Tuesday, July 21, 2009

An Emerging Understanding

Recent articles about the illness in question suggest an increasingly coherent and comprehensive understanding of the illness may be emerging.

Note: This illness is variously known as CFIDS, CFS, ME, and Fibromyalgia. The acronyms stand for "Chronic Fatigue and Immune Dysfunction Syndrome," "Chronic Fatigue Syndrome," "Myalgic Encephalomyelitis." I'll use a combination of the acronyms ME and CFIDS.

Diverse paths of investigation appear to be converging on a connection between mitochondrial dysfunction, cardiomyopathy, and immune dysregulation; secondary factors such as leaky gut and central nervous system abnormalities; and possible causative factors such as viral activity and neurotoxins. These connections provide a complex but compelling picture of the workings of this heretofore baffling disease.

In this model, an initial insult (viral, physical trauma, or environmental toxin) causes mitochondrial failure leading to secondary cardiomyopathy, which in turn leads to immune dysregulation which permits ongoing viral activity. This viral activity sustains the mitochondrial dysfunction, creating a stable closed-loop system of persistent illness which is very difficult to disrupt.

At the same time, the low oxygen environment resulting from the cardiomyopathy leads to leaky gut and the overgrowth of organisms in the digestive system which are normally controlled or not present in healthy people. These organisms produce toxins which also degrade mitochondrial function and impede other systems critical to health, thus further reinforcing the closed-loop system.

ME/CFIDS Overviews

Come to bed with ME - A brief introduction to the experience of being ill with ME/CFIDS. See also A Sudden Illness by Lauren Hillenbrand and Olympian Battles CFIDS, an interview with legendary soccer star Michelle Akers.

Evidence that ME/CFS is not a somatisation disorder - ME/CFS advocate Margaret Williams discusses heart failure and post-exertional fatigue and their connection to other CFS symptoms such as cognitive impairment, persistent muscle and joint pain, headaches, and sleep disorders. This article contains a concise summary of Dr. Paul Cheney's cardiomyopathy theory (more on Cheney below) and also a powerful description of the impact on the quality of life of patients with this illness.

From the article:
“In my experience, (ME/CFS) is one of the most disabling diseases that I care for, far exceeding HIV disease except for the terminal stages.” (Dr Daniel L Peterson: Introduction to Research and Clinical Conference, Fort Lauderdale, Florida, October 1994; published in JCFS 1995:1:3-4:123-125)

"In comparison with other chronic illnesses such as multiple sclerosis, end-stage renal disease and heart disease, patients with (ME)CFS show markedly higher levels of disability." (Quality of Life and Symptom Severity for Individuals with Chronic Fatigue Syndrome: Findings from a Randomised Clinical Trial. RR Taylor. American Journal of Occupational Therapy 2004:58:35-43)

“There is evidence that the patients with this illness experience a level of disability that is equal to that of patients with late-stage AIDS, patients undergoing chemotherapy (and) patients with multiple sclerosis.” (Professor Nancy Klimas, University of Miami, speaking at the launch of the US CDC campaign to raise awareness of ME/CFS, 3 November 2006, National Press Club, Washington DC)

Laboratory Marker

Dr. Kenny De Meirleir's "News Heard Round the World" - Dr. De Meirleir announces the discovery of a marker for CFS: high levels of the neurotoxin hydrogen sulfide (H2S) in the urine. He introduces an inexpensive lab test for H2S and connects H2S to many of the symptoms suffered by CFS/ME patients - and to mitochondrial dysfunction.

ME/CFIDS: Mitochondrial Dysfunction, Oxygen Toxicity, and Cardiomyopathy

CFS, The Central Cause: Mitochondrial Failure - Dr. Sarah Myhill describes what she believes is the underlying cause of CFS: cardiac failure secondary to mitochondrial dysfunction. This page includes an excellent discussion of the delayed fatigue phenomenon that I have experienced consistently throughout my illness and explains the causes of many of the other symptoms experienced by people with CFS (including me). Dr. Myhill suggests testing for ATP production and other markers which she believes can provide a definitive diagnostic picture of CFS. She also touches on strategies for recovery.

