Viruses and fatigue - why do viruses make us tired?

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The relationship between a virus and ME is critical and perhaps an understanding of the different ways in which a virus can impact may give us a handle on how to best tackle this problem.

Availability of Energy

The first has to do with availability of energy. We all have a certain pot of energy available to us on a daily basis. When life is normal we can spend that energy physically, mentally or emotionally. ME patients, of course, have a small pot of energy because their mitochondria are going slow and they have to spend that smaller pot of energy accordingly. This was proved in my joint scientific paper of 2009, which showed that those patients with the worst levels of energy had the worst mitochondrial function test results and vice versa. Ref: Int J Clin Exp Med (2009) 2, 1-16; see - "Chronic Fatigue Syndrome and Mitochondrial Dysfunction". See also CFS - The Central Cause: Mitochondrial Failure

This, of course, is the biological basis of pacing. My job as a doctor is to make that pot of energy bigger. See Overview of CFS/ME protocol

When the body is attacked by infection, the priority is to fight the infection and so that pot of energy is used up by the immune system and none is left for you to have a life – this explains why we all feel ill and have many of the symptoms of ME with acute viral infection. However, what we don’t fully understand is why ME patients don’t recover after their acute virus attack. It is possible that this could be explained by virus blocking mitochondria, but I don’t think this is likely. Whilst Dr John McLaren-Howard from Acumen occasionally sees viral DNA stuck onto mitochondria, this is an unusual finding and I suspect we have to look for other causes.


What is a major cause of fatigue is allergy. Again, I am not sure I know the mechanism of this but I suspect it has to do with us drawing on our pot of energy. Allergy is a very wasteful use of the immune system because the immune system becomes active against substances which are not noxious, such as pollen, food and some chemicals. As a result, the immune system is "busy" and this drains our energy pot. Hay fever, which is an allergy to grass pollen, is called such because, in addition to obvious symptoms, sufferers feel ill. Work done by Dr Martin Lerner in America has shown that giving antivirals to post viral ME patients often improves them markedly. However, these patients have no evidence of active infection with no raised IgM levels and no raised levels of the classical immune parameters one would expect to see in acute viral infection. Lerner diagnoses these patients on the basis of a classical history, i.e. post viral fatigue, combined with some immunological evidence of the immune system having seen virus in the past, i.e. raised IgG antibodies.

Again, this begs the question as to mechanism and the only mechanism which seems to fit the bill in my mind is viral allergy. This is not such a bizarre concept – we certainly recognise yeast allergy (such as allergic aspergillosis), we recognise bacterial allergy (such as rheumatic fever) and, indeed, palindromic rheumatism is probably a sort of form of a viral allergy. Alan Ebringer explains ankylosing spondylitis in terms of allergy to bacteria in the gut, namely Klebsiella. ( Please see The Link between Ankylosing Spondylitis, Crohn's Disease, Klebsiella, and Starch Consumption Spondyloarthritis, uveitis, HLA-B27 and Klebsiella and Ankylosing spondylitis, HLA-B27 and Klebsiella. I. Cross-reactivity studies with rabbit antisera. ) It may be that Martin Lerner’s treatment of post viral ME patients with antivirals works because he is reducing an already low viral load to one that is even lower, so much so that the body ceases to react allergically to it. So, as you can see, it is not a case of finding out whether or not you have a virus but really the question should be: is one reacting against it?

Again, we have another handle on this – Dr John Mansfield RIP would get excellent clinical results by desensitising his patients using neutralisation to the putative virus. Even in cases of acute ‘flu he was able to switch off their symptoms very quickly in this way. Again this points to some sort of inappropriate reaction by the immune system against a virus – it is, of course, the immune system’s reaction to the virus that makes us feel ill, not the virus itself.

Chronic Low Grade Infection (following an acute infection)

This may be indistinguishable from allergy as such. The common viruses that Dr Lerner tests for are Epstein Barr virus, cytomegalovirus and HHV6 (shingles) virus and treats them with the appropriate antiviral. See Valacyclovir in the treatment of post viral fatigue syndrome and Chronic viral presence in CFS/ME. Another possibility would be to consider some of the natural antiviral compounds such as oxymatrine (see Oxymatrine in the treatment of post viral fatigue), astragalus, neem and possibly artesunates. See My book The Infection Game - life is an arms race

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