Conditions > CFS/FMS
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The Canadian Clinical Case Definition for Chronic Fatigue Syndrome (2003) is the gold standard case definition for CFS. CFS and general chronic fatigue are often confused with each other. They are not the same thing and have no relevance to each other. Chronic fatigue is simply long lasting fatigue. Hundreds of different medical conditions can cause chronic fatigue. It is a symptom not a medical condition. Chronic Fatigue Syndrome is a medical condition of which severe chronic fatigue is one of several key symptoms. The name Chronic Fatigue Syndrome is largely to blame for this confusion.
According to the National Fibromyalgia Association Fibromyalgia syndrome (FMS) “is characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances.” Many CFS/FMS researchers believe that FMS and CFS are very similar if not the same underlying condition with a slightly different expression of symptoms.
What causes CFS?
All chronic illnesses are multi-factorial. In most chronic medical conditions you have factors which predispose to illness, factors which trigger the illness, and factors which exacerbate/perpetuate the illness. A unique sequence of events take place which leads to the development of CFS.
Genetics are no doubt an important predisposing factor. Genetics alone do not cause chronic illnesses like CFS, but they determine your susceptibility and unique response to environmental challenges. Certain specific genetic abnormalities have already been linked to CFS. These relate to immune function, stress response, detoxification capacity, endocrine function, blood coagulation mediators and others. The expression of our genes is also changed by environmental stimuli.
The second line of predisposing factors includes biological abnormalities present prior to the onset of CFS. These may include nutrient imbalances, low-grade chronic exposures to environmental chemicals, tendency to allergy, abnormal gastrointestinal flora, medications and many other factors.
Lifestyle, behavioural and psychological factors may also play a predisposing role. For example inadequate rest, sleep, relaxation & poor diet. While some people with CFS report ‘burning the wick at both ends’ prior to their CFS, most people report good health until their sudden onset.
An individual’s unique combination of possible predisposing factors determines their response to a triggering event. This triggering agent pushes the individual past their threshold, within which they can maintain good health. In the majority of cases CFS is initially triggered by a viral infection, for example Ross River Virus (RRV), Epstein Barr Virus (EBV) and many others. No one single infection is to blame. A variety of other precipitating events have been reported by those with CFS. These include:
- Non-viral infections (bacterial and parasitic)
- Toxic chemical exposures
- Excessive physical activity
- Having just had a baby
- Having an injury or surgery
- Adverse vaccination reaction (particularly hepatitis B)
- Blood transfusion
- Long airplane flights
- Traumatic event(s)
The individual does not respond normally to this trigger (i.e. return to normal good health shortly thereafter). Other people report a more gradual onset of symptoms with no known triggering agent.
CFS – A vicious cycle.
By the time you get to this stage you already have the predisposing factors plus the damage done by the triggering factor. The triggering factor may or may not still be present. For example if a viral infection triggered your CFS, it may be long gone with the damaging results left in place, or it may still be lingering at a more subtle low-grade level. From this point a cascade of inter-relating biological changes take place. Sleep quality declines, immune dysfunction occurs (activation [e.g. RNase-L] & depression [e.g. low natural killer cell function]), hormones and biochemistry changes, liver function changes, neurological function changes, mitochondrial changes, etc. These factors inter-relate strongly and the cycle goes round and round in a vicious cycle.
CFS is essentially a total body lack of homeostasis. Almost every body system you look at you can find distinct abnormalities. There are disturbances in the following systems – neurological, gastrointestinal, immune, biochemical, haematological, hepatic, endocrine, cardiovascular, etc. When your doctor runs some tests on you and says everything is ‘normal’, nothing could be further from the truth. If everything was really normal you wouldn’t have CFS. The multi-factorial nature of CFS is the reason no one cause of CFS has been found. Not one factor alone has the potential to cause CFS. No two cases of CFS are identical, although as a group those with CFS have many biological similarities. This book is treatment focused, rather than pathophysiology focused, and is not meant to represent a detailed literature review of the masses of biological abnormalities present in CFS.
Table 1: Model of chronic fatigue syndrome (CFS) development.
Table 2: Description of contributing factors in chronic fatigue syndrome (CFS).
