Chronic Fatigue Syndrome
Multivitamin mineral supplementation in patients with chronic fatigue syndrome
Daniela Maric,1,A,B,C,D,E,F Snezana Brkic,1,A,C,D,G Aleksandra Novakov Mikic,2,A,C,D,G Slavica Tomic,1,A,B,D Tatjana Cebovic,3,A,C,D,F and Vesna Turkulov1,A,D,E,G
Chronic fatigue syndrome (CFS) is characterized by medically unexplained persistent or reoccurring fatigue lasting at least 6 months. CFS has a multifactorial pathogenesis in which oxidative stress (OS) plays a prominent role. Treatment is with a vitamin and mineral supplement, but this therapeutic option so far has not been properly researched.
This prospective study included 38 women of reproductive age consecutively diagnosed by CDC definition of CFS and treated with a multivitamin mineral supplement. Before and after the 2-month supplementation, SOD activity was determined and patients self-assessed their improvement in 2 questionnaires: the Fibro Fatigue Scale (FFS) and the Quality of Life Scale (SF36).
There was a significant improvement in SOD activity levels; and significant decreases in fatigue (p=0.0009), sleep disorders (p=0.008), autonomic nervous system symptoms (p=0.018), frequency and intensity of headaches (p=0.0001), and subjective feeling of infection (p=0.0002). No positive effect on quality of life was found.
Treatment with a vitamin and mineral supplement could be a safe and easy way to improve symptoms and quality of life in patients with CFS.
Source : Medical Science Monitor
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Traditional Chinese Medicine for Chronic Fatigue Syndrome
Rui Chen1,2, Junji Moriya2, Jun-ichi Yamakawa2, Takashi Takahashi2 and Tsugiyasu Kanda2
1Department of Traditional Chinese Medicine, Union Hospital Affiliated to Huazhong University of Science and Technology, Wuhan, China and 2Department of General Medicine, Kanazawa Medical University, Ishikawa, Japan
More and more patients have been diagnosed as having chronic fatigue syndrome (CFS) in recent years. Western drug use for this syndrome is often associated with many side-effects and little clinical benefit. As an alternative medicine, traditional Chinese medicine (TCM) has provided some evidences based upon ancient texts and recent studies, not only to offer clinical benefit but also offer insights into their mechanisms of action.It has perceived advantages such as being natural, effective and safe to ameliorate symptoms of CFS such as fatigue, disordered sleep, cognitive handicaps and other complex complaints, although there are some limitations regarding the diagnostic standards and methodology in related clinical or experimental studies.Modern mechanisms of TCM on CFS mainly focus on adjusting immune dysfunction, regulating abnormal activity in the hypothalamic-pituitary-adrenal(HPA) axis and serving as an antioxidant. It is vitally important for the further development to establish standards for ‘zheng’of CFS, i.e. the different types of CFS pathogenesis in TCM,to perform randomized and controlled trials of TCM on CFS and to make full use of the latest biological, biochemical, molecular and immunological approaches in the experimental design.
Chronic fatigue syndrome (CFS) is defined by: (i) clinically unexplained, persistent or relapsing fatigue of at least 6 months’duration, and (ii) concurrent occurrence of at least 4 accompanying symptoms, such as significant impairment in memory/concentration and muscle pain (1). Factors causing this condition remain unclear.Thus, the diagnosis depends upon an evaluation of the self-reported symptoms while the pathophysiology remains uncertain.
As yet there is no definitive treatment, rather, therapy is directed toward relieving symptoms, which often cause different side-effects (2) (Table 1). Therefore, utilization of complementary and alternative medicine (CAM) has been common in fatiguing illnesses (3). As a form of CAM, tradition Chinese medicine(TCM) has been reported to be useful and without any side-effects for CFS not only in China but also in other parts of the world(4–5). In this study, we explore the benefits that TCM can provide for CFS and its limitations. We also provide some suggestions for further development.
Adjusting the Immune Dysfunction of CFS by TCM drugs
Immune system dysfunction and its close interactions with the nervous and endocrine systems have been clearly reported in recent years as playing a role in the development of CFS (32). Hence, maintaining an efficient and equilibrated immune system is a reasonable approach to prevent certain chronic illnesses.
Drugs that invigorate qi and tonify the spleen (6) has been used most frequently for CFS patients and have shown outstanding effects in improving their immune
situation. In animal experiments, Bu-Zhong-Yi-Qi-Tang significantly enhanced running activity in a Brucella abortus induced mouse model of CFS by decreasing the
organ weight of spleen and interleukin (IL)-10 mRNA expression in the spleen (33). It can also significantly inhibit tumor necrosis factor-a, IL-6, IL-10 and transforming growth factor- b1 production in CFS patients (34). Kuibitang (identical to Chinese Gui-Pi-Tang, Japanese Kihi-to) markedly inhibits lipopolysaccharideinduced tumor necrosis factor-a, IL-10 and transforming growth factor-b1 production and increases interferon-g production in the peripheral blood mononuclear cells of CFS patients (35). Ren-Shen-Yang-Rong-Tang can ameliorate lower NK cell activity, which is an important immune characteristic of CFS patients (9). Furthermore, extracts of Ginseng can also boost natural killer cell function and the cellular immunity of patients with CFS (36). In short, the TCM therapeutic approach of invigorating qi and tonifying the spleen (6) can improve the function of immune organs and immune cells as well as alter the expression of immune molecules which are abnormal in CFS patients and experimental animals. Regulating the Abnormal Activity of the HPA Axis of CFS by TCM Drugs
Subtle dysregulation of the HPA axis has been proposed as an underlying pathophysiological mechanism in CFS (37). There is evidence for a hypofunction of the HPA
axis in a proportion of the patients with CFS, despite the negative studies and methodological difficulties (38,39).Several underlying mechanisms have been proposed.
Main findings include mild hypocortisolism, blunted adrenocorticotropin response to stressors and enhanced negative feedback sensitivity to glucocorticoids (39).
Ito reported that a type of Japanese Kampo named Koso-san (Xiang-Su-San in Chinese medicine) had antidepressant-like effects due to its suppression of the hyperactivityof the HPA axis in a mouse model of depression. It can reduce the increased levels of corticotropin-releasing hormone mRNA expression in the hypothalamus and proopiomelanocortin mRNA expression in the pituitary, and reverse the decreased glucocorticoid receptor protein expression in the hypothalamus paraventricular nucleus to normal (40).
A number of studies have shown that oxidative stress may be involved in the pathogenesis of CFS pathogenesis, and, therefore, CFS should be treated with specific
antioxidants (41). Some specific natural antioxidants from herbs, such as Withania somnifera, Quercetin and Hypericum perforatum L. have been used for the treatment
of CFS with the intent of reducing lipid peroxidation, restoring the glutathione levels and increasing the superoxide dismutase levels in the brains of CFS mice
(42). Ginkgo biloba and Vaccinium myrtillus (bilberry) have also been reported to possess beneficial antioxidants for CFS (43).
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