Chronic Fatigue Syndrome, - some possible helps.
From The Desk of Charles Weber

    INTRODUCTION

     Chronic fatigue syndrome (CFS) is a disease characterized by symptoms of impaired sleep, extreme long lasting fatigue, loss of memory [Marcel], disruption of the circadian rhythm [Tomoda], sore throat, muscle and joint aches, headache, cough, photophobia, night sweats, [Evengard] depression that has much lower ACTH and cortisol secretion than typical depression [Demitrack], lymph node pain, eye pain and fibromyalgia (muscle pain) [Bell DS] as well as white spots on MRI brain scans [Buchwald 1992] and single-photon emission computed tomography (SPECT) scans [Schwartz], loss of fingerprints in a third of the patients [Johnson p345], changes in the body's hormones, increased sensitivity to glucocorticoid hormones [Zisser], alterations in some of the immune enzymes, and a chronic low level activation of the immune system [Cannon] which last may be accounting for many of the non neurological symptoms, but all very variable, perhaps because different parts of the brain are attacked. and perhaps because there is more than one species of virus involved or both. Many physiological parameters are altered. Women are much more often affected than men.

     There have been other names for the syndrome proposed. Chronic fatigue immune dysfunction syndrome (CFIDS) was proposed because the immune system was distorted and it was hoped that this name would gain the victims some support and research funds. After all the magic letters "ID" had gained massive support for AIDS. It would be too bad if the early cavalier attitude toward CFS resulted in adopting such a cumbersome name. Fibromyalgia, which is widespread muscular pain, was proposed as a variant of CFS and probably is [Buchwald 1994] (see this site for a discussion of fibromyalgia symptoms). Low molecular weight R Nase L increased activity correlates well with severity of CFS symptoms but is normal in fibromyalgia, rheumatoid arthritis, lupus erythmatosis, HIV, and depression [Levine - Copies of the complete article are available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: mailto:getinfo@haworthpressinc.com ]. Yuppie flu was proposed because at first only higher income people had enough money saved to hire doctors or lobby officials. High income has been ruled out as a risk factor for fibromyalgia [White] and also CFS[*]. The name "myalgic encephalomyelitis" (ME) was assigned to a similar disease by medical researchers in the British Commonwealth. Post viral fatigue syndrome (PVFS) and post infectious neuromyasthenia were also used.

     No one has been able to assign a definitive cause to it with certainty, although it has been proposed to be a hypochondria from misdiagnosis [Johnson p 126] or mass hysteria from reading newspaper articles proposed by the Center for Disease Control in the USA [Johnson p 135-138, 339, 342] (both very unlikely [White] ), an Epstein-Barr virus [Holmes] (because that virus antigen is often found in it as an opportunistic infection, but refuted [Buchwald 1988] ), poor nutrition compounded by lack of exercise [Johnson p685], a poison [Racciatti] , or a retrovirus (because fragments were detected in some of its victims similar to retrovirus) [DeFreitas]. The retrovirus work has ended because DeFreitas has become very sick and no one else has been competent to continue her work. That it is caused by a virus which damages the immune system is highly probable since it comes on suddenly with flu like symptoms and shows up in clusters associated with social groups [Buchwald 1992]. Fragments of mycoplasma pathogen species have been found in CFS and fibromyalgia but they are probably opportunistic infections because when multiple species are found in the same patient it correlates with the length of time CFS was present [Nasralla].

     The hypothesis that CFS is a psychosomatic illness has resulted in thousands of ruined and destitute lives. There probably has not been so ruinous a result from a failed hypothesis since governor Phips ended the Salem witch craft trials. Even the blood letting of the 18th century was fairly minor. After all, how much harm can you do removing a few drops of blood? The hypothesis by medical doctors that it was not necessary to wash hands for child birth caused many deaths, but at least these mothers were given a fairly quick end. The CFS victims could not collect insurance support or disability and descended into poverty. That hypothesis was probably an important part of the chief cause of death, which was suicide. It is not only in the USA that the physical nature of this disease was denied. A young girl in Australia was taken away from her mother until the age of 18 because the mother dared to disagree with a doctor that the girl was faking her symptoms. Indeed this inane hypothesis seems to be pervasive world wide. The psychosomatic hypothesis was probably the main reason why funds were diverted from a congressional mandate by the NIH.

