Chris Kresser: Yeah, very complicated, and it’s long been posited that chronic infection plays a role in ME/CFS. At some point, the dominant idea was that ME/CFS was caused by viral infection, although there’s not a lot of evidence to support that, and that has kind of fallen out of favor as a hypothesis. There’s some evidence now that biotoxin-related illness, like chronic inflammatory response syndrome, may be at the root of ME/CFS for some people. I think it’s very likely a multifactorial condition with multiple different etiologies, depending on the patient and the presentation. And I do think that chronic infection can be misdiagnosed as ME/CFS.
It’s really difficult to give a kind of concise overview of how to work a patient up like this because the level of complexity is really high, and also the level of equivocality in the diagnostic procedures is really high, which is one of the reasons why I’m not covering it in this initial course. When I do cover it, it’ll probably be one of the last things I cover because it’s something that I feel like I need more time with and more experience with to develop a level of expertise where I would feel comfortable sharing and teaching this. Dr. Schweig, who is my co-director at CCFM, is a chronic infection specialist, and we’ve talked about teaching that module together.
We have an extensive panel of labs that we use to work up a patient who we think has a chronic infection, and the trouble is, what do you do with those lab results? I’ve talked with Dr. Schweig about this extensively and other clinicians. As you hint at, Tom, the problem with these conditions is they’re stealth infections, and by definition, a stealth infection is something that evades the immune system’s ability to detect it. It’s problematic if you’re using antibodies as the primary means for detecting infection, and the body can’t see the infection because it’s intracellular and is not producing antibodies, and you can see how that would lead to a problem with the test. Then the other issue is that even if you do see IgG antibodies, there’s no telling whether that infection is current or past, and many of these conditions are very common. Mycoplasma pneumoniae affects a really high percentage of people, so if you see IgG antibodies to mycoplasma, that really doesn’t tell you much in terms of the pathogenicity of that infection, and that can even be true with Lyme or bartonella.
It’s murky. It’s problematic. I would suggest if you’re new to this just sticking with all of the things that you know and are learning now as much as possible or referring out to someone who specializes in that kind of workup because it’s pretty tricky to do even with some experience, and if you have no experience at all, I probably wouldn’t … I guess it depends on your makeup. If you want to just dive in and do it, it could be instructive and you might learn something, but it’s really problematic. I think that’s the best way to summarize it.