Search This Blog

Monday, September 9, 2024

Recent human evolution

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Recent_human_evolution
 
Recent human evolution refers to evolutionary adaptation, sexual and natural selection, and genetic drift within Homo sapiens populations, since their separation and dispersal in the Middle Paleolithic about 50,000 years ago. Contrary to popular belief, not only are humans still evolving, their evolution since the dawn of agriculture is faster than ever before. It has been proposed that human culture acts as a selective force in human evolution and has accelerated it; however, this is disputed. With a sufficiently large data set and modern research methods, scientists can study the changes in the frequency of an allele occurring in a tiny subset of the population over a single lifetime, the shortest meaningful time scale in evolution. Comparing a given gene with that of other species enables geneticists to determine whether it is rapidly evolving in humans alone. For example, while human DNA is on average 98% identical to chimp DNA, the so-called Human Accelerated Region 1 (HAR1), involved in the development of the brain, is only 85% similar.

Following the peopling of Africa some 130,000 years ago, and the recent Out-of-Africa expansion some 70,000 to 50,000 years ago, some sub-populations of Homo sapiens have been geographically isolated for tens of thousands of years prior to the early modern Age of Discovery. Combined with archaic admixture, this has resulted in relatively significant genetic variation. Selection pressures were especially severe for populations affected by the Last Glacial Maximum (LGM) in Eurasia, and for sedentary farming populations since the Neolithic, or New Stone Age.

Single nucleotide polymorphisms (SNP, pronounced 'snip'), or mutations of a single genetic code "letter" in an allele that spread across a population, in functional parts of the genome can potentially modify virtually any conceivable trait, from height and eye color to susceptibility to diabetes and schizophrenia. Approximately 2% of the human genome codes for proteins and a slightly larger fraction is involved in gene regulation. But most of the rest of the genome has no known function. If the environment remains stable, the beneficial mutations will spread throughout the local population over many generations until it becomes a dominant trait. An extremely beneficial allele could become ubiquitous in a population in as little as a few centuries whereas those that are less advantageous typically take millennia.

Human traits that emerged recently include the ability to free-dive for long periods of time, adaptations for living in high altitudes where oxygen concentrations are low, resistance to contagious diseases (such as malaria), light skin, blue eyes, lactase persistence (or the ability to digest milk after weaning), lower blood pressure and cholesterol levels, retention of the median artery, reduced prevalence of Alzheimer's disease, lower susceptibility to diabetes, genetic longevity, shrinking brain sizes, and changes in the timing of menarche and menopause.

Archaic admixture

Simplified phylogeny of Homo sapiens for the last two million years

Genetic evidence suggests that a species dubbed Homo heidelbergensis is the last common ancestor of Neanderthals, Denisovans, and Homo sapiens. This common ancestor lived between 600,000 and 750,000 years ago, likely in either Europe or Africa. Members of this species migrated throughout Europe, the Middle East, and Africa and became the Neanderthals in Western Asia and Europe while another group moved further east and evolved into the Denisovans, named after the Denisova Cave in Russia where the first known fossils of them were discovered. In Africa, members of this group eventually became anatomically modern humans. Migrations and geographical isolation notwithstanding, the three descendant groups of Homo heidelbergensis later met and interbred.

Map of western Eurasia showing areas and estimated dates of possible Neandertal–modern human hybridization (in red) based on fossil samples from indicated sites.

Archaeological research suggests that as prehistoric humans swept across Europe 45,000 years ago, Neanderthals went extinct. Even so, there is evidence of interbreeding between the two groups as humans expanded their presence in the continent. While prehistoric humans carried 3–6% Neanderthal DNA, modern humans have only about 2%. This seems to suggest selection against Neanderthal-derived traits. For example, the neighborhood of the gene FOXP2, affecting speech and language, shows no signs of Neanderthal inheritance whatsoever.

Introgression of genetic variants acquired by Neanderthal admixture has different distributions in Europeans and East Asians, pointing to differences in selective pressures. Though East Asians inherit more Neanderthal DNA than Europeans, East Asians, South Asians, Australo-Melanesians, Native Americans, and Europeans all share Neanderthal DNA, so hybridization likely occurred between Neanderthals and their common ancestors coming out of Africa. Their differences also suggest separate hybridization events for the ancestors of East Asians and other Eurasians.

Following the genome sequencing of three Vindija Neanderthals, a draft sequence of the Neanderthal genome was published and revealed that Neanderthals shared more alleles with Eurasian populations—such as French, Han Chinese, and Papua New Guinean—than with sub-Saharan African populations, such as Yoruba and San. According to the authors of the study, the observed excess of genetic similarity is best explained by recent gene flow from Neanderthals to modern humans after the migration out of Africa. But gene flow did not go one way. The fact that some of the ancestors of modern humans in Europe migrated back into Africa means that modern Africans also carry some genetic materials from Neanderthals. In particular, Africans share 7.2% Neanderthal DNA with Europeans but only 2% with East Asians.

An estimated 4–6% of the genome of modern Melanesians is derived from Denisovans, but the highest amounts detected thus far are found in the Negrito populations of the Philippines. New Guineans and Aboriginal Australians have similar rates of Denisovan admixture, indicating that interbreeding took place prior to their common ancestors' entry into Sahul, at least 44,000 years ago.

Some climatic adaptations, such as high-altitude adaptation in humans, are thought to have been acquired by archaic admixture. An ethnic group known as the Sherpas from Nepal is believed to have inherited an allele called EPAS1, which allows them to breathe easily at high altitudes, from the Denisovans. A 2014 study reported that Neanderthal-derived variants found in East Asian populations showed clustering in functional groups related to immune and haematopoietic pathways, while European populations showed clustering in functional groups related to the lipid catabolic process. A 2017 study found correlation of Neanderthal admixture in modern European populations with traits such as skin tone, hair color, height, sleeping patterns, mood and smoking addiction. A 2020 study of Africans unveiled Neanderthal haplotypes, or alleles that tend to be inherited together, linked to immunity and ultraviolet sensitivity.

The gene microcephalin (MCPH1), involved in the development of the brain, likely originated from a Homo lineage separate from that of anatomically modern humans, but was introduced to them around 37,000 years ago, and has become much more common ever since, reaching around 70% of the human population at present. Neanderthals were suggested as one possible origin of this gene. But later studies did not find this gene in the Neanderthal genome nor has it been found to be associated with cognitive ability in modern people.

The promotion of beneficial traits acquired from admixture is known as adaptive introgression.

A study concluded only 1.5–7% of "regions" of the modern human genome to be specific to modern humans. These regions have neither been altered by archaic hominin DNA due to admixture (only a small portion of archaic DNA is inherited per individual but a large portion is inherited across populations overall) nor are shared with Neanderthals or Denisovans in any of the genomes of the used datasets. They also found two bursts of changes specific to modern human genomes which involve genes related to brain development and function.

Upper Paleolithic, or the Late Stone Age (50,000 to 12,000 years ago)

Cave paintings (such as this one from France) represent a benchmark in the evolutionary history of human cognition.

Victorian naturalist Charles Darwin was the first to propose the out-of-Africa hypothesis for the peopling of the world, but the story of prehistoric human migration is now understood to be much more complex thanks to twenty-first-century advances in genomic sequencing. There were multiple waves of dispersal of anatomically modern humans out of Africa, with the most recent one dating back to 70,000 to 50,000 years ago. Earlier waves of human migrants might have gone extinct or returned to Africa. Moreover, a combination of gene flow from Eurasia back into Africa and higher rates of genetic drift among East Asians compared to Europeans led these human populations to diverge from one another at different times.

Around 65,000 to 50,000 years ago, a variety of new technologies, such as projectile weapons, fish hooks, porcelain, and sewing needles, made their appearance. Bird-bone flutes were invented 30,000 to 35,000 years ago, indicating the arrival of music. Artistic creativity also flowered, as can be seen with Venus figurines and cave paintings. Cave paintings of not just actual animals but also imaginary creatures that could reliably be attributed to Homo sapiens have been found in different parts of the world. Radioactive dating suggests that the oldest of the ones that have been found, as of 2019, are 44,000 years old. For researchers, these artworks and inventions represent a milestone in the evolution of human intelligence, the roots of story-telling, paving the way for spirituality and religion. Experts believe this sudden "great leap forward"—as anthropologist Jared Diamond calls it—was due to climate change. Around 60,000 years ago, during the middle of an ice age, it was extremely cold in the far north, but ice sheets sucked up much of the moisture in Africa, making the continent even drier and droughts much more common. The result was a genetic bottleneck, pushing Homo sapiens to the brink of extinction, and a mass exodus from Africa. Nevertheless, it remains uncertain (as of 2003) whether or not this was due to some favorable genetic mutations, for example in the FOXP2 gene, linked to language and speech. A combination of archaeological and genetic evidence suggests that humans migrated along Southern Asia and down to Australia 50,000 years ago, to the Middle East and then to Europe 35,000 years ago, and finally to the Americas via the Siberian Arctic 15,000 years ago.

Epicanthic folds are thought to be a particular trait in archaic humans from Eastern and Southeast Asia, and may have originated already within early humans in Africa.

DNA analyses conducted since 2007 revealed the acceleration of evolution with regards to defenses against disease, skin color, nose shapes, hair color and type, and body shape since about 40,000 years ago, continuing a trend of active selection since humans emigrated from Africa 100,000 years ago. Humans living in colder climates tend to be more heavily built compared to those in warmer climates because having a smaller surface area compared to volume makes it easier to retain heat. People from warmer climates tend to have thicker lips, which have large surface areas, enabling them to keep cool. With regards to nose shapes, humans residing in hot and dry places tend to have narrow and protruding noses in order to reduce loss of moisture. Humans living in hot and humid places tend to have flat and broad noses that moisturize inhaled air and retain moisture from exhaled air. Humans dwelling in cold and dry places tend to have small, narrow, and long noses in order to warm and moisturize inhaled air. As for hair types, humans from regions with colder climates tend to have straight hair so that the head and neck are kept warm. Straight hair also allows cool moisture to quickly fall off the head. On the other hand, tight and curly hair increases the exposed areas of the scalp, easing the evaporation of sweat and allowing heat to be radiated away while keeping itself off the neck and shoulders. Epicanthic eye folds are believed to be an adaptation protecting the eye from overexposure to ultraviolet radiation, and is presumed to be a particular trait in archaic humans from eastern and southeast Asia. A cold-adaptive explanation for the epicanthic fold is today seen as outdated by some, as epicanthic folds appear in some African populations. Dr. Frank Poirier, a physical anthropologist at Ohio State University, concluded that the epicanthic fold in fact may be an adaptation for tropical regions, and was already part of the natural diversity found among early modern humans.

