Daily Mail article : Are you tired all the time? You could be ill

"
A quarter of the population claim to suffer from fatigue.

But sometimes extreme tiredness can be hiding a more serious illness.

It is easy to blame exhaustion on the stresses of an increasingly demanding lifestyle or work.

But if after six months those feelings of exhaustion haven't gone away then you may have an illness classified by doctors as chronic fatigue syndrome (CFS).

Chronic fatigue syndrome also known as ME (myalgic encephalomyelitis) is a potentially disabling neurological disorder."

https://www.dailymail.co.uk/health/article-32348/Are-tired-time-You-ill.html

not sure if this is a new article or rehashed. Not particularly inspiring.

 

That’s the daily fail; even more than a typical newspaper they are guaranteed to be wrong on any technical scientific mechanical electrical or biological subject. Maybe they get recipes and crosswords OK.

Edit: this was more of a rant then thoughtful comment. I haven’t had the time or energy to actually read the article I’n criticizing. For all I know they got this one right; when you choose articles based only on how many clicks you expect a few of them will acidentally be pretty good.

 

One of the things that the article mentions is stress, specifically

and then adds this a little bit later

I'm always annoyed when stress gets mentioned in any context because it is assumed that everyone knows what the author of the article mentioning it actually means by the word. I've always felt that "stress" has a pejorative sense to it - a suggestion that someone suffering from stress is weak and is somehow to blame for whatever ails them. The sufferer needs to "man up", and a stronger, better, more worthwhile person would take these stresses in their stride, whereas the "weaker" person buckles.

And the unfairness of this makes me furious!

I just looked up the dictionary definition of stress and got this :

and a few of the synonyms given are :

But stress can be caused in all sorts of ways that have absolutely nothing to do with the character of the person feeling stressed.

To take a very common problem as an example : iron-deficiency anaemia. The sufferer has, amongst other things, fewer red blood cells to carry oxygen around. Every activity will take more effort because of the reduced number of red blood cells and the reduced oxygen carrying capacity of the blood. In severe cases muscles will suffer from lack of oxygen and cause a lot of pain. The heart will speed up. The sufferer may have no visible signs showing a medical issue so this problem may go on for a long time before it is discovered. And in the meantime you can guarantee that people will assume the person is "stressed", or burning the candle at both ends (so it's their own fault), or isn't coping because of some personality weakness.

Physiological "stress" can have hundreds or thousands of causes, and it can take a long time for doctors to even consider the common ones, because they suffer from the same prejudices that the general public do - that stress must be a psychological defect that can be treated with contempt and dismissed. And this makes me so angry.


/gets off soapbox

 

Dr Anne Macintyre, respected ME doc and M.e sufferer. Published it in the 90s when I was first ill, new edition 2009, but googled and said she was still ill 2011.

 

What in particular things did you find factually wrong with this article? I could not spot any errors.

I think it's a pretty good — even excellent — article, that although short sums up ME/CFS well, and includes a lot of the important and salient points and facts about ME/CFS.

I would challenge anyone here to come up with a better introductory description of ME/CFS in under 500 words (which is the length of this Daily Mail article).

 

Yes, you could include more details, but then it would be a longer article. As it stands, short and simple, I would say this is one of the better articles on ME/CFS I have seen.


There are quite a few studies showing emotional stress is a risk factor for developing ME/CFS, and I tend to accept these studies as correct (though my view is that because stress weakens antiviral immunity, this is the likely reason chronic stress increases the risk of ME/CFS: I think if you happen to catch an ME/CFS virus during a time of major chronic stress, then there's a higher chance of developing ME/CFS from the infection).

As for stress being a perpetuating factor, I don't think I have seen studies demonstrating this; but most of us ME/CFS patients know that emotional stress or social disharmony tends to hit us 10 times harder (in terms of its unpleasantness) than healthy people, so certainly avoiding stress where possible is not bad advice to give.

 

Well to be honest I made a sort of hit-and-run general post about the DM. I did not even read the original article. Sooooo maybe that was poor taste on my part

 

I know the the Daily Mail gets a lot of flak, but generally I don't find its health articles too bad; and it seems they tend do more health articles than other newspapers (or at least when I Google search for a health topic, a Daily Mail article often pops up).

They are not in-depth or highly scientific health articles; they are written more from the human interest angle, for general interest; but I sometimes find them a useful source of information, at least as a starting point into a health topic.

