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Fibromyalgia & Chronic Fatigue Syndrome: The Nature vs. Nurture Debate
By Kent Holtorf, M.D.

Some of the most frequently asked questions we get when we talk to people about Fibromyalgia (FM) and Chronic Fatigue Syndrome (CFIDS) are about the propensity for these conditions to run in families.

We are frequently asked:

  • Are these diseases genetically linked?
  • Are they contagious since, in the case of Gulf War Syndrome, a significant number of spouses have been known to contract the disease?
  • Is there just a weakness that may be passed down from generation to generation that increases the chances of contracting these diseases?
  • And if so can someone be identified early on and do things to prevent it?
The basic question really becomes: Is this nature or nurture? Genetics or environment?

The concerns regarding this have made many patients who have contracted these conditions early on in life seriously consider reproduction choices. For those who have had children prior to the onset of their condition, most now worry about the future for their children.

While some preliminary research has been completed, the questions come faster than the answers and more in-depth studies are underway in both areas to clearly define this aspect of these conditions. It is clear that FM, CFIDS and even the similar condition of Gulf War Syndrome (GWS) are more common among siblings, parents and children of those who have these conditions than those of the general population.

This could be due to genetic influences or due to the fact that these relatives also would tend to be exposed to the same environmental factors such as emotional stress, chemicals, toxins or infectious agents. It appears that, as with most diseases, both these scenarios can influence the risk for these conditions.


A number of studies have demonstrated through the use of gene mapping that there are certain genes that make one much more prone to becoming afflicted with FM and CFIDS. For instance, certain mutations in genes that code for enzymes or adrenal function can make one 8 times more likely to get CFIDS or FM.

This research has been expanded and is currently underway to more closely look for the specific genetic markers that may lead to the development of FM and CFIDS among family members.


On the other hand, a number of studies have also indicated that non-genetic linked relatives, such as spouses, also have a much higher incidence of FM and CFIDS. Indications are that this is due to the shared environment - nurture.

They live together, are in close contact with each other, come down with the same viruses and are exposed to the same chemicals. They eat the same food, use the same cleaning products, drink the same water, and share the same lifestyle. They generally tend to be equally active or passive. Family stresses such as financial, not to mention those stresses associated with having a family member with a chronic disease, are all shared by the family.

Frequently with family members, traumas (physical, emotional or viral) that often trigger the onset of these conditions are shared experiences as well. Something as simple as a car accident involving several members of the family, or a virus several family members contract, may trigger FM or CFIDS in one or more of the family members.

And we know from research that all of things help contribute to the onset of FM and CFIDS. In the case of Gulf War Syndrome, it is interesting that a significant number of spouses of veterans with GWS also came down with these conditions.

A study demonstrated that this was most likely due to a mycoplasma infection. With this information in mind, many infections may be the trigger that causes the neurochemical cascade of FM and CFIDS. Those infections may be shared and spread to family members.

As nuclear families become more mobile, siblings moving apart and raising the next generation in different environments, it will be interesting to see if indeed the occurrence of FM and CFIDS within families changes.


Until more research is done to strengthen the correlation between the development of FM and the HLA allele, specific genetics testing will not be available to predetermine who is at risk and who isn't. And even if there is a genetic predisposition to FM and CFIDS, this will merely mean that some people in the family may develop the conditions and others may not.

One way you can easily assess your own risk for contracting these conditions or predicting if members of your family are at risk is to do some research into the family medical history. Since FM and CFIDS are generally more prevalent in women you can expect to see it in your grandmother, aunts, sisters and daughters more often then in the male members of your family.

However, men do get FM and CFIDS as well so as you are talking to your family members about their health history in order to get a better idea of where you may stand with regard to your risk, don't exclude your grandfathers, father, brothers and sons.

Since FM and CFIDS are frequently misdiagnosed or not diagnosed conditions, ask family members if they are or have been experiencing any of the symptoms associated with these conditions. If they are answering yes to many of the symptoms that may lead you to suspect they have FM or CFIDS, encourage them to consult a specialist and be thoroughly examined and evaluated for these diseases.


Since the clear cause of FM and CFIDS is unknown there is currently no known way to prevent contracting these diseases. There are some things you can do to help reduce your risk. If you think you may be at risk for FM or CFIDS due to environment and/or genetics, consider the following:

Analyze your environment and lifestyle - Look for things that can trigger FM and CFIDS such as high stress levels, unrefreshed sleep patterns, sedentary lifestyles, or even physical trauma risk through your personal or professional activities. Analyze your health - Be sure to identify and correct potential medical conditions that could potentially add to the onset of FM or CFIDS.

Don't overlook such things chronic sinusitis, change in metabolism (may be an indication of hypothyroidism), sensitivities or allergies to chemicals or foods, chronic infections such as yeast infections, or viruses such as Epstein Barr Virus or HHV6. If you get these under control now it may help prevent them in the future.

Fibromyalgia and Chronic Fatigue Syndrome are complex diseases in which both genetics and environmental factors play a role. The best way to address these conditions is to be aware of everything that impacts the wellness of not only a FM and CFIDS patient, but what influences the onset of these conditions as well.

If you do you may be better able to live a life with the conditions and possibly minimize your risk of contracting these life altering diseases.

Dr. Kent Holtorf is the Chief Medical Officer for the Fibromyalgia & Fatigue Centers, Inc. Dr. Holtorf has been practicing exclusively on Fibromyalgia and Chronic Fatigue Syndrome patients for over six years after struggling for over 15 years to find the answers to his chronic fatigue condition.

With proven medical therapies he has seen outstanding results in reducing pain and increasing energy in his patients and himself. His practice outcomes are the basis for the medical protocols used in the Fibromyalgia & Fatigue Centers (FFC) nationwide and in the FFC here in Cleveland.

The six step approach to positive outcomes is now available in Cleveland exclusively through the FFC. For more information visit www.fibroandfatigue.com or call 440-260-9700.

Reprinted with permission of The Cleveland Women's Journal

Cleveland Women's Journal

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