People with long-term fatigue problems are, according to Belgian doctor Dr. Coucke, a specialist in the field of chronic fatigue, often classified in the CFS/ME category. Or worse, they are told that they suffer from psychological problems. Merely treating symptoms is the result of a number of things, which only makes the immune system weaker. Additional research into the real causes of this fatigue is therefore an urgent need. Dr. Coucke has written a book about the possible causes of CFS/ME. He discusses several causes of this disease.
- Diagnosis of chronic fatigue syndrome
- Theory of Dr. Coucke regarding CFS
- A damaged intestinal mucosa
- A dysfunction of the immune system
- Lupus
- Diagnosing Lupus
- NK cell dysfunction
- Hormone deficiencies
- The functioning of the pituitary gland
- Testing the pituitary gland
Diagnosis of chronic fatigue syndrome
The symptom pattern of CFS, which is manifested in (prolonged) fatigue, concentration problems, depression, muscle pain and headaches, is caused by an excess of cytokines. In order to be able to make an early diagnosis, a treating physician must by definition be able to work multidisciplinary. This means that he is not limited to his field of expertise, but approaches the disease from different angles. For anyone who has been diagnosed with CFS (ME) in the past and still has symptoms of exhaustion, it is advisable to check whether an immune deficiency is involved. In those cases, the GP should start with an anamnesis, a traditional blood test and an assessment of the antibodies present in the blood. After all, these antibodies are a harbinger of the diseases that may occur at a later stage. This line of thought is wrongly paid little attention in conventional medicine.
Referral
If the anamnesis, serology and blood tests do not reveal anything unusual, the GP should refer, for example, to a specialist in gastrointestinal disease or an endocrinologist. If the cause is identified, nutrients and/or hormones can be administered to the patient through, among other things, replacement therapy.
Shortages of specialized CVS doctors
There is an enormous need for doctors and centers that focus on immunodeficiency, because immunologists often specialize in more accessible diseases such as AIDS and allergies. In addition, the doctors who deal with CFS are often paediatricians, which means that adults are hardly offered adequate help if immune disorders are identified. This can manifest itself in the fact that abnormal blood values can be trivialized due to an incorrect interpretation of the blood values.
Theory of Dr. Coucke regarding CFS
Dr. Coucke, a Belgian endocrinologist who specializes in treating people with chronic fatigue, has some different ideas about the cause of CFS. This may be based on:
- A damaged intestinal mucosa
- The autoimmune disease Lupus
- Deficiencies in NK killer cells
- Hormone deficiencies
- an adverse influence on the pituitary gland
A damaged intestinal mucosa
If one knows how many problems a leaky gut causes, then the importance of an intact and healthy intestinal mucosa goes without saying. If this mucous membrane is damaged, a leaky intestine can develop, with all its consequences. Toxins released in the intestines, such as methanol, propanol and butanol, can then enter the bloodstream, reaching almost all body cells via the liver and thus gradually causing chronic self-poisoning of the intestines. Vascular cramps, nervousness, joint and muscle cramps and a coated tongue can be the result.
Toxins and slags are deposited in the form of cholesterol, bile/kidney stones, cataracts, glaucoma, gout, osteoarthritis and blackheads.
Intestinal flora
Autoimmune diseases therefore have a lot to do with the health and quality of the intestinal mucosa and the balance of the intestinal flora. Dysbiosis, with an imbalance of the intestinal flora, then automatically leads to a leaky gut due to an excess of harmful bacteria. Many people with an immune disorder also have a leaky gut.
Normally, the helicobacter pylori bacteria provide protection against autoimmune diseases and allergies. Only when this bacteria starts to spread, for example due to a weakened immune system, it causes inflammation of the stomach mucosa.
Checking the intestinal lining
You can check whether the intestinal mucosa is healthy by: blood and urine tests, a breath test with lactose, fructose and sucrose, a complete serology for CMV, borrelia, mycoplasma and herpes. Autoimmunity tests (ANF and thyroid antibodies) and inflammatory parameters (CRP) are also part of the treatment. In general, treatment should first strengthen the immune system, while good intestinal flora can be obtained by supplementing with good bacteria, vitamins C, D and B complex, glutamine, probiotics and prebiotics and antioxidants.
Protection of the organs
The intestinal wall is protected by the intestinal mucosa and a mucus layer. The intestinal mucosa consists of one layer of cells that absorbs the right substances and removes harmful substances such as toxins, pathogenic bacteria, metals, fibers and undigested food remains from the body through a valve system through the feces. The intestinal flora also forms a barrier.