|Parasites|| One published study found that 28%
of people with CFS where infected with the parasite Giardia lamblia. (J
Nutr Med 1990;I,27-31.) A
study presented at The Third International Clinical and Scientific Meeting
on ME/CFS (2001) found that roundworm parasite, Cryptostrongylus Pulmoni
|Dysbiosis||Australian research documented 17 of 27 CFS patients and 0 of 4 controls respectively, had low % distribution of Escherichia coli. (Butt HL, Low Urinary. 1998) Furthermore CFS patients had higher Klebsiella/Enterobacter group and Enterococcus faecalis, plus lower Bacteroides, Bifidobacterium & Lactobacillus (Butt HL, Faecal Microbial. 1998) Additional research by the same group analysed stool levels 1390 patients with persistent fatigue. Similarly abnormal results where discovered in these subjects as in the research previously described. 'Bacterial Colonosis' (aka ‘dysbiosis’) was also found to correlate strongly with fatigue as well as neurological/cognitive dysfunction. (Butt HL, Bacterial Colonosis. 1998) Other research has documented increased levels of enterococci and streptococci correlate highly with cognitive dysfunctions (nervousness, memory loss, forgetfulness, confusion, mind going blank) and impaired sleep patterns. (Bioscreen.) Australian CFS specialist Dr. Mark Donohoe has documented ~63% of referred CFS patients presented with a history of long-term broad-spectrum antibiotic use (more than 6 months continuous use or 12 months intermittent use over a 3 year period) 3-8 years before symptoms onset. (Donohoe, Relationship…) Of these patients 89% presented with IBS and 65% with sleep complaints. Additional research has revealed that 14/31 CFS patients had evidence of small intestinal bacterial overgrowth. (Pimentel M. 2000) It is clear that disorder gastrointestinal flora are present in a large group of those with CFS.|
|Pesticides||Two studies by Australian CFS and toxicology specialist, Dr. Mark Donohoe, have documented higher levels of chlorinated hydrocarbons in CFS patients compared to controls.|
|Heavy metals||Upon appropriate testing many integrative health professionals have reported that the majority of those with CFS have elevated heavy metals, the most common being mercury. The ideal method for heavy metal testing is called a post chelation (‘provocation’) urine heavy metal test.|
|Glutathione depletion||Glutathione (GSH) is a protein produced in our bodies containing three amino acids, cysteine, glycine and glutamic acid. Glutathione's key functions include the following, just to name a few 1) Major intracellular antioxidant; 2)Detoxification agent (heavy metals, pesticides, medications, hormones, etc.); 3)Immune modulator. 4) Helps maintain the oxidation-reduction (redox) potential within cells. Glutathione depletion has been detected in the majority of those with CFS and is a biochemical abnormality of central importance to CFS. In the late 90’s CFS specialist Dr. Paul Cheney reported that glutathione deficiency was present in the vast majority of those with CFS. In recent years Richard Van Konynenburg, Ph.D. has done extensive investigation into the CFS-glutathione connection, furthering our knowledge on this topic. It is unknown exactly what proportion of those with CFS have glutathione deficiency although most authorities on this issue consider the level to be well above 50%. Glutathione depletion at this point in time appears to be a pivotal factor in CFS! Glutathione depletion results in oxidative stress, immune abnormalities and increased levels of toxic chemicals, all of which have been reported in the CFS population.|
|Food sensitivities|| CFS specialist Paul Cheney, M.D.,
Ph.D. has documented food sensitivities in roughly 50% of CFS cases. An
article by Immunologist Dr. Loblay in the book entitled ‘The Clinical and
Scientific Basis of Myalgic Encephalomyelitis--Chronic Fatigue Syndrome’,
|Blood hypercoagulability|| Researchers from HEMEX
Laboratories which specialize in the evaluation of disorders in hemostasis,
thrombosis, and special hematology, have released three
articles documenting abnormalities of blood coagulation in CFS. In one
of their publications this research group writes...
|Magnesium deficiency||Two studies from Belgium documented magnesium deficiency in 44/93 (47%) and 44/97 (45%) respectively.(J Am Coll Nutr. 2000 Jun;19(3):374-82. & Magnes Res. 1997 Dec;10(4):329-37. ) Another study published in the Lancet documented lower RBC magnesium levels in CFS.( Lancet. 1991 Mar 30;337(8744):757-60.) An additional study found no differences in magnesium levels compared to controls.( Ann Clin Biochem. 1994 Sep;31 ( Pt 5):459-61.) Nutritional medicine practitioners fairly consistently claim magnesium deficiency is evident in approximately 50% of cases.3,14 Reportedly CFS specialist Dr. Paul Cheney recommends a test for magnesium status which involves analyzing cells scraped from sublingual soft tissue of the floor of the mouth. Dr. Cheney concurs with the ~50% deficiency rate.|
*This table does not inlcude all contributing factors nor does it review all related literature.
Treatment of chronic fatigue syndrome
There is no one treatment that has been demonstrated to 'cure' every person with ongoing fatigue. Treatment involves careful and thorough identification and management of individual contributing factors.
- Alison Hunter Memorial Foundation for research into ME/CFS (contains research abstracts from the 1998, 1999 & 2001 International Clinical and Scientific Meetings on ME/CFS)
- Fibromyalgia & Chronic Fatigue Syndrome Resource
- Dr Mark Donohoe’s CFS page
- Genova Diagnostics: Chronic Fatigue Syndrome (CFS)
- Insights Into the Pathophysiology and Treatment of CFS (PDF file) by Dr. Paul Cheney
- Life Extension Foundation: Chronic
Fatigue Syndrome Resource
- New theory (Hypothesis
of Pall) for the induction of chronic fatigue
- The Annapolis
Research Center for Effective CFS/Fibromyalgia Therapies by Jacob Teitelbaum,
- Complementary Medicine, Nutritional Medicine, chronic fatigue and immune dysfunction syndrome, Alternative Medicine, Alternative Therapies, Integrative Medicine, Natural Therapies, Naturopathic Medicine, Holistic Medicine, Nutritional Healing, Complementary and Alternative Medicine (CAM), Chronic Fatigue Syndrome Treatment, Natural Healing, Natural Medicine, Herbal Medicine, Nutritionist, Herbs, Diet, Nutrition, EFT [Emotional Freedom Techniques], Perth