Skip to comments.Chronic fatigue syndrome from vagus nerve infection: A psychoneuroimmunological hypothesis
Posted on 02/22/2014 7:00:16 PM PST by Seizethecarp
Chronic fatigue syndrome (CFS) is an often-debilitating condition of unknown origin. There is a general consensus among CFS researchers that the symptoms seem to reflect an ongoing immune response, perhaps due to viral infection. Thus, most CFS research has focused upon trying to uncover that putative immune system dysfunction or specific pathogenic agent. However, no single causative agent has been found. In this speculative article, I describe a new hypothesis for the etiology of CFS: infection of the vagus nerve. When immune cells of otherwise healthy individuals detect any peripheral infection, they release proinflammatory cytokines. Chemoreceptors of the sensory vagus nerve detect these localized proinflammatory cytokines, and send a signal to the brain to initiate sickness behavior. Sickness behavior is an involuntary response that includes fatigue, fever, myalgia, depression, and other symptoms that overlap with CFS. The vagus nerve infection hypothesis of CFS contends that CFS symptoms are a pathologically exaggerated version of normal sickness behavior that can occur when sensory vagal ganglia or paraganglia are themselves infected with any virus or bacteria.
(Excerpt) Read more at medical-hypotheses.com ...
Here is a more detailed article about this vagus nerve hypothesis on a ME/CFS research blog(hat-tip to this blog):
“One Theory To Explain Them All? The Vagus Nerve Infection Hypothesis for Chronic Fatigue Syndrome”
VanElzakker proposes that an infection triggers ME/CFS, but if his theory is right the most important thing about that infection is not what it is but where it is. That where is the biggest nerve in the body; the vagus nerve a wandering nerve that stretches over much of our torso and sends its roots into most of the organs of the body.
The vagus nerve isnt just any nerve; its the nervous systems immune conduit to the brain. VE believes that an infection there doesnt need to be large to cause havoc in the brain; it just needs to be present.
In some ways, vagus nerve appears, in fact, to be ripe for infection in ME/CFS. As it wanders through the body it comes into contact with virus havens such as the esophagus, stomach, lungs and spleen, all of which have likely at one time or another harbored the herpesviruses (HHV6, HHV-5 [cytomegalovirus], HHV-4 [Epstein-Barr virus]) that have been thought to be associated with ME/CFS for decades.
Most humans carry several of these herpesviruses in latent form unless some stressor or biological event allows them to become reactivated.
VanElzakker believes that upon reactivation these viruses replicate and move outside the nerves where they run into glial cells that attempt to gobble them up. The glial cells perk up remarkably in the presence of viruses, releasing all manner of pro-inflammatory and neuroexcitatory compounds (proinflammatory cytokines [IL-1B, IL-6, TNF-a], glutamate, prostaglandins, nitric oxide and free radicals. ) - See more at: http://simmaronresearch.com/2013/12/one-theory-explain-vagus-nerve-infection-chronic-fatigue-syndrome/#comment-5430
I’ve read that the vagus nerve may constitute another brain.
With all the chemical additives and hormones and GMO we stuff in our food and let polute our waters, I wonder if any of that has to do with syndromes like CFS and Fibromyalgia?
Good article, the trouble is, what happens is Vagus doesn’t always stay in Vagus!
I don’t think it’s new news that people who are fatigued, stressed, and depressed tend to have health problems becasue these things can break down your immune system. Maybe this is a detailed explanation of how it happens, but the cause-effect thing doesn’t seem to be new news.
“Ive read that the vagus nerve may constitute another brain.”
The vagus nerve is involved in a lot of “autonomic” processes that are semi or totally autonomous:
The vagus nerve supplies motor parasympathetic fibers to all the organs except the suprarenal (adrenal) glands, from the neck down to the second segment of the transverse colon. The vagus also controls a few skeletal muscles, notable ones being:
Levator veli palatini muscle
Superior, middle and inferior pharyngeal constrictors
Muscles of the larynx (speech).
