О.І. Волошин1, Л.І. Власик1,2, Л.О. Волошина1, Н. Айнуссі1, А.Л. Сухолотюк1
1 Буковинський державний медичний університет,
2 ДП «Науковий центр превентивної токсикології, харчової та хімічної безпеки імені академіка Л.І. Медведя, Міністерство охорони здоров'я, м.Чернівці, Україна
РЕЗЮМЕ. Актуальність. Синдром хронічної втоми (СХВ) вважають одним із викликів медицині світу: зростає його поширеність, складні патогенез і діагностика, низькі результати лікування.
Мета – підвищити ефективність комплексного лікування хворих із СХВ (після основного етапу) шляхом застосування патогенетично вдосконаленого оздоровчого харчування.
Матеріали і методи. Спостереження проведені у 48 хворих із СХВ, у 25 з яких застосували удосконалене оздоровче харчування (основна група) на тлі дозованих фізичних навантажень, психотерапії та ког-нітивно-поведінкової терапії в обох групах. Тривалість спостереження – один рік.
Результати. Встановлено, що у хворих основної групи впродовж року вірогідно рідше спостерігались рецидиви СХВ, меншою була їх тривалість, тривалішими періоди ремісії та повне відновлення професійної здатності; лише зрідка потребувалось застосування медикаментозних засобів (при рецидивах), кращими були якісні показники життя.
Висновок. Правильно побудоване оздоровче харчування хворих із СХВ з урахуванням впливу на основні ланки патогенезу цієї недуги може значно покращити загальні результати безмедикаментозних методів комплексного лікування.
Ключові слова: синдром хронічної втоми, патогенетично вдосконалене оздоровче харчування.
Relevance. Chronic fatigue syndrome (CFS) is a multiple organ disease, polyetiologic in nature, with inadequately examined pathogenesis, which affects a part of the most creative population, urban residents mostly and women in particular. It diagnostics and treatment today are rather [1, 3, 5, 8]. CFS has a tendency to increase, especially in the most developed countries. It occurs under the influence of numerous external and internal factors. The issue is examined intensively and diversely by means of modern methods including neurovisualization. Different names of the disease are found in scientific literature such as myalgic encephalomyelitis (ME), CFS/ME, systemic exertion intolerance disease (SEID) [8, 18]. The number of such patients in the world is considered to achieve dozens of millions including less developed countries and Ukraine, which can cause a burdensome medical-social problem for any state [4, 6, 18]. For example, the USA spends about 24 billion dollars for medical service issued to two millions of CFS registered patients [8]. Though there are certain opinions that it is only 20% out of an expected amount of patients who are not still diagnosed as those having CFS on different reasons.
Deep and expensive studies of CFS pathogenesis in recent years have shown that the basis of the disease is formed by systemic and stable metabolic disorders (decrease) on the levels from the neurostructures to cellular mitochondria [15, 16], considerable and resistant immune disorders [11], systemic inflammation, oxidative, nitric oxide stresses, and endothelial dysfunction [14, 15]. All of them are caused by dysfunctions of the nervous, endocrine, immune systems, deterioration of their interaction [16], reduction of cognitive functions, psychosocial functioning, and deterioration of activity of other organs and systems [18]. The above mentioned promotes frequent infection by viral diseases of herpes virus group (cytomegalovirus, Epstein-Barr virus (EBV), VІ type virus or Borna virus etc.), which are characterized by lifelong persistency with periodical reactivation, immune suppression, pantropism, opportunistic pattern and a complicated strategy of parasitizing enabling them to avoid the action of antiviral agents [17]. These peculiarities of herpes virus parasitizing in a depressed organism are considered to be one of the causes of systemic and multiple organ signs of CFS, stable maladjustment on various levels and low results of treatment [17]. Though, bio-
logical “behavior” of herpes viruses in the human body is evidenced to depend on the state of its immune system, and the viruses play the role of triggers promoting exacerbation of the disease [17, 18]. The latest information concerning possible pathogenic role of intestinal microbiome disorders in CFS patients deserves certain consideration [9].
Scientific achievements and conceptions mentioned have become powerful arguments for improvement of a comprehensive treatment of this complicated illness called a new challenge to the world medicine [6, 8]. Nowadays a comprehensive treatment of CFS in the view of evi-denced-based medicine is rather complicated in its structure and realization. It is based on the use of non-drug and pharmacological measures, but non-drug approaches appeared to be more effective [6, 12]. In the context of the latter the following measures are recognized: dosed increasing physical activity, psychotherapy, cognitive-behavioral therapy, psychosocial support and education of patients, health-improving diet [10]. It is health-improving diet that is least described in modern literature in the aspect of CFS treatment [10]. Though there are certain studies concerning effect of dietary supplements in the form of vitamin-trace elements complexes, L- carnitine, coenzyme Q10, adenine nucleotide, apiculture products in a comprehensive treatment of CFS patients [7, 13].
