Chronic Fatigue Key To Successful Treatment

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Chronic FatigueKey To Successful Treatment

Raj Patel, MD Medical Options for Wellness Los
Altos, CA 650-964-6700 www.DrRajPatel.net
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• 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

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• 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.

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• Chronic Fatigue Other Similar Illnesses
  (cont)
• 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

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• Useful Testing in Evaluating Chronic
  Fatigue
• RNase-L activity (Viral Immune Pathology)
• Urine Amino Acid Analysis (Doctors 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 individuals symptoms

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• 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

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Methylation Cycle
5,10 MTHF
Methionine
SAM
MSR
Methionine Synthase
MTHR
SAH
5 MTHF
Homocysteine
Homocysteine
CBS
Cystathione
Cysteine
Glutathione
Taurine
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• Methylation Cycle (cont)
• 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
  Aug8(8)659-68
• Heavy metals at low levels can suppress key
  enzymes involved in methylation
• Viruses can impair methylation cycle enzymes

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• Methylation Cycle (cont)
• 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

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Chronic Fatigue Take Home
Message Identifying the underlying factors
playing a role in a particular individuals
illness is critical to determining what treatment
to prescribe, and thereby achieving a successful
outcome.