CFS: Suggestions for a nutritional treatment in the therapeutic approach

Chronic fatigue syndrome (CFS): Suggestions for a nutritional treatment in the therapeutic approach, by Geir Bjørklund, Maryam Dadar, Joeri J Pen, Salvatore Chirumbolo, Jan Aaset in Biomedicine & Pharmacotherapy Vol 109, Jan 2019, Pp 1000-1007

Review abstract:
Chronic fatigue syndrome (CFS) is known as a multi-systemic and complex illness, which induces fatigue and long-term disability in educational, occupational, social, or personal activities. The diagnosis of this disease is difficult, due to lacking a proper and suited diagnostic laboratory test, besides to its multifaceted symptoms. Numerous factors, including environmental and immunological issues, and a large spectrum of CFS symptoms, have recently been reported.

In this review, we focus on the nutritional intervention in CFS, discussing the many immunological, environmental, and nutritional aspects currently investigated about this disease. Changes in immunoglobulin levels, cytokine profiles and B- and T- cell phenotype and declined cytotoxicity of natural killer cells, are commonly reported features of immune dysregulation in CFS. Also, some nutrient deficiencies (vitamin C, vitamin B complex, sodium, magnesium, zinc, folic acid, l-carnitine, l-tryptophan, essential fatty acids, and coenzyme Q10) appear to be important in the severity and exacerbation of CFS symptoms.

This review highlights a far-driven analysis of mineral and vitamin deficiencies among CFS patients.

Excerpt:

A meta-analysis with 27 studies concludes that there are still few data to provide a promising hypothesis for the effective role of mineral and vitamin supplementation in the CFS pathophysiology and therapy. Current studies on minerals and vitamins in CFS patients need large population-based and age-matched prospective research, as well as well-observed interventional studies in CFS patients, to achieve more awareness in the efficacy of minerals and vitamins in the CFS pathophysiology. According to this analysis, vitamin A and vitamin E are promising vitamins that need further examination.

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Hand grip strength as a clinical biomarker for ME/CFS & disease severity

Hand grip strength as a clinical biomarker for ME/CFS and disease severity, by Luis C Nacul, Kathleen Mudie, Caroline Kingdon, Taane G Clark, Eliana M Lacerda in Frontiers in Neurology, 5 Nov 2018 [Preprint]

Research abstract:

Background:
The diagnosis of myalgic encephalomyelitis (ME/CFS) in research and clinical practice has largely relied on clinical history, which can be subjective in nature. Clinical signs are often subtle, overlap with other conditions, and are not formally included as part of diagnostic workup. The characterisation of clinical signs and biomarkers is needed for better diagnosis and classification of patients and to monitor treatment response.

Hand grip strength (HGS) has been used as an objective measure of muscle strength and fatigue, which is a primary symptom of ME/CFS. We assessed the potential usefulness of HGS as a diagnostic marker in ME/CFS.

Methods:
We compared HGS measurements from participants in the UK ME/CFS Biobank, with groups consisting of people with ME/CFS of differing severity (n=272), healthy (n=136), multiple sclerosis (n=76) controls, and others with chronic fatigue not meeting the diagnosis of ME/CFS (n=37). We correlated the maximum and minimum of, and differences between, 3 repeated HGS measurements with parameters of disease severity, including fatigue and pain analog scales, and physical and mental component summaries from the SF-36v2TM questionnaire across recruitment groups.

Results:
HGS indicators were associated with having ME/CFS, with magnitudes of association stronger in severely affected than in mild/moderately affected patients. Compared with healthy controls, being severely affected was associated with a reduction in minimum HGS of 15.3kg (95%CI 19.3-11.3; p<0.001), while being mild/moderately affected was associated with a 10.5kg (95%CI 13.2-7.8; p<0.001) reduction. The association persisted after adjusting for age, sex and body mass index. ME/CFS cases also showed lower values of maximum HGS and significant drops in values from the first to second and third trials, compared to other study groups. There were significant correlations between HGS indicators and clinical parameters of disease severity, including fatigue analog scale
(Spearman’s Rho= -0.40, p<0.001), pain analog scale (Rho=-0.38, p<0.001), and physical component summary (Rho=0.42, p<0.001).

