CHRONIC FATIGUE SYNDROME

CHARACTERISTICS OF FATIGUED PERSONS ASSOCIATED WITH FEATURES OF CHRONIC FATIGUE SYNDROME

The type of fatigue of greatest interest to researchers is part of a syndrome such as chronic fatigue syndrome (CFS), fibromyalgia, or the gulf war syndrome. It has been suggestion that CFS is a heterogenous disorder with a variety of subgroups. An alternative to this is to consider that both the fatigue and the characteristics associated with the fatigue are distributed on a continuum. This study may help with to evaluate the relationships between variables used to define CFS, and also with the understanding of the many possible contributing causes of CFS-like symptoms in the majority of fatigued people who do not meet all of the criteria for CFS.

By means of an extensive questionnaire data were obtained from 268 subjects with idiopathic chronic fatigue of over 6 months' duration. The association of the subjects' characteristics with 5 features of CFS were examined:

• The number of CFS symptoms.
• The severity of neuro-cognitive symptoms.
• The number of hours fatigued after exercise.
• The frequency of unrefreshing sleep.
• Sudden onset of fatigue following an infectious illness.

The feature of greatest interest was the number of the following CFS symptoms that a subject had:

• Impairment in short-term memory or concentration.
• Sore throat.
• Tender cervical or axillary lymph nodes.
• Muscle aches.
• Joint pain.
• Headaches.
• Unrefreshing sleep.
• Postexertional malaise over 24 hours.
• Fatigue was of sudden onset.
• Fatigue interferes with work, family or social life.

Results showed that the distribution of CFS symptoms was bell-shaped with a peak at number 5. There was no evidence that there was a population of subjects with CFS that was distinct from other subjects with chronic fatigue.

The number of CFS symptoms was strongly associated with the severity of fatigue, the response of fatigue to mental and physical activity, and other symptoms including a higher frequency of sinus and respiratory infections and migraine headaches.

A large number of relationships were tested in this study, some of which arestatistically significant and not previously reported, and which need to be confirmed.

The implications of the results are as follows:

• They complement a 1996 study by Komaroff and Fagioli who found that the CFS minor criteria distinguished patients with debilitating chronic fatigue from groups of controls who were healthy, had multple sclerosis or had depression, by confirming that the minor CFS criteria are useful for characterizing persons with chronic fatigue and suggesting additional criteria.
• They suggest that the number of criteria met by persons with chronic fatigue is districuted in a bell shaped rather than a binomial fashion.
• They suggest new factors associated with CFS features and confirm associations found in previous studies.
• They cannot provide definitive information on the aetiology of CFS, but they are more consistent with some possibile etiologies than others.

Hartz A, Kuhn E and Levine P.
J. CHRONIC FATIGUE SYNDROME 1998, Vol. 4 (3) 71-97,
The Haworth Press Inc.
10 Alice St
Binghamton
NY 13904-1580

MAGNESIUM - A VITAL MINERAL

Magnesium is a mineral that is abundant both in nature and in the human body, where it is involved in the activation of more than 300 enzymes and body chemicals. The Department of Health has set the Reference Nutrient Intake (RNI) for magnesium at 300mg per day. However, many nutritionists now feel that the average world RNI should be set at 450mg per day. A survey in 1994 showed that 72% of women and 42% of men aged between 19 and 50, and 89% of females aged 16-18 years do not achieve the RNI for magnesium. Low levels of magnesium in the diet and in our bodies increase susceptibility to a variety of diseases, including heart disease, high blood pressure, kidney stones, cancer, insomnia, PMS, and menstrual cramps. Signs and symptoms of magnesium deficiency are fatigue, mental confusion, irritability, weakness, heart disturbance, problems in nervous conduction and muscle contraction, muscle cramps, loss of appetite, insomnia and predisposition to stress. Magnesium is essential for the proper functioning of the entire cardiovascular system. Because magnesium contributes greatly to the strength of contraction by heart muscle, magnesium supplementation has been found to be helpful in the management of angina, atherosclerosis, intermittent claudication and high blood pressure.

One of the most important components of any osteoporosis programme is magnesium. As much as 60% of all magnesium in the body is found in the bones. A defect of bone crystal formation in magnesium-deficiency women is thought to be one of the factors that increase fracture risk.

Magnesium works in many ways to preserve the health of the nervous system. During times of stress, magnesium stores are depleted and large amounts of this mineral are lost in the urine. With its ability to exert a calming effect on the nervous system together with its muscle relaxing role, magnesium, taken 30-40 minutes before retiring, may help those suffering stress or insomnia.

Studies have shown a low intracellular magnesium content in patients with bronchial asthma. Magnesium deficiency can also increase the release of histamine into the bloodstream. Thereby increasing allergic reactivity in general.

