Chronic
fatigue syndrome (CFS) affects up to 2.5 million Americans and incurs
up to $51 billion in annual medical costs; as symptoms are varied and no
definitive cause has been identified, many physicians question the
diagnosis
Recent
research has identified 17 biomarkers associated with the severity of
symptoms in CFS, offering concrete evidence the condition exists and
hope to sufferers told it is “all in their head”
Although
there is no cure, there are strategies you may use to support your
health and reduce symptoms, including reducing leaky gut, reducing
inflammation and supporting your mitochondrial health
By Dr. Mercola
Chronic fatigue syndrome (CFS) is a debilitating condition that affects up to 2.5 million Americans,1 incurring up to $51 billion in annual medical costs.2
There are actually a number of different names used for this condition,
including myalgic encephalopathy/myalgic encephalomyelitis (ME),
post-viral fatigue syndrome (PVFS) and chronic fatigue immune
dysfunction syndrome (CFIDS).3 The most common designation is ME/CFS.
Without an ability to pinpoint a cause, many physicians have credited
the condition to psychological roots. Reports of the condition were
first published in the literature in 1934.4
It has only been very recently that researchers have found
physiological commonalities between groups of individuals that has
separated their symptoms from other comparable conditions.
Diagnostic changes have been discovered in gut bacteria and in brain
tissue of individuals suffering from symptoms of ME/CFS. Now, scientists
have found biomarkers in blood that correlate with ME/CFS symptoms.
This combination of information puts researchers one step closer to
finding a causative agent, and potentially improving treatment options.
What Is Chronic Fatigue Syndrome?
Researchers have not found a reason for the symptoms of ME/CFS. A
significant hurdle is the fact that symptoms can vary widely from one
person to the next. However, the most common symptom is one of overwhelming exhaustion that gets worse with physical or mental activity, and does not get better with additional rest.5 Interestingly, you may not experience the full extent of the exhaustion until up to 48 hours after the activity.
Complications from the symptoms may also include depression, social
isolation, increasing absences at work and lifestyle restrictions that
are related to an inability to function at your activities of daily
living.6
The condition affects people of all socioeconomic, ethnic and racial groups as well as people of all ages.7
However, more people report symptoms in their 40s and 50s and women
report symptoms four times more frequently than men. The way in which
people who suffer from ME/CFS is not described completely by a simple
list of symptoms. David Tuller, coordinator at the University of
California (UC), Berkley writes:8
"In an interview with The New York Times earlier this year,
best-selling author Laura Hillenbrand ("Seabiscuit," "Unbroken"), who
has lived with CFS for decades, called the name of the illness
'condescending' and 'so grossly misleading.' She added: 'The average
person who has this disease, before they got it, we were not lazy
people; it's very typical that people were Type A and hard, hard workers
…
Fatigue is what we experience, but it is what a match is to an
atomic bomb. This disease leaves people bedridden. I've gone through
phases where I couldn't roll over in bed. I couldn't speak. To have it
called 'fatigue' is a gross misnomer.'"
Symptoms of the condition may mimic other medical conditions
necessitating a diagnosis by excluding other health conditions, such as thyroid disorders, sleep disorders and kidney or liver problems.9 These additional symptoms may include:10,11,12
Muscle pain
Sore throat
Tender lymph nodes
Short attention span
Palpitations
Enlarged glands
Food intolerance
Memory problems
Irritable bowel-like symptoms
Pain in multiple joints
Visible muscle twitching
Intermittent flu-like symptoms
Word find problems
Fainting
Mood swings
Gastrointestinal problems
Headaches
Difficulty sleeping
Clumsiness
Alcohol intolerance
Difficulty concentrating
Excessive sweating
Difficulty with temperature control
Hypersensitivity to light and noise
New Study Finds Biomarkers Indicating an Inflammatory Problem
A recent study from Stanford University School of Medicine identified
17 biomarkers in the blood that correlated closely with reported
symptom severity in patients suffering from ME/CFS.13
These biomarkers are cytokines, small proteins your immune system
secretes that are used by other cells in your body. This new finding
offers hope to both sufferers and physicians, as it provides objective
evidence and concrete confirmation of the existence of ME/CFS. It may
also lead to better treatment options or a cure.
During the study, researchers analyzed blood from over 185 people who
suffer from ME/CFS and had suffered symptoms for at least 10 years.
These were compared against blood samples of over 385 healthy
individuals.14 They tested for 51 different cytokines in all individuals and found two that were significantly different between the groups.
