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Test for FMS?

>Does this mean that FMS can be diagnosed from a blood test now?

Hi Jesse,
You asked if the data published by John Russell, M.D. in "Biochemical Abnormalties in Fibromyalgia Syndrome" in the _Journal of Musculoskeletal Pain_ could provide the basis of a blood test for CFS. In a word, the answer is no. These findings are quite non-specific, and would not provide for a definitive test for CFS.

My area of expertise is celiac disease, and all of these findings could also be found in someone with untreated celiac disease. Of course, the serum and CSF features are also not the defining characteristics of celiac disease. I have, however, previously suggested a relationship between celiac disease and FMS. It is my opinion that FMS is often undiagnosed celiac disease or gluten sensitivity. If we take each of the findings reported by Dr. Russell, I think you will see some of the reasons for my suspicion:

1. Kynuernine is a metabolite of tryptophan, a metabolite of tryptophan. CSF kynuernine levels were elevated in FS patients. Such findings have also been reported in some forms of epilepsy(1,2). Abnormal levels of CSF kynuernine have also been reported during severe phase anorexia (3). This finding is non-specific, and may, according to Russell's report, be the indirect result of the NADP abnormalities he also reported in CFS. Since anorexia and epilepsy are overrepresented among celiac patients, there may also be a connection with celiac suggested by these data.

2. Low serum serotonin is reported in CFS by Dr. Russell. Celiac disease has long been associated with abnormalities in serum serotoinin, and recent research suggests this is due to a reduction in platelet receptors for serotonin (4). Impaired availability of serum tryptophan, the precursor of serotonin, has also been reported in celiac disease (5), which would further support the possibility of a connection. Relatedly, depression has been asserted to be the most common symptom of celiac disease (6).

3. Dr. Russell also reported deficienciencies in ATP, a finding which is paralleled in celiac disease (7).

4. I could find no direct parallel in the celiac literature for Dr. Russell's report of elevated CSF substance P in CFS. I did, however find a report of elevated substance P in the duodenal mucosa of untreated celiacs (8).

Taken together, these data support my suspicion that CFS may sometimes represent undiagnosed celiac disease, but Dr. Russell's data would not be diagnostic for either celiac disease, or CFS. Still, it is an exceedingly interesting report, and I am grateful that you posted it.


  1. Yamamoto H, et al. Studies on cerebrospinal fluid kynurenic acid concentrations in epileptic children. Brain Dev. 1995 Sep-Oct;17(5):327-9.
  2. Heyes MP, et al. Kynurenine pathway metabolites in cerebrospinal fluid and serum in complex partial seizures. Epilepsia. 1994 Mar-Apr;35(2):251-7.
  3. Demitrack MA, et al. Cerebrospinal fluid levels of kynurenine pathway metabolites in patients with eating disorders: relation to clinical and biochemical variable. Biol Psychiatry. 1995 Apr 15;37(8):512-20.
  4. Chiaravalloti G, et al. Platelet serotonin transporter in coeliac disease. Acta Paediatr. 1997 Jul;86(7):696-9.
  5. Hernanz A, et al. Plasma precursor amino acids of central nervous system monoamines in children with coeliac disease. Gut. 1991 Dec;32(12):1478-81.
  6. Cooke & Holmes Coeliac Disease. Churchill Livingstone, N.Y., 1984
  7. Lundberg A, et al. Muscle abnormalities in coeliac disease: studies on gross motor development and muscle fibre composition, size and metabolic substrates. Eur J Pediatr. 1979 Feb 8;130(2):93-103.
  8. Domschke S, et al. Coeliac sprue: abnormalities of the hormone profile of gastroduodenal mucosa. Scand J Gastroenterol Suppl. 1989;167:86-9.