Discussion:
HGS is markedly reduced in ME/CFS, particularly in patients with more severe disease, and may indicate muscle and fatigue related symptoms.

HGS is a potential diagnostic tool in ME/CFS, and could also be used to enhance patient phenotyping and as an outcome measure following interventions.

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Understanding ME & CFS symptoms in children – take part in research project!

Symptomatology of pediatric ME & CFS – research project

The Center for Community Research at DePaul University in the USA, led by Prof Leonard Jason says:

There is currently little research on children with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Through this study, we hope to learn more about the symptoms and experiences of children who are living with ME and CFS.

We are requesting responses from children (ages 5-17) with ME and CFS and their parents. Parents will complete the first set of questionnaires (30 minutes), and children will complete the next (final) set of questionnaires (30 minutes).

Take the online survey

We recognize that this survey contains many questions, and we are extremely grateful for the time and effort you devote to this study.  You do not need to complete all of the questions at one time; you may save and return to complete the survey later as many times as necessary.

Contact Madison Sunnquist  msunnqui@depaul.edu with any questions, or if you would like to be contacted about future research opportunities related to pediatric ME and CFS.

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Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review & meta-analysis

Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis, by Swati Mehta, Vanessa A Peynenburg, Heather D Hadjistavropoulos in Journal of Behavioral Medicine, 1 November 2018 [Preprint]

Review abstract:

This systematic review and meta-analysis aims to evaluate the effectiveness of internet-delivered cognitive behavioural therapy (ICBT) on anxiety and depression among persons with chronic health conditions.

A systematic database search was conducted of MEDLINE, CINAHL, PsycInfo,
EMBASE, and Cochrane for relevant studies published from 1990 to September 2018. A study was included if the following criteria were met:
(1) randomized controlled trial involving an ICBT intervention;

(2) participants experienced a chronic health condition;

(3) participants >=18 years of age; and

(4) effects of ICBT on anxiety and/or depression were reported.

The Cochrane Risk of Bias tool was used to assess the risk of bias on the included studies. Pooled analysis was conducted on the primary and condition specific secondary outcomes. Twenty-five studies met inclusion criteria and investigated the following chronic health conditions: tinnitus (n = 6), fibromyalgia (n = 3), pain (n = 7), rheumatoid arthritis (n = 3), cardiovascular disease (n = 2), diabetes (n = 1), cancer (n = 1), heterogeneous chronic disease population (n = 1), and spinal cord injury (n = 1). Pooled analysis demonstrated small effects of ICBT in improving anxiety and depression.

Moderate effects of therapist-guided approach were seen for depression and anxiety outcomes; while, self-guided approaches resulted in small effects for depression and moderate effects in anxiety outcomes. ICBT shows promise as an alternative to traditional face-to-face interventions among persons with chronic health conditions. Future research on long-term effects of ICBT for individuals with chronic health conditions is needed.

 

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Updated NICE guideline committee list

NICE added an updated (but still incomplete) committee membership list to their website on 1 November 2018.  The Committee will operate as an advisory Committee to NICE’s Board, developing a guideline on ME/CFS.

Membership list

Chair

Peter Barry, Consultant, Paediatric Intensivist, University Hospitals of Leicester

Vice Chair

Ilora Finlay, Consultant in Palliative Medicine, Clinical Lead for Palliative Care for Wales,
Velindre NHS Trust, Cardiff

Secondary care paediatrician

Theo Anbu, Consultant general paediatrician and lead for paediatric CFS/ME, Alder Hey Children’s NHS Foundation Trust, Liverpool

Physician with an interest in ME/CFS

Michael Beadsworth, Consultant in Infectious Diseases, Clinical Director Specialist and
Academic Medicine, Clinical Lead CFS/ME Regional Services, Royal Liverpool University Hospital

