# Chronic Fatigue Syndrome

Category: Conditions

Also known as: CFS, ME/CFS, fibromyalgia

Chronic Fatigue Syndrome is a state of cellular energy deficiency that Ray Peat characterized as fundamentally similar to a seizure state in the brain or a failure state in the heart, driven by low progesterone and excess estrogen. He argued that the condition involves a…

11 passages · 3 authors · 1993–2024 · Most-cited: [Ray Peat](https://bioenergeticoracle.com/md/voices/ray-peat/index.md)

Canonical page: https://bioenergeticoracle.com/concepts/chronic-fatigue-syndrome

## Synthesis

**Chronic Fatigue Syndrome** is a state of cellular energy deficiency that Ray Peat characterized as fundamentally similar to a seizure state in the brain or a failure state in the heart, driven by **low progesterone** and **excess estrogen**. [Source 1] He argued that the condition involves a *hypometabolic* physiology where cells become swollen, over-excitable, and de-energized, a process closely resembling hypothyroidism. [Source 1, 11] This low-energy state is not merely subjective tiredness but a systemic failure of oxidative metabolism, often rooted in mitochondrial damage and the accumulation of *polyunsaturated fatty acids* (PUFAs) that inhibit the crucial respiratory enzyme **cytochrome oxidase** and interfere with thyroid hormone function at every level. [Source 11]

The etiology of the syndrome, in Peat's framework, is multifactorial but consistently points to a self-perpetuating cycle of intestinal inflammation, hormonal imbalance, and metabolic suppression. He identified dietary legumes as a common trigger, noting that the **bean toxin** phytohaemagglutinin acts as a powerful anti-thyroid agent, causing hepatic necrosis and suppressing mitochondrial respiration, which leads to decreased aerobic capacity. [Source 2, 3] This gut-derived stress increases the absorption of **endotoxin** and allergens, especially during adrenergic stimulation from exertion or low blood sugar, which then promotes the release of histamine and other inflammatory substances. [Source 3] The resulting biochemical profile typically includes elevated **nitric oxide**, **endorphins**, **serotonin**, and **prolactin**, alongside a deficiency of vitamin D and calcium, all superimposed on an increased ratio of estrogen to progesterone and androgens. [Source 4]

Peat and subsequent commentators have placed significant emphasis on the role of **serotonin** as a direct mediator of the fatigue experience. Peat noted that excessive serotonin, often resulting from stress-induced muscle catabolism and tryptophan release, interferes with muscle mitochondria and is a major factor in related syndromes like fibromyalgia. [Source 7] Georgi Dinkov has extended this by highlighting the "central fatigue hypothesis," which posits that elevated brain serotonin creates a perception of severe fatigue even in the absence of peripheral biochemical markers like lactate buildup, explaining why CFS is often dismissed as hypochondria. [Source 5] Dinkov also noted that SSRI drugs, commonly prescribed for CFS, are paradoxically one of the worst treatments because they increase extracellular serotonin, and that viral infections implicated in CFS onset often require activation of specific serotonin receptors to take hold. [Source 5]

Therapeutic interventions center on restoring oxidative energy production and reducing the toxic burden. Peat advocated for strict avoidance of dietary triggers like beans and carrageenan, correction of thyroid function, and the use of anti-lipid-peroxidation agents such as **vitamin E** and short-chain saturated fats to counteract the effects of stored toxic PUFAs. [Source 6, 10] He found that low-dose **naloxone** or naltrexone could break a depressed, fatigued state by suppressing the endorphins induced by lactic acid. [Source 1] Dinkov has further specified that restoring mitochondrial integrity involves increasing and re-saturating **cardiolipin**, a process achievable through thyroid hormone (T3), fully hydrogenated fats, phosphatidylcholine, and taurine, noting that CFS patients sometimes produce antibodies against their own cardiolipin. [Source 8] The use of antibiotics or charcoal to reduce intestinal endotoxin was also cited as a historically effective but suppressed strategy for breaking the inflammatory cycle. [Source 9, 10]

## People also ask

### How does excess serotonin contribute to the fatigue in CFS?

Peat argued that excessive serotonin, often from stress-induced muscle breakdown, directly interferes with muscle mitochondria. Georgi Dinkov added that elevated brain serotonin creates a perception of severe fatigue even without peripheral markers like lactate buildup.

### Why did Ray Peat consider legumes a trigger for the syndrome?

Peat identified the bean toxin phytohaemagglutinin as a powerful anti-thyroid agent that causes hepatic necrosis and suppresses mitochondrial respiration, leading to decreased aerobic capacity and increased gut-derived stress.

