Bachelor of Science (Adelaide), Master of Nutrition and
Dietetics (Flinders).
PhD, Senior Hospital Scientist-in-Charge, Division of
Microbiology and Infectious Diseases at the John Hunter Memorial, Newcastle
and visiting Lecturer, Department of Biological Sciences, University of Newcastle.
Despite wild, cold weather approximately 150 people turned out to hear two of the Newcastle CFS Research Team speak.
Dr Ian Buttfield gave a preliminary talk, providing a brief overview of Chronic Fatigue Syndrome (CFS), and of the Newcastle research work.
Ms Tania Emms, a dietitian, presented data from her clinical practice on alleviating symptoms in CFS patients. Tania is currently undertaking doctoral research with the University of Newcastle that will include the upcoming serine supplementation trial and an extension of her current clinical observations.
Tania, a longtime sufferer herself, explained how CFS symptoms could be managed by diet in a subgroup of patients exhibiting food chemical intolerances.
She commenced by explaining her interest as a practitioner in the links between Irritable Bowel Syndrome (IBS), food intolerances, multi-organ dysfunction, and alterations to colonic bacteria and metabolites. She reported that the medical literature indicates a significant overlap in symptomatology between CFS patients and those with IBS, suggesting the possibility of a common starting point and/or disease progression. Studies report an alteration in the number of colonic ‘bugs’ in CFS, IBS and food intolerances. This was picked up later by Dr Henry Butt.
Tania then moved on to her research on food intolerances. She was quick to point out that food intolerances are not allergic reactions, which is an immune system dysfunction. Although similar and body systems can be affected, the timing and mechanism of these reactions are quite different. As such, the diagnosis and management of food intolerances, as opposed to allergies, is different. Food intolerances are best thought of as inducing a “drug-like” reaction in their target organs. A small amount may not induce any side effects, but too much over a certain threshold could affect us greatly. In the short term, elimination of these chemicals may actually produce withdrawal making us crave them more, and further ingestion can aggravate symptoms even more.
Food intolerances can be induced by naturally occurring foods – not just preservatives and additives. Naturally occurring food chemicals such as salicylates, amines, monosodium glutamate, and lactose, as well as proteins such as gluten and milk can have a big impact on us.
We must understand that until we hit our “threshold” for a particular chemical we may be fine. A little more of the substance in question can tip us over the edge, producing drastic results in our bodies. Chemicals have a certain lifetime in our system, and any one particular chemical may be present in many different foods we eat. As we consume more of them, our levels build up. These chemicals are as prevalent in an ideally “healthy, natural” diet as in a highly processed one; just the type of chemical and amount may alter.
Tania stressed the importance of seeking professional advice, as we might attribute our symptoms to specific foods, when it is really may be a combination of that food and others with common chemicals that are causing the problem, particularly with characteristically delayed reactions. Eliminating one part of the problem is obviously not the whole solution.
Tania’s research has shown that multiple CFS symptoms including fatigue, pain and cognitive dysfunction, can be significantly reduced in many patients by correctly identifying chemical groups inducing symptoms and determining tolerance limits. 89.5% of patients involved in the clinical study reported a positive outcome with multiple symptom reduction or alleviation. Some individuals find some symptoms are eliminated altogether. Finally, preliminary research shows the reverse is also true. CFS patients challenged with certain foods show significant increase in specific symptoms. That is, there is a correlation between specific chemicals and specific symptoms. Tania hopes to confirm this in an upcoming double-blind trial.
To test our food intolerances the right elimination diet protocols must be put in place. There are many diets – like the anti-candida and yeast-free diets (not designed to diagnose food chemical intolerances) – that may help symptoms for a while by reducing some of the chemical load, but usually symptoms return sometimes worse as no systematic identification has taken place. We must work with our practitioner to identify which chemicals are symptom-provoking using a specific challenge protocol to confirm our diagnosis, otherwise symptom improvement won’t be maintained, and there is even a danger of increasing intolerances by staying solely on a base elimination diet. We should make sure we are going to see the right people if we want to find helpful results.
Tania is in the process of preparing her results for publication and will send us a summary of these later in the year.
Dr Henry Butt, PhD, followed Ms Tania Emms with a talk on the faecal microbial changes in CFS patients with irritable bowel. He stated that fatigue presentation in CFS patients with symptoms of irritable bowel were more severe than CFS patients without irritable bowel. Furthermore, patients with irritable bowel had poorer appetite, increased abdominal pain increased severity of loose stool / diarrhoea, nausea, and gastric reflux. Face, neck, shoulder, and lower back pain of fatigue patients with symptoms of irritable bowel were significantly more severe than fatigue patients with little or no symptoms of irritable bowel.
Dr Butt has reported the change in the faecal microbial flora of patients with CFS previously. This change in the gastrointestinal microbial flora may help to explain the observation of Dr Jacobs of the United Kingdom that 50% of a population of CFS patients were deficient in folic acid. Folic acid has been shown to be produced by gastrointestinal microorganisms. Dr Butt stated that folic acid is an important precursor for the synthesis of nucleic acids and proteins in all tissues, and demand for it increases during infection. However, activation of folic acid requires the presence of serine, an amino acid which is a building block of proteins. Hence, patients deficient in folic acid and serine may require a combined intake of the substances. Investigative work performed in Newcastle demonstrated a highly significant number of patients with CFS were deficient in serine. Low serine level can affect cell membrane function and integrity, and result in gut dysfunction.
Dr Butt ended with a call for volunteers diagnosed as having CFS who would like to participate in a research project to be conducted by the University of Newcastle in the city of Adelaide. The project is a clinical trial of 17 weeks aiming to determine if supplements of serine can improve the symptoms of CFS. Any patient interested in participating is invited to send their contact details to:
Ms Tania Emms
10 Moore Street,
Birmingham Gardens,
New South Wales 2287
E-mail: bitme@cc.newcastle.edu.au
*******************************
From Talking Point, June 2000
Copyright © ME/CFS Australia (SA) Inc
Web site: http://www.sacfs.asn.au/