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Investigating Fatigue and Exercise Intolerance in a University Immunology Clinic


Senior Member
York, England
Summary: The majority of patients (95%) referred with idiopathic fatigue and exercise intolerance after extensive evaluations were found to have underlying metabolic dysfunction. Frequently associated problems included gastrointestinal dysmotility disorders, recurrent infections, Raynaud’s, migraine headaches and various autoimmune diseases. Most patients showed symptomatic improvement with treatment of their metabolic dysfunction.

Investigating Fatigue and Exercise Intolerance in a University Immunology Clinic | Iris Publishers

Does anyone know the treatment of their metabolic dysfunction ?


Senior Member
United States, New Hampshire
The treatment they used sounds very familiar......

The treatment of mitochondrial dysfunction or mitochondrial respiratory chain disorders involved a combination of medications shown to enhance respiratory chain function and ATP production.

CoQ10, which transports electrons between the complex I and complex III of the respiratory chain, folic acid, which is a cofactor for several respiratory chain enzymes, carnitine, which helps import fatty acids into the mitochondria, alpha lipoic acid, which is a strong anti-oxidant and creatine, which generates ATP through the creatine phosphate shuttle [26,36-42].

Patients with low carnitine palmitoyl transferase activity were also put on diets minimizing long chain fatty acids [43,44].

Patients with glycogen storage diseases were placed on diets restricting complex carbohydrates with larger amounts of simple sugars [45,46].

In patients with low activity of lactate dehydrogenase, patients were also given the medications to treat mitochondrial dysfunction, because of the influence of lactic acid on mitochondrial functions [47,48].

Patients with myoadenylate deaminase deficiency were treated with ribose [49]. In addition, they were given the medication for mitochondrial dysfunction because loss of ammonia could lead to depletion of fumarate which is necessary for the normal functioning of the citric acid cycle [32,50], although this affect has been questioned in one study [51].

Doses of these medications were adjusted as needed for individual patients. At the same time, it was necessary to optimize management of other clinical issues that contributed to the patients’ symptoms, such as sleep apnea, food hypersensitivities and Raynaud’s.
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