Note: following changes at Bioscreen, some of the information on this page may be out of date. Check out the revised Bioscreen website for the latest information.
A Lecture given by Dr Gary Deed to the
ME/CFS Society of Queensland, 24 October
1998
[ Introduction ]
[ The Urine Test ] [ The Faecal Test ]
[ The Blood Test ] [ The Staphylococcal Test ]
[ The Organopesticide Test ] [ More information
]
Dr Deed began by stressing the importance of the Newcastle research team's Bioscreen testing program. Chronic Fatigue Syndrome is a collection of many different symptoms and effects, and some tests are therefore needed to "map out" the treatment plan. If the physician merely tries to manage the symptoms, he or she is "flying blind". There is also a risk of the symptoms being attributed to a psychiatric illness. Thus any available useful way of defining the presenting patient’s condition will not only help protect them against inadvertent psychiatric diagnosis, but also - importantly - help the treating doctor instigate some effective management. Dr Deed said he felt that any persistent fatigue state should be tested, even those under 6 months, and especially in cases where glandular fever appeared to be involved.
He said that there appeared to be many risk factors involved with CFS. The presence of these conditions may lead to a greater risk of fatigue when the person is challenged. Common ones included: hyperlax joints, narcolepsy gene, lactose intolerance, sinusitis, bowel problems (such as bloating), Gilbert's syndrome, and liver problems.
Where patients presented with postural low blood pressure - Neurally Mediated Hypotension (NMH) - it would be appropriate to check for heart problems using tests such as an ECG or even Holter Monitoring as per Dr Lerner's papers. Further, a nasal swab for Coagulase Negative Staphylococci (CNS) should be performed. The Newcastle researchers had found that this bug seemed to be much more active in CFS patients in producing a potent "delta" toxin. The production of this toxin was particularly associated with dermatitis, headaches and joint pains and palpitations. Of course, recent information on the relevance of Mycoplasma and rickettsial infections means most patients should also consider being assessed correctly for these unusual organisms.
Dr Deed warned that CNS may be present even if the nasal swab were negative - in one nasal swab negative patient, he subsequently performed a groin swab which was positive. While he didn't believe that CNS caused every case of CFS, it certainly wouldn't be helping. He used antibiotics to kill the CNS, but noted that there may be an initial worsening of symptoms. The CNS seemed to "fight back" with a greater production of the toxin.
[ Contents ]
Explaining the significance of the metabolites on the analysis sheet, Dr Deed said first that ethanolamine gives an indication of phospholipid turnover. Phospholipids are important substances in cell membranes etc. Serine, if deficient, has been associated with neuro-cognitive changes and may be produced in large quantities by gut bacteria. Increased B-alanine is associated with more muscle pains and GIT symptoms, usually from a viral and/or bacterial source. Lysine, proline and hydroxyproline are products of breakdown of the supporting structures of our body, the connective tissues.
The metabolite CFSUM1 is associated with possible infection in the body, even at times the 'delta' toxin produced by the Coagulase Negative Staphylococcus. It correlates with severity of symptoms. Urinary metabolites UM13, UM13A and UM14 indicate if there is a problem with hidden infection. High UM15 correlates with depression.
If phenylalanine is low, the patient has a problem with pain. If ornithine or hippuric acid are high, this may indicate the patient is having difficulties processing protein, and it is not a good idea to attempt amino acid supplementation without alpha-ketoglutarate to help the patient’s body cope with the added load of amino acids. Otherwise the amino acids may make the patient depressed. (This may not occur in all patients, but should be considered.) High glutamic acid is associated with foggy thinking. Where lysine is high, Dr Deed said he would test the patient's reaction to dairy products or lactose intolerance, and look for the presence of kidney stones. If it was extremely high he would consider the possibility of Neurally Mediated Hypotension as a co-factor in that person's illness.
Where tyrosine, 1-methyl-histidine and 3-methyl-histidine are high, this reflects muscle fatigue. These substances should only be high after exercise, not first thing in the morning when the urine for the test is collected. Tyrosine indicates that the muscles are burning energy at a higher than normal rate, such as occurs after exercise or infection. High methyl-histidines indicates that muscle breakdown is occurring. Aconitic acid is an indicator of whether energy usage is normal. Citric acid is involved in the basic energy pathway for cellular energy. If high, the pathway is not producing much energy and, if combined with high aconitic acid and succinic acid, gross disturbances of energy metabolism are present. Metabolites UM27 and UM28 are elevated if a persistent infection is involved. The tyrosine/leucine ratio gives a close index of pain. The higher the ratio (greater than 4) the more pain is usually present.
