Energy balance in CFS/ME

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Update - October 2023

Since first writing this page, I have refined my thinking, and indeed I see my entire protocol as being one of:

  • Energy delivered


  • Energy Demanded.

And these are linked by the Energy Equation:

  "Available Energy = Energy Delivery MINUS Energy Demand"

In more detail, the Energy Delivery side of the equation will include the following components:

  • Fuel in the tank --Diet, hypoglycaemia, micronutrients and gut function
  • Regular servicing --Sleep
  • The engine-- Mitochondria
  • Oxygen and fuel delivery --Heart, lung, blood supply
  • Accelerator pedal-- Thyroid gland
  • Gear box --Adrenal gland
  • Exhaust system-- Liver, kidney, detoxing
  • The driver of the car --The brain

And the Energy Demand side of the equation will include the following components:

1.Normal energy expenditure:

  • Housekeeping duties – basic metabolism: heart, gut, liver, kidney, lung, hormonal function
  • Physical activity
  • Mental activity

2.Wasteful energy expenditure:

  • Immunological holes:

a. Inflammation for healing and repair
b. Inflammation in infection
c. Useless inflammation in allergy and autoimmunity

  • Emotional holes.

You will see these ideas cropping up, again and again in all my writing, but if you would like a brief introduction, then My book - The Energy Equation - from The Naked Ape to The Knackered Ape is the one for you!

Or see Overview of CFS/ME protocol for a one page summary.

The Basic Idea

We all have a pot of energy available to us on a daily basis and we can choose to spend that energy mentally, physically, emotionally or immunologically, although there may not be choice with regard to the immunological expenditure, and also to an extent, in the emotional expenditure. When that pot of energy is empty, we have no more to spare. The brain stops us from doing more by making us feel fatigued, and we develop other distressing symptoms. Of course, it is normal to feel tired at the end of the day and a night’s rest together with good food restores the energy pot for the next day.

The symptom of fatigue

The symptom of fatigue is a very important one – it prevents us spending too much energy in a day. If we didn’t experience fatigue, we would simply go on doing things without rest or nourishment, rapidly get into a situation that was unsustainable, and die. So, for example, a person who has a normal energy pot may develop ‘flu and all his energy goes into the immunological department so he has no energy left for mental, physical or emotional work. That person becomes bed bound for a few days until he gets rid of his ‘flu virus and recovers.

CFS and ME patients

Remember that -

  • Chronic fatigue syndrome [‘CFS’] is characterised by poor energy delivery mechanisms.
  • Myalgic-encephalitis [‘ME’] is characterised by poor energy delivery mechanisms AND inflammation.

Poor energy delivery is caused by the wrong diet, poor sleep, mitochondrial failure, and poor adrenal and thyroid function.
Inflammation occurs when the immune system is activated. The immune system is activated in allergy, chronic infection and auto-immunity.
In both CFS and ME there may also be an emotional hole in the energy bucket.

CFS and ME patients have a small pot of energy and therefore they have to ration the amount that they spend. We call this pacing and it is an essential part of management. However, my job is to make the energy pot larger and this is achieved using all the interventions described in CFS/ME - my book Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis, i.e. improving the engine of our car (mitochondrial function), improving the fuel supply (diet), improving our service record (sleep), accelerator pedal (thyroid function), gear box (adrenal gland) and so on.

Energy is "Money in the Bank"

One can think of this pot of energy as money in the bank that we can use to spend in various ways. The wise person has a deposit account for rainy days and a current account for everyday expenditure. How much we put in our deposit and current account is determined by the brain and I can certainly see clinical situations where too much money is put in the deposit account and not enough in the current account. I suspect people who have a tendency to anxiety, depression and hypervigilance do this. In these cases, the brain perceives threats in the future that have to be dealt with – we deal with threats with an outpouring of adrenal hormones that allow us to gear up our engine and to work at a much higher level to cope with that threat. But to be able to do this there must be money in the deposit account. One can easily see how, through bad past experiences, the brain works out that it must put some money in the deposit account to cope with future horrors.


A promising technique which is being used is neurobiofeedback. I think the idea here is to “remap” the brain so that it responds appropriately to stress – whatever that stress may be. It has been shown to be effective in many conditions such as attention deficit disorder and autism. See Wikipedia Entry on Neurofeedback for a general overview. For more specific detail, see:

I think that for some people, whatever illness they present with, such techniques can be useful. For others they will not work - it is a case of 'suck it and see'!

Immunological Energy

Once again, since writing this paragraph, I have written an entire book - My book The Infection Game - life is an arms race - which looks at immune activation caused by acute and chronic infections, and also there are sections in CFS/ME - my book Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis on allergy and autoimmunity, regarding them all as "Immunological Holes" in our Energy Buckets. See also Category:Allergies, autoimmunity and infections

I think of the immune system as being very similar to the brain – it is intelligent, communicative, responsive and directive. Like the brain it is enormously demanding of energy – indeed, some fascinating work by Caroline Pond ( Professor Caroline Pond ) showed that when wild animals store fat, the first place they dump it is around their lymph nodes – this is because immune cells here require an immediate supply of energy to protect against infection. See The Fats of Life by Caroline Pond

The obvious way in which the immune system may be activated is through such an infectious threat and, of course, we all feel fatigued with acute infection. This may be one mechanism by which allergy, particularly food allergy, causes fatigue. 90% of the immune system is associated with the gut and if there are chronic low grade inflammatory reactions here as a result of a food to which one is allergic, then 90% of the immune system may be activated! Certainly, it is my clinical experience that when patients with fatigue syndromes have put in place all the lifestyle and nutritional interventions to get their car running normally, what often stops them getting well is undiagnosed allergy.

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