Klimas Conference Video 4: The Basics of Treating CFS/ME and GWI

Jody Smith continues her review of INIM’s Patient Conference with a look at Dr Irma Rey’s presentation.

In the fourth video of the Institute for Neuro Immune Medicine’s Patient Conference in January, Dr. Klimas introduced Dr. Irma Rey, Assistant Professor of Medicine, of the Department of Clinical Immunology. Dr. Rey is also Director of Medical Education, Nova Southeastern University, College of Osteopathic Medicine, Institute of Neuro-Immune Medicine.

Without Dr. Rey, none of what is happening at NSU for Chronic Fatigue Syndrome and Gulf War Illness would be possible, Dr. Klimas said.

Lymphocytes the main focus of study

Dr. Rey said that lymphocytes are the main focus of study. She explained a little bit about the blood tests that are taken, displaying the information on the screen.

The blood tests reflect the overall immune system, though 95 percent of the immune system is in the tissues (lymph nodes, spleen, skin and gut).
White blood cells start out as stem cells in the bone marrow, and they learn their “destiny” as they travel through the body to the thymus and liver.
Part of the immune system stem cells are composed of lymphocytes. Lymphocytes are the main focus of immune studies in CFS/ME and GWI.
Cytotoxic T cells and NK cells prevent viruses from reactivating and kill tumor cells to prevent cancer.

An Immunologic and Biologic Illness

Dr. Rey described CFS/ME as an immunologic and biologic illness. She reported that CFS/ME patients have lower than normal NK cell activity. She described Natural Killer cells as the SWAT team of the immune system, on the lookout for invaders like tumors or viruses.

Dr. Rey said that she is always looking for markers for things that can be treated. They make a practice of testing for the following viruses:

Parvo B 19, also called Fifth Disease
CMV, similar to mononucleosis
EBV (mono) also called HHV 4
HHV 6 (roseola)
Coxsackie B (Hand, Foot & Mouth)

Sleep and Endocrine Disorders

CFS/ME is associated with sleep disorders, as well as endocrine disorders such as thyroid, adrenal, pituitary and sex organ problems. Dr. Rey said that just treating one aspect of the syndrome doesn’t help much. If you don’t address all components, it’s hard to bring any improvement.

Cognitive dysfunction includes memory problems, difficulty concentrating and processing thought.

Autonomic disorders involve abnormalities in blood pressure, heart rate and temperature. When you push the autonomics, Dr. Rey observed, the disease in general seems to get worse.

Mood disorders can accompany this illness. Dr. Rey emphasized that mood disorders may result just because of the loss of so many aspects of a patient’s past life.

Sleep disorders can include:

Sleep apnea, even if the body mass index (BMI) is normal. This may be due to fatigue of neck muscles.
REM abnormalities
Restless leg syndrome

Endocrine abnormalities include:

Thyroid nodules
Hashimoto’s disease
Under functioning thyroid gland
Adrenal fatigue
Irregular menstrual periods
Absent menstrual periods
Abnormalities in estrogen and progesterone production, endometriosis, polycystic ovaries syndrome, and uterine fibroids
In men, low testosterone levels, even in young men
Pituitary evaluation is necessary if there are abnormalities in the adrenal axis

CDC Criteria for CFS

Dr. Rey put the CDC Criteria for Chronic Fatigue Syndrome up on the screen:

The individual has had severe chronic fatigue for 6 or more consecutive months that is not due to ongoing exertion or other medical conditions associated with fatigue. The individual concurrently has 4 or more of the following 8 symptoms (CDC: 2012)

Post-exertion malaise lasting more than 24 hours
Unrefreshing sleep
Significant impairment of short-term memory or concentration
Pain in the joints without swelling
Headaches of new type, pattern or severity
Muscle pain
Tender lymph nodes in the neck or armpit
A sore throat that is frequent or recurring

Immune Cells and Lymphocytes

Dr. Rey moved on to a screen that read Meet The Cells of Immune System:

Natural Killer Cell
Macrophage
T-Lymphocyte
Lymphocyte
Dendritic Cells

Then it was on to the Members of the Lymphocyte Family:

Helper/Inducer cells start the immune response
B cells make antibodies
NK cells kill virally infected cells and cancer cells
T cells include CD4 (helper cells), CD8 (cytotoxic T cells) and T-reg cells
Cytotoxic T cells kill infected cells and cancer cells

Immunologic and Virologic Testing

Dr. Rey went next to a screen about Immunologic/Virologic Testing checks:

Numbers of CD4 cells and percents
Types – what kinds of cells and their purpose
Function – do they work? In vitro testing
Infection – survey of possible reactivated viruses or chronic infection

Information Immunologic Testing:

Products: Cytokines are messenger proteins made by the cells. Some cause inflammation, others help the cells with antiviral or antibody production. Some are anti-inflammatory

Numbers: T cells, B cells, NK cells and their activity state of mind — activated or quiet, memory or naive

Function: NK cell function tests the ability to clear virally infected cells and cancer cells

The NK Cell Diet

Dr. Rey gave some information about the recommended Natural Killer Cell Diet:

Step 1:

Week 1 – 50 mg CoQ10, 1000 mg omega-3 fatty acids, 500 mg vitamin C, for vitamin D3 levels should be checked because D3 is fat soluble and it may be possible to have too much, vitamin B12 levels should also be checked.

Week 2 – 100 mg CoQ10, 2000 mg omega-3 fatty acids, 1000 mg vitamin C, vitamin D3 and B12 levels should be checked.

Week 3 – 150 mg CoQ10, 3000 mg omega-3 fatty acids, 1500 mg vitamin C, vitamin D3 and B12 levels should be checked because anything under 400 could indicate neuropathic problems.

Week 4 – 250 mg CoQ10, 4000 mg omega-3 fatty acids, 2000 mg vitamin C, vitamin D3 and B12 levels should be checked.

Step 2:

Dr. Rey said that this information was not up on the screen because they discourage people trying to treat themselves with Immunovir due to its possible side effects. They start first with things that cause the least amount of side effects, which are the antioxidants.

Step 2 includes amino acids, and Inosine or Immunovir.

Step 3:

Studies have indicated it can be beneficail to use antivirals for treating the herpes family viruses.

Famvir, Zovirax or Valtrex, Equilibrant and Valcyte may be prescribed.

Dr. Rey recommends that people start supplements in small amounts and slowly increase, because most CFS/ME patients have a hard time processing medicines.

In the beginning she and Dr. Klimas were starting all supplements at once and almost 100 percent of their patients couldn’t handle it. She suspects that it is due to our lack of detoxification pathways. Starting slowly allows the body to metabolize supplements more easily and tolerate the doses.

She repeated something that Dr. Klimas said on an earlier video. “If it’s making you sick, stop. Let us know that you stopped … so we can make correction in the middle of your treatment. However it’s important to try to take it even if we have to go up very slowly, every other week, every three weeks, every month, whatever is required is what we recommend doing.”

Dr. Rey showed a short video on Natural Killer Cells. “I wanted to let you know how much I’m in love with the Natural Killer cells [laughter from the audience] and how much I want to try to help them do their work for you. Thanks for listening.”