The lungs are protected by the lung mucosa and ciliated cells. The stomach protects the intestine by stomach acid, the acidity of which is so high that most bacteria are destroyed in the stomach before they end up in the intestine. The vagina is also protected by a high acidity. Finally, the skin is protected by a layer of fat and moisture.
A dysfunction of the immune system
An immune disorder will therefore mainly occur in the intestine, which increases the risk of a leaky intestine. This makes the intestinal cells permeable and undigested food etc. can infiltrate the bloodstream. A leaky gut is therefore not the cause, but the consequence of an immune disorder. This results in poor absorption of food, which causes the immune system to function even less effectively. Proper functioning of the small intestine, where proteins are converted into amino acids, is crucial for our nutritional status. The immune system plays an important role in this and 80% of the immune system is active in the gastrointestinal tract.
Leptin
This protein with a hormonal effect plays a key role in digestion. When leptin levels drop, the body is urged to eat by means of a signal. The effect of the leptin then produced is then dependent on its binding to receptors in the lower part of the hypothalamus. With a defect in these receptors, people still become fat despite having a lot of leptin. Lab tests (pre) albumin, ferritin, total protein, white blood cells and a fatty acid profile are indispensable in addition to weight determination and a stool examination. The treatment of a leaky gut should therefore primarily focus on restoring and strengthening the immune system and secondarily on repairing the intestinal mucosa.
Lupus
This disease, also called SLE or LE, often affects girls aged 15-18 years and is therefore very estrogen sensitive. It is characterized by a characteristic butterfly-shaped rash on the face and a normal CRP value and increased erythrocyte sedimentation rate in the blood. This differs from other inflammations, in which CRP and erythrocyte sedimentation rate are both increased. Lupus patients can suffer greatly from premenstrual syndrome. LE only affects the skin, SLE also affects other organs. Sufferers of diabetes I have an increased risk of developing lupus. According to Dr. Coucke, many more people have Lupus than previously thought. If, among other things, a patient’s parents have an autoimmune disease such as psoriasis or rheumatism, this is a reason to test for the presence of Lupus. Lupus cannot currently be cured, but it can be treated effectively.
Symptoms of lupus include:
- hypersensitivity to UV light
- arthritis and/or pleurisy (inflammation of the lining of the lungs)
- kidney abnormalities and anemia
- too few white blood cells and platelets
- a positive ANA serology (antinuclear antibodies)
- immunological abnormalities
Diagnosing Lupus
The diagnosis of this hereditary disease is difficult for doctors who are not familiar with the complete clinical picture, especially because the complaints can be vague, general and non-specific and there are often few clinical clues during clinical examination. In CFS and fibromyalgia patients (mainly muscle complaints), the diagnosis of lupus should always be considered and further investigation should be performed. Patients with early-stage lupus also often have a deficiency of NK cells, which suggests that these cells have a protective function in the immune system, preventing people from attacking themselves. This once again confirms that not only a lack of antibodies (IgA deficiency) but also a cellular dysfunction can lead to the development of autoimmune diseases
NK cell dysfunction
The diagnosis for this deficiency of NK cells, in which either too few natural killer cells are found in the blood, or in which there are sufficient NK cells but their activity is lagging behind, is easy to detect using flow cytometry (FCM) of B -, T and NK cells. FCM is a technology in which the physical characteristics and functioning of ultra-small particles can be studied and measured on the basis of electrical resistance occurring in a flowing liquid. It is mainly used in the medical world, including for research into abnormalities in the blood and the immune system. NK cells form a kind of commando force that mainly eliminates cancer cells and virus-infected cells. When these NK cells malfunction, viral or intracellular infections arise, which are not so easy to treat. Deficiencies in gamma globulins can also occur, which can be remedied by taking globulins . To improve the functioning of NK cells, beta-glucans, antioxidants, isoprinosine, arabinoside, DHEA, cortisol and growth hormone can be taken. A good nutritional status and support with nutrients such as high doses of omega-3 fatty acids is a requirement.
IIimmunoglobulins
Immunoglobulins are proteins that bind to foreign substances so that they can no longer cause damage to other cells. They exist in various shapes and sizes. The most important globulins are IgM, IgG, IgA, IgD and IgE and these are all produced by B lymphocytes. They have different functions and are active in several places.