Various theories have been proposed to explain the short stature of pygmies and negritos. Some studies suggest that it could be related to adaptation to low ultraviolet light levels in tropical rainforests.

Physiological or phenotypical changes have been traced to Upper Paleolithic mutations, such as the East Asian variant of the EDAR gene, dated to about 35,000 years ago in Southern or Central China. Traits affected by the mutation are sweat glands, teeth, hair thickness and breast tissue. While Africans and Europeans carry the ancestral version of the gene, most East Asians have the mutated version. By testing the gene on mice, Yana G. Kamberov and Pardis C. Sabeti and their colleagues at the Broad Institute found that the mutated version brings thicker hair shafts, more sweat glands, and less breast tissue. East Asian women are known for having comparatively small breasts and East Asians in general tend to have thick hair. The research team calculated that this gene originated in Southern China, which was warm and humid, meaning having more sweat glands would be advantageous to the hunter-gatherers who lived there. A subsequent study from 2021, based on ancient DNA samples, has suggested that the derived variant became dominant among "Ancient Northern East Asians" shortly after the Last Glacial Maximum in Northeast Asia, around 19,000 years ago. Ancient remains from Northern East Asia, such as the Tianyuan Man (40,000 years old) and the AR33K (33,000 years old) specimen lacked the derived EDAR allele, while ancient East Asian remains after the LGM carry the derived EDAR allele. The frequency of 370A is most highly elevated in North Asian and East Asian populations.

The most recent Ice Age peaked in intensity between 19,000 and 25,000 years ago and ended about 12,000 years ago. As the glaciers that once covered Scandinavia all the way down to Northern France retreated, humans began returning to Northern Europe from the Southwest, modern-day Spain. But about 14,000 years ago, humans from Southeastern Europe, especially Greece and Turkey, began migrating to the rest of the continent, displacing the first group of humans. Analysis of genomic data revealed that all Europeans since 37,000 years ago have descended from a single founding population that survived the Ice Age, with specimens found in various parts of the continent, such as Belgium. Although this human population was displaced 33,000 years ago, a genetically related group began spreading across Europe 19,000 years ago. Recent divergence of Eurasian lineages was sped up significantly during the Last Glacial Maximum (LGM), the Mesolithic and the Neolithic, due to increased selection pressures and founder effects associated with migration. Alleles predictive of light skin have been found in Neanderthals, but the alleles for light skin in Europeans and East Asians, KITLG and ASIP, are (as of 2012) thought to have not been acquired by archaic admixture but recent mutations since the LGM. Hair, eye, and skin pigmentation phenotypes associated with humans of European descent emerged during the LGM, from about 19,000 years ago. The associated TYRP1 SLC24A5 and SLC45A2 alleles emerge around 19,000 years ago, still during the LGM, most likely in the Caucasus. Within the last 20,000 years or so, lighter skin has evolved in East Asia, Europe, North America and Southern Africa. In general, people living in higher latitudes tend to have lighter skin. The HERC2 variation for blue eyes first appears around 14,000 years ago in Italy and the Caucasus.

Larger average cranial capacity is correlated with living in cold regions.

Inuit adaptation to high-fat diet and cold climate has been traced to a mutation dated the Last Glacial Maximum (20,000 years ago). Average cranial capacity among modern male human populations varies in the range of 1,200 to 1,450 cm3. Larger cranial volumes are associated with cooler climatic regions, with the largest averages being found in populations of Siberia and the Arctic. Humans living in Northern Asia and the Arctic have evolved the ability to develop thick layers of fat on their faces to keep warm. Moreover, the Inuit tend to have flat and broad faces, an adaptation that reduces the likelihood of frostbites. Both Neanderthal and Cro-Magnons had somewhat larger cranial volumes on average than modern Europeans, suggesting the relaxation of selection pressures for larger brain volume after the end of the LGM.

Australian Aboriginals living in the Central Desert, where the temperature can drop below freezing at night, have evolved the ability to reduce their core temperatures without shivering.

Holocene (12,000 years ago to present)

Neolithic or New Stone Age

By domesticating various plants and animals, humans have shaped the evolution of not only those species but also themselves.
 
Teosinte (left) was cultivated and evolved into modern corn (right).
 
Populations that cultivated carbohydrate-rich food crops such as rice evolved to produce the enzyme amylase in their saliva.

Impacts of agriculture

The advent of agriculture has played a key role in the evolutionary history of humanity. Early farming communities benefited from new and comparatively stable sources of food, but were also exposed to new and initially devastating diseases such as tuberculosis, measles, and smallpox. Eventually, genetic resistance to such diseases evolved and humans living today are descendants of those who survived the agricultural revolution and reproduced. The pioneers of agriculture faced tooth cavities, protein deficiency and general malnutrition, resulting in shorter statures. Diseases are one of the strongest forces of evolution acting on Homo sapiens. As this species migrated throughout Africa and began colonizing new lands outside the continent around 100,000 years ago, they came into contact with and helped spread a variety of pathogens with deadly consequences. In addition, the dawn of agriculture led to the rise of major disease outbreaks. Malaria is the oldest known of human contagions, traced to West Africa around 100,000 years ago, before humans began migrating out of the continent. Malarial infections surged around 10,000 years ago, raising the selective pressures upon the affected populations, leading to the evolution of resistance.

Examples for adaptations related to agriculture and animal domestication include East Asian types of ADH1B associated with rice domestication, and lactase persistence.

Migrations

As Europeans and East Asians migrated out of Africa, those groups were maladapted and came under stronger selective pressures.

Lactose tolerance

Today, most Northwestern Europeans can drink milk after weaning.

Around 11,000 years ago, as agriculture was replacing hunting and gathering in the Middle East, people invented ways to reduce the concentrations of lactose in milk by fermenting it to make yogurt and cheese. People lost the ability to digest lactose as they matured and as such lost the ability to consume milk. Thousands of years later, a genetic mutation enabled people living in Europe at the time to continue producing lactase, an enzyme that digests lactose, throughout their lives, allowing them to drink milk after weaning and survive bad harvests.

Today, lactase persistence can be found in 90% or more of the populations in Northwestern and Northern Central Europe, and in pockets of Western and Southeastern Africa, Saudi Arabia, and South Asia. It is not as common in Southern Europe (40%) because Neolithic farmers had already settled there before the mutation existed. It is rarer in inland Southeast Asia and Southern Africa. While all Europeans with lactase persistence share a common ancestor for this ability, pockets of lactase persistence outside Europe are likely due to separate mutations. The European mutation, called the LP allele, is traced to modern-day Hungary, 7,500 years ago. In the twenty-first century, about 35% of the human population is capable of digesting lactose after the age of seven or eight. Prior this mutation, dairy farming was already widespread in Europe.

A Finnish research team reported that the European mutation that allows for lactase persistence is not found among the milk-drinking and dairy-farming Africans, however. Sarah Tishkoff and her students confirmed this by analyzing DNA samples from Tanzania, Kenya, and Sudan, where lactase persistence evolved independently. The uniformity of the mutations surrounding the lactase gene suggests that lactase persistence spread rapidly throughout this part of Africa. According to Tishkoff's data, this mutation first appeared between 3,000 and 7,000 years ago. This mutation provides some protection against drought and enables people to drink milk without diarrhea, which causes dehydration.

Lactase persistence is a rare ability among mammals. Because it involves a single gene, it is a simple example of convergent evolution in humans. Other examples of convergent evolution, such as the light skin of Europeans and East Asians or the various means of resistance to malaria, are much more complicated.

Skin color

Humans evolved light skin after migrating from Africa to Europe and East Asia.

The light skin pigmentation characteristic of modern Europeans is estimated to have spread across Europe in a "selective sweep" during the Mesolithic (5,000 years ago). Signals for selection in favor of light skin among Europeans was one of the most pronounced, comparable to those for resistance to malaria or lactose tolerance. However, Dan Ju and Ian Mathieson caution in a study addressing 40,000 years of modern human history, "we can assess the extent to which they carried the same light pigmentation alleles that are present today," but explain that c. 40,000 BP Early Upper Paleolithic hunter-gatherers "may have carried different alleles that we cannot now detect", and as a result "we cannot confidently make statements about the skin pigmentation of ancient populations.”

Eumelanin, which is responsible for pigmentation in human skin, protects against ultraviolet radiation while also limiting vitamin D synthesis. Variations in skin color, due to the levels of melanin, are caused by at least 25 different genes, and variations evolved independently of each other to meet different environmental needs. Over the millennia, human skin colors have evolved to be well-suited to their local environments. Having too much melanin can lead to vitamin D deficiency and bone deformities while having too little makes the person more vulnerable to skin cancer. Indeed, Europeans have evolved lighter skin in order to combat vitamin D deficiency in regions with low levels of sunlight. Today, they and their descendants in places with intense sunlight such as Australia are highly vulnerable to sunburn and skin cancer. On the other hand, Inuit have a diet rich in vitamin D and consequently have not needed lighter skin.