     A poison can not be ruled out as at least a contributing factor [Bell IR 1998], and may have been involved, by virtue of protective chemicals, in the gulf war syndrome. Anthrax vaccine has been proposed as triggering gulf war syndrome with some convincing statistical evidence. However, I believe there may have been other medical procedures at the same time. These brave men were denied support at first also. There is a discussion of a case history of a patient who believes that mercury poisoning caused a CFS like affliction. Half of people who have fibromyalgia are sensitive to pollution/exhaust, cigarette smoke, gas/paint/solvent fumes, and perfumes [Bell IR 2002]. This may be the reason why poisons seem to be causal. It seems to me that it would be good common sense to eat, drink or smoke no poisons if you are afflicted with CFS or fibromyalgia.

DISCUSSION

      So the cause is unknown. This leaves us with the problem of what to do about the disease currently while we wait for researchers to find the cure.

     It has been proposed that poor nutrition and lack of exercise are contributing factors [Johnson p 685]. It certainly is plausible that a poorly nourished body would be more at risk as is probably the case with most diseases. A vegetarian diet using lots of raw vegetables has significantly improved the symptoms of fibromyalgia with 19 out of 30 subjects reporting considerable improvement of all symptoms after a few weeks [Donaldson]. It would be a good idea to find out what in raw vegetables was responsible. That diet gave five to six thousand milligrams of potassium per day and 460 milligrams of magnesium. It has been discovered that magnesium injections mute the symptoms significantly [Takahasha][Cox]. So magnesium supplements may be in order for CFS people who eat junk food and maybe for everyone with CFS. However, magnesium was found to be normal in the red cells in CFS patients [Hinds] and magnesium is normal in blood cells during a magnesium deficiency as well, so red cell content can not be used in diagnosis. You may see an excellent article by Seelig which proposes magnesium as of central importance in CFS and fibromyalgia.

     A whole body (cell content) analysis of potassium has found that potassium averaged a little lower in CFS than the general population [Burnet] which general population is low in potassium in our society to start with. The CFS average was about two thirds of the highest values of healthy people. This is ominous because the highest values is the normalcy which the body attempts to attain since there is no storage of potassium in the body other than the tolerable range of soluble potassium in the cell fluid. It could be that potassium supplements are in order [Lawson 1996], especially if the diet consists of processed food. Magnesium should be part of the experiment since potassium requires adequate magnesium in order to be absorbed effectively [Petersen][MacIntyre] and it is possible that inositol [Charalampous] is necessary also. While excessive salt intakes are detrimental to potassium retention, it is necessary to receive moderate amounts of sodium salt because extremely low intakes of sodium (or chloride?) also increase potassium excretion. Experiments must be performed with caution, however, because when a patient thought to be exhibiting symptoms of fibromyalgia was brought to 5.0 mEq/l in her blood (which is close to normal) she contracted paralysis [Gotze]. This may be because experiments have shown that people who have CFS with muscle pain have normal serum potassium [* ] and so fibromyalgia must be a different variation of CFS. In monkeys the electrocardiogram in magnesium deficiency resembles that of high serum potassium (hyperkalemia) in spite of low serum potassium (hypokalemia) [Manitius p39]. So it is possible that lower cell potassium requires lower serum potassium for adequate nerve transmission, but the serum potassium does not drop correspondingly [Manitius p38] during a magnesium defficiency. This may be part of the pain in fibromyalgia, analogous to the pain from cold fingers [Benjamin]. probably arising from potassium [Ghosh] released from the cells by cold [Ulrich] below 4 degrees C [Hendricks]. If muscle spasms are associated with chronic fatigue syndrome, it is possible that a low cell calcium in that disease even though serum calcium is normal [Magaldi] could be the reason. If a magnesium deficiency does develop, half a year of magnesium supplements can be required for complete normalization of magnesium and potassium - sodium pumps [Anonymous] [http://www.lef.org/prod_hp/abstracts/potassiu mabs.html#26 ]. Not all the phenomena associated with a magnesium deficiency take so long. Magnesium supplements reduced leg cramps during a pregnancy in three weeks without any change in serum [Dahle]. There is a suspicion that malic acid is helpful in the CFS diseases, so perhaps magnesium should enter as the malate. Aspartate has been used with magnesium during heart disease therapy in the past, so the aspartate may prove advantageous as well. Also the greater ease with which potassium enters the body as the chloride [Classen] suggests that perhaps this anion should be tried as well for magnesium. It is also possible that associating magnesium with the chloride might prove disadvantageous since 18 hydroxy deoxcorticosterone (18 OH DOC)may be low during CFS and that is probably the steroid the body uses to stimulate acid excretion. I do not know which steroids stimulate or inhibit chloride excretion and it may not be known. This then would be an additional reason fr being cautious about chloride. If you wish to try increasing potassium by diet you may see a table which gives the relative values of potassium. Considerable increases in potassium are possible without the necessity of eating food raw and there is less danger of imbalances with other nutrients using food rather than supplements. For instance the magnesium problem should be adequate that way at least for maintenance amounts. For CFS patients magnesium injections may be necessary at first and maybe throughout.

