(We believe that there are natural answers to CFS Chronic Fatigue Syndrome. They are much simpler and better than artificially created drugs. Our 3-step program defends against the broadest spectrum of possible causes, or multiple causes of CFS and Lyme Disease. There are articles in the “A-Z Index” but, in brief, the 3-Step program includes:
1. Monolaurin: a natural antiviral and antibacterial – the most critical step.
2. Detox: to remove heavy metals, especially mercury, and pesticide toxins that can weaken the body.
3. The Foundation (and Ribose): the best multi-vitamin / mineral / nutrient available, including nutrients recommended by world renowned Dr. Klinghardt, with additional iodine. Ribose to help “re-boot” your metabolism.
However, many people would like a general overview on conventional CFS treatment. We are also asked about our opinion on conventional drug treatment. The simple answer is: “Natural is better, but ‘anything that helps’ is ok.” Just be aware of the limitations involved. Thus, we offer the following – information from conventional sources!)
Symposium on Viruses in Chronic Fatigue Syndrome
The biggest problem in prescribing drugs is diagnosis. Doctors don’t have biomarkers to show them exactly which viruses, or other causes, they’re dealing with. This means they don’t know which antiviral to give you – if it is even a virus! They’re stuck with broad-spectrum drugs, which often have little or no effect on a particular pathogen.
At the June 2008 Symptosium on Viruses in Chronic Fatigue Syndrome, Dr. Kenny De Meirleir, who has treated thousands of people with ME/CFS, reviewed anti-virals currently in use. (* indicates those approved, for other uses, in the U.S.) They are:
Ampligen (poly I: poly C12U): May be most effective in post-Epstein-Barr virus cases. Some studies show increased cognitive function and exercise capacity. Awaiting approval by the FDA.
Symmetrel (amantadine): Inhibits cellular infection and boosts dopamine activity. Currently used to fight fatigue in MS. Anecdotal success in ME/CFS is not supported by studies.
AzaSite (azithromycin): Shows promise against central nervous system infections. Studies report response in 50% of people with ME/CFS.
Immunoglobulins: May neutralize viral antigens and rebalance the immune system. Mixed results in studies.
Kutapressin (aka Nexavir): Lab tests show it’s effective against EBV. Anecdotal reports of success rate are very promising – as high as 75% in De Meirleir’s practice in Australia.
Zadaxin (thymalfasin): Hepatitis C drug used off-label in Europe for ME/CFS. Placebo-controlled trial is planned.
Empiric Therapies: (observation, survey or common use)
Although there is no one drug or group of drugs specific for Chronic Fatigue Syndrome,symptomatic treatment can be helpful. To reduce the muscle and joint pains, headaches, or feelings of feverishness associated with the illness, aspirin, other nonsteroidal anti-inflammatory drugs, or acetaminophen may be prescribed. Nonsedating antihistamines may help relieve any prominent allergic symptoms. Double-blind, placebo-controlled Chronic Fatigue Syndrome therapy trials have found no or limited utility for most other drugs tested.
The first such trial reported found the antiviral drug acyclovir to be no better than placebo, with a large portion of the patients on placebo reporting improvement. Although some physicians prescribe intramuscular or intravenous gamma globulin, three controlled clinical trials of intravenous immunoglobulin have yielded conflicting results regarding efficacy. Despite the high prevalence of allergies in the Chronic Fatigue Syndrome population, a trial of terfenadine found no benefit for patients with Chronic Fatigue Syndrome. One placebo-controlled trial of essential fatty acids found some efficacy while another did not. Injectable liver extract also did not appear to be effective in controlled clinical trials.
Several additional empiric therapies have been tried for Chronic Fatigue Syndrome. Because well-designed clinical trials have demonstrated the benefit of low doses oftricyclic antidepressant drugs in fibromyalgia, tricyclics such as amitriptyline,desipramine, doxepin, and nortriptyline are widely prescribed for Chronic Fatigue Syndrome patients. Anecdotal experience with tricyclics and selective serotonin reuptake inhibitors (SSRIs) generally has been positive. Besides targeting depression, someantidepressants appear to act by improving the quality of sleep and/or decreasing pain.