Eye color

Blue eyes are an adaptation for living in regions where the amounts of light are limited because they allow more light to come in than brown eyes. They also seem to have undergone both sexual and frequency-dependent selection. A research program by geneticist Hans Eiberg and his team at the University of Copenhagen from the 1990s to 2000s investigating the origins of blue eyes revealed that a mutation in the gene OCA2 is responsible for this trait. According to them, all humans initially had brown eyes and the OCA2 mutation took place between 6,000 and 10,000 years ago. It dilutes the production of melanin, responsible for the pigmentation of human hair, eye, and skin color. The mutation does not completely switch off melanin production, however, as that would leave the individual with a condition known as albinism. Variations in eye color from brown to green can be explained via the variation in the amounts of melanin produced in the iris. While brown-eyed individuals share a large area in their DNA controlling melanin production, blue-eyed individuals have only a small region. By examining mitochondrial DNA of people from multiple countries, Eiberg and his team concluded blue-eyed individuals all share a common ancestor.

In 2018, an international team of researchers from Israel and the United States announced their genetic analysis of 6,500-year-old excavated human remains in Israel's Upper Galilee region revealed a number of traits not found in the humans who had previously inhabited the area, including blue eyes. They concluded that the region experienced a significant demographic shift 6,000 years ago due to migration from Anatolia and the Zagros mountains (in modern-day Turkey and Iran) and that this change contributed to the development of the Chalcolithic culture in the region.

Bronze Age to Medieval Era

Sickle cell anemia is an adaptation against malaria.

Resistance to malaria is a well-known example of recent human evolution. This disease attacks humans early in life. Thus humans who are resistant enjoy a higher chance of surviving and reproducing. While humans have evolved multiple defenses against malaria, sickle cell anemia—a condition in which red blood cells are deformed into sickle shapes, thereby restricting blood flow—is perhaps the best known. Sickle cell anemia makes it more difficult for the malarial parasite to infect red blood cells. This mechanism of defense against malaria emerged independently in Africa and in Pakistan and India. Within 4,000 years it has spread to 10–15% of the populations of these places. Another mutation that enabled humans to resist malaria that is strongly favored by natural selection and has spread rapidly in Africa is the inability to synthesize the enzyme glucose-6-phosphate dehydrogenase, or G6PD.

A combination of poor sanitation and high population densities proved ideal for the spread of contagious diseases which was deadly for the residents of ancient cities. Evolutionary thinking would suggest that people living in places with long-standing urbanization dating back millennia would have evolved resistance to certain diseases, such as tuberculosis and leprosy. Using DNA analysis and archeological findings, scientists from the University College London and the Royal Holloway studied samples from 17 sites in Europe, Asia, and Africa. They learned that, indeed, long-term exposure to pathogens has led to resistance spreading across urban populations. Urbanization is therefore a selective force that has influenced human evolution. The allele in question is named SLC11A1 1729+55del4. Scientists found that among the residents of places that have been settled for thousands of years, such as Susa in Iran, this allele is ubiquitous whereas in places with just a few centuries of urbanization, such as Yakutsk in Siberia, only 70–80% of the population have it.

Evolution to resist infection of pathogens also increased inflammatory disease risk in post-Neolithic Europeans over the last 10,000 years. A study of ancient DNA estimated nature, strength, and time of onset of selections due to pathogens and also found that "the bulk of genetic adaptation occurred after the start of the Bronze Age, <4,500 years ago".

Adaptations have also been found in modern populations living in extreme climatic conditions such as the Arctic, as well as immunological adaptations such as resistance against prion caused brain disease in populations practicing mortuary cannibalism, or the consumption of human corpses. Inuit have the ability to thrive on the lipid-rich diets consisting of Arctic mammals. Human populations living in regions of high altitudes, such as the Tibetan Plateau, Ethiopia, and the Andes benefit from a mutation that enhances the concentration of oxygen in their blood. This is achieved by having more capillaries, increasing their capacity for carrying oxygen. This mutation is believed to be around 3,000 years old.

The Sama-Bajau have evolved to become durable free divers.

A recent adaptation has been proposed for the Austronesian Sama-Bajau, also known as the Sea Gypsies or Sea Nomads, developed under selection pressures associated with subsisting on free-diving over the past thousand years or so. As maritime hunter-gatherers, the ability to dive for long periods of times plays a crucial role in their survival. Due to the mammalian dive reflex, the spleen contracts when the mammal dives and releases oxygen-carrying red blood cells. Over time, individuals with larger spleens were more likely to survive the lengthy free-dives, and thus reproduce. By contrast, communities centered around farming show no signs of evolving to have larger spleens. Because the Sama-Bajau show no interest in abandoning this lifestyle, there is no reason to believe further adaptation will not occur.

Advances in the biology of genomes have enabled geneticists to investigate the course of human evolution within centuries. Jonathan Pritchard and a postdoctoral fellow, Yair Field, counted the singletons, or changes of single DNA bases, which are likely to be recent because they are rare and have not spread throughout the population. Since alleles bring neighboring DNA regions with them as they move around the genome, the number of singletons can be used to roughly estimate how quickly the allele has changed its frequency. This approach can unveil evolution within the last 2,000 years or a hundred human generations. Armed with this technique and data from the UK10K project, Pritchard and his team found that alleles for lactase persistence, blond hair, and blue eyes have spread rapidly among Britons within the last two millennia or so. Britain's cloudy skies may have played a role in that the genes for light hair could also cause light skin, reducing the chances of vitamin D deficiency. Sexual selection could also favor blond hair. The technique also enabled them to track the selection of polygenic traits—those affected by a multitude of genes, rather than just one—such as height, infant head circumferences, and female hip sizes (crucial for giving birth). They found that natural selection has been favoring increased height and larger head and female hip sizes among Britons. Moreover, lactase persistence showed signs of active selection during the same period. However, evidence for the selection of polygenic traits is weaker than those affected only by one gene.

A 2012 paper studied the DNA sequence of around 6,500 Americans of European and African descent and confirmed earlier work indicating that the majority of changes to a single letter in the sequence (single nucleotide variants) were accumulated within the last 5,000-10,000 years. Almost three quarters arose in the last 5,000 years or so. About 14% of the variants are potentially harmful, and among those, 86% were 5,000 years old or younger. The researchers also found that European Americans had accumulated a much larger number of mutations than African Americans. This is likely a consequence of their ancestors' migration out of Africa, which resulted in a genetic bottleneck; there were few mates available. Despite the subsequent exponential growth in population, natural selection has not had enough time to eradicate the harmful mutations. While humans today carry far more mutations than their ancestors did 5,000 years ago, they are not necessarily more vulnerable to illnesses because these might be caused by multiple mutations. It does, however, confirm earlier research suggesting that common diseases are not caused by common gene variants. In any case, the fact that the human gene pool has accumulated so many mutations over such a short period of time—in evolutionary terms—and that the human population has exploded in that time mean that humanity is more evolvable than ever before. Natural selection might eventually catch up with the variations in the gene pool, as theoretical models suggest that evolutionary pressures increase as a function of population size.

Early Modern Period to present

A study published in 2021 states that the populations of the Cape Verde islands off the coast of West Africa have speedily evolved resistance to malaria within roughly the last 20 generations, since the start of human habitation there. As expected, the residents of the Island of Santiago, where malaria is most prevalent, show the highest prevalence of resistance. This is one of the most rapid cases of change to the human genome measured.

Geneticist Steve Jones told the BBC that during the sixteenth century, only a third of English babies survived until the age of 21, compared to 99% in the twenty-first century. Medical advances, especially those made in the twentieth century, made this change possible. Yet while people from the developed world today are living longer and healthier lives, many are choosing to have just a few or no children at all, meaning evolutionary forces continue to act on the human gene pool, just in a different way.

Natural selection affects only 8% of the human genome, meaning mutations in the remaining parts of the genome can change their frequency by pure chance through neutral selection. If natural selective pressures are reduced, then more mutations survive, which could increase their frequency and the rate of evolution. For humans, a large source of heritable mutations is sperm; a man accumulates more and more mutations in his sperm as he ages. Hence, men delaying reproduction can affect human evolution.

A 2012 study led by Augustin Kong suggests that the number of de novo (new) mutations increases by about two per year of delayed reproduction by the father and that the total number of paternal mutations doubles every 16.5 years.

For a long time, medicine has reduced the fatality of genetic defects and contagious diseases, allowing more and more humans to survive and reproduce, but it has also enabled maladaptive traits that would otherwise be culled to accumulate in the gene pool. This is not a problem as long as access to modern healthcare is maintained. But natural selective pressures will mount considerably if that is taken away. Nevertheless, dependence on medicine rather than genetic adaptations will likely be the driving force behind humanity's fight against diseases for the foreseeable future. Moreover, while the introduction of antibiotics initially reduced the mortality rates due to infectious diseases by significant amounts, abuse has led to the rise of antibiotic-resistant strains of bacteria, making many illnesses major causes of death once again.

Many humans today have jaws that are too small to accommodate their wisdom teeth.

Human jaws and teeth have been shrinking in proportion with the decrease in body size in the last 30,000 years as a result of new diets and technology. There are many individuals today who do not have enough space in their mouths for their third molars (or wisdom teeth) due to reduced jaw sizes. In the twentieth century, the trend toward smaller teeth appeared to have been slightly reversed due to the introduction of fluoride, which thickens dental enamel, thereby enlarging the teeth.

Recent research suggests that menopause is evolving to occur later. Other reported trends appear to include lengthening of the human reproductive period and reduction in cholesterol levels, blood glucose and blood pressure in some populations.

Population geneticist Emmanuel Milot and his team studied recent human evolution in an isolated Canadian island using 140 years of church records. They found that selection favored younger age at first birth among women. In particular, the average age at first birth of women from Coudres Island (Île aux Coudres), 80 km (50 mi) northeast of Québec City, decreased by four years between 1800 and 1930. Women who started having children sooner generally ended up with more children in total who survive until adulthood. In other words, for these French-Canadian women, reproductive success was associated with lower age at first childbirth. Maternal age at first birth is a highly heritable trait.

Human evolution continues during the modern era, including among industrialized nations. Things like access to contraception and the freedom from predators do not stop natural selection. Among developed countries, where life expectancy is high and infant mortality rates are low, selective pressures are the strongest on traits that influence the number of children a human has. It is speculated that alleles influencing sexual behavior would be subject to strong selection, though the details of how genes can affect said behavior remain unclear.