     It may be that meals should be more than three times per day in smaller increments. I suggest this because secretions from the adrenal glands are important in handling nutrient disposition in the body, especially potassium. Since the adrenal glands in CFS patients average smaller than other people [Scott & Dinan] and the patient's depression has much lower ACTH (and therefore cortisol and 18 hydroxy deoxycorticosterone secretion) [Demitrack] which lower cortisol may be partly from the smaller glands, it is possible that any disruption in secretion mediators would be more difficult to handle. There is a good chance damage to the part of the brain which controls the pituitary is a more important part of that low cortisol than gland size, by disruption of the brain-pituitary axis [Scott, Svec & Dinan] and therefore of ACTH secretion, which ACTH stimulates cortisol secretion and is essential for 18 OH DOC. Any long term negative feedback operating on the viability of the cells themselves could conceivably be accentuated by nutrient surges. Also smaller meals would help prevent surges of potassium too high for those with weakened kidneys to handle efficiently as well as possibly increasing the useful cell retention by virtue of preventing the correction of high plasma potassium which otherwise takes place by excretion in the urine and lower colon. Richard Burnet recommends small solid food meals. His rationale is that such a strategy helps prevent the bacterial overgrowth resulting from delayed emptying of the stomach. Since liquids have an even greater delay, he suggests drinking liquids 20 minutes later. I know of no additional experiments to further verify this.

     Copper intake in America is about half of the RDA. Researchers fed 24 male subjects low copper diets and found a closely tied drop in the levels of enkephalins (the internally produced substances that provide us with pain relief and pleasure) that were produced in the brain. [Journal of the American Medical Assoc. 224: 1578 (1973) ]. Therefore it may be that copper supplements should be tried for people with fibromyalgia. There is the additional possibility that relieving the low copper intake characteristic of our society would be helpful in view of the known strong dependence of the immune system on adequate copper. To see how to increase copper in the diet read this site; Shellfish and liver are the richest food sources. If you would like to explore nutrition further there is a good site which lists many good links organized in categories at [ http://www-sci.lib.uci.edu/HSG/Nutrition.html ] but not especially useful for nutrition during CFS. There have been encouraging improvements achieved in CFS victims with lifestyle changes including nutrition, alterations in intestinal bacterial flora, and removal of foods causing allergic reactions.

     Food elimination strategies have been said to produce significant clinical responses in 50-80% of patients with particular benefits seen in gastrointestinal complaints, migraine, arthralgias, recurrent upper respiratory tract infections including the sinuses and urinary tract infections. It is also thought that weight gain during CFS could be largely from food sensitivity. While individual nutrient supplements may prove to be in order for CFS, it is futile to think that any patient can get nourishment just right by eating processed food with varied nutrient losses and correcting with pills. This is so even if the macro nutrients like potassium and magnesium are supplemented also and even for people who are expert dietitians. There is no substitute for an undamaged diet.

CFS Relief by Exercise

     Exercise has also been found to be helpful in CFS by numerous experiments [Hakkinen][Mengshoel]. Both moderate and intense exercise has shown to be helpful [Hadhazy]. However, over training can precipitate CFS [Shephard] and exercise brings on a severe fatigue which lasts for days [Johnson p329-330, 491-492] so it seems to me that exercise should be mild (such as walking [Coutts] ). This is supported by an experiment which showed that exercise in a pool gave less pain, anxiety, depression, and more days of feeling good [Jentoft] than terrestrial exercise and short, mild treadmill exercise caused no obvious problem [Clapp]. I suspect that many short periods of mild exercise across the day would be the preferred routine. I suspect "across the day" partly because clearance of blood through the liver in order to remove electrolyte hormones such as aldosterone [Messerli] (which removal decreases potassium losses and sodium retention) is probably an important part of the value of exercise. Even robust exercise had beneficial results in some of the symptoms other than the symptoms mentioned above [Hadhazy] but it is conceivable that these patients had a different part of their brain affected by the disease. Until researchers get it figured out it would be a good idea to approach exercise cautiously and moderately.

