The Natural History Of Me/cfs
In an earlier paper, we conceptualised the progression of ME/CFS using a natural history of disease framework a concept familiar to many other chronic diseases. By considering each distinct stage along a chronological development timeline, we can move away from the multitudes of ways patients have previously been characterised including, but not limited to, the following: symptom presentation co-morbidities genetic traits metabolomics and disease duration , enabling an initial alignment of disease stage, clinical phenotype and potential pathophysiological mechanisms . While ME/CFS aetiology and its pathophysiological mechanisms remain elusive at some of the stages, this proposed framing draws attention to the less defined pre-morbid phases, the understanding of which may be the key to identifying the early causes of ME/CFS, and where early intervention may be effective. The proposed stages are as follows:
Myalgic Encephalomyelitis/chronic Fatigue Syndrome: Essentials Of Diagnosis And Management
- Alison C. BestedAffiliations
- Lily ChuCorrespondenceCorrespondence: Address to Lily Chu, MD, MSHS, Independent Consultant, 16 Lorton Ave, Unit 4, Burlingame, CA 94010.
- Nancy G. KlimasAffiliationsInstitute for Neuro Immune Medicine, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
- Jose G. MontoyaAffiliationsDr Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto Medical Foundation Research Institute, Palo Alto, CA
- Irma R. ReyAffiliationsInstitute for Neuro Immune Medicine, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
How Is Chronic Fatigue Syndrome Diagnosed
CFS diagnosis depends on two criteria:
A specific treatment for CFS has yet to be proven effective. Vitamin supplements and medicines have some benefit. Many treatments just relieve the symptoms of CFS.
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Addressing Oxidative And Nitrosative Stress
In Prolonged Critical Illness
There have been a few trials to restore oxidative balance during critical illness, often with the aim of improving thyroid hormone function . In one case, researchers found that treating patients of acute myocardial infarction with n-acetyl-cysteine a precursor to the antioxidant glutathione could virtually eliminate the decrease in serum T3 levels and prevent the increase in serum rT3 which are characteristic of NTIS . They propose that supplementation with NAC relieves the competition for GSH between the thyroid hormone deiodinase and antioxidant enzymes, which would otherwise negatively affect thyroid hormone conversion and enable O& NS. Likewise, controlled experiments showed that administration of sodium selenite on human cells reduces cytokine-induced oxidative stress , and supplementation with selenium is associated with modest normalization of thyroid hormones during critical illness . Thus, in-vivo supplementation might similarly relieve competition for selenium required in the production of both thyroid hormone deiodinase and antioxidant enzymes.
In ME/CFS
Finally, akin to critical illness, it has been suggested to incorporate the upregulation of HSP into future treatments for ME/CFS . Studies have shown that ME/CFS is also characterized by impaired HSP production whichcombined with O& NS and low-grade inflammationcould explain muscle dysfunction and exercise intolerance .
New Research To Explore Myalgic Encephalomyelitis/chronic Fatigue Syndrome
Jason Murphy is a freelance journalist and economist who began his career in the Federal Department of Treasury before moving onto journalism. Now Jason’s work can be found all over the internet in the Australian Financial Review, News.com.au, The Advertiser and many other Australian news outlets. Jason excels in taking complex information and breaking it down for readers to give a better understanding of intricate systems to the public.
Chronic FatigueAugust 18, 2021
We are currently recruiting for the Myalgic encephalomyelitis/ chronic fatigue syndrome Research Study. Find more information here
Myalgic encephalomyelitis/chronic fatigue syndrome is a complex and disabling disease that affects many parts of the body, including the brain and muscles, as well as the digestive, immune and cardiac systems, among others.
2021 is an exciting time for ME/CFS science in Australia. Money is flowing. That means in time, research results will also flow. Australian labs are gearing up to do the work to deliver insights into the cause of ME/CFS and, most importantly, possible treatments.
