The Treatment of Chronic Fatigue Syndrome (ME) by Complementary Medicine PDF Print E-mail

by Dr David Dowson

Summary

Although there is an increasing acceptance of Chronic Fatigue Syndrome as a real and debilitating physical illness, there is little orthodox medicine has to offer in treatment. In addition, research has so far been directed more to the cause of the condition rather than its management. Despite this practitioners in the field of complementary medicine are successfully treating patients using a range of methods, both conventional and alternative. Since little research is available, many of these approaches remain unproven.

Introduction

Despite the apparent recent increase in the incidence of this condition, Chronic Fatigue Syndrome is not a new disease. Descriptions of the condition date from early times in that Galen described a disease complex closely resembling CFS [1], and the first recorded epidemic occurred during the reign of Henry VIII [2]. It has been suggested that Darwin and Florence Nightingale both had the condition.

In more recent times a syndrome of symptoms similar to CFS was reported on a group of nurses in Coventry in 1954 [3], and at the Royal Free Hospital between July and November 1955 [4]. In the latter case 292 members of staff were affected, and over 90% required hospitalisation.

Since then there have been sporadic outbreaks at various locations in the UK, but it is becoming clear that CFS is not an illness limited to small areas, although there may be a geographic trend. Sufferers appear amongst the community without any apparent contact with other patients.

The Conventional View of ME

Many practitioners find it hard to accept that there is such a condition as Chronic Fatigue Syndrome. Regrettably, and often to the detriment of patients, they view such a problem as being psychosomatic and tend to refer patients for psychological treatment. Unfortunately, there are patients for whom illness is an advantage who self diagnose ME - and this colours the view when faced with genuine patients. The tendency for self diagnosis is reinforced by the fact that there is no specific test for ME. But if the symptoms and characteristics of true ME patients are understood and recognised, it is relatively easy to distinguish the ‘fake’ sufferer.
Genuine ME is a devastating condition which may affect the lives of sufferers for many years at the prime of life and should not be dismissed lightly.

Symptoms and Diagnosis

Despite attempts there is to date no adequate diagnostic test for CFS. At one time tests for a specific viral protein (VP 1) was thought to be diagnostic, but it has since become clear that only a minority of patients with the condition have a positive test [5], and that there are a large number of positive results amongst the normal population. The diagnosis therefore rests on an opinion, depending on the symptoms.

Several definitions of the condition have been made by various authorities, depending on major and minor symptoms. For the purposes of research, the author has tended to favour the Australian criteria [6] of three major signs and ten supporting symptoms:

Major Signs:

  • Generalised chronic persisting or relapsing fatigue, exacerbated by very minor exercise, causing significant disruption of usual daily activities and of over six months duration; and,
  • Neuropsychiatric dysfunction including impairment of concentration and/or short term memory impairment and/or;
  • Abnormal cell-mediated immunity indicated by reduction in absolute count of T4 and/or T8 lymphocytes.

Supporting Symptoms:

  • Myalgia.
  • Muscle tenderness.
  • Arthralgia.
  • Headaches.
  • Depression.
  • Tinnitus.
  • Paraesthesia.
  • Insomnia.
  • Lymphadenopathy.
  • Recurrent pharyngitis.

One additional common symptom not mentioned in this definition is irritable bowel.

Frequently the condition develops following a viral infection, and in early stages can be viewed as post-viral fatigue syndrome. When this becomes more severe and longer lasting it should be viewed as CFS.

CFS tends to be a disease commonest in young adults and adolescents. Several studies have shown that the peak incidence is at age 37, with it rarely developing below 10 or above 55. [7]. In the same studies the male/female ratio has been shown to be 1:3.

The course of the condition is variable, with spontaneous recovery occurring in the early stages. In its most severe form patients can be restricted to bed for months or even years. Commonly there is variation in the severity, with exacerbation following over-exertion or co-incidental infection. In one study of fifty patients the duration was up to twenty-two years with a mean of five years. [8]. Although in itself not fatal, CFS causes considerable morbidity and can lead to suicide. Generally it is estimated that there are between 150,000 and 200,000 sufferers in the UK.

Because the diagnosis depends on subjective symptoms rather than objective signs, and there is no diagnostic test, abuse of the illness occurs by those for whom being ill has an advantage. This tends to impair the acceptability of the condition as a true physical illness by some practitioners, who as a consequence view CFS as being a purely psychological condition.

