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Cellular Hypoxia and Neuro-Immune Fatigue

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One of the signs of a great mind is the ability to analyze a new area of science in order to make it easier to grasp. It's not a question of dumbing down the material or over-simplifying it. It's a question of choosing how to categorize things, looking at both the forest and the trees, and knowing which details to focus on.

Dr. Bell has accomplished this task in his new book, "Cellular Hypoxia and Neuro-Immune Fatigue". In this book, Bell is able to cogently summarize the different strings of research on chronic fatigue syndrome and related disorders, while providing strong ideas for the future of medical research. He is able to go through the literature with the proficiency of a skilled athlete, who makes difficult tasks look graceful. It's been a long time since I've read a non-fiction book that was truly a page-turner.

As Bell points out, the research on CFS is scattered. It is as if chronic fatigue syndrome is simultaneously everywhere in the body and nowhere in the body. Over the past few years, chronic fatigue syndrome has been the short-lived focus of diverse areas of research: experts in cardiology, autoimmunity, gastrointerology, endocrinology, infection, psychiatry, and other fields have all attempted to add to the puzzle, and often with little avail. Such experts will often draw conclusions that range from sheer bafflement at the illness to disbelief of the patient. The symptom presentation alone would suggest that the condition may be caused by damage to many different systems of the body. And at times studies will support this. Yet these studies are often not directly applicable to clinical practice; and it is clear that few of them get at the root cause of the illness.

In spite of this maze, Bell understands the importance of brevity. In a world where science is constantly changing, there is push-and-pull between specialized and generalized knowledge. In this book, Bell always goes straight to the point. At times, you get the impression that writing this book was an exercise in restraint; as if Bell was asking himself "What details are simply most essential?" instead of "What have I left out?"

In erring on the side of less rather than more, this book provides a sensible conceptualization of the illness, and I get the impression that it is more likely to find itself under the arm of physicians and researchers. It almost seems like it was written specifically to sneak its way into already busy and crowded minds. At the same time, Bell writes in a warm and inviting tone. He raises many ideas and questions; but he also focuses the reader on the tangible questions that can and need to be answered first.

The book's central argument is almost deceptively simple: Look at the cellular processes, and nitric oxide, and the conversion of energy, and the potential way that the immune system and the neurological system can affect these areas. Dysfunctions in these areas are likely to involve multiple organs and physical systems; consequently, research or treatment that only focuses on one organ or system is likely to be insufficient.

Bell's approach in writing this book should be tempered with the enormous task of dedicated writers in this field. There's a lot to cover: Since physicians often don't recognize the signs of ME/CFS, there's a need to adequately describe the symptom presentation. Since standard treatment often does little to fully relieve the symptoms, books on ME/CFS often provide miscellaneous ideas for treatment. Since academic research has not fully taken on the problem, remedies often consist of herbs, Eastern treatments, and oftentimes recommendations that lack empirical validation. Since most physicians lack a basic understanding, writers have often provide patients with warm and encouraging words of support. Bell has confined himself to only discussing the latest scientific ideas behind ME/CFS.

In sketching his overall argument, Bell highlights the major areas of research into ME/CFS, but he also draws out information from other fields. He draws connections bewteen facets of ME/CFS and multiple sclerosis, hypothyroidism, autoimmunity, and even septic shock. Despite the book's brevity, fully realized, its implications are likely to extend far beyond understanding ME/CFS.

Chronic fatigue syndrome is a puzzling phenomena - it is currently on the horizon of science, as researchers are just beginning to connect many of the dots, but it remains just beyond our grasp. To try to understand it is to directly confront the unknown; as expected, medical experts' reactions are almost always in the extreme. However, a curious reader can extract many important lessons about the principles of science here: Its rigidity and flexibility; the clash between common sense and scientific skepticism; the methods by which scientific results are applied to decision-making; the benefits and limitations of current methods of empirical measurement.

Perhaps most importantly, Bell draws an arrow towards what he thinks is the future of this field: The study of cellular and metabolic processes. Current research into the genetics of ME/CFS is already beginning to lay the groundwork for this area. Hopefully, after reading this book, medical experts will further continue to pursue this direction.

Thank you, Dr. Bell, not only for this your latest publication, but for all the years you've been a champion for all of us with ME/CFS/FM.

I've had ME/CFS/FM for more than 26 years and have always tried to be current with research on this terrible illness. But in the past few years the amount of information coming from doctors/researchers/organizations has been to say the least overwhelming.

Dr. Bell has taken a measure of all of the recently emerging research/theses/ideas about this and similar neuro-immune illnesses and processed them into what is the most understandable form I've yet encountered. He has kept it technical enough for health care professionals to be interested/informed, yet simple enough for patients to comprehend.

