The medical profession is always hard on disease states that we can’t readily observe or measure. As an example, if you break an arm, nobody will question the injury and the disability that goes with it. However, other problems, like chronic back pain, often don’t show up on X-rays, and hence they get much less respect from the average physician. Chronic fatigue syndrome (CFS) is one of those “invisible” diseases where many a patient has been tortured by physicians who couldn’t run a quick lab test to verify the diagnosis. Well, it looks like all of that just changed for the sufferers of this awful disease.
What if you woke up one day and found that you were so tired, you couldn’t get out of bed. Or if you did make it out of bed, that you were so tired that you couldn’t go to work or get anything done? That’s the reality that CFS patients live with every day. The latest medical practice guideline uses these criteria:
“-Fatigue that is new, persistent and/or recurrent, not explained by other conditions and has resulted in a substantial reduction in activity level characterized by post-exertional malaise and/or fatigue (typically delayed, for example by at least 24 hours, with slow recovery over several days) and
-One or more of the following list of symptoms: difficulty with sleeping, muscle and/or joint pain at multiple sites without evidence of inflammation, headaches, painful lymph nodes that are not pathologically enlarged, sore throat, cognitive dysfunction, worsening of symptoms by physical or mental exertion, general malaise, dizziness and/or nausea and palpitations with no identifiable heart problem.”
Translation? These patients get very tired after any exertion or activity and have a host of unexplained flu-like symptoms.
The purpose of the new study was to try to unravel some the uncertainties met in attempting to diagnose Chronic Fatigue Syndrome. It was made up of two groups. One group consisted of 192 subjects with chronic fatigue syndrome (CFS), and one group consisted of 392 control, or healthy, subjects. A variety of cytokines (51 in total) were measured in each group. Cytokines are cell-signaling proteins that release substances that tell other cells how to behave.
The cytokine TGF-β (transforming growth factor beta) was elevated in the CFS group, and the cytokine resistin was decreased. Seventeen additional cytokines that correlated with the severity of the CFS were also noted as being significant, and 13 of these were proinflammatory markers, showing a likely relationship between CFS and the immune system. Leptin specifically was pointed out as being a significant correlation with the severity of CFS because CFS occurs more frequently in females, and levels of leptin are naturally higher in females.
The interesting part of the discovery is that these aren’t levels that are measured on the average blood test. More importantly, there wasn’t just a clear relationship between a single level being high or low, but in fact a complex relationship between many levels being high and low in relationship to each other. This is likely critical as it explains how these patients have eluded diagnosis. There is a pattern of levels of cytokines that can detect CFS, but the average physician is looking for a single blood level or two that’s out of whack. Simply put, the diagnosis is not simple.
While there are likely many issues that can lead to chronic fatigue, there are lots of things that can cause fatigue that doesn’t seem to go away. While this is different than CFS, it’s important to review what we’ve covered on the blog. So here’s a short list of things that may be causing you to be tired or feel bad.
We know that statin drugs have been shown to cause fatigue. These are the common cholesterol lowering drugs that most physicians hand out like M&Ms. Statins can harm our mitochondria inside our cells which are the little battery packs that provide energy. When statins damage the mitochondria, they zap that cellular energy source. Statins can also cause chronic muscle pain. So if you’re tired all the time and have muscle aches and take statin drugs, it’s a good idea to talk to your doctor about an alternative.
Chronic inflammation and loss of blood sugar control (metabolic syndrome), which was a key finding in our featured CFS study above, seems to be a player in being tired in general. Inflammation can be tackled through diet by eliminating sugars and processed carbohydrates, exercise, and maintenance of your immune system and gut microbiome health. Inflammation can also be addressed through supplements, such as fish oil and glucosamine and choindroitin.
The upshot? It’s amazing as a physician to hear that we’re finally getting into what I call diagnosis 2.0. Meaning moving beyond simple things to diagnose and into the harder diseases that have eluded physicians for decades. Most of those will be like CFS. The diagnosis will depend on a complex pattern of findings that advances in artificial intelligence will help physicians recognize. What this means for patients is that awful problems like CFS, chronic pain, and other “invisible” diseases will become visible. Since being able to identify a disease is the first step in finding the cure, I expect the next 20 years in medicine will leap forward at an exponential pace relative to the last 20 years. All of that is good for patients suffering from these awful problems!
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…