### What role does cardiolipin play in restoring energy production?

Dinkov specified that restoring mitochondrial integrity requires increasing and re-saturating cardiolipin, a process achievable through thyroid hormone (T3), fully hydrogenated fats, phosphatidylcholine, and taurine.

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## Cited passages

Passage numbers match the `[Source N]` markers in the synthesis above.

### Source 1 — Ask the Herb Doctor: Progesterone vs Estrogen, Listener Questions (Part 2)

Ray Peat · Interview · May 18, 2018

> ## Chronic Fatigue Syndrome and Naltrexone
>
> **Shauna (Caller):** Regarding Chronic Fatigue Syndrome (CFS), what is the underlying condition? Is it hypometabolism? Also, is Low Dose Naltrexone (LDN) effective for CFS?
>
> **Ray Peat:** One way of thinking of CFS is that it is very similar to the seizure state in the brain, or the failure state in the heart, under the influence of low progesterone and excess estrogen. It is a deficiency of energy where the cell goes into that swollen, over-excitable state. When a cell is in very bad condition, it can produce histamine. In the hypothyroid, low-progesterone chronic state, the body tends to locally produce a lot of histamine and other inflammatory substances.
>
> **Andrew Murray:** What do you think about Low Dose Naltrexone?
>
> **Ray Peat:** I have experience using Naloxone more than Naltrexone, but they are essentially identical. I found that 1 to 4 milligrams per day of Naloxone would break a depressed condition by suppressing the endorphins, which are induced by lactic acid and fatigue. Endorphins are an emergency measure to turn off excitation. Some people use even a hundredth of a milligram and find a therapeutic effect. I consider 4 milligrams a fairly large dose.

### Source 2 — Your Own Health And Fitness: Thyroid/Progesterone And Diet

Ray Peat · Interview · Nov 12, 1996 · http://www.l-i-g-h-t.com/files/your-own-health-and-fitness-thyroid-progesterone-and-diet -november-12-1996-57-mins.mp4

> **Layna Berman:** Okay, so basically maybe the fish oils get rid of the other stuff is a transitional thing possibly. Anyway let's move to some more callers. Caller, you’re on the air with KPFA. Do you have a question?
>
> **Caller:** Hello?
>
> **Layna Berman:** Yes.
>
> **Ray Peat:** Hello.
>
> **Caller:** Yeah, I have had chronic fatigue syndrome for 15 years Do you have any information that might help me?
>
> **Ray Peat:** Yeah, very often it starts with either thyroid or beans in the diet.
>
> **Caller:** Beans?
>
> **Layna Berman:** Yeah.
>
> **Ray Peat:** Beans are very common dietary factor of – they contain antigens that makes them a more complex toxin that cause the liver and the intestine and the thyroid to malfunction and you can break the cycle sometimes just with diet but usually thyroid is an important thing to consider.
>
> **Caller:** Okay.
>
> **Layna Berman:** Hunter-gatherer diet.
>
> **Caller:** Can you just go into this?
>
> **Ray Peat:** I think I’ve talked about it in newsletters, one called the bean syndrome, which involves muscle soreness as well as chronic fatigue. Several people have written about it in the past but…

### Source 3 — The Bean Syndrome

Ray Peat · Newsletter · 1993

> Endotoxin suppresses mitochondrial respiration, and tends to produce a shock-physiology similar to that produced by endogenous hormones. I have mentioned before that I think endotoxin can be involved in the premenstrual syndrome, and I think it might even be involved in some breast syndromes.
>
> Two features of mitochondrial damage in severe stress (regardless of whether endotoxin is involved) are a depletion of the antioxidant reserves, and loss of the ability to convert cholesterol into the protective steroid hormones. Mitochondrial damage is more likely in hypothyroidism, as I have discussed previously; thyroxin inhibits lipid peroxidation, end it tends to be inversely related to adrenalin, preventing or minimizingcatecholamine toxicity, for example. Beans and lentils happen to be powerful anti-thyroid agents, so it isn't surprising to see indications of decreased aerobic capacity, resulting from decreased peak oxygen consumption in association with the chronic fatigue syndrome (CFS), if that syndrome is caused by chronic exposure to dietary legumes.
>
> Hypothyroidism causes poor magnesium retention, so the report that a magnesium supplement caused reduced pain and improved energy level and emotional state, while increasing intracellular magnesium in CFS patients, suggests a role for hypothyroidism in CFS. One of the symptoms specific to chronic fatigue syndrome—postexertional malaise, marked by pain and weakness and by an exacerbation of other symptoms including fever and adenopathy—can be explained as the result of increased absorption of bowel toxins which follows the relative ischemia of the intestine during intense adrenergic stimulation.
>
> A day or more after eating an allergen, it can be resting harmlessly in the intestine, and exertion, or emotion, or hunger, or nighttime can lower the blood sugar enough to cause a surge of adrenalin. The adrenalin reduces the flow of blood to the intestine, allowing allergens to be absorbed via the de-energized tissues. If the blood sugar stays low in spite of the adrenalin, white cells will be stimulated to release histamine and other pro-inflammatory substances, but the adrenalin will also cause the secretion of glucocorticoids. Night-sweats and neurological symptoms can be produced by these hormonal responses. The glucocorticoids first induce, then—at high levels—destroy the detoxifying enzymes.

