Allostatic overload in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

[Firestormm]

Allostatic overload in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

From Medical Hypotheses, 15 July 2013.

Megan Anne Arroll (drarroll@theoptimumhealthclinic.com)

Abstract

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterised by diverse symptoms such as fatigue, pain, sleep disturbance and autonomic dysfunction.

There remains to be a singular biomarker identified for this illness, hence numerous theories about its development and perpetuation have been posited in the literature.

This brief report presents the model of ‘allostasis’ as a framework for understanding ME/CFS, specifically the notion that the physiological mechanisms employed in the body to deal with stress termed here as ‘allostatic states’ (e.g. elevation of inflammatory cytokines), may in and of themselves contribute to the perpetuation of the disorder.

This theoretical assertion has important consequences for the understanding of ME/CFS and treatment; rather than searching for a singular pathogen responsible for this condition, ME/CFS can be conceptualised as a maladaptive stress disorder and interventions aimed at addressing the allostatic states may be incorporated into current symptom management programmes.

Taken from ME Association:
TGI Friday! Our weekly round-up of recently published ME/CFS research abstracts | 19 July 2013

 

[Bob]

In short, this paper hypothesises that we don't have ME but we are chronically stressed.
i.e. we have a stress disorder that is out of control.
But they dress it up in complex language to hide its simple meaning.

(Note: I haven't seen the full paper, so I may have misinterpreted it.)

The author appears to be affiliated to The Optimum Health Clinic. (She is the director of research.)
I don't know much about them, but I've just looked them up, and they don't appear to treat CFS patients medically.
They seem to take an alternative approach, along with some psychological interventions, which they call 'integrative medicine'. Integrative medicine combines alternative approaches with evidence based medicine. (But the only widely accepted evidence for treating CFS/ME is that CBT and GET help some patients.)

Anyway, the following link gives an indication of the sort of alternative approach that they take to dealing with patients (The website is hosted by The Optimum Health Clinic):
http://www.secretstorecovery.com/

So perhaps this paper is motivated by way the health clinic deals with its patients. i.e. it's looking at a hypothesis that would validate its 'integrative medicine' approach to dealing with CFS patients.

Rather worryingly, the promotional material on their website seems to associate their clinic with CFS patients who 'recover', albeit with very careful wording, without explaining that there is little evidence that any treatments for ME/CFS lead to a recovery (in the lay sense of the word):

“Secrets to Recovery: 12 Lessons in Healing M.E./C.F.S./Fibromyalgia” is a book packed full of inspiration for anyone on the path to recovery from this group of debilitiating illnesses.

 

[Firestormm]

Bob she is also involved with this new research that the MEA RRF has just announced.

Edit: See the comments on their Facebook page.

Without reading the full hypothesis I can't really say one way or the other if this Allostatic Overload is of concern to me.

Cytokines are mentioned a lot these days and it is true we all arrive at this diagnosis from different triggers.

Some have indeed turned now to trying to explain the 'whole' and I am not sure if that isn't a good idea.

We had the Vagus Nerve Infection theory only the other week - I have still to read that one in full - and I think increasingly we will see others.

There is a move - understandable in some respects - to suggest that research has not been able to lock onto specific cause and effect for individual triggers; but that maybe there is something we all might have in common, within us, that has resulted in similar symptoms.

What I think some will find perhaps more disagreeable perhaps is the suggested 'treatments' for this assumed commonality - and that may include those that we tend to shun.

Without the full paper I can't say which way this author is leaning in terms of treatment but as you say it seems fairly obvious.

 

[Bob]

Firestormm, yes, I may have been premature to judge the paper, without reading it in full.
It's just that the abstract says quite a lot, in itself, and the science seems very wishy-washy, and quite meaningless, to me.

And when they say: "...ME/CFS can be conceptualised as a maladaptive stress disorder", then my brain freezes over, as it's utterly devoid of any scientific meaning.

An "elevation of inflammatory cytokines" and the term 'stress' could mean very many things, and are meaningless, unless one knows the source of the 'stress' and the cause for the "elevation of inflammatory cytokines". i.e. is it viral, genetic, environmental etc. (Or are they suggesting that it is purely psychological stress?)

But this paper seems to be suggesting that 'stress', of itself, is the cause ('perpetuates') ME.

Yes, perhaps turning down the levels of these inflammatory signals might perhaps lead to an improvement in symptoms, so perhaps that could be useful research. But, to date, there hasn't been any successful research that indicates that any approaches to lowering 'stress' have had any success in CFS patients, that I'm aware of.

