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Is It Chronic Fatigue Syndrome?

New Research May Let Doctors Know for Sure

New York (May 15, 2009)

Tired looking woman

NewYork-Presbyterian scientist Dikoma C. Shungu, Ph.D. is collaborating with other researchers in a new study to develop a clearer method to diagnose patients with chronic fatigue syndrome (CFS). Earlier diagnosis can lead to earlier intervention and a more effective course of treatment.

Chronic Fatigue Syndrome: From "Yuppie Flu" to Recognized Diagnosis

Doctors sometimes find it difficult to diagnose CFS because there is no one definitive test, and because CFS shares symptoms with a number of other conditions including diabetes, thyroid disease, depression, anxiety, and substance abuse. The disease was not so long ago dismissed as the "yuppie flu," but it has gradually gained legitimacy and is now accepted as an established diagnosis. The Centers for Disease Control (CDC) developed a set of diagnostic criteria in 1994, and the agency has started tracking cases and reports that as many as 4 million Americans suffer from CFS.

Dr. Shungu's earlier research, published in the October 2008 issue of NMR in Biomedicine, revealed that patients with CFS often have elevated levels of lactate in their cerebrospinal fluid, the fluid that bathes the brain. Lactate is a type of salt that the body produces when there is increased demand for energy to power certain body functions and oxygen levels are low – during intense exercise, for example.

Understanding the Connection Between Chronic Fatigue Syndrome and Lactate

Chronic fatigue syndrome often develops on the heels of flu-like illness from which the patient does not really recover, said Dr. Shungu. "They remain sick and start feeling very, very tired." The illness may set in motion a chain of events, he explained: As the body works to fight off the infection and attempts to neutralize viruses and bacteria, the immune system forms highly reactive molecules called free radicals. These molecules sometimes accumulate in such high numbers that they create a destructive process called oxidative stress, which targets and destroys the mitochondria, the cellular "engine" that processes oxygen and generates energy for cell function. When these can no longer produce cellular energy, an alternate energy-production process kicks in called glycolysis – "and the end product of glycolysis is lactate, also called lactic acid, which is what we're detecting," Dr. Shungu said.

Another theory is that damage to the mitochondria may be due to low levels of oxygen in the brain, Dr. Shungu said. Mitochondria require a minimum amount of oxygen to operate, if oxygen levels dip, the mitochondria cannot product energy efficiently so glycolysis kicks in, and lactic acid is produced. "Preliminary studies have shown that brain blood flow is decreased in CFS compared to the other groups, which might be a cause for the increased lactate," said Dr. Shungu.

Dr. Shungu's New Study for Chronic Fatigue Research

Dr. Shungu's new study, sponsored by the Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America, will attempt to better understand what is happening within the brains and bodies of patients with CFS – what mechanical processes are taking place that lead to elevated lactate levels. In this study – as he did in his earlier work – Dr. Shungu will employ a technology known as magnetic resonance spectroscopy. This imaging test reveals the chemical composition of tissues in the body such as the brain. The researchers will observe markers of oxidative stress, mitochondrial dysfunction and cerebral blood flow.

This study will also have much narrower parameters than the previous one. Dr. Shungu's earlier study showed levels of lactate that varied considerably among the CFS patients in the study. "We actually had a very big spread – more than half of them had significantly increased lactate, but there were also patients who didn't have increased lactate." This is consistent with CFS, he said, which is a "very, very heterogeneous, multisystem condition." This study will compare patients with similar symptoms and should make it easier for researchers to draw conclusions about the mechanisms that link CFS with elevated levels of lactate.

Faculty Contributing to this Article:

Dikoma C. Shungu, Ph.D. is a Professor of Physics in Radiology at Weill Cornell Medical College, one of the affiliate medical colleges of NewYork-Presbyterian Hospital.

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