### Source 4 — Ray Peat Email Advice Depository — Post 353

Ray Peat · Email · Feb 28, 2017

> **Question:** Asked Ray about chronic fatigue syndrome;
>
> **Ray Peat:** Low thyroid function and intestinal inflammation are usually involved, with increased endotoxin, nitric oxide, endorphins, serotonin, sometimes prolactin and an increased ratio of estrogen to progesterone and the androgens. A deficiency of vitamin D and calcium is sometimes involved.

### Source 5 — SSRI drugs, serotonin (5-HT) can cause chronic fatigue syndrome (CFS)

Georgi Dinkov · Article · Mar 22, 2024 · https://haidut.me/?p=2514

> Mainstream medicine does not officially recognize the condition commonly known as CFS. Depending on which doctor one asks, the response would be that CFS is either hypochondria, malingering, mental illness, hidden substance abuse disorder, subclinical viral infection, or just sensationalism. As such, the treatment for most patients suspected as having CFS has usually been prescribed (psycho)therapy and SSRI drugs to treat their suspected underlying mental illness. Unfortunately, a new study below demonstrated that SSRI drugs are just about the worst treatment a CFS patient can get due to the fact that it is elevated extracellular 5-HT potentially causing most of the CFS symptoms, especially the debilitating physical/mental fatigue. I am actually surprised it took researchers so long to make that connection, considering the well-tested so-called “central fatigue hypothesis” (CFH), which stipulates that most of the perception of fatigue is brain-derived and often is not peripherally biochemically justified. More specifically, it is the accumulation of serotonin in the brain, which leads one to perceive severe fatigue even if the bioenergetic state of their muscles do not demonstrate signs of fatigue (e.g. lactate buildup, creatine kinase and LDH leakage, ammonia accumulation, etc). Conversely, lowering serotonin levels in the brain usually leads to abolishing the feelings of fatigue. In fact, there are multiple animal studies demonstrating that tryptophan depletion in the brain (which leads to lower 5-HT levels in the brain) is a reliable mechanism to delay or even abolish feelings of fatigue even in animals whose muscles are biochemically fatigued.
>
> Well, the primary symptom of CFS is…fatigue. Also, multiple studies have demonstrated that aside from mitochondrial dysfunction, the cells of CFS sufferers do not exhibit the biochemical signs of fatigue. In some cases, there is a buildup of pyruvate and lactate, but this finding is not consistent. It is this lack of direct evidence of true biochemical fatigue that is the likely main driver behind medicine’s decision to not recognize CFS as an actual organic condition, and to often accuse CFS patients of malingering or hypochondria. However, when viewed through the CFH lenses the CFS condition makes perfect sense and, of course, involves elevated brain serotonin (5-HT).

### Source 6 — The Bean Syndrome

Ray Peat · Newsletter · 1993

> The larger the quantity oftoxic fat stored in the body, the more careful the person must be about increasing metabolic and physical activity.
>
> Using more vitamin E, short-chain saturated fats, and other anti-lipid-peroxidation agents is important.
>
> Sixty years ago, people with chronic fatigue were often said to suffer fromnervous breakdown, and advised to go to a sanitarium for a vacation, and to stop bothering the doctor. A change of activity, of place, of work, or of associates can sometimes be very therapeutic. Changing the diet can have social and ideological overtones, and can be done more easily while on a vacation trip. But sometimes the problem can be solved simply by avoiding some vegetable materials and food supplements, and/or by correcting hormonal problems, and/or by modifying the intestinal ecology.

