Private chronic fatigue (me/cfs) clinic in London, same-day endocrinology.

What is required for the diagnosis

All four must be present, for at least three months, and be significantly disabling:

• Debilitating fatigue that is worsened by activity, not caused by excessive exertion, and not significantly relieved by rest
• Post-exertional malaise — symptoms worsening after activity, often delayed by hours or days and disproportionate to the effort
• Unrefreshing sleep, or disturbed sleep patterns
• Cognitive difficulties — brain fog, poor concentration, slowed processing, word-finding problems

Energy management

The central approach is staying within your energy limits rather than trying to expand them by pushing. This is not giving up; it is the intervention with the best chance of stabilising and slowly improving things.

• Establish your baseline — what you can do on a bad day without a crash. Live at or below it.
• Plan, pace and prioritise. Split tasks, rest between, sit rather than stand where possible.
• Count all forms of exertion — physical, cognitive, emotional, sensory and social.
• Rest proactively, not only when exhausted. Rest means genuine rest, not scrolling.
• Increase only after sustained stability, and by small amounts, prepared to step back.
• Manage sleep, orthostatic symptoms, pain and nausea specifically — each has treatments.

What should be tested

There is no diagnostic test for ME/CFS, so the diagnosis rests on the criteria plus exclusion of alternatives. Baseline testing should include a full blood count, inflammatory markers, ferritin, B12, folate, thyroid function, kidney and liver function, calcium, glucose or HbA1c, coeliac screening, vitamin D and a urine test. Further tests are added where the history suggests them.

Practical support

• ME/CFS can meet the definition of a disability under the Equality Act 2010 — reasonable adjustments at work or in education can be requested.
• Detailed evidence letters help with PIP, Access to Work, university disability services and blue badge applications.
• Severe ME/CFS can leave people housebound or bedbound, needing home visits and adapted care. This is recognised in the guidance and should not be met with scepticism.
• Action for ME and the ME Association both provide information and advocacy.