CFS and ME Flashcards
CFS and ME
CFS = chronic fatigue syndrome. ME = myalgic encephalomyelitis. CFS and ME are terms often used interchangeably though ME is sometimes defined as CFS + inflammation.
- Characterised by long-term physical and cognitive fatigue, not alleviated by rest.
- Other symptoms include post-exertional malaise, muscle and joint pain, unrefreshing sleep, flu-like symptoms with sore throat and tender lymph nodes, mood disturbances.
- While mitochondrial dysfunction is recognised as a key player, there are a number of proposed contributing factors.
CFS and ME are not diagnoses — they are clinical pictures. The role of healthcare practitioners is to identify the underlying mechanisms and contributing factors.
- Both are characterised by fatigue but in ME there is also an inflammatory process:
‒ CFS = poor energy delivery mechanisms. ‒ ME = CFS plus inflammation.
- Inflammation occurs when the immune system is active i.e., chronic infection, allergy and / or autoimmunity.
- Poor energy delivery systems can result in myriad symptoms
Chronic stress effectively ‘kicks’ mitochondria unrelentingly but:
- Eventually mitochondria will fatigue either because they run out of raw materials and / or there is no proper ‘shut down’ during sleep for healing and repair.
- If they become unable to respond to the unrelenting adrenaline kick, it results in the clinical picture of chronic fatigue syndrome.
- If the immune system lacks energy, then it cannot deal with an infection efficiently so the infection may become chronic.
- The above mechanisms result in the clinical picture of myalgic encephalomyelitis
CFS and ME aetiologies
Proposed aetiologies:
- Infectious organisms — in particular EBV (high antibody titres in patients with symptoms indicative of CFS). Other: Human herpes virus-6, Borrelia burgdorferi (Lyme’s).
- Immunological — e.g., increased cytokines, NK cell abnormalities, decreased CD8 suppressor cells. Imbalances that collectively suggest chronic, low level activation of the immune system.
- Abnormal HPAA functioning — association with hypocortisolism.
- Mitochondrial dysfunction and high oxidative stress — associated with ↓ GPO and SOD. Also low melatonin (sleep dysregulation). Consider polymorphisms in antioxidant or detox pathways
- Serotonin studies have concluded:
‒ Increased 5-HT autoimmune activity is associated with activation of inflammatory pathways and increased bacterial translocation. A reduction in 5 HT neurons has been noted.
‒ Proposed upregulation of the serotonin transporter (5-HTT) in astrocytes, reducing extracellular serotonin (5-HT) levels.
- A breakdown in the bidirectional communication between the brain and the gut mediated by bacteria and their metabolites. CFS / ME are commonly associated with GI symptoms
- Findings in relation to intestinal health and CFS:
– High relative abundance of bacterial species such as clostridium and ruminococcus in CFS / ME; decreased faecalibacterium abundance.
– Metabolic endotoxaemia as a driver for CFS / ME.
- Microbes that cause dysbiosis can alter the immune system and disregulate mitochondrial function.
Further, CNS manifestations are thought to relate in part to increases in neurotoxic ammonia and D-lactic acid-producing gut bacteria
Natural approach to CFS / ME — avoid
- Caffeine (coffee, tea, chocolate, energy drinks). Temporarily counters fatigue, but the effect is short-lived and places strain on the adrenal glands exacerbating an already fatigued body.
- Sugar — an immune system depressant. Destabilises blood glucose causing peaks and troughs in energy.
- Artificial sweeteners — interact with sweet receptors to trigger insulin release (destabilise blood glucose). Aspartame contains excitotoxins (e.g., aspartates) and methanol, which converts to formic acid — a neurotoxin. Can worsen neurological symptoms.
- Alcohol — worsening of symptoms, depletes body of nutrients.
Natural approach to CFS / ME — include
- Good quantities of essential fatty acids:
– Omega-3 is especially important for the activity of the mitochondrial membrane. EPA — anti-inflammatory properties and increases mitochondrial growth, size and distribution. DHA — essential for the structure of ETC complexes.
– Most notable benefits observed are improvements in cognitive function and reduction in relapse frequency.
- Sufficient protein to allow for immune cell restoration and function.