Hormone deficiencies
Hormones are produced by glands and ensure that cells can grow or that growth is slowed down or stopped. Hormone deficiencies can cause XLA, hyper IgM, CVID and IgA deficiency. This can be demonstrated by blood and urine tests. The diagnosis of humoral immunodeficiency is not at all difficult, all subclasses of globulins can be determined by taking a blood sample. This allows you to immediately check whether the amount and composition of the globulins is normal and whether any deviations can be registered. However, the vast majority of physicians do not look for IG shortages because they apparently do not care about them. However, IgG3 deficiencies in immunodeficiency are very common and are therefore one of the main causes of a poorly functioning immune system, according to Dr. Coucke. It is very possible to live with hormonal deficiencies, but a weakened immune system is accompanied by always being tired, weakened muscles and bones and easily contracting infections.
Treatment of abnormal values consists of replacement therapy, in which the gamma globulins that the body no longer produces itself are supplemented with the blood serum of healthy donors. In case of IgG3 deficiencies, the injections should be administered intravenously every 10 days. With most gamma globulins, administration once a month is sufficient.
Gamma globulins can be produced unlimitedly from the plasma of donors, but strangely enough, such a treatment costs approximately one thousand euros per month for at least 6 months. Nevertheless, it is impossible to match the natural production and the treated patients still remain weakened and in the event of infections the doctor should be aware of possibly starting targeted antibiotics, where restoration of the intestinal flora is a requirement.
The functioning of the pituitary gland
The single most important organ in the endocrine (hormonal) system is the very small pituitary gland, about the size of a pea.
This in fact regulates the functioning of all hormones, which, however, can only work if they have found the right receptors. The pituitary gland consists of an anterior and posterior lobe, in which hundreds of thousands of cells produce different hormones. The hormones ACTH, FSH, LH, prolactin, TSH and growth hormone are produced in the anterior lobe, while the posterior lobe provides oxytocin and ADH. The pituitary gland itself is controlled by the hypothalamus and receives constant input from the brain and the hypothalamus to produce a lot or a little of certain hormones, depending on the circumstances and needs.
The indirect action of the pituitary gland
The hormones produced in the pituitary gland work exclusively indirectly. In this way, ACTH stimulates the adrenal cortex to produce cortisol. In this context we speak of the endocrine axis, which starts from the hypothalamus and travels via the pituitary gland to the organs where active hormones are produced. This takes place in the thyroid, adrenal glands, adrenal cortex, ovaries, testes and the liver. Hormones are produced by various glands and ensure that cells grow or slow down or stop. There are a total of 18 different hormones, including cortisol, thyroid hormone (T3-T4) growth hormones, melatonin, DHEA, insulin, glucagon and sex hormones such as testosterone, estrogen and progesterone.
Damage to the pituitary gland
The pituitary gland is a vulnerable organ in which blood vessels can die and no longer function properly due to whiplash or a fall, bleeding, tumors, cysts or an immune disease. The pituitary gland can also tear completely or partially. As a doctor, it is therefore appropriate to always inquire about any head injury sustained. In pituitary insufficiency, first the growth hormone located on the outside of the pituitary gland is lost, then cortisol (ACTH), then the thyroid hormone (TSH) and finally the sex hormones. Dr. Coucke finds Addison’s disease in a number of his patients, in which the pituitary gland no longer functions (sufficiently).
Testing the pituitary gland
To obtain a precise picture of the hormone function, a number of endocrine tests are available, in which the values of morning cortisol, free T4 and TSH, IGF-1, prolactin and FSH/LH are determined. By far the most important test, however, is the specific ITT test (Insulin Tolerance Test), in which the pituitary gland is stimulated by injecting insulin into the patient.
This creates a stress condition, after which the pituitary gland is stimulated to produce more cortisol, ACTH and GH. The values of the three hormones mentioned are determined four times over a period of two hours, while at the same time the sugar level in the blood must drop to below 40 milligrams per deciliter. Normally, hormone levels drop. This is done in case of low cortisol values and/or IgF-I. A TRH test and a clinical examination can also provide a definitive answer.
The Synacthen test
Most doctors decide to perform a Synacthen test, in which a crisis situation is created by injecting the patient with high doses of ACTH, after which the cortisol levels are measured to see how the adrenal glands respond. However, this test does not provide information about the adrenal glands.
read more
- (Chronic) fatigue due to adrenal fatigue
- The functioning of the hypothalamus and pituitary gland
- Lupus: an autoimmune disease
- Good intestinal flora is extremely important