Magnesium also plays a central role in the secretion and action of insulin. Without adequate magnesium levels within the body’s cells, control over blood sugar levels is impossible.

Magnesium has also been found to play a role in the aetiology of migraines, fibromyalgia, PMS, kidney stones and attention deficit hyperactivity disorder (ADHD).

Williams, E.
NUTRIT. PRACT. 1999,1 (3) 27-9

VITAMIN B STATUS IN PATIENTS WITH CHRONIC FATIGUE SYNDROME

Chronic fatigue syndrome (CFS) is characterised by profound physical and mental fatigue and exhaustion after minimal physical activity. Vitamin-mineral supplements have been recommended in CFS on the basis of anecdotal claims that sufferers have recovered after taking large doses of one or more vitamins. The most commonly recommended vitamins include vitamin C, the B vitamins (especially B6, B12 and folic acid), vitamin A and ?-carotene. Therefore, researchers assessed functional status for the B vitamins pyridoxine¬¬ riboflavin and thiamine in 12 vitamin-untreated CFS patients and in 18 healthy controls. Vitamin-dependent activities - aspartate aminotransferase (AST) for pyridoxine, glutathione reductase (GTR) for riboflavin, transketolase (TK) for thiamine - were measured in erythrocyte haemolysis before and after in-vitro addition of the relevant vitamin. It was found that for all three enzymes basal activity (U/g Hb) was lower in CFS patients than in controls, and this was also true of activated values.

Thus, these data provide preliminary evidence of reduced functional vitamin B status, particularly of pyridoxine, in CFS patients.

Heap, L.C. et al
J. ROY. SOC. MED. 1999, 92 (4) 183-5

IN VITRO STUDY OF MUSCLE AEROBIC METABOLISM IN CHRONIC FATIGUE SYNDROME

A study was carried out to establish if muscle aerobic metabolism is abnormal in patients with chronic fatigue syndrome (CFS). Muscle biopsies of 16 patients with CFS and 10 healthy controls were taken and micromethods were used to determine the lactate/pyruvate (L/P) ratio, respiratory chain function and cytochrome oxidase and lactic dehydrogenase activities.

Results showed that myoblasts from 10 of the 16 CFS subjects had defects in aerobic metabolism. Two had increased L/P ratios, suggestive of a defect in oxidative phosphorylation, and 8 had decreased ratios, consistent with a deficiency in pyruvate dehydrogenase.

Behan, Wilhelmina M.H. et al,
J. CHRONIC FATIGUE SYNDROME 1999, Vol. 5 (1), 3-16,
The Haworth Press, Inc.
10 Alice St
Binghamton,
NY 13904-1580, USA.

CYTOKINE EXPRESSION AND MORPHOLOGY OF IN VITRO GROWN MONOCYTES FROM PATIENTS WITH CHRONIC FATIGUE SYNDROME

A study was carried out to investigate the morphology of cells from CFS patients compared with healthy controls. Peripheral blood mononuclear cells from CFS patients and healthy controls were fractionated as adherent cells (monocyte-enriched fraction) and non-adherent cells. The morphology of adherent cells from CFS patients, cultivated with homologous non-adherent cells, differed between CFS patients and controls for 21 out of 24 (84%) paired samples.

Gimenez, H.B. et al,
J. CHRONIC FATIGUE SYNDROME 1999, Vol. 5 (1), 47-60,
The Haworth Press, Inc,. 10 Alice St. Binghamton, NY 13904-1580, USA.

CHRONIC FATIGUE SYNDROME AND SEASONAL AFFECTIVE DISORDER

A study was carried out to determine seasonal symptom patterns in patients with chronic fatigue syndrome (CFS) and patients with seasonal affective disorder (SAD). Symptoms that confirm with the Centres for Disease Control and Prevention (CDC) case definition of CFS were rated as moderate to very severe during the winter months by varying proportions of patients (from 43% for lymph node pain or enlargement, to 79% for muscle, joint, or bone pain). Retrospective monthly ratings of mood, social activity, energy, sleep duration, amount eaten, and weight change showed a coherent pattern of winter worsening. It was also found that a subgroup of patients with CFS shows seasonal variation in symptoms resembling those of SAD, with winter exacerbation. Light therapy may provide patients with CFS an effective treatment alternative or adjunct to antidepressant drugs.

Terman, M. et al
AMER. J. MED. 1998, 105 (3A) 115S-124S

CHRONIC FATIGUE SYNDROME - AN ATOPIC STATE

The author postulates that the environment we are in and the food and chemicals to which we are exposed play a major role in provoking the multiple symptoms which make up the diagnosis of chronic fatigue syndrome (CFS). 234 patients who had fulfilled both the major and minor criteria of CFS took part in an elimination and rotation programme (E&RP) to find out whether their CFS symptoms were relieved by removing offending environmental factors.

