Transcript Document
Chronic Fatigue Key To Successful Treatment Raj Patel, MD Medical Options for Wellness Los Altos, CA 650-964-6700 www.DrRajPatel.net Raj Patel, M.D. Chronic Fatigue vs CFIDS CFIDS: Centers for Disease Control and Prevention (CDC) uses the following criteria: Having severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis, and Concurrently having four or more of the following symptoms: substantial impairment in short-term memory or concentration, sore throat, tender lymph nodes, muscle pain, multi-joint pain without swelling or redness, headaches of a new type, pattern or severity, unrefreshing sleep, and post-exertional malaise lasting more than 24 hours. CFIDS is vaguely defined with no consistently conclusive test Level of testing to rule out other diagnoses can vary dramatically based on the knowledge and expertise of the clinician Raj Patel, M.D. Chronic Fatigue & Other Similar Illnesses Examples: Fibromyalgia Chronic Fatigue Chronic Lyme Disease Autism ADHD These illnesses lack hard objective diagnostic tests Diagnosis is made based on signs and symptoms which can and do greatly overlap These illnesses are syndomes rather than a single disease entity. Therefore, each illness is a “mixed bag” with different underlying contributing factors playing a role in each individual. Raj Patel, M.D. Chronic Fatigue & Other Similar Illnesses (con’t) All of these illnesses are frequently associated with methylation cycle impairments and chronic viral &/or bacterial infections These two factors in turn lead to a number of disturbances that we frequently associate with these conditions: Neurotransmitter Imbalances Hormonal Imbalances Food Intolerances Heavy Metals * Lifestyle and emotional factors play a big role in determining how active these infections become Raj Patel, M.D. Useful Testing in Evaluating Chronic Fatigue* RNase-L activity (Viral Immune Pathology) Urine Amino Acid Analysis (Doctor’s Data) SAM/SAH/Homocysteine (Vitamin Diagnostic) Urinary neopterin/biopterin (Philippe Auguste Labs) Lyme & Coinfection Panel (IgenX) TSH, total & free T4, total & free T3 CBC and Chemistry Panel 24 hour salivary cortisol Urinary neurotransmitter profile Electrodermal testing Testing for HHV6, EBV, CMV, XMRV, etc. Mental status and psychological screening * Other testing may be necessary based on the individual’s symptoms Raj Patel, M.D. Methylation Cycle Definition: Methylation involves transfer of methyl group Methylation plays a role in: Neurotransmitter synthesis and breakdown Renal disease Cardiovascular disease Cancer Heavy metal detoxification Anti-viral immune modulation Raj Patel, M.D. Methylation Cycle 5,10 MTHF Methionine Mg Zn SAM MSR Methionine Synthase MTHR B12 SAH 5 MTHF Homocysteine Homocysteine P5P CBS Cystathione P5P Cysteine Raj Patel, M.D. Taurine Glutathione Methylation Cycle (con’t) Methylation Impairments result from: Single Nucleotide Polymorphisms (SNPs): Can impair methylation Commonly found in the general population SNPs involving MTHFR C677T have a 47% incidence among Caucasians Ulrich CM. et al. Cancer Epidemiol Biomarkers Prev. 1999 Aug;8(8):659-68 Heavy metals at low levels can suppress key enzymes involved in methylation Viruses can impair methylation cycle enzymes Raj Patel, M.D. Methylation Cycle (con’t) Testing to assess methylation: genomic testing urine/serum amino acid analysis Nutritional Support to open/bypass areas of impairment: Methyl B12 / Cyano B12 TMG (or DMG) Folic/Folinic acid P5P/B6 Reduced Glutathione Raj Patel, M.D. Chronic Fatigue Take Home Message: Identifying the underlying factors playing a role in a particular individual’s illness is critical to determining what treatment to prescribe, and thereby achieving a successful outcome. Raj Patel, M.D.