Personally, I consider "elevated inflammatory cytokines" to be a symptom, and not a cause.
It's just too easy, and simplistic, to say that 'stress' or 'elevated inflammatory cytokines' cause the illness.
It seems to suggest that some maladaptive stress-loop is at play. (i.e. an initial trigger causes a stress response, and this stress response feeds a further stress response, causing a perpetual stress-response loop.)
It's a hypothesis that's been done to death, and has never provided any results, beyond the poor results of the PACE trial, which used a similar flawed hypothesis (i.e. a trigger event leading to deconditioning leading to a maladaptive response to pain signals leading to further deconditioning.)

Will treating the symptom (an elevation of inflammatory cytokines) really lead to a cure? I don't buy into the hypothesis that ME is caused by any sort of stress 'loop'. But if they can find medicines to alter the immune response, such that our symptoms are improved, then I would certainly welcome that. If that's the motivation of this paper (which I doubt) then that would be great.

 

[Bob]

Bob she is also involved with this new research that the MEA RRF has just announced.

Thanks Firestormm. I hadn't seen that. It looks like helpful research. Dr Megan Arroll's role seems to be testing the cognitive function of the participants.

 

[Esther12]

From what I've read about them and from those that have used them, I think of the optimum health clinic as a quack-fest that fleeces people of cash.

Their theoretical assertion should have no impact upon how patients are treated until there is clear evidence which shows that their claims are true. At e moment it's just uninteresting speculation from someone out to justify how they make their money.

A bit worrying that mea is giving funding to people like this IMO - don't encourage them! It might be difficult, but it would probably be preferable to fund new researchers with no experience in CFS (or anything)!

 

[Bob]

A bit worrying that mea is giving funding to people like this IMO - don't encourage them! It might be difficult, but it would probably be preferable to fund new researchers with no experience in CFS (or anything)!

I don't think that the MEA is providing any funding to The Optimum Health Clinic.
The research that they have funded does not seem to be led by The Optimal Health Clinic, and includes a range of researchers, including Dr Amolak Bansal (I think he's quite a well known CFS researcher.)
Dr Megan Arroll, who is affiliated to The Optimum Health Clinic, is just one of the researchers in the MEA funded research, and she appears to simply be carrying out cognitive tests.

 

[MeSci]

I don't think that the MEA is providing any funding to The Optimum Health Clinic.
The research that they have funded does not seem to be led by The Optimal Health Clinic, and includes a range of researchers, including Dr Amolak Bansal (I think he's quite a well known CFS researcher.)
Dr Megan Arroll, who is affiliated to The Optimum Health Clinic, is just one of the researchers in the MEA funded research, and she appears to simply be carrying out cognitive tests.

Hmmm... did a search for Amolak Bansal and got this:

http://www.epsom-sthelier.nhs.uk/ou...athology/immunology/chronic-fatigue-syndrome/

where it says among other things:

"We use a combined bio-psycho-social and cognitive behavioural therapy model in teaching patients to manage their symptoms."

The FAQ section includes this:

"There is no evidence that following any particular diet will improve your CFS although many patients appear to be intolerant to alcohol and other stimulants such as caffeine based products. Food allergy is never involved in CFS. The blood investigations that form part of the referral process will help exclude coeliac disease caused by gluten sensitivity. The CFS service recommend that you follow the Government healthy eating guidelines"

I disagree profoundly with this.

Then there is this page which features Dr Amolak Bansal:

http://www.mesolutions.org.uk/who-we-are/

which states that he is an immunologist with an interest in autoimmunity among other things. He seems to have some odd associations in view of his specialisms, and I haven't yet found anything in which he links ME/CFS with autoimmunity. The same appears to apply to Professor Tony Pinching, who is also a retired immunologist but has been associated with what appear to be fairly standard ME/CFS services with no reference to autoimmunity.

Has pressure been exerted on such specialists not to use their specialisms in the field of ME/CFS?

More promising is this 2011 paper:

http://www.ncbi.nlm.nih.gov/pubmed/21756995

 

[Esther12]

I'm not keen on the Bansal stuff I've read so far. I'm pretty sceptical of anyone who has been taking money for treating CFS though.

 

[Bob]

Then there is this page which features Dr Amolak Bansal:
http://www.mesolutions.org.uk/who-we-are/

Thanks for all the info, MeSci. I know very little about Dr Bansal.
That webpage, which you provided a link to, also features Dr Megan Arroll.