I recently got a chance to do an interview with Dr. Martin Pall. I have been interested in his ideas on CFS since I came across a theory of his on the WSU School of Molecular Biosciences website – here
He believes that Chronic Fatigue Syndrome is a NO/ONOO cycle disease. He also states that the nitric oxide/peroxynitrite cycle may play a role in other illnesses such as Fibromyalgia, Multiple Chemical Sensitivity, and other chronic disorders. He states on the WSU website that short-term stressors such as viral infection, bacterial infection, physical trauma, mental trauma, etc. can lead to a cycle of increased nitric oxide levels.
He wrote a book based on this theory called “Explaining ‘Unexplained Illnesses’: Disease Paradigm for Chronic Fatigue Syndrome, Multiple Chemical Sensitivity, Fibromyalgia, Post-Traumatic Stress Disorder, and Gulf War Syndrome”
Here is the inteview:
Q: Do you think nitric oxide activity is important in both CFS and FMS patients?
A: Yes, but it is only part of what we call the NO/ONOO- (no, oh no) cycle. This whole vicious cycle should be considered the cause of these illnesses, not just nitric oxide. The best single type of evidence that nitric oxide is involved is that the injections of the nitric oxide scavenger, hydroxocobalamin (a form of vitamin B12) provide rapid improvement in symptoms in many patients.
Q: I’ve had improvement from supplements that increase NO production, do you believe that CFS/FMS patients have decreased or increased NO production?
A: Increased, and that is supported by published studies. But I wish to state that agents that lower uncoupling of the nitric oxide synthases (the enzymes that produce nitric oxide) by increasing the availability of a compound called tetrahydrobiopterin will increase nitric oxide production but will still probably be helpful because they decrease superoxide production, another cycle element. (Sorry for this complex biochemistry)
Q: What is the single most helpful supplement, or drug that youve come across in the treatment of CFS?
A: I think that the hydroxocobalamin mentioned above and also magnesium supplements are probably the most widely used things that seem to be generally useful, although optimal dosage regimens may vary among different individuals. I want to make clear that I am a PhD, not an MD and nothing stated here (or elsewhere) by me should be viewed as medical advice.
Q: Where do you think the future of CFS research is headed?
A: I hope it is headed to both a widely accepted mechanism (which I think is the NO/ONOO- cycle) and effective treatment and potentially many cures. I think that the most attractive treatments involved multiple components, many of which are classified as nutritional supplements.
Q: What do you think of the Methylation Cycle Block theory and does it apply to your theories in your Nitric Oxide Cycle Theory?
A: First of all, it is a misnomer to talk about a methylation block, if it were completely blocked, it would be lethal. I do think that there is lowered methylation cycle activity, caused at least in part by nitric oxide (which inhibits the methylation cycle enzyme methionine synthase) and by oxidative stress, produced by peroxynitrite, which also lowers this same enzyme activity. I think that the data that Dr. Jill James and her colleagues have published on autism patients is consistent with the NO/ONOO- cycle mechanism. In fact in their study, they clearly state that there is must be more than one pathway involved to explain their data, it is not a simple methylation cycle defect. I think the that the effects of the NO/ONOO- cycle not only on methionine synthase but also on other oxidative stress effects and on lowering energy metabolism is the best explanation of the James data.
Q: Do you believe that viral/bacterial infections are a primary cause or a symptom of the CFS disease state?
A: There is no question that viral and bacterial infections are involved in the initiation of many cases of CFS. And chronic infections can also have important roles in the chronic phase of illness. These chronic infections are, in many cases opportunistic infections but there are also fairly common situations where initiating infections may be chronic, as well (such as in Lyme disease). It may be very important where there are such chronic infections to treat the infections as well as to lower the NO/ONOO- cycle activity.
Q: Have you seen patients completely overcome the disease?
A: Yes. But I don’t think that we are yet at the stage where a particular treatment approach will lead reproducibly to cures in many patients. It is my hope that we are close to this but we are not there yet.
Q: Do you think that the medical community is headed towards the acceptance of CFS as serious illness?
A: I don’t know. In Chapter 13 of my book, one of the questions I asked is why the psychogenic interpretation of this group of illnesses has so much resonance in the medical community, despite the fact that it is incompatible with so much of the evidence. One of the answers that I give to that question is that the psychogenic interpretation is very similar to what physicians learn in medical school. How long it will take to get around this, I don’t know.
Dr. Pall: Let me add one other thing – one thing that is clearly needed is a specific biomarker test for CFS. Something that can be objectively measured that is specific for CFS. I discuss at the end of Chapter 5 in my book how we should, in my view, approach the development of such a test.
I just got a copy of your book at Barnes & Nobles.
I am intrigued.
I have been coping with Fibromyalgia, Chronic Myofascial Pain, PTSS, Menopause and Seasonal Affective Disorder. I have done a lot of research to help me to understand the cycle my body and mind are taking me through. Your insightful, well written book hits the nail on the head.
Thank you.
I have struggled with post viral CFS for 5 years, and now I seem to be developing fibromyalgia.
I bought a copy of Dr. Palls book recently, and I am very impressed with the research that supports his paradigm. His references alone comprise about one fifth of his book. I believe that his paradigm has much to offer me and others like me. He supports his research by expaining why major MD player’s protocals support his theory. Plus, he’s at WSU! Go Cougs!
I have bought his supplements. We’ll see…