Historically, as a by-product of the ability to walk upright, humans evolved to have narrower hips and birth canals and to have larger heads. Compared to other close relatives such as chimpanzees, childbirth is a highly challenging and potentially fatal experience for humans. Thus began an evolutionary tug-of-war (see Obstetrical dilemma). For babies, having larger heads proved beneficial as long as their mothers' hips were wide enough. If not, both mother and child typically died. This is an example of balancing selection, or the removal of extreme traits. In this case, heads that were too large or hips that were too small were selected against. This evolutionary tug-of-war attained an equilibrium, making these traits remain more or less constant over time while allowing for genetic variation to flourish, thus paving the way for rapid evolution should selective forces shift their direction.

All this changed in the twentieth century as Cesarean sections (or C-sections) became safer and more common in some parts of the world. Larger head sizes continue to be favored while selective pressures against smaller hip sizes have diminished. Projecting forward, this means that human heads would continue to grow while hip sizes would not. As a result of increasing fetopelvic disproportion, C-sections would become more and more common in a positive feedback loop, though not necessarily to the extent that natural childbirth would become obsolete.

Paleoanthropologist Briana Pobiner of the Smithsonian Institution noted that cultural factors could play a role in the widely different rates of C-sections across the developed and developing worlds. Daghni Rajasingam of the Royal College of Obstetricians observed that the increasing rates of diabetes and obesity among women of reproductive age also boost the demand for C-sections. Biologist Philipp Mitteroecker from the University of Vienna and his team estimated that about six percent of all births worldwide were obstructed and required medical intervention. In the United Kingdom, one quarter of all births involved the C-section while in the United States, the number was one in three. Mitteroecker and colleagues discovered that the rate of C-sections has gone up 10% to 20% since the mid-twentieth century. They argued that because the availability of safe Cesarean sections significantly reduced maternal and infant mortality rates in the developed world, they have induced an evolutionary change. However, "It's not easy to foresee what this will mean for the future of humans and birth," Mitteroecker told The Independent. This is because the increase in baby sizes is limited by the mother's metabolic capacity and modern medicine, which makes it more likely that neonates who are born prematurely or are underweight to survive.

Westerners are evolving to have lower blood pressures because their modern diets contain high amounts of salt (NaCl), which raises blood pressure.

Researchers participating in the Framingham Heart Study, which began in 1948 and was intended to investigate the cause of heart disease among women and their descendants in Framingham, Massachusetts, found evidence for selective pressures against high blood pressure due to the modern Western diet, which contains high amounts of salt, known for raising blood pressure. They also found evidence for selection against hypercholesterolemnia, or high levels of cholesterol in the blood. Evolutionary geneticist Stephen Stearns and his colleagues reported signs that women were gradually becoming shorter and heavier. Stearns argued that human culture and changes humans have made on their natural environments are driving human evolution rather than putting the process to a halt. The data indicates that the women were not eating more; rather, the ones who were heavier tended to have more children. Stearns and his team also discovered that the subjects of the study tended to reach menopause later; they estimated that if the environment remains the same, the average age at menopause will increase by about a year in 200 years, or about ten generations. All these traits have medium to high heritability. Given the starting date of the study, the spread of these adaptations can be observed in just a few generations.

By analyzing genomic data of 60,000 individuals of Caucasian descent from Kaiser Permanente in Northern California, and of 150,000 people in the UK Biobank, evolutionary geneticist Joseph Pickrell and evolutionary biologist Molly Przeworski were able to identify signs of biological evolution among living human generations. For the purposes of studying evolution, one lifetime is the shortest possible time scale. An allele associated with difficulty withdrawing from tobacco smoking dropped in frequency among the British but not among the Northern Californians. This suggests that heavy smokers—who were common in Britain during the 1950s but not in Northern California—were selected against. A set of alleles linked to later menarche was more common among women who lived for longer. An allele called ApoE4, linked to Alzheimer's disease, fell in frequency as carriers tended to not live for very long. In fact, these were the only traits that reduced life expectancy Pickrell and Przeworski found, which suggests that other harmful traits probably have already been eradicated. Only among older people are the effects of Alzheimer's disease and smoking visible. Moreover, smoking is a relatively recent trend. It is not entirely clear why such traits bring evolutionary disadvantages, however, since older people have already had children. Scientists proposed that either they also bring about harmful effects in youth or that they reduce an individual's inclusive fitness, or the tendency of organisms that share the same genes to help each other. Thus, mutations that make it difficult for grandparents to help raise their grandchildren are unlikely to propagate throughout the population. Pickrell and Przeworski also investigated 42 traits determined by multiple alleles rather than just one, such as the timing of puberty. They found that later puberty and older age of first birth were correlated with higher life expectancy.

Larger sample sizes allow for the study of rarer mutations. Pickrell and Przeworski told The Atlantic that a sample of half a million individuals would enable them to study mutations that occur among only 2% of the population, which would provide finer details of recent human evolution. While studies of short time scales such as these are vulnerable to random statistical fluctuations, they can improve understanding of the factors that affect survival and reproduction among contemporary human populations.

Evolutionary geneticist Jaleal Sanjak and his team analyzed genetic and medical information from more than 200,000 women over the age of 45 and 150,000 men over the age of 50—people who have passed their reproductive years—from the UK Biobank and identified 13 traits among women and ten among men that were linked to having children at a younger age, having a higher body-mass index, fewer years of education, and lower levels of fluid intelligence, or the capacity for logical reasoning and problem solving. Sanjak noted, however, that it was not known whether having children actually made women heavier or being heavier made it easier to reproduce. Because taller men and shorter women tended to have more children and because the genes associated with height affect men and women equally, the average height of the population will likely remain the same. Among women who had children later, those with higher levels of education had more children.

Evolutionary biologist Hakhamanesh Mostafavi led a 2017 study that analyzed data of 215,000 individuals from just a few generations in the United Kingdom and the United States and found a number of genetic changes that affect longevity. The ApoE allele linked to Alzheimer's disease was rare among women aged 70 and over while the frequency of the CHRNA3 gene associated with smoking addiction among men fell among middle-aged men and up. Because this is not itself evidence of evolution, since natural selection only cares about successful reproduction not longevity, scientists have proposed a number of explanations. Men who live longer tend to have more children. Men and women who survive until old age can help take care of both their children and grandchildren, in benefits their descendants down the generations. This explanation is known as the grandmother hypothesis. It is also possible that Alzheimer's disease and smoking addiction are also harmful earlier in life, but the effects are more subtle and larger sample sizes are required in order to study them. Mostafavi and his team also found that mutations causing health problems such as asthma, having a high body-mass index and high cholesterol levels were more common among those with shorter lifespans while mutations leading to delayed puberty and reproduction were more common among long living individuals. According to geneticist Jonathan Pritchard, while the link between fertility and longevity was identified in previous studies, those did not entirely rule out the effects of educational and financial status—people who rank high in both tend to have children later in life; this seems to suggest the existence of an evolutionary trade-off between longevity and fertility.

In South Africa, where large numbers of people are infected with HIV, some have genes that help them combat this virus, making it more likely that they would survive and pass this trait onto their children. If the virus persists, humans living in this part of the world could become resistant to it in as little as hundreds of years. However, because HIV evolves more quickly than humans, it will more likely be dealt with technologically rather than genetically.

The Amish have a mutation that extends their life expectancy and reduces their susceptibility to diabetes.

A 2017 study by researchers from Northwestern University unveiled a mutation among the Old Order Amish living in Berne, Indiana, that suppressed their chances of having diabetes and extends their life expectancy by about ten years on average. That mutation occurred in the gene called Serpine1, which codes for the production of the protein PAI-1 (plasminogen activator inhibitor), which regulates blood clotting and plays a role in the aging process. About 24% of the people sampled carried this mutation and had a life expectancy of 85, higher than the community average of 75. Researchers also found the telomeres—non-functional ends of human chromosomes—of those with the mutation to be longer than those without. Because telomeres shorten as the person ages, those with longer telomeres tend to live longer. At present, the Amish live in 22 U.S. states plus the Canadian province of Ontario. They live simple lifestyles that date back centuries and generally insulate themselves from modern North American society. They are mostly indifferent towards modern medicine, but scientists do have a healthy relationship with the Amish community in Berne. Their detailed genealogical records make them ideal subjects for research.

In 2020, Teghan Lucas, Maciej Henneberg, Jaliya Kumaratilake gave evidence that a growing share of the human population retained the median artery in their forearms. This structure forms during fetal development but dissolves once two other arteries, the radial and ulnar arteries, develop. The median artery allows for more blood flow and could be used as a replacement in certain surgeries. Their statistical analysis suggested that the retention of the median artery was under extremely strong selection within the last 250 years or so. People have been studying this structure and its prevalence since the eighteenth century.

Multidisciplinary research suggests that ongoing evolution could help explain the rise of certain medical conditions such as autism and autoimmune disorders. Autism and schizophrenia may be due to genes inherited from the mother and the father which are over-expressed and which fight a tug-of-war in the child's body. Allergies, asthma, and autoimmune disorders appear linked to higher standards of sanitation, which prevent the immune systems of modern humans from being exposed to various parasites and pathogens the way their ancestors' were, making them hypersensitive and more likely to overreact. The human body is not built from a professionally engineered blue print but a system shaped over long periods of time by evolution with all kinds of trade-offs and imperfections. Understanding the evolution of the human body can help medical doctors better understand and treat various disorders. Research in evolutionary medicine suggests that diseases are prevalent because natural selection favors reproduction over health and longevity. In addition, biological evolution is slower than cultural evolution and humans evolve more slowly than pathogens.

Whereas in the ancestral past, humans lived in geographically isolated communities where inbreeding was rather common, modern transportation technologies have made it much easier for people to travel great distances and facilitated further genetic mixing, giving rise to additional variations in the human gene pool. It also enables the spread of diseases worldwide, which can have an effect on human evolution. Furthermore, climate change may trigger the mass migration of not just humans but also diseases affecting humans. Besides the selection and flow of genes and alleles, another mechanism of biological evolution is epigenetics, or changes not to the DNA sequence itself, but rather the way it is expressed. Scientists already know that chronic illnesses and stress are epigenetic mechanisms.

