Red Blood Cells and Chronic Fatigue Syndrome
http://www.immunesupport.com/library/
showarticle.cfm/ID/4226/t/CFIDS_FM

By Jule Klotter
(Townsend Letter, issue: November 2001)

01-15-2003

According to an article by Maryann Spurgin, Ph.D., New Zealand researcher Dr. L.O. Simpson has theorized that myalgic encephalomyelitis (ME), also known as Chronic Fatigue Immune Deficiency Syndrome (CFIDS), results from "insufficient oxygen availability due to impaired capillary blood flow."

Simpson attributes the impaired capillary blood flow to smaller-than-usual capillaries and to the presence of abnormal red blood cells (nondiscocytes).

In healthy people, most red blood cells are smooth-surfaced and concave-shaped with a donut-like appearance. These discocytes have extra membranes in the concave area that give them the flexibility needed to move through capillary, beds, delivering oxygen, nutrients, and chemical messengers to tissue and removing metabolic waste, such as carbon dioxide and lactic acid.

Abnormal red blood cells lack flexibility that allow them to enter tiny capillaries.
These nondiscocytes are characterized by a variety of irregularities, including surface bumps or ridges, a cup or basin shape, and altered margins instead of the round shape found in discocytes.

When people become ill or physically stressed, a higher percentage of discocytes transform into the less flexible nondiscocytes. Simpson says that the blood samples of marathon runners show a higher percentage of cup-shaped nondiscocytes (somatocytes) after a race. This higher percentage soon reverts to pre-race, normally-low levels of abnormally-shaped cells. Similarly, researchers found that the percentage of nondiscocytes in people with a viral head cold peaked on the fifth day and declined by the tenth day. [indicating major influences by viruses and short-term adrenal fatigue]

Simpson found that people with ME/CFIDS have higher percentages of nondiscocytes than people with other chronic illnesses, such as Lupus, multiple sclerosis, Huntington's disease, malaria, and diabetes. In addition, the percentages of cup-shaped somatocytes in ME/CFIDS patients can remain high for months, inhibiting blood flow.

Simpson believes that, in ME/CFIDS, either the mechanism whereby red blood cells revert to the discocyte form is hampered for some reason or that whatever triggered the red blood cells to transform into nondiscocytes remains in effect, albeit unidentified. Ms. Spurgin notes that red blood cell morphology is also affected by toxic chemicals, providing a possible link between ME/CFIDS, environmental illness and multiple chemical sensitivity, and Gulf War Syndrome.

Simpson found that vitamin B12 injections reduced nondiscocyte levels in some ME patients. These patients also experienced symptomatic improvement. Patients whose nondiscocyte levels remain unaffected by the B12 injections noticed no improvement. Research with diabetic patients found that omega-3 fatty acids can also reduce nondiscocyte levels and improve capillary flow; and omega-6, in the form of evening primrose oil, has improved blood filterability in cigarette smokers.

Reference: "The Role of Red Blood Cell Morphology in the Pathogenesis of ME/CFIDS"
by Maryann Spurgin, PhD, The CFIDS Chronicle, Summer 1995

Ciguatera Toxin and Chronic Fatigue Syndrome:
Should You Be Tested?
http://www.immunesupport.com/library/
showarticle.cfm/ID/4277/t/CFIDS_FM
ImmuneSupport.com
02-10-2003

The ciguatera toxin may be found in large reef fish, most commonly barracuda, grouper, red snapper, eel, amberjack, sea bass, and Spanish mackerel. These fish live in coral reef waters between 35 degrees south to 35 degrees north latitude. This area lies basically between the Tropic of Cancer and the Tropic of Capricorn that ring the Earth north and south of the equator and make up what we commonly call the tropics. Areas include the Caribbean, Hawaii, and coastal Central America.

The toxin tends to concentrate in predator fish, such as the barracuda and other carnivorous reef fish, because they eat other fish that consume toxin-producing algae (dinoflagellates) living in coral reef waters.

The toxin is harmless to fish but poisonous to humans.
The toxin is odorless and tasteless and is NOT destroyed by cooking.
People are poisoned by the toxin after eating tropical or subtropical contaminated fish. ...

