Here are a few empirical observations I've made in my practice about the post viral fatigue syndrome, with a suggestion for a fresh approach to its treatment.

I've repeatedly seen patients with very severe cases of what had previously been diagnosed as ME who have shown a significantly increased bacterial fermentation in the colon. This became evident when the patients were tested for the presence of gut fermentation products in their blood plasma, a test carried out in the UK at Biolab in London. Various toxic propyl and butyl compound alcohols, as well as different short chain fatty acids (acetic, propionic, butyric and succinic), appeared in their bloodstreams an hour after they were orally given a glucose "loading dose".

At the same time, very little ethanol or methanol was found in their blood plasma. This ruled out candidiasis. Ethanol, the "normal" alcohol drunk socially, appears in such tests when the patient has a yeast overgrowth in his intestines.

Extremes of fermentation (or putrefaction) have long been known to cause problems (Bartle, H J: "Protein Intoxication", Med J Rec. 1928, 12: 28-3). Small quantities of propyl and butyl alcohols will produce generalized muscle tenderness, reduced reflexes, depressed respiration, some other nervous system effects and a state of profound fatigue (Dreisbach, R H: Handbook of Poisoning, Los Altos Ca: Lange Medica Publications, 1983): in other words, the classic ME symptoms.

Bacterial fermentation in the colon is usually associated with a so called "malabsorption syndrome", which so often is the result of too little gastic acid (hypochlorhydria) or no gastric acid production at all (achlorhydria) and/or a pancreatic exocrine insufficiency (Di Magno, E P et al, "Relation between Pancreatic Enzyme Outputs and Malabsorption in Severe Pancreatic Insufficiency, New England J Med, 1973, 228: 813-51).

Patients with this problem usually have deficiencies accompanying a lack of absorption of nutrients in the intestine (McCarthy, C F, "Nutritional Defects in Patients with Malabsorption:, Proc Nutr Soc. 1976, 35: 37-40). These substantially aggravate ME symptoms.

Supplementation with pancreatin and/or betaine hydrochloride with pepsin, in my experience, has in many cases made a startling difference in a matter of days, and the improvement that sets in has lasted. After suitable testing, this is an avenue which can be considered in appropriate cases.

One other aspect to this treatment protocol is worth mentioning. The naturopathic physician, Frederic M Speer MD, coined the phrase "allergic tension fatigue syndrome" (Speer, F M, "Allergy of the Nervous System", Springfield: C C Thomas, 1970). He was describing how delayed food allergy can manifest itself.

In cases described above, when I've suspected that delayed food allergy may have played a part in ME, the offending food item has been excluded from the patient's diet and supplements introduced.

Harald Gaier, a registered homoeopath, naturopath and osteopath is author of Thorsons Dictionary of Homoeopathy.