A: There are many triggers that can cause the gradual onset of CFS/FMS. They fall into several major categories:

1. Fungal infections -- where viral, parasitic, and antibiotic sensitive infections tend to have a sudden onset, fungal infections tend to sneak up on an individual. Repeated or long-term antibiotic use (e.g. for acne), high sugar intake, extensive use of high dose prednisone and other steroids, and high estrogen levels from birth control pills are some of the major contributing factors.
2. Hormonal problems -- both an under and over active thyroid are common and tend to sneak up on people gradually. Another very common cause of CFS/FMS is estrogen deficiency. Most women will become deficient in estrogen for 5 to 12 years before their periods stop and before the blood tests the doctor uses to diagnose menopause becomes abnormal. Often, sleep is the first thing to go followed by one's memory. The person then becomes gradually achy and fatigued. Chronic stress can also cause cortisol deficiency. All of these will be discussed in much more detail in upcoming letters.
3. Chronic stresses -- these can include work stresses and family stresses. In addition, CFS is much more common in people who had abusive childhoods -- especially in the presence of sexual abuse. Some companies are so abusive that I have had several employees in the same company come in as patients. In some relationships, the patient feels locked into staying in an abusive situation because of financial and emotional dependence. In those situations, it is often time to seek help from family and friends. In abusive work situations, The Americans with Disabilities Act can often help people to get reassigned to other positions and situations that are less stressful. In addition, feeling that one is locked into a job that they hate because they feel like they have no choice (e.g. -- because of lack of other job skills or being locked into a high cost of living) or feeling that they're abandoning their children to their job can be contributing factors that need to be evaluated.
4. Chronic nutritional deficiencies are, sadly, routinely seen in Western societies. This occurs largely because of food processing, increased sugar and white flour intake, and possibly also depletion of nutrients in the soil because of modern farming techniques. As an example, the average American diet contains approximately 150 pounds each of processed sugar and white flour -- both of which have been largely stripped of vitamins and minerals, but are full of calories. Because of these problems, high calorie malnutrition is common in the U.S. and other Western societies.
5. Chronic sleep disorders such as sleep apnea and restless leg syndrome are common triggers of CFS/FMS. The sleep apnea is often characterized by snoring, gasping noises during sleep when the person is unable to take a breath, being markedly overweight, and high blood pressure. In thin people, sleep apnea can sometimes be associated with compression of the brain and spine (Chiari malformation and spinal stenosis). Restless legs syndrome is also very common in CFS/FMS. In this syndrome the legs tend to move a lot at night. Sometimes, they feel like things are crawling on them and even jump during the day -- making the person look fidgety. A blanket (or bed partner) that tends to get kicked around a lot at night are important clues to the presence of restless leg syndrome. Both sleep apnea and restless leg syndrome can be diagnosed by sleep studies. This test again runs about $2000 and is often not paid for by the insurance companies. Some smart patients simply set up a video camera to record themselves while they are sleeping to look for these conditions! Fortunately, the diagnoses can also usually be suspected from the patient's history. These are just two of over a hundred underlying problems that are looked for when people do my web site program.

Dr. Teitelbaum is a board certified internist and director of the Annapolis Research Center for Effective CFS/Fibromyalgia Therapies, where he sees CFS/Fibromyalgia/Chronic pain patients from all over the world (410-266-6958). Having suffered with and overcome these illnesses in 1975, he spent the next 28 years creating, researching, and teaching about effective therapies. He is the author of the best-selling From Fatigued to Fantastic!" and the newly released "Three Steps to Happiness! Healing through Joy". His web site can be found at: www.vitality101.com