Devices

     There are many clever devices which have been invented for other degenerative diseases. There is no reason why these devices can not be made available if they can be financed by society. Societal support would be necessary for most because severe CFS is so debilitating that it is impossible for some of these people to support themselves. The most debilitating infirmity other than fatigue is loss of memory. CFS patients should carry maps with them showing the way home and notebooks with important information like phone numbers and grocery lists. This should help considerably. For those who have lost fingerprints [Johnson p345] a good ID should always be on them and perhaps name and number imprinted on their arm with a dye. Another procedure which should be effective would be to set up a system whereby a CFS patient could carry a cell phone with a button which automatically dials a central office which has people on duty familiar with the important information in the patients life. They should be skilled at giving emotional support in order to deal with the depression often present. For a dozen or so other clever devices to use during the fibromyalgia type CFS see this site.

Possible Natural Medications and Other Foods

     There is evidence of opportunistic herpes infection since 77% of CFS patients contain antibodies to HHV-6 EA as IgM and IgG [Patnaik]. It may be prudent for these CFS people also to eat sparingly of foods high in arginine continuously after CFS or maybe until tests determine that the immune peptide hormones [Patarca] and natural killer cells [Caligiuri] are all normal again. This is because the amino acid arginine accentuates the symptoms of herpes [McCune] and maybe even trigger a resurgence of a dormant infection such as shingles (which disease is a resurgence of dormant chicken pox virus from nerves near the spine). Foods high in arginine are peanuts, cashews (peanuts are 50% higher than cashews but cashews are substantial), chocolate, and seeds other than the grass derived grain. (see here for a table which gives lysine and arginine values Lysine supplements may be in order during an actual disease also because lysine helps to mute the effects of the herpes virus significantly, reducing the occurrence (when taken routinely during the disease), severity, and healing time of herpes simplex virus [Griffith, 1981][Griffith, 1987]. It probably does so by interfering with the absorption of arginine by the virus. You can recognize shingles by large patches of a painful rash which appears on one side of the body in people under emotional stress [Irwin], older people, or people whose immune system has been compromised. An additional reason for decreasing arginine intake may exist. It is said that the enzyme which creates nitric oxide, which in turn stimulates neural sensitization, does so by acting on arginine.

     You may see an excellent table of nutrients including amino acids (just divide the values by the Kcal figure to get valid comparisons. Gain access by typing in food desired, then using the enter or return key).

     Those who have CFS should not be afraid to experiment with nutrients. The human body is very resilient. As long as you do not use a poison or procedure known to be harmful, there is not much chance that irreversible harm will transpire. Experimenting has some risk but doing nothing is even riskier. If you do come across a nutrient, combination of nutrients, or procedure or other circumstance which produces perceptible positive or negative effects, perhaps you could see yourself clear to email the information into a site which is attempting to archive such experiences and/or the author of this article at; Charles Weber ------- isoptera@angelfire.com with CFS as the subject. The author will never use your name or email address for any purpose. Single case histories can sometimes be more effective in moving forward research than blind experiments averaged [Buchanen][Urowitz].

     As to NOT eating something in order to test the possibility of food allergy which is often present, the chances of irreversible harm are vanishingly small. Some of the reactions to foods were pain, headache, and gastrointestinal distress in one study. The most common problem-causing foods or ingredients for the patients in this study were corn, wheat, dairy, citrus and sugar [Edman]. It is very unlikely that sugar can produce an allergy. However sucrose and fructose can interfere considerably with copper metabolism so a different mechanism could be involved with sugars. Of course your single case history for allergy or deficiencies is almost useless epidemiologically (the study of health statistics) by itself. However, perhaps it could become useful if you became a member of a group which keeps records and is willing to make the records public anonymously. Millions of people eat things about which no records are kept, such as hydrogenated oils. If they are not to be studied by the people who sell them, the federal agencies, or the universities, then it would be a good idea if the people who eat food did so.

