In a nutshell, Dr Myhill's ideas on this topic boil down to:
Having CFS means you have mito dysfunction and this in turn means you =
are likely to have chronic infections.
=20
ie CFS----> CHRONIC INFECTIONS
=20
NOT
=20
CHRONIC INFECTIONS---> CFS
Here is the most recent handout:
Dr Sarah Myhill MB BS, Upper Weston, Llangunllo, Knighton, Powys, Wales =
LD7 1SL
Tel: 01547550331 Fax: 01547550339 E-mail: office@doctormyhill.co.uk =
Website: www.drmyhill.co.uk
=
=20
Information / Chronic infections in CFS =
=
August 2009
=20
Chronic Infections in CFS
=20
Titles in CAPITALS refer to my other information handouts - please, ask =
for a copy to be sent or emailed to you, or look for it on my website.=20
=20
Whilst there is no doubt that an acute infection is a common trigger for =
CFS, the question is: to what extent does chronic infection perpetuate =
the fatigue? I have struggled with this question for years! There is a =
body of evidence pointing to chronic infections such as Lyme disease, =
borreliosis, mycoplasma, HHV, Epstein Barr, cytomegalovirus etc. present =
in CFS patients together with various trials showing benefits from =
anti-microbials. The trouble is the diagnosis is difficult, the =
treatments often expensive and all carry potential for harm from toxic =
drugs.
=20
We are all exposed to infections, but only a few get chronic problems. =
The difference has to do with individual susceptibility - as Pasteur =
famously said "The microbe is nothing, the terrain is everything".
=20
What is central to CFS is mitochondrial function. I believe this will be =
the most important marker of CFS and testing mitochondrial function =
often points to nutritional deficiencies or toxic blockages which, when =
corrected, in many case result in clinical improvement. However, Dr Paul =
Cheney believes that one's redox state is also central in the control of =
mitochondria. See CHENEY on CFS MECHANISMS, also FERMENTATION IN GUT, =
FREE RADICALS and CFS.
=20
What is the redox state?
Think of redox state as a fire. For the fire (mitochondria) to burn =
brightly we need optimum conditions of fuel, oxygen and the molecular =
machinery to handle this. If the fuel supply is sluggish, the fire burns =
low. If the oxygen supply is sluggish, the fire burns smokey (free =
radicals). Getting the right balance between fuel, oxygen and the =
molecular machine (magnesium, coenzyme Q 10, acetyl L carnitine, =
magnesium D-ribose, NADH etc) together with adequate antioxidant cover =
to mop up smoke (superoxide dismutase, co-enzyme Q 10, glutathione =
peroxidase, vitamins A,E and C etc) is necessary for the efficient use =
of energy.
=20
The graph below illustrates this. To have adequate supply of energy, the =
redox state must be central. At this level, the fire is burning =
brightly; we have a good balance of supply of fuel and oxygen on the one =
hand, with good antioxidant cover on the other to carry the smoke (free =
radicals) away.=20
=20
Graph: Energy REDOX STATE
Oxidation Fire =
Reduction
Ash and smoke =
Fuel and oxygen supply needed
To be got rid of=20
by anti-oxidants
=20
If one falls to the right side, the fire burns low because we do not =
have the raw materials to feed it so energy levels are low. One would =
see this in starvation, or chronic poor oxygen supply from lung disease =
or anaemia.=20
=20
If one falls to the left side, there is too much free radical =
production, which overwhelms the antioxidant mopping up system. The free =
radials then inhibit mitochondrial function directly and the fire burns =
low and again we see low levels of energy.=20
=20
There is a further complication. Mitochondria have to adjust the level =
of their fire from second to second so that energy supply is coupled to =
energy demands. Mitochondria need to supply energy at a millisecond's =
notice! In the micro-respirometry studies that John McLaren-Howard does, =
we often see uncoupling of oxidative phosphorylation so this link is =
lost and energy is wasted.
=20
Why is this important?
Using his methods of assessing heart function (also a measure of =
mitochondrial function), Dr Cheney has shown that CFS sufferers respond =
to oxygen very differently from healthy controls. People with normal =
energy levels who function in the middle of this redox state perform =
better with additional oxygen. Their fire glows brighter! In contrast, =
CFS sufferers get worse. Cheney postulates that this is because they are =
sitting to the left side - with low levels of energy and poor =
anti-oxidant status. They cannot cope with free radicals which are =
already making their mitochondria go slow. Give them oxygen and this =
creates further pro-oxidant stress which worsens the situation by =
pushing them further to the left. Indeed, this is how he distinguishes =
experimentally between people with CFS and normals.
=20
Why is this relevant to viral infection?