Myalgic encephalomyelitis/chronic fatigue syndrome

From Wikipedia, the free encyclopedia
Myalgic encephalomyelitis/chronic fatigue syndrome
Icons of the four key ME/CFS symptoms: low battery for profound fatigue, weak muscle for post-exertional malaise, bed for sleep problems and crossed wires in brain for cognitive difficulties.
The four primary symptoms of ME/CFS according to the National Institute for Health and Care Excellence
SpecialtyRheumatology, rehabilitation medicine, endocrinology, infectious disease, neurology, immunology, general practice, paediatrics, other specialists in ME/CFS
SymptomsWorsening of symptoms with activity, long-term fatigue, sleep problems, others
Usual onsetPeaks at 10–19 and 30–39 years old
DurationLong-term
CausesUnknown
Risk factorsBeing female, family history, viral infections
Diagnostic methodBased on symptoms
TreatmentSymptomatic
PrevalenceAbout 0.17% to 0.89% (pre-COVID-19 pandemic)

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling chronic illness. People with ME/CFS experience profound fatigue that does not go away with rest, sleep issues and problems with memory or concentration. Further common symptoms include dizziness, nausea and pain. The hallmark symptom is a worsening of the illness which starts hours to days after minor physical or mental activity. This "crash" can last from hours or days to several months.

The cause of the disease is unknown. ME/CFS often starts after an infection, such as mononucleosis. It can run in families, but no genes that contribute to ME/CFS have been confirmed. ME/CFS is associated with changes in the nervous and immune systems, as well as in energy production. Diagnosis is based on symptoms because no diagnostic test is available.

The illness can improve or worsen over time, but full recovery is uncommon. No therapies or medications are approved to treat the condition, and management is aimed at relieving symptoms. Pacing of activities can help avoid worsening symptoms, and counselling may help in coping with the illness. Before the COVID-19 pandemic, ME/CFS affected 2 to 9 out of every 1000 people, depending on the definition. However, many people, after contracting long COVID, fit ME/CFS diagnostic criteria. ME/CFS occurs more often in women than in men. It most commonly affects adults between ages 40 and 60 but can occur at other ages, including childhood.

ME/CFS has a large social and economic impact, and the disease can be socially isolating. About a quarter of those affected are unable to leave their bed or home. People with ME/CFS often face stigma in healthcare settings, and care is complicated by controversies around the cause and treatments of the illness. Doctors may be unfamiliar with ME/CFS, as it is often not fully covered in medical school. Historically, research funding for ME/CFS has been far below that of diseases with comparable impact.

Classification and terminology

ME/CFS has been classified as a neurological disease by the World Health Organization (WHO) since 1969, initially under the name benign myalgic encephalomyelitis. The classification of ME/CFS as a neurological disease is based on symptoms, which indicate a central role of the nervous system. Alternatively, based on abnormalities in immune cells, ME/CFS is sometimes labelled a neuroimmune condition. The disease can further be regarded as a post-acute infection syndrome (PAIS) or an infection-associated chronic illness. PAISs such as long COVID and post-treatment Lyme disease syndrome share many symptoms with ME/CFS and are suspected to have a similar cause.

Many names have been proposed for the illness. The most commonly used are chronic fatigue syndrome, myalgic encephalomyelitis, and the umbrella term myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Reaching consensus on a name has been challenging because the cause and pathology remain unknown. In the WHO's most recent classification, the ICD-11, chronic fatigue syndrome and myalgic encephalomyelitis are named under post-viral fatigue syndrome. The term post-infectious fatigue syndrome was initially proposed as a subset of 'chronic fatigue syndrome' with a documented triggering infection, but might also be used as a synonym of ME/CFS or as a broader set of fatigue conditions after infection.

Many individuals with ME/CFS object to the term chronic fatigue syndrome. They consider the term simplistic and trivialising, which in turn prevents the illness from being taken seriously. At the same time, there are also issues with the use of myalgic encephalomyelitis (myalgia means muscle pain and encephalomyelitis means brain and spinal cord inflammation), as there is only limited evidence of brain inflammation implied by the name. The umbrella term ME/CFS would retain the better-known phrase CFS without trivialising the disease, but some people object to this name too, as they see CFS and ME as distinct illnesses.

A 2015 report from the US Institute of Medicine recommended the illness be renamed systemic exertion intolerance disease (SEID) and suggested new diagnostic criteria. While the new name was not widely adopted, the diagnostic criteria were taken over by the CDC. Like CFS, the name SEID only focuses on a single symptom, and opinion from those affected was generally negative.

Signs and symptoms

ME/CFS causes debilitating fatigue, sleep problems, and post-exertional malaise (PEM, overall symptoms getting worse after mild activity). In addition, cognitive issues, orthostatic intolerance (dizziness or nausea when upright) or other physical symptoms may be present (see also § Diagnostic criteria). Symptoms significantly reduce the ability to function and typically last for three to six months before a diagnosis can be confirmed. ME/CFS usually starts after an infection. Onset can be sudden or more gradual over weeks to months.

Core symptoms

People with ME/CFS experience persistent debilitating fatigue. It is made worse by normal physical, mental, emotional, and social activity, and is not a result of ongoing overexertion. Rest provides limited relief from fatigue. Particularly in the initial period of illness, this fatigue is described as "flu-like". Individuals may feel restless and describe their experience as "wired but tired". When starting an activity, muscle strength may drop rapidly, which can lead to difficulty with coordination, clumsiness or sudden weakness. Mental fatigue may make cognitive efforts difficult. The fatigue experienced in ME/CFS is of a longer duration and greater severity than in other conditions characterized by fatigue.

The hallmark feature of ME/CFS is a worsening of symptoms after exertion, known as post-exertional malaise or post-exertional symptom exacerbation. PEM involves increased fatigue and is disabling. It can also include flu-like symptoms, pain, cognitive difficulties, gastrointestinal issues, nausea, and sleep problems.

The onset of PEM is usually within two days. Peak PEM occurs within seven, while recovery can take months.
Typical timeframes of post-exertional malaise after normal daily activities

All types of activities that require energy, whether physical, cognitive, social, or emotional, can trigger PEM. Examples include attending a school event, food shopping, or even taking a shower. For some, being in a stimulating environment can be sufficient to trigger PEM. PEM usually starts 12 to 48 hours after the activity, but can also follow immediately after. PEM can last hours, days, weeks, or months. Extended periods of PEM, commonly referred to as "crashes" or "flare-ups" by people with the illness, can lead to a prolonged relapse.

Unrefreshing sleep is a further core symptom. People wake up exhausted and stiff rather than restored after a night's sleep. This can be caused by a pattern of sleeping during the day and being awake at night, shallow sleep, or broken sleep. However, even a full night's sleep is typically non-restorative. Some individuals experience insomnia, hypersomnia (excessive sleepiness), or vivid nightmares.

Cognitive dysfunction in ME/CFS can be as disabling as physical symptoms, leading to difficulties at work or school, as well as in social interactions. People with ME/CFS sometimes describe it as "brain fog", and report a slowdown in information processing. Individuals may have difficulty speaking, struggling to find words and names. They may have trouble concentrating or multitasking, or may have difficulties with short-term memory. Tests often show problems with short-term visual memory, reaction time and reading speed. There may also be problems with attention and verbal memory.

People with ME/CFS often experience orthostatic intolerance, symptoms that start or worsen with standing or sitting. Symptoms, which include nausea, lightheadedness, and cognitive impairment, often improve again after lying down. Weakness and vision changes may also be triggered by the upright posture. Some have postural orthostatic tachycardia syndrome (POTS), an excessive increase in heart rate after standing up, which can result in fainting. Additionally, individuals may experience orthostatic hypotension, a drop in blood pressure after standing.

Other common symptoms

Pain and hyperalgesia (an abnormally increased sensitivity to pain) are common in ME/CFS. The pain is not accompanied by swelling or redness. The pain can be present in muscles (myalgia) and joints. Individuals with ME/CFS may have chronic pain behind the eyes and in the neck, as well as neuropathic pain (related to disorders of the nervous system). Headaches and migraines that were not present before the illness can occur as well. However, chronic daily headaches may indicate an alternative diagnosis.

Additional common symptoms include irritable bowel syndrome or other problems with digestion, chills and night sweats, shortness of breath or an irregular heartbeat. Some experience sore lymph nodes and a sore throat. People may also develop allergies or become sensitive to foods, lights, noise, smells or chemicals.

Illness severity

ME/CFS often leads to serious disability, but the degree varies considerably. ME/CFS is generally classified into four categories of illness severity:

  • People with mild ME/CFS can usually still work and care for themselves, but they will need their free time to recover from these activities rather than engage in social and leisure activities.
  • Moderate severity impedes activities of daily living (self-care activities, such as making a meal). People are usually unable to work and require frequent rest.
  • Those with severe ME/CFS are homebound and can do only limited activities of daily living, for instance brushing their teeth. They may be wheelchair-dependent and spend the majority of their time in bed.
  • With very severe ME/CFS, people are mostly bedbound and cannot care for themselves.
A bar graph showing the average quality of life score of those with ME/CFS.
Results of a study on the quality of life of individuals with ME/CFS, showing it to be lower than in 20 other chronic conditions

Roughly a quarter of those living with ME/CFS fall into the mild category, and half fall into the moderate or moderate-to-severe categories. The final quarter falls into the severe or very severe category. Severity may change over time. Symptoms might get worse, improve or the illness may go into remission for a period. People who feel better for a period may overextend their activities, triggering PEM and a worsening of symptoms.

Those with severe and very severe ME/CFS experience more extreme and diverse symptoms. They may face severe weakness and greatly limited ability to move. They can lose the ability to speak, swallow, or communicate completely due to cognitive issues. They can further experience severe pain and hypersensitivities to touch, light, sound, and smells. Minor day-to-day activities can be sufficient to trigger PEM.