Australias National Health and Medical Research Council last year allocated $3.3 million for ME/CFS research. That money was split three ways, and a third of it went to a man named Ken Walder, Co-Director and Theme Leader of the team at IMPACT.
Its not the most obvious place to conduct cutting-edge research, but Walder likes it.
My motivation is around understanding metabolism, Walder says.
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Talking With Your Doctor About Chronic Fatigue Syndrome
If you are experiencing fatigue on an ongoing basis despite getting adequate sleep, talk to your doctor. While you could be facing chronic fatigue syndrome, many illnesses ranging from obstructive sleep apnea to iron-deficiency anemia can cause fatigue. Your doctor will need to ask questions and order tests to determine what is causing fatigue in your personal situation. Preparing for your appointment can help it go more smoothly.
Approach A: Treatments With Peripheral Hormones
The use of peripheral hormonesnotably glucocorticoids and other adrenal hormones, growth hormone , insulin-like growth hormone-1 , thyroid hormones, and a combination of these hormoneshave been trialed to improve outcomes in prolonged critical illness as well as in ME/CFS and fibromyalgia with varied successes as described below.
Treatments With Glucocorticoids and Other Adrenal Hormones
In Prolonged Critical Illness
Administration of large daily doses of hydrocortisone in patients during critical illness is quite common, particularly in sepsis or when cortisol levels are deemed low relative to the severity of the illness. The aim is to treat critical illness-related corticosteroid insufficiency which is thought to lead to an exaggerated proinflammatory response with increased tissue injury and organ dysfunction . Some researchers, however, have recently argued that such high doses of hydrocortisone may be counterproductive because they drive the inhibitory feedback loop inherent to endocrine axes, resulting in further central suppression of the axes . Moreover, large hydrocortisone doses heighten catabolic effects , especially if administered for too long .
In ME/CFS
Treatments With GH and IGF-1
In Prolonged Critical Illness
Treatments With Peripheral Hormone Combinations
In Prolonged Critical Illness
In ME/CFS
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How Can I Care For Myself With Chronic Fatigue Syndrome
In addition to the treatments above, there are things you can do to help manage this condition, such as:
- reducing your stress
- getting plenty of rest
- making sleep a priority if you are having trouble sleeping, check out these tips to improve your sleeping habits
- eating a healthy diet to make sure your body is getting the nutrients it needs
- having plenty of salt if you have low blood pressure and a tendency to feel dizzy or even faint on standing
- learning to prioritise the things you need to get done, and then pacing yourself by dividing them into short times of activity with rest breaks in between
- learning mindfulness, meditation or creative visualisation
- getting out into nature regularly, listening to music and enjoying your pets
- developing a support network of understanding friends and family/whnau for when you need help
- joining a support group if there is one in your area
- talking to your doctor about whether there are any medications or supplements that may help you.
Research At Different Disease Stages
Several research questions still need answers, requiring different strategies and ways of selecting research participants. Researchers should consider the advantages of restricting the study population of cases to those who meet diagnostic criteria with higher specificity and of case stratification, including sub-grouping of cases into disease stages. Alternatively, research could focus on a specific stage. While there is no doubt that molecular research is essential to revealing disease pathways and for biomarker discovery, other types of research, such as clinical, epidemiological, environmental, health service, policy and education are essential for better disease recognition, prevention, diagnosis, and treatment while an emphasis on cross-cultural studies may encourage a more standardised view of ME/CFS internationally.
Refocusing to include pre-clinical or invisible stages of illness can be hugely beneficial for the study of disease. One such example is Alzheimer’s where, over the past decade, a conceptual shift to consider the disease as a continuum has occurred and, along with the discovery of biomarkers, has re-focused the research agenda towards the pre-clinical stage and early intervention . Similarly, we suggest that a re-focus of the ME/CFS research agenda towards the pre-clinical stage , may contribute to revealing potential risk factors to support primary prevention efforts.