Medical Procedures

     There have been two case histories in which dramatic improvements were attained in which removal of pathogenic bacteria by doxycycline 2 was the principal medication. It is said that that medicine has anti inflammatory affects also, so one can not draw certain conclusions yet. A way of stimulating the immune system by use of a medicine called Ampligen (polyI-polyC12U) produced by Hemispherx Biopharma Co. (HEB) is said to show promise. Just do not engage in any procedures out of the ordinary which go on interminably, especially medication or pain deadeners (analgesics) as pain deadeners have been proposed as a risk factor for CFS [Johnson p574]. Also several pain deadeners have been found to damage the kidneys. Among the prescription and over the counter medications that predispose patients to such damage are acetaminophen (Tylenol, Anacin-3, Liquiprin, Panadol, and Tempra) but not aspirin [Schwarz]. Kidney damage is extremely serious. Also it is plausible that anything which can damage kidney cells could damage immune cells as well. The chance that a pain deadener will have any direct curative affect is extremely small, so it usually is better to tolerate the pain if at all possible. Fibromyalgia seems often to be made worst in hypertensive patients who are treated with ACE (angiotensin conversion enzyme) inhibitors and ACE receptor blockers. A study of the side effects of these medications shows muscle pain as a potential side effect. Medications by name include accupril, altace, atacand, avapro, capoten cozaar, diovan, hyzaar, lotensin, mavik, micardis, monopril, univasc, vasotec, and zestril. Ask your doctor if your medications for high blood pressure are any of the above. Attempting to correct the low cortisol in CFS is useless because there are no significant good effects [Levine] [Copies of the complete article are available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com]. There is an extensive discussion of drug and herbal medicine adverse interactions at this site. When surgery is necessary for CFS patients (including dental procedures) it is imperative that doctors become familiar with contraindications for medication because CFS patients are very susceptible to adverse reactions from some anesthetics and other medications and usually much smaller doses are indicated.

Emotional Support

     Depression often shows up in CFS. Therefore it is almost certainly desirable for those who love the sufferer to apply as much emotional support as possible. Good jokes, camaraderie, and tactile approval (like hugs) will not cure the disease, but there is a good chance they will mute or distract some of the symptoms and make an eventual defeat of whatever infection is involved or become involved opportunistically a little more likely. Massage has been helpful for fibromyalgia but there is a good chance that this is also a placebo effect. Just be sure to make kissing or eating and drinking out of the same plate not part of the procedure because there is a suspicion that the last of the two is a risk factor. Guarding the sufferer from fear and tapping spiritual resources and staying warm will also probably prove to be advantageous since it has been shown that staying warm enhances immunity [Hanson] and fear is well known to affect the immune hormones. Fear may be contributing to the lower potassium in CFS by increasing aldosterone as well.

Society Efforts

     CFS and fibromyalgia are potentially extremely dangerous to society because of their severity and length of recovery time. The vector for this disease is unknown at present but there is a good chance that it is an infectious disease. 6.4% of patients in an unreported study were triggered by a blood transfusion [from an unreported study]. If a mosquito ever "learns" how to transmit it, the situation will be desperate for society. Therefore enormous research effort should be mobilized to not just ameliorate it, but like smallpox, to eradicate it.

     You may see abstracts of the 2nd World Congress on chronic fatigue syndrome and related disorders with 73 paragraphs on almost every current line of research at this site

Epilogue

     While it is not the policy of this author to use testimonials, you may, if you wish, tell of the outcome of health strategies to a new site which archives such experiences.

     You may find useful for definitions and easy to use a search for abstracts of journal references, "Gateway". For those which have abstracts available, click on "expand" or for definitions click on "find terms". or a list of medical search engines and also some very good nutritional sites organized in categories.

     Google is a large, general search engine which lists the most informative articles first. Google has a free program which enables you to put a tool bar on your screen which at the click of a button enables you to perform a search of the web right from the window you are viewing or the article itself, determine its rank, find anyone linking to it, find similar articles, translate it into English, and bring up its lead articles. It also will mark any word in the article you wish and search within the article. It is something else.

     The author has a degree in chemistry and a master of science degree in soil science. He has researched potassium and copper nutrition for 40 years, primarily library research, and CFS for several months. He has cured his own early onset of arthritis. He has published articles on allied subjects in; The Journal of Theoretical Biology (1970, 1983), The Journal of Applied Nutrition (1974) which gained the best article of the year award, Clinical and Experimental Rheumatology (1983), and Medical Hypotheses (1984, 1999)

     Confidentiality of data relating to individual patients and visitors to a medical/health Web site, including their identity, is respected by this Web site. The Web site owners undertake to honor or exceed the legal requirements of medical/health information privacy that apply in the USA

REFERENCES

[*] I do not have this reference immediately available. Anonymous 1994 Potassium and sodium and potassium in the skeletal muscle. Laeger Ugeskr 156; 4007-4010.

