Dr. Sarah Myhill MD
The relationship between a virus and Myalgic Encephalomyelitis (ME/CFS) is critical. And perhaps an understanding of the different ways in which virus can impact may give us a handle on how to best tackle this problem.
The first has to do with availability of energy.
We all have a certain pot of energy available to us on a daily basis. When life is normal we can spend that energy physically, mentally or emotionally.
ME patients, of course, have a small pot of energy because their mitochondria are going slow and they have to spend that energy accordingly. This was proved in our scientific paper of 2009 ("Chronic Fatigue Syndrome and Mitochondrial Dysfunction"), which showed that those patients with the worst levels of energy had the worst mitochondrial function test results, and vice versa.
This, of course, is the biological basis of pacing. My job as a doctor is to make that pot of energy bigger.
When the body is attacked by infection, the priority is to fight the infection, and so that pot of energy is used up by the immune system and none is left for you to have a life. This explains why we all feel ill and have many of the symptoms of ME with acute viral infection.
However, what we don’t understand is why ME patients don’t recover after their acute virus attack.
It is possible this could be explained by virus blocking the mitochondria, but I don’t think this is likely. Whilst Dr. John McLaren-Howard from Acumen [a co-author of the CFS & mitochodrial dysfunction article] occasionally sees viral DNA stuck onto mitochondria, this is an unusual finding and I suspect we have to look for other causes.
What is a major cause of fatigue is allergy.
Again, I am not sure I know the mechanism of this, but I suspect it has to do with drawing on our pot of energy.
Allergy is a very wasteful use of the immune system, which becomes active against substances which are not noxious, such as pollen, food and some chemicals. The immune system is busy as a result, and this drains our energy pot.
Hay fever - allergy to grass pollen - is called such because, in addition to obvious symptoms, sufferers feel ill.
Work done by Dr. Martin Lerner in America has shown that giving antivirals to post viral ME patients often improves them markedly.
However, these patients have no evidence of active infection, with no raised IgM levels and no raised levels of the classical immune parameters one would expect to see in acute viral infection. Dr. Lerner diagnoses these patients on the basis of a classical history; i.e., post viral fatigue, combined with some immunological evidence of the immune system having seen virus in the past; i.e., raised IgG antibodies.
Again, this begs the question as to mechanism, and the only mechanism which seems to fit the bill in my mind is viral allergy.
This is not such a bizarre concept:
- We certainly recognize yeast allergy (such as allergic aspergillosis)
- We recognise bacterial allergy (such as rheumatic fever)
- And, indeed, palindromic rheumatism is probably a sort of form of viral allergy
- Dr. Alan Ebringer at Kings College London explains ankylosing spondylitis in terms of allergy to bacteria in the gut, namely Klebsiella .
It may be that Martin Lerner’s treatment of post viral ME patients with antivirals works because he is reducing an already low viral load to one that is even lower, so much so that the body ceases to react allergically to it.
So, as you can see, it is not a case of finding out whether or not you have a virus but really the question should be, is one reacting against it?
Again, we have another handle on this - Dr. John Mansfield [author of the classic book Arthritis: Allergy, Nutrition & The Environment] has retired from allergy medicine recently, but he would get excellent clinical results by desensitizing his patients using neutralization to the putative virus. Even in cases of acute ’flu he was able to switch off their symptoms very quickly in this way.
Again this points to some sort of inappropriate reaction by the immune system against virus - it is of course the immune system’s reaction to the virus that makes us feel ill, not the virus itself.
The common viruses that Dr. Lerner tests for are Epstein-Barr virus, cytomegalovirus and HHV6 (shingles) virus, and he treats them with the appropriate antiviral. The trouble is, these are rather expensive and so far I have had no experience of using them. See "Valacyclovir in the Treatment of Post Viral Fatigue Syndrome."
Another possibility would be to consider some of the natural antiviral compounds such as oxymatrine (see "Oxymatrine in the Treatment of Post Viral Fatigue"), astragalus, neem and possibly artesunates.
There are two other possibilities I am working on with some of my patients. Many who have such chronic low grade antiviral activity have swollen lymph nodes in their neck, armpits, and groins. My guess is that this represents immune activity to low grade infection. I have been developing some transdermal supplements - in particular vitamin C and colloidal silver - which could be sprayed directly onto the skin over these lymph nodes. What makes these sprays effective is an organic carrier molecule DMSO, which carries vitamin C and/or colloidal silver through the skin very readily.
Both these natural products have powerful antiviral activity. It is possible these could help the immune system reduce the viral load where it is concentrated in these glands. Watch this space!