Hi Agy I didn't finish because I had a question. Can you please clarify how they can be in fight or flight with low cortisol? what hormone drive the sympathetic NS ? Also, my understanding is that CFS is due to dysautonomia many time following a viral infection. I will go back promise. Thanks for writing.
Hi! Thank you so much for reading and for asking such thoughtful questions. I really appreciate you taking the time to engage with the piece.
You’re absolutely right that dysautonomia is a common pattern seen in chronic fatigue, especially in cases that follow a viral illness. It plays a major role for many people. And yes, the sympathetic nervous system is what drives that classic “fight or flight” response. That response is mediated by catecholamines, particularly norepinephrine and epinephrine, which act quickly to prepare the body for action. Cortisol enters the picture a little later, helping to sustain the stress response and regulate inflammation.
What makes things tricky is that in some people with chronic fatigue syndrome, the nervous system can stay stuck in a sympathetic state even when cortisol levels are low. This can happen when the HPA axis (the system that regulates stress hormones) starts to misfire. The body may keep releasing catecholamines, keeping the person wired and overstimulated, but without the steady support of cortisol. That’s why someone can feel anxious, jittery, and completely exhausted all at once.
Also, just to gently clarify—while dysautonomia is a very common presentation, it’s not the only potential cause of CFS/ME. It’s considered a multifactorial condition, with overlapping contributors like mitochondrial dysfunction, immune irregularities, neuroinflammation, viral reactivation, and hormonal imbalance. It’s not always easy to tease apart, which makes the diagnostic process so difficult for many.
If you’re curious to dig deeper, I’d recommend checking out the first two sources listed in my bibliography. They do a great job outlining these topics.
Thank you for this 🙏🏾. I think I may be developing this because my fatigue and chronic pain has gotten increasingly worse. My doctor hasn’t been the most supportive nor helpful, so having this article is a nice companion to ease some of the symptoms while I continue to look for a doctor or specialist. I’m hoping to be able to upgrade to a paid subscription because all of your articles have been so so helpful.
Thank you so much for sharing this with me. I’m really sorry to hear that your symptoms have been getting worse and that you haven’t felt supported by your doctor. That’s such a hard and frustrating place to be in, and I just want to say—you’re not alone. So many of us have walked that same path, searching for answers while trying to manage the day-to-day reality of it all.
I’m genuinely honored that this article could be a source of comfort or support in the meantime.🦋
Thank you. I have fibromyalgia which my doc said CFS and FM are in the same spectrum, but if you have more pain than fatigue have FM and if you have less pain and more fatigue you have CFS.
My fatigue levels are off the chart horrible and it’s been worse since long COVID from 2020. It’s better than it was but still I struggle. I’m going to try some of these I’m also going to ask my doc about POTS I have all the symptoms. I was told it’s vaso vagal syncope but it’s all the same symptoms as POTS
I’ve heard that same idea about FM and CFS being on a spectrum, and it makes sense—especially when long COVID adds another layer.
From my own experience with POTS, keeping a log of your blood pressure and heart rate can be really helpful. Bring it to your doctor if you can. It may help speed up the diagnosis.
An excellent overview of this debilitating condition Agy.
You're so right. There is no magic solution to this complex condition, but as is always the case with herbal medicine, it is the individual that is the variable, and this is where an allopathic approach can sometimes miss the mark.
Currently navigating this condition myself, I've also tentatively tried to explore the subject of fatigue (and my nemesis anaemia) from an energetic perspective on my own Substack. It is a difficult topic to tackle, and so I commend you for explaining in an easy to understand manner, how "feeling like your body has been unplugged from the source" affects so many people on a daily basis.
As someone who has battled CFS/ME and numerous autoimmune diseases most of my life, I found this to be an accurate description of my experience and a comprehensive guide to the disease. (I contracted spinal meningitis at 6wks and had a slew of other viral infections throughout my life, including mono, H1N1 and Covid, before anyone knew what it was.) Cordyceps along with a super B-complex helped greatly with energy, so I’m with you there. However, I’ve recently had a setback with pneumonia, but I’m hoping to get back to a relatively tolerable place soon.
CFS almost sounds similar to the crash I had last year, but I'm finally coming out of the symptoms for the most part. My very strong suspicion for myself is that I had an autistic shutdown. I have done the official tests free online from a psychologist/naturopathic doctor in Ontario that has a website and does complete consultations. I would love to get the official diagnosis but I don't have $2500 to do it.