I've just purchased another copy to send to my doctor, I want him to be ready when the next inevitable step, successful treatment arrives. For the first time in many years I'm hopeful after reading this monograph, thanks again, Dr. Bell.

This book is easy to read and understand and breaks down the complicated biological processes that take place in the ME patient. Being a ME patient myself, I have found it essential to understand these processes and I identify with everything that is described here. Especially important has this been as the majority of medical opinions, in traditional arrogance, will point the ME patient towards the psychological explanation. Thanks David, for a great book, and for the sense of humour you deliver it with ;-)

Dr. Bell was one of the first doctors in the US to identify, diagnose and treat patients with CFS, and, as such, his views on CFS/ME/FM are based on a wealth of experience. Basically, Bell's theory is that there is a spectrum of neuro-immune illnesses which produce cellular hypoxia (cellular starvation). These illnesses can be triggered by a variety of factors--viral, bacterial, environmental, or CNS trauma. No matter what the trigger, they all lead to a condition in which the body continues to produce inflammatory chemicals, notably nitric oxide. The end result is a hyper-aroused immune response that interferes with the cellular production of ATP, the body's source of energy. This, Bell believes, is the root cause of the myriad symptoms common to these conditions.

There is a lot of research to support Bell's position, the most significant of which Bell cites at the end of each chapter. The notion that impaired mitochondrial production of ATP leads to the chronic phase of the illness is not a new one. The first doctor to have pointed out that patients with this disorder might have a mitochondrial defect was Dr. Ramsay, the British doctor who investigated Royal Free Disease in the 1950s. (As Dr. Bell points out, CFS/ME is indeed the disease of a thousand names.) Since that time Dr. Cheney and a host of researchers have amply demonstrated that patients suffering from this illness show defects in the Krebs cycle, the biological process that transforms vitamin C into ATP. Now that we understand the process, the question remains: What does one do about it? For, as Dr. Bell points out "a little bit of vitamin C" is not going to solve the problem.

Unfortunately, Dr. Bell tends to drop the ball when it comes to implications. For example, he gives the immune shift from Th1 to Th2 only a casual mention. This is a significant aspect of immune dysfunction in CFS/ME patients, and deserves more than a single sentence. And as for treatments, Bell has little to suggest outside of vitamin B12. (One is tempted to point out that "a little bit of B12" isn't going to solve the problem, either.) Dr. Bell, while long on explanation, tends to get vague when it comes to practical suggestions that might put his theory to good use. For those with the illness, this book might prove frustrating. But for those who simply wish to understand CFS/ME, Dr. Bell's simple and straightforward explanation will prove invaluable.

People who have ME/CFS/FM, have hope! This book confirmed that there is research being conducted in this field and the 'specialists' have not given up and put you in the 'too hard basket'. David Bell is a humorous writer and a brilliant mind. May all professionals working on treating this condition be blessed with David's ability to simplify complex subjects yet simultaneously analyse critical information as he has in this book. May they also be blessed with his inquisitive approach.
One critique; it does need another proofread. There are a few typo's. :)

The best part I like this book is author's comprehensive and integrative thinking and knowledge. The medical and clinical sciences today are divided into so many branches. Many specialists focus on and expertize in their certain field, but very often lose the whole picture. I appreciate Dr. David S. Bell's open minded, scientific and also with common sense analysis and his compassionate work. I hope to see more doctors like him.

The best short theory book I could find. I am not a medical professional but I was able to understand what the author was talking about. The chapters are short and comprehensible. It was a pleasant read. Dr. Bell is a gifted writer with a nice, ironic sense of humor. And you can tell he has a compassionate heart, which means a lot when you're someone who has endured one of these ailments for years. I was surprised and interested to read a description of my idiosyncratic traits -- like preferring to read in a horizontal position and not wanting to go shop at the mall.

The only warning I give is that this is not a treatment book. There is a brief mention of treatment options, such as taking B12, in the last chapter. If you want a comprehensive treatment book, buy "From Fatigued to Fantastic" by Jacob Teitelbaum, M.D. The two books combined are a winning combination.

A very important book, invaluable information. An absolute must-read for anyone with Fibromyalgia or Chronic Fatigue Syndrome.

Cellular Hypoxia and Neuro-Immune Fatigue
good information filling in a segment of the metabolic puzzle BUT sorely needing a good proofreader and a top notch editor.

Using the term 'fatigue' in the title is bad enough, but for someone like Bell who KNOWS the difference between M.E. and 'CFS' to just disregard science and patient rights in this way is terrible.

Each book Bell releases is less and less scientific. More and more about vague mixed patient groups of 'CFS' rather than any distinct patient group. Studying mixed patient groups is just pointless.

