It is the opinion of the authors that the disease called chronic fatigue syndrome (CFS), or fibromyalgia, or myalgic encephalomyelitis, is primarily due to a disorder of the immune system and should rather be called “systemic immune disorder”. This disorder probably results from external factors such as inadequate stress adaptation, or a (retro)-viral infection deregulating the function of the memory T-lymphocytes in persons who are predisposed because of genetic or epigenetic alterations. Chronic inflammation with overproduction of cytokines, reactive oxygen and nitrogen species causes mitochondrial dysfunction with metabolic disturbance resulting in muscular and cerebral signs and symptoms.
The reference treatment consisting of cognitive behavioural therapy (CBT) and graded exercising (GET) considers CFS to be a somatoform disease, but was proven ineffective. Causal therapy should be directed toward restoring T-cell function and is now under assessment. Organ-directed treatment aims at improving stress tolerance, at reducing inflammation and oxidative stress, and at optimizing mitochondrial function by means of nutriceutical food supplementation. Symptomatic treatment uses antidepressants, sedatives and pain killers. Experimental treatments interfere with the immune system or attempt to activate brain metabolism, and need further assessment. Adverse effects of long-term medication must be avoided. In the opinion of the authors an acceptable therapeutic result can commonly be attained by combining meditation, such as mindfulness, adaptation of lifestyle and nutrition, with complementary food supplementation using nutriceuticals and plant extracts.