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Chronic Fatigue Key To Successful Treatment. Raj Patel, MD Medical Options for Wellness Los Altos, CA 650-964-6700 www.DrRajPatel.net. Chronic Fatigue vs CFIDS CFIDS: Centers for Disease Control and Prevention (CDC) uses the following criteria:

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chronic fatigue key to successful treatment

Chronic FatigueKey To Successful Treatment

Raj Patel, MD

Medical Options for Wellness

Los Altos, CA

650-964-6700

www.DrRajPatel.net

Raj Patel, M.D.

slide2

Chronic Fatigue vs CFIDS

  • CFIDS: Centers for Disease Control and Prevention (CDC) uses the following criteria:
  • Having severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis, and Concurrently having four or more of the following symptoms:
  • substantial impairment in short-term memory or concentration,
    • sore throat,
    • tender lymph nodes,
    • muscle pain,
    • multi-joint pain without swelling or redness,
    • headaches of a new type, pattern or severity,
    • unrefreshing sleep, and
    • post-exertional malaise lasting more than 24 hours.
    • CFIDS is vaguely defined with no consistently conclusive test
    • Level of testing to rule out other diagnoses can vary dramatically based on the knowledge and expertise of the clinician

Raj Patel, M.D.

slide3

Chronic Fatigue & Other Similar Illnesses

    • Examples: Fibromyalgia
          • Chronic Fatigue
          • Chronic Lyme Disease
          • Autism
          • ADHD
    • These illnesses lack hard objective diagnostic tests
    • Diagnosis is made based on signs and symptoms which can and do greatly overlap
    • These illnesses are syndomes rather than a single disease entity. Therefore, each illness is a “mixed bag” with different underlying contributing factors playing a role in each individual.

Raj Patel, M.D.

slide4

Chronic Fatigue & Other Similar Illnesses (con’t)

    • All of these illnesses are frequently associated with methylation cycle impairments and chronic viral &/or bacterial infections
    • These two factors in turn lead to a number of disturbances that we frequently associate with these conditions:
    • Neurotransmitter Imbalances
    • Hormonal Imbalances
    • Food Intolerances
    • Heavy Metals
    • * Lifestyle and emotional factors play a big role in determining how active these infections become

Raj Patel, M.D.

slide5

Useful Testing in Evaluating Chronic Fatigue*

    • RNase-L activity (Viral Immune Pathology)
    • Urine Amino Acid Analysis (Doctor’s Data)
    • SAM/SAH/Homocysteine (Vitamin Diagnostic)
    • Urinary neopterin/biopterin (Philippe Auguste Labs)
    • Lyme & Coinfection Panel (IgenX)
    • TSH, total & free T4, total & free T3
    • CBC and Chemistry Panel
    • 24 hour salivary cortisol
    • Urinary neurotransmitter profile
    • Electrodermal testing
    • Testing for HHV6, EBV, CMV, XMRV, etc.
    • Mental status and psychological screening
  • * Other testing may be necessary based on the individual’s symptoms

Raj Patel, M.D.

slide6

Methylation Cycle

    • Definition:

Methylation involves transfer of methyl group

    • Methylation plays a role in:
  • Neurotransmitter synthesis and breakdown
  • Renal disease
  • Cardiovascular disease
  • Cancer
  • Heavy metal detoxification
  • Anti-viral immune modulation

Raj Patel, M.D.

slide7

Zn

P5P

P5P

Mg

B12

Methylation Cycle

5,10 MTHF

Methionine

SAM

MSR

Methionine

Synthase

MTHR

SAH

5 MTHF

Homocysteine

Homocysteine

CBS

Cystathione

Cysteine

Glutathione

Taurine

Raj Patel, M.D.

slide8

Methylation Cycle (con’t)

  • Methylation Impairments result from:
    • Single Nucleotide Polymorphisms (SNPs):

Can impair methylation

Commonly found in the general population

SNPs involving MTHFR C677T have a 47% incidence among

Caucasians

  • Ulrich CM. et al.Cancer Epidemiol Biomarkers Prev. 1999 Aug;8(8):659-68
    • Heavy metals at low levels can suppress key enzymes involved in methylation
    • Viruses can impair methylation cycle enzymes

Raj Patel, M.D.

slide9

Methylation Cycle (con’t)

    • Testing to assess methylation: genomic testing
  • urine/serum amino acid analysis
    • Nutritional Support to open/bypass areas of impairment:
  • Methyl B12 / Cyano B12
  • TMG (or DMG)
  • Folic/Folinic acid
  • P5P/B6
  • Reduced Glutathione

Raj Patel, M.D.

slide10

Chronic Fatigue

    • Take Home Message:
    • Identifying the underlying factors playing a role in a particular individual’s illness is critical to determining what treatment to prescribe, and thereby achieving a successful outcome.

Raj Patel, M.D.

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