TM Emms , M Thrift , I Buttfield , TK Roberts , HL Butt , RH Dunstan , NR McGregor 
1: Collaborative Pain Research Unit, School of Biological and Chemical Sciences, University of Newcastle, Callaghan, NSW, 2308 Australia
2: Cooranbong Medical Centre, NSW, Australia.
3: Warinilla Drug Clinic, SA, Australia
Previous studies investigating a molecular basis to Chronic Fatigue Syndrome (ME/CFS) reported that urinary excretion of the amino acid serine is an important discriminatory metabolite distinguishing subjects from controls . Excretion of serine was negatively correlated to neurological and total symptom indices and positively with overall symptom severity. Serine deficiency is suggested as an important factor contributing to the severity of symptoms in ME/CFS patients. Serine is proposed to be conditionally essential wherein the disease process may increase metabolic demands.
Recent studies have reported an alteration in faecal coliforms such as E. coli in ME/CFS subjects that may result in changes to production of bacterial metabolites including serine and tryptophan . The essential amino acid tryptophan, an indirect precursor of the neurotransmitter serotonin, can be synthesised directly from serine by micro-organisms. It is plausible that altered production of serotonin could result in cognitive dysfunctions characteristic of ME/CFS. Symptom improvement and increased quality of life for ME/CFS patients have been reported in uncontrolled clinical trials in South Australia and New South Wales . This study is a preliminary evaluation of clinical data to assess the potential efficacy of L-serine with view to a larger, fully controlled study.
Twenty eight ME/CFS patients fulfilling the Fukuda diagnostic criteria and having low urinary serine excretion were supplemented with 1-3 g L-serine daily (n=17) or in combination with other mineral, protein or probiotic supplements (n=11). The mean treatment time was 14.6 weeks (range: 74). Self-completed 86 question symptom severity checklists were implemented pre- and post- intervention. Data was analysed by Wilcoxin Matched Pairs test using Statistica for Windows (StatSoft Inc., 1999, Tulsa).
Significant reductions in symptom expression were seen in core CFS diagnostic symptoms, cognitive, neurological and musculoskeletal symptoms as summarised below (mean ± SE).
Preliminary results indicate L-serine supplementation, alone or in combination therapy, shows potential for symptom management in ME/CFS subjects and implementation of a double blind, placebo controlled clinical trial is justified.
1. McGregor NR, Dunstan RH, Zerbes M, Butt HL, Roberts TK, Klineberg IJ. Biochemical and Molecular Medicine 1996;57:73-80
2. Butt HL, Dunstan RH, McGregor NR, Roberts TK, Harrison T, Niblett S, Emms T. Proceedings Second World Congress on Chronic fatigue Syndrome, Brussels, 1999, p33.
3. Buttfield I, Thrift M: Unpublished data
Source: www.ahmf.org. Presented at the 2001 Clinical and Scientific Meeting: Myalgic Encephalopathy/Chronic Fatigue Syndrome: "The Medical Practitioners' Challenge in 2001."