Positive Health Online

ME is still a diagnostic enigma. Our own researches have demonstrated that about half of all GPs lack the confidence either to diagnose or treat the condition.[1] Consequently, it is a great pleasure to see a text by such a distinguished expert in investigative medicine, which makes accessible to a much wider section of the population than the scientific and medical communities some important lessons about positive ways forward in managing its illness and mitigating its impact.

Professor Puri's book[2] provides a very succinct and informative background to ME for members of the lay public who may come to the topic afresh, without any previous knowledge. He makes the important point that, although ME and Chronic Fatigue Syndrome are recent terms, the illness itself is nothing new. It has much in common with the nineteenth century diagnosis of 'neurasthenia', from which Elizabeth Barrett Browning, Marcel Proust and Florence Nightingale are all said to have suffered. Indeed, nineteenth century literature is full of such examples; see, for example, The Yellow Wallpaper by Charlotte Perkins Gilman.[3]

The history of the illness in the twentieth century is one of increasing recognition, largely as a result of well-publicized epidemic outbreaks such as 'Royal Free disease' in the 1950s,[4] although such epidemics account for only a small proportion of all cases. At the same time, there was polarization in the medical profession between those who believed the condition to be largely psychological in origin, and those who considered it to be a manifestation of underlying physical disease.

Genuine scientists like Professor Puri appreciate that this cannot and should not be a matter of belief, but rather of objectively ascertainable scientific fact. However, there are problems in undertaking scientific work in this area, some of which he goes on to elucidate. High on the list of problems is that of defining the illness. This is important because, if we are to study it, we need to be able to identify, in a consistent and rigorous fashion, those who have the disease from those who do not. Professor Puri discusses the current 'state-of-the-art' clinical research definition, that of Fukuda and colleagues.[5] The difficulty is that such definitions are designed primarily to enable relatively homogeneous groups of people with well-characterized clinical features to be identified as potential participants in clinical trials. People with other additional diseases tend to be excluded, and people who meet the criteria are only a relatively small proportion of people with what is in fact a very heterogeneous disease.

Professor Puri has no doubt as to the physical origins of ME. He cites formidable clinical and scientific evidence in support of this contention, pointing to strong histories of exposure to trigger factors, particularly viruses, to immune dysfunction in ME, and to evidence from magnetic resonance imaging (MRI) of fatty acid changes in the brains of people with ME. The latter may be particularly important in people with ME, as two classes of fatty acids, omega-3 and omega-6, are important in the maintenance of cell membranes, and prone to derangement as a result of infection by viruses known to be triggers for ME. He cites two trials of dietary supplementation of omega-3 and omega-6 fatty acids in ME, with impressive results.[6],[7]

As a result of these, and his own clinical experience, he has devised an intervention regime which he has used with success in his own patients. The formulation used, called Veg EPA, comprises cold pressed virgin evening primrose oil, as a source of gamma-linoleic acid (GLA), an omega-6 fatty acid and precursor of arachidonic acid (AA), to rectify omega-6 depletion caused by viral infection, and eicosapentaenoic acid (EPA), an omega-3 fatty acid with viricidal properties. His formulation includes none of the omega-3 fatty acid docosahexaenoic acid (DHA), as this may be associated with damage to DNA molecules. It is important to have a diet rich in vitamins and minerals, as many of these are co-factors necessary for the effective functioning of GLA and EPA, which also have widespread beneficial effects, for example on mood, concentration, cardiovascular functioning and arthritis.

Those who wish to try Professor Puri's approach will find a wealth of detail in this interesting book. I look forward to seeing the results of randomised controlled trials of this dietary approach to the management of ME, as this is the only was to convince a sceptical medical profession of the merits of this, or indeed any approach. There is a sound theoretical basis for anticipating that this approach may produce positive results, though, since it is likely that ME is an outcome of a range of different pathological processes, it is unlikely that all patients will benefit equally from it.

References

1. Bowen J, Pheby D, Charlett A, McNulty C. Chronic Fatigue Syndrome: a survey of GPs' attitudes and knowledge. Family Practice. 22. In Press. 2005.2. Puri BK. Chronic Fatigue Syndrome – a natural way to treat ME. London, Hammersmith Press. 2005.3. The Yellow Wall-Paper and other stories. London, Oxford University Press, 1998 (first published 1890).4. McEvedy CP, Beard AW. Royal Free epidemic of 1955: a reconsideration. BMJ. 1: 7-11. 1970.5. Fukuda K, Strauss SE, Hickie I, Sharpe MC, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann. Intern Med. 121: 953-959. 1994.6. Behan PO, Behan WMH, Horrobin D. Effect of high doses of essential fatty acids on the postviral fatigue syndrome. Acta Neurologica Scandinavica. 82: 209-216. 1990.7. Warren G, McKendrick M, Peet M. The role of essential fatty acids in chronic fatigue syndrome. Acta Neurologica Scandinavica. 99: 112-116. 1999.

Further Information

Hammersmith Press is offering Positive Health readers this title at the special price of £12. Please contact Hammersmith Press Tel: 020-7736 9132; www.hammersmithpress.co.uk York Publishing Services Tel: 01904 431213; www.yps-publishing.co.uk and quote PH.Veg EPA may be obtained from Igennus Ltd Tel: 0845 1300 424; www.vegepa.com