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Letter from the Publisher:

Chronic Fatigue, Mycotoxins, Abnormal Clotting

and Other Notes

    Over the past decade there has been a steady increase in alternative medicine meetings. Some are organization-based, some are presentations of individual practitioners, and some have been sponsored by groups focused on a certain protocol or sponsored by a manufacturing company. Our Townsend Calendar is burgeoning with meeting announcements, yet can certainly not be considered all-encompassing. Although the majority of these meetings do not carry continuing medical education credits, the material offered greatly exceeds the breadth and scope of our writings in the Townsend Letter and all the other publications in the alternative medical arena. Clearly, we need to have representative individuals report the pertinent findings or summarize practitioner techniques from a broader number of the meetings held.

    One recent meeting held this June in Mallorca, Spain, organized by American Biologics Company as well as American Biologics-Mexico Hospital, organized by Brigitte G. Byrd, offered a relaxed atmosphere to review a number of orthomolecular and anti-aging theories. Dr. Paul R. Cheney, MD, PhD's work has been discussed in these pages and elsewhere, but it is always more provocative to hear the lecturer in person review his/her findings. As director of the Cheney Clinic in Charlotte, North Carolina, Dr. Cheney has been preeminent in researching chronic fatigue syndrome. Notes from his lecture offer some interesting "pearls" about CFS which we may overlook. We may look at this problem as "Energy/Brain/Pain" as a triad of brain fag, depleted energy and pain are required before CFS can be diagnosed. Based on good epidemiology, CFS affects 1% of the population. The number of disability claims based on CFS has climbed 500% from 1989-1993. If year of onset is graphed from 1983 to present, the highest number of cases are seen to have started in 1987. It is unclear what etiologic factor might be responsible for onset in 1987, although this is essentially 4 years after a similar dating can be made for AIDS. A review of the physical stigmata for CFS is interesting indeed. There is lymphatic pain, lymphodynia (pain of the lymph system) particularly supraclavicular pain and posterior cervical pain, but no lymphadenopathy, no lymph node enlargement. Peculiarly, there is predominance of left-sided lymphatic pain, which Cheney speculates is due to the lymphatic duct emptying in the left jugular vein. Swelling is usually noted over the left supraclavicular area. In 80% of patients, a crimson crescent is noted over the uvula and tonsils; this is different from the swelling and erythema of strep throat. Patients are so hyperreflexic that practitioners need to take caution not to place themselves in the path of the reflexing lower extremity on testing. There is abnormality on simple standing with eyes closed; it is not unusual for a patient to topple over. Very unusual is the loss of fingerprints on many of the fingers; police departments report it's very rare for fingerprints to be obliterated, yet nearly 40% of CFS patients have some fingerprint obliteration, and 10% cannot be fingerprinted whatsoever. This appears to be related to a periarteritis secondary to fibroblasts congregating in the distal circulation. Cheney suspects that CFS patients, mimicking in many ways a scurvy process, might have scurvy contributing to fingerprint obliteration.

    Chronic fatigue syndrome reveals remarkable abnormalities in the laboratory arena as well, but not in usual chemistry and CBC profiles. Researchers investigating cleavage by-products of antibody digestion, a relatively new area of study in immunology, are fascinated by the rapidity of immune product digestion in the CFS patient. What most people would digest immunologically in 20 minutes, the CFS patient will cleave in 20 seconds. If some of these immune proteins are important in regulating energy mechanisms, this would mean that the CFS patient is depleting important enzyme mechanisms 60 times faster than normal. Such mechanism activation and depletion is seen not only in studies of cleavage by-products, but also in relatively new studies of mitochondrial regulation and synthesis of ATP, demonstrating a severe abnormality in CFS patients.

    In the brain arena, abnormalities are now being noted in the CFS patient cerebellum which are not seen in AIDS, Alzheimer's, or Parkinson's. Studies comparing relative index of blood flow in the cerebrum compared to the cerebellum demonstrates an 81% reduction in cerebellar blood flow of CFS patients, not seen in any of the aforementioned brain disorders. It is to be noted for the skeptics who consider CFS to be a form of depression, that a true case of clinical depression has no abnormality in cerebral to cerebellum blood flow. Abnormal proteins are also being demonstrated in the CFS patient's spinal fluid, not seen in the normal or other brain disorders. CFS patients show abnormality in their ACTH/adrenal biochemistry. Cheney's clinic has studied the CFS patient using bicycle ergometry, which clearly and definitively demonstrates the weakness is related to abnormality in their aerobic metabolism of energy. A normal individual and athlete will show typical vital capacities of Oxygen, vO2 of 100%. The same study of the CFS patient, using the bicycle, reveals vO2 of 60%. Cheney compares this to a different organism, an organism adjusted to anaerobic metabolism, who does not use normal oxidative mechanisms of energy production. A normal individual attempts to convert from anaerobic to aerobic metabolism as quickly as possible, as anaerobic mechanisms are highly inefficient; the CFS patient survives continuously on anaerobic mechanisms and quickly fails any effort to change to normal aerobic mechanisms.

