myhill
I see chronic fatigue syndrome as a stress induced disorder, by which I mean infectious stress, physical stress, mental stress, emotional stress and so on. The body deals with stress in ways which are either specific to that particular stressor (such as immune activation with a virus) or a general response to stress. As a part of that general response to stress, the adrenal glands are centrally important. This was well illustrated in some work done after the Second World war by the German physiologist Hans Selye.
Selye stressed rats in nasty ways (which you and I do not want to think about). If he sacrificed these stressed rats he found that the adrenal gland had got larger. This was in order to allow it to produce more of the stress hormones cortisol, DHEA and probably others as well.
If Selye took some rats and stressed them and then gave them a rest, he found that the adrenal glands had returned back to their normal size.
In a third experiment Selye took rats and stressed them unremittingly with no break or rest. Initially the rats appeared to function fairly normally. However they suddenly became ill and died and when he examined them, he found that the adrenal gland had wasted away.
I suspect this is what is happening in many of my chronic fatigue syndrome patients. I liken the adrenal gland to the gearbox in a car. When the stress goes on one can move up into third or fourth gear or even into overdrive to cope with that stress. However, one then needs a time of rest and recuperation for the body to recover. This system is necessary because if we all went round in overdrive all the time, we simply would not be able to fuel all of that activity and we would die from starvation. The body has to able to adjust its level of arousal to cope with the stresses of life.
In evolutionary terms we are evolving faster now than at any previous stage and this involves us having to make changes to our lifestyle. Changes, whether that be change in relationships, moving house, changing jobs or whatever are inevitably stressful events. That combined with the fact that the population of the world is increasing and therefore we have more viruses which spread rapidly round the world causing infection, combined with the fact that the quality of our food is declining and we are further contaminating ourselves with toxic chemicals, means that our stress levels have never been greater.
Different people can tolerate different amounts of stress. However, we all have our limits and anyone who is sufficiently stressed will eventually develop a "burnout syndrome". This is what happens when the adrenal gland fails. Coming back to the analogy of the car, this means that when the stress goes on we can no longer move into fourth or fifth gear to cope with the stress, we can only struggle on in first. This manifests in the body clinically with severe fatigue, both physical and mental, sleep disturbance and many other physical symptoms, which of course are all the symptoms of a chronic fatigue syndrome.
In order to allow the adrenal glands to recover, one needs a long time of reducing mental and emotional stress, excellent diet, good nutrition and reduction of toxic stress in order to allow the adrenal gland to recover. It does, but it takes time.
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