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What Causes CFS?

How to Begin Thinking about CFS and GWS
Main Amino Acid Deficiencies in CFS

How to Begin Thinking about CFS and GWS

You will soon read about the amino acid deficiencies that are associated with Chronic Fatigue Syndrome and Gulf War Syndrome and, in our Case Reports, you will see how good the results can be when one supplements with high doses of the missing aminos.

Before going into the details of the amino acid deficiencies, let's take a look at the possible causes of CFS. This is a complex illness, which requires multiple approaches in order to get a cure, remission or symptomatic relief. In truth I believe CFS, FM, GWS, EM, NMH, MCS are final common pathways that can be reached through:

  1. Parasites
  2. Bacteria
  3. Candida
  4. Chronic viruses, including: EBV (Epstein-Barr Virus), CMV (Cytomegalo Virus) Herpes I, Herpes II, HHV6 (Human Herpes VI Virus)
  5. Chemical exposure
  6. Mycoplasma
  7. GI malabsorption
  8. Endocrine imbalances
  9. Stress, acute, overwhelming
  10. Stress, chronic, especially that arising out of child abuse or neglect

At The Gersten Institute, we want to make it clear that we do not know what causes CFS. In fact, symptomatology, causation, and treatment all reflect where we are looking. If we are looking at a cellular level, we will be able to test for and identify metabolic abnormalities. This is the level we are looking at with amino acid testing. Let's take a minute to review some theoretical ideas about what CFS is. By this, we don't mean, "What virus, stress, or chemical initiated the illness process." We mean, "What is the process that keeps this illness going, that creates the variety of symptoms, and disability." Here are just a few of those theories:

  1. CFS is a neurological, limbic system abnormality. This is the theory which Jay Goldstein, M.D. has written about, and which is central to his treatment of thousands of patients.

  2. CFS is a disorder of red blood cell size, shape and function. This is the theory of Les Simpson, Ph.D.

  3. CFS is partially a disorder of amino acid metabolism. At The Gersten Institute we hold that this is a partial truth. Just because supplementation with amino acids can lead to symptomatic relief or even a cure for CFS, that does not lead us to believe that disorders of amino acid metabolism are THE central process.

  4. CFS is a dysregulation of the immune system.

  5. CFS is an infectious process.

  6. CFS is partially a genetic disorder.

How we look at illness, how we diagnose, and how we treat, is entirely a function of the belief systems that we, as doctors and healers, hold. For example, a Doctor of Oriental Medicine might believe that CFS is, "A deficiency of kidney yang energy with liver stagnation." I am not a practitioner of Oriental Medicine so I do not know if the above statement is correct, but it should give you the idea of the concept, namely that our belief systems will dramatically affect how we understand illness and its treatment.

Furthermore, one needs to understand that some of us working with CFS and related illnesses are looking with "microscopes," others with our "hands", others with our "eyes", others with "SPECT scans of the brain". Anyone who has read "Molecules of Emotion: Why We Feel the Way We Feel" by Candace Pert, Ph.D., will have eyes to look at an entirely new level, namely that of the receptor site. Dr. Pert discovered the receptor site for endorphins, our natural pain killers. Subsequently, she "built" Peptide-T, a string of six amino acids that fills the receptor site where the AIDS virus enters a cell, and alleviates many symptoms of AIDS. Every cell in our body is covered with receptor sites, and this should one day be an area of research with CFS.

I'd like to describe an analogy that will help you see the problem of causation with CFS. Let's imagine we're thinking about a soldier, Soldier X, on the battlefield who has just been wounded by a hand grenade that exploded right in front of him. In the hospital, doctors would find that:

  1. He had his right leg blown off below the knee,and would need emergency surgery to stop blood loss and infection. Later on he would need an artificial limb.

  2. Shrapnel punctured his left lung, thereby causing a) a lung infection, b) a pneumothorax, c) poor ventilation and perfusion resulting in d) abnormal blood gases, and e) extra strain on the heart.