Achievements in investigation of pathogenesis of numerous illnesses have made the foundation to improve not only pharmacological treatment but created new views and conceptual approaches in dietology. One of the examples is the book by H.K.Bakhru “Healing through Natural Foods” [5]. On the basis of the world achievements in dietology the author distributes the most valuable health-improving food staff according to a key mechanism of action: antibacterial, anti-inflammatory, antioxidant, antidepressant, immune modulating, sedative, nootropic etc. Such an approach forms totally different opinions concerning different healthimproving food staff in the context of pathogenic thinking of a doctor in case of disease, extends understanding of their differentiation application in diet strategy, and demonstrates a diverse, multiple organ effect produced on the human body by one food item in particular and in their combination.
Possessing the experience of many years in using health-improving diet and apiculture products in case of internal diseases summarized in the monograph [2] and considering modern scientific approaches in dietology presented by H.K.Bakhru [5], we have advanced healthy-improving diet of CFS patients at the second stage of their rehabilitation (2-2,5 months after a comprehensive non-drug and pharmacological treatment) considering the latest achievements in investigation of pathogenesis of the disease.
Objective is to increase the results of a comprehensive treatment of CFS patients by means of the use of pathologically advanced healthy-improving diet at the second stage of rehabilitation.
Materials and Methods. 48 patients suffering from CFS at the age of 28-53 were observed including a dominating group of women (36 individuals – 75,0%). The diagnosis of CFS was made according to the criteria of the US Center for Disease Control and Prevention (CDC). All the patients underwent the first (main) stage of treatment by means of complexes of non-drug means (dosed physical exercises, variants of psychotherapy, autogenic training, yoga, Wushu, cognitive-behavioral therapy, therapeutic diet focused on vitamin intake) and pharmacological ones (one of nonsteriod anti-inflammatory agents, antidepressants, antioxidant vita-min-trace elements complexes) during 2,5-3 months achieving complete remission in 25 individuals and incomplete remission in 23 patients (47,91%).
Further course of the disease has a tendency to frequent relapses, and even during remission the tolerance to psychophysical exertion decreases which later can cause exacerbation. The management of such patients at further stages of observation should include non-drug measures only, mainly dosed physical exercises, certain elements of psychotherapy, rational job placement, improved diets and minimized administration of medicine as much as possible [1, 4]. Considering our own long-term experience of an effective use of therapeutic diet in case of other internal diseases [2] as well as the latest achievements in investigation of CFS pathogenesis [14], and according to the distribution of health-improving food by key mechanisms of action suggested by H.K. Bakhru [5], we have developed our own recommendations of health-improving diet for this group of patients and instructions for CFS patients containing information about the nature of the disease, importance to realize the suggested healthimproving diet in order to promote recovery from
the illness, proper restoration of capacity to work (maintenance of professional and social activity), and the role of the patient and his family in the overall process (Table 1 and Instructions).
The patients were randomized into two clinical groups: the main one (25 individuals) who gave a written consent to realize dietary program, and the group of comparison (23 patients), who were not able to keep to the suggested recommendations due to various reasons. Both groups were matched concerning age, sex, duration and manifestation of the disease.
The information about the nature of the disease and recommendations are presented in the form understandable for the patient in order he/she follows them consciously but not automatically. The patient will be able independently evaluate efficacy and requirements for further keeping to the recommendations as a new reliable life style and diet. Such Instructions were issued to every patient from the main group.
The patients were observed for a year. They were visited with inspection every quarter, and in certain cases – by the telephone.
Table 1
Basic dietary recommendations issued to CFS patients (the list, description of the recommended food containing higher content of arginine and carnitine, and recommendations to use them)
The following efficacy criteria are indicated: frequency and duration of CFS relapses during a year, duration of remission, qualitative indices of life (mood, sleep, tolerance to psychophysical exertion, restoration of professional ability), the need to administer medicines additionally.
The materials were statistically processed by means of PC and the package of statistical software Excel for Windows, Statistica 6,0 and SPSS Statistics.
Results and discussion. Clinical age-sexual, urban characteristics and risk factors of the examined groups with CFS are presented in Table 2.
It should be noted that women suffered from the disease longer (2,8±0,43 роки). They did not readily respond to treatment at the preliminary stages. Risk factors both industrial (night shift work) and domestic (daily desynchronosis) were more frequent among them; night recovery period was reduced (duration of sleep), and meals were inadequate and irregular.
The majority of patients followed the recommendations contained in the Instructions carefully. Compliance was considered to be satisfactory (about 80% of recommendations). The level of performance was determined by social-economic status of the patient and level of education.
The results of the suggested health-improving diet depended on the degree of elimination/min-imization of risk factors, duration and manifestation of the disease. Particular results of treatment according to the suggested criteria in the main group and the group of comparison are presented in Table 3.
The statistical data presented in Table 3 demonstrate that the health-improving diet added to a comprehensive treatment of patients with CFS at the second (after the main one) stage of rehabilitation improves general outcomes considerably. Worse results of treatment in the group of comparison demonstrate that keeping to dosed physical exercises and various variants of psychotherapy, education of patients with usual regimens and quality of diet do not provide reliable recovery, and occupational restoration. Frequent and longer relapses require additional administration of 2-4 medicines, usually nonste-riod anti-inflammatory drugs in combination with adaptogens or antidepressants, antioxidants. CFS relapses in both groups of patients examined were found under conditions of inadequate elimination of risk factors, long anamnesis of the disease and individuals over 40, and low social-economic status.
