by Dr. Martin L. Pall

ImmuneSupport.com

02-13-2001 Editor's Note: Dr. Martin L. Pall, Ph.D., received his Ph.D. in Biochemistry and genetics from Caltech after receiving his B.A. degree at Johns Hopkins University. He is a professor of iochemistry and Basic Medical Sciences at Washington State University. He teaches medical students and is the chief instructor at Washington State University in the medical biochemistry course for first year medical students.

Dr. Pall writes that he came down with CFS in June/July 1997 after a severe bout of Varicella zoster infection. "My CFS was diagnosed by my primary care physician and my case did meet the 1994 CDC criteria. So this was, in many ways, a typical case of post-viral fatigue syndrome, sudden onset. However, I have had an excellent recovery, over about a year and a half (possibly due to self-medication?), and consider myself cured. So, I don't view myself as a CFS patient. It was only after recovery from the severe cognitive dysfunction that I was able to dedicate myself to understanding the basis of CFS."

I asked Dr. Pall about his comment that he considers himself cured. Is he not afraid of a relapse in the future? Also, to what does he attribute the 'cure' and how does he stay healthy? This is his response:

I became ill with CFS in June/July 1997 and spent most of July and August in bed trying to recuperate. The following semester, I was able to perform at a minimal level in my teaching, taking lot's of sick leave, living from day to day, as most of us do. I self medicated on several things (more about that later) but had little apparent improvement. However, the following winter, I did improve substantially and by May was doing very well, not completely recovered but maybe 80% recovered. A year later, I considered myself completely recovered although I am still self-medicating, not wanting to take any chances of having a relapse. Specifically, over the past two summers, I have been able to go on a series of fairly taxing Sierra Club hikes with no post-exertional malaise. That is quite distinct from my earlier condition where I could only walk (slowly) circa 50 yards before having to sit down for a long rest.

My self medication was primarily with antioxidants (natural mixed tocopherols, vitamin C, selenium, some carotenoids, calcium/magnesium supplement, Ginkgo extract and coenzyme Q10). I also tried some black currant seed oil and some choline/inositol supplements - I did not think these helped but maybe I was wrong? I am very careful with my diet, eating nutritionally rich foods and antioxidant-rich foods (it would take a book to tell you all about the food issue). I did not have any GI tract problems so was able to tolerate both the supplements and a wide variety of foods.

The most dramatic effects that I saw, appeared to be from the Ginkgo extract (this over a period of two or more months, however) and, following that, from the Co Q10 , the latter of which was a dramatic, within 24 hours, recovery of cognitive function. I have never had a problem with cognitive dysfunction since that time and am still taking the Co Q10. I am aware that most others who have tried Co Q10 have not had as favorable a response, and I can only think that my body was primed, possibly by the other supplements and foods, to be ready to respond to it.

I have been running a clinical trial/pilot study with a physician (Dr. Albert G. Corrado) using a series of supplements based on my theory, and the results have been both encouraging and discouraging - encouraging because essentially everyone who was on the trial and was able to tolerate most of the supplements reported an improvemnt but all reported a modest improvement, over a 150 day period. So no one was cured over that time. I met yesterday with a group of pwcs, a few of whom were on the trial, and we are seeing some continued improvement (most people opted to continue on the supplements after the trial was officially completed, suggesting that they felt that the supplements were helpful). One person even reported that she was "almost normal" now about 13 months after starting on the supplements. So, maybe there is hope.

With regard to your question about a possible relapse, that is, of course, the nightmare of all us who have largely or partially recovered from CFS. All I can say is that over the past two years, I have functioned on a completely normal level - but then, I am still self-medicating and plan to continue doing so indefinitely. Some of the hikes I have been on have been quite taxing - 8 1/2 to 9 mile fairly tough hikes, with substantial elevation gains - and the results have been some fatigue afterwards, but normal fatigue, just requiring normal resting. So I am hopeful that this functional recovery is permanent.

Novel chronic fatigue syndrome (CFS) theory finally produces detailed explanations for many CFS observations

A novel theory of the cause of CFS has been published which is supported by diverse biochemical and physiological observations of CFS, while providing explanations for five of most difficult puzzles about this medical condition. The theory has been published by Dr. Martin L. Pall (Professor of Biochemistry and Basic Medical Sciences, Washington State University) in several publications (1-4,9).

The theory starts with the observation that infections that precede and may therefore induce CFS and related conditions act to induce excessive production of inflammatory cytokines that induce, in turn, the inducible nitric oxide synthase (iNOS). This enzyme, in turn, synthesizes excessive amounts of nitric oxide which reacts with another compound (superoxide) to produce the potent oxidant peroxynitrite. Peroxynitrite acts via six known biochemical mechanisms to increase the levels of both nitric oxide and superoxide which react to produce more peroxynitrite. In this way, once peroxynitrite levels are elevated, they may act to continue the elevation, thus producing a self-sustaining vicious cycle. It is this cycle, according to the theory, that maintains the chronic symptoms of CFS and it is this cycle, therefore, that must be interrupted to effectively treat this condition.

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