Anorexia (appetite loss)

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Anorexia is a physical symptom also known as appetite loss causing an inability to eat.[1]

See also
Anorexia nervosa
the mental and behavioral illness which involves a refusal to eat combined with fears of being fat and other factors.

Prevalence[edit | edit source]

Whitney Dafoe is an American photographer who has very severe ME, which causes him very severe gastrointestinal symptoms, because of this he is tube fed and remain severely underweight. Whitney can no longer speak, eat, or have contact with anyone but his parents due to visual dysfunction and very severe ME. Whitney was previously misdiagnosed with the eating disorder anorexia, which resulted in him being refused the surgery needing for a feeding tube and in-patient psychiatric care recommended instead. Whitney is now fed via a PEG, is still unable to even drink water, and he needs full time care.[citation needed]

Symptom recognition[edit | edit source]

Anorexia is recognized as a possible symptom in the Canadian Consensus Criteria for ME, but is not regarded as a diagnostic symptom.[2][3][4]

Misdiagnosis[edit | edit source]

A number of patient groups have raised concerns that the eating disorder anorexia nervosa may be incorrectly diagnosed in some patients who actually have weight loss caused by ME/CFS symptoms, particularly children or young people, and people with severe ME.[5]

Digestive symptoms and gastrointestinal symptoms are very common symptoms in ME/CFS and cause significant weight loss in some patients.

Possible causes[edit | edit source]

While ME/CFS can cause significant appetite loss in some people, other ME/CFS symptoms may also cause changes in eating behaviors or weight include:

Severe ME[edit | edit source]

Severe myalgic encephalomyelitis/chronic fatigue syndrome can also cause

  • dysphagia (swallowing difficulties or an inability to swallow)[6]
this symptom also found in some people after a stroke, in multiple sclerosis and Parkinson's diseases[7]
  • vomiting, which may be linked to vertigo
  • food intolerances, food or medication intolerances are found in approximately 50% of people with ME/CFS, and may become severe
this may cause a reluctance to eat/swallow in severe cases[2]

These swallowing and eating symptoms can lead to the sufferer becoming severely underweight; this can cause a misdiagnosis of anorexia[8] or another eating disorder, which may lead to inappropriate treatment.

Some people severely affected by ME/CFS need feeding tubes or artificial nutritional, and may become severely underweight purely as a result of their ME/CFS symptoms, and may starve to death.[9] This is also the case for some people with anorexia or eating disorders.


Merryn Crofts was bedbound and unable to eat when she died of very severe ME. Merryn weighed six stone (84 lbs) at her death but did not have an eating disorder, she had severe gastrointestinal symptoms causing weight loss. Merryn's autopsy revealed ganglia inflammation. It is suspected that in the later years of her illness Merryn also suffered from EDS and MCAD. Her death certificate is the second in the UK publicly known to have been attributed to ME.[citation needed]

Notable studies[edit | edit source]

There do not appear to be any significant studies assessing swallowing or eating issues in patients with ME/CFS, or investigating the presence of comorbid eating disorders, or the potential misdiagnosing of eating disorders, although there are many different accounts from patients or their carers/parents.

Byron Hyde has started that enteroviruses may disrupt swallowing reflexes in ME/CFS.[7]

Notable studies[edit | edit source]

Possible causes[edit | edit source]

See more[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. ↑ Harris, Peter; Nagy, Sue; Vardaxis, Nicholas, eds. (2018). Mosby's Dictionary of Medicine, Nursing and Health Professions (Revised 3rd Anz ed.). Australia: Elsevier Health Sciences. p. 102. ISBN 978-0-7295-8691-7.
  2. ↑ 2.0 2.1 2.2 Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, A C Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols (PDF). Journal of Chronic Fatigue Syndrome. 11. p. 7-115. doi:10.1300/J092v11n01_02.
  3. ↑ Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6
  4. ↑ Fukuda, K.; Straus, S. E.; Hickie, I.; Sharpe, M. C.; Dobbins, J. G.; Komaroff, A. (December 15, 1994). "The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group" (PDF). Annals of Internal Medicine. American College of Physicians. 121 (12): 953–959. ISSN 0003-4819. PMID 7978722.
  5. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named kos
  6. ↑ The Grace Charity for M.E.; The 25% ME Group (January 2019). "KNOWLEDGE IN THE HOPE OF PROTECTING M.E. SUFFERERS FROM UNNECESSARY SECTIONING". ... the terrible act of sectioning sound minded M.E. patients who are neither a threat to themselves nor to others ... Cite has empty unknown parameter: |1= (help)
  7. ↑ 7.0 7.1 The 25% ME Group (Summer 2018), "Drs. Byron Hyde and John Chia - Questions and Answers", The Quarterly Newsletter, 25 Percent ME Group, p. 10, Some M.E. specialist researchers believe that the gastric mucosa which is infected with enteroviruses may reach the brain by travelling up the vagus nerve, which controls the swallowing reflex.
  8. ↑ Colby, Jane. "ME - The Illness and Common Misconceptions: Abuse, Neglect, Mental Incapacity. A summary originally produced for the legal profession" (PDF). Tymes Trust. Retrieved February 25, 2019. Cite has empty unknown parameter: |dead-url= (help)
  9. ↑ Bannerman, Lucy (May 29, 2018). "ME sufferer who was dismissed as hysterical vindicated in death". The Times.

enterovirus A genus of RNA viruses which typically enter the body through the respiratory or gastrointestinal systems and sometimes spread to the central nervous system or other parts of the body, causing neurological, cardiac, and other damage. Since the first reports of myalgic encephalomyelitis (ME), enteroviruses have been suspected as a cause of ME. Enteroviruses have also been implicated as the cause of Type I diabetes, congestive heart failure, and other conditions. Enteroviruses include poliovirus, coxsackieviruses, and many others. New enteroviruses and new strains of existing enteroviruses are continuously being discovered. (Learn more: viralzone.expasy.org)

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

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