1. Is this a fish toxin?
Ciguatera is a fish toxin but until all research is complete, we don't know if this is the exact same entity as ciguatera toxin. We do know that all tests for ciguatera toxin come up positive in those with CFS that we've heard from thus far and are far higher than those seen in acute ciguatera poisoning.

2. Is testing available?
Yes. Testing has been ongoing as announced and the protocol may be read.
Those on the east coast are now advised to include a cold pack in the shipment.
No kit is given by the laboratory so first check to see what the laboratory you are using requires of you (i.e.: packing material). A testing Protocol is available here:
http://www.ncf-net.org/library/CiguateraTesting.htm

Yoshitsugi Hokama, Ph.D.
University of Hawaii at Manoa
Department of Pathology
Biomedical Building T-610
1960 East-West Road
Honolulu, HI 96822

3. How much does testing cost?
The test now costs US $100.00 and patients will be sent an invoice.
The prescribing physician will receive the results.

4. What treatment is recommended?
There is currently no known, proven treatment for this.
Cholestyramine, mentioned by many, will not help.

Ciguatera Toxin and Treatment
http://www.chronicneurotoxins.com/learnmore/ciguatera.cfm
Visual Contrast Sensitivity Test Center
02-10-2003

Don't eat barracuda, especially in August and September when levels may be the highest. What levels? Toxins, made by small dinoflagellates (Ciguatera) living under algae growing on a reef, accumulate in the fish that eat the algae. Ciguatoxins don't affect the fish. Those fish, when eaten by bigger fish and bigger fish again, concentrate the minute quantities of toxins to the point that the large predator fish including red snapper, grouper, jack and barracuda (among a group of 400 species across the world) often are an illness waiting to happen, disguised as a gourmet meal. This illness often, but not always, has an explosive onset with diarrhea and vomiting, and even more insidious is the chronic illness that set in for those unable to naturally eliminate the toxin.

More than 1,000,000 cases of Ciguatera Seafood Poisoning occur annually worldwide, especially in areas around Puerto Rico, Hawaii, Australia, Indonesia and Micronesia. Recent years have seen a large increase in South Florida. A map of the tropics is a map of Ciguatera. Just as in Pfiesteria cases, the illness has political and economic consequences. Ads promoting tourism in St. Thomas don't say, "come on a cruise, eat local fish, get sick and stay sick for years".

But it does happen and it is now happening more often, as tropical reefs around the world are attacked with silt, alien algae, pollution and chemical killers including pesticides, hydrocarbons and heavy metals (see chapter 3, Desperation Medicine).

If you are lucky enough to recover from Ciguatera after eating a poisoned fish, take the VCS test anyway. Like with Pfiesteria, a low level, chronic illness frequently occurs in which itching, fast heart rate, headache, nausea, fatigue and funny numbness may become a chronic problem. If you are unlucky and the illness sets in with its full force, don't expect the medical profession to be able to help you. Blood tests, MRI and EMG studies will be normal, as will the UGI series and GB sonogram. Even if diagnosed, prior to our protocol, there has been no effective treatment

If you develop a metallic taste or reversal of hot and cold sensation, your astute Family Practice physician may recognize the possibility of chronic ciguatera. Take the VCS test; it is the first step to return to normal health. Treatment may be prolonged, however, as Ciguatera frequently requires more time to reach cure than its cousin, Pfiesteria.

You might not have any dramatic symptoms with ciguatera at first, but feel bad after you drink alcohol, eat something sweet, or curiously, after eating fish (a sign of sensitization or an adverse reaction to even minute quantities of the toxins). Women may especially notice their symptoms before menses. ...

Ciguatera Fish Poisoning
http://www.holistichealthtopics.com/HMG/ciguatera.html

Graham Williamson
webmaster@holistichealthtopics.com
02/10/06

Ciguatera - General Description and Incidence
Ciguatera is a type of sea food poisoning caused by the consumption of fish, especially certain tropical reef fish, which contain one or more naturally occurring neurotoxins from the family of ciguatoxins and maititoxins. It has also been suggested that ciguatera may be caused by occupational exposure to ciguatoxic fish organs during repetitive handling or processing of fish ( Codella: pers. comm. ). In confirmation of this are reports that cleaning of ciguatoxic fish may cause tingling of the hands ( 18a ), clear evidence that ciguatoxins may be absorbed through the skin ( 18 ).

