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Fluctuation of serum vitamin E (alpha-tocopherol) concentrations during exacerbation and remission phases in patients with chronic fatigue syndrome – Source: Heart and Vessels, Jul 31, 2010

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By Kunihisa Miwa, Masatoshi Fujita • • August 3, 2010

[2012 update note: Kunihisa Miwa, MD, a world leader in ME/CFS research, explains in this article that low vitamin E serum concentrations are strongly associated with cardiovascular risk factors, are "low in ME/CFS patients irrespective of the presence of coronary risk factors," and are evidence that increased need for antioxidants is an important factor in ME/CFS symptoms and severity. His new book - An International Perspective on the Future of Research in Chronic Fatigue Syndrome, released Feb 2, 2012 and edited by ME/CFS physiology researcher Christopher Snell, PhD - features a discussion of cardiovascular issues in ME/CFS, including this chapter reviewing his ongoing research on "Small Heart as a Constitutive Factor Predisposing to Chronic Fatigue Syndrome."]


The etiology of chronic fatigue syndrome remains unknown. Oxidative stress may be involved in its pathogenesis. Vitamin E is a major endogenous lipid-soluble antioxidative substance, and is consumed during the lipid peroxidation process [to counteract free radical damage to lipids in cell membranes].

We studied a population comprising 27 patients with chronic fatigue syndrome (10 men and 17 women, 29 +/- 6 years of age) and 27 age- and sex-matched control subjects.

Serum vitamin E (alpha-tocopherol) concentrations were determined and expressed as mg/g total lipids (total cholesterol and triglyceride) to evaluate oxidative stress.

Serum alpha-tocopherol concentrations (mg/g lipids) were significantly (P < 0.001) lower in the patients with chronic fatigue syndrome (2.81 +/- 0.73) than in the control subjects (3.88 +/- 0.65).

The patients with chronic fatigue syndrome were re-examined during a follow-up interval. After 8 +/- 2 months, 16 patients exhibited a status that warranted re-examination during remission of the symptoms at a regular visit to our hospital (Group 1), while the remaining 11 did not (Group 2).

• The serum alpha-tocopherol levels were significantly elevated during remission as compared with those at baseline in Group 1 [CFS patients] (2.71 +/- 0.62 --> 3.24 +/- 0.83, P < 0.001).

• The levels did not significantly change after the interval in Group 2 [control subjects] (2.97 +/- 0.86 --> 2.85 +/- 0.73, not significant).

In conclusion:

• Serum alpha-tocopherol concentrations were significantly lower in the patients with chronic fatigue syndrome as compared with the control subjects, suggesting increased oxidative stress in the former.

• The low level of serum alpha-tocopherol was ameliorated during the remission phase as compared with the exacerbation phase in the patients with chronic fatigue syndrome, suggesting that increased oxidative stress may be involved in the pathogenesis of chronic fatigue syndrome and might also be directly related to the severity of the symptoms of chronic fatigue syndrome.

Source: Heart and Vessels, Jul 31, 2010;25(4):319-23. PMID: 20676841, by Miwa K, Fujita M. Department of Internal Medicine, Nanto Family and Community Medical Center, Nanto, Toyama, Japan [E-mail:]

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