However, in looking more closely at the cytokines tested in the
symptomatic group, the researchers also found different levels of 17
cytokines that appeared to correlate with the severity of the symptoms
the individual reported. The researchers hypothesized this had not been
discovered in prior studies as the high levels of cytokines in some
individuals that were low in others, may have canceled out the
information.
Of the 17 cytokines identified in this study, 13 are known to be
associated with increased levels of inflammation. This confirms a
suspicion of some researchers that symptoms of fluctuating flu-like
symptoms and body aches associated with ME/CFS is linked to an
inflammatory response.15 Senior researcher Mark M. Davis, Ph.D., from Stanford University, commented:16
"There's been a great deal of controversy and confusion
surrounding ME/CFS — even whether it is an actual disease. Our findings
show clearly that it's an inflammatory disease and provide a solid basis
for a diagnostic blood test."
Inflammatory Response May Be Triggered by Leaky Gut
Another recent study from Cornell University found a difference in
the gut microbiome of people diagnosed with ME/CFS and a group of
healthy individuals.17
This discovery may help shed some light on diagnostic procedures for
other health conditions and lead to strategies for treatment and
prevention of ME/CFS. The differences the researchers found were evident
in both blood and stool samples.
The researchers used DNA sequencing to find a distinct lack of diversity in the gut microbiome of individuals and found inflammatory biomarkers in their blood.18
The changes could not be clearly linked to either a cause or
consequence of the condition. Professor of molecular biology and
genetics at Cornell University, Maureen Hanson, Ph.D., commented in The
Washington Post:19
"Our work demonstrates that the gut bacterial microbiome in
chronic fatigue syndrome patients isn't normal, perhaps leading to
gastrointestinal and inflammatory symptoms in victims of the disease.
Furthermore, our detection of a biological abnormality provides further
evidence against the ridiculous concept that the disease is
psychological in origin."
The researchers theorize these markers could be the result of a
"leaky gut from intestinal problems that allow bacteria to enter the
blood."20
A leaky gut is triggered by the development of "gaps" that occur
between the membrane walls that line the intestines. This allows
material that was meant to stay in your intestinal tract, such as
undigested food, bacteria or waste products, to leak into your
bloodstream.
There is a distinct link between the development of these gaps and
the food you consume each day. Grains are particularly problematic as
research demonstrates gluten stimulates zonulin, a protein in your gut
that triggers the opening of these junctures. Legumes and other lectin-rich foods are also best avoided21
if you are struggling with an inflammatory condition such as ME/CFS.
Not all people with a leaky gut will develop ME/CFS, but healing and
sealing your gut may help to reduce the inflammatory response in your
body and result in a reduction in symptoms.
Neurological Changes Also Found in People Suffering from ME/CFS
ME/CFS sufferers also experience changes in the white matter in their
brains, another piece of concrete evidence that it's a real
physiological condition.22
Using new technology, imaging studies were used to distinguish
differences in the brains of people who suffer from ME/CFS compared to
those who don't. ME/CFS sufferers had both a diminished amount of white
matter and changes to the right hemisphere of the brain. Researchers
commented in a press release from Stanford Medical Center where this
study was also completed:23
"It's not uncommon for CFS patients to face several
mischaracterizations of their condition, or even suspicions of
hypochondria, before receiving a diagnosis of CFS. The abnormalities
identified in the study ... may help to resolve those ambiguities …"
The study exposed three findings:
A reduction in brain white matter responsible for transporting
information throughout the brain. This was not unexpected as chronic
inflammation has a known effect on white matter.
A consistent abnormal appearance using advanced imaging techniques
in patients suffering from ME/CFS in the right hemisphere of the brain,
which connects the frontal and temporal lobes.
Thickening of the gray matter in the brain on either end of the
white matter between the temporal and frontal lobes, indicating it is
highly unlikely the findings were coincidental.
ME/CFS Sufferers Struggle With More Than the Disease
Although the condition is often physically and emotionally
devastating, sufferers struggle with many other challenges as well. Lead
researcher in the study that demonstrated cytokine biomarkers in the
blood of people who suffer from ME/CFS, Dr. Jose Montoya, told NPR News:24
"This is a field that has been full of skepticism and
misconception, where patients have been viewed to have invented their
disease. These data clearly show the contrary, and demonstrate what can
be achieved when we couple good research design with new technology."
Unfortunately, information from these studies does not quickly reach
practicing physicians, and patients continue to be met with resistance
and recommendations they improve their physical conditioning based on
the PACE trial published in the Lancet,25 which recommends cognitive behavioral therapy and physical exercise to cure patients with ME/CFS.
