MAGICAL MEDICINE: HOW TO MAKE AN ILLNESS ... - Invest in ME

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Pall’s ME/CFS Review, a requested paper on ME/CFS in a Nova Biomedical volume on ME/CFS was due to
be published towards the end of 2009, and chapter XX in the prestigious toxicology reference book “General
and Applied Toxicology”, 3 rd Edition, Eds. Ballantyne, Marrs and Syversen was published by John Wiley &
Sons on 23 rd October 2009. The press release for this book says: “1. MCS is a stunningly common disease, even
more common than diabetes. 2. MCS is caused by toxic chemical exposure. 3. The role of chemicals acting as toxicants
in MCS has been confirmed by genetic studies. 4. We have a detailed and generally well supported mechanism for
MCS. 5. For over 20 years, some have falsely argued that MCS is a psychogenic disease. This view is
completely incompatible with all the evidence. It is clear now that MCS is a physiological disease initiated
by toxic chemical exposure”.
Given that MCS in the form of intolerance to everyday household chemicals and foods, and to medicinal
drugs ‐‐ especially those acting on the central nervous system ‐‐ is a well‐documented feature of ME/CFS (a
feature that in May 1994 at the Dublin International Symposium on the disorder held under the auspices of
The Ramsay Society and The World Federation of Neurology, the internationally renowned neurologist
Professor Charles Poser of Harvard described as pathognomonic of the disorder), Pall’s work cannot be
separated from the body of knowledge that now exists about ME/CFS.
For a resume of Pall’s significant paper “Exquisite Chemical Sensitivity Mechanisms in MCS” (FASEB
2002:16:1407‐1417), see http://www.meactionuk.org.uk/Resume_of_Pall_MCS_paper_‐_August_2002.htm
Pall provides compelling evidence that none of these overlapping disorders is a somatoform disorder and
that the Wessely School paradigm is deeply flawed.
Pall posits that these multi‐system chronic disorders are initiated and maintained by chemicals that produce
a toxic response in the body, characterised by NMDA activity.
NMDA is N‐methyl‐D‐aspartate, an amino acid derivative acting at the NMDA receptor, mimicking the
actions of the neurotransmitter glutamate on that receptor. Glutamate is the most important excitatory
transmitter in the brain. Activation of NMDA receptors results in the opening of an ion channel. A unique
property of the NMDA receptor is that it allows changes in the flow of sodium, calcium and potassium into
and out of the cell.
The main classes of chemicals that initiate multi‐system disorders such as ME/CFS are the very large
class of organic solvents and related compounds, and three classes of pesticides: (i) organophosphorus
and carbamate pesticides, (ii) the organochlorine pesticides and (iii) the pyrethroid pesticides, all of
which are known to produce a common toxic response in the body (ie. increased activity of the NMDA
receptors).
Increased NMDA activity is known to produce increased calcium influx into cells, leading to increased
activity of two calcium‐dependent nitric oxide synthases, nNOS and eNOS, which in turn produce increased
nitric oxide. Nitric oxide reacts with superoxide to form peroxynitrite, a potent oxidant. Peroxynitrite leads
to a partial breakdown of the blood‐brain barrier, leading to increased chemical access to the brain. This
cycle is known as the NO/ONOO‐ cycle.
Cases of ME/CFS are also commonly initiated by viral or bacterial infection, including Coxsackie, Epstein‐
Barr, rubella, varicella, parvovirus, Borna and Ross River viruses; such viral initiating stressors also act to
increase nitric oxide levels, which is the common feature. Physical trauma also increases nitric oxide levels.
Once the cycle is initiated, it becomes the cause of the chronic illness, with the initiating chemical, viral
or traumatic stressor often long gone.
Pall notes that the most characteristic symptom in ME/CFS is the inability to deal effectively with
exercise, and that it has been observed that the difference in ME/CFS patients in response to exercise is