Lyme Disease and Chronic Fatigue Syndrome

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Lyme Disease and Chronic Fatigue Syndrome

In this blog, we will focus on Lyme Disease and Chronic Fatigue Syndrome. You will learn:

  • How chronic Lyme Disease and Chronic Fatigue Syndrome can look very similar to each other
  • How diagnosing, testing and treating these two conditions can be quite challenging
  • What to look for to tell the difference
  • How we can apply Functional Medicine principles, look for the root causes and successfully treat Lyme Disease & Chronic Fatigue Syndrome

Do your clients suffer from chronic fatigue that doesn’t seem to go away? Do they have Lyme Disease or Chronic Fatigue Syndrome and do you know how to spot the difference? Then this blog is for you. Please read on for the details! 

Do you get stuck clinically with symptoms of Lyme or Chronic Fatigue with your patients?  Would you like to have a larger impact on improving fatigue issues? The key to treating disease is an individual approach using nutrition, lifestyle and exercise. To improve your patient’s quality of life, you need to identify and address each patient’s root causes. Our functional medicine course will teach you how to do this. Look into our functional medicine school ( to have a greater impact on improving your client’s lives.

** Please note: If you want the short summary version of this article, then please click here **

Let’s first take a look at these individual conditions and then we will go into the interrelationship between Lyme Disease and Chronic Fatigue Syndrome.

What is Lyme Disease (LD)?

We have written extensively lately about Lyme Disease. LD is a tick-borne illness that causes multiple symptoms. Fatigue is one of the main symptoms. It can be difficult to diagnose and treat, depending on the individual case. Please see our blog here ‘What is Lyme Disease?’ to understand this condition better.

What is Chronic Fatigue Syndrome (CFS)?

Chronic Fatigue Syndrome (CFS) is a condition of extreme fatigue that lasts for at least six months (CDC, 2021). The fatigue worsens with physical or mental activity, but doesn’t improve with rest. Other symptoms can include problems with sleep, cognition, pain and dizziness.

People with CFS typically have a very poor quality of life. They can’t function ‘normally’. They probably cannot perform normal daily tasks, like taking a shower or cooking a meal. They may struggle to keep a job, go to school and participate in family and social life. CFS can last for years. At least one in four CFS patients is bed- or house-bound for long periods during their illness (CDC, 2021).

CFS Causes

CFS is thought to be caused by a number of factors, such as viral infections, intracellular bacteria, environmental factors, immune system dysregulation/dysfunction and hormonal imbalances (Bjørklund G, 2019). It is thought there is an autoimmune component, as well as a microbiome/ gut component (Bjørklund G, 2019).

Viral infection is a critical factor for some CFS patients (Rasa S, 2018). In some cases, an acute viral infection (Epstein Barr, Herpes, enteroviruses, Parvovirus B19 and other viruses) can trigger the onset of CFS (Sandler CX, 2020) and (Rasa S, 2018).

CFS Diagnosis

There isn’t a straightforward definition or clear-cut criteria to define CFS (Bjørklund G, 2019). At this time, there is no diagnostic test, biomarker, clear pathophysiology or treatment for CFS available in conventional medicine (Sandler CX, 2020).

In Functional Medicine, we look deeper to identify and find root causes. We would look for a previously undiagnosed underlying chronic infection, as this can often be a root cause of CFS. Other potential root causes include gut dysfunction or infections, autoimmune tendencies, HPA axis issues, thyroid or other hormonal imbalances, toxic overload (particularly metals) and nutrient deficiencies.

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Similarities between Lyme Disease and Chronic Fatigue Syndrome – Do they Overlap?

  • People with chronic Lyme Disease and Chronic Fatigue Syndrome are generally unable to meet the demands of a ‘normal life’. They struggle to hold a full-time job, have sleep problems and profound fatigue (Patrick DM, 2015).
  • Chronic fatigue is a key symptom across both conditions (IGenex Inc, 2021). Patients with chronic LD also show greater cognitive problems than patients with CFS (Gaudino EA, 1997).
  • Other symptoms that can be caused by both chronic fatigue and Lyme are: cognitive issues, headaches, enlarged lymph nodes in the neck or armpits, unexplained muscle/ joint pain, dizziness that gets worse when sitting or standing from a lying down position and extreme exhaustion after physical or mental exercise (post-exertional malaise) (IGenex Inc, 2021).
  • Both CFS and chronic Lyme are often misdiagnosed (IGenex Inc, 2021).
  • In one study, there was no difference between chronic LD and CFS patients in terms of their medical histories, physical examination and basic laboratory test results (Patrick DM, 2015).