This means that the vagus nerve is responsible for such varied tasks as heart rate, gastrointestinal peristalsis, sweating, and quite a few muscle movements in the mouth, including speech (via the recurrent laryngeal nerve) and keeping the larynx open for breathing (via action of the posterior cricoarytenoid muscle, the only abductor of the vocal folds). It also has some afferent fibers that innervate the inner (canal) portion of the outer ear, via the Auricular branch (also known as Alderman’s nerve) and part of the meninges. This explains why a person may cough when tickled on the ear (such as when trying to remove ear wax with a cotton swab).
With CFS (the defined syndrome, of just “chronic fatigue”) the body appears to be trying to fight of a pathogen somewhere in the body. Chemical additives and hormones, etc., aren’t pathogens and haven’t been found to provoke the same cytokine responses in the body seen in CFS as far as I know.
“Often, mild to mild/heavy exercise for 20-30 minutes a day helps dissipate chronic fatigue.”
A person with simple “chronic fatigue” who responds favorably to what is called “graded exercise training” or GET does NOT have true CFS in my understanding.
People with CFS, the identified syndrome, have something called post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE). They can suffer a relapse after even moderate exercise that mysteriously starts 24 to 48 hours AFTER the exercise and can last for a week or longer.
I have experienced this for the last 13 years!
People with CFS must scrupulously minimize their activities (called pacing) and limit their exercise to avoid debilitating relapses.
Here is a video lecture from the NOVA University’s CFS research center on excecise and CFS. They have found that CFS sufferers do best when they limit specific exercise to 2 minutes:
Here is a link to numerous NOVA CFS lectures from the opening day their opening day of their new CFS research center and clinic in January 2013:
“Maybe this is a detailed explanation of how it happens, but the cause-effect thing doesnt seem to be new news.”
CFS patients appear to be responding to a pathogen but no pathogen has been found in the blood to date.
What is new in this article is the hypothesis that the pathogen is attacking multiple organs not from the blood but from within an infected vagus nerve!
Post of the day!
Interesting, informative and : )
And one of the sneakiest and most mutatable infections comes from Chronic Lyme Disease—an infection the CDC is loathe to discuss.
Interesting, and again, seems to support and give a more detailed explanation as to why frayed nerves and stress cause disease.
“Just curious, do people that have CFS suffers from seizures more often than the general population?”
I have seen no increased correlation between CFS and actual seizures in the research, although a person could also have seizures just as they could also have any other condition.
What I have seen and do experience personally is debilitating orthostatic intolerance (intolerance of sitting or standing) which results on loss of blood to the brain.
This causes fainting (syncope) or near-fainting (pre-syncope).
For people with CFS this is usually caused by either POTS (Postural Orthostatic Tachycardia Syndrome) or neurally-mediated syncope (aka neurocardiogenic syncope).
As you can see there is a lot of jargon.
Here is the Wiki-page on POTS:
Here is the Wiki-page on neurally-mediated syncope (also aka vasovagal response):
So no seizures with CFS but when the brain stops working it
might as well be!
The way that othostatic intolerance is confirmed is by using a “tilt-table” test conducted by a cartiologist in a lab where they can revive you if you pass out (in agony). I made a little joke with the MD that the tilt-table test is like being crucified, only without the nails. He joked back to me that they had stuck two IV’s into me, one in each arm, so it was getting close!
Here is the Wiki page on tilt-table test:
“A tilt table test, occasionally called upright tilt testing, is a medical procedure often used to diagnose dysautonomia or syncope. Patients with symptoms of dizziness or lightheadedness, with or without a loss of consciousness (fainting), suspected to be associated with a drop in blood pressure or positional tachycardia are good candidates for this test.
“The procedure tests for causes of syncope by attempting to cause syncope by having the patient lie flat on a special table or bed and then be monitored with ECG and a blood pressure monitor. The table then creates a change in posture from lying to standing.”
“Interesting, and again, seems to support and give a more detailed explanation as to why frayed nerves and stress cause disease.”
Stress has been shown to be correlated to the onset of a large subset of CFS cases due to compromise of the immune system caused by stress. The resulting vulnerability makes possible attack by either new pathogens or the reactivation of old pathogens in the body that the immune system can no longer keep in check.
However, there is a large subset of CFS cases where there is NO link to stress but rather a sudden onset after a viral disease in perfectly healthy non-stressed people many of whom were athletes in top condition.
At the NOVA clinic I am currently being screened for antibodies of a range of viral infections and also with PCR testing to detect specific DNA of possible reactivated viruses or new pathogens.
