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Chronic Fatigue Syndrome Diagnosis

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The clinical features of ME were first clearly described by the late Dr. Melvin Ramsay MA MD (a physician at the Royal Free Hospital in London during an epidemic outbreak in 1955, and The ME Association’s first President). Since then, in the light of there being no diagnostic tests, there have been several more attempts to define the illness by way of its symptoms, although never with all-round agreement.

In recent years there have been the American Center for Disease Control (CDC) definition, the “Oxford Criteria” and more recently the “Canadian Guidelines”. Although the first two criteria tend to be used as a diagnostic aid by many clinicians, they were compiled primarily for researchers to identify particular sets of people for their studies. These earlier definitions (of “CFS” as opposed to “ME”) give various physical and neurological symptoms; however, in these definitions, the cardinal features of “ME” – the muscle fatigability and pain, and post-exertional malaise – do not have to be present for such a diagnosis. This suggests that nowadays, not everyone with a diagnosis of “Chronic Fatigue Syndrome” necessarily has the disease “ME” as described by Dr Ramsay. It also seems that CFS can cover a spectrum of fatigue-prominent diseases, possibly including illness based in depression, stress or ‘burn-out’. However the Canadian Guidelines were developed with clinicians more in mind.

Two other features of ME are first the fluctuation of symptoms from day to day, or within the day; and secondly the tendency for the condition to persist for several years.

However, here are some tests that can help in regards to coming to a diagnosis:

Tests helpful in making a diagnosis
The main value of blood tests in the assessment of someone with possible ME/CFS is to exclude other common conditions which produce fatigue as a principle symptom. This means the following tests should always be considered before a diagnosis is confirmed; these can be arranged by your GP if she/he is agreeable:

    • anaemia
      People with ME/CFS do not have anaemia as part of this illness. If the haemoglobin level is reduced, then an alternative explanation should always be pursued.
    • white cell count
      A measurement of the number of cells which fight off infection. This count is often increased during the early stages of an infection but as ME/CFS becomes chronic, the level usually starts to return to normal. Some people with ME/CFS have abnormally shaped white cells (atypical lymphocytes), particularly following glandular fever. A raised level of a type of white cell known as eosinophils can occur with allergies or when infection with toxocara is present (the latter should always be queried when a child has eosinophilia).
    • ESR or acute phase protein changes (e.g.CRP)
      The ESR test is a useful indicator of general health. If raised, this suggests some form of chronic infection or inflammation is present. The vast majority of people with ME/CFS have a normal ESR.
    • liver, thyroid and kidney function tests
      Liver function tests are sometimes abnormal in ME/CFS. This may be due to the precipitating infection causing liver inflammation or the effects of antidepressant drugs. There is also a condition called Gilbert’s disease which seems to be more common in people with ME/CFS (ref: Lancet, 1993, 341, 842 and 1162-1163). If liver tests remain abnormal then further investigation may be warranted. There is no evidence that hormonal disturbances in ME/CFS involve the thyroid gland: the results of thyroid function tests should always be normal.
    • routine biochemistry (urea, electrolytes, calcium etc.)
      results should all be within the normal range. A raised level of blood calcium could be due to sarcoidosis. A lowered level may indicate osteomalacia (a bone disease causing fatigue and bone pain). Research from Australia indicates that the total amount of body potassium may be lowered in ME/CFS (ref: Medical Journal of Australia, 1996, 164, 384). A raised level of potassium can occur in Addison’s disease.

  • creatine kinase
  • urine tests for sugar/protein
  • hormone levels
In some cases, investigations should also include checking female hormone levels (serum oestradiol) and adrenal gland function.

Other blood tests which could be considered will depend on specific symptoms. For example, if irritable bowel symptoms are experienced then checking for adult-onset coeliac disease would be worthwhile, particularly if the symptoms appear to be relieved by a wheat-free diet.

Source: ME Association UK


Active Member
You can definitively test for ME/CFS and Fibromyalgia but it is too expensive.
1. Exercise stress test O2 uptake on repeat test.
2. Alan Lights immune change profile after exertion (

What irritates me is that the CDC and NIH or NHS (UK) will not accept this. Of course they cannot do the Light tests on everyone but what they do is show where the problem lies with this "group" of diseases. The immune system is significantly disturbed. Further research by the excellent group at Griffith in Australia has amplified this to show in more detail where the problems lie, not the cause of the disease but its immune parameters.

Now we are told by the IOM that this group of diseases should be called SEID (systemic exertion intolerance disease)
This is not accurate and as Prof Jason points out there are problems with the word "exertion". Severe cases of ME/CFS and FM can hardly brush their teeth. I was like this for nearly two years.

Another problem with this name is that it does not take into account the chemical exposure triggering of worsening symptoms, a much more common trigger than most recognise. The immune system deals with the daily/hourly intake of toxins but in people with ME/CFS and FM these immune changes cause a serious increase in symptoms and a poor inhibition of response ie. a prolonged response of increased symptoms.

Let us hope that if this strange name is adopted tests for exertion intolerance will be used to diagnose the illness and Prof. Light be acknowledged for his ground breaking research in clarifying this group of illnesses. Sadly those with MCS will miss out unless they also have PEM (about 50%).
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