However, Chronic Fatigue Syndrome patients often report that antidepressants given in full, therapeutic doses exacerbate their fatigue. It may be necessary to escalate doses very slowly and urge patience in detecting benefit, or to try the more activating antidepressants such as desipramine, SSRIs such as fluoxetine and sertraline, ormonamine oxidase inhibitors. Many Chronic Fatigue Syndrome patients are extremely sensitive to these drugs, and it is common practice to start a patient at one-tenth to one-quarter of the usual clinical dose.
Although adequate controlled trials are lacking, some Chronic Fatigue Syndrome patients who also suffer from panic disorder or anxiety have reported benefit fromanxiolytic medications such as alprazolam, clonazepam, other benzodiazepines, or buspirone.
Because no specific regimen for treating Chronic Fatigue Syndrome exists, several different treatment approaches may have to be tried before the patient reports benefit. Both the physician and the patient need to be open to reasonable treatment options and appreciate that improvement may occur in small increments.
Etiologic Theories (dealing with causes)
The etiology of Chronic Fatigue Syndrome continues to be vigorously investigated. Because of the syndrome’s heterogeneity, many researchers argue against it being a discrete disease caused by one agent. For example, although some Chronic Fatigue Syndrome patients exhibit any of a variety of immunologic disturbances, no single pattern of disturbances appears consistently, and many patients test in the normal range.
Sometimes the syndrome appears to follow an infection or physical or psychological trauma, but cases also develop gradually without an obvious triggering event. Higher-than-normal antibody levels to a variety of viruses appear in some but not all patients.
Finally, although many people with Chronic Fatigue Syndrome suffer from anxiety or depression, which may or may not predate their Chronic Fatigue Syndrome, about one-third of Chronic Fatigue Syndrome patients do not have a psychiatric illness.
Instead of a discrete disease, many researchers believe Chronic Fatigue Syndrome represents a common set of symptoms triggered by different combinations of various infectious and noninfectious factors. This idea is consonant with a model proposing that, like hypertension or anemia, Chronic Fatigue Syndrome be considered a clinical condition.
Central Nervous System Model
The central nervous system figures prominently in other theories of Chronic Fatigue Syndrome etiology that try to unify the disparate biological and clinical features of the syndrome. According to one such theory, the interaction between various events (for example, infectious agents, physical or emotional stress, environmental exposures, genetics, and psychiatric history) prior to the onset of the syndrome ultimately converge in a clinical condition that is perpetuated by a specific pathologic response to those events. This pathologic response may represent a disruption of a common biologic pathway coordinated by the central nervous system.
Supporting this theory is the finding of a confirmed, well-controlled neuroendocrinestudy. Chronic Fatigue Syndrome patients as a group were found to have a subtle deficiency of the stress hormone cortisol, the opposite of the hypercortisolism that characterizes melancholic depression, one of the most common subtypes of major depression.
Not only do these observations suggest that disturbances in the hypothalamic-pituitary-adrenal (HPA) axis play a role in both syndromes, the results attest to the biologic distinctions between Chronic Fatigue Syndrome and a principal form of major depression while offering one possible explanation for their overlapping clinical presentations. Because cortisol is a potent suppressor of immune responses, this finding also may explain the immune disturbances seen in some people with Chronic Fatigue Syndrome. Hypocortisolism also has been reported in patients with fibromyalgia, an illness strikingly similar to Chronic Fatigue Syndrome.
Although researchers have just begun to explore at the molecular level the interactions between stress, the neuroendocrine system, and the immune response, this is an active area of research. Recently reported preliminary research also suggests considerable overlap between Chronic Fatigue Syndrome and neurally mediated hypotension, a potentially treatable illness (see Drug Treatments). This finding is consistent with the neuroendocrine abnormality described above and, if confirmed, would support the theory that Chronic Fatigue Syndrome is a multisystem illness with prominent CNS involvement.