There was a high incidence of atopy in 95% of patients. The atopic symptoms most frequently recorded were rhinitis or sinusitis in 202 patients, and relief of symptoms was achieved in 78% of these. Bread and other wheat products were found to be the most common provoking factors of these atopic symptoms. Asthma in 88 patients was improved in 73%, eczema was improved in 67% of 70 patients, and urticaria improved in 62% of 38 patients. 65% of patients reacted to foods alone, 30% to a combination of foods and inhalants. Depression and emotional symptoms were relieved in 95% of 200 patients. Bread was the most common trigger of depression, followed by confectionery.

Borok G.
J. CHRONIC FATIGUE SYNDROME 1998, Vol. 4 (3) 39-57
The Haworth Press Inc.
10 Alice St
Binghamton
NY 13904-1580

CIRCULATING BLOOD VOLUME IN CHRONIC FATIGUE SYNDROME

A study was carried out to explore the prevalence of abnormalities in the total circulating volumes of red blood cells (RBCs), plasma, and whole blood in a series of 19 patients (15 female, 4 male) with severe, well documented chronic fatigue syndrome (CFS). RBC mass was found to be significantly reduced (p<0.001) below the published normal range in the 16 women, being subnormal in 15 (93.8%) of them as well as in 2 of the 4 men. Plasma volume was subnormal in 10 (52.6%) patients and total blood volume was below normal in 12 (63.2%). The high prevalence and frequent severity of the low RBC mass suggest that this abnormality might contribute to the symptoms of CFS by reducing the oxygen-carrying power of the blood reaching the brain in many of these patients.

Streeten, David H.P., & Bell, David S.J.
CHRONIC FATIGUE SYNDROME
1998, 4 (1) 3-11
The Haworth Press, Inc.
10 Alice Street
Binghamton
NY 13904-1580

COINCIDENTAL SPLENECTOMY IN CHRONIC FATIGUE SYNDROME

A patient sho had a 2-year history of chronic fatigue syndrome (CFS) suffered a road traffic accident, as a result of which a splenectomy had to be performed 10 days later. Histological examination of the spleen revealed chronic inflammatory changes of uncertain aetiology. The spleen had a similar macroscopic appearance and consistency to that in conditions such as infectious mononucleosis. A year later, the patient recovered from her CFS symptoms and returned to work. These histopathological changes in the spleen of a CFS patient have not been described before.

Miller, Brian, et al,
J. CHRONIC FATIGUE SYNDROME
1998, 4 (1) 37-42
The Haworth Press, Inc.
10 Alice Street, Binghamton
NY 13904-1580

UFOs OF THE INTESTINES

Interstinal parasites are much closer to home than we think. Antony Haynes reviews evidence which highlights the prevalence of previously unidentified faecal organisms (UFOs) and their significance to health. Parasitic infestations are now so widespread thay they affect about 150 million people in the US and at least 40% of the world’s population. Dr. Hermann Bueno, one of the world’s most experienced parasitologists, believes that parasites are the missing diagnosis in the genesis of many chronic health problems. Signs of parasitic infection in adults include:

• abdominal pain
• abdominal bloating
• aches and pains
• anaemia
• arthritis
• autoimmune disease
• chronic fatigue
• colitis
• constipation
• diarrhoea
• fever
• flatulence
• food allergy
• gastritis
• headaches
• inflammatory bowel disease
• immune system problems
• irritable bowel syndrome
• malabsorption
• skin conditions and itching
• sleep disturbances
• rectal bleeding
• vomiting

While over 130 different parasites have been found in Americans, the following are the most common:

• Blastocystis hominis, which can be asymptomatic, but can cause irritable bowel, chronic fatigue, arthritis and rheumatism.
• Dientamoeba fragilis, which can also be asymptomatic, or cause diarrhoea, tenderness and melaena.
• Entamoeba coli, often asymptomatic, but can cause systemic illness and auto-immune reactions.
• Giardia lamblia, which adhere to the upper part of the small intestine, preventing digestion and assimilation and causing a range of symptoms.
• Endolimax nana, the smallest of the intestinal amoebas, and suspected of being the cause of rheumatoid arthritis and collagen-related diseases.

Most NHS laboratories do not use techniques which could help to identify parasites, and some organisms are thought to be harmless. It can take an average of 16 investigations to diagnose the presence of Giardia.

The major sources of infection are tap water, badly cooked or stored food, human and pet faeces, and holidays abroad.

The best laboratories for detecting UFOs are:

• Parascope Laboratory, Tel: 01133 292 4657.
• Diagnos-Techs Labs., Tel: 0121 458 3407.
• Health Interlink (agents for Great Smokies Diagnostic Lab.), Tel: 01582 794 094.

OPTIMUM NUTRITION 1998, 11; 1; 22-7

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