MEDICAL UPDATE August 2000

No resources for a full update this time but here is a quick overview of the research published during the past few months.

Firstly, there have been more reports indicating oxidative stress and free radical damage in patients with CFS (e.g. Richards et al, Redox Report, 2000, 5, 1, 35-41). That supports the use of antioxidants like vitamins C, E and Co-enzyme Q10. Another paper which alludes to the benefits of nutritional intervention is by Keenoy et al. They found signs of reduced levels of magnesium in a subgroup of people with CFS and chronic fatigue (Journal of the American College of Nutrition, 2000, 19, 3, 374-382).

There's also more evidence of problems with the blood supply, which might explain symptoms like faintness on prolonged standing (Streeten et al, American Journal of the Medical Sciences, 2000, 320, 1, 1-8). However, as the study was on only 15 patients, it's too early to be more definite.

Meanwhile, Deale and Wessely admitted in a recent study that of the patients with CFS seen at their fatigue clinic, 68% of those who had been diagnosed by the referring doctor as having a psychiatric disorder did not actually have one (Journal of the Royal Society of Medicine, 2000, 93, 6, 310-312). On the other hand, of the 37 patients who were NOT thought to have a psychiatric illness, 35% had been wrongly diagnosed.

Deale and Wessely recommend that doctors should look for subtle features which discriminate between psychiatric disorders and CFS, such as the lack of low-self-esteem, hopelessness, anhedonia and suicidal ideation, all of which are not characteristic of CFS. They also advocate the use of a screening instrument like the HAD.  (I've been saying this for over ten years. It was a nice surprise to see the same advice coming from these two researchers/clinicians. It's probably the first time they agree with me in public.) 

My letter summarising the lack of evidence for the use of CBT in children was published in the Irish Journal of Psychological Medicine (2000, 17, 2, 76-77). The reply by Wright et al indicates that they cannot see the difference between advocating "complete rest" (which few do) and encouraging rest (which many do). There's also a subtle jibe at people like myself, who want more balanced, evidence-based articles on CFS. According to Wright et al, this is not because we want to see more accurate and reliable information but because we are pro or anti psychiatry.  I mention it only to support my contention that the pro-CBT lobby tends to deal with criticisms, not only by misrepresenting the literature, but also by implying that those with a different view are not as competent and objective as they are.

Perhaps the most interesting paper of the past few months is the one by ME specialist Dr. John Richardson (J. Chronic Fatigue Syndrome, 2000, 6, 2, 11-21). He reported four cases where people had been misdiagnosed with ME, but actually had evidence of pesticide poisoning. He treated all four successfully with a mixture of choline and vitamin C.

Pesticides were also implicated in the patients with Gulf War Syndrome studied by Haley et al (Radiology, 2000, 215, 807-817). The brain scans of some of the veterans revealed significant damage in the brainstem and basal ganglia (for the scientists amongst you, there was a reduction in functional neuronal mass). This, plus their history and the results of blood tests points to a link with pesticides.

Like Gulf War Syndrome, food intolerance has been the subject of much psychologisation. However, a report in the Lancet by Jacobsen et al (2000, 356, 400-401) showed a link between sensitivities to foods and activation of the immune system. A fascinating report, but not very surprising.

To update you on another topic, an English study has recently found that progesterone cream, taken over time, can increase the concentration of progesterone in the blood. Earlier research had suggested that this hormone could not be used in cream form. However, whether the cream is of clinical value, e.g. to treat osteoporosis, remains unclear (Carey et al. British Journal of Obstetrics and Gynaecology, 2000, 107, 722-726).

Also worth noting is a letter indicating that the only published report on NADH (Enada) may not be reliable. In short, the figures didn't add up (Colquhoun and Senn, Annals of Allergy, Asthma and Immunology, 2000, 84, 639). I found it very convincing.

As always, you can obtain copies of the articles above through your local library.

Copyright EM. Goudsmit 2000. ©
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