Table 2
Age-sexual characteristics and risk factors of the examined patients with CFS
Table 3
Results of the health-improving diet use after the main stage of a comprehensive treatment of patients suffering from chronic fatigue syndrome
Note: * - degree of confidence in the main and comparison groups of patients (р<0,05-0,01)
Conclusions
1. Chronic fatigue syndrome is a long and often relapsing pathological condition requiring an improved comprehensive treatment including the period after the main stage of therapy focusing on non-drug methods of treatment.
2. Rationally developed health-improving diet considering the effect produced on the main pathogenic chains of the disease (activation of metabolic processes, increase of immune, cognitive properties; decrease of the signs of systemic inflammation, depression and intestinal dysbiosis) can improve general results of treatment and rehabilitation of such patients considerably.
3. Appropriate educational component of patients concerning their diet, their motivation to conscious fulfillment of the suggested recommendations are an important constituent in the improvement of results of a comprehensive treatment.
In further studies the authors consider to test different apiculture products in a comprehensive treatment of patients with CFS.
INSTRUCTIONS
for a patient with chronic fatigue syndrome (or how to get rid of the illness)
Chronic fatigue syndrome (CFS) is a disabling disease, but unlike the majority of other diseases its course is considerably longer, it does not respond to treatment readily and the success of treatment depends on both doctors and patients (following all the recommendations, especially those concerning diet and life style).
1. Determine risk factors of the disease and eliminate them as much as possible. Risk factors of CFS include: malnutrition (insufficient mount of vitamins, fruits, vegetables, animal proteins, trifling breakfast or its absence, overeating before going to bed, two meals a day, abuse of tonics, coffee, tea etc.), long psychophysical exertion, long excessive stresses of various origin, short recovery period (sleep, lack of days off, holidays), occupational sedentary style (drivers, IT workers etc.), bad habits (nicotine, alcohol), unfavorable environment or working conditions etc.
Calculate a fluid balance of your diet (norm – 2-2,5 L/day: first dishes 250-350 ml; fruit, vegetables or juices – 400-700 ml, sour dairy products 250-500 ml, herbal teas or mineral waters – 500-750 ml, the rest – usual drinking water of a good quality).
2. Remember: your disease is based on disturbed (reduced) metabolism, decreased (inhibited) immunity, weal but stable inflammation on all the levels of the body, chronic infections (including viral ones), depressed activity of the central nervous system (memory, ability to concentrate, sleep, mood, headache, depression), muscular-skeletal system (chronic weakness, muscular pain and ache in joints), gastrointestinal tract (abdominal discomfort, flatulence, stomach rumbling, unstable defecation) and other systems.
3. The above signs can be eliminated (or reduced) by means of the following food included into your everyday meals:
a) improve metabolism: carrot, cabbage, ginger, garlic, oats, onion, nuts, seeds of pumpkin, sunflower, tomatoes, pumpkins, squash, green vegetables such as parsley and dill, currants, blueberries;
b) increase immunity: sour dairy products (especially yoghurt, kefir), carrot, garlic, mushrooms (porcini (Boletus edulis), ), chanterelle), zinc and selenium containing food including nuts, seeds of pumpkin, sunflower, peas, beans, cereals, raw fresh domestic chicken or quail eggs (4-6 eggs/day);
c) eliminate chronic inflammation or pain of various localization: ginger, curcuma, onion, honey, lemon, lime, radish, cloves, cabbage, home cheese, caraway seeds, sage (tea), carrot, egg-plant, dill seeds, cinnamon, green vegetables such as parsley and dill, red bilberries, cranberries;
d) reduce depression: apples, honey, chili pepper, garlic, green vegetables, selenium containing food – milk, tomatoes, garlic, onion;
e) improve memory: bee pollen with honey (1:1) 1-2 table spoons a day with herbal tea, apples, black pepper, nuts, caraway seeds, sunflower seeds, lemon, parsley;
f) normalize the activity of the gastrointestinal tract: yoghurt, kefir, ginger, curcuma, seeds of dill and caraway, cinnamon, garlic, parsley.
4. Notice that such available health-improving food as carrots, cabbage, garlic, onion, ginger, nuts, oats, honey, apples, peas, tomatoes, green vegetables (parsley, dill) possess many-sided action practically for all the signs of the disease.
5. Health-improving mixtures should be combined most often: honey with bee pollen (1:1), honey with nuts (walnuts, hazelnuts) or seeds of pumpkin or sunflower; sour dairy food, ginger, curcuma, cinnamon.
Remember: keeping to all the doctor’s recommendations concerning the use of non-drug means of treatment of the disease is considerably more effective and reliable than expensive pharmacological therapy.
All these recommendations have been developed according to Hippocrates’ postulate: «Let your food become your medicines».
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Received 3/16/2020