Individuals with ME/CFS have decreased quality of life when evaluated by the SF-36 questionnaire, especially in the domains of physical and social functioning, general health, and vitality. However, their emotional functioning and mental health are not much lower than those of healthy individuals. Functional impairment in ME/CFS can be greater than multiple sclerosis, heart disease, or lung cancer. Fewer than half of people with ME/CFS are employed, and roughly one in five have a full-time job.

Causes

The cause of ME/CFS is not yet known. Between 60% and 80% of cases start after an infection, usually a viral infection. A genetic factor is believed to contribute, but there is no single gene responsible for increased risk. Instead, many gene variants probably have a small individual effect, but their combined effect can be strong. Problems with the nervous and immune systems and energy metabolism may be factors. ME/CFS is a biological disease, not a psychological condition, and is not due to deconditioning.

Besides viruses, other reported triggers include stress, traumatic events, and environmental exposures such as to mould. Bacterial infections such as Q-fever are other potential triggers. ME/CFS may further occur after physical trauma, such as an accident or surgery. Pregnancy has been reported in around 3% to 10% of cases as a trigger. ME/CFS can also begin with multiple minor triggering events, followed by a final trigger that leads to a clear onset of symptoms.

Risk factors

ME/CFS can affect people of all ages, ethnicities, and income levels, but it is more common in women than men. People with a history of frequent infections are more likely to develop it. Those with family members who have ME/CFS are also at higher risk, suggesting a genetic factor. In the United States, white Americans are diagnosed more frequently than other groups, but the illness is probably at least as prevalent among African Americans and Hispanics. It used to be thought that ME/CFS was more common among those with higher incomes. Instead, people in minority groups or lower income groups may have increased risks due to poorer nutrition, lower healthcare access, and increased work stress.

Viral infections

Viral infections have long been suspected to cause ME/CFS, based on the observation that ME/CFS sometimes occurs in outbreaks and is possibly connected to autoimmune diseases. How viral infections cause ME/CFS is unclear; it could be via viral persistence or via a "hit and run" mechanism, in which infections dysregulate the immune system or cause autoimmunity.

Different types of viral infection have been implicated in ME/CFS, including airway infections, bronchitis, gastroenteritis, or an acute "flu-like illness". Between 15% and 50% of people with long COVID also meet the diagnostic criteria for ME/CFS. Of people who get infectious mononucleosis, which is caused by the Epstein–Barr virus (EBV), around 8% to 15% develop ME/CFS, depending on criteria. Other viral infections that can trigger ME/CFS are the H1N1 influenza virus, varicella zoster (the virus that causes chickenpox and shingles), and SARS-CoV-1.

Reactivation of latent viruses, in particular EBV and human herpesvirus 6, has also been hypothesised to drive symptoms. EBV is present in about 90% of people, usually in a latent state. The levels of antibodies to EBV are commonly higher in people with ME/CFS, indicating possible viral reactivation.

Pathophysiology

ME/CFS is associated with changes in several areas, including the nervous and immune systems, as well as disturbances in energy metabolism. Neurological differences include autonomic nervous system dysfunction and a change in brain structure and metabolism. Observed changes in the immune system include decreased natural killer cell function and, in some cases, autoimmunity.

Neurological

A range of structural, biochemical, and functional abnormalities are found in brain imaging studies of people with ME/CFS. Common findings are changes in the brainstem and the use of additional brain areas for cognitive tasks. Other consistent findings, based on a smaller number of studies, are low metabolism in some areas, reduced serotonin transporters, and problems with neurovascular coupling.

Neuroinflammation has been proposed as an underlying mechanism of ME/CFS that could explain a large set of symptoms. Several studies suggest neuroinflammation in the cortical and limbic regions of the brain. Individuals with ME/CFS, for instance, have higher brain lactate and choline levels, which are signs of neuroinflammation. More direct evidence from two small PET studies of microglia, a type of immune cell in the brain, were contradictory, however.

ME/CFS affects sleep. Individuals experience decreased sleep efficiency, take longer to fall asleep, and take longer to achieve REM sleep, a phase of sleep characterised by rapid eye movement. Changes to non-REM sleep have also been found, together suggesting a role of the autonomic nervous system. Individuals often have a blunted heart rate response to exercise, but a higher heart rate during a tilt table test when the body is rotated from lying flat to an upright position. This again suggests dysfunction in the autonomic nervous system.

Immunological

People with ME/CFS often have immune system abnormalities. A consistent finding in studies is a decreased function of natural killer cells, a type of immune cell that targets virus-infected and tumour cells. They are also more likely to have active viral infections, correlating with cognitive issues and fatigue. T cells show less metabolic activity. This may reflect they have reached an exhausted state and cannot respond effectively against pathogens.

Autoimmunity has been proposed to be a factor in ME/CFS. There is a subset of people with ME/CFS with increased levels of autoantibodies, possibly as a result of viral mimicry. Some may have higher levels of autoantibodies to muscarinic acetylcholine receptors as well as to β2 adrenergic receptors. Problems with these receptors can lead to impaired blood flow.

Energy

A scatterplot with fifty datapoints. They show that people with ME/CFS score worse in work rate at ventilatory threshold than those with unexplained chronic fatigue on the second day of a 2-day exercise test.
When people with ME/CFS exercise on consecutive days, their performance declines on the second day, unlike those with unexplained chronic fatigue (ICF).

Objective signs of PEM have been found with the 2-day cardiopulmonary exercise test. People with ME/CFS have lower performance compared to healthy controls on the first test. On the second test, healthy people's scores stay roughly the same or increase slightly, while those with ME/CFS have a clinically significant decrease in work rate at the anaerobic threshold. Potential causes include mitochondrial dysfunction, and issues with the transport and use of oxygen. Some of the usual recovery processes following exercise may be lacking, providing an alternative explanation for PEM.

Studies have observed mitochondrial abnormalities in cellular energy production, but differences between studies make it hard to draw clear conclusions. ATP, the primary energy carrier in cells, is likely more frequently produced from lipids and amino acids than from carbohydrates.

Other

Some people with ME/CFS have abnormalities in their hypothalamic–pituitary–adrenal axis hormones. This can include lower cortisol levels, less change in cortisol levels throughout the day, and a weaker reaction to stress and stimuli. Other proposed abnormalities are reduced blood flow to the brain under orthostatic stress (as found in a tilt table test), small-fibre neuropathy, and an increase in the amount of gut microbes entering the blood. The diversity of gut microbes is reduced compared to healthy controls. Women with ME/CFS are more likely to experience endometriosis, early menopause, and other menstrual irregularities compared to women without the condition.

Diagnosis

Diagnosis of ME/CFS is based on symptoms and involves taking a medical history and a mental and physical examination. No specific lab tests are approved for diagnosis; while physical abnormalities can be found, no single finding is considered sufficient for diagnosis. Blood and urine tests are used to rule out other conditions that could be responsible for the symptoms. People with ME/CFS often face significant delays in obtaining a diagnosis, and diagnoses may be missed altogether. Specialists in ME/CFS may be asked to confirm the diagnosis, as primary care physicians often lack a good understanding of the illness.

Diagnostic criteria

ME/CFS symptoms according to five diagnostic criteria
Symptom
M: Mandatory
O: Optional
Fukuda
CCC
ICC
IOM
NICE
Fatigue M M M M M
Functional impairment M M M M M
PEM O M M M M
Sleep problems O M O M M
Cognitive issues O O O O M
Pain or headaches O M O

Orthostatic intolerance
O O O
Flu or cold symptoms O O O

Nausea
O O

Cardiovascular problems
O O

Hypersensitivities
O O

Susceptibility to infection

O

Multiple research and clinical criteria exist to diagnose ME/CFS. These include the NICE guidelines, Institute of Medicine (IOM) criteria, the International Consensus Criteria (ICC), the Canadian Consensus Criteria (CCC), and CDC criteria. The criteria sets were all developed based on expert consensus and differ in the required symptoms and which conditions preclude a diagnosis of ME/CFS. The definitions differ in their conceptualisation of the cause and mechanisms of ME/CFS.

As there is no biomarker for ME/CFS, it is not possible to determine which set of criteria is the most accurate. A trade-off must be made between overdiagnosis and missing more diagnoses. The broad Fukuda criteria have a higher risk of overdiagnosis, whereas the strict ICC criteria have a higher risk of missing people. The IOM and NICE criteria fall in the middle.

The 1994 CDC criteria, sometimes called the Fukuda criteria, require six months of persistent or relapsing fatigue for diagnosis, as well as the persistent presence of four out of eight other symptoms. While used frequently, the Fukuda criteria have limitations: PEM and cognitive issues are not mandatory. The large variety of optional symptoms can lead to diagnosis of individuals who differ significantly from each other.

The Canadian Consensus Criteria, another commonly used criteria set, was developed in 2003. In addition to PEM, fatigue and sleep problems, pain and neurological or cognitive issues are required for diagnosis. Furthermore, three categories of symptoms are defined (orthostatic, thermal instability, and immunological). At least one symptom in two of these categories needs to be present. People diagnosed under the CCC have more severe symptoms compared to those diagnosed under the Fukuda criteria. The 2011 International Consensus Criteria defines ME using symptom clusters and has no minimum duration of symptoms. Similarly to the CCC criteria, ICC is stricter than the Fukuda criteria and selects more severely ill people.

The 2015 IOM criteria share significant similarities with the CCC but were developed to be easy to use for clinicians. Diagnosis requires fatigue, PEM, non-restorative sleep, and either cognitive issues (such as memory impairment) or orthostatic intolerance. Additionally, fatigue must persist for at least six months, substantially impair activities in all areas of life, and have a clearly defined onset. Symptoms must be present at least half of the time, and be of moderate severity or worse; previous criteria just required symptoms to be present. In 2021, NICE revised its criteria based on the IOM criteria. The updated criteria require fatigue, PEM, non-restorative sleep, and cognitive difficulties persisting for at least three months.