This study appeared to use a large cohort of patients and underwent
peer review before being published. However, after the raw data from the
study was released, it revealed several major flaws in the assumptions
of the researchers.26
Prior to the study the researchers determined their standards for
success, defining "recovery" and "improvement." However, once the
unblinded portion of the study began, the researchers revised the
definitions so patients could actually get worse over the course of the
study in both fatigue and physical function and still would be
classified as being "recovered."27
Tuller published his analysis of the study results,28
and another recent analysis confirms his evaluation the PACE trial,
which he concluded was severely flawed and made poor conclusions.29 The damage to individuals and their families by physician-driven recommendations to increase physical activity
and seek psychological care to cure their condition contributes greatly
to the emotional and mental burden these people must bear.
In another analysis of this patient population, researchers evaluated
any increased risk of death caused by a diagnosis of ME/CFS. While they
found no increase in all-cause mortality, there was a significant
increased risk of death due to suicide that accompanied a diagnosis of
ME/CFS.30
Could Mitochondrial Support Help Reduce Symptoms?
It stands to reason that a condition that triggers an inflammatory
response in the body and that results in overwhelming fatigue will
respond favorably to lifestyle choices that reduce inflammation and
support the function of your mitochondria. These tiny powerhouses are an
interconnected network that rapidly and effectively distributes energy
throughout your body's cells.31
In other words, supporting a system that provides energy to all the
cells in your body will likely affect many health conditions, not just
ME/CFS. Studies of mitochondrial function have increased our
understanding of the development of heart disease and other
mitochondrial diseases, including cancers.
There are significant challenges to your health when you experience
mitochondrial dysfunction. It plays a role in neurodegenerative
diseases, seizure disorders, diabetes, hypertension and more. In fact,
many of the conditions being treated with toxic drugs could potentially
resolve with proper nutritional and lifestyle intervention that
addresses the fuel your cells use for energy.
Healthy Support Options to Use at Home
At this time there is no known cure for ME/CFS, but there are methods of supporting your body to alleviate your symptoms,32
including the foods you choose and the decisions you make throughout
your day. Each of these choices may not only help reduce your symptoms
of ME/CFS, but also may help improve your overall health. Practical
changes to your nutritional plan that can help heal your gut and lower
inflammation include:
• Avoid gluten and wheat products:
Gliadins, a component of gluten, are a class of protein found in wheat
and cereals. These proteins increase the permeability of your gut. Keep
in mind that gluten can also be found in other grains, not just wheat.
Wheat germ agglutinin (WGA) is a lectin, or plant protein found in high
concentration in seed form.
Bread wheat is a relatively new form of wheat that has a resilient
and problematic form of WGA. It plays a key role in a toxic effect on
your kidneys, and there is evidence it increases the damage to your
intestinal membrane walls. • Avoid lectins: Some lectins,
including WGA, bind to receptor sites on your intestinal mucosal cells
and interfere with absorption of nutrients. As such, they act as
"antinutrients," and can have a detrimental effect on your gut
microbiome by shifting the balance of your bacterial flora — a common
precursor to leaky gut.
Lectins are also strongly associated with autoimmune diseases of all
kinds. To learn more, including which foods are best avoided due to high
lectin content, please see "How to Reduce Lectins in Your Diet." • Reduce your net carbs: The carbohydrate sugar, like grains, will upset the balance of microbes in your gut. Sugar
is the food source for bacteria that can prompt damage to your
intestinal walls, while fiber is the food source for bacteria that build
your intestinal membranes.
Your net carbs are the total grams of carbohydrates you've eaten in a
day, minus the grams of fiber you've eaten. The difference is your net
carbs. Seek to reduce your net carbs to 50 grams per 1,000 calories of
food eat each day. • Increase your fiber intake: The fiber
you eat from whole foods is the nutrient source for bacteria in your
gut that help maintain and build the membrane cells in your intestinal
walls. This helps to seal the "gaps" between the cells and reduces any
leakage of waste products and bacteria into your blood stream. Focus on
eating whole food vegetables, nuts and seeds (with the exception of
lectin-rich varieties). • Eat fermented foods:
although the idea of eating "fermented" foods may sound distasteful,
you might be surprised by the list of tasty delicacies produced through
this ancient preparation and preservation technique. By breaking down
carbohydrates and proteins using bacteria, foods become functional,
delicious and a source of natural probiotics to feed your gut.
Olives, pickles, cheese from grass fed cows, homemade yogurt and
sauerkraut are just a few of the foods you may not have considered. Your
best bet is to make your own. In this video, Julie and I demonstrate
how to make your own fermented vegetables at home.
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