### Source 7 — Tryptophan, serotonin, and aging

Ray Peat · Article · 2006 · https://raypeat.com/articles/aging/tryptophan-serotonin-aging.shtml

> There are people who advocate the use of tryptophan supplementation or other means to increase serotonin in the tissues as a treatment for the fibromyalgia syndrome, but the evidence increasingly suggests that excessive serotonin, interfering with muscle mitochondria, is a major factor in the development of that syndrome. In 1965, Hans Selye showed that the injection of serotonin caused muscular dystrophy. Subsequent studies suggest that serotonin excess is involved in both muscular and nervous dystrophy or degeneration (O'Steen, 1967; Narukami, et al., 1991; Hanna and Peat, 1989).
>
> The fatigue produced by “over-training” is probably produced by a tryptophan and serotonin overload, resulting from catabolism of muscle proteins and stress-induced increases in serotonin. Muscle catabolism also releases a large amount of cysteine, and cysteine, methionine, and tryptophan suppress thyroid function (Carvalho, et al., 2000). Stress also liberates free fatty acids from storage, and these fatty acids increase the uptake of tryptophan into the brain, increasing the formation of serotonin. Since serotonin increases ACTH and cortisol secretion, the catabolic state tends to be self-perpetuating. This process is probably a factor influencing the rate of aging, and contributing to the physiological peculiarities of aging and depression.
>
> Malnutrition, and specifically protein deficiency, produces an inflammatory state that involves extreme serotonin dominance. Stress or malnutrition prenatally or in infancy leads to extreme serotonin dominance in adulthood. Other functions of tryptophan are reduced, as more of it is turned into serotonin. Decreasing tryptophan or decreasing serotonin improves learning and alertness, while increased serotonin impairs learning.
>
> Tryptophan is an essential amino acid for reproduction and growth of the young animal. Most research on the nutritional requirements for amino acids has been done on farm animals, because of the economic incentive to find the cheapest way to produce the fastest growth. Farmers aren't interested in the nutritional factors that would produce the longest-lived pigs.
>
> Some research has been done on the amino acid requirements of rats over a significant part of their short lifespans. In rats and farm animals, the amount of tryptophan required decreases with time as the rate of growth slows.

### Source 8 — A Bioenergetic View of Dementia [Generative Energy #20]

Danny Roddy · Interview · Feb 3, 2016 · https://www.youtube.com/watch?v=8lDx8Y93iwk

> **Georgi Dinkov:** And actually some dementias, I haven't seen the evidence for Alzheimer's yet, but it has been found that people with chronic fatigue syndrome and some dementias produce antibodies to cardiolipin. It is as if their own body is trying to reject its own mitochondria. If nothing else, it is a sign that mitochondria are not working well and it's systemic. Some things that increase the levels of cardiolipin and I just posted about this on the forum, there's a discussion going back and forth right now whether this is true or not but Ray hinted to it, the substance phosphatidylcholine is something that helps increase the levels of cardiolipin and the amino acid taurine is another such substance which increases the levels of cardiolipin. And so that's one of the steps. The second one is ensuring that cardiolipin has a proper composition. Feeding animals and people fully hydrogenated fats has resulted in the complete reconstitution of the saturated form of cardiolipin called dipalmitoyl in just four weeks. So eating fully saturated fat will basically re-saturate your cardiolipin. If you don't have sufficient levels, potentially taking phosphatidylcholine or... should be able to restore it. I just saw a study about five minutes before we got on the show that thyroid hormone, T3 specifically, greatly boosts the production of cardiolipin.

### Source 9 — #68: Nutrition for Thyroid Function | Serotonin and Libido | CO2 and Cancer with Georgi Dinkov

Georgi Dinkov (with Danny Roddy) · Interview · Sep 12, 2021 · https://open.spotify.com/episode/6y2xOeFlDqmHlNtrizsFyM

> **Danny Roddy:** I haven't read this article for a long time. I think, I forgot who posted it, and I know this website looks a little sketch, but the title was why... It's a doctor who wrote the article. Okay, fair enough. Why I prescribe antibiotics to my patients with chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity, and other autoimmune diseases. So this is really similar to what you're saying. Same thing, basically.
>
> **Georgi Dinkov:** And by the way, not to give me or this guy too much credit, he's been known since the 1920s. For some reason, medicine, well, not for some reason, we know why, but it's really scary how effective propaganda is. If you go on PubMed and start looking at things like rheumatoid arthritis, antibiotics, right, you'll see that after about the 1940s, almost all references to this topic disappeared. And then you start seeing things, you know, discuss genetics, the genetic component of autoimmune conditions, the role of like bad upbringing in autoimmune conditions. I kid you not. It's like your mom yelled at you and suddenly your joints were swollen. They would make even that absurd argument before they consider, you know, the role of endotoxin.