Separate diagnostic criteria have been developed for children and young people. A diagnosis for children often requires a shorter symptom duration. For example, the CCC definition only requires three months of persistent symptoms in children compared to six months for adults. NICE requires only four weeks of symptoms to suspect ME/CFS in children, compared to six weeks in adults. Exclusionary diagnoses also differ; for instance, children and teenagers may have anxiety related to school attendance, which could explain symptoms.

Clinical assessment

A leaflet from the CDC describing the Institute of Medicine criteria for ME/CFS.
Could You Have ME/CFS? handout from the US Centers for Disease Control and Prevention

Screening can be done using the DePaul Symptom Questionnaire, which assesses the frequency and severity of ME/CFS symptoms. Individuals may struggle to answer questions related to PEM, if they are unfamiliar with the symptom. To find patterns in symptoms, they may be asked to keep a diary.

A physical exam may appear completely normal, particularly if the individual has rested substantially before a doctor's visit. There may be tenderness in the lymph nodes and abdomen or signs of hypermobility. Answers to questions may show a temporary difficulty with finding words or other cognitive problems. Cognitive tests and a two-day cardiopulmonary exercise test (CPET) can be helpful to document aspects of the illness, but they may be risky as they can cause severe PEM. They may be warranted to support a disability claim. Orthostatic intolerance can be measured with a tilt table test. If that is unavailable, it can also be assessed with the simpler NASA 10-minute lean test, which tests the response to prolonged standing.

Standard laboratory findings are usually normal. Standard tests when suspecting ME/CFS include an HIV test, and blood tests to determine full blood count, red blood cell sedimentation rate (ESR), C-reactive protein, blood glucose and thyroid-stimulating hormone. Tests for antinuclear antibodies may come back positive, but below the levels that suggest the individual may have lupus. C-reactive protein levels are often at the high end of normal. Serum ferritin levels may be useful to test, as borderline anaemia can make some ME/CFS symptoms worse.

Differential diagnosis

Some medical conditions have symptoms similar to ME/CFS. Diagnosis often involves clinical evaluation, testing, and specialist referrals to identify the correct condition. During the time other possible diagnoses are explored, advice can be given on symptom management to help prevent the condition from getting worse. Before a diagnosis of ME/CFS is confirmed, a waiting period is used to exclude acute medical conditions or symptoms which may resolve within that time frame.

Possible differential diagnoses span a large set of specialties and depend on the medical history. Examples are infectious diseases, such as Epstein–Barr virus and Lyme disease, and neuroendocrine disorders, including diabetes and hypothyroidism. Blood disorders, such as anaemia, and some cancers may also present similar symptoms. Various rheumatological and autoimmune diseases, such as Sjögren's syndrome, lupus, and arthritis, may have overlapping symptoms with ME/CFS. Furthermore, it may be necessary to evaluate psychiatric diseases, such as depression or substance use disorder, as well as neurological disorders, such as narcolepsy, multiple sclerosis, and craniocervical instability. Finally, sleep disorders, coeliac disease, and side effects of medications may also explain symptoms.

Joint and muscle pain without swelling or inflammation is a common feature of ME/CFS, but is more closely associated with fibromyalgia. Modern definitions of fibromyalgia not only include widespread pain but also fatigue, sleep disturbances, and cognitive issues. This makes it difficult to distinguish ME/CFS from fibromyalgia and the two are often co-diagnosed.

Another common condition that often co-occurs with ME/CFS is hypermobile Ehlers–Danlos syndrome (EDS). Unlike ME/CFS, EDS is present from birth. People with ME/CFS are more often hypermobile compared to the general population. Sleep apnea may also co-occur with ME/CFS. However, many diagnostic criteria require ruling out sleep disorders before confirming a diagnosis of ME/CFS.

Like with other chronic illnesses, depression and anxiety co-occur frequently with ME/CFS. Depression may be differentially diagnosed by the presence of feelings of worthlessness, the inability to feel pleasure, loss of interest, and/or guilt, and the absence of ME/CFS bodily symptoms such as autonomic dysfunction, pain, migraines, and PEM. People with chronic fatigue, which is not due to ME/CFS or other chronic illnesses, may be diagnosed with idiopathic (unexplained) chronic fatigue.

Management

There is no approved drug treatment or cure for ME/CFS, although some symptoms can be treated or managed. Care for ME/CFS is multidisciplinary. Usually, the primary care clinician plays an important role in coordinating health care, social care and educational support for those still in school. This coordinator can help provide access to community resources such as occupational therapy and district nursing. Management may start with treating the most disabling symptom first, and tackle symptoms one by one in further health care visits.

Pacing, or managing one's activities to stay within energy limits, can reduce episodes of PEM. Addressing sleep problems with good sleep hygiene, or medication if required, may be beneficial. Chronic pain is common in ME/CFS, and the CDC recommends consulting with a pain management specialist if over-the-counter painkillers are insufficient. For cognitive impairment, adaptations like organisers and calendars may be helpful.

Co-occurring conditions that may interact with and worsen ME/CFS symptoms are common, and treating these may help manage ME/CFS. Commonly diagnosed ones include fibromyalgia, irritable bowel syndrome, migraines and mast cell activation syndrome. The debilitating nature of ME/CFS can cause depression, anxiety, or other psychological problems, which can be treated. People with ME/CFS may be unusually sensitive to medications, especially ones that affect the central nervous system.

Pacing and energy management

A smart watch displaying heart rate on a person's wrist
A heart rate monitor can be helpful for energy management.

Pacing, or activity management, involves balancing periods of rest with periods of activity. The goal of pacing is to stabilize the illness and avoid triggering PEM. This involves staying within an individual's available energy envelope to reduce the PEM "payback" caused by overexertion. The technique was developed for ME/CFS in the 1980s.

Pacing can involve breaking up large tasks into smaller ones and taking extra breaks, or creating easier ways to do activities. For example, this might include sitting down while doing the laundry. The decision to stop an activity (and rest or change an activity) is determined by self-awareness of a worsening of symptoms. Use of a heart rate monitor may help some individuals with pacing.

Research on pacing and energy envelope theory typically shows positive effects. However, these studies have often had a low number of participants and have rarely included methods to check if study participants implemented pacing well. Pacing is difficult to apply for people with very severe ME/CFS, as the activities that trigger PEM in this group, such as eating, cannot be avoided completely.

Those with a stable illness who understand how to "listen to their body" may be able to carefully and flexibly increase their activity levels.[29] The goal of an exercise programme would be to increase stamina, while not interfering with everyday tasks or making the illness more severe. In many chronic illnesses, intense exercise is beneficial, but in ME/CFS it is not recommended. The CDC states:

Vigorous aerobic exercise can benefit people with many chronic illnesses. But people with ME/CFS do not tolerate such exercise routines. Standard exercise recommendations for healthy people can be harmful for patients with ME/CFS. However, it is important that patients with ME/CFS undertake activities that they can tolerate.

Graded exercise therapy (GET), a proposed treatment for ME/CFS that assumes deconditioning and a fear of activity play important roles in maintaining the illness, is no longer recommended for people with ME/CFS. Reviews of GET either see weak evidence of a small to moderate effect or no evidence of effectiveness. GET can have serious adverse effects. Similarly, a form of cognitive behavioural therapy (CBT) that assumed the illness is maintained by unhelpful beliefs about the illness and avoidance of activity is no longer recommended.

Symptom relief

The first management step for sleep problems in ME/CFS is improving sleep habits. If sleep problems remain after implementing sleep hygiene routines, cognitive behavioural therapy for insomnia can be offered. Avoiding naps during the day can further improve sleep, but there may be a trade-off with needed rest during the day. Drugs that help with insomnia in fibromyalgia, such as trazodone or suvorexant, may help in ME/CFS too.

Pain is initially managed with over-the-counter pain medication, such as ibuprofen or paracetamol. If this is insufficient, referral to a pain specialist or counselling on pain management can be the next step. Heat treatment, hydrotherapy and gentle massage can sometimes help. In addition, stretching and exercise may help with pain, but a balance must be struck, as they can trigger PEM. While there is lack of evidence on pharmaceutical options for pain management in ME/CFS, medication that works for fibromyalgia may be tried, such as pregabalin.

Like in other chronic illnesses, those with ME/CFS often experience mental health issues like anxiety and depression. Psychotherapy, such as CBT may help manage the stress of being ill and teach self-management strategies. Family sessions may be useful to educate people close to those with ME/CFS about the severity of the illness. Antidepressants can be useful, but there may be more side effects than in the general population. For instance, it may be difficult to stop weight gain due to exercise intolerance.

Bowel issues are a common symptom of ME/CFS. For some, eliminating specific foods, such as caffeine, alcohol, gluten, or dairy, can alleviate symptoms. Those with orthostatic intolerance can benefit from increased salt and fluid intake. Compression stockings can help with orthostatic intolerance.

Severe ME/CFS

People with moderate to severe ME/CFS may benefit from home adaptations and mobility aids, such as wheelchairs, disability parking, shower chairs, or stair lifts. To manage sensitivities to environmental stimuli, these stimuli can be limited. For instance, the surroundings can be made perfume-free, or an eye mask or earplugs can be used. Those with severe ME/CFS may have significant trouble getting nutrition. Intravenous feeding (via blood) or tube feeding may be necessary to address this or to address electrolyte imbalances.

Patients who cannot move easily in bed may need help to prevent pressure sores. Regular repositioning is important to keep their joints flexible and prevent contractures and stiffness. Osteoporosis may pose a risk over the long term. Symptoms of severe ME/CFS may be misunderstood as neglect or abuse during well-being evaluations, and NICE recommends that professionals with experience in ME/CFS should be involved in any type of assessment for safeguarding.

Prognosis

Information on the prognosis of ME/CFS is limited. Complete recovery, partial improvement, and worsening are all possible, but full recovery is uncommon. Symptoms generally fluctuate over days, weeks, or longer periods, and some people may experience periods of remission. Overall, many will have to adjust to life with ME/CFS.

