It is as likely that the success of Nizoral is due to its chemical action, which blocks cortisone synthesis. Isn't that a paradox? CSF is aggravated by stress and yet here is a treatment that works by interfering with the anti-stress hormone! How can that be? One possible way is via the amino acid, tryptophan, which breaks down into a toxic by-product, xanthurenic acid. Cortisone promotes this directly by enzyme activation. Viral infections do so indirectly via gamma interferon, which stimulates the same enzyme, tryptophan oxidase. The effect is to shunt tryptophan into the manufacture of xanthurenic acid, which is known to cause auto-immune symptoms, such as muscle inflammation and pain. It also can cause diabetes, ie. blood sugar disturbance; hence the success of therapy that restricts sugars. And by blocking cortisone Nizoral prevents the production of toxic xanthurenic acid.
Modern medicine relies on differential diagnosis to assure completeness in reviewing possible causes of disease. There are ten general categories to be considered: 1) nutrition; 2) metabolic; 3) toxic; 4) infection; 5) allergy; 6) intestinal malabsorption; 7) cancer; 8) trauma; 9) genetic; 10) psychologic. Each of these categories of illness can cause fatigue and a complete discourse would fill a textbook. I put nutrition first because it is the most common cause of general fatigue and always a factor in treatment.
Nutrition surveys in our country document widespread deficiency of folic acid, vitamin B6, magnesium and zinc, all of which influence energy and immune power. Iron and vitamin B1 are both crucial to energy and endurance and both are commonly at risk, especially in women and adolescents. Vitamin A deficiency must be considered in all who are chronically ill or taking medication. Vitamin C deficiency causes severe fatigue early on, within a few weeks at low intake. In the many Americans who do not eat fresh, uncooked fruits and vegetables or take vitamin pills, this is a problem.
Amino acids can be important, especially methionine, which is often low in vegetarian diets and in those actively reducing intake of animal products. Coenzyme Q is often remarkably helpful in these cases. Lysine is at risk in those whose diets consist mostly of cooked foods, especially foods cooked in the presence of sugars. Essential Fatty Acids, particularly the omega-3 variety, are generally low in our diet and their replenishment is often followed by a boost in energy level. Vitamin E, which is depleted by diets high in polyunsaturates, is also an energy booster.
Nutrition deficiency is aggravated by any intestinal disorder. Food intolerances, particularly milk and wheat, commonly cause chronic inflammation. Infection with the parasite, Giardia lamblia, often found in public water supplies in America if unfiltered, can cause chronic bowel inflammation. Intestinal diagnosis is often hard to pin down and symptoms are not always severe enough to be diagnosable. However chronic irritation can cause malabsorption and measurement of vitamins, minerals and amino acids is often the most sensitive evidence.
Environmental pollution has been suspect in CSF, particularly since some researchers have found cell membrane damage similar to effects of the organic chlorine pesticides, such as DDT, chlordane, lindane and dioxins, chemicals that linger in the body for decades. In my own series of 100 patients, fatigue was not increased in the high organochlorine group. However I have seen chronic fatigue in patients with low cholinesterase levels, an indication of sensitivity to malathion and other organophosphates, the most common pesticides now in use. A blood test to measure cholinesterase in plasma and red blood cells is indicated in CSF.
Treatment of fatigue states is most likely to be effective if directed to a specific diagnosis; hence laboratory testing is recommended. In addition to the nutrient factors above, there are tests to identify metabolic problems, such as: thyroid excess or deficiency, hypoglycemia or diabetes, parathyroid disorder, adrenal excess or deficiency and other hormonal disorders.
Specific testing is also available to identify toxic metals. such as mercury from dental amalgam and house paints; aluminum from antacids, medications and cooking with fluoridated water in aluminum containers. Lead pollution is decreasing in the United States since the Lead Paint Control Act of 1974 but the hazard from remodeling, earthenware and pewter is still present. The hair mineral test panel is the most convenient and inexpensive screening test for exposure to lead and mercury. It can also measure fluoride.
Written by Richard Kunin, MD