### Source 10 — Food-junk and some mystery ailments: Fatigue, Alzheimer's, Colitis, Immunodeficiency

Ray Peat · Article · 1995

> I have previously discussed the use of antibiotics (and/or carrot fiber and/or charcoal) to relieve the premenstrual syndrome, and have mentioned the study in which the lifespan was extended by occasionally adding charcoal to the diet. A few years ago, I heard about a Mexican farmer who collected his neighbors' runt pigs, and got them to grow normally by adding charcoal to their diet. This probably achieves the same thing as adding antibiotics to their food, which is practiced by pig farmers in the US to promote growth and efficient use of food. Charcoal, besides binding and removing toxins, is also a powerful catalyst for the oxidative destruction of many toxic chemicals. In a sense, it anticipates the action of the protective enzymes of the intestinal wall and the liver.
>
> Some women with premenstrual fatigue have found that the “premenstrual” phase tends to get longer and longer, until they have chronic fatigue. I found that to be one of the easiest "PMS" problems to correct. When people are older, and have been sick longer, the fatigue problem is likely to involve more systems of the body. The larger the quantity of "toxic fat" stored in the body, the more careful the person must be about increasing metabolic and physical activity. Using more vitamin E, short-chain saturated fats, and other anti-lipid-peroxidation agents is important.
>
> The inflammatory diseases that develop after prolonged stress are sometimes hard to correct. But avoiding exposure to the major toxic allergens--such as carrageenan--is an essential consideration, just as important as correcting the thyroid function and avoiding the antithyroid substances.
>
> Low cholesterol is very commonly involved in the diseases of stress, and--like inadequate dietary protein--will make the system less responsive to supplementary thryoid hormone.
>
> The proliferative aspects of the inflammatory diseases represent, I think, a primitive form of regeneration. Arthritis, atherosclerosis, various granulomatous processes, breast diseases, liver adenomas, etc., provide an opportunity for investigating the various systems and substances that guide cell proliferation toward reconstruction, rather than obstructive and deformative, degenerative, processes. Degenerative diseases probably all contain clues for understanding regeneration, as I have suggested in relation to Alzheimer’s disease and inflammation. I will be talking about these in other newsletters, but the first step will always be to minimize exposure to the disruptive substances.
>
> [references]

### Source 11 — Nutrition for Women

Ray Peat · Book · 1993

> Acta 105: 301 - 312, 1965.
> - "Immune deficiency in malnutrition," Nutrition Reviews 33(11), 334, 1975.
> - "New Evidence favors breast-feeding," Med. World News 16(13), 26, 1975.
> - "Thymic function in malnutrition," Nutrition Reviews 32(6), 100, 1974.
> - "Ascorbic acid and the catabolism of cholesterol," Nutrition Reviews 31(5), 154, 1973.
> - "The growth of children given stimulant drugs," Nutrition Reviews 31(3), 91, 1973.
> - "Riboflavin and adrenal cortex," Nutrition Reviews 31(3), 95, 1973.
> - "Maternal dietary supplementation and infant birth weight," Nutrition Reviews 31(2), 45, 1973.
> - "Oral contraceptives and vitamin B6," Nutrition Reviews 31(2), 49, 1973.
> - "Brain biochemistry and intrauterine growth," Nutrition Reviews 31(1), 16, 1973.
>
> ### Chronic Fatigue
>
> Various researchers have found that the cells of fat, or depressed, or tired people are in a low energy state, and, increasingly, it is being recognized that this low energy state resembles hypothyroidism. Many things can cause hypothyroidism--too much estrogen or cortisol, too little progesterone, a diet containing too little good quality protein, too few calories, or diets containing significant quantities of beans, lentils, or undercooked broccoli or cauliflower—but in our culture unsaturated oils are probably the most important cause. As early as 1951, it was known (Kunkel and Williams, J. Biol. Chem.) that the polyunsaturated fatty acids strongly inhibit the crucial respiratory enzyme, cytochrome oxidase, and that inhibition of this enzyme has a very important effect on the whole animal, suppressing its metabolic rate, reducing the number of calories it can burn. It is now known that polyunsaturated fats interfere with thyroid hormone in just about every conceivable way. One of the most common symptoms of hypothyroidism is lethargy, fatigue that persists even while getting extra rest and sleep. Everything is inefficient in hypothyroidism, even sleep.

_Generated 2026-07-20 from the Bioenergetic Oracle corpus._