Physiotherapist

Joanne Bond Kendall, Senior Physiotherapist, Specialist paediatric CFS/ME, Bath

GP

Chris Burton Professor of Primary Medical Care, University of Sheffield

Social worker

Tony Crouch, Social work advisor

Psychologist

Jo Daniels, Senior Lecturer Clinical Psychology, University of Bath. Chartered
Clinical Psychologist, North Bristol NHS Trust

Physician with an interest in ME/CFS

Gabrielle Murphy Clinical Lead, Fatigue Service Royal Free London NHS Foundation Trust

GP

Luis Nacul GP

Community paediatrician

Alan Stanton Consultant Community Paediatrician, University Hospitals Birmingham

Occupational therapist

Susan Watson Senior occupational therapist, Leeds and West Yorkshire CFS/ME Service

Lay members

  • Saran Bonser
  • Sally Burch
  • Nicola Kidby
  • Adam Lowe
  • Dorinda Jack

Community paediatric nurse – To be appointed
Nurse with experience in ME/CFS – To be appointed
Dietitian – To be appointed
Physician with an interest in ME/CFS (1 or 2)- To be appointed

WAMES is concerned by the predominance of committee members from institutions which promote the use of GET and CBT for people with ME.

We understand that applications from doctors working outside the NHS have been rejected, but that talks are ongoing to redress the balance.

We are pleased that 5 patients have been appointed, which is more than normal.

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CFS & the somatic expression of emotional distress

Chronic fatigue syndrome and the somatic expression of emotional distress: applying the concept of illusory mental health to address the controversy, by AD Bram, KA Gottschalk, WM Leeds in J Clin Psychol. 2018 Aug 28. [Epub ahead of print]

Abstract:

OBJECTIVE:

The process of somatization in chronic fatigue syndrome (CFS) was investigated using the concept of illusory mental health (IMH). IMH involves self-reporting low emotional distress alongside performance-based assessment of distress.

METHOD:

We studied IHM and physical symptoms in 175 women across four groups: (a) CFS plus depression; (b) CFS with no depression (CFS-ND); (c) depressive disorder without CFS; and (d) healthy controls (HC). IMH was assessed using a self-report measure plus the performance-based Early Memory Index (EMI).

RESULTS:

CFS-NDs were no more likely to have IMH compared with HCs. Among the CFS-NDs, IMH was associated with more physical symptoms. For CFS-NDs, EMI added meaningfully beyond self-reported mental health in predicting physical symptoms.

CONCLUSION:

Findings refute reducing CFS to somatization, but there is a subgroup of CFS whose lacking access to emotional distress is associated with heightened physical symptomatology.

Read full article.

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Exercise-induce hyperalgesia, complement system & elastase activation in ME/CFS

Exercise-induce hyperalgesia, complement system and elastase activation in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome – a secondary analysis of experimental comparative studies, by Andrea Polli, Jessica Van Oosterwijck, Mira Meeus, Luc Lambrecht,  Jo Nijs, Kelly Ickmans in Scandinavian Journal of Pain [Published Online: 2018-10-16]

Research abstract:

Background and aims:
The interaction between the immune system and pain has been thoroughly explored in the recent decades. The release of inflammatory mediators from immune cells has the capability of activating neurons and glial cells, in turn sensitizing the nervous system.

Both immune system alterations and pain modulation dysfunctions have been shown in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) following exercise. However, no studies tried to explore whether these two phenomena are linked and can explain exercise-induced symptoms worsening in people with ME/CFS.

We hypothesized that exercise-induced changes in descending pain modulation is associated to changes in immune system functions. We used complement system product C4a and elastase activity as indicators of immune system activity.

Methods:
The study design was a secondary analysis of controlled experimental studies. Twenty-two patients with ME/CFS and 22 healthy sedentary controls were enrolled. In experiment 1, subjects performed an aerobic submaximal exercise test; in experiment 2 they underwent a self-paced exercise test. One week of rest period were set between the two exercise tests. Before and after each experiment, subjects underwent clinical assessment, pain thresholds (PPTs) measurement, and blood sampling. Immune system function was assessed measuring complement system C4a products and elastase activity.