Treatment

A. Orthodox Treatment

The mainstay of treatment by orthodox means is rest and education. Antidepressants are used commonly, though often strongly resisted by patients who consider that their prescription implies that the practitioner considers CFS to be purely a psychological condition. Anti-viral drugs are rarely used for common viral infections, but if prescribed may reduce the risk of development of CFS. Antibiotics are sometimes inappropriately prescribed for viral infections, and it seems likely that this practice may enhance the development of CFS.

Prolonged sleep therapy, by the administration of high dose sedatives, has been used and may produce temporary benefit. Hyperbaric oxygen has been claimed to be of benefit, but remains untested.

For many patients the frustration of their condition being not accepted by their practitioner aggravates the illness, and sympathy, support and understanding can, on their own, be therapeutic.

B. Non-Orthodox Treatment

Often approaches to the treatment of CFS has to involve both orthodox and unorthodox methods. This dual approach is effective in some aspects of the condition, and neither method, alone, is successful.
In management of gastrointestinal aspects of CFS this particularly applies.
Patients frequently complain of altered bowel action, abdominal discomfort and excess flatulence as part of their condition. This implies an overdevelopment of yeast organisms in the bowel, and occurs in probably 60% of patients. Supporting symptoms for this aspect are an intolerance of alcohol and a craving for sugar.

Recently there has been developed a diagnostic test for this condition - the Glucose Fermentation Test. In this, following a three hour fast and a twenty-four hour abstinence from alcohol, the patient is given encapsulated glucose. An hour later a blood sample is taken and the ethanol level estimated. Levels of over 0.5 mgm% demonstrates an excess of fungal organisms, and up to 12 mgm% is not uncommon.

If this aspect of CFS is present treatment is threefold:

  • A diet free of yeast and sugar must be maintained (such a diet can be used as a diagnostic test - symptomatic improvement over two weeks supports the presence of yeast overgrowth).
  • Antifungal medication should be prescribed, which may be orthodox or herbal. Orthodox anti-fungals, such as Nystatin and Amphotericin act fastest, but may cause initial aggravation of symptoms. Caprilic acid and garlic extracts are commonly self prescribed by patients, but take many months to have full effect.
  • Homeopathic medication to aid liver and kidney function is helpful, and in the later stages probiotic medication to restore the normal bowel flora may be introduced. The latter tends to prevent a recurrence of the problem once a normal diet is resumed.

Some patients exhibit symptoms suggestive of yeast overload, but the glucose fermentation test is negative. They commonly have a dysbiosis, or abnormal commensal bowel flora together with food sensitivities, in which case appropriate avoidance diet together with probiotics should be instituted.

Other than yeast overgrowth treatment involves different therapeutic methods, each of which has a part to play for different aspects of the condition. It is therefore preferable to consider each approach separately rather than different problems with CFS.

1. Homoeopathy.

In addition to support for the gastrointestinal system the main role for homoeopathy in CFS is in treating any persistent viral or bacterial infection. A high proportion, though probably not the majority, have this as part of the condition. Symptoms such as recurrent sore throat, enlarged glands and intermittent pyrexia may be present. The use of generalised homoeopathic anti-virals may be beneficial, but if the exact virus present can be identified - by orthodox or complementary methods - high potency preparations of that virus may be more successful.

Specific nosodes, particularly in bacterial infection, combined with homoeopathic drainage and renal stimulation can help, although nosodes commonly cause an initial aggravation of symptoms.

Occasionally a focus of infection may be present, often in the tonsils or appendix, and medication is unsuccessful. In such cases surgical intervention may become necessary, but this should only be advised with caution as anaesthesia may itself exacerbate CFS.

2. Ecological methods

Sensitivity to environmental substances can form part of the CFS condition. This is usually to dietary items or commonly encountered chemical pollutants, particularly volatile chemicals. Symptoms commonly caused by food sensitivity are gastrointestinal or headaches, and the patient may be aware of the particular food causing the problem.

Chemical sensitivity may result in respiratory, dermatological or psychological symptoms, especially sudden unexplained mood swings.

Two approaches may be used if sensitivities are present or suspected. If the offending item is avoidable - such as a food item - avoidance should be advised. If unavoidable de-sensitisation should be initiated, either using the appropriate Miller dilution or isopathic methods with high homeopathic potencies of the substance.

Patients who have a yeast overgrowth as part of their condition often have become sensitised to environmental fungi and fungal spores. Specific desensitisation to fungi may be needed.
Frequently patients with food sensitivity have an underlying dysbiosis which must be corrected or further sensitivities will develop.

