From PLOSone, 28 April 2017
Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis
Monica L. Joustra(1) , Isidor Minovic(2), Karin A. M. Janssens(1), Stephan J. L. Bakker(2), Judith G. M. Rosmalen(1)
1) Interdisciplinary Center Psychopathology and Emotion regulation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
2) Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Top Institute Food and Nutrition, Wageningen, the Netherlands
Abstract
BACKGROUND
Many chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) patients (35–68%) use nutritional supplements, while it is unclear whether deficiencies in vitamins and minerals contribute to symptoms in these patients. Objectives were (1) to determine vitamin and mineral status in CFS and FMS patients as compared to healthy controls; (2) to investigate the association between vitamin and mineral status and clinical parameters, including symptom severity and quality of life; and (3) to determine the effect of supplementation on clinical parameters.
METHODS
The databases PubMed, EMBASE, Web of Knowledge, and PsycINFO were searched for eligible studies. Articles published from January 1st 1994 for CFS patients and 1990 for FMS patients till March 1st 2017 were included. Articles were included if the status of one or more vitamins or minerals were reported, or an intervention concerning vitamins or minerals was performed. Two reviewers independently extracted data and assessed the risk of bias.
RESULTS
A total of 5 RCTs and 40 observational studies were included in the qualitative synthesis, of which 27 studies were included in the meta-analyses. Circulating concentrations of vitamin E were lower in patients compared to controls (pooled standardized mean difference (SMD): -1.57, 95%CI: -3.09, -0.05; p = .042). However, this difference was not present when restricting the analyses to the subgroup of studies with high quality scores. Poor study quality and a substantial heterogeneity in most studies was found. No vitamins or minerals have been repeatedly or consistently linked to clinical parameters. In addition, RCTs testing supplements containing these vitamins and/or minerals did not result in clinical improvements.
DISCUSSION
Little evidence was found to support the hypothesis that vitamin and mineral deficiencies play a role in the pathophysiology of CFS and FMS, and that the use of supplements is effective in these patients.
REGISTRATION
Study methods were documented in an international prospective register of systematic reviews (PROSPERO) protocol, registration number: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015032528.
From Modern Clinical Medicine Research (full paper as a pdf), Vol. 1, No. 1, April 2017
Access to Medical Care for Individuals with Myalgic Encephalomyelitis and Chronic Fatigue Syndrome: A Call for Centers of Excellence
Madison Sunnquist(1), Laura Nicholson(1), Leonard A. Jason(1*), and Kenneth J. Friedman(2)
1) Center for Community Research, DePaul University, Chicago, Illinois, United States
2) Green Mountain College, Poultney, Vermont, United States
* Correspondent: ljason@depaul.edu
Abstract
The current study sought to better understand the experience of individuals with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) in accessing care for their debilitating illness.
Of 898 participants, less than half had ever seen an ME or CFS specialist, though 99% of participants were interested in specialist care. Participants cited geographic and financial barriers as most
frequently precluding access to specialists.
Furthermore, satisfaction with specialist care greatly exceeded satisfaction with non-specialist
care.
These findings suggested that individuals with ME and CFS represent a medically-underserved population, due to lack of available care.
The CFS Advisory Committee and NIH Pathways to Prevention Working Group recommended the creation of ME and CFS Centers of Excellence to improve the healthcare access of patients with ME and CFS. The current study documents the need for these centers, as they would ameliorate geographic and financial barriers to quality care.
From FASEB Journal, April 2017
The role of IP-10 in Chronic Fatigue Syndrome
Anne McArdle(1), Arief Gusnanto(2), Kate Earl(1), George Sakellariou( 1), Clare Lawton(2), Daniel Owens(3), Graeme Close(3), Michael Beadsworth(1) , Louise Dye(2)
1) University of Liverpool, Liverpool, United Kingdom
2) University of Leeds, Leeds, United Kingdom
3) Liverpool John Moores University, Liverpool, United Kingdom
Abstract
Chronic fatigue syndrome (CFS) is a severely debilitating and complex illness of uncertain cause, characterised by prolonged, fatigue triggered by minimal activity. There is evidence that CFS is associated with chronic inflammation.
