ME - Management & Treatment
Antioxidants
While there are no “FDA approved” treatments for myalgic encephalomyelitis, there are many things I have found to treat my symptoms. I think it is inaccurate to say that there are “no treatments” for ME. The experts have been offering a variety of management and treatment suggestions for decades. There is no cure for ME, but that can be said of many chronic illnesses.
Long before the ME International Consensus Primer (ICP) was published in 2012, I had followed information provided within the community and built a regimen that has helped me maintain a fairly reliable baseline (except when I do activity outside my energy production envelope or get exposed to a virus).
Some of my regimen is explained in the Personalized Management & Treatment section of the ICP starting on page 13. Antioxidants is one of the important parts of my regimen.
The ME IC Primer states the following about ME and oxidative stress:
“elevated oxidative stress markers”
(pg 3 - Pathophysiology section)“elevated lactate is consistent with reduced cortical blood flow, mitochondrial dysfunction & oxidative stress”
(pg 5 - Neurological Structural & Functional Abnormalities section)“increased oxidative stress”
(pg 6 - Energy Production & Ion Transport Impairments section)
In the management and treatment section of the ICP their suggestions for antioxidants include:
vitamin C
L-glutathione
Omega 3 essential fatty acids
The importance of using antioxidants to manage symptoms is mentioned several times.
Antioxidants are valuable tools for many diseases
NAC
This recent study offered findings that caught my eye since it discusses symptoms seen in ME. NAC is one of the antioxidants I have found helpful.
“Oxidative stress is associated with cardiovascular and neurodegenerative diseases.... Our observations indicate that neurovascular oxidative stress is sufficient to cause sensory ataxia and cardiac hypertrophy.”
This research goes on to state:
“mice were treated first with an anti-oxidant “cocktail” consisting of N-acetyl cysteine (10 mM) and sodium selenite (10 μM)... the ataxia phenotype induced by D-alanine was attenuated.”
Ataxia is poor muscle control that causes clumsy voluntary movements and is a symptom listed in the ME ICC.
ALA
I have also found alpha lipoic acid (ALA) to be very helpful. The following is research that offers support for using ALA to manage symptoms caused by oxidative stress.
Alpha-Lipoic Acid Supplementation Protects Enzymes from Damage by Nitrosative and Oxidative Stress
“Inhibiting protein S-nitrosylation with α-lipoic acid seems to be a protective mechanism against nitrosative stress.”
I also take Vit C and Omega 3.
Reminder, this information is not to be considered medical advice. Because ME causes so many biological changes, what is helpful for some may be harmful to others. I think the following from page 13 of the IC Primer is important:
“Most patients are extremely sensitive to medication.
Start low – Go slow!
Dosage levels are not given because it is recommended that dosage be reduced, at least initially. Start at ¼ - ½ of the recommended dose.”
Some Antioxidant Information Resources
This video with Dr. Amy Proal interviewing Dr. Liisa Selin about T cell exhaustion and viral activity in ME/CFS includes discussion about oxidative stress and the importance of antioxidants.
This video from the 14th Invest in ME Research International ME Conference with Dr. Nancy Klimas talks about the importance of NAC. (around 17:25 minutes) the transcript states:
“but you can also make reasonable guesses at decent antioxidants for example nac-nac an acetal cysteine [N-acetyl cysteine] is precursor for glutathione and it crosses the blood-brain barrier very few antioxidants cross the blood-brain barrier”
This 2003 paper, Relationship Between Musculoskeletal Symptoms and Blood Markers of Oxidative Stress in Patients with CFS, states:
Increased oxidative stress and decreased antioxidant defenses are related to the extent of symptomatology in CFS, suggesting that antioxidant supplementation might relieve muscle symptoms in the syndrome.
I hope we can take advantage of the information we already have, while we wait for researchers to find more answers.
Colleen
Information provided here or in comments is not to be considered medical advice.
Resource links
The IC Primer lists the following studies to support the information about oxidative stress.
Maes M, Kubera M, Uytterhoeven M, Vrydags N, Bosmans E. Increased plasma peroxides as a marker of oxidative stress in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Med Sci Monit 2011; 17: SC11-5. [PMID: 21455120]
Jammes Y, Steinberg JG, Mambrini O, Brégeon F, Delliaux S. Chronic fatigue syndrome: assessment of increased oxidative stress and altered muscle excitability in response to incremental exercise. J Intern Med 2005; 257: 299-310. [PMID: 15715687]
Broderick G, Craddock RC, Whistler T, Taylor R, Klimas N, Unger ER. Identifying illness parameters in fatiguing syndromes using classical projection methods. Pharmacogenomics. 2006; 7: 407-19. [PMID: 16610951]
Mathew SJ, Mao X, Keegan KA, Levine SM, Smith EL, et al. Ventricular cerebrospinal fluid lactate is increased in chronic fatigue syndrome compared with generalized anxiety disorder: an in vivo 3.0 T (1)H MRS imaging study. NMR Biomed 2009; 22: 251-8. [PMID: 18942064]
Miwa K, Fujita M. Fluctuation of serum vitamin E (α-tocopherol) concentrations during exacerbation and remission phases in patients with chronic fatigue syndrome. Heart Vessels. 2010; 25: 319-23. [PMID: 20676841]
Richards RS, Wang L, Jelinck H. Erythrocyte oxidative damage in chronic fatigue syndrome. Arch Med Res 2007; 38: 94-8. [PMID: 17174731]
Spence VA, Kennedy G, Belch JJ, Hill A, Khan F. Low-grade inflammation and arterial wave reflection in patients with chronic fatigue syndrome. Clin Sci (Lond). 2008; 114: 561-6. [PMID: 18031285]
NOTE: While various labels are used in these research studies (CFS, ME/CFS), the information is expected to apply to people with ME.