Chronic fatigue key to successful treatment
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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

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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.


Chronic fatigue key to successful treatment

  • 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, andConcurrently 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.


Chronic fatigue key to successful treatment

  • 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.


    Chronic fatigue key to successful treatment

    • 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.


    Chronic fatigue key to successful treatment

    • 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.


    Chronic fatigue key to successful treatment

    • 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.


    Chronic fatigue key to successful treatment

    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.


    Chronic fatigue key to successful treatment

    • 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.


    Chronic fatigue key to successful treatment

    • 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.


    Chronic fatigue key to successful treatment

    • 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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