Dr. Michael VanElzakker formulated the vagus nerve infection hypothesis, which identifies the vagus nerve as a key player in ME/CFS. We often refer to his work as we have long been aware of it, and what we see in active practice treating hundreds of patients supports his hypothesis perfectly. We routinely check for the signs of chronic viral infections that are often undetected by traditional tests or inexperienced healthcare professionals. We see evidence of viral and/or bacterial infections in every ME/CFS case.
Through the years, based on the result of our diagnostic tests and the unique symptoms and signs that support the hypothesis that an infection may be at the root of many of these symptoms, we have formed our own opinion that agrees with others (such as Dr. VanElzakker) who believe that an infection ultimately causes the central nervous system as well as the immune system to malfunction.
As a result, we have based our neurologic rehabilitation program on the premise that infections (past and present) must be ruled out or in, and if present, simply must be addressed. However, it is futile to simply treat an infection (with for example strong antivirals or antibiotics) if the central nervous system is not also repaired at the same time. Why is this? Think of the immune system as a circulating nervous system. It is an army mobilized by a general. The general is the nervous system. If the nervous system cannot activate the immune system to respond against infections, any medication will only work while you are taking it, as the infection will simply return. It is also very important to heal the vagus nerve.
In 2013, Dr. VanElzakker proposed that neurotropic viruses (like Epstein-Barr, CMV, HSV) can infect the vagus nerve, triggering an ongoing immune response. This leads to the chronic fatigue, post-exertional malaise, and cognitive fog associated with ME/CFS. COVID wasn’t around back then, but we could certainly add it to the list now. Dr. VanElzakker’s work has inspired our approach and continues to be validated by cutting-edge research on immune dysregulation, neuroinflammation, and the vagus nerve’s role in sickness behaviors.
His hypothesis is virtually identical to ours. The only difference is that we have observed that the vast majority of patients in this population has either diagnosed or undiagnosed Ehler’s Danlos Syndrome.
The symptoms can vary widely depending on the type of EDS, but the most common symptoms across different types include:
Hypermobile Ehlers-Danlos Syndrome (hEDS) is one of the most challenging conditions to diagnose, and here’s why: there’s no genetic test for hEDS, and not everyone with the condition is hypermobile or shows “classic” symptoms.
However, after working with countless patients dealing with dysautonomia and suspected EDS, we’ve noticed some unmistakable patterns. One surprising clue? The activities you’re naturally drawn to. Gymnasts, dancers, cheerleaders, and ballerinas often have EDS. Male patients often have a natural athletic grace and excel in sports like baseball, swimming, or basketball. These patients are also more prone to chronic injuries from physical trauma—think falls or car accidents—and their recovery is often slower.
EDS patients are often the ones who react poorly to medications. If there’s a side effect or a weird reaction to be had, they’re likely to experience it. Many also report a history of frequent childhood illnesses, GI issues (bloating, acid reflux, IBS, gastroparesis), and food sensitivities.
EDS patients commonly suffer from Mast Cell Activation Syndrome (MCAS). This condition makes mast cells hypersensitive, leading to exaggerated immune responses like histamine release that trigger inflammation and discomfort. They’re also prone to Postural Orthostatic Tachycardia Syndrome (POTS), a condition where standing causes heart rate spikes due to autonomic nervous system dysfunction.
Put simply, EDS is more than a diagnosis—it’s a pattern of symptoms and experiences. And the better we understand these connections, the better equipped we are to help those with this complex condition.
Citations:
1. VanElzakker, M. B. (2013). “Chronic fatigue syndrome from vagus nerve infection: A psychoneuroimmunological hypothesis.” Medical Hypotheses, 81(3), 414-423. https://doi.org/10.1016/j.mehy.2013.05.034
2. Hornig, M., et al. (2015). “Distinct plasma immune signatures in ME/CFS are present early in the course of illness.” Science Advances, 1(1), e1400121. https://doi.org/10.1126/sciadv.1400121
3. Nakatomi, Y., et al. (2014). “Neuroinflammation in patients with chronic fatigue syndrome/myalgic encephalomyelitis: An ^11C-(R)-PK11195 PET study.” The Journal of Nuclear Medicine, 55(6), 945-950. https://doi.org/10.2967/jnumed.113.131045
4. Tracey, K. J. (2002). “The inflammatory reflex.” Nature, 420(6917), 853–859. https://doi.org/10.1038/nature01321
This body of evidence supports the plausibility of the vagus nerve infection hypothesis, though more direct experimental and clinical studies are needed to fully establish causation.
Disclaimer: The information written on this website is designed to provide helpful information on various conditions and the subjects discussed. This website is not meant to be used to diagnose or treat any medical condition or to replace the advice of your physician(s). The author of this website does not claim to treat, diagnose or cure Long COVID, CRPS, EDS/POTS, AMPS, or any other specific condition or infection. The Spero Clinic treats the central nervous system only, often resulting in the body being able to heal itself.
You should regularly consult a physician in matters relating to your health, particularly with respect to any symptoms that may require diagnosis or medical attention. For diagnosis or treatment of any medical problem, consult your own physician(s).
Start your patient journey with the Spero Clinic's neurologic rehabilitation program.