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Establishing Your Unique Treatment Plan
Although each patients treatment plan will be different there are some common approaches that can be discussed. In order to restore and rejuvenate the vital force within the body, a multi-factor approach must be taken.The main treatments addressed by Dr. Nirvana for Chronic Fatigue can include:
Critique Synthesis And Discussion
Perhaps related to referral patterns in America where patients with widespread pain were sent to rheumatologists and patients with severe fatigue to infectious disease specialists, research on CFS and FM has tended to follow separate tracks. However, the overlap in symptomatology between the two syndromes and the fact that both remain medically unexplained despite decades of research has led some to consider them common illnesses, indicative of somatic amplification, differing from one another only in degree. While such an explanation may explain some number or percentage of patients with these disorders, this review provides evidence that it cannot explain all cases in that the data we have reviewed suggest that, at least in some cases, the illnesses may be different. Across a number of systems, patients with CFS alone differ from those either with CFS + FM or from those with FM alone with the bulk of these studies showing clear qualitative differences differentiating CFS from FM.
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Depression Stress And Anxiety
Adjusting to a chronic, debilitating illness sometimes leads to other problems, including depression, stress, and anxiety. Many patients with ME/CFS develop depression during their illness. When present, depression or anxiety should be treated. Although treating depression or anxiety can be helpful, it is not a cure for ME/CFS.
Some people with ME/CFS might benefit from antidepressants and anti-anxiety medications. However, doctors should use caution in prescribing these medications. Some drugs used to treat depression have other effects that might worsen other ME/CFS symptoms and cause side effects. When healthcare providers are concerned about patients psychological condition, they may recommend seeing a mental health professional.
Some people with ME/CFS might benefit from trying techniques like deep breathing and muscle relaxation, massage, and movement therapies . These can reduce stress and anxiety, and promote a sense of well-being.
Can You Have Both Chronic Fatigue Syndrome And Fibromyalgia
You can have both chronic fatigue syndrome and fibromyalgia. In fact, many people do.
These conditions are considered cousins, of a sort. They belong to the same family of illnesses, which is called central sensitivity syndromes.
The symptoms are extremely similar. So, it can be difficult to tell if you have just one or both of these conditions.
Until theres better diagnostic testing, it may sometimes be impossible to tell if you have both. It may never even be clear which one you have, either, depending on your specific mix of symptoms.
Fortunately, the treatments are similar. So, you may get the right treatments even if youre not correctly diagnosed.
Ascending and descending pathways that influence pain sensitivity.
2.1.1. Peripheral and Central Sensitization
As previously mentioned, the chronic pain typical of FM is due to alterations in central and peripheral sensitization. Over the years, researchers have searched for biomarkers that are capable of detecting these changes. In particular, they focused on factors capable of acting on the growth and survival of nerve cells, such as nerve growth factor . This factor is indeed involved in promoting the growth, proliferation and survival of sensory neurons that transmit pain, temperature and tactile sensations .
2.1.2. Inflammation and Immunity
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Metabolic Changes Seen In Me/cfs
Various metabolic mechanisms are turned on by the damage to the body, and these ongoing metabolic changes can cause lasting fatigue if they are not reprogramed back to the original normal metabolic state. Naviaux et al. suggests that these changes are characteristic of the Dauer state due to the cell danger response . One such metabolic change is the increase in glycolysis in the cytoplasm of the cell. This shift in metabolism was first described by Otto Warburg in the 1930s and has been named the Warburg Effect. Warburg described the metabolic energy shift in relation to cancer cells, and indeed, almost all cancers exhibit this change in energy metabolism. Otto Warburg thought that once the cell changed to this different energy production method, it could not change back into a normal cell. This energy pathway change can lead to pathological fatigue .
The Warburg Effect is not only present in cancer cells but is seen in adaptive immune cells of myeloid and lymphoid lineage, characterized by a shift to aerobic glycolysis . The Warburg Effect is present in the replication of viruses such as MERS-CoV and SARS-CoV-2 . Clinical work in ME/CFS patients shows this change to Warburg Effect metabolism, thus generating most of the energy currency, ATP, from non-mitochondrial sources .