An early diagnosis may improve care and prognosis. Factors that may make the disease worse over days, but also over longer periods, are physical and mental exertion, a new infection, sleep deprivation, and emotional stress. Some people who improve need to manage their activities to prevent a relapse.Children and teenagers are more likely to recover or improve than adults. For instance, a study in Australia among 6- to 18-year-olds found that two-thirds reported recovery after ten years and that the typical duration of illness was five years.

The effect of ME/CFS on life expectancy is poorly studied, and the evidence is mixed. One large retrospective study on the topic found no increase in all-cause mortality due to ME/CFS. Death from suicide was, however, significantly higher among those with ME/CFS. In extreme cases, people can die from the illness.

Epidemiology

Graph showing that females have two incidence peaks (teenagers and 30–39 years old), and males' incidence peaks in the teenager years.
Incidence rates by age and sex, from a 2014 study in Norway

Reported prevalence rates vary widely depending on how ME/CFS is defined and diagnosed. Overall, around 1 in 150 people have ME/CFS. Based on the 1994 CDC diagnostic criteria, the global prevalence rate for CFS is 0.89%. In comparison, estimates using the stricter 1988 CDC criteria or the 2003 Canadian Consensus Criteria for ME/CFS produced a prevalence rate of only 0.17%.

In England and Wales, over 250,000 people are estimated to be affected. These estimates are based on data before the COVID-19 pandemic. It is likely that numbers have increased as a large share of people with long COVID meet the diagnostic criteria of ME/CFS. A 2021–2022 CDC survey found that 1.3% of adults in the United States, or 3.3 million, had ME/CFS.

Women are diagnosed about 1.5 to 4 times more often with ME/CFS than men. The prevalence in children and adolescents is slightly lower than in adults, and children have it less than adolescents. The incidence rate (the onset of ME/CFS) has two peaks, one at 10–19 and another at 30–39 years, and the prevalence is highest in middle age.

History

From 1934 onwards, there were multiple outbreaks globally of an unfamiliar illness, initially mistaken for polio. A 1950s outbreak at London's Royal Free Hospital led to the term "benign myalgic encephalomyelitis" (ME). Those affected displayed symptoms such as malaise, sore throat, pain, and signs of nervous system inflammation. While its infectious nature was suspected, the exact cause remained elusive. The syndrome appeared in sporadic as well as epidemic cases.

In 1970, two UK psychiatrists proposed that these ME outbreaks were psychosocial phenomena, suggesting mass hysteria or altered medical perception as potential causes. This theory, though challenged, sparked controversy and cast doubt on ME's legitimacy in the medical community.

Melvin Ramsay's later research highlighted ME's disabling nature, prompting the removal of "benign" from the name and the creation of diagnostic criteria in 1986. These criteria included the tendency of muscles to tire after minor effort and take multiple days to recover, high symptom variability, and chronicity. Despite Ramsay's work and a UK report affirming that ME was not a psychological condition, scepticism persisted within the medical field, leading to limited research.

In the United States, Nevada and New York State saw outbreaks of what appeared similar to mononucleosis in the middle of the 1980s. People suffered from "chronic or recurrent fatigue", among a large number of other symptoms. The initial link between elevated antibodies and the Epstein–Barr virus led to the name "chronic Epstein–Barr virus syndrome". The CDC renamed it chronic fatigue syndrome (CFS), as a viral cause could not be confirmed in studies. An initial case definition of CFS was outlined in 1988 the CDC published new diagnostic criteria in 1994, which became widely referenced.

In the 2010s, ME/CFS began to gain more recognition from health professionals and the public. Two reports proved key in this shift. In 2015, the US Institute of Medicine produced a report with new diagnostic criteria that described ME/CFS as a "serious, chronic, complex systemic disease". Following this, the US National Institutes of Health published their Pathways to Prevention report, which gave recommendations on research priorities.

Society and culture

a group of people offering a petition. The group includes a person on a camp bed holding up a placard that says she is in bed 23 hours a day.
Presentation of a petition to the National Assembly for Wales relating to ME support in South East Wales

Controversy

ME/CFS is a contested illness, with debates mainly revolving around the cause of the illness and treatments. Historically, there was a heated discussion about whether the condition was psychological or neurological. Professionals who subscribed to the psychological model had frequent conflicts with patients, who believed their illness to be organic. While ME/CFS is now generally believed to be a multisystem neuroimmune condition, a subset of professionals still see the condition as psychosomatic, or an "illness-without-disease".

The possible role of chronic viral infection in ME/CFS has been a subject of disagreement. One study caused considerable controversy by establishing a causal relationship between ME/CFS and a retrovirus called XMRV. Some with the illness began taking antiretroviral drugs targeted specifically for HIV/AIDS, another retrovirus, and national blood supplies were suspected to be tainted with the retrovirus. After several years of study, the XMRV findings were determined to be the result of contamination of the testing materials.

Treatments based on behavioural and psychological models of the illness have also been the subject of much contention. The largest clinical trial on behavioural interventions, the 2011 PACE trial, concluded that graded exercise therapy and CBT are moderately effective. The trial drew heavy criticism. The study authors weakened their definition of recovery during the trial: some participants now met a key criterion for recovery before the trial started. A reanalysis under the original clinical trial protocol showed no significant difference in recovery rate between treatment groups and the controls receiving standard care.

Doctor–patient relations

People with ME/CFS often face stigma in healthcare settings, and the majority of individuals report negative healthcare experiences. They may feel that their doctor inappropriately calls their illness psychological or doubts the severity of their symptoms. They may also feel forced to prove that they are legitimately ill. Some may be given outdated treatments that provoke symptoms or assume their illness is due to unhelpful thoughts and deconditioning.

Clinicians may be unfamiliar with ME/CFS, as it is often not fully covered in medical school. Due to this unfamiliarity, people may go undiagnosed for years or be misdiagnosed with mental health conditions. As individuals gain knowledge about their illness over time, their relationship with treating physicians changes. They may feel on a more equal footing with their doctors and able to work in partnership. At times, relationships may deteriorate instead as the previous asymmetry of knowledge breaks down.

Economic and social impact

ME/CFS negatively impacts people's social lives and relationships. Stress can be compounded by disbelief in the illness from the support network, who can be sceptical due to the subjective nature of diagnosis. Many people with the illness feel socially isolated, and thoughts of suicide are high, especially in those without a supportive care network. ME/CFS interrupts normal development in children, making them more dependent on their family for assistance instead of gaining independence as they age. Caring for somebody with ME/CFS can be a full-time role, and the stress of caregiving is made worse by the lack of effective treatments.

Advocacy

see caption
The blue ribbon is used for ME/CFS awareness.

Patient organisations have aimed to involve researchers via activism but also by publishing research themselves—similarly to AIDS activism in the 1980s, which also sought to combat underfunding and stigma. Citizen scientists, for example, helped start discussions about weaknesses in trials of psychological treatments.

ME/CFS International Awareness Day takes place on 12 May. The goal of the day is to raise awareness among the public and health care workers about the diagnosis and treatment of ME/CFS.[86] The date was chosen because it is the birthday of Florence Nightingale, who had an unidentified illness similar to ME/CFS.

Research

Graph of ME/CFS papers published by year, showing an increasing trend since about 1985
Graph of ME/CFS papers published by year:
  Papers mentioning ME or CFS
  Papers whose title mentions ME/CFS

Research into ME/CFS seeks to find a better understanding of the disease's causes, biomarkers to aid in diagnosis, and treatments to relieve symptoms. The emergence of long COVID has sparked increased interest in ME/CFS, as the two conditions may share pathology and treatment for one may treat the other.

Funding

Historical research funding for ME/CFS has been far below that of comparable diseases. In a 2015 report, the US National Academy of Sciences said that "remarkably little research funding" had been dedicated to causes, mechanisms, and treatment. Lower funding levels have led to a smaller number and size of studies. In addition, drug companies have invested very little in the disease.

The US National Institutes of Health (NIH) is the largest biomedical funder worldwide. Using rough estimates of disease burden, a study found NIH funding for ME/CFS was only 3% to 7% of the average disease per healthy life year lost between 2015 and 2019. Worldwide, multiple sclerosis, which affects fewer people and results in disability no worse than ME/CFS, received 20 times as much funding between 2007 and 2015.

Multiple reasons have been proposed for the low funding levels. Diseases for which society "blames the victim" are frequently underfunded. This may explain why COPD, a severe lung disease often caused by smoking, receives low funding per healthy life year lost. Similarly, for ME/CFS, the historical belief that it is caused by psychological factors may have contributed to lower funding. Gender bias may also play a role; the NIH spends less on diseases that predominantly affect women in relation to disease burden. Less well-funded research areas may also struggle to compete with more mature areas of medicine for the same grants.

Directions

Many biomarkers for ME/CFS have been proposed. Studies on biomarkers have often been too small to draw robust conclusions. Natural killer cells have been identified as an area of interest for biomarker research as they show consistent abnormalities. Other proposed markers include electrical measurements of blood cells and Raman microscopy of immune cells. Several small studies have investigated the genetics of ME/CFS, but none of their findings have been replicated. A larger study, DecodeME, is currently underway in the United Kingdom.

Various drug treatments for ME/CFS are being explored. Drugs under investigation often target the nervous system, the immune system, autoimmunity, or pain directly. More recently, there has been a growing interest in drugs targeting energy metabolism. In several clinical trials of ME/CFS, rintatolimod showed a small reduction in symptoms, but improvements were not sustained after discontinuation. Rintatolimod has been approved in Argentina. Rituximab, a drug that depletes B cells, was studied and found to be ineffective. Another option targeting autoimmunity is immune adsorption, which removes a large set of (auto)antibodies from the blood.

Challenges

Symptoms and their severity can widely differ among people with ME/CFS. This poses a challenge for research into the cause and progression of the disease. Dividing people into subtypes may help manage this heterogeneity. The existence of multiple diagnostic criteria and variations in how scientists apply them complicate comparisons between studies. Definitions also vary in which co-occurring conditions preclude a diagnosis of ME/CFS.

Education

From Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Education Education is the transmissio...