Saturday, January 17, 2009

Research shows genetic abnormalities in ME/CFS patients

From 15 December 2008:
Research shows genetic abnormalities in CFS patients

New research from the United Kingdom supports the theory that patients with Chronic Fatigue Syndrome (referred to outside the U.S. as Myalgic Encephalomyelitis) have identifiable genetic markers for the disease.

London’s Journal of Infectious Diseases reported in March of this year that seven (7) genetic sub-types could be found in the genotype of patients diagnosed with CFS/ME.

The same team of researchers is now conducting a follow-up study, using “a larger number of patients in order to confirm the existence of these CFS subtypes, to determine their natural history, the most important and predictive genes which can be used to aid diagnosis, and to determine the particular immune cells in which these abnormalities occur.”

European physicians have led the world in research regarding CFS/ME, recognizing symptoms of the disease as “neurasthenia” as far back as 1869.

In 1955 a relatively large outbreak of the illness in England sparked a renewed interest in research into the etiology of the disease.

The European medical community’s attention to the physiological origins of CFS/ME allowed researchers a head-start, while efforts in the U.S. have been hampered by a kind of medical “tabu” in which misinformed physicians tend to either minimze patients’ symptomology, or blame their experience of exhaustion and pain on mental health conditions such as depression.

Unfortunately, such misdiagnosis can add to the stress that many CFS/ME patients experience, and therefore tend to either cause or exacerbate such depression, leading to further confusion in the differential diagnoses process.

U.K. research focusing on the physiological components of the disease will hopefully go a long way toward validating patients’ experiences, and re-educating the American medical community about the disease’s primary nature and treatment.

New study recommends cortisol treatment for FM/CFIDS patients

Holtorf found that the majority of CFS and FM patients displayed abnormal adrenal function due to hypothalamic-pituitary dysfunction. The comprehensive review also showed that the majority of patients could be treated for this adrenal dysfunction with cortisol, in doses of as little as 5 mg to 15 mg a day, as part of a multi-system treatment.

Source: 24 March 2008:
New Study Recommends Cortisol Treatment For FM/CFIDS Patients

The body’s cortisol feedback system

Photo: The body’s cortisol feedback system

A study published in the recent edition of the Journal of Chronic Fatigue Syndrome suggests that the hormone cortisol may play a significant role in the etiology and symptomatology of Chronic Fatigue Immune Deficiency Syndrome (CFIDS) and Fibromyalgia (FM).

Patients who suffer from either syndrome know firsthand how difficult it can be to find effective treatments for the conditions. The new study, conducted by Torrance, CA Dr. Kent Holtorf, states that patients may experience significant relief from symptoms of exhaustion and pain by including little as 5 - 15 mg of cortisol per day in their treatment regimens. A summary on the Occupational Health and Safety website states:
… Kent Holtorf, M.D., medical director of the Torrance, Calif.-based Holtorf Medical Group Center for Endocrine, Neurological and Infection related illness, is advising a simplified treatment process that may help alleviate the diseases’ symptoms. From an extensive review of more than 50 published studies that assessed adrenal function in CFS and FM patients, Holtorf found that the majority of CFS and FM patients displayed abnormal adrenal function due to hypothalamic-pituitary dysfunction. The comprehensive review also showed that the majority of patients could be treated for this adrenal dysfunction with cortisol, in doses of as little as 5 mg to 15 mg a day, as part of a multi-system treatment.

“This research provides a new understanding that treating the known causes of illness in CFS and FM can improve the symptoms and quality-of-life of patients who suffer from these conditions,” Holtorf says. He adds that his research was confirmed in an observational study following the conditions of 500 patients from his clinic where, of the patients given cortisol as part of their treatment protocol, 94 percent showed improvement by the fourth visit, 75 percent noted significant improvement, and 62 percent reported substantial improvement. In addition, by the fourth visit energy levels and a general sense of well-being for patients doubled, Holtorf says. The effectiveness of this multi-system treatment was further confirmed through the analysis of the cumulative findings of more than 40 independent physicians and more than 5,000 patients, the study says.
Though no specific tests currently exist which can definitively diagnose CFIDS or FM, physicians can perform laboratory tests to determine patients’ cortisol levels. It is unclear whether patients whose levels fall within the normal range might still benefit from additional cortisol treatment.

* Editor’s Note - Several years of personal experience with Dr. Holtorf and his clinic have taught me caution regarding his level of enthusiasm for new treatments. Though we have every reason to hope that this study marks significant progress in the understanding and treatment of these conditions, the urge to believe in a single miraculous cure, while understandable, must be tempered with the acknowledgment that CFIDS and FM are complicated syndromes which require a great deal of further study by the medical community.

Cortisol regulates the body's response to stress and a lack may hinder this coping mechanism

From BBC Online, 06 January 2009 (via M.E. Association website) - Stress hormone 'a marker for ME':
Low levels of the stress hormone cortisol marks out children at higher risk of developing chronic fatigue syndrome as adults, experts believe.

These children if exposed to trauma, particularly emotional maltreatment and sexual abuse, had a six-fold increased risk for CFS, evidence shows.

Cortisol regulates the body's response to stress and a lack may hinder this coping mechanism, say the US authors.

Their work is published in the journal Archives of General Psychiatry.

Myalgic encephalomyelitis (ME), or CFS, causes long-term - and in some cases debilitating - tiredness which is not relieved by rest or sleep.

It is estimated that 250,000 people in the UK have the condition.

The authors of the latest study recruited 113 people with CFS and 124 other people without CFS as a control from a population of nearly 20,000 adults living in Georgia, the US.

The study participants were asked to complete a questionnaire on five different types of childhood trauma including emotional, physical and sexual abuse, and emotional and physical neglect.

They also gave saliva samples to record levels of cortisol over one hour after awakening, typically an individual's highest cortisol level for the day.

Abuse in childhood was a strongly linked to CFS, although not all of those with a traumatic childhood went on to develop CFS and not all of those with CFS as adults had been abused as children.

Only the individuals with CFS and a history of childhood trauma had lower than normal cortisol levels, however.

Early stress

Experts know that certain experiences children have while the brain is developing and vulnerable can make a difference in the way the body reacts to stress later in life.

This may have long-term health consequences, including CFS, said lead researcher Christine Heim of Emory University School of Medicine.

"The study indicates that low cortisol levels may actually reflect a marker for the risk of developing CFS rather than being a sign of the syndrome itself.

"Trauma that occurs at different times in childhood may be linked to different long term changes. It's an area in which more work is needed."

Sir Peter Spencer, CEO of Action for ME, said: "Childhood trauma has been linked to a higher incidence of all kinds of medical problems over the years and ME is no exception - but it is important to make one thing crystal clear. A diagnosis of ME does not mean that a patient has been mistreated or had a bad childhood.

"ME may be triggered by a wide range of factors including glandular fever, chickenpox, shingles, viral meningitis, gastroenteritis, salmonella and Lyme disease. The main conclusion that I draw from this rather limited study is the urgent need for much more biomedical research into the causes, risk factors and development of this very distressing illness."