Testing
1. A thorough history that covers medical and psychosocial circumstances at the onset of fatigue; depression or other psychiatric disorders; episodes of medically unexplained symptoms; alcohol or other substance abuse; and current use of prescription and over-the-counter medications and food supplements.
2. A mental status examination to identify abnormalities in mood, intellectual function, memory, and personality. Particular attention should be directed toward current symptoms of depression or anxiety, self-destructive thoughts, and observable signs such as psychomotor retardation. Evidence of a psychiatric or neurologic disorder requires that an appropriate psychiatric, psychological, or neurologic evaluation be done.
3. A thorough physical examination.
4. A minimum battery of laboratory screening tests including complete blood count with leukocyte differential; erythrocyte sedimentation rate; serum levels of alanine aminotransferase, total protein, albumin, globulin, alkaline phosphatase, calcium, phosphorus, glucose, blood urea nitrogen, electrolytes, and creatinine; determination of thyroid-stimulating hormone; and urinalysis.
Routinely doing other screening tests for all patients has no known value. However, further tests may be indicated on an individual basis to confirm or exclude another diagnosis, such as multiple sclerosis. In these cases, additional tests or procedures should be done according to accepted clinical standards.
The use of tests to diagnose the Chronic Fatigue Syndrome (rather than to exclude other diagnostic possibilities) should be done only in the setting of protocol-based research. The fact that such tests are investigational and do not aid in diagnosis or management should be explained to the patient.
In clinical practice, no additional tests, including laboratory tests and neuroimaging studies, can be recommended for the specific purpose of diagnosing the chronic fatigue syndrome, including serologic tests for Epstein-Barr virus, retroviruses, human herpesvirus 6, enteroviruses, and Candida albicans; tests of immunologic function, including cell population and function studies; and imaging studies, including magnetic resonance imaging scans and radionuclide scans (such as single-photon emission computed tomography and positron emission tomography) of the head.
References:
1. Wessely S, Hotopf M, Sharpe M 1998. Chronic fatigue and its syndromes. Oxford; New York: Oxford University Press.
2. Tobi M, Morag A, Ravid Z, et al Prolonged atypical illness associated with serological evidence of persistent Epstein-Barr virus
infection. Lancet. 1982;1:61–4.
3. Jones JF, Ray CG, Minnich LL, Hicks MJ, Kibler R, Lucas DO Evidence for active Epstein-Barr virus infection in patients with persistent, unexplained illnesses: elevated anti-early antigen antibodies. Ann Intern Med. 1985;102:1–7.
4. Ballow M, Seeley J, Purtilo DT, St. Onge S, Sakamoto K, Rickles FR Familial chronic mononucleosis. Ann Intern Med. 1982;97:821–5.
5. Camus F, Henzel D, Janowski M, Raguin G, Leport C, Vilde JL Unexplained fever and chronic fatigue: abnormal circadian temperature pattern. Eur J Med. 1992;1:30–6.
6. Friedberg F, Jason LA Understanding chronic fatigue syndrome: an empirical guide to assessment and treatment. Washington DC: American Psychological Association. 1998.
7. Sharpe MC, Archard LC, Banatvala JE, et al A report–chronic fatigue syndrome: guidelines for research. J R Soc Med. 1991;84:118–21.
8. Schluederberg A, Straus SE, Peterson P, et al NIH conference. Chronic fatigue syndrome research. Definition and medical outcome assessment. Ann Intern Med. 1992;117:325–31.
9. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121:953–9.
10. Vollmer-Conna U, Wakefield D, Lloyd A, et al Cognitive deficits in patients suffering from chronic fatigue syndrome, acute infective illness or depression. Br J Psychiatry. 1997;171:377–81.
11. Swanink CM, Vercoulen JH, Bleijenberg G, Fennis JF, Galama JM, van der Meer JWChronic fatigue syndrome: a clinical and laboratory study with a well matched control group. J Intern Med. 1995;237:499–506.