Table 1 Metabolic Changes That May Affect Fatigue in ME/CFS Patients
Rationale of this study
Aim of this study
Experimental hypothesis of this study
What Is Adrenal Fatigue
Adrenal fatigue is a medical expression related to a compilation of imprecise symptoms including fatigue, inability to sleep, anxiety or nervousness, body aches, feeling run down, depression, and digestive problems. Adrenal glands are endocrine glands that are located directly above the kidneys where specific hormones are secreted to help the body deal with daily life events and activities. When these adrenal glands do not function the way they are supposed to, a series of symptoms can occur giving way to a syndrome known as Adrenal Fatigue. Symptoms of adrenal fatigue include depression, weight loss, low blood pressure, body aches, fatigue, anxiety, and loss of body hair, nervousness, and insomnia.
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The Supplement Of Calcium
Calcium is a mineral that can help combat nervous tension, stress, and anxiety. The upset emotional state may worsen fatigue in many susceptible women dramatically. A calcium deficiency will worsen not only the emotional irritability but also cramps & muscular irritability. In addition, calcium can be taken along with magnesium at night to calm the mood & induce a restful sleep. Any woman with menopause related to anxiety, mood swings & fatigue can also feel the calcium supplementation useful. Furthermore, calcium has added benefits of aiding in preventing osteoporosis or bone loss because it is a main structural component of bone.
Food sources that contain calcium:
- Vegetables & legumes: kale, kidney beans, leeks, artichoke, beet greens, broccoli, black beans, black-eyed peas, spinach, turnip, watercress, brussels sprouts, cabbage, pinto beans, rutabaga, soybeans, collards, eggplant, garbanzo beans, lentils, parsley, parsnips, green beans, and green onions
- Meat, poultry, seafood: shrimp, venison, abalone, beef, bluefish, carp, lobster, oysters, perch, salmon, crab, haddock, herring, and lamb
- Fruits: raisins, rhubarb, tangerine juice, oranges, pineapple juice, prunes, blackberries, black currants, and boysenberries
- Grains: bran, brown rice, millet and bulgur wheat
Keep reading this writing to get to know another diet tip for chronic fatigue syndrome treatment.
Chronic Fatigue Syndrome Treatment Market Size Key Players & Forecast Report To 2028
he Global Chronic Fatigue Syndrome Treatment Market size, share, key players, growth, industry forecast by type, end-user and regional analysis report to 2028
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The broad chronic fatigue syndrome treatment market has been sub-grouped into type and end-user. The report studies these subsets with respect to the geographical segmentation. The strategists can gain a detailed insight and devise appropriate strategies to target specific market. This detail will lead to a focused approach leading to identification of better opportunities.
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What Are The Symptoms Of Chronic Fatigue Syndrome
Symptoms of CFS often mimic the flu. The following are the most common symptoms of CFS. However, each person may experience symptoms differently. Symptoms may include:
- Sensitivity to light
- Low-grade fever
The symptoms of CFS may look like other medical conditions. Always talk with your healthcare provider for a diagnosis.
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Clinical Presentation And Implications
The clinical presentation of CFS is heterogeneous with the most common symptoms being mental and physical fatigue, cognitive dysfunction, and mood disturbances. Cognitive dysfunction has been subjectively reported and objectively measured in experiments . Orthostatic hypotension is also common and may be debilitating . CFS may share similarities in presentation with idiopathic intracranial hypertension, and given that these are both diagnoses of exclusion affecting a similar patient population, it has been postulated that they may be related . Consequently, there is a need to develop objective measures rather than reliance on subjective reporting of symptoms . Understanding the pathogenesis of CFS is important in making accurate diagnoses and improving treatment and management. Children and adolescents with CFS have higher rates of school absenteeism, resulting in missed educational opportunities as well as valuable psychosocial experiences . Given the trend of recent data pointing towards a biological basis of CFS, novel treatments will likely be similarly directed .