What Bell should be telling us is that patients told they have 'CFS' need is a real diagnosis, not advice from 'CFS' experts. CFS is always a misdiagnosis. Bell talks like it's a distinct disease made up of Epstein Barr and Lyme and so on, last I heard, it's so crazy!

Illnesses most often misdiagnosed as 'CFS' include Lyme disease, vitamin deficiencies, cancer, MS, Bechet's disease, thyroid and adrenal illnesses, FM and so on.

Many of the illnesses misdiagnosed as 'CFS' are testable and treatable...but only once patients and their doctors ditch the useless 'CFS' misdiagnosis. Many illneses can also be very serious or fatal if not correctly diagnosed and treated, and this includes Myalgic Encephalomyelitis. (M.E. is NOT the same thing as 'CFS'!)

Please, if you have a 'CFS' (mis)diagnosis, do everything you can to find your correct diagnosis, do not accept 'CFS' ever as an end point to the process of diagnosis.

Bell was there in the big ME outbreaks in the late 80s, when the 'CFS' scam was created. Bell has been such a huge disappointment to so many of us, he just should know better than this! Very depressing.

What needs to be known is:

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M.E. patients were treated appropriately and correctly diagnosed until around 1988, when there was an increase in the number of M.E. patients and outbreaks in the US. Some medical insurance companies (and others) decided that they would prefer not to lose many millions of dollars on so many new claims and so they created a new vague fictional disease category called 'Chronic Fatigue Syndrome' to try to confuse the issue of M.E. and to hide M.E. in plain sight.

Under the cover of 'CFS' certain vested interest groups have assiduously attempted to obliterate recorded medical history of M.E.; even though the existing evidence has been published in prestigious peer-reviewed journals around the world and spans over 70 years.

M.E. is a distinct, scientifically verifiable and measurable, acute onset, organic neurological disease. 'CFS' in contrast, is not a distinct disease. 'CFS' doesn't exist. Every diagnosis of CFS - based on any of the CFS definitions - can only ever be a misdiagnosis. A watebasket diagnosis.

The fact that a person qualifies for a diagnosis of 'CFS' (a) does not mean that the patient has M.E., and (b) does not mean that the patient has any other distinct illness named CFS.' M.E. and 'CFS' are not the same.

Far fewer than 0.5% of the population has the distinct neurological disease known since 1956 as Myalgic Encephalomyelitis.

Chronic Fatigue Syndrome is an artificial construct created in the US in 1988 for the benefit of various political and financial vested interest groups. It is a mere diagnosis of exclusion based on the presence of gradual or acute onset fatigue lasting 6 months. If tests show serious abnormalities, a person no longer qualifies for the diagnosis, as 'CFS' is 'medically unexplained.' A diagnosis of 'CFS' does not mean that a person has any distinct disease (including M.E.). According to the latest CDC estimates, 2.54% of the population qualify for a 'CFS' (mis)diagnosis.

The patient population diagnosed with 'CFS' is made up of people with a vast array of unrelated illnesses, or with no detectable illness. However, while 'CFS' is not a genuine diagnosis, those given this misdiagnosis are in many cases significantly or even severely ill and disabled. 'CFS' is made up of people with cancer, MS, Lyme disease, depression and hundreds of other unrelated conditions.

Sub-grouping different types of 'CFS,' refining the bogus 'CFS' definitions further or renaming 'CFS' with some variation on the term M.E. (such as 'ME/CFS') would achieve nothing and only create yet more confusion and help to continue and further entrench the mistreatment and abuse.

The problem is not that 'CFS' patients are being mistreated as psychiatric patients; some of those patients misdiagnosed with CFS actually do have psychological illnesses. There is no such distinct disease/s as 'CFS' - that is the entire issue.

Due to outrageous political influences on medicine and govermnent policy, the vast majority of M.E. patients will not be able to be correctly diagnosed with M.E. Most M.E. patients will unfortunately be misdiagnosed with 'CFS.' It is extremely important to note, however, that only a very tiny percentage of those told they have 'CFS' will be M.E. patients. The overwhelming majority of those misdiagnosed with 'CFS' do NOT have M.E. 'CFS' is NOT just another term for M.E.

The name Myalgic Encephalomyelitis must be fully restored (to the exclusion of all others) and the World Health Organization classification of M.E. (as a distinct neurological disease) must be accepted and adhered to in all official documentations and government policy. M.E. patients must again be diagnosed with M.E. and treated appropriately for M.E. based on actual M.E. research. For this to happen, there is a real need for patients (and others) to participate in genuine advocacy and activism.

The bogus disease category of 'CFS' must be abandoned. All those misdiagnosed with 'CFS' must immediately reject this harmful misdiagnosis and begin the search to find their correct diagnosis whether this be M.E., PVFS, depression, cancer, or any other disease. Correct diagnosis is vital in obtaining the correct treatment.

Jodi Bassett, HFME