Dr. Paul Cheney's complex cardiac failure/mitochondrial dysfunction/oxygen toxicity model is based on Dr. Arnold Peckerman's study (see below) and backed by 20 years of research into CFS and treatment of many severely ill CFS patients. In my opinion Dr. Cheney's grasp of the characteristics and progression of the illness is second to none.

Dr. Cheney also makes a connection between mitochondrial dysfunction, immune system dysregulation, and chronic viral activity (see below for more on viral involvement in CFS).

Here are reports on Dr. Cheney's recent lecture in Virginia:
Dr. Cheney currently has two new web sites under construction:
You may also wish to read Cheney's seminal lecture, The Heart of the Matter: CFS & Cardiac Issues, at the CFS & FM Support Group of Dallas-Fort Worth, and keep an eye out for publication of his latest lectures on DVD.

Slow Flow - Dr. Suzanne Vernon says that as many as 70% of people with CFIDS also have POTS (postural orthostatic tachycardia syndrome). Not enough oxygen is getting to our brains. She also cites a study which showed decreased blood volume in people with CFIDS.

Antiviral Treatments

Cardiac Insufficieny Hypothesis - Dr. A. Martin Lerner argues that a subset of ME/CFS exists in which chronic mononucleosis, caused by a virus such as Epstein Barr, cytolomegalovirus, or HHV6, is a factor - and that the virus infection persists in the heart and contributes to cardiac dysfunction. Dr. Lerner holds several US patents related to diagnosis and treatment of CFS/ME. This article contains links to articles related to Paul Cheney's work.

A clinical trial by Dr. Lerner et al showed CFS patients treated with valacyclovir and/or valganciclovir experienced marked improvement. More Lerner articles are here.

Physicians Encouraged by Valcyte - Dr. Jose Montoya's study suggests that CFS can be caused by HHV-6 and/or Epstein Barr virus, and that Valcyte might be an effective treatment for CFS when HHV-6 is involved.

CFIDS/CFS vs. Myalgic Encephalomyelitis

The Hummingbirds' Foundation for M.E. - M.E. activist Jodi Basset makes an emphatic distinction between Myalgic Encephalomyelitis and CFS/CFIDS. She connects M.E. with low blood volume and cardiac insufficiency, CNS and spinal abnormalities, and presents a comprehensive list of tests which can be used to diagnose M.E.

This site contains a massive amount of material relevant to these illnesses. Also, Jodi's personal story is a powerful cautionary tale about the risks involved in taking advice from physicians (and others) who do not understand this illness.

The Nightingale Foundation - Dr. Byron Hyde also makes a distinction between M.E. and CFS and says CFS is not a disease but M.E. is - and asserts that M.E. can be diagnosed by specific tests.

Web Sites

CFIDS Association of America - Information on diagnosis, treatment, research, and advocacy.

Maylgic Encephalomyelitis Society of America - This site's home page makes a powerful distinction between the illness commonly known as Chronic Fatigue Syndrome and the symptom of fatigue.

FightFM - A web site devoted to Fibromyalgia which contains a large body of information relevant to CFS/ME/CFIDS.

Phoenix Rising - News about ME/CFS and Fibromyalgia.

Background Information

Peckerman et al - Study by Dr. Arnold Peckerman and others demonstrating that patients with severe CFS had significantly lower stroke volume and cardiac output than controls and less ill patients. This is the study which on which Dr. Paul Cheney and others have based subsequent research and treatment regimes.

Low Blood Volume and CFIDS - A discussion of the phenomenon of low blood volume which has been observed in CFIDS patients, and the connection with low blood pressure and other symptoms related to CFIDS and Fibromyalgia.

Cortisol Treatment for FM/CFS - A study suggesting cortisol can provide relief of symptoms. I've tried cortisol myself, with dreadful results, so I'm skeptical.