Testing for Chronic Fatigue Syndrome:
By Cara Lan, N.D.
Currently there is no one lab or imagining test that can diagnose Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). However, having blood work done is very helpful as it helps to identify other important causes of fatigue which can mimic ME/CFS. Blood work can detect other illnesses such as aberrations or deficiencies in immune cells, decreased red blood cell production (anemia), metabolic dysfunction such as diabetes, endocrine disorders such as hypothyroidism, autoimmune disorders such as Rheumatoid Arthritis or Systemic Lupus Erythematosus, kidney or liver disease, etc. A doctor will likely order the following tests to look for any of these areas of dysfuction:
Complete Blood Count (CBC)— looks at your white blood cells (many of the cells that make up your immune system) and red blood cells (cells that have the vital function of carrying oxygen to all the organs, tissues and cells in your body
Comprehensive Metabolic Panel (CMP)— assess your fasting blood sugar, electrolytes, kidney and liver function
Hemoglobin A1c— assess your approximate blood sugar measurement over the past 3 months
AM cortisol— assess your morning cortisol levels and the ability of your adrenal glands to produce the cortisol that gets you up and running
TSH, fT3, fT4, rT3, and Thyroid Antibodies— all markers for thyroid function or dysfunction
ANA with reflex to titer— one marker to assess for possible autoimmune conditions
RF and Anti-CCP— markers used to assess for Rheumatoid Arthritis
Other antibodies present in other autoimmune conditions such as: Anti-SS-A and Anti-SS-B antibodies
Vitamin D— to assess for this ever so important nutrient
Vitamin B12 and Folate— two more nutrients critical for cellular function and energy production
MTHFR variants— assess your ability to methylate which is also important in creating ATP and energy
Infections with intracellular pathogenic organisms are also common in those with ME/CFS. This finding suggests that the infections may be the underlying cause of the syndrome or may be due to underlying immune dysfunction. For this reason, blood work can also help rule in or rule out current or past infections that may be causing or contributing to your symptoms. This type of blood work includes testing for current or past infections with pathogens such as:
Epstein Barr Virus (EBV)— the virus that causes mononucleosis and may be one of the foundational cause of ME/CFS
Cytomegalovirus (CMV)
HHV6 and HHV7
Borrelia burgdorferi (the bacterium that causes Lyme Disease) and other tick borne bacteria
HIV
Hepatitis B or C
Mycoplasma
Chlamydia
Coxiella— the bacterium that causes Q Fever
Coccidiomycoses— the fungus that causes Valley Fever
West Nile Virus
Sars-CoV-2— the virus that causes COVID-19
And others that your doctor may want to order
Even if all of the above tests come back negative, at least you know more about what is NOT causing the illness which further helps your practitioner to narrow down treatment options. (This, however, is not the case with homeopathic treatment, which does not depend on knowing the root cause of the illness, only the symptoms themselves, to effectively treat the illness. More on that under ‘Natural Treatments for Chronic Fatigue Syndrome’).
If some of the above tests come back positive, you may either have a different illness whose symptoms are very similar to ME/CFS or you may have ME/CFS and other diagnoses as well, as is often the case for many people. Again, the tests can help you and your doctor narrow down treatment options to those that will be most beneficial for the conditions you are dealing with. Once you begin to treat each diagnosis and causative agent found, you will begin to notice marked improvements in your stamina and ability to function normally again.
Similarly, work up by a neurologist can rule in or out other neurological issues that can mimic ME/CFS. Work ups usually involve a physical exam, CT or MRI imaging, electromyography, a tilt table test, and sometimes lumbar puncture.
Many physicians will often refer you to other specialists as needed for your specific symptoms. Aside from neurologists these include: endocrinologists, rheumatologists, hematologists, otolaryngologists, gastroenterologists, etc.