Care for Chronic Fatigue

It took a long time for chronic fatigue to be recognized as a physiological and not a psychological illness. The CDC now estimates that between one and four million people suffer. Chances are good that’s an underestimate. It’s certainly true that many people suffer because they are not properly diagnosed by physicians who don’t take the condition seriously.

In an effort to correct this, some researchers conducted a study of the burden that chronic fatigue imposes. Published in BMC Health Services Research, the researchers examined the medical records of 29 medical practices in England covering a four-year period. They identified patients whose symptoms indicated they suffered from chronic fatigue—no matter what their actual diagnosis and treatment. Noting that most of these patients did not feel that their physician took them seriously, the researchers looked at what costs were imposed on these people as a result of their condition.

The annual cost per person turned out to be an average £3,900—the equivalent of $5,900 per year. Sixty percent of those costs were in lost employment. Another twenty-six percent was the hidden cost of family and friends helping out. Only thirteen percent was due to professional services, including the out-of-pocket costs for the complementary and alternative treatments these people sought.

Putting a number to the burden born by people who suffer from chronic fatigue is a nice addition to mainstream health care. However, I doubt that it will affect the practice of physicians in recognizing chronic fatigue. In my opinion, the problem runs much deeper than physicians’ failure to take their patients’ suffering seriously. The deeper failure is the inadequacy of the conventional disease model in diagnosing and treating chronic fatigue and other multi-system illnesses such as multiple chemical sensitivity, post-traumatic stress disorder, and fibromyalgia.

Biochemist Martin Pall has proposed that although these conditions have their origin in a wide range of traumatic events that include viral, bacterial, and protozoan infections, exposure to carbon monoxide, organophosphates, and radiation, and physical and emotional trauma, the biochemical effect is the same. That effect is a disruption in the balance of nitric oxide and its metabolite peroxynitrite. The imbalance is not a general one such as blood sugar and lipids in diabetes but is instead localized to specific tissues. This localization is what gives each of the conditions their distinctive set of symptoms. The imbalance affects biochemistry in three important metabolisms: immune function, neurological function, and energy production.

For causation, conventional thinking has focused on single stressors that lead directly to the symptom without examining the underlying biochemistry. For example, Dr. Pall’s work is not mentioned on the CDC site for any of these conditions. Conventional thinking also fails in treatment because it works to suppress symptoms without addressing the underlying imbalance. On the other hand, Dr. Pall describes several complex nutrient protocols used to treat chronic fatigue and the other multi-system illnesses. These nutrients are specifically targeted to calm the out-of-control nitric acid-peroxynitrite metabolism and with it the immune, neurological, and energy dysfunctions that result.

This is a very different way of thinking about illness, a way of thinking in which most practitioners are not trained. Conventional training tends to be linear: a single cause affects a single tissue or metabolism that evokes a set of characteristic symptoms that are suppressed using targeted interventions. Instead, chronic fatigue must be treated as a rebalancing of several metabolisms. That is why I said that I doubt that, well-intentioned though it might be, informing practitioners of the condition’s hidden costs is not likely to improve recognition. And even if it does, it’s not likely that effective treatment will result.

This perspective is reflected in another area of research: aging. A recent study published in Experimental Biology and Medicine examined the decline in the capacity for movement with age. This decline occurs from nematodes to vertebrates. In humans, the decline is associated with a wide variety of chronic illness, including cognitive decline. These researchers took the perspective that these effects of aging occurred as a result of five mechanisms: oxidative stress, inflammation, loss of mitochondrial function, insulin resistance, and loss of cell membrane integrity.

So the researchers concocted a dietary supplement for their experimental animals that consisted of more than twenty nutrients that targeted these mechanisms. Past research had indicated that a nutrient taken singly had at best a mild effect on the aging process. However, when given as a complex, the expected affects of aging were virtually eliminated. In other words, physiological functions in decline were nourished—and ceased to decline.

There are two morals to this story. The first is that the body works as an ecology, one system supporting or balancing others. Illness, especially chronic illness, is a disruption to the ecology as a whole, not just a single system. So treating chronic illness, the point of the second moral, is not about attacking a symptom with a magic bullet. It’s most effective when the entire ecology is brought into balance in a language it understands.

See in particular the section “The Body as an Ecology” section in our book Too Much Medicine, Not Enough Health.