Botanicals in ME/CFS
Kevin Spelman, PhD, MCPP Health, Education & Research ME/CFS
CFS was formally defined in 1988 as a disabling fatigue of at least 6 months duration of uncertain etiology . Besides fatigue, symptoms can include: . mild fever . sore throat . painful lymph nodes . weight gain . exertional malaise . muscle weakness . muscle and joint pain . headaches . depression . light-headedness . anxiety . visual and cognitive impairment . disturbed sleep patterns
Holmes GP, Kaplan JE, Gantz NM, et al. Chronic fatigue syndrome: a working case definition. Ann Intern Med. 1988 Mar;108(3):387-9. ME/CFS
United States Centers for Disease Control and Prevention (1994):
1. Having severe chronic fatigue for at least 6 months or longer with other unknown medical conditions (that can cause fatigue) excluded by clinical diagnosis
Prevention CfDCa. CFS case definition. 2011 [cited; Available from: www.cdc.gov/cfs/general/case_definintion/index.html ME/CFS
United States Centers for Disease Control and Prevention (1994):
2. Concurrently having four or more of the following symptoms: - post-exertional malaise - impaired memory or concentration - unrefreshing sleep - muscle pain - multi-joint pain without redness or swelling - tender cervical or axillary lymph nodes - sore throat - headache
Prevention CfDCa. CFS case definition. 2011 [cited; Available from: www.cdc.gov/cfs/general/case_definintion/index.html CFS
United States Centers for Disease Control and Prevention (1994):
3. The symptoms must have persisted or occurred during 6 or more consecutive months of illness and must not have predated the fatigue.
. Currently there is no accepted biochemical test for the condition Somatic Syndrome Crossover Wessely et al. 1999. Lancet 354:936-39
• IBS pt may also have sx of other syndromes • Atypical facial pain • CFS/FM • Non-cardiac chest pain • Food allergy • Chronic hyperventilation • Tension HA • Chronic pelvic pain • PMS Hypothesis on Etiology A Mosaic for Understanding Fatigue Fatigue
Mitochondrial Neurologic Immunologic Cardiovascular
Postural Hypotension Transport ETC Membrane Glial Cytokines DTH orthostatic Autonomic tachycardia Dysfunction Heart Rate Variability A Mosaic for Understanding ME/CFS
Fatigue
Mitochondrial Neurologic Immunologic Cardiovascular
Orthostatic Hypotension Transport ETC Membrane Glial Cytokines DTH tachycardia Autonomic Dysfunction Heart Rate Variability
Energy Loss CNS Inflammation Inflammation Orthostatic Hypotension Muscle Weakness Unrefreshing Sleep Sickness Behavior Orthostatic Tachycardia Post-Exertional Malaise Depression Defense Compromise Increased Recovery Times Brain Fog Muscle/Joint Pain Hypotension Tender Lymph Nodes Headache Sore Throat
Biasutto L, Szabo’ I, Zoratti M. 2011. Mitochondrial Effects of Plant-Made Compounds. Antioxidants & Redox Signaling 15(12):3039-59. Mitochondrial Functions & Processes
Biasutto L, Szabo’ I, Zoratti M. 2011. Mitochondrial Effects of Plant-Made Compounds. Antioxidants & Redox Signaling 15(12):3039-59. Mitochondrial Ca2+ Handling
Biasutto L, Szabo’ I, Zoratti M. 2011. Mitochondrial Effects of Plant-Made Compounds. Antioxidants & Redox Signaling 15(12):3039-59. AMPK Integrates Signals To Coordinates Mitophagy
Biasutto L, Szabo’ I, Zoratti M. 2011. Mitochondrial Effects of Plant-Made Compounds. Antioxidants & Redox Signaling 15(12):3039-59.
Morris G, et al. A narrative review on the similarities and dissimilarities between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and sickness behavior. BMC Medicine 2013, 11:64 Morris G, et al. A narrative review on the similarities and dissimilarities between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and sickness behavior. BMC Medicine 2013, 11:64
In searching for T-cell gateways into and out of the meninges, we discovered functional lymphatic vessels lining the dural sinuses. These structures express all of the molecular hallmarks of lymphatic endothelial cells, are able to carry both fluid and immune cells from the cerebrospinal fluid, and are connected to the deep cervical lymph nodes.
The discovery of the central nervous system lymphatic system may call for a reassessment of basic assumptions in neuroimmunology and sheds new light on the aetiology of neuroinflammatory and neurodegenerative diseases associated with immune system dysfunction.
Phytotherapeutics Fatigue
Mitochondria Neurologic Immunologic Cardiovascular
Postural Hypotension Transport ETC Membrane Glial Cytokines DTH orthostatic Autonomic tachycardia Dysfunction Heart Rate Variability Adaptogens Autophagic Restoratives Immunomodulators Immunostimulants Trophorestoratives Anti-Inflammatories Nootropics Analgesics Anti-Inflammatories Adrenal Tonic Anxiolytics Trophorestoratives Hypnotics General Tonics Lycium barbarum
Theobroma cacao
Adaptogens Eleutherococcus senticosus
Panax ginseng Schisandra chinensis
Withania somnifera
Avena sativa Glycyrrhiza glabra Rehmannia glutinosa Rhodiola rosea
Immunomodulators & Immune Stimulants Astragalus membranaceus Echinacea spp. Picrorhiza kurroa Antiviral Herbs Andrographis paniculata Hypericum perforatum Thuja occidentalis Anti-Inflammatory Herbs Bupleurum chinense Boswellia serrata Other strategies Blood Flow Ginkgo biloba Salvia miltiorrhiza
Zanthoxylum clava-herculis Sleep Disorders Valeriana officinalis Passiflora incarnata Piper methysticum Cardiac & Circulatory Crataegus spp. Venous Tonics Ruscus aculeatus Aesculus hippocastanum Remember that we only look where we already know/understand MOAs
We cannot see what we do not see
Don’t ever underestimate your own clinical observations Thoughts and/or Questions?