6 Sneaky Signs You Have Chronic Fatigue Syndrome

Also known as myalgic encephalomyelitis, chronic fatigue syndrome is known to cause persistent, unexplained and overwhelming fatigue that becomes worse after physical or mental exertion. But overwhelming tiredness or fatigue that gets in the way of daily life is just the start with CFS. It actually causes a whole bunch of symptoms throughout the body—and some of them may surprise you. 

CFS is a complex illness that can impact digestion, sleep, and more. Symptoms also vary from person to person, and their intensity can change daily. From unexplained taste sensitivities to brain fog and joint pain, here are some lesser-known signs that could point to chronic fatigue syndrome, according to health experts.

1. Some Foods Are No Longer Appealing

People with chronic fatigue syndrome can become extra-sensitive to sensory inputs, such as smells, tastes, sounds and light. Research suggests that this may be related to sensory overload. And as a result, some foods—even some of your favorites—may lose their appeal. “In order to compensate for the fatigue, the brain increases its awareness of stimuli, such as smell and taste, which may ultimately result in an increase in nausea, food intolerances or sensitivities and overall displeasure of food,” says Tracy Lockwood Beckerman, M.S., RD.

2. Trouble Falling or Staying Asleep

Sleep disturbances are another common feature among people with chronic fatigue syndrome. These sleep issues can show up in a number of ways, including lighter sleep, more trouble falling asleep or staying asleep, restlessness during the night or waking up too early in the morning. “Because of lighter sleep, [people with chronic fatigue syndrome] may require longer overall sleep times—up to 10 to 12 hours to feel refreshed,” says Alex Dimitriu, M.D., who is double board-certified in psychiatry and sleep medicine. As a result of less restorative sleep, Dimitriu adds that it’s not uncommon for people with CFS to need a nap during the day.

3. Digestive Issues

Some people with chronic fatigue syndrome experience gut-health issues, including constipation, diarrhea, bloating and abdominal pain. Research suggests this could partly be due to dysfunction within the autonomic nervous system, which plays an important role in regulating digestion. “An unfavorable by-product of chronic fatigue could be a lazy GI tract, resulting in less-frequent bowel movements,” Beckerman says. Slower transit time in the bowels can increase the risk of abdominal discomfort. 

Another theory is that people with CFS may have alterations in their gut microbiome—including a reduction in beneficial bacteria—which could contribute to these gut-health challenges. Overall, more research is needed to fully understand the relationship between CFS and changes in digestive health. 

4. Flu-Like Symptoms 

Unexplained flu-like symptoms, such as a sore throat, muscle aches, headaches, swollen lymph nodes and feeling feverish, may also signal chronic fatigue syndrome. These symptoms may come and go and often worsen after physical or mental exertion. “This happens because immune system dysfunction leads to chronic low-grade inflammation and sometimes reactivates old viral infections,” says Michael Ednie, M.D., RD, who’s board-certified in family medicine. “This immune activation can cause lymph nodes to swell and produce flu-like symptoms, even in the absence of an active infection,” he explains.

5. Brain Fog

Memory loss and brain fog are common symptoms of chronic fatigue, and they usually become worse after physical or mental exertion. These symptoms may manifest as trouble concentrating, recalling words or recent events, planning or making decisions or processing information. You may also just feel mentally hazy.

The exact cause of cognitive issues in CFS isn’t fully understood, but Ednie explains that it could be due to one or a combination of factors, such as altered brain function and blood flow, orthostatic intolerance, inflammation within the brain or spinal cord and/or hormone changes. “For many, these cognitive symptoms are among the most disabling aspects of the illness, sometimes even more so than physical fatigue,” says Ednie. 

6. Muscle or Joint Pain

Many people with chronic fatigue syndrome experience painful and achy muscles and joints. The muscles may even feel like they’re burning or tingling. As with other CFS symptoms, this may look different from one person to another, but, typically, the pain is widespread throughout the body rather than focused on just one joint or muscle.

“As with other symptoms of CFS, the cause has not been proven, but there is growing evidence that a mind-to-body, or neuroplastic, process could be involved,” says David D. Clarke, M.D., a board-certified physician in internal medicine and gastroenterology.

Strategies to Manage Chronic Fatigue Syndrome

There’s no cure for chronic fatigue syndrome. Instead, the condition is typically managed by focusing on symptom relief. Luckily, there are lifestyle factors that can help. Here are a few key strategies: 

• Eat Balanced Meals: Studies suggest that eating a varied, healthy diet and limiting processed foods can help manage GI symptoms associated with CFS.8 A healthy diet may also help with energy levels. “To avoid energy crashes associated with chronic fatigue, individuals should prioritize stable blood sugar levels by always combining carbohydrates with fats and protein in every meal and snack, rather than consuming carbohydrates alone. This strategy helps maintain consistent energy throughout the day and could reduce general feelings of fatigue,” says Beckerman.
• Eat Smaller, More Frequent Meals: Another way to help reduce exhaustion and fatigue is by eating frequently throughout the day for a steady stream of energy. 
• Stay Hydrated: Chronic fatigue syndrome can increase the risk of dehydration. For this reason, Beckerman recommends drinking plenty of water, maintaining electrolyte levels and eating hydrating foods, like watermelon, cucumbers and celery. 
• Wind Down Without Technology: Dimitriu suggests keeping a regular sleep schedule and establishing a tech-free bedtime routine. His rule of thumb? “Tech off at 10.” 

The Bottom Line

Chronic fatigue syndrome is well known for causing exhaustion and unrelenting fatigue, but the symptoms go much deeper than that. From brain fog to digestive troubles and muscle aches, CFS symptoms can be widespread throughout the body. In addition to establishing a regular sleep schedule, maintaining other healthy lifestyle habits, like eating a balanced diet and staying hydrated, can also help manage symptoms. If you think you may have chronic fatigue syndrome, it’s important to make an appointment with a health care professional for personalized guidance and advice.