  3. Shrapnel also punctured his skull, penetrated brain tissue, and caused temporary loss of consciousness along with weakness on the right side of his body. Soldier X recovers from a complicated and long surgery involving his brain, skull, right leg, left lung, and all of the other less important wounds.

  4. Several days after surgery, Soldier X developed a high fever. He was found to be septic, meaning he had an infection circulating in his blood. He was put on high doses of intravenous antibiotics, and the fever resolved, along with the mental confusion it caused.

  5. One month after his injury, as his physical wounds were healing, he began having nightmares, flashbacks of the grenade explosion, and mood swings. A psychiatrist was asked to visit him.

Soldier X has structural problems, fractures, blood loss, blood gas abnormalities, neurological problems, and mental-emotional problems. Now, if the five doctors working on him were entirely unaware of all of the problems, each might think that the patient suffered from only one problem. For example, the orthopedic surgeon might believe that the patient had an orthopedic problem, the neurosurgeon a neurological problem, the general surgeon multiple wounds, the infectious disease doctor an infection, and the psychiatrist a mental-emotional problem called "PTSD."

The point is that many people working with CFS patients fail to recognize that there are a number of valid theories and approaches, each motivated by what each of us is looking at. If we return for a moment to Soldier X, we could clearly state that all of these problems were caused by a single agent, namely an exploding hand grenade. That single "insult" caused problems on every conceivable level: metabolic, structural, infectious, neurological, inflammatory. In addition, he will have marked changes in endocrine status due to the physical stress on his body. Basically, the injury will affect almost every part of his body, either directly or indirectly.

It is clear that, once Soldier X has been injured, there is not much one can do about the hand grenade, other than remove shrapnel. Using this analogy, let's now move our attention to CFS and GWS. Even if the original grenade injury was the Stealth Virus, it does not necessarily hold that our treatment plan should aim at that virus, any more than the doctors of Soldier X should only focus on the shrapnel. No, they need to keep him alive, sew him up, give him antibiotics, etc.

CFS has a life of its own once the illness has been triggered. It is a final common pathway. There are a lot of ways to get sick with CFS, but once you have it, thousands of others with CFS will also suffer the same symptom of post-exertional fatigue.

With this philosophical overview, let's now look at the most common amino acid deficiencies that are seen with CFS and GWS patients. At this point, I want you to remember our analogy of Soldier X. While looking at the amino acid deficiencies, we do not want to forget about the rest of Soldier X.

Main Amino Acid Deficiencies in CFS

I. Neurotransmitters

There are 9 amino acids that are either neurotransmitters or precursors to neurotransmitters:

L-Tyrosine and L-Phenylalanine are precursors to norepinephrine. L-Tyrosine deficiencies are among the most common deficits seen in CFS

L-Tryptophan is the immediate precursor to serotonin - also a very common deficiency in CFS.

The other neurotransmitter amino acids are: glutamic acid, glutamine, aspartic acid, asparagine, glycine, taurine, and GABA.

II Muscle Metabolism

The so-called "branch-chain" amino acids are involved in muscle metabolism and muscle endurance. These are: L-leucine,:- isoleucine, L-valine. L-Glutamine, although not classified as a branch-chain amino acid, is heavily involved in muscle metabolism.

Because of the physical weakness seen in CFS and GWS, one usually sees deficiencies in one or more the branch-chain amino acids as well as glutamine.

III Glycogenic (Sugar Metabolism)

L-serine, L-alanine, and L-glycine are the glycogenic amino acids. Whenever one has problems with sugar metabolism, you will find deficiencies in one or more of the glycogenic amino acids. Symptoms related to diabetes mellitus, hypoglycemia, or generalized candidiasis are a function of sugar metabolism and hence L-serine, L-alanine, and L-glycine abnormalities. More about candidiasis later on...