A paper published in 1991 by Fauci looked at the ability of viruses to =
replicate according to redox status of the host. What was so fascinating =
about this paper is that in those individuals with normal redox status =
viruses were unable to replicate and so their hosts were markedly =
resistant to viral infection. This explains why when we see an epidemic =
of infectious disease such as influenza, not all people are equally =
affected. Some have no symptoms, whereas others are completely =
flattened. In those people with poor redox state, the virus was able to =
replicate easily and it is high numbers of viruses in a human host which =
dictate the severity of the illness. Furthermore, if the immune system =
moves into "overdrive", one can get a "cytokine storm" resulting in =
massive tissue damage and possible death. Indeed, this is what kills =
people in flu epidemics.
=20
So, if one gets an acute viral infection, and one cannot drag oneself =
back from the left pro-oxidation side into a normal redox state, one =
will be stuck with low levels of energy because the mitochondria cannot =
work. A recent article in the New Scientist (29.8.09) shows that some =
viruses generate oxygen. If this were the case, it could partly explain =
how viruses keep one in this pro-oxidant state. The virus has =
manipulated the host's biochemistry to suit itself and allow it to =
multiply!
=20
So how does one get rid of a chronic infection?
The majority of people I see improve without resorting to =
anti-microbials by putting in place all the interventions to restore =
mitochondrial function and good anti-oxidant status. These include:
STONEAGE DIET
NUTRITIONAL SUPPLEMENTS
SLEEP
PACING
Correcting MITOCHONDRIAL FUNCTION
Correcting ANTI-OXIDANT status
DETOX regimes
Etc
=20
However, Cheney has seen good results by treating CFS sufferers using =
artesunate. This is derived from the Chinese herb artemesia. It is of =
proven benefit in treating malaria. But, interestingly, it is active =
against a wide range of other infections including schistosomiasis, =
cytomegalovirus, hepatitis B, Human Herpes Virus simplex type 1, Human =
Herpes Virus type 6, hepatitis C, Epstein Barr virus, bovine viral =
diarrhea virus and probably others. Artemesins have also been shown to =
be effective against bacterial infections, yeast infections and also =
they have powerful anti-cancer activity. What is most remarkable is that =
side-effects are minimal and rare.
=20
This begs the question as to how one drug can have such a broad spectrum =
of activity against so many different pathogens? The answer is that it =
has an effect on the redox state of the host - it pushes it back to the =
right. It creates a terrain in which bugs cannot replicate! In a normal =
redox state mitochondria can work normally, energy levels are restored, =
the body warms up (many pathogens are markedly heat sensitive- that is =
why we run a fever to get rid of bugs) and the immune system has the =
energy to kill infection. BUT THIS WILL ONLY WORK IF ALL OTHER =
INTERVENTIONS ARE IN PLACE. Without normal mitochondrial function, =
normal antioxidant status, etc. artemesins cannot work!
=20
Using Artesunate
The dose is 2-4mgs per kg body weight daily given by mouth in two doses. =
I would suggest 100-200mgs twice daily for one week, then go to a =
maintenance dose of 100-200mgs alternate days, gradually tailing off =
until there is clinical improvement and stability.=20
=20
Side effects are remarkably few - see below:
Possible side effects: Artemether has been remarkably well-tolerated, =
and appears less toxic than quinine or chloroquine; adverse effects =
include bradycardia, electrocardiogram abnormalities, gastrointestinal =
disturbances (nausea, abdominal pain, diarrhoea - oral therapy only), =
dizziness, injection site pain, skin reactions, and fever. Transient =
decreases in neutrophils and reticulocytes have been reported in some =
patients treated with artemether.
Drug induced fever has been observed with artemether. Mild reactions =
were seen in patients to whom artemether had been administered =
intramuscularly. These included nausea, hypotension, dizziness and =
tinnitus. These side effects were also reported: dark urine, sweating, =
somnolence, and jaundice. There were no deaths or any other side =
effects. No irreversible side effects were seen.=20
Slight rise of SGOT and SGPT may occur in individual cases. Neurological =
side effects have not yet been observed in clinical use but clinical =
trials suggest that coma may be prolonged in patients treated with =
artemether and there was an increased incidence of convulsions in one =
trial in cerebral malaria. Transient first degree heart block has been =
documented in three patients receiving artemether.
Neurotoxicity has been observed in animal studies but not in humans.=20
Cardiotoxicity has been observed following administration of high doses =
of Artemether.
=20
Using artesunate in CFS is still experimental although Cheney has =
reported some good results. I cannot emphasise enough how important it =
is to put in place all the other interventions - artesunate is the icing =
on the cake! No cake and the icing does not work!
---------------------------------------------
Send posts to CO-CURE@listserv.nodak.edu
Unsubscribe at http://www.co-cure.org/unsub.htm
---------------------------------------------
Co-Cure's purpose is to provide information from across the spectrum of
opinion concerning medical, research and political aspects of ME/CFS and/or
FMS. We take no position on the validity of any specific scientific or
political opinion expressed in Co-Cure posts, and we urge readers to
research the various opinions available before assuming any one
interpretation is definitive. The Co-Cure website <www.co-cure.org> has a
link to our complete archive of posts as well as articles of central
importance to the issues of our community.
---------------------------------------------