Chronic fatigue syndrome is a disease of exclusion. This means it is diagnosed when other disease processes are ruled out. If you have been diagnosed with chronic fatigue syndrome, we encourage you to get THOROUGHLY tested for Lyme Disease. Many of the common tests run by doctors for Lyme Disease have high rates of false negatives.

What is the Cause of Chronic Fatigue Syndrome or Chronic Lyme Disease? Is it Psychological?

These rare, complicated, and multi-system diseases such as Lyme Disease and Chronic Fatigue Syndrome are often misdiagnosed as being caused by psychological issues. But the onset of a multi-system illness is rarely due to psychological causes (Bransfield RC, 2019). Many complex conditions that have been described as “all in your head” are actually immune-mediated infections (Bransfield RC, 2019). They are most likely related to the immune system and/or the microbiome. Complex diseases require complex explanations. A disease is caused by something. When clinical findings are confusing, the Functional Medicine approach is to find the root causes, rule out other diseases and address the problem at its root. We have extensive experience in our clinic addressing Lyme and other complex diseases (

Testing & Diagnosis is Key

To diagnose Lyme Disease, a Lyme-literate doctor should interpret a blood test called the Western Blot or use other diagnostic methods such as a PCR test. There can be confusion about interpreting this test. This is why we recommend seeing a Lyme-literate doctor. If you have chronic fatigue symptoms and think you have been exposed to Lyme or other bacterial infections through a tick bite, see a doctor who can help to properly understand the Western Blot test immediately. Even if you don’t know for sure that you been exposed to a tick bite, proper testing is still important because the bacteria that causes Lyme Disease can also be found in mosquitos and fleas.

If chronic fatigue symptoms are caused by Lyme Disease, or another tick-borne illness, it is crucial to get the right diagnosis. Lyme, as a bacterial infection, requires specific treatment with antibiotics or natural herbal approaches. If the Lyme infection goes untreated, symptoms will not improve.

Is Mis-Diagnosis Possible or Frequent?

There are patients who are not aware of any tick bite or rash, who have symptoms like chronic fatigue and cognitive dysfunction. This could be due to Lyme Disease. These patients typically have multiple medical evaluations, but don’t receive the right testing or a precise diagnosis. They often end up being categorized as having Chronic Fatigue Syndrome, Fibromyalgia or even depression. They may be told they do not have Lyme Disease. As there are no clear-cut diagnostic criteria in these conditions, many doctors have great difficulty clinically identifying if someone thought to have Chronic Fatigue or Fibromyalgia might actually have chronic Lyme Disease (Donta, 2012).

Accurate testing for Lyme Disease is super important in these tricky cases. In patients with these symptoms, a test such as the ELISA, used as the standard test for Lyme, is usually negative (Donta, 2012). But a Western Blot often shows antibody reactions to highly specific proteins, especially by IgM, that support the clinical diagnosis of Lyme (Donta, 2012). Studies indicate that 2/3 or more of these patients have negative ELISA tests, but positive Western Blot reactions, especially by IgM (Donta, 2012). A reaction on the Western Blot to even one specific protein of Borrelia burgdorferi has a 90% positive correlation with a Lyme diagnosis (Donta, 2012).

Whether Chronic Fatigue Syndrome or Lyme Disease (or something else) is the main cause of a person’s fatigue, we use Functional Medicine principles to find the root causes. We may uncover other reasons for the fatigue. For example, Lyme can contribute to hypothyroidism, HPA axis dysregulation, mitochondrial dysfunction or reduced cellular metabolic function. In Functional Medicine, we can look into these other issues and treat them alongside the Lyme Disease or CFS. This would improve symptoms of overall fatigue.

In our clinic, we have expertise in treating a range of complicated, difficult-to-diagnose conditions like Lyme Disease and Chronic Fatigue Syndrome. We look for the root causes in our patients to identify what could be causing the symptoms. We regularly treat and resolve Lyme, chronic infections, fatigue and other complex conditions in patients in our Functional Medicine clinic.

** Please stay tuned for our next Blog!  **

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