General practitioners' perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study

Sir

In response to Peter Morrells' question re. LGS:-

You could say all reality is nebulous, even dogs and telegraph poles,
depending on how you wish to represent them - do we not live an illusion?
Certainly disease tends to be nebulous, even the most widely researched
eg. HIV-AIDS remains nebulous since it is dependent on the isolation of,
and thence description of, a virus which (even after isolation) remains
nebulous at certain levels due to investigatory limitation.

The references I gave already in my previous response suggest that
scientists have already investigated the concept of LGS and have produced
a working description - as 'working' as so many medical concepts and
models.

From my TCM perspective and experience with ME/CFS sufferers I agree
with the viability of LGS because most, if not all, ME/CFS sufferers I
have treated this past 15 to 20 years show signs of 'small intestinal (SI)
dysfunction' - I won't go into detail of how that is diagnosed in TCM.
Food intolerances, and IBS, seem at times to create SI rather than LI
dysfunction (hence medics define IBS as 'irritable' suggesting
unidentifiable, guessing dysfunctional, without obvious physically
identifiable signs in the LI) in my ME/CFS patients who respond rapidly to
dietary change and acupuncture & moxibustion treatments involving SI
'manipulation'. People have described their IBS as feeling 'poisoned'
after certain foods, distended gut, much flatulence, tending to be
reversed by avoidiong certain foods (often cereals) with which they never
had a problem before developing IBS/CFS/ME. They may suffer several days
'fluiness', as though having a systemic infection which relieves within 4
to 7 days, from those foods and as the food would be expected to leave
their system and their immune systems restore order.

Their symptoms are often like those of 'infection', but in this case
(LGS like) are caused by specific dietary triggers (individualised to the
person); they are not unlike the kind of symptoms experienced by a person
who is found to have a physical lesion in the colon, but in many of these
IBS/CFS/ME sufferers the colon shows no abnormality by endoscopy plus many
IBS sufferers have normal regular stools, but have recurrent discomfort
bloating and wind which seems to affect the SI mainly and at times the LI.

Many of these IBS/ME/CFS sufferers appear to have contracted their
condition from a vaccination - typically Hep B or Anti-Tetanus which
research tends to support. Others have been prescribed anti-biotics during
a viral illness and found that their recoverey was suddenly halted on
taking anti-biotics leading to a downward spiral until CFS/ME is diagnosed
months later. Quite a number of my ME/CFS patients were able to check
dates of origin of their first taste of 'strong and unusual fatigue' early
in the illness and on checking vaccination dates found either Hep B
(medical workers) or anti-tetanus vaccinations were received within a week
or so of the onset of a downward spiral in health to what became ME/CFS.

To sum up, the idea of a damaged SI 'leaking' contents into the blood
stream is not new, it is supported by research, by scientific
plausibility, by signs and symptoms and patient histories, by lack of
other medical explanations for IBS as defined by Western Medicine; and for
me also by TCM diagnostic practices and concepts. Which part of the
spectrum from 'real' to 'nebulous' LGS lies must ultimately depend on a
sufferer's experience - it's 'real' enough to them.

Regards

John H.

Competing interests:
None declared