Bell DS Bell KM Cheney PR 1994 Primary juvenile fibromyalgia syndrome and chronic fatigue syndrome in adolescents. Clin. Infect. Dis. Suppl. 1; S21-3.

Bell IR Baldwin CM Schwartz GE 1998 Illness from low levels of environmental chemicals: relevance to chronic fatigue syndrome and fibromyalgia. Am. J. Med. 105; 74S-82S.

Bell IR Baldwin CM Stoltz E Walsh BT Schwartz GER 2002 Concomitant Environmental Chemical Intolerance Modifies the Neurobehavioral Presentation of Women with Fibromyalgia. Journal: J of Chronic Fatigue Syndrome, Vol. 9(1/2) 2002, pp. 3-19

Benjamin F 1959 Release of intracellular potassium as the physiological stimulus for pain. Journal Appl. Physiol. 14; 643.

Buchanan WW Kean WF 2002 Evidence Based Medicine: The Median Is Not the Message. Journal of Rheumatology, Vol. 28, No. 11 2371

Buchwald D Sullivan JL Leddy S Komaroff AL 1988 "Chronic Epstein-Barr virus infection" syndrome and polymyalgia rheumatica. J. Rheumatol. 15; 479-82.

Buchwald D Chenet PR Peterson DL Henry B Wormsley SB Geiger A Ablashi DV Salahuddin SZ Saysinger C Biddle R et al 1992 A chronic illness characterized by fatigue,neurologic and immunologic disorders, and active human herpesvirus type 6 infection. Annals of Internal Medicine 116; 103-13.

Buchwald, D Garrity 1994 Comparison of patients with Chronic Fatigue Syndrome, Fibromyalgia and Multiple Chemical Sensitivities," Archives of Internal Medicine; 154;2049-53.

Burnet RB Yeap BB Chatterton BE Gaffney RD 1996 Chronic fatigue syndrome: is total body potassium important? Med. J. Aust. 164; 384.

Caligiuri M, Murray C, Buchwald D, Levine H, Cheney P, Peterson D, Komaroff AL, Ritz J 1987. Phenotypic and functional deficiency of natural killer cells in patients with chronic fatigue syndrome. J. Immunol. 139(10):3306- 13.

Cannon JG Angel JB Abad LW Vannier E Mileno MD Fagioli L Wolff SM Komaroff AL 1997 Interleukin-1 beta, interleukin-1 receptor antagonist, and soluble interleukin-1 receptor type II secretion in chronic fatigue syndrome. J. Clin. Immunol 17; 253-261.

Charalampous FC 1971 Metabolic functions of myoinositol: VIIII - Role of inositol in Na+-K+ transport and in Na+ and K+ activated adenosine triphosphate of KB cells. Journal of Biol. Chem> 246; 455 & 461.

Clapp LL, Richardson MT, Smith JF, et al. Acute effects of thirty minutes of light-intensity, intermittent exercise on patients with chronic fatigue syndrome. Phys. Ther. 1999;79:749-56.

Classen HG Marquardt P Spath M Schumacher KA Grabling B 19?? Experimental studies on the intestinal uptake of organic and inorganic magnesium and potassium compounds given alone or simultaneously. Arzeneim Forsch. 28 807-811.

Coutts R Weatherby R Davie A 2002The use of a symptom "self report" inventory ro evaluate the acceptability and efficiency of a walking program for patients suffering with chronic fatigue syndrome. .J. Psychosom. Res. 51; 425- 29.

Cox IM, Campbell MJ, Dowson D. 1991 Red blood cell magnesium and chronic fatigue syndrome. Lancet Mar 30;337(8744):757-60.

Dahle LO Berg G Hammar M Hurtig M Larsson L 1996 The ffect of oral magnesium substitution on pregnancy induced cramps. American Journal of Obstet. Gynecol. 175; 233-234.

Demitrack MA, Dale JK, Straus SE, Laue L, Listwak SJ, Kruesi MJ, Chrousos GP, Gold PW 1991 Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome. J. Clin Endocrinol. Metab. 73(6): 1224-34.

DeFreitas E Hilliard B Cheney PR Bell DS Kiggunde E Sankey D Wroblewska Z Palladino M Woodward JP Koprowski H 1991 Retroviral sequences related to human T-lymphotropic virus type II in patients with chronic fatigue immune dysfunction syndrome. Proc. Natl. Acad. Sci. 88; 2922-2926.

