Chronic Fatigue Key To Successful Treatment

1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.