So, overall, the results of the urine test may indicate the presence of muscular energy deficits, or even muscle breakdown. They may also indicate problems with assimilation of protein from the gut and possible imbalances of gut bacteria. They can suggest that a chronic infection - especially of the CNS delta toxin-producing staph - is present and needs to be assessed. Also, rarely, metabolic problems of amino acid or protein metabolism can be established. The test results may also show possible reasons for liver detoxification problems (low glycine); direct management to restoration of gut/liver and protein metabolism; or indicate that care is needed with some supplements or certain foods.
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If there were a gut problem, Dr Deed would order the faecal test. The gut contains about 60% of the immune system cells, these being dynamically controlled by substances produced by gut bacteria. About 1.2kg to 2 kgs of bacteria of many species inhabit the intestines. If there were a disturbance in this system, there may be immune problems as well as digestion problems. In treating any gut problem, there may be initial adverse side effects. One organism that appears to be important is Bacteroides. This is able to remove other commensals by producing bactericidal substances that also inhibit gut liver function. The other organism of relevance is E Coli. It helps produce large quantities of good substances for the body such as serine and glycine. If this is low it needs to nurtured with gut bacterial supports such as Acidophilus/bifidus and Fructo-oligosaccharides (FOS) etc. Candida can also be assessed by this test.
Notably the test can give an overall assessment, not only of individual bacteria, but of the dynamic balance between oxygen-loving species and other more putrefactive organisms. Balance is everything - for instance, normally, bacteria should break down a portion of cholesterol to coprostanol, so a failure to do this may lead to conclusions that the bacteria are poorly balanced.
Methods of restoring the balance of the gut flora can be indicated by analysing the results of this test. Possible strategies include feeding and replacing good bacteria, plus elimination of any "pests".
[ Contents ]
The blood test looks at the blood lipid profile. Amongst other lipid data, the test looks at the levels of the unsaturated fatty acids omega 9, omega 7, omega 6 and omega 3. Dr Deed said that Omega 9, omega 6, and omega 3 fatty acids govern inflammation and pain. Omega 9, which is found in meat, dairy foods and certain processed foods, sharpens the pain/inflammation response, while omega 6 and 3, promote healing. Omega 6 can be found in evening primrose oil, and omega 3 in fish and linseed oil.
The results of the blood test can indicate deficiencies or excesses of the certain types and direct appropriate supplementation. For instance if there are low Omega 3 fatty acids, then - depending on whether linoleic acid levels were low or elevated - fish or flax seed oil could be used. (Both contain linoleic acid, but Cod Liver Oil has significantly more on a weight for weight basis.)
If are were increased saturated fatty acids, possible viral illnesses needed to be excluded, and chronic pain, neurologic or muscle disorders may be present.
The Newcastle team had been able to break CFS blood types into 5 groups. Dr Deed mentioned only 2 groups. "Type 3" or accumulated long chain fatty acids was associated with pain and viral illnesses, and was the commonest - Dr Deed found that these patients responded to treatment with zinc; vitamins A, C and E; and flax oil. "Type 5" patients have a lowered cholesterol level. Despite reports, cholesterol is important for health and these patients responded to Co-enzyme Q10 &/ or DHEA. "Type 5" patients may also have problems with bile secretion and gut disturbances when eating fats.
[ Contents ]
This reveals the presence of a toxin producing subtype of Staphylococcus. This organism is being studied at the Bioscreen facility and has been associated with pain and muscle breakdown. The toxins can be alpha, beta or delta. These toxins have also been associated with Toxic Shock Syndrome in females using tampons. The toxins injure cells by 'drilling' membrane holes and causing slow leakage of cell contents and fluids. These fluids may be minerals essential for cell life or even enzymes that power the cell up. Think of a slowly leaking balloon, and some of the symptoms of CFS may seem obvious if the cell affected is a brain or muscle cell.
[ Contents ]
This test is an accurate way of assessing accumulations of pesticides from direct exposure from soil and water accumulations.
The results may indicate inadequate detoxification systems such as in the liver, plus may give an indication of how these pesticides may be allowing immune destruction to continue. For instance, high levels of DDE ( a breakdown product of DDT) and HCB have been shown to negatively affect immune cell activity.
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Reported by Peter Evans; with corrections and additions by Dr Gary Deed; ed. M Smith May 1999. This article appears by kind permission of Peter Evans and Dr Gary Deed. It is also posted on the website of the ME/CFS Society of Queensland
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