- Individualised immune support (e.g., anti-microbials, vitamin C etc.)
and GI support (e.g., digestive bitters, pro and prebiotics etc.)
Nutritional ketosis in CFS / ME
Nutritional ketosis in CFS / ME — considered a beneficial dietary strategy for supporting mitochondrial function.
- Total carbohydrate intake < 50 g / day (or whatever is needed to get into ketosis).
- Moderate protein intake, around 1.5 g / kg bodyweight per day.
- Fuel as ketones come from fat AND the fermentation of fibre in the large bowel to short chain fatty acids.
- Typical macronutrient ratio — 75% fat, 20% protein, 5% carbohydrate.
- Changes the body’s primary fuel source from glucose to ketones.
- Ketones enter the mitochondria of body tissues for ATP production.
Benefits of a ketogenic diet
- While excess levels of mitochondrial ROS (mtROS) are associated with mitochondrial dysfunction, low concentrations of mtROS can act as signalling molecules, upregulating mitochondrial capacity and antioxidant defence — known as mitohormesis.
- Ketosis causes a significant shift in energy metabolism increasing reliance on mitochondrial respiration ― this induces mitohormesis.
- Further, in addition to their role as energy substrates, ketones (especially β-hydroxybutyrate) act as signalling molecules increasing expression of antioxidant enzyme systems.
Liquorice Glycyrrhiza glabra 1‒2 tsp powder daily.
- Suboptimal HPAA function and low cortisol is a common feature of CFS / ME. Liquorice is an adrenal cortex restorative, supporting cortisol production and ↓ fatigue.
- Anti-inflammatory activity — research indicates inhibitory effects on ROS-induced tissue inflammation and the COX, LOX and NF-κB inflammatory pathways.
Astragalus Astragalus membranaceus
2.5‒3.5 g dry herb
- An adaptogen and tonic indicated for debility and CFS.
- Regulatory effect on immune function; supports aspects of innate immunity while promoting Th1 / Th2 balance.
- Reduces abnormal cytokine production.
Poor energy delivery to the body:
- Physical fatigue, poor stamina.
- Post-exertional malaise (akin to over-training in athletes).
- Loss of muscle power — muscles heavily rely on ATP!
- Muscle pain — because of an early switch into anaerobic metabolism with production of lactic acid.
- Variable blurred vision — the ciliary body muscles required for focusing tire easily.
- Subnormal core temperature
Poor energy delivery to the brain
- Mental fatigue with brain fog — the brain weighs 2% of body weight but consumes 20% of total energy.
- Light and noise intolerance.
Mental symptoms which inhibit energy expenditure
- Low mood.
- Feeling stressed.
- Procrastination.
Poor energy delivery to the heart
- Hypotension — in severe cases this manifests with orthostatic intolerance and POTS.
- Angina described as ‘atypical’ (from lactic acid)
Poor energy delivery to the immune system
- Susceptibility to infection, unable to run a good fever.
- Slow healing and repair
Naturapatic approach to CFS and ME
To improve energy delivery mechanisms, all aspects must be addressed. They must also be addressed in the correct order.
- Fuel in the tank (paleo-ketogenic diet, basic package of nutritional supplements and good gut function).
- Mitochondrial engine — servicing and repair (quality and quantity of sleep).
- The control mechanisms:
- Thyroid accelerator pedal.
- Adrenal gear box.
Fuel in the tank — paleo-ketogenic diet (PK Diet)
Fuel in the tank — paleo-ketogenic diet (PK Diet):
- Mitochondria evolved to use ketones from fat and fibre for energy.
- Increases expression of energy-producing genes — energy output is increased.
- Decreases inflammatory end-products and the toxic load on the mitochondria
Avoid gluten and all dairy except butter (almost 100% fat).
- Gluten — Non-coeliac wheat sensitivity (NCWS), identified in a subset of individuals with CFS / ME, is linked with increased intestinal permeability and systemic immune activation.
- Other grains are permitted so long as ketosis is maintained — this is why a ketone breath meter is so helpful.
- Dairy — at least 30% of people are allergic; lactose may be fermented; milk protein contains growth promoters (risk for cancer); high Ca / Mg ratio which induces Mg deficiency, increased risk of osteoporosis; milk protein increases blood viscosity
Factors that inhibit mitochondrial function