 

Didn't they change editors not too long ago?

Fair point.

Prospective, or retrospective recall studies?

 

Retrospective studies which used questionnaires, and recruited people who were willing to answer those questionnaires having some idea of what the hypothesis is. (Such evidence is only ever suggestive, not conclusive).

 

The people I know with MS feel their illness becomes worse during periods of stress, physical and emotional.

Dr McIntyre was a staunch defender of ME when it was being badmouthed in the 90s. I have a copy of her book which helped me a lot at the time (preinternet when information was very hard to get).

She was very seriously ill recently, not expected to survive.

 

I am not sure why being retrospective would lower the level of evidence, when we are dealing with objective events (divorce, bereavement, etc).

The following four stress-ME/CFS studies were cited by femtosecond99 on Phoenix Rising. I have not had the chance to read them thoroughly and have a good think about them, but I understand they asked questions about whether patients and controls experienced major major life stressors (eg divorce, bereavement) in the months preceding the onset of their ME/CFS.

Four papers showing increased major life stressor events in the months preceding the onset of ME/CFS:

• Precipitating factors for the chronic fatigue syndrome

• Life events, difficulties and dilemmas in the onset of chronic fatigue syndrome: a case-control study

• Cumulative life stress in chronic fatigue syndrome

• Critical life events, infections, and symptoms during the year preceding chronic fatigue syndrome (CFS): an examination of CFS patients and subjects with a nonspecific life crisis

As mentioned above, I my hunch is that since chronic stress (but not acute stress) weakens antiviral immunity (ref: here), if you are unlucky enough to catch an ME/CFS virus during a time of major chronic stress, the weakened immunity might allow the virus to insinuate itself more deeply into body tissue compartments during the acute infection, thereby leading to ME/CFS. So that could be the why stress may increase the risk of ME/CFS.

A recent presentation by Dr Jonathan Kerr looks at the effects of stress on viral infection (at timecode 8:02).

 

I already stated the problem: participation and reporting biases. Such biases certainly apply to whether financial or relationship problems were significant enough to mention. The controls in Sailit 1997 are not recruited in an unbiased way either.

All of the studies you mentioned are retrospective and three of the four are case-control (or pseudo-case control) studies, which provides suggestive (as opposed to conclusive) evidence at best.

Do you understand that when there is a common narrative, such as stressful/traumatic events are potential predisposing factors then this can skew questionnaire answering behaviour in this way? Only by measuring such events before the incidence of illness can we hope to control for this bias.

Nater 2011 notably does not compare CFS patients to other illnesses, and worryingly, they do not report the demographic factors of the (unmatched) controls compared to the CFS cases - there may be substantial demographic and particularly gender skew that cannot effectively be accounted for using statistical adjustments.

The problem with prospective population based studies is their measures have been fairly non specific, sample sizes have been too small to get enough CFS or ME cases, or they have not actually screened such CFS samples to see whether they actually meet the criteria.

The problem is that unless such factors are highly specific, it doesn't really matter. Precipitating factors that are neither necessary nor sufficient to cause CFS aren't terribly interesting unless you happen to be a person (hammer) who studies those factors (nail).

 

I do understand, and I would agree that if the questionnaires asked for example: "Did you feel stressed in the year before you were hit with ME/CFS?" then that could involve recall bias.

However, I understand that the questionnaires asked not about how people felt in terms of being stressed, but asked about major objective events like marriage, divorce or bereavement (events that are known to cause stress).

Surely you are not going to have a recall bias about whether or not you got married or divorced in the year before ME/CFS hit?

I don't follow that. Any factors, even if they are not necessary nor sufficient to cause ME/CFS, throw light on this disease.

I think it is very relevant that for example ME/CFS is usually kicked off by viral infection.

I also find it very relevant that in the historical ME/CFS infectious outbreaks, the ME/CFS epidemic was always confined to a specific area, and never travelled further outside that area (thankfully). That to me suggests that a virus alone does not usually cause ME/CFS; it requires the virus in combination with some other second factor local to the outbreak area — a second factor that allowed the virus to trigger ME/CFS. In the case of Lake Tahoe, the proposed second factor was the toxic cyanobacteria that had grown on the Lake that year.

 

At the same time none of that supports the notion of stress being relevant. If we don't know what the virus is we don't know how long the contagious stage is.