IV Immune System

L-lysine, L-arginine, and L-glutamine are indicators of immune system function. A deficiency in L-arginine is a strong indicator of a weakened immune system. A deficiency in L-lysine indicates the possibility of a chronic virus, such as EBV and CMV. However, almost all amino acids have complex functions. For now, we are providing an overview without a great amount of detail. Suffice it to say that L-arginine is also involved in the production of human growth hormone as well as DNA synthesis. L-lysine is involved in protein synthesis in general and, if someone is lacking in L-lysine, they will have general problems in protein metabolism.

V Other Common Deficiencies in CFS and GWS

  1. With allergy and chemical sensitivity you will see deficiencies in cysteine and/or methionine. With Gulf War Syndrome, in particular, one should be on the lookout for these deficiencies since chemical exposure may be an important contributing factor, especially for those vets who fought on Iraqi soil and who had more direct exposure to the burning oil well.

  2. There are estimates of 70 million Americans with generalized candidiasis. More than half of the CFS patients I have worked with have candida as a contributing factor. On rare occasions, I have seen it to be the main etiologic factor in CFS. The amino acid, Taurine, when deficient, is an indication of candida. It is not predictive, but does indicate that further testing should be done. The most important test to be done next is comprehensive stool analysis with yeast culture and sensitivity. To read a detailed case report of a patient with CFS caused by candida, click on Tess' story.

  3. Zinc deficiency is much less associated with CFS and GWS than are the amino acids discussed above, but it does occur and is associated with a deficiency in L-histidine. If your L-histidine blood level is low, zinc levels should be tested for.

  4. Low L-aspartic acid can be associated with low calcium and magnesium levels. Therefore, if one has this deficiency, calcium and magnesium levels should be checked. A deficiency in L-aspartic acid is not seen as frequently in CFS and GWS as are the other abnormalities listed above.

Amino acid chemistry is quite complex as you can see. It is not sufficient to merely know what your amino acid deficiencies are. You must also know what other tests to run . . . and how to create a supplementary schedule out of the raw data.

Finally, the question will arise, "Do these amino acid deficiencies cause CFS and GWS?" Let's return to Soldier X. His five different kinds of problems are equivalent to the amino acid deficiencies. Amino acid problems are probably not the initial cause of CFS in the way the the hand grenade was the immediate cause of Soldier X's multiple problems.

It is more likely that a pathogen (virus, bacteria, fungus, parasite) sets the disease process in motion, creating a cascade of metabolic problems, which, in turn, cause a host of symptoms. While it is vitally important to get rid of the bacteria or fungus (and try to inactivate a virus), that alone is not likely to provide a cure, any more than picking up the pieces of grenade shrapnel is going to get rid of the wounds it caused. Amino acid deficiencies, once set in motion, need to be replenished by supplementing the deficient amino acid. Healing will not be deep enough if one treats mycoplasma, for example, without repairing the damage left in its wake. That is, your amino acids will not go back to normal simply because you have identified mycoplasma as a causative agent and have taken antibiotics to kill it. The mycoplasma (bacteria, fungus, parasite, virus) may have been brought under control but now the metabolic havoc must be dealt with.

A word of caution: The general amino acid deficiencies described above are not guidelines for how you or anyone else should be treated, if they have CFS, GWS, or anything else. First of all, there are no two amino acid profiles that are identical. Each person must truly be treated individually. Secondly, you cannot simply go to a health food store and begin taking the supplements that you think are deficient, now that you have some idea of the amino acid deficiencies seen in CFS and GWS. It is imperative that you have your amino acid program put together by a clinician with many years of experience in a) CFS, and b) amino acid testing and supplementation. If this is not done in a serious, monitored, clinical fashion, you can take the wrong amino acids, too much of an amino acid, etcetera. Likewise, if you take the wrong amino acids at the wrong time of day, they can cancel each other out, so that it may seem as if you are not taking anything at all. Finally, you must have a physician review your entire medical history, including family history, abnormal laboratory data, current symptoms, current medications, and current nutritional supplements.

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