Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Treatment

Komaroff Paper: State of Knowledge of ME/CFS in JAMA

ME/CFS State of the Knowledge 

The Journal of the American Medical Association is a major medical journal. A recently published paper by Harvard professor emeritus, Anthony Komaroff has had over 75,000 hits. This is likely a record for a paper on ME/CFS. Published in July, Komaroff summarized the state of the knowledge of ME/CFS following the NIH conference in April. Komaroff categorizes what is known about ME/CFS into three categories: central and autonomic nervous systems, metabolic and immune dysfunction.

As a group and compared with healthy individuals, patients with ME/CFS have:

• Impaired cognition and abnormal white matter lesions on MRI
• Neuroinflammation as measured by functional MRI and PET
• Impaired autonomic nervous system function including low blood volume even when blood pressure and heart rate are normal
• Problems generating and maybe using energy at the cellular level
• Hypometabolism (low levels of many important compounds in the body)
• Increased numbers of activated CD8 T cells and decreased function of natural killer cells
• Elevated levels of cytokines (immune chemicals) correlating with patients’ symptoms

Komaroff proposes that these abnormalities could be the result of the body’s attempts to protect itself from injury or potential injury. For example, in the presence of neuroinflammation, the body may use the available energy to protect and heal and not waste it on thinking, eating or physical activities. He mentions Dr. Robert Naviaux’s research as a possible model for this self-protection. The paper is not freely available but several websites provide commentary.

Both the new US clinical guidelines and the Komaroff paper are excellent documents to take to your health care professionals. The Komaroff paper is behind a paywall. Canadian physicians can access the JAMA article through their CMA membership.

Author: Eleanor (Ellie) Stein MD FRCP(C)

I am a psychiatrist with a small private practice in Calgary and am an assistant clinical professor in the faculty of medicine at the University of Calgary. Since 2000, I have worked with over 1000 patients, all with ME/CFS, FM and ES. My passion for this field comes from my own struggle with these diseases, my desire to improve my health and then pass on what I learn. My goal is for every patient in Canada to have access to respectful, effective health care within the publicly funded system. 

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