It could be very limited therefore less like to spread to further geographical areas after an outbreak.

In terms of traumatic life experiences like bereavement or divorce etc presumably all family members who were connected to such events were not studied as part of the control group?

Did the bereavement cause a long and sustained period of physical demand on a carer for example who potentially was going to get ME at some point or maybe already had it underlying.

Maybe holding down a job and caring full time for the beavered? Was the divorce the cause of one partner suddenly being responsible for all the childcare and a fulltime job which would be extremely physically demanding.

Which partner in the divorce got ME, did the other partner get ME also, if not why not?

Presumably the people studied in stress related studies had family members, maybe who even live or lived in the same house and experienced the same life situation and therefore would also come into contact with the virus. Did they also get ME or not? etc etc

 

Yes, my guess is that stress was not involved in the ME/CFS outbreaks (it would be hard to imagine how everyone in the villages around Lake Tahoe, or a whole hospital in the case of the Royal Free, all became stressed all together).

But I am trying to construct a bigger picture of how ME/CFS is triggered, and my working theory is a dual-factor theory: the first factor is a virus or other pathogen, which are commonly observed to trigger ME/CFS.

But we know that the viruses linked to ME/CFS are ubiquitous in the population, and do not cause ME/CFS in the general case. Thus logic dictates that other secondary factors must be involved, that only in tandem with the virus lead to ME/CFS.

Those secondary factors might be genetic; but so far genetic studies have not found much in the way of ME/CFS susceptibility genes. So I think an environmental second factor is more likely, and my hypothesis is that the second factor is anything which suppresses the antiviral immune response, which then allows the acute viral infection to run riot in the body. In other words, in my theory of ME/CFS, a virus plus an immune weakening factor puts you at high risk of developing ME/CFS.

I think that in the ME/CFS outbreaks, there must have been a second immune weakening factor present in the outbreak locale which suppresses the antiviral immune response. This would then explain why the virus caused a devastatingly high incidence of ME/CFS in that locale; but when the virus spread beyond that local, it no longer caused ME/CFS (except perhaps for the odd sporadic case here and there).

This is dual-factor theory is the only one I can think of which would explain why the outbreaks always remained localized. If anyone can come up with another theory for the outbreak localization, I am listening. To me this is the only one that makes sense.

In the case of Lake Tahoe, my hunch is that the toxic cyanobacteria growing on the Lake that year suppressed the antiviral immune response.

We also know from Dr Chia's telling discovery that immunosuppressive corticosteroids, when erroneously prescribed during an acute viral infection, create a high risk ME/CFS. Again, I think this is because the immunosuppression of corticosteroids allows the virus to run riot in the body during the acute infection, giving opportunity for the virus to insinuate itself more deeply into the body.

And this leads us on to why major chronic stress can also act as an immunosuppressive second factor: because chronic stress releases the cortisol hormone, which acts in the same way as corticosteroid drugs to lower the antiviral (but not antibacterial) immune response. Thus I think Chia's corticosteroid discovery supports the chronic stress connection to ME/CFS.

Another factor linked to ME/CFS is organophosphate pesticide exposure, which in one study quadrupled the risk of developing ME/CFS. Again, with organophosphates being immunosuppressive, in my view they can act as the second factor which weakens antiviral immunity.



So this is the bigger picture in which I view the chronic stress connection to ME/CFS. I don't believe in all the psychobabble that the psyches come up with, and I don't believe in the "all in the mind" view of of ME/CFS that the psyches propose. I think chronic stress is just one of many factors which can weaken antiviral immunity, and I think it is this weakening of immunity that allows a viral infection to cause ME/CFS. This has been my working theory of ME/CFS for some years now. I have not found any evidence which contradicts this theory.

I should add that I think it is important to provide a counter theory of the stress connection to ME/CFS, a theory which counters the views of the somatoform psychologists. If we leave it to these psyches, they will invent all sorts of crazy psychobabble reasons as to why stress can cause ME/CFS. But my theory removes all psychobabble, and provides a down-to-Earth biological explanation of how stress can increase the risk of ME/CFS.

I tried to explain my immunosuppressive theory of how stress may cause ME/CFS to Prof Sharpe on Twitter, but as soon as I did, he banned me... I guess he has too much invested in his psychobabble views to consider my biological theory of stress.