When speaking with people who suffer from ME/CFS, it is rare to find two individuals reporting mirroring symptoms. This is because ME/CFS is a multi-system disease, meaning that it affects not only the neurological system but also the immune, musculoskeletal, endocrine and cardiovascular systems. Thus the complex nature of the condition, coupled with the current knowledge of its potential ‘causes’ makes it not only extremely hard to diagnose but also incredibly difficult to manage. Several hypotheses have been put forward as to the cause(s) of ME/CFS and these include viral or bacterial infection, emotional/physical trauma, chemical or toxic overload, and issues with immune function brought about by both physical and mental chronic stress. Current ‘treatments’ range from pharmaceutical interventions, to dietary/lifestyle changes and the use of supplements, to a range of holistic interventions that include manual manipulations and activity ‘pacing’ through to hypnosis and cognitive behaviour therapy (CBT). The key to success appears to focus on the patient finding the correct intervention that matches their individual requirements and is often related to the severity and type of symptoms expressed.
The Perrin Technique as a diagnostic tool for CFS/ME
Whilst there is no one treatment or even a combination of treatments that can guarantee successful outcomes, there do appear to be interventions that have higher success rates than others. One such treatment that is gaining significant interest, not only as a treatment, but also as a validated diagnostic tool, is a form of manual therapy known as the Perrin Technique™. In its simplest form, The Perrin Technique™ is a hands-on osteopathic approach developed by Dr Raymond Perrin that detoxifies the body and the brain. The technique has had such success that it is now the focus of an NHS research project that could potentially see it used as an evidence-based diagnostic procedure which may lead to patients having their illness managed significantly more efficiently than with the present NHS protocol.
Shifting the toxic flow
The Perrin Technique™ is based on the work of Dr Raymond Perrin, in which he has shown that different stress factors (physical, allergies, emotional or infections) lead to an over-strain of the sympathetic nervous system (the ‘branch’ of the nervous system that activates the fight or flight response) due to a build-up of toxins in the fluid around the brain and the spinal cord and disruption of normal lymphatic flow. The lymphatic system is a network of tissues and organs that help rid the body of toxins, waste and other unwanted materials. In CFS/ME, toxins accumulate in the head or spine because the drainage points that allow the normal flow of toxins into the lymphatic system appear to be blocked. By using an osteopathic approach, the Perrin Technique™ manually stimulates the fluid motion around the brain and spinal cord, allowing drainage of these toxins out of the cerebrospinal fluid. Massage of the soft tissues in the head, neck, back and chest direct all the toxins out of the lymphatic system and into the blood, where they are eventually detoxified in the liver. The ‘clearance’ of the toxins that would affect the brain allows the sympathetic nervous system to begin to function correctly. Dr Perrin has routinely found that the technique, when used in combination with lifestyle ’modifications’ and nutritional intervention, has great success and patients find that, over time, their symptoms gradually improve, with some patients becoming totally symptom free.
Optimised nutritional support for The Perrin Technique
CFS/ME is characterised primarily by prolonged periods of fatigue, but is also associated with cognitive symptoms such as poor concentration and decreased memory, as well as numerous other symptoms including painful joints and muscles, disordered sleep patterns and issues relating to gut function. The inflammatory nature of the condition means that dietary changes coupled with nutritional supplements can be of significant value for managing the patient’s symptoms during their recovery. As part of his recommendations to run alongside the Perrin Technique™, Dr Perrin recommends his patients take omega-3, ubiquinol CoQ10 and the full spectrum of B-vitamins. The importance of choosing the right supplements has been key to his patients’ recovery processes and the longstanding collaboration that has existed between Igennus and Dr Perrin has allowed his patients to benefit enormously, confident that the products they take are delivering optimal doses of key nutrients in very absorbable forms that are highly effective.
The scientific basis of omega-3 in CFS/ME
Cellular levels of long-chain fatty acids are known to be lower in CFS/ME patients than in individuals without the condition, and especially so in omega-3 EPA and DHA.[1,2] This is because CFS/ME is associated with persistent viral infection that impairs the body’s ability to make omega-3 (EPA & DHA) and omega-6 (AA) long-chain polyunsaturated fatty acids by inhibiting the enzyme delta-6 desaturase. The reduced efficiency of this key process results in disruption of hormone-like products called eicosanoids, which directly affects the regulation of inflammatory and immune processes thereby exacerbating symptoms. In addition to being precursors to eicosanoids, these long-chain fats, as components of cell membranes, play a vital role in regulating fluidity of the cell membrane which, if disrupted, can have a direct impact on cell function itself. Fatty acids are ‘anchored’ into cell membranes via a number of supporting compounds, including choline. If there are insufficient fatty acids to attach to choline or the turnover is high, then levels of ‘free’ choline rise. The excess choline found within key areas of the brain in CFS/ME sufferers further supports the potential for abnormal fatty acid turnover metabolism associated with the condition. The simplest solution is to provide the key fatty acids required via supplementation and the Igennus Pharmepa range ticks all the right boxes by providing these essential fats in forms that are not only highly bioavailable, but also in the high doses that are required to correct deficiencies and support the numerous affected pathways. Furthermore, with the EPA in Pharmepa directly virucidal, the products help to quash the viral load that plays havoc in CFS/ME patients, thereby adding further support to the intervention.