Results:
Changes in elastase activity were not associated to changes in PPTs. Associations were observed in the ME/CFS group between changes in PPTs and C4a products, following both types of exercise. After submaximal exercise, the change in C4a products was associated with the change in PPT at the thumb in patients (r=0.669, p=0.001). Similarly, after self-paced exercise the change in C4a products was associated witht the change in PPT at the calf in patients (r=0.429, p=0.047). No such correlations were found in healthy controls. Regression analysis showed that C4a changes after the submaximal exercise significantly predicted the change in PPTs (R2=0.236; p=0.02).

Conclusions:
Moderate associations between exercise-induced changes in PPTs and immune system activity were found only in ME/CFS. The change in the complement system following submaximal exercise might be able to explain part of the change in patient’s pain thresholds, providing evidence for a potential link between immune system alteration and dysfunctional endogenous pain modulation. These results have to be taken with caution, as only one out of three measures of PPTs was found associated with C4a changes. We cannot reject the hypothesis that C4a might therefore be a confounding factor, and changes during exercise might be mediated by other mechanism.

Implications:
Immune system changes following exercise might contribute to exercise-induced symptoms worsening in patients with ME/CFS. However, the role of the complement system is questionable.

Read the full article

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ME: “Her life has just stopped”

ME: “Her life has just stopped”

A translation of ME: “Mae ei bywyd hi jest wedi stopio” online at BBC Cymru fyw, 25 October 2018

Natalie Price, the girlfriend of Jonathan Vaughan, has been suffering from ME (Myalgic Encephalomyelitis) for four years. This is a condition that causes extreme fatigue, and prevents the person suffering from being able to live a normal life.

Jonathan spoke at a Senedd event on Wednesday October 24 where a movie about the condition was shown.

In his own honest words, he spoke about what it was like to live with the condition, and the effect it had on him and Natalie.

I met Natalie almost five years ago, and we got together soon after. She loved running, she became an incredible artist. She studied – just finished one grade and started on another, in dietetics.

 

 

 

 

 

 

 

 

 

In September 2016 she had to stop working part-time – she had been ill for about two and a half years – and in March 2017 she had to leave university, It was a very difficult decision.

In June 2018, we went to a doctor’s appointment … and that is the last time she went down the stairs. She’s been stuck in bed since.

I have to stand and watch a decisive, person who was full of life changing into someone who cannot even eat a bowl of soup now because it takes too much energy. Her life has just stopped.

I care for her full time, and also work full time. I cook, clean, wash the clothes, change the bedding, put magnesium oil on her legs, order the drugs and so on. And when she needs a shower, she sits on a chair in the bath and I wash her.

This is obviously not fun.

Told to google it…

The diagnosis took quite a long time – about two years, which is just below the average – but it was not great. We had a ‘little advice from the GP at that time, but it only took two words – “Google it”.

The doctor said there’s nothing in Wales, no expert, no one can help. So we had to go on forums and find out for ourselves.

Of course, through trying to deal with the fact that her body had failed, she became depressed. The doctor started prescribing anti-depressant tablets. The first drug exacerbated her symptoms, and she stopped getting out of the house.

The new drug she takes now affects parts of the brain that increase the sensitivity to light and sound. So being on the drugs, her ability to watch television at all has gone. Thank goodness for audio books. That’s the only thing we’ve really got left.

 

 

 

 

 

 

 

 

In terms of healthcare, we’ve not got a lot of help. We asked for her to have magnesium injections, but you cannot get these on the NHS, so I mix saline and Epsom strong salts. Natalie takes it with a nebuliser every day, for about half an hour to a hour, with a mask. And nebulisers are noisy, so this really does not help with her sensitivity to noise.

