Chronic Fatigue Syndrome / ME


Overview

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Myalgic Encephalomyelitis (ME), also known as Chronic Fatigue Syndrome (CFS), is a severe debilitating condition, characterised by prolonged periods of fatigue. It is often experienced with numerous accompanying physical symptoms such as pain, an inability to concentrate and/or poor memory.

The condition’s name Myalgic (meaning muscle pain or tenderness) Encephalomyelitis (meaning inflammation of the brain or spinal cord) goes some way towards explaining the cause and symptoms of chronic fatigue, but many other factors contribute to the development of this complex condition. ME/CFS manifests in a variety of symptoms –any or all of which can be experienced by the sufferer.

The earliest known ‘outbreak’ of the condition was in 1955 at the Royal Free Hospital, yet little has been done since that time to understand the causes or develop treatments for the condition. ME has only recently been recognised as a real and serious neurological condition by the WHO and UK government.

Between 0.2 and 0.4 % of the population – up to 40 in every 10,000 people – are thought to suffer with ME but, because of the difficulty with diagnosing the condition and the need for symptoms to persist for several months before a diagnosis is confirmed, it is very likely that considerably more people are affected.

Symptoms

Typical symptoms may include:

  • Persistent fatigue over a period of at least six months
  • Impaired memory and concentration
  • Sore throat and generally feeling unwell
  • Tender neck and underarm lymph nodes
  • Muscle and joint pain (if this is a major problem check for fibromyalgia)
  • Headaches
  • Non-restorative or disturbed sleep
  • Decreased libido
  • Weight changes
  • Low mood, frustration or anxiety
  • Poor temperature control
  • Hypersensitivity to sound, light and other stimuli
  • Digestion and appetite problems

Causes

ME/CFS can be triggered by a number of factors, though around 60% of cases start after a viral infection of some sort. The most common virus triggers for ME are glandular fever, the herpes virus, meningitis and in some cases hepatitis or gastroenteritis. Many non-viral infections can also be associated with onset of CFS. Other triggers can include vaccinations, physical trauma due to an accident, surgery or aggressive medical treatments. Environmental toxins and mental or emotional stress also appear to play a role in increasing the likelihood that a person will develop CFS, but these latter are not generally thought to cause CFS when experienced alone.

Researchers have found that CFS sufferers often have altered functions of chemical processes in the brain and central nervous system, as well as an abnormally low capacity to create energy within the cells.

“Reduced energy production capacity in ME/CFS sufferers results from damaged or dysfunctional mitochondria.”

One of the processes heavily affected in CFS sufferers is fatty acid production and low levels of fatty acids, particularly EPA, are a common feature in CFS patients. EPA, along with other fatty acids, is vitally important for the proper functioning of the immune system and in regulating inflammation, which is also negatively affected in CFS. Fatty acid deficiency is therefore a considerable problem, given that high levels of inflammatory cytokines are known to produce symptoms of fatigue, as well as pain and muscle aches. EPA also plays a crucial role in cellular communication and is particularly important for brain function and central nervous system activity. At the same time, viral infections (common in ME/CFS) directly reduce the activity of the enzyme delta-6-desaturase, needed to make long-chain fatty acids such as EPA from plant foods in the diet, which further adds to the severity of CFS symptoms.

Activity of the hypothalamus, the part of the brain responsible for regulating sleep, temperature control and appetite, as well as the immune system, appears to be either hyperactive or very underactive in CFS sufferers, both of which contribute to fatigue.

Some cutting-edge research and clinical evidence suggests that the reduced energy production capacity in ME/CFS sufferers results from damaged or dysfunctional mitochondria – tiny cellular structures in our cells responsible for turning food into energy. Mitochondria can be damaged or affected by toxins and stress, either mental (for example, the demands of daily life, relationships, work issues or trauma) or physiological (due to high free radical production from everyday chemical reactions and poor nutrition).

There is some support for the role of food intolerance and sensitivities in the onset and progression of CFS symptoms. Identifying which foods may be contributing to your symptoms may be helpful in condition management and recovery.

Food

beautiful girl choosing between an apple and hot dog

What you eat has a dramatic impact on how your body detoxes, repairs and functions at a cellular level. Eating nutrient-dense foods is an essential part of the road to recovery for individuals with M.E.

We strongly recommend ensuring that your diet avoids any factors that could contribute to worsening symptoms of CFS. Ideally, your diet should be low in carbohydrates in order to regulate blood sugar levels, with rich sources of good quality proteins and fats for slow and steady energy release.

