Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME / CFS) is a poorly understood disease of unknown etiology that affects 0.1%–0.2% of the population, according to Canadian consensus criteria. Compared with many other chronic diseases, patients with ME / CFS have a lower quality of life, with major implications for patients and their families and for society. Recent research suggests that ME / CFS is associated with changes in fundamental processes of energy metabolism. Importantly, such metabolic changes may arise from dysregulated physiological response mechanisms that may be relevant in ME / CFS, such as immune activation, inflammation, and receptor-mediated signaling. However, there are no consistent data indicating a common metabolic defect that could explain the symptoms in these patients. Identification of responsible mechanisms is urgent in order to understand the disease pathophysiology and for the development of clinical strategies to diagnose and treat the patients.
The main symptoms of ME / CFS are fatigue, postexertional malaise, and lack of adequate restitution after rest or sleep, accompanied by cognitive disturbances and sensory hypersensitivity, including pain. The intensity of the symptoms is increased by exertion. Patients frequently suffer from additional symptoms ascribed to the autonomic nervous system or cardiovascular system, such as dizziness and palpitations, cold hands and feet, disturbed perceived body temperature, thirst, irritable bowel, and urinary urgency. Immune symptoms include recurrent sore throat and tender lymph nodes. In several studies, ME / CFS patients demonstrated reduced functional capacity in repeated cardiopulmonary exercise tests compared with healthy controls. These observations suggest that the systemic exertion intolerance in ME / CFS may, at least in part, involve a switch to anaerobic glycolysis, with generation of lactate at a significantly lower workload threshold than that observed for healthy subjects. Increased lactate levels have been found in the cerebrospinal fluid of ME / CFS patients. However, defects in glucose utilization and lactate production are not evident based on routine blood sample analyses, possibly because the sampling is performed under resting conditions without preceding physical exercise.
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