Combating fatigue in chronic fatigue
It’s not uncommon for any of us to feel tired and this can often be explained by something as simple as low blood sugar levels or inadequate amounts of sleep. The crippling fatigue experienced by a typical CFS/ME patient is more likely to be at the cellular level as an underlying methylation problem. So what is methylation and why would it lead to exhaustion if it goes wrong? Simply, the transfer of ‘methyl groups’ from one chemical to another is called methylation and a chemical that receives a methyl group is said to be ‘methylated’. The process of moving methyl groups around (which works in a continuous cycle) is necessary for the functioning of several biochemical reactions involved in detoxification processes (resulting in sluggish liver function), neurotransmitter production (required for healthy mood and quality sleep) and immune function (needed to deal with viral and bacterial infections), as well as the production of a number of key products vital for energy production (such as carnitine and the enzyme CoQ10). Anything that disrupts this cycle will have an impact on health and the easiest way to determine any disruption is by measuring the level of a product called homocysteine. Elevated homocysteine is the clearest indicator that the methylation cycle has gone wrong and is a particularly useful biomarker for determining issues related to CFS/ME.  There are several ways that homocysteine can accumulate but the most frequent are due to low levels of key nutrients that act to ensure each stage of the cycle is allowed to move fluidly. These key nutrients are vitamins B12, B6 and folate; individuals with CFS/ME with higher homocysteine levels often present with low levels of all or some of these nutrients. The accumulation of homocysteine can potentially lead to or exacerbate many of the symptoms related to CFS/ME including fatigue, inability to deal with toxic load, poor sleep and low mood; including a quality B-Complex (one that delivers pre-methylated active forms of B-vitamins) should therefore play an essential part of any CFS/ME protocol. In addition, the daily onslaught of free radicals, damaging molecules produced continuously as a result of poor diet, stress, smoking, exercise, inflammation and drugs, or even from exposure to sunlight or air pollution, can put intense strain on our health at the best of times. For the CFS/ME patient, the production of these harmful molecules is further exaggerated. Unsurprisingly the body’s army of antioxidants have to deal with this burden of ‘oxidative stress’ continuously and a failure to reduce this oxidative damage increases inflammation, which kicks off a chain reaction of events resulting in a further increase in harmful free radicals! Coenzyme Q10 (CoQ10) in the form of ubiquinol, which is present in all cell membranes, is one of the most important of all the antioxidants, playing a direct and constant role in protecting our cells from the onslaught of damage. In addition, the energy ‘currency’ (ATP) that is required to carry out all physiological and metabolic processes also requires CoQ10, putting increased strain on CoQ10 levels! Levels of this powerful molecule are known to be significantly lower in CFS/ME patients and can be directly related to the severity of fatigue symptoms. Supplementing with CoQ10 therefore offers huge benefit in the relief from fatigue and helps to manage free radical production and lower inflammation, but only when delivered in the active form ubiquinol.  Furthermore, we have enhanced the bioavailability of ubiquinol by using a patented delivery system, VESIsorb, to increase absorption and uptake into the bloodstream; VESIsorb also enables ubiquinol to remain at therapeutic levels in blood plasma for up to 6 times longer than standard ubiquinol, making it the ideal supplement for those with fatigue issues.
Having a recognised and validated diagnostic tool for CFS/ME will offer patients suffering with this crippling condition a faster route for NHS treatment. The use of the Perrin Technique™ as both a method of diagnosis and a recognised NICE treatment appears to be drawing closer. Understanding how diet and lifestyle play a role in managing symptoms also needs to be the focus of the practitioner’s intervention; the Perrin Technique™ used in conjunction with the Perrin protocol (Pharmepa RESTORE & Pharmepa MAINTAIN, VESIsorb ubiquinol and Super B-Complex) is providing relief from symptoms for thousands of CFS/ME patients.
- Liu Z, Wang D, Xue Q, Chen J, Li Y, Bai X, Chang L. Determination of fatty acid levels in erythrocyte membranes of patients with chronic fatigue syndrome. Nutr Neurosci. 2003 Dec;6(6):389-92.
- Maes M, Mihaylova I, Leunis JC. 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. Neuro Endocrinol Lett. 2005 Dec;26(6):745-51.
- Regland B, Andersson M, Abrahamsson L, Bagby J, Dyrehag LE, Gottfries CG. Increased concentrations ofhomocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue Scand J Rheumatol. 1997;26(4):301-7.
- Fukuda S, Nojima J, Kajimoto O, Yamaguti K, Nakatomi Y, Kuratsune H, Watanabe Y. Ubiquinol-10 supplementation improves autonomic nervous function and cognitive function in chronic fatigue syndrome. Biofactors. 2016 Apr 29.