January 2016

Environment-Linked Illnesses: A Mainpro Workshop Recap

By guest author Dr. Alison Bested

Myalgic encephalomyelitis-chronic fatigue syndrome (ME/CFS) fibromyalgia (FM) and environmental sensitivities/multiple chemical sensitivity (ES/MCS) are complex chronic medical conditions. As a result of not having diagnostic blood tests or investigative tools, along with the variety of case criteria, clinicians can be skeptical that these conditions are legitimate. Patients with these medical conditions can be maligned and told they do not have a real physical illness.

Most patients struggle to get a diagnosis because doctors have not been trained to use consensus criteria to diagnose or treat ME/CFS, FM and ES/MCS.

The precise etiology of these conditions remains unknown, but recent advances and discoveries are beginning to shed light on the enigma of these diseases including their genetic, immune, cognitive, metabolic and biochemical abnormalities. Management of patients with these conditions involves supportive symptomatic treatment with a patient-centered care approach, which begins with addressing the symptoms which are most troublesome for the patient.

Statistics indicate these conditions are very common. The Institute of Medicine (IOM) reviewed the ME/CFS literature and estimated between 836,000 to 2.5 million Americans have ME/CFS. The cost of ME/CFS alone is between $17 and $24 billion dollars annually in the US. In Canada according to the 2010 Canadian Community Health Survey (CCHS), over 400,000 individuals were diagnosed with ME/CFS, over 400,000 diagnosed with FM and over 800,000 with ES/MCS. The CCHS also found these patients had the following issues: 13 to 20 per cent had food insecurity; 26 to 31 per cent had unmet health-care needs (twice as much as the general population) and 10 per cent had a household income of less than $15,000.

The presence of ME/CFS, FM or ES/MCS may not be straight-forward, but are important to consider when supporting patients. The following scenarios provide some examples that can assist family physicians consider ME/CFS, FM or ES/MCS in their practices:

  • Consider ME/CFS in the differential diagnosis for patients, like a middle aged woman who never recovers after a flu or after mononucleosis in a teen. The patient is severely fatigued and has to lie down after pushing herself to finish a task which pre-morbidly was doable. They have unrefreshed sleep, difficulty concentrating, remembering multi-tasking and recurrent sore throats and other new symptoms such as Irritable Bowel Syndrome (IBS).
  • Consider FM in a middle aged woman who was in a recent car accident where she was rear ended and sustained a whiplash injury and pain in her neck and shoulders. Six months later she has pain throughout her body, unrefreshing sleep, difficulty concentrating, remembering multi-tasking and is so severely fatigued that she is missing work.
  • Consider ES/MCS in a person who chronically has a stronger sense of smell than others. When exposed to low levels of unrelated chemicals such as cigarette smoke or perfumes, the person has difficulty concentrating, feels groggy or spacey. The person's symptoms improve when the person is removed from the stimulating scented product.
About the author:
Dr. Alison Bested is a Haematological Pathologist and Clinical Associate Professor (Faculty of Medicine) at University of British Columbia. For the past 25 years her medical specialty practice has been dedicated to patients with complex chronic medical conditions including ME/CFS, ES/MCS, FM, and persistent Lyme disease. She works in Toronto and Vancouver and is also the co-author of two books: Hope and Help for Chronic Fatigue Syndrome and Fibromyalgia and The Complete Fibromyalgia Health Diet Guide and Cookbook. Additionally, she has also co-authored (with EHC Chair Dr. Lynn Marshall) a Review of Myalgic Encephalomyelitis /Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians that was published in the Reviews of Environmental Health in December 2015.