Main Article Content
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.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
Harvey SB, Wadsworth M, Wessely S, Hotopf M. Etiology of chronic fatigue syndrome: testing popular hypotheses using a national birth cohort study. Psychosom Med. 2008;70:488-495
Palmero Neto J, Santos F, Guerra JL, Santos GO, Pinheiro SR. Glue solvent inhalation impairs host resistance to Mycobacterium bovis-induced infection in hamsters. Vet Hum Toxicol 2001;43:1-5.
Little CH, Georgiou GM, Shelton MJ, Simpson F, Cone RE. Clinical and Immunological responses in subjects sensitive to solvents. Arch Environ Health 1999;54(1):6-14.
Nijem K, Kristensen Pe, Al-Khatib, Takrori F, Bjertness E. Prevalence of neuropsychiatric and mucous membrane irritation complaints among Palestinian shoe factory workers exposed to organic solvents and plastic compounds. Am J Indust Med 2001;40:192-8.
Yokohama K, Araki S, Murata K, Nishikitani M, et al. Postural sway frequency analysis in workers exposed to n-hexane, xylene and toluene: assessment of subclinical cerebellar dysfunction. Environ Res 1997;74:110-5.
Checkoway H, Costa LG, Camp J, Coccini T, Daniell WE, Dills RL. Peripheral markers of neurochemical function among workers exposed to styrene. Brit J Indust Med1992;49:560-5.
Chen R, Dick F, Semple S, Seaton A, Walker LG. Exposure to organic solvents and personality. Occup Environ Med 2001;58:14-18.
Chen R, Dick F, Seaton A. health effects of solvent exposure among dockyard painters: mortality and neuropsychological symptoms. Occup Environ Med 1999;56:383-387.
Schmidt CW. Unraveling Environmental Effects on Mitochondria. Environmental Health Perspectives. 2010;118(7):A292-A297.
Iris R Bell MD. PhD et al. Illness from low levels of environmental chemicals: relevance to chronic fatigue syndrome and fibromyalgia. The American Journal of Medicine Volume 105, Issue 3, Supplement 1, 28 September 1998, Pages 74S-82S,
Rea WJ, Pan Y, Laseter JL, Johnson AR, Fenyves EJ. Toxic volatile organic hydrocarbons in chemically sensitive patients. Clinical Ecology 1987;5(2):70-4.
Liu L, Li Y, Tollefsbol TO. Gene-Environment Interactions and Epigenetic Basis of Human Diseases. Curr Issues Mol Biol. 2008; 10(1-2): 25–36.
Feero WG. Introducing “Genomics and Precision Health”. JAMA. 2017;317(18):1842–1843. doi:10.1001/jama.2016.20625