Ciguatera is reported to be the most common form of sea food poisoning in the world ( 1, 2, 4 ) with the estimated number of cases ranging from 50,000 ( 1, 2 ) to 1,000,000 ( 3, 9 ) annually. In view of the fact that only 2% - 10% of ciguatera cases are actually reported ( 2 ), and many doctors have never heard of ciguatera, it is clear that the true prevalence of this disorder could be much greater than these figures suggest. Although ciguatera is often considered to be a mild non fatal disease, it has a world wide mortality rate ranging between 0.1% - 12% ( 2 ) with isolated outbreaks as high as 20% ( 1, 8, 18 ).

Symptoms and Duration of Ciguatera
Since ciguatera may be caused by a cocktail of different fat and water soluble toxins, this disorder may cause numerous different symptoms. The variation in symptoms in different cases, which may also follow a geographical pattern ( 2, 6, 12, 18, 30 ), is thought to be caused by the different biological effects of the various toxins which may be involved ( 1, 2, 11, 12, 18 ).

Ciguatera typically presents as an acute gastrointestinal ( and perhaps neurological ) illness, which may, in some cases, only last for a few days ( 1, 5, 6, 12, 18 ), following the consumption of contaminated fish ( 1, 2, 12 ). This initial illness is then frequently followed by a chronic, mainly neurological illness, which may last for months, or even as long as ten years ( 5, 7 ), with claims that the toxin could even remain in the body for 25 years ( 18b ). Since ciguatera is particularly damaging to the nervous system, recovery may not occur until the damaged nerves regenerate and it seems that this may not always occur. Ciguatera, it should be emphasised, can also present as a psychiatric disorder or a dermatologic disorder.

Ciguatera may also have a slow insidious onset if there is a gradual accumulation of toxins due to the continuing consumption of fish which have a low level of toxicity ( 10, 30 ). Such cases of course, would be most unlikely to obtain a correct diagnosis.

Once a person has contracted ciguatera poisoning they may develop an extreme sensitivity to any further exposure to ciguatoxins ( 2, 18, 30 ). A second attack of ciguatera therefore, may be much more severe than the first one ( 2, 18, 32 ).

.. suffer relapses following the consumption of seemingly innocuous foods ( 2, 12, 18, 32 ). For instance, consumption of nuts, nut oils, caffeine, alcohol, or animal protein foods, has been known to cause relapses months or years after the initial attack ( 2, 12, 18, 32 ). Consumption of any type of fish can also cause relapses ( 2, 18 ). Even the consumption of poultry which has been fed fish meal has been known to have this effect ( 18, 32 ). ...

Other symptoms
Dermatitis, itch, rash, aches and pains, arthralgia, myalgia, general weakness, salivation, breathing problems, dyspnea, neck stiffness, headache, ataxia, exhaustion, fatigue, sweating, depression, and metallic taste in the mouth. Ciguatera, it should be noted, may also be sexually transmitted ( 2, 18 ) and may cause premature labour or spontaneous abortion ( 2, ). Ciguatoxins may also be transmitted via breast milk ( 2, 5, 18 ).

Ciguatera and Chronic Fatigue Syndrome
Chronic ciguatera poisoning may so resemble CFS that it may be difficult to distinguish between the two illnesses ( 13, 31, 36 ). But are they separate illnesses? CFS it seems, has actually been caused by ciguatera ( 14, 15, 33, 36 ). It is indeed interesting to note that CFS may actually be caused by toxins which closely resemble ciguatoxin ( 37 ). ...

... all these infections or toxins may cause considerable and prolonged internal stress and therefore may have a considerable impact on the adrenal system. ...

The nature of ciguatoxins, both their persistence in the body and their extreme toxicity, ensures that ciguatera has a very real capacity to impact upon the adrenal system.