Donaldson M Speight N Loomis S 2002 Fibromyalgia syndrome improved using mostly raw vegetarian diet: an observational study. BMC Complimentary and Alternative Medicine 1;7. Erdman JS 2002 Lead investigator Dr. Joel S.

Edman of the Center for Integrative Medicine at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, presented the findings at the annual meeting of the American College of Nutrition in Orlando, Florida.

Evengard B Schacterle RS Komaroff 1999 Chronic fatigue syndrome: new insights and old ignorance. Journal Intern. Med. 246; 455-469.

Ghosh HN Glover WE Hutchison KJ 1963 The effect of introarterial potassium chloride infusioons on vascular reactivity in the human hand. Journal Phys. , London, 168.

Gotze FR Thid SK Kyllerman M 1998 Fibromyalgia in hyperkalemic periodic paralysis. Scand. Journal of Rheumatol. 27; 383-384.

Griffith RS, DeLong DC, Nelson JD 1981 Relation of arginine-lysine antagonism to herpes simplex growth in tissue culture. Chemotherapy ;27(3):209-13.

Griffith RS, Walsh DE, Myrmel KH, Thompson RW, Behforooz A 1987 Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis. Dermatologica ;175(4):183-90.

Hadhazy VA Ezzo J Creamer P Berman BM 2000 Mind-body therapies for the treatment of fibromyalgia; a systematic review. J. Rheumatol. 27; 2911-8.

Hendricks SB 1964 Salt transpoty across cell membranes. Amer. Sci 52; 306.

Hinds G, Bell NP, McMaster D, McCluskey DR. 1994 Normal red cell magnesium concentrations and magnesium loading tests in patients with chronic fatigue syndrome. Ann. Clin. Biochem. Sep;31(Pt 5):459-61.

Hanson, D.E.; Murphy, P.A.; Silicano, R.; Shin, H.S. 1983 The effect of temperature on the activation of thymocytes by interleukin I & II. Journal of Immunol. 130: 216, 1983.

Holmes GP et al 1987 A cluster of patients with a Chronic Mononucleosis-like Syndrome: Is Epstein-Barr virus the cause? Journal of the American Medical Association 257; 2297-302.

Irwin M, Costlow C, Williams H, Artin KH, Chan CY, Stinson DL, Levin MJ, Hayward AR, Oxman MN: Cellular immunity to varicella-zoster virus in patients with major depression J Infect Dis 1998 Nov;178 Suppl 1:S104-8.

Jenthoft ES Kvalik AG Mengshoel AM 2002 Effects of pool based and land-based aerobic exercise on women with fibromyalgia / chronic widespread pain. Arthitis Rheum. 45; 42-7.

Johnson H 1997 Osler's Web. Penguin's Books, Ontario Canada.

Lawson K & Eisinger J (2002) Pharmacological agents to treat Fibromyalgia Syndrome, Exp. Opin. Invest. Drugs, in press.

Lawson K (2000) Is there a role for potassium channel openers in neuronal ion channel disorders? Exp Opin Investl. Drugs 9(10) 2269-2280.

Lawson K, Barras M, Armstrong JM & Hicks PE (1997) Effects of K channel inhibitors and antagonists on NS-004 evoked relaxations in guinea-pig isolated trachea. Fundam. Clin Pharacol 11, 78-82.

Lawson K (1996) Potassium channel activation: a potential therapeutic approach? Pharmacol. Ther., 70, 39-63.

Lawson K & Hicks PE (1993) Potassium channel openers: Pharmacological anomalies suggest heterogeneous sites of action. Curr. Opin. Invest. Drugs, 2, 1209-1216.

Levine PH Klimas N Armitage R Fredericks R Stewart J Torch W Schwartz S Suhadolnik R Reichenbach NL Rhodes L 2002 Nevada Chronic Fatigue Syndrome Consensus Conference. Journal: J of Chronic Fatigue Syndrome, . 9 (1/2) , pp. 53-62.

MacIntyre I & Davidson D 1958 The production of secondary potassium depletion, sodium retention, nephrocalcinosis and hypercalcemia by magnesium deficit. Biochem. Journal 70; 456-462.

Magaldi M, Moltoni L Biasi G Marcolongo R 2000 Role of intracellular calcium ions in the physiopathology of fibromyalgia syndrome. Boll Soc Ital Biol Sper Jan-Feb;76(1-2):1-4.

Magaldi M, Moltoni L Biasi G Marcolongo R 2000 Role of intracellular calcium ions in the physiopathology of fibromyalgia syndrome. Boll Soc Ital Biol Sper Jan-Feb;76(1-2):1-4.

