Tag: opinion

The Role of Immunity and Inflammation in ME/ CFS and Post-COVID Syndrome: Implications for Treatment

Abstract:

Probably one in seven patients who have experienced acute COVID-19 continue having long-lasting complaints, called post-COVID syndrome or long-COVID, that are similar to those observed in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).

There are good reasons to believe that common immunological, epigenetic and inflammatory mechanisms are involved in the pathogenesis both diseases.

To date, various therapeutic approaches have been recommended, but with moderate success. In the present opinion paper, the author weights his clinical experience against data from the literature, and suggests novel approaches.

In addition to general measures and paramedical approaches, food supplementation with a specific nutraceutical can be completed by oral administration of sodium dichloroacetate and Meldonium to optimize glucose metabolism and mitochondrial energy generation.

Alternatively, intravenous infusions with magnesium salt and multivitamins can be completed with glutathione, m-tranexamic acid, and cultured stem cells.

Preliminary results of an open-label, prospective, two-centre trial suggest more than four in five patients benefit from combined oral and infusion therapy with significantly diminished fatigue and improved well-being.

Monoclonal antibodies in “biologicals”, blocking the effects of cytokines, and “small molecules” with Janus kinase inhibiting activity may offer novel opportunities by focusing on both immunologic and inflammation targets. A pilot trial with, in particular, one of the Janus kinase inhibitors could be considered.

Source: Comhaire F. The Role of Immunity and Inflammation in ME/CFS and Post-COVID Syndrome: Implications for Treatment. MedLife Clinics 2022, Volume 4 (2), Article 1043 http://www.medtextpublications.com/open-access/the-role-of-immunity-and-inflammation-in-me-cfs-and-1254.pdf (Full text)

Known unknowns, and as yet medically unexplained diseases

Seen from the outside, the process of scientific exploration of diseases seems chaotic and confusing. Indeed, from within, it is tempting to deduce that clinical academics are chaotic and confused.

To be fair, that is an appropriate deduction. Einstein famously said, ‘If we knew what we were doing, it wouldn’t be called research.’ The vast majority of medical research can be compared to solving a particularly complex crossword puzzle. We start with the ‘easy answers’, then progress to the deducible, before staring endlessly at the problems that don’t make sense to us. The hope is that the pieces we already have will enable us to fill the gaps and produce a semblance of sense.

Practising medicine often does not allow this freedom of thought. If the CRP is falling, the antibiotics are working; if it is rising, they’re not; fracture is a fracture; air under the diaphragm represents burst viscera.

Where, then, do we place conditions that we don’t as yet have diagnostic tests for?

Read the rest of this article HERE.

Source: Known unknowns, and as yet medically unexplained diseases by David Strain. BMA, May 12, 2022. https://www.bma.org.uk/news-and-opinion/known-unknowns-and-as-yet-medically-unexplained-diseases

Report of the Dutch National Health Council on chronic fatigue syndrome

Abstract:

In our opinion, the recent report of the Dutch National Health Council on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) lacks balance: it is very critical on the quality of evidence regarding behavioural interventions, but lacks a critical attitude regarding the presumed somatic components of the disorder. Without solid evidence, the report coins ME/CFS as a severe multisystem disease, and it embraces the diagnostic criteria of the American Institute of Medicine. We underscore the remarks in the report that physicians should not be reluctant to make diagnosis in patients with the disorder, and that these patients should be approached with empathy and respect. Regarding a future research programme, there is need for a well-designed research agenda.

Source: van der Meer JWM, Roerink ME, van de Putte EM. Report of the Dutch National Health Council on chronic fatigue syndrome. Ned Tijdschr Geneeskd. 2018;162(0):D2845. [Article in Dutch]   https://www.ncbi.nlm.nih.gov/pubmed/29600930

Unproven diet therapies in the treatment of the chronic fatigue syndrome

Abstract:

This report is a review of the unproven diet therapies recommended for individuals with chronic fatigue syndrome (CFS). Diet therapies promoted for the relief of CFS symptoms by the authors of five CSF self-help books were evaluated on the basis of nutritional adequacy and scientific rationale.

Unproven diet therapies for patients with CFS include megavitamin/mineral supplements; royal jelly and other dietary supplements; and elimination, avoidance, and rotation diets. Claims that these therapies relieve CFS symptoms and promote recovery are anecdotal and have not been substantiated by clinical research.

The yeast-avoidance and sugar-free diets, both promoted to combat Candida albicans overgrowth, are of questionable value in treating patients with CFS. The rotation diet is not balanced and does not meet the current recommended dietary intake levels. Diet strategies that call for the avoidance of food additives, preservatives, sweeteners, and other ingredients are not supported by available evidence and are not practical for patients with CFS.

A diet plan for patients with CFS should be based on sound nutritional principles and common sense. Until the results of studies demonstrating the benefits of particular diet therapies in the management of CFS are available, patients with CFS are advised to eat a varied diet selected from among and within the basic food groups to ensure an adequate nutrient intake and to reach and maintain a reasonable body weight.

 

Source: Morris DH, Stare FJ. Unproven diet therapies in the treatment of the chronic fatigue syndrome. Arch Fam Med. 1993 Feb;2(2):181-6. http://www.ncbi.nlm.nih.gov/pubmed/8275187