In 2015, the Institute of Medicine provided this definition of the condition:

1. a substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest;
2. postexertional malaise (often described by patients as a “crash” or “collapse” after even minor physical or mental exertion);
3. unrefreshing sleep; and
4. cognitive impairment and/or orthostatic intolerance.

There have been recent developments in this field that take some steps forward. In late 2016, the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFSME) research conference emphasized the role of postexertional malaise (an energy “crash”) following physical exertion or emotional distress, rather than just general fatigue, as the most important aspect of ME/CFS. This has been verified through experiments that test physiologic function in ME/CFS patients following exercise.

Conference speakers also reported on some possible laboratory tests that could identify the abnormalities associated with ME/CFS. Kenny L. DeMeirleir, MD, PhD found that the four blood tests that were most helpful were prostaglandin E2, interleukin 8, soluble CD14, and CD57+ lymphocytes — all of which are associated with an inflammatory immune response. This combination of tests is already being used as a panel to diagnose ME/CFS in Belgium, where Dr. DeMeirleir is originally from. Jose Montoya, MD, professor of medicine at Stanford University, found abnormalities in levels of 17 specific cytokines (chemical messengers used by immune cells) that correlate with the condition. U.S. researchers caution that larger studies are needed before either panel is adopted in this country for diagnosis of ME/CFS.

Researchers at the University of California San Diego School of Medicine published an extensive study in 2016 about what is actually going on inside the body’s cells in ME/CFS. Without getting too deep into the technical information, they found several problems with the cell’s ability to produce energy from the nutrients that we get from food. Other scientists presented information at the IACFSME conference that suggested that a slightly altered gene (called a single nucleotide polymorphism, or SNP [pronounced “snip”]) may be responsible for the body’s inability to process energy correctly.

What is emerging, then, is a picture of a genetic predisposition toward less efficient energy production, that may be aggravated by some outside factor, such as infection or environmental toxins. Those outside influences then set up a chronic inflammatory state that affects the brain in particular. Physical exertion or emotional distress can aggravate the inflammatory messengers in the body, leading to “crashes” (postexertional malaise). I speculate that this could be the explanation of why some people are “wiped out” for years by something that should be temporary, such as a Lyme disease infection, or an adverse reaction to medication like Cipro. This is also why trying to fight the inciting factor is so often ineffective (like years of antibiotics for Lyme, or elaborate detox protocols for medication reactions). Careful evaluation of a patient’s metabolic state, and appropriate lifestyle and nutritional support (in particular, for mitochondrial energy production) is probably the more effective strategy.

References:

1. IOM Gives Chronic Fatigue Syndrome a New Name and Definition. Medscape. Feb 10, 2015.
2. Postexertion ‘Crash,’ not Fatigue per se, Marks Syndrome. Medscape. Nov 04, 2016.
3. Biomarker Research Advances in ‘Chronic Fatigue Syndrome’. Medscape. Nov 08, 2016.

Why “cold”? Before the dawn of our understanding of infectious organisms, people thought that cold weather caused these symptoms. It wasn’t until the 1950s that scientists first identified the viruses that actually cause cold. Since then, over 200 different types of virus that can cause it have been identified – that’s why the cold is so common!

Even with our understanding of its infectious origins, it’s still clear that the cold is much more common during cold winter weather. The most frequent explanation for this has been that people spend more time indoors in close quarters in the winter. However, in our modern world, people spend much more time indoors year-round, yet the winter prevalence remains.

There are several factors that can explain this phenomenon:

• Cold air and indoor dry air (think furnaces) carry droplets of coughs and sneezes much farther and more easily.
• The shell of the influenza virus gets tougher in cold weather, making it hardier and easier to spread.
• The hairs and mucus in our nose have a harder time stopping germs when it’s cold.
• The rhinovirus (the most common type of cold virus) reproduces more easily in cold weather.

One thing most people don’t think about is that most of the symptoms of the cold are actually caused by our immune system fighting off the virus, not the virus itself. And our bodies have an amazing adaptation to those viral factors listed above: our genes that control inflammation are actually expressed at much higher rates in the winter than in the summer. This is great to combat those more aggressive viruses, but it also explains the symptoms we experience. This is another step in the field of epigenetics: our modern understanding that while our DNA does not change, the way that DNA is expressed does.

Know that it’s not your imagination or superstition that we get colds more frequently in the winter. And it’s worth reiterating the natural steps we can take to prevent and treat URIs that I wrote about last month:

• Frequent hand-washing: remember, it does not need to be antibacterial soap (the common cold is caused by viruses, not bacteria). Just scrub your hands thoroughly for at least 20 seconds.
• Ensure good vitamin D status: Studies have found that individuals with low levels of vitamin D are more susceptible to flu. A supplement of vitamin D3 (the active form), 2000-5000 IU daily, is a cheap and safe insurance policy through the winter months.
• Don’t skimp on sleep: This is often the “forgotten” foundation of health from a naturopathic viewpoint, because it’s not sexy. But turning off the electronic screens and getting your 7-9 hours of sleep per night is one of the main things you can do to boost your immune system.
• Get extra herbal support when needed: If you’re around a lot of people with upper respiratory illnesses, try beta-glucan rich immune boosters like WholeMune by Ortho Molecular Products. If you get a cold or the flu, load up on andrographis, elderberry, echinacea, vitamin C, and zinc. The keys are to start early (at the first sign of a sniffle or a tickle in your throat), and to dose frequently (every two hours while awake for the first two days). The combo I most often recommend for this is Viracid by Ortho Molecular.

Reference: Why you’re more likely to get sick in the winter — and how to stay healthy. http://news.yahoo.com/why-youre-more-likely-sick-174310738.html