Short report
Alcohol use in chronic fatigue syndrome

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Abstract

Objective: To examine the anecdotal observation that patients with chronic fatigue syndrome develop alcohol intolerance. Methods: A consecutive case series of 114 patients fulfilling UK criteria for chronic fatigue syndrome referred to a specialist clinic. Self-reported alcohol use pre- and postdiagnosis, fatigue symptoms and comorbidity measures were collected. Results: Two-thirds reduced alcohol intake. The most common reasons were increased tiredness after drinking (67%), increased nausea (33%), exacerbated hangovers (23%) and sleep disturbance (24%). One-third of the subjects also stopped drinking because “it seemed sensible.” Some had been advised to avoid alcohol, but the majority (66%) did so on the basis of personal experience. Conclusion: Our data supports the anecdotal belief that chronic fatigue syndrome patients reduce or cease alcohol intake. This is associated with greater impairment in employment, leisure and social domains of function, and may hint at psycho-pathophysiological processes in common with other conditions that result in alcohol intolerance.

Introduction

Chronic fatigue syndrome is a symptomatic illness of uncertain aetiology. It is defined by operational criteria such as those devised by Fukuda et al. [1]. They suggested that diagnosis is defined by the presence of clinically evaluated, unexplained persistent or relapsing chronic fatigue, along with at least four specific concurrent symptoms. These include memory or concentration impairment, muscle pain, joint pain, headaches or unrefreshing sleep [1], [2].

The aetiology of CFS remains poorly understood but is likely to be multifactorial, for which there is a mounting base of epidemiological, psychological and physiological research evidence [3], [4], [5]. There is no diagnostic test and prognosis is difficult to predict [6].

It is often asserted that alcohol intolerance is common in patients with chronic fatigue syndrome [7]. This association was first documented almost 150 years ago:

“… the fact that neurasthenic patients seldom tolerate the use of alcoholic stimulants. A single teaspoonful will often produce flushing of the face, burning heat of the eyelids and distress in the head.” [8]

We report a study of self-recounted alcohol intolerance in chronic fatigue syndrome and its associations.

Section snippets

Participants

We studied a consecutive series of 114 patients who met UK criteria for CFS, referred by general practitioners or consultants to a chronic fatigue clinic at King's College Hospital, London. A diagnosis of CFS was confirmed on clinical and operationally defined grounds (CDC 1994 criteria) [1] using standard history and examination along with fatigue and nonspecific symptom checklists.

Questionnaire assessments

Routine clinic measures used in the clinic include the following: The assessment checklist—a screening

Results

Table 1 illustrates the demographics, alcohol use, reasons for alcohol reduction and comorbidity.

Overall, this sample is typical of chronic fatigue patients seen in specialist services, and not of CFS in primary care or the community [11]. The response rate to alcohol questionnaires was 98.25% and showed that approximately two-thirds (n=74, 65%) of patients reduced or stopped alcohol intake altogether. There was no statistically significant difference between the ongoing or reduced alcohol

Discussion

In this study of 114 CFS patients referred to a hospital fatigue clinic, two-thirds claimed that they had reduced or stopped alcohol intake altogether. This supports the widely expressed anecdotal view.

The most common reasons given for a reduction in alcohol use were of an exacerbation of physical symptoms (fatigue, nausea, sleep disturbance or hangovers). Worsening of any depression or anxiety symptoms was much less common. Interestingly, about one-third of alcohol reducers also gave a “common

Conclusion

We present self-report data to support the previously anecdotal observation that chronic fatigue syndrome patients reduce or cease alcohol intake. It may provide additional support for the nosological distinction of CFS as a discrete entity, particularly differentiating it from depression. Comparison with other illnesses linked with acquired alcohol intolerance may also provide some aetiological clues, linking with theories such as neuroendocrine, immunological and cognitive attribution.

Acknowledgements

We thank the patients who participated in this study and the clinical and database management staff of the Chronic Fatigue Syndrome research unit, King's College hospital—especially Dorothy Blair. No conflicts of interest declared.

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