The Nature and Origin of Ciguatera Toxins
Ciguatera toxins or ciguatoxins, are said to be amongst the deadliest mammalian poisons known ( 2, 4, 36 ), reportedly being, volume for volume, 1000 times more potent than arsenic (10). These heat stable toxins originate from a type of microorganism which attaches to certain species of algae on dead or damaged coral in tropical areas around the world ( 1, 11, 18, 30 ). Increasing damage to coral reefs therefore correlates with an increasing frequency of ciguatera outbreaks ( 16, 18 ). ..

... fish oil and fish liver oil supplements, it should be emphasized, that although fat soluble ciguatoxins may accumulate throughout the flesh of a fish, it is the organ areas such as the liver which accumulate the greatest concentration of these toxins (2, 11, 18 ). These parts of the fish are by far the most toxic ( 2, 11, 18 ). Since there is no simple routine test for the presence of ciguatoxins, stringent steps should be taken to ensure the source, and safety, of fish oil products. ...

Treatment of Ciguatera
... From my experience, the two most effective treatments were the complete elimination of all sea food from the diet, and the use of megadoses of vitamin B12.

... symptoms which were very similar to vitamin B12 deficiency.
These symptoms were largely neurological and occurred predominantly below the waist, although I also experienced some similar symptoms around the scalp, face, eyes and mouth. It was the symptoms in the lower back and legs which were most severe however. These symptoms included burning sensations, numbness, and pain and weakness which would be greatly exacerbated by standing for only a few minutes. These symptoms were progressive until I began weekly supplements of 4000 mcg tablets of vitamin B12 ( smaller doses were ineffective)

My response to the B12 was dramatic with a very rapid improvement in vitality and well being and a more gradual improvement in the neurological symptoms. I found however, that if I did not take the B12 weekly I would relapse. This continued for several months when I then found I could discontinue the B12 with no repercussions.

Vitamin B12 blood tests which were not done until after I began B12 supplements, revealed that my B12 levels were in the low end of the normal range, even less than 24 hours after taking the vitamin. This led to the suggestion that I was malabsorbing B12, however a subsequent vitamin B12 absorption test was normal.

... since toxins produce their toxic effects by disrupting normal metabolic pathways, it would not surprise if there was some kind of interaction between ciguatoxins and vitamin B12.

In view of the ability of ciguatera to destroy nerve tissue, it is indeed interesting to note that high doses of methylcobalamin, the active form of vitamin B12, has recently been shown to stimulate regeneration of damaged nerve tissue ( 28, 29, 35 ). Futhermore, various neurological disorders have been linked to a deficiency of methylcobalamin ( 28, 29, 35 ).

Ciguatera Prevention
Since ciguatoxins are unaffected by cooking or processing of food ( 1, 2, 5, 16, 26, 32 ), and contaminated fish is not detectable by appearance, taste, or smell ( 1, 2, 5, 26, 32 ), prevention of this disorder can only be achieved by avoiding contaminated fish ( 2, ). ...

... For a more comprehensive list of species go to
http://www.fishbase.org/search.cfm and search for ciguatera under topic search. ...

... large carnivorous reef inhabiting fish such as the barracuda are generally considered the most toxic species ( 2, 9, 11,18, 26 ) although pelagic fish like the Spanish mackerel seem to cause the most outbreaks of ciguatera ( 18 ) Some fish, such as red bass ( bohar snapper ) and paddletail, may be banned from sale in some localities ( 18, 32 ). ...

Skipjack tuna in particular, is a well known cause of ciguatera poisoning ( 20 ).
This is extremely important since the dark fleshed skipjack is by far the most commercially important species of tuna in the world, comprising 50% of the total world tuna trade in 1999 ( 22, 23 ). ... the darker fleshed forms of canned tuna may contain skipjack, yellowfin, or bluefin ( 25 ).

.. Since it is impossible to say where a given fish has been, or where its dietary victims have been, it is impossible to guarantee the absolute safety of a particular fish. As has been aptly noted, "any fish living in the sea may be a potential vector of ciguatoxin ( 18, 18c ). Having said this however, it is clear that the risk of ciguatera may be minimised by selecting a suitable species of fish.