Scott LV Svec F Dinan T 2000 A preliminary study of dehydroepiandrosterone response to low-dose ACTH in chronic fatigue syndrome and in healthy subjects. Psychiatry Research 97; 21-28.

Manitius A 1965 Some physiological effects of magnesium deficiency p28. in: Electrolytes and Cardiovascular Diseases, Bajusz E, editor. S. Karger, New York.

Marcel B, Komaroff AL, Fagioli LR, Kornish RJ 2nd, Albert MS. 1996 Cognitive deficits in patients with chronic fatigue syndrome. Biol Psychiatry 1996 Sep 15;40(6):535-41.

McCune MA, Perry HO, Muller SA, O'Fallon WM 1984 Treatment of recurrent herpes simplex infections with L-lysine monohydrochloride. Cutis Oct;34(4):366-73.

Mengshoel AM Haugen M 2002 Health status in fibromyalgia - a follow up study. J. Rheumatol. 28; 2085-9.

Messerli FH, et al 1977 Effects of angiotensin II on steroid metabolism and hepatic blood flow in man.. Circ. Res 40; 204-207.

Nasralla M, Haier J, Nicolson GL.1999 Multiple mycoplasmal infections detected in blood of patients with chronic fatigue syndrome and/or fibromyalgia syndrome. Eur. J. Clin. Microbiol. Infect. Dis. Dec;18(12):859-65. Patarca R Klimas NG Lugtendorf S Antoni M Fletcher MA 1994 1994 Dysregulated expression of tumor necrosis factor in chronic fatigue syndrome interelations with cellular sources and patterns of soluble immune mediator expression. Clin Infect. Dis. Jan 18 Suppl. 1; s147-s153.

Patnaik M Komaroff AL Conley E Ojo-Amaize EA Peter JB 1995 Prevalence of IgM antibodies to human herpesvirus 6 early antigen (p41/38) in patients with chronic fatigue syndrome. J. Infect. Dis. 172; 1364-67.

Petersen VP 1963 Potassium and magnesium turnover in magnesium deficiency. Acta Med. Scand. 174; 595-604.

Racciatti D Vecchiet J Ciccomancini A Ricci F Pizzigallo E 2002 Chronic fatigue syndrome following toxic exposure.. Sci. Total Environ. 270; 27-31.

Schwartz A, Perez-Canto A. 1998 Nephrotoxicity of antiinfective drugs. Int. J. Clin. Pharmacol. 36(3):164-7.

Scott LV Dinan TG 1999 Small adrenal glands in chronic fatigue syndrome: a preliminary computer tomograph study psychoneuroendocrinology 24; 759-768.

Scott LV Svec F Dinan T 2000 A preliminary study of dehydroepiandrosterone response to low dose ACTH in chronic fatigue syndrome and in healthy subjects. Psychiatry Research. 97; 21-8.

Schwartz RB, Garada BM, Komaroff AL, Tice HM, Gleit M, Jolesz FA, Holman BL. 1994 Detection of intracranial abnormalities in patients with chronic fatigue syndrome: comparison of MR imaging and SPECT. Am. J. Roentgenol. 1994 Apr;162(4):935-41.

Schwarz A, Perez-Canto A. 1998 Nephrotoxicity of antiinfective drugs Int. J. Clin. Pharmacol. Ther. 36(3):164-7.

Tomoda A Jhodoi T Miike, T 2002 Chronic Fatigue Syndrome and Abnormal Biological Rhythms in School Children. Journal of Chronic Fatigue Syndrome, Vol. 8 (2) , ; 29-37. Ulrich F 1959 Ion transport by heart and skeletal muscle mitochondria. Amer. Journal Phys.197; 997.

Urowitz MB 2002 How Do I Know Thee...? Let Me Count the Ways. The Varieties of Medical Evidence. Journal of Rheumatology, Vol. 28,. 2373

White KP, Harth M 2002 Classification, epidemiology, and natural history of fibromyalgia. Curr Pain Headache Rep 2002 5(4);320-9.

Visser J, Lentjes E, Haspels I, Graffelman W, Blauw B, de Kloet R, Nagelkerken L 2002 Increased sensitivity to glucocorticoids in peripheral blood mononuclear cells of chronic fatigue syndrome patients, without evidence for altered density or affinity of glucocorticoid receptors. J Investig Med 2002 Mar;49(2):195-204.

Charles Weber ------- isoptera@angelfire.com

home