Studies have shown that plasma levels of cytokines are chronically modified in patients with CFS. This study examined physiological, subjective and cognitive factors associated with plasma cytokine concentrations in a cohort of 92 patients compared with age and sex matched healthy controls.
A sub-group of patients and healthy controls (HCs) also underwent more detailed analyses of muscle
function, cytokine production and cognitive function.
Patients were diagnosed with CFS if they met the Oxford criteria for Chronic Fatigue Syndrome and recommended NICE guidelines. Patients completed a number of validated questionnaires including the Chalder Fatigue Questionnaire (CFQ) which is considered a valid and reliable measure of fatigue in
patients with CFS.
Patients with CFS demonstrated a characteristic significant reduction in Maximal Voluntary Contraction Force compared with HCs. Data on plasma concentrations of 27 pro- and anti-inflammatory cytokines were analysed using multiple or logistic regression with age and sex which were significant covariates included in each model.
CFS was strongly associated with a limited number of cytokines. Diagnosis of CFS was associated with increased plasma contents of MIP-1a, MIP-1b and RANTES (p<0.05) and marginally with Eotaxin (p=0.07) when modelled individually. MVC and self-reported fatigue both showed particularly strong associations with plasma IP-10 concentrations. Muscle content of IP-10 mRNA was significantly elevated, suggesting that, at least in part, muscle was a source of this IP-10 but not the other cytokines.Pairwise associations between MVC and cytokines demonstrated that the reduced MVC seen in patients with CFS was strongly associated with plasma levels of IP-10, TNF-alpha and IL-5. Further analyses revealed strong correlations between plasma RANTES and eotaxin levels and poorer verbal recall and RTs of patients with CFS.The consistent association of IP-10 with the physiological features and of RANTES and eotaxin with the cognitive features of CFS provides compelling evidence for a role of these cytokine/chemokines in the physiological and cognitive pathology of CFS.This work was funded by the Medical Research Council.
“Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis.
DISCUSSION
Little evidence was found to support the hypothesis that vitamin and mineral deficiencies play a role in the pathophysiology of CFS and FMS, and that the use of supplements is effective in these patients.”
This is discouraging for those like me who have thought that ME/FM may, at least in part, be due to multiple vitamin, co-factor and mineral (VCM) deficiencies of multiple combinations. Without knowing which VCMs were investigated, exactly and in which combinations, it is difficult to know if these studies included in the review have all the ‘bases’ covered. It would be interesting to know if Dr Myhill’s work was included or not?
10 of the 45 studies were of CFS, the other 35 were fibromyalgia
Of those ten:-
1. CDC criteria of CFS. 24 on supplement, 25 placebo, (Randomised, double blind, controlled). 2002
The intervention-a polynutrient supplement containing several vitamins, minerals and (co)enzymes (unspecified in pubmed), or placebo, twice daily for 10 weeks-was preceded by 2 weeks of baseline measurements.
The main outcome measures were CIS fatigue score, number of CDC symptoms and SIP8 score.
No significant differences were found between the placebo and the treated group.
2. CFS. 25 on Vit D v 25 placebo. RCT DB 2014
Changes in Fatigue Score (Piper) – after 6 months = not significant
(no significant change in cardiovascular measurements either)
The other 8 were observational case control studies measuring:-
Vit C Potassium Sodium Vit E Magnesium Zinc
1 *
2 *
3 *
4 *
5 *
6 * *
7 *
8 * * *
In other words, the review (while acknowledging that several vitamins and minerals are known to be deficient in CFS/ME sufferers) discovered from looking at these 10 studies that, trying to replenish just one, or just some, of these vitamins and minerals doesn’t seem to help! This was interpreted as the vitamin deficiencies identified were probably not involved in the illness or its symptoms.
Phew! Just 2 of the 10 CFS studies actually tried to treat. It is difficult to find out what the multivitamin/multimineral and (co)enzyme treatment was in the first, and the second was just looking at Vit D.
The work can continue…. with hope and expectation. The search for the coverall cocktail continues.