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Chronic Fatigue Syndrome



CHRONIC FATIGUE SYNDROME has many names, "Yuppie flu", "neurasthenia", "irritable heart", "effort syndrome", "myalgic encephalomyelitis", etc. It is not a disease, but rather a condition of exhaustion with many possible causes, presentations and treatments.

ETIOLOGY
--multifactorial
--immune dysfuction
--stress/adrenal fatigue
--virus, microbes (EBV, HTLV, Enterovirus, Brucella, Borrelia)
--allergy and atopy
--food intolerance
--oxidative stress (mitochondrial dysfunction)
--usu severe stress 3-12 months before onset

INCIDENCE
--age 40-59 most common
--4x more common in women than men
--more in adults than adolescents that children
--even distribution across incomes, socioeconomic status and race (this is unusual)
--runs in families

SIGNS AND SYMPTOMS
--fatigue, disabling
--fever, low grade
--chest pain
--dizziness
--mood problems
--sleep problems, unrefreshing sleep
--forgetfulness, loss of concentration
--weakness
--GI problems
--negative mental outlook
--continues for 6+ months, unexplained, persistent or relapsing
--sore throat
--tender lymph nodes
--headaches
--exertional fatigue (tired for more than 24 hours from exertion)
--changes in appetite
--night sweats
--joint pain
--never feel like you've recovered

DIFFERENTIAL
--fibromyalgia
--hypothyroid
--adrenal disease
--toxicity
--lupus
--chronic dehydration
--EBV (95% of CFS pts have Ab's, higher titer correlates with more fatigue, test costs $200-300)
--HTLV (50% either have virus or viral genes integrated into host genome)
--enterovirus (20% have it in stool)
--Brucella, Borrelia

IT'S NOT CFS IF WE CAN BLAME ONE OF THESE
--bipolar
--schizophrenia
--anorexia
--medication SE
--obesity
--hep B or C
--depression

IMMUNE SYSTEM EFFECTS
--looks like chronic viral infection, pesticide exposure, sick building or Gulf war syndrome
--increased cytokines, IL's, IFN
--decreased T cell count
--decreased CD8 T cell function (less perforin, granzymes)
--decreased antibodies even though there are increased B cells
--decreased natural killer cell function, less perforin, even though number of NK cells may be up, need L-arginine?, exposed to organochloropesticides?
--CFIDS = chronic fatigue immune deficiency syndrome
--genetic components??
ALLERGY/ATOPY COMPONENT
--50% of CFS sufferers have it
--hypersensitivity to metals is common, esp nickel
--eosinophilic cationic protein (ECP) is elevated
--77% have positive RAST test to 1+ allergens
--"common immunologic background
FOOD INTOLERANCE
--IgG (vs IgE)
--diet modification helps a great many sufferers
--esp elimination of wheat, dairy

OXIDATIVE STRESS
--disrupted cell membranes
--mitochondrial disfunction
--worse causes muscle pain
--higher markers correlate with CFS
--RBC's
--pts have IgM against waste products, immune activation
--peroxynitrite due to viral infx
--inhibits hormone synthesis and release

HORMONES
--ATCH is usually high but sometimes low
--CRH, synthetic sometimes used as Tx
--cortisol is usually low or abnormal pattern, low in am when it should be high
--DHEA is usually high
--common Tx is to normalize DHEA with hydrocortisone, dangerous

TREATMENTS (incomplete)
--modulate immune system via hydro, diet, etc
--diet modification incl elimination diet
--test for bugs
--test hormones
--herbs
--???

Comments

( 2 comments — Leave a comment )
(Anonymous)
Jun. 23rd, 2008 06:24 pm (UTC)
doesn't fit!
"negative mental outlook" seriously does not fit in this list. I myself have CFS and have met four or five other CFS patients, all of which are optimists living highly successful and creative lives, one of which is an Oscar winner. While depression can be a side effect of CFS, CFS itself is not a bi-product of a mental disposition.
liveonearth
Jun. 23rd, 2008 08:23 pm (UTC)
Re: doesn't fit!
No individual is likely to have ALL of the S/Sx listed, however all of them occur at statistically significant numbers in CFS sufferers. So please don't take it personally that the list includes things that don't apply to you! It's an overview, not a case study.
( 2 comments — Leave a comment )

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