The only reason I asked about the seizure connection is because I had never paid much attention to what the vagus nerve does until I was DX’ed with partial seizures in October. Since then I have read a lot about the vagus nerve.
“And one of the sneakiest and most mutatable infections comes from Chronic Lyme Diseasean infection the CDC is loathe to discuss.”
Like many other conditions, CFS is a “diagnosis of exclusion” meaning that you get the CFS Dx only after all other known testable conditions have been excluded and you still meet the CDC 1994 Fukuda criteria.
Because the symptoms overlap, people with Lyme Disease are frequently misdiagnosed with CFS when false negatives (frequent) fail to identify Lyme Disease or they are never tested for Lyme.
If you have Lyme Disears, you do NOT have CFS, although you will be chronically fatigued until treated with antibiotics. Lyme is a bacterial infection.
Wiki on Lyme (great pics of the “bullseye” tick-bite symptom):
“Lyme disease (Lyme borreliosis) is an infectious disease caused by at least three species of bacteria belonging to the genus Borrelia. Borrelia burgdorferi sensu stricto is the main cause of Lyme disease in North America, whereas Borrelia afzelii and Borrelia garinii cause most European cases. The disease is named after the towns of Lyme and Old Lyme, Connecticut, US, where a number of cases were identified in 1975. Although it was known that Lyme disease was a tick-borne disease as far back as 1978, the cause of the disease remained a mystery until 1981, when B. burgdorferi was identified by Willy Burgdorfer.”
“The late disseminated stage is where the infection has fully spread throughout the body. Chronic neurologic symptoms occur in up to 5% of untreated patients. A polyneuropathy that involves shooting pains, numbness, and tingling in the hands or feet may develop. A neurologic syndrome called Lyme encephalopathy is associated with subtle cognitive problems, such as difficulties with concentration and short-term memory. These patients may also experience fatigue. However, other problems, such as depression and fibromyalgia, are no more common in people who have been infected with Lyme than in the general population.
“Chronic encephalomyelitis, which may be progressive, can involve cognitive impairment, weakness in the legs, awkward gait, facial palsy, bladder problems, vertigo, and back pain. In rare cases untreated Lyme disease may cause frank psychosis, which has been mis-diagnosed as schizophrenia or bipolar disorder. Panic attacks and anxiety can occur; there may also be delusional behavior, including somatoform delusions, sometimes accompanied by a depersonalization or derealization syndrome, where the patients begin to feel detached from themselves or from reality.”
Glad to share some accumulated findings after fighting my CFS for 13 years (and having my PCP tell me last week that I am “just depressed”)
CFS is the Rodney Dangerfield of medical conditions, (”can’t get no respect”) despite extensive new research that many MDs still chose to ignore.
Treatment of Lyme with antibiotics does not always solve the problems associated with Lyme. The spirochetes(distant relatives of syphillis) hide in something called biofilm and migrate to almost any organ and masquerade as any number of diseases including, but not limited to, Parkinsons. Lyme literate docs all over the country are losing their licenses and being stifled in their attempts to treat Lyme. In face, the CDC has now grudginly admitted that over 300, 000 new cases a year are a likely probablility. That is more than AIDS being diagnosed. Unfortunately, since it is not spread by peoples choices, like most AIDS and Hep C, cases, the cause has not been championed by the pc crowd—in which case, real research maight ensue.
“Lyme literate docs all over the country are losing their licenses and being stifled in their attempts to treat Lyme.”
In my experience and observation it is almost impossible to get an MDs ticket pulled and MDs themselves won’t go near anything that would cause them to lose their license unless it is some money-making scheme.
Apparently “vagus nerve stimulation” is now treatment for epileptic seizures:
“Little is understood about exactly how vagal nerve stimulation modulates mood and seizure control but proposed mechanisms include alteration of norepinephrine release by projections of solitary tract to the locus coeruleus, elevated levels of inhibitory GABA related to vagal stimulation and inhibition of aberrant cortical activity by reticular system activation.
“Randomized control trials indicated that thirty-percent of patients would have a greater than fifty-percent reduction of seizures.”
Here is a link to the numerous CDC fact sheets on Lyme Disease and related links:
I have read on the epilepsy boards of many people having great results from VNS after suffering from partial seizures for years.
