Environmental Exposures as a Potential Underlying Factor in Chronic Fatigue Syndrome; a Case Report An Environmental Medicine perspective on a complex syndrome; Could toxic exposures be the cause?

Abstract

ABSTRACT:

The current standard of care medical model is a disease-based approach, focused on achieving a specific diagnosis and applying a monotherapy to the labeled condition. Chronic fatigue syndrome (CFS), not dissimilar to other complex syndromes may require a different viewpoint to improve patient outcomes.  This model that would be adequately suited for complex conditions must intervene at multiple levels to address core clinical imbalances.  In these syndromes, diagnosis and determination of appropriate treatment options is a complex process that requires a move toward a more patient-centric model of care.  One that includes elucidation of potential causes, such an ongoing environmental exposures, involves patient participation and provides individualized care. The functional medicine model is uniquely suited to more fully evaluate and understand underlying factors in multifaceted syndromes such as CFS.  Functional medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and disease progression.  This model goes beyond the diagnosis, and focuses on an understanding of the distinct mechanisms including predisposing genetic factors, unique environmental susceptibilities and underlying dysfunctions in order to determine and avoid hazardous toxic exposures and/or lifestyles, prescribe appropriate evidence based therapies all aimed to improve overall health and function over time.

Objectives: The purpose of this case study is to describe the potential benefits of a functional medicine approach, emphasizing genetic uniqueness and environmental exposures, in the development, progression and treatment of CFS.

Methods: A patient diagnosed with CFS was assessed using the functional medical model, with a focus on environmental exposures and genetic SNP profiles.  Personalized care was provided, including education on environmental hazards and treatment.  Outcome measures were obtained pre- and post-treatment. These measures included validated surveys (Medical Symptoms Questionnaire, Revised Fibromyalgia Impact Questionnaire and Chronic Fatigue-Fibromyalgia Questionnaire) and objective markers such as blood and salivary biomarkers of health and function. 

Results: The patients had clinically significant reduction in fatigue, improved health and function as documented with both subjective and objective outcome measures, up to as much as 12 months after treatment initiation. Although some mild side effects were reported, no serious adverse effects occurred.

Conclusion: This unique case study suggests the functional medicine model with emphasis on environment-genetic interactions may be of benefit in the assessment and management of patients with complex syndromes such as CFS. Further investigations with larger studies, including randomized controlled trials, in a more specific CFS population (with known toxic hazardous exposures) may be warranted.