Living in a dark room

There has been a lot of research into B12 for ME patients, and almost all ME patients I have spoken to have noticed significant improvement after taking B12. In Natalie, ‘significant’ is going to the toilet twice a day instead of once, because that’s the only time she can get out of bed.

We looked into this, but Nathalie’s B12 levels were too high to get it from the doctor. So we ship it all over from Germany, and I give the injections to her. Luckily, Mum became a nurse, so she taught me how to do it.

We’ve been doing this for about five weeks, and Natalie, at last, can spend some two hours on her phone every day. This is, literally, her only window on the world – because light is  so painful for her, we’ve had to block the windows. She spends her days in a dark room.

And the sensitivity is so bad, I can not stay in the room very long. I can see my fiance for about half an hour a day. She was going to become my wife two years ago, but obviously it did not happen …

I’m proud to be Welsh and live in Wales – we look after each other here. So it’s so weird that the only advice we got with the diagnosis of ME was to “Google it”.  Help has to come from somewhere.

#TimeForUnrestWales

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Does fatigue & distress in a clinical cohort of adolescents with CFS correlate with fatigue and distress in their parents?

Does fatigue and distress in a clinical cohort of adolescents with CFS correlate with fatigue and distress in their parents? by Maria E Loades, Katherine  A Rimes, S Ali, Kate Lievesley, Trudie Chalder in Child: Care, Health and Development, 20 Oct 2018 [preprint]

Research abstract:

Objectives
Previous studies have found that parents of children with CFS are more fatigued, and mothers are more distressed than healthy controls. Managing the disabling symptoms of CFS can result in disruption and burden for the family. Most research has focused on mothers. This study sought to further explore the associations between adolescent fatigue
and distress, and parental fatigue and distress, as well as family functioning, including both mothers and fathers.

Design
Cross‐sectional study of a clinical cohort of consecutive attenders at a specialist chronic fatigue unit.

Methods
Questionnaires were completed by adolescents (N=115, age 11-18) with a confirmed diagnosis of CFS and their mothers (N=100) and fathers (N=65)..

Results
Maternal fatigue was significantly correlated with maternal distress, but not with adolescent fatigue, depression, anxiety or functioning.

This pattern held true for paternal fatigue. Maternal and paternal anxiety and depression were significantly correlated with family functioning. Paternal and maternal distress were correlated with each other. Mothers and fathers tended to have a consistent view of family
functioning. Family functioning, specifically being overwhelmed by difficulties and scoring lower on strengths and adaptability was positively associated with adolescent depression. Unexpectedly, higher levels of adolescent fatigue and poorer physical functioning were
associated with better family functioning as rated by the mother.

Conclusions
Parents of adolescents with fatigue scored near to or within normative range for non‐clinical samples on distress, fatigue and family functioning. Parental distress may contribute to or result from poorer family functioning. Family functioning, particularly building strengths and adaptability, may be clinically important in CFS, as well as
attending to parental, (particularly paternal) distress in families where adolescents are low in mood.

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The development of an instrument to assess post-exertional malaise in patients with ME & CFS

The development of an instrument to assess post-exertional malaise in patients with myalgic encephalomyelitis and chronic fatigue syndrome, by Leonard A Jason, Carly S Holtzman, Madison Sunnquist, Joseph Cotler in Journal of Health Psychology, 24 Oct 2018 [Preprint]

Research abstract:

Post-exertional malaise, or a variation of this term, is a key symptom of myalgic encephalomyelitis and chronic fatigue syndrome, as this symptom is mentioned in almost all myalgic encephalomyelitis and chronic fatigue syndrome case definitions.

Until now there has not been a comprehensive questionnaire to assess post-exertional malaise. To rectify this situation, in this article we describe the development of a new questionnaire, called the DePaul Post-Exertional Malaise Questionnaire, which was based on input from hundreds of patients.

Preliminary validation was provided by the findings of significant and predictable relationships between different domains of this post-exertional malaise questionnaire and physical functioning.

Download full text pdf from this link

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