Kent Holtorf, MD, medical director, Holtorf Medical Group Center for Endocrine, Neurological and Infection related illness, Torrance, Calif., reports that after a comprehensive literature study that the majority of CFS and FMS patients display abnormal adrenal function–due to hypothalamic-pituitary dysfunction. He believes that the majority of patients could be treated for this adrenal dysfunction.

Holtorf’s believes his study suggests that a treatment protocol of early administration of cortisol may help improve and reduce the symptoms of chronic fatigue syndrome and fibromyalgia. He confirmed his research in an observational study following the conditions of 500 patients from his clinic, where the patients who were given cortisol as part of their treatment:

• 94% showed improvement by the 4th visit;
• 75% noted significant improvement;
• 62% reported substantial improvement; and
• Energy levels and a general sense of well-being for patients doubled by the 4th visit.

The effectiveness of this multi-system treatment was further confirmed through the analysis of the cumulative findings of over 40 independent physicians and over 5,000 patients. Cortisol treatment carries significantly less risk and a greater potential for benefit than treatments considered to be the standard of care for both conditions, according to Holtorf. As shown in the Journal of Chronic Fatigue Syndrome study, cortisol doses of 5-to-15mg a day have been shown to be safe, with little or no associated risk, while having the potential for significant benefit for CFS and FM patients–according to Holtorf’s article in the Journal of Chronic Fatigue Syndrome.

Common among chronic fatigue syndrome patients is intermittent or persistent gut problems, including indigestion and irritable bowel syndrome. There are viral infections, such as Epstein Barr virus, cytomegalovirus, and parvovirus, among others, that are known to produce many of the same symptoms associated with chronic fatigue syndrome.

Researchers moved one step closer in demonstrating that chronic fatigue syndrome is something biological and possibly a way to help diagnose the disease. The study involved 165 patients diagnosed with chronic fatigue syndrome and a control group who were considered healthy except for a gut disease. All of the subjects were subjected to endoscopy (which involves the threading of a long tube with a camera on the tip through the gullet and into the stomach.)

The result was that most of the patients, with gut problems, showed evidence of mild long-term inflammation. The chronic fatigue syndrome patients tested positive for enteroviruses in 80% of patients, while the control group tested positive in 20% of the patients. Although not conclusive as a diagnostic tool the inclusion of enteroviruses can be helpful in diagnosing CFS.

Researchers selected 10 subjects.  One group of 5 subjects had post-infective fatigue that lasted for at least 6 months, while the remaining 5 subjects had recovered from their bout with mono. Blood samples where taken at various times. What the researchers were looking for was a genetic difference between those with a long-lasting form of the disease and those who recovered from it within a normal time frame.

Scientists found that there were genetic changes in the group with long-term symptoms. The reason that some people’s immune systems were better at fighting the disease than those where the disease persisted long-term is not understood, but the discovery of the genetic change shines light on where research needs to continue.

Recently, the CDC released controversial studies that link CFS to to genetic mutations and abnormalities in key physiological processes. The CDC is also sponsoring a $6 million public awareness campaign about CFS. A study released last month by the CDC indicates that CFS is more prevalent than previously thought.

The CDC provides several fact sheets for healthcare professionals.

Although not absolute that the 35 isolated genes will yield the one gene they are looking for, the scientists feel confident they are close to finding the key to unlock the CFS mystery. The researchers also feel that they have enough evidence to show that CFS is separate from mood disorders or depression and is definitely not psychological.

Ann Lang is a N.Y. based paralegal who has won SSDI benefits for more than 20 CFS sufferers in the past 15 years. She acknowledges that her job is one of educating people on what CFS is and doesn’t doubt for a minute that it can render a person legally disabled. She makes her point by explaining that multiple sclerosis was once thought to be something in the afflicted person’s mind. That is, until it was proven that the cause stemmed from plaque on the brain.

Winning CFS claims can be arduous and take time. Sometimes it takes up to three years of appeals before winning a CFS claim.

When deciding if a CFS sufferer qualifies for disability benefits, the Social Security Administration requires a minimum of four symptoms that persist for at least 6 months from this list:

1. Impairment of short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social, or personal activities
2. Sore throat
3. Tender cervical or axillary lymph nodes
4. Muscle pain
5. Multi-joint pain without joint swelling or redness
6. Headaches of a new type, pattern or severity
7. Unrefreshing sleep
8. Postexternal malaise lasting more than 24 hours

Dr. Elizabeth Vliet says that the standard thyroid hormone panel does not usually detect the symptoms that are the underlying cause of fibromyalgia and chronic fatigue. She says that, “…women are told their thyroid is normal without having the complete thyroid tests done.” She relies on a thyroid antibodies test for a better picture of how the thyroid is really functioning.

Vliet encourages fibromyalgia patients to include T3 thyroid hormone treatment. For hypothyroid symptoms she relies on standard thyroid replacement (like levothyroxine sodium).

All of the stressors that bring on each of the syndromes share one thing in common. They increase the levels of nitric oxide in the body and in turn result in increased levels of peroxynitrite. It is peroxynitrite that causes a cycle that is responsible for a chronic illness that frequently last a lifetime.

Pall suggests the best approach to treat these chronic illnesses is to reduce the peroxynitrite cycle. Although there is not a magic bullet to break the peroxynitrite cycle there are some basic guidelines to follow:

1. Avoid foods that cause allergic reactions.
2. Avoid foods containing: mono-sodium glutamate, aspartame, and possibly hydrolyzed vegetable proteins.
3. Consider using a combination of nutritional supplements that help reduce the peroxynitrite cycle.

Visit Professor Pall’s web site for detailed information on possible nutritional supplement regimens.

Then there is the problem that a great many doctors think it is psychological rather than biological, or physiological. How CFS is defined is subjective rather than objective.

Last year the Center for Disease Control (CDC) began a $4 million educational program and is currently involved in a study to standardize the criteria for diagnosis of CFS.

As simple as it sounds one key factor was how survey questions are asked. For example, rather than ask if a family member suffers from ‘fatigue’ the question becomes “Have you had one or more of the following symptoms for a month or more: ‘fatigue, cognitive impairment, un-refreshing sleep, muscle pain, joint pain, sore throat, tender lymph nodes, or headache’. Studies already indicate that positive answers to similar question triples.

* Note: The article is well documented with 16 sources listed in the bibliography.