    Cheney's presentation provided some insight as to why careless anti-oxidant supplementation of a CFS patient may actually worsen the patient instead of improve him/her. When the CFS metabolism is under such high oxidative stress, adding high levels of certain antioxidants will simply deplete the limited glutathione reserves the individual has and potentially worsen the mitochondrial energy mechanisms, increasing the anaerobic metabolism. It is necessary to ensure that vitamin supplements, including basic antioxidants, also include chelated minerals, superoxide dismutase, green pigmented foods, bioflavonoids and glutathione to prevent upregulation of anaerobic metabolism.

Mycotoxins

    Undoubtedly, the most controversial work presented at the meeting was by A.V. Constantini, MD, who notes that he is "just a general internist," a country doctor who has taken his retirement days to investigate this relatively new area of pathology, mycotoxins. We are pleased to note that Dr. Constantini has agreed to submit future columns to the Townsend Letter to investigate this field, mycotoxins, exploring its relationship to cancer and cardiovascular pathology as well as other chronic diseases. His organization, the Collaborative Center for Mycotoxins in Food is located in Freiburg, Germany.

    At the meeting, Dr. Constantini noted that his work is not based on individual examinations in a private practice, but on research in the peer-review literature which has been either ignored or overlooked. His presentation focused on gout which his literature review concludes is not a disease of metabolism but an infectious, granulomatous disorder based on abnormality of mycotoxicity, due to exposure to fungus. Looking at the veterinarian literature, it is observed that chicken and turkey develop gout from mycotoxins or oosporeins. Animals dosed with this mycotoxin develop gout. Could this represent a fungal etiology? Examination of chickens does not reveal uric acid tophi in joints, but massive complex granuloma with presence of an orchratoxin. Other animal studies reveal gout processes, again with an infective etiology. Dr. Constantini questions how a metabolic process, like gout, can form lesions holding draining pus? He then looked at one of the standard gout cures, colchicine, to understand its mechanism of action. Colchicine has no specific activity against uric acid, but is highly effective in the acute gout attack. His literature research reveals that colchicine has an anti-fungal activity. He then looked at agents which are reportedly anti-fungal, griseofulvin, for example. Griseofulvin has been shown to eliminate toenail fungus after continued use for one year. Griseofulvin also has a remarkable effect against gout. This led Dr. Constantini to suspect that fungus may play an important role in causing a broad number of diseases. His research suggests that fungal etiologies may be seen in some forms of cancer, cardiovascular disease, alcoholism, psoriasis, leukemia, rheumatoid arthritis, bowel-related diseases, and sarcoidosis. Given the wide range of disorders with a common etiology, could there be a dietary relationship to fungal disorders? Yes, yes, yes!

    The number one culprit in the diet is PEANUTS! Peanuts are attacked in storage by aflatoxin, one of the foremost causes of liver cancer and a highly toxic agent in its own right. Unfortunately other grains are equally suspect of carrying fungal mycotoxins. Cereal grains and rice are all stored for periods of time, allowing mycotoxin exposure and proliferation. Complicating exposure of grains, any fermentation process allows for further introduction of mycotoxins. This means that essentially all beers and wines carry mycotoxins as well. Bread baked with yeast offers its own unique mycotoxin. Hence the classic alcohol, bread and cheese diet we love and crave offers us a continuous exposure to mycotoxins which in Dr. Constantini's eyes offers us a perfect diet to progressively develop chronic disease. Look for Dr. Constantini to share this work with us on these pages in the future.

Abnormal Clotting

    Undoubtedly there is always something suspect when a manufacturer is the leading proponent of a medical theory. In this case our publication has advertised American Biologics' microscope for many years, as a tool for investigative diagnosis and evaluation. Some letters have appeared in the past scoffing at the claims of the manufacturer in magnification capabilities. It is one thing to joust in print; it is quite another to examine the tool in person and review its diagnostics personally. As an aside, the microscope is now considered an important academic tool in China as well as a number of other countries overseas. Given its international recognition, it appears appropriate to investigate its capabilities at home. American Biologics has given two microscopes to the Bastyr University of Naturopathic Medicine in Seattle, Washington; hopefully the university will undertake a serious examination of the microscope to report to the Townsend Letter in the future.

    One diagnostic the microscope permits for office examination is a close look at the clotting mechanism of patients under medical treatment. Basically, fibrinogen is actively used and networked in the formation of the blood clot. Normal clotting examined microscopically reveals a honeycombed blood clot with well delineated black layers of fibrin separating the clotted blood cell, platelet, fibrin combination. Abnormal clotting reveals a milky-colored, amorphous pool of fibrinogen separating the clotted blood cell, platelet, fibrin combination. These accumulations of translucent fibrin pools, present in large enough quantities and encompassing a higher percentage of the blood smear, represents an abnormal blood clot. Examiners of the blood clot using the HLBTM (Bradford) technique described, have been able to correlate acute and chronic pathology to pathology related in the abnormal clotting. Given the fact that the smear preparation and examination can be accomplished within 15 minutes of lancing the finger, the technique permits a powerful tool for evaluation and follow-up as well as patient education, all within the time constraints of a routine office visit. If the HLBTM technique proves to be as accurate as reported, it will permit the clinician to have a far better tool than most other laboratory technology in assessing treatment progress.

    Medical seminars abroad offer one other advantage for the weary practitioner: a chance to relax, if time is actually taken to enjoy a vacation. As our holistic colleagues remind us, letting go is a useful tool in the healing process. Take some time off, and enjoy!

Jonathan Collin M.D.

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