A reader asked how long CFS has been around and why does it and related conditions seem to be more and more common a.k.a. increasing incidence.

I have a model and I have read many papers on the history of CFS. First, medicine has a habit of renaming old ailment with new names: for example, consumption (“weight loss”) is now known as tuberculosis. From 4000 BC until 460 BC there was no name for it, but it existed. From 460 BC (Phthisis (Φθισις)) until 1839 is was known as consumption only. It was only after 1882 that the name tuberculosis started to became common. Many medical conditions were not defined until the 1900’s.

A person with CFS exhibiting weight loss would likely be described as having consumption historically. A CFS diagnosis is done by excluding a large number of other conditions. Prior to those modern tests for those conditions, a person with CFS would likely be deemed to have those other conditions, often with the term “atypical” added to those conditions when there is a slight mismatch in symptoms or response to treatment. The most common tentative diagnosis was poliomyelitis. Even today, there are many conditions which are define by symptoms or a few fragile lab tests which may all be deemed to be the same illness at some future date.

The earliest person deemed to have CFS as a distinctive illness was a nurse, named Florence Nightingale (1820-1910) who many suspect had it from 1857 onwards, immediately after she returned from the Crimean war that made her famous.

A brief history of old clusters:

• In 1934, Los Angeles had clusters of “atypical poliomyelitis” (polio)
• In 1937, two towns in Switzerland had “abortive poliomyelitis”
• In 1939, 73 Swiss soldiers
• In the 1940s, Iceland had  “simulating poliomyelitis”
• In 1949, Adelaide had “resembling poliomyelitis.”
• In 1955, Royal Free Hospital Group had benign myalgic encephalomyelitis
•  In the mid 1980s, Incline Village, Lake Tahoe (which was given the name chronic fatigue syndrome)
• Since then, it had become common in the general population.

Model

The model is based on a shift of the bacteria in the microbiome. For allergies, there is strong evidence that a rural person is less likely to develop allergies compared to a city person. Our bodies have adapted to living within a rural environment. The transition to a urban, very “hygienic” environment with food out of season from around the world and increased sugar and chemical consumption would result in a microbiome shift. This shift increases the probability of shifting into an autoimmune condition microbiome.

“The Amish and Hutterites are U.S. agricultural populations whose lifestyles are remarkably similar in many respects but whose farming practices, in particular, are distinct; the former follow traditional farming practices whereas the latter use industrialized farming practices….Despite the similar genetic ancestries and lifestyles of Amish and Hutterite children, the prevalence of asthma and allergic sensitization was 4 and 6 times as low in the Amish” – i.e. industrialized farming practices resulted in six times (600%) the rate of asthma and allergies. See Innate Immunity and Asthma Risk in Amish and Hutterite Farm Children(2016). This is also echoed in their farm products!!! Amish and Hutterite Environmental Farm Products Have Opposite Effects on Experimental Models of Asthma [2016]. Given a choice of buying groceries from a Hutterite farm or a Amish farm, buy the Amish (non industrialized) groceries!!!!

Rural life appears to reduce the risk of allergies (and by implication CFS). In 1990, 25% of the US was rural. In 1900, 60% [source]. In 1860, 80%. In 1800, 94%.  The incidence would likely double in the last century by just that shift of population to the cities.

Another factor (implicated with some outbreaks) is the introduction of a new infection into a population (best example was Iceland where the US troops, stationed there from 1941 onward, introduced a lot of conditions never seen prior in the then isolated Icelandic population). A new infection alters the body and it’s microbiome in ways that the microbiome may not know how to recover from. World travel and immigration increases that risk — I know people who came down with CFS immediately after a trip to Latin America.

The average age of onset has been 34-40 in females. Prior to the common adoption of birth control, onset would occur after several children and be ascribed to that having had so many children.

[Source of Life Expectancy]

• In 1850, female life expectancy was 40.5 years — they would likely be dead before CFS onset (or if it happens, it would be ascribed to aging or children)
• In 1890, female life expectancy was up to 44.5
• In 1920, it had climbed to  58.5 so CFS would start showing up in small numbers but likely the fatigue would be ascribed to environment.
• By 1959, it was up to 74.5 and birth control started to become common
• Today, it is 81 years  — with the life expectancy of a 40 yo with CFS being 42.5 years

In short, CFS has been around forever. The incidence of CFS would be expected to increase with life expectancy, travel/immigration, change of living environment (i.e. in cities instead of farms) and changes of diet, resulting in a much greater percentage of the general population having it than 50  years ago. Getting actual numbers is impossible because there is no requirement to report it and many MDs still do not believe in it.