Hi Agy I didn't finish because I had a question. Can you please clarify how they can be in fight or flight with low cortisol? what hormone drive the sympathetic NS ? Also, my understanding is that CFS is due to dysautonomia many time following a viral infection. I will go back promise. Thanks for writing.
Hi! Thank you so much for reading and for asking such thoughtful questions. I really appreciate you taking the time to engage with the piece.
You’re absolutely right that dysautonomia is a common pattern seen in chronic fatigue, especially in cases that follow a viral illness. It plays a major role for many people. And yes, the sympathetic nervous system is what drives that classic “fight or flight” response. That response is mediated by catecholamines, particularly norepinephrine and epinephrine, which act quickly to prepare the body for action. Cortisol enters the picture a little later, helping to sustain the stress response and regulate inflammation.
What makes things tricky is that in some people with chronic fatigue syndrome, the nervous system can stay stuck in a sympathetic state even when cortisol levels are low. This can happen when the HPA axis (the system that regulates stress hormones) starts to misfire. The body may keep releasing catecholamines, keeping the person wired and overstimulated, but without the steady support of cortisol. That’s why someone can feel anxious, jittery, and completely exhausted all at once.
Also, just to gently clarify—while dysautonomia is a very common presentation, it’s not the only potential cause of CFS/ME. It’s considered a multifactorial condition, with overlapping contributors like mitochondrial dysfunction, immune irregularities, neuroinflammation, viral reactivation, and hormonal imbalance. It’s not always easy to tease apart, which makes the diagnostic process so difficult for many.
If you’re curious to dig deeper, I’d recommend checking out the first two sources listed in my bibliography. They do a great job outlining these topics.
Thanks Agy I will, I had a couple of Long COVID with dysautonomia that looked like CFS
Thank you for this 🙏🏾. I think I may be developing this because my fatigue and chronic pain has gotten increasingly worse. My doctor hasn’t been the most supportive nor helpful, so having this article is a nice companion to ease some of the symptoms while I continue to look for a doctor or specialist. I’m hoping to be able to upgrade to a paid subscription because all of your articles have been so so helpful.
Thank you so much for sharing this with me. I’m really sorry to hear that your symptoms have been getting worse and that you haven’t felt supported by your doctor. That’s such a hard and frustrating place to be in, and I just want to say—you’re not alone. So many of us have walked that same path, searching for answers while trying to manage the day-to-day reality of it all.
I’m genuinely honored that this article could be a source of comfort or support in the meantime.🦋
Thank you. I have fibromyalgia which my doc said CFS and FM are in the same spectrum, but if you have more pain than fatigue have FM and if you have less pain and more fatigue you have CFS.
My fatigue levels are off the chart horrible and it’s been worse since long COVID from 2020. It’s better than it was but still I struggle. I’m going to try some of these I’m also going to ask my doc about POTS I have all the symptoms. I was told it’s vaso vagal syncope but it’s all the same symptoms as POTS
I’ve heard that same idea about FM and CFS being on a spectrum, and it makes sense—especially when long COVID adds another layer.
From my own experience with POTS, keeping a log of your blood pressure and heart rate can be really helpful. Bring it to your doctor if you can. It may help speed up the diagnosis.
An excellent overview of this debilitating condition Agy.
You're so right. There is no magic solution to this complex condition, but as is always the case with herbal medicine, it is the individual that is the variable, and this is where an allopathic approach can sometimes miss the mark.
Currently navigating this condition myself, I've also tentatively tried to explore the subject of fatigue (and my nemesis anaemia) from an energetic perspective on my own Substack. It is a difficult topic to tackle, and so I commend you for explaining in an easy to understand manner, how "feeling like your body has been unplugged from the source" affects so many people on a daily basis.
Great article. Thanks for sharing.
As someone who has battled CFS/ME and numerous autoimmune diseases most of my life, I found this to be an accurate description of my experience and a comprehensive guide to the disease. (I contracted spinal meningitis at 6wks and had a slew of other viral infections throughout my life, including mono, H1N1 and Covid, before anyone knew what it was.) Cordyceps along with a super B-complex helped greatly with energy, so I’m with you there. However, I’ve recently had a setback with pneumonia, but I’m hoping to get back to a relatively tolerable place soon.
CFS almost sounds similar to the crash I had last year, but I'm finally coming out of the symptoms for the most part. My very strong suspicion for myself is that I had an autistic shutdown. I have done the official tests free online from a psychologist/naturopathic doctor in Ontario that has a website and does complete consultations. I would love to get the official diagnosis but I don't have $2500 to do it.