3. Vitamin and Mineral Supplements

Self-medication with vitamins, often with little or no advice, is common in CFS patients and demonstrates their desperation and frustration at lack of treatment. With one exception there is little evidence in support of this practice unless the diet is nutritionally inadequate because of restriction due to dietary avoidance. Calcium and iodine supplements are probably wise, for example, if the patient is avoiding dairy products.

The one exception is magnesium, which has been demonstrated to be the single most effective treatment of CFS. It was demonstrated that CFS sufferers are significantly deficient in magnesium (shown by red cell magnesium levels) compared to healthy controls, and that parenteral administration of magnesium was significantly helpful in 80% of patients [9]. At present it is unclear whether magnesium deficiency is part of the cause of the condition or a result. However, as oral magnesium is relatively ineffective, it would appear that reduced absorption and/or increased excretion is probably the cause.

Patients with yeast overgrowth appear to be particularly susceptible to magnesium deficiency, possibly because the yeasts themselves extract magnesium from the diet and interfere more directly with absorption.

Some patients respond only slowly and temporarily to magnesium supplementation. Recent research has shown high excretion to be probably responsible for this, which in turn is due to a reduced level of intracellular glutathione peroxidase, an enzyme with the trace element selenium as a constituent. When this is reduced magnesium ‘leaks’ across the cell membrane into the serum and is hence excreted in the urine. Selenium supplements should therefore be taken by those on magnesium supplementation, particularly if they are vegetarian, as meat is the main source of dietary selenium.

Occasionally other minerals can be deficient, particularly zinc. Hair analysis can be useful as a screening aid to demonstrate overall mineral levels.

4. Acupuncture

Although acupuncture is probably the most acceptable and best understood complementary therapies, its role in the treatment of CFS is limited. It helps symptomatically, but usually only for a limited period of time, and is probably not curative without other therapies being provided concurrently.

5. Healing

In their desperate search for treatment patients frequently seek the help of a healer, and commonly find benefit in the sympathy and compassion they find. But some healers appear to do more in restoring energy levels.
It would seem, from our own observations, that such approaches are only successful when biochemical and physiological problems have been resolved and the patient has ‘plateaued’ in the progress, often after considerable improvement. Healers’ efforts before underlying problems are resolved are probably no more than psychological in their effect.

6. Colonic therapy

As irritable bowel is a common complaint, patients seek the temporary relief provided by colonics. The role, however, seems to be limited to those with a very severe degree of yeast overload or dysbiosis and should be confined being an adjunct to the treatments described above for these conditions.

7. Psychotherapy

Depression is common in Chronic Fatigue Syndrome, but contrary to many practitioners’ opinion is as a result of the illness, not the cause of it. In view of the long duration of the illness, combined with frustration at not being accepted, such depression is hardly surprising. Often the depression does not need to be addressed as the patient feels psychologically better once they feel a physical improvement.

With deeply depressed patients, especially those who, due to their illness have become socially isolated, may need psychological support to aid their physical recovery and resumption of normal life.

8. Massage Aromatherapy Reflexology

These therapies may be helpful in some patients, particularly those with a tendency to anxiety over their condition. However, they are, probably in the majority of cases, symptomatic treatment rather than being curative.

9. Pulsed Magnetic Field Therapy

Research in the last few years has demonstrated that patients with CFS often have abnormal EEG’s in that there is a deficiency in one or more of the frequencies produced by the brain. This research was originally into migraine sufferers, who show similar defects.

Earlier it had been found that some CFS patients improved when exposed to certain frequencies of pulsed magnetic fields, but these were not patient specific. A method has recently been developed whereby an electronic device can be programmed to oscillate at the deficient frequencies (up to four) after a record of the EEG has been taken. The patient then keeps this device within two centimetres of the skin, and the nervous system detects and responds to this magnetic field.

Although at first sight this appears a bizarre form of treatment, initial impressions are encouraging in that more than 50% of patients appear to gain significant benefit.

Any approach to treating patients with CFS must be an individual approach tailored specifically to that patient. Not all patients have the same problems, and there is therefore no one ‘cure’ suitable for all patients. Above all, much benefit can be gained from the mere recognition that the sufferer has a genuine, devastating physical condition, and that the sufferer believes there is a real concern in the therapist for their recovery.

 

© David Dowson MMVI

THE TREATMENT OF CHRONIC FATIGUE SYNDROME (ME)
BY COMPLEMENTARY MEDICINE