Your diet should also be rich in vitamins, minerals and antioxidants to support chemical processes and energy production. Animal protein, such as eggs, meat and fish, is important to help repair cellular damage caused by toxins and high stress levels, as well as replenish functional proteins involved in cellular communication and central nervous system function. If you eat a strict plant-based diet, it is important to ensure you achieve good levels of protein from sources such as quinoa, nuts, seeds and pulses.Avocado, walnuts and almonds, puddle of olive oil on white plate

It is also important to avoid any foods that will add toxins and stress to the body. Choosing foods that are natural, unprocessed and do not contain any added ingredients or preservatives will help reduce the energy needed to process and eliminate the unwanted ingredients and chemicals found in many modern foods. Reducing trans fats and high sugar foods will help keep inflammation levels low, as these foods increase stress and in turn increase cytokine production, which worsens CFS symptoms. Where possible, choose organic, local vegetables and organic, pasture reared or free range meats, eggs and dairy products to help reduce indirect consumption of antibiotics, pesticides, hormones and environmental toxins, which can add to the body’s toxic load and deplete energy reserves in trying to eliminate these from the body.

“Your diet should also be rich in vitamins, minerals and antioxidants to support chemical processes and energy production.”

If you suffer from food intolerances, an elimination diet may help with symptom reduction and recovery. Symptoms of food intolerance are not limited to digestive issues and many people suffer a range of issues that can lessen or disappear when removing the trigger food(s) from the diet. It may not be necessary to test for specific sensitivities and the accuracy of tests is still variable, though a basic screen might be useful as a starting point, as certain sensitivities can cause cross-reaction to other foods that are not the real problem.

Nutrients

Dr Sarah Myhill CFS ME expert

ME/CFS expert Dr Sarah Myhill recommends 4 capsules of Vegepa daily as part of her treatment protocol.

Supplementing with the omega-3 EPA and the omega-6 fatty acid gamma-linolenic acid (GLA) provides the body with the pre-formed omega-3 and 6 fatty acids most heavily affected by altered fatty acid production.

By bypassing the need for the body to perform several complex, inefficient conversion steps to produce these long-chain fats from shorter dietary fats, the energy needed for this process is spared and normal fatty acid levels can be restored more quickly and effectively. Pure EPA supplementation directly increases EPA levels, helping to restore an optimal AA to EPA ratio, which results in reduced inflammation and enhanced immune function. EPA and GLA also give rise to products that inhibit viral replication and act as antiviral compounds, as well as supporting brain function and cellular communication.

Phytosterols, present in cold-pressed organic virgin evening primrose oil (EPO), the source of GLA in Igennus products, are important cholesterol-like molecules found in plants that are in part responsible for the health-enhancing effects of fruit and vegetables. Those found in EPO exhibit antibacterial and antifungal activities and numerous anti-inflammatory effects, including the reduced production of pro-inflammatory products derived from the omega-6 AA. In addition, specific triterpenes (another group of health-promoting plant molecules unique to unrefined virgin EPO), possess free radical-scavenging and anti-inflammatory properties.

“EPA and GLA also give rise to products that inhibit viral replication and act as antiviral compounds, as well as supporting brain function and cellular communication.”

Homocysteine is a by-product of the methylation cycle – a vital biochemical process involved in the production of brain chemicals and antioxidants, and genetic control. Levels of homocysteine are directly influenced by blood levels of the B vitamins folic acid, vitamin B6 and vitamin B12. Supplementation with these vitamins supports the recycling of homocysteine, helping to prevent a blockage in the above-mentioned processes and subsequent health issues. Of particular importance in CFS is homocysteine’s role in producing glutathione, which is a powerful antioxidant that helps to reduce oxidative stress and thus protect against cell and mitochondrial damage. Supplementation with these B vitamins also helps improve neurotransmitter production and cognitive function – a useful mechanism to help address the commonly experienced symptom ‘brain fog’.

Evening primrose oil is a rich source of anti-inflammatory GLA and important phytosterols

Coenzyme Q10 (CoQ10) is a key molecule needed by the body to produce the body’s energy currency ATP, which is often depleted in individuals with CFS/ME because of mitochondrial dysfunction. Mitochondrial failure, low dietary intake, high oxidative stress and ageing increase the body’s need for CoQ10, so supplementation helps overcome the deficiency in CoQ10 supply commonly observed in CFS. Ubiquinol is the most potent, body-ready form of CoQ10 and is especially beneficial for overcoming CoQ10 deficiency, improving energy levels, enhancing sleep and improving cognitive performance. CoQ10 in the ubiquinol form is also a very powerful antioxidant, ideal for helping to reduce potential damage caused by high toxin and stress levels in CFS/ME.

References

Afari N & Buchwald D. (2003). Chronic fatigue syndrome: a review. American Journal of Psychiatry 160:221-236.

Caliguiri M, Murray C, Buchwald D, Levine H, Cheney P, Peterson D, Komaroff AL & Ritz J. (1987). Phenotypic and functional deficiency of natural killer cells in patients with chronic fatigue syndrome. Journal of Immunology 139:3306-3313.

Chaudhuri A. Condon AJ, Surtees RA, Lees AJ, Adock JE, Harding B, Neville BG & Giovannoni G. (2004). Encephalitis lethargica syndrome: 20 new cases and evidence of basal ganglia autoimmunity. Brain 127:21-33.

Fekety R. (1994). Infection and chronic fatigue syndrome. In: S. Straus (editor) Chronic Fatigue Syndrome. New York, USA: Marcel Dekker.

Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff AL and the International Chronic Fatigue Syndrome Study Group (1994). The Chronic Fatigue Syndrome: A Comprehensive Approach to its Definition and Study. Annals of Internal Medicine 121:953-959.

Jones JF, Nisenbaum R, Solomon L, Reyes M & Reeves WC. (2004). Chronic fatigue syndrome and other fatiguing illnesses in adolescents: a population-based study. Journal of Adolescent Health 35: 34-40.

Klimas NG, Salvato FR, Morgan R & Fletcher MA. (1990). Immunologic abnormalities in chronic fatigue syndrome. Journal of Clinical Microbiology 28:1403-1410.

Maes M, Mihaylova I & Leunis JC. (2005)  In chronic fatigue syndrome, the decreased levels of omega-3 poly-unsaturated fatty acids are related to lowered serum zinc and defects in T cell activation. Neuroendocrinology Letters 26:745-51.

Peet M, Brind J, Ramchand CN, Shah S & Vankar GK. (2001) Two double-blind placebo-controlled pilot studies of eicosapentaenoic acid in the treatment of schizophrenia. Schizophrenia Research 49:243-51.

Puri BK. (2004) The use of eicosapentaenoic acid in the treatment of chronic fatigue syndrome. Prostaglandins Leukotrienes and Essential Fatty Acids 70:399-401.

Puri BK, Counsell SJ, Zaman R, Main J, Collins AJ, Hajnal JV & Davey NJ. (2002). Relative increase in choline in the occipital cortex in chronic fatigue syndrome.  Acta Psychiatrica Scandinavica 106: 224-226.

Puri BK, Holmes J & Hamilton G. (2004). Eicosapentaenoic acid-rich essential fatty acid supplementation in chronic fatigue syndrome associated with symptom remission and structural brain changes. International Journal of Clinical Practice 58: 297-299.

Puri BK, Chronic Fatigue Syndrome: A Natural Way to Treat M.E., (Hammersmith Press, London, 2005) ISBN 1-905140-00-2.

Puri BK. (2007) Long-chain polyunsaturated fatty acids and the pathophysiology of myalgic encephalomyelitis. Journal of Clinical Pathology 60:122-4.

Tamizi far B & Tamizi B. (2002) Treatment of chronic fatigue syndrome by dietary supplementation with omega-3 fatty acids–a good idea? Medical Hypotheses 58:249-50.

We recommend

Vegepa E-EPA 70 combines the benefits of 70% EPA omega-3 concentrate extracted from wild anchovy oil with GLA and triterpene antioxidants from organic evening primrose oil. Taking preformed EPA bypasses inefficient enzyme conversions and helps to restore normal eicosanoid production. Pure EPA in Vegepa specifically helps to restore an optimal AA to EPA ratio (a more accurate measure of omega-6 & omega-3 balance), resulting in reduced inflammation and enhanced immune function. EPA and GLA work together to produce substances that inhibit viral replication and provide beneficial antiviral properties, particularly helpful in CFS/ME. Phytosterols in organic, cold-pressed virgin evening primrose oil also offer antibacterial and antifungal properties, along with anti-inflammatory effects, thus further supporting a healthy AA to EPA ratio.

For vegetarians, our Echiomega supplement provides a more effective solution than flaxseed oil, with higher conversion to the important long-chain fatty acid EPA.

Homocysteine levels can be managed effectively via supplementation with Homocysteine Control, supporting efficient neurotransmitter production, increased antioxidant levels, reduced oxidative stress and improved cognitive function.

CoQ10, essential for the body’s production of the energy molecule ATP, is often depleted in CFS patients due to mitochondrial failure. Ubiquinol CoQ10 is especially potent as it is in a ‘body-ready’ form for instant uptake, while the patented delivery system VESIsorb® ensures CoQ10 blood plasma levels are reached rapidly and remain at therapeutic levels for longer.
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Recommended dosages

Vegepa E-EPA 70 & Orange Chewables

Vegepa omega-3 for CFS ME & fatigue

  • Adults and children aged eight years and over should take two capsules twice daily.
  • For children we recommend Vegepa E-EPA 70 Orange Chewables.
  • For the most severe cases of ME/CFS we would recommend following our therapeutic Restore & Maintain protocol, starting with 2 capsules daily of our 90% pure EPA supplement Pharmepa Step 1: RESTORE before introducing omega-6 GLA for maintenance in STEP 2: MAINTAIN.
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Echiomega Echium Seed Oil – for vegetarians & vegans

Adults and children should take 4 capsules of Echiomega twice daily to provide a sufficiently high dose of long-chain omega-3s. Take Echiomega with food for optimum absorption.
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Homocysteine Control


Adults and children aged twelve years and over should take 1 tablet 3 times daily, at mealtimes for optimum absorption.
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VESIsorb Ubiquinol-QH

Igennus ubiquinol for chronic fatigue syndrome support
Adults and children over 12 years should take 1 capsule daily with food.
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