I've suspected that I suffer from CFS for the past several years now although all the normal type of tests that are usuall done thru blood work show me to be healthy and I am extremely active sports wise.
Lethargy, slight loss in regular muscular coordination and at times, depression and the sensation that I'm thinking thru a fog.
It's just weird and I really can't explain it in words......
The symptoms started after I had been on Celebrex for about a year and a half so I stopped taking it. although my cholesterol was 71/129, my doctor prescribed simvastatin but I only took that briefly after reading up on it.
So basically, all I'm taking now is excedrin or an occasional Ibuprofin for muscular and joint pain from my sports activities.......
HULU “Under Our Skin” Lengthy, but worth it if you or a loved one has been diagnosed.
This may be the link to the HULU site:
The CDC wouldn’t even admit that Lyme was a factor in the Southern states until recently. I went to my GP a couple of years ago and told him I thought I had Lyme. He kind of chuckled, told me one doesn’t get it in the south according to the CDC but said he would send my samples off if it would make me feel better. He called me the next week to let me know that I also had co-infections that went with even though I had no telltale rash to start with(I’ve learned since, from my LLD, that at least 50% of those infected do not have that rash which means they don’t get the necessary treatment early on.)
Yes, my lyme disease doctor says chronic fatigue is really chronic lyme disease helped with antibiotics and many other things.
I am glad you are getting good treatment for your TIAs!
“I’ve suspected that I suffer from CFS for the past several years now although all the normal type of tests that are usuall done thru blood work show me to be healthy and I am extremely active sports wise.”
IMO if you are still able to be “extremely active in sports” then you probably don’t have CFS as more narrowly defined in recent research.
Most of the best clinicians prefer the Canadian Consensus Criteria (CCC) of 2001 over the CDC 1994 Fukuda standard.
Under Fukuda “post exertional malaise” (PEM) is OPTIONAL and only one of several symptoms which, if there are enough of them (5 IIRC) allow a CFS diagnosis.
Under the CCC, PEM is MANDATORY and the signature symptom of the CFS disease. So if you do NOT suffer debilitating exhaustion (not just “fatigue”) that starts from 24-48 hours after strenuous or even moderate exercise, then you don’t have CFS (aka ME: myalgic encephalomyelitis).
Like most folks with “chronic fatigue” you probably don’t have “chronic fatigue SYNDROME.”
Here is a link to the CCC:
Here is a link to a 2013 letter from the top international CFS clinicians and researchers begging the US Gov’t to affirm the CCC and NOT to go off and adopt another wishy-washy updated definition of Fukuda:
Looks like only one MD had his license temporarily suspended and it wasn’t for his Lyme treatments but for his failure to properly INFORM his patients that his treatments were “unorthodox.” This most likely means that the treatments were experimental and not that requires “informed consent” from the patients, which apparently wasn’t given to them.
“The board found that Jemsek had departed from standard medical practice and had failed to inform patients that his treatments were unorthodox; his medical license was suspended with stay, allowing him to continue practicing medicine. Facing a lawsuit from an insurance company, Jemsek declared bankruptcy and closed his medical practice.”
I have long suspected such a connection because I have a truly screwy set of CFS like symptoms that seem to respond well to Nexium....
I’m glad that you stood up to your GP, got tested and got treatment! This is still a dream for people with ME/CFS.
Thanks, but I was never having TIA’s. The seizures mimiced TIA’s. I was having undiagonised seizures all along.
“Yes, my lyme disease doctor says chronic fatigue is really chronic lyme disease helped with antibiotics and many other things.”
That is not correct. Chronic fatigue caused by Lyme disease is an exclusionary condition for Chronic Fatigue Syndrome (ME/CFS).
When a person presents to a clinician with symptoms that might be CFS one of the required tests is the Western Blot to exclude Lyme disease.
“The CDC proposes that persons with symptoms resembling those of CFS consult a physician to rule out several treatable illnesses: Lyme disease, ‘sleep disorders, depression, alcohol/substance abuse, diabetes, hypothyroidism, mononucleosis (mono), lupus, multiple sclerosis (MS), chronic hepatitis and various malignancies.’ Medications can also cause side effects that mimic symptoms of CFS.”