Comprehensive digestive stool analysis with parasitologyFatigue is one of the most common complaints that bring people into a physician’s office. Fatigue can be caused by nearly every illness and is part of the natural healing process. Excessive fatigue that lasts and lasts may be a sign of illness or of chronic fatigue syndrome. Also called CFIDS (chronic fatigue and immune dysfunction syndrome), CFS, myalgic encephalomyelitis (ME), chronic Epstein-Barr virus (CEBV), and yuppie flu, chronic fatigue syndrome is a long-lasting, debilitating fatigue that is not associated with any particular illness. Although people have been fatigued for millennia, the term chronic fatigue syndrome was only coined in 1988. CFIDS affects more than half a million people. Incidence has increased two to four times within the past decade. According to the Centers for Disease Control and Prevention (CDC), 200 people per 100,000 experience CFIDS. About 50 percent return to normal health within five years. The rest may be affected for decades.
By definition, individuals with chronic fatigue syndrome have been extremely tired for at least six months for no obvious reason. The CDC has provided the following criteria for diagnosis of CFIDS. First, the fatigue is not eliminated by rest, and the fatigue substantially reduces the person’s ability to function normally. Second, the diagnosis includes at least four of the following symptoms for a period of at least six months: loss in ability to concentrate or short-term memory function; sore throat; swollen and tender lymph nodes; muscle pain; multiple-joint pain without swelling or redness; headaches of a new type, pattern, or severity; sleep disturbances; and exercise-caused fatigue that lasts more than 24 hours.
People with CFIDS share many common symptoms, but not everyone has all the same ones. CFIDS often begins with an infectious flu-like disease accompanied by fevers that come and go. There is often accompanying joint stiffness and pain, sore throat, cough, sleep disturbances, light sensitivity, night sweats, and extreme exhaustion after the slightest exertion. Commonly, a short walk or bit of exercise will wipe out your energy for days afterward. Some people have the Epstein-Barr virus, or cytomegalovirus, but others don’t. Sometimes healthy people have high blood antibodies for these viruses and have no symptoms of CFIDS. It’s possible that these viruses trigger CFIDS, but it’s also possible that the low immune function in people with CFIDS increases their chances of catching a wide variety of infectious illnesses. Although you can chase the virus, it’s often just the trigger and not the ultimate cause of the illness. As with many illnesses, there is speculation on the part of researchers that there may be an autoimmune mimicry that gets triggered by a virus.
Many with CFIDS cannot hold down a job and become depressed because the fatigue is so extreme. Those who do work come home exhausted and go immediately to bed so they can generate enough energy for work the next day. Because there isn’t any apparent cause and no observable symptoms, people with CFIDS are often confronted by people and doctors who just don’t believe it’s real.
In 1990, the CDC began to keep records and study people with CFIDS to understand more about possible causes and therapies. We now know that CFIDS is multifactorial and affects many biochemical systems. Cytokine production of inter-leukin-2 (IL-2) is low and causes poor immune function. Other immune parameters appear to be overstimulated. Although this seems paradoxical, it’s probably not. According to Hans Selye, an expert on stress, our systems initially react to stress by overproducing. If working harder doesn’t eventually solve the problem, they underproduce. Many people with CFIDS have exhausted adrenal glands and produce low amounts of cortisol and other adrenal hormones. They often have thyroid insufficiencies and may require thyroid hormone replacement. Other hormones, such as estrogen, progesterone, DHEA, and testosterone, may also be out of balance.
To find relief for CFIDS, use the DIGIN approach discussed in Part II. People with CFIDS almost always have dysbiosis, and most have candidiasis. Leaky gut syndrome is usually present, accompanied by a host of food and environmental sensitivities. There is often malabsorption. The liver is overburdened and overworked, so the toxic by-products of life accumulate in tissues, and the cycle deepens.
Eventually, the mitochondria are affected. Mitochondria are the energy factories inside our cells, creating ATP from glucose in a complicated process called the citric acid cycle, or Krebs cycle. Mitochondrial DNA is extremely susceptible to environmental damage from nutritional deficiencies, infection, disrupted sleep, pregnancy, changes in pH balance in the cell, magnesium status, hormonal deficiencies, and stress. Mitochondrial function can be inhibited by magnesium insufficiency, changes in cellular pH, and abnormal products of metabolism. These can be interpreted by the body as toxins. Magnesium is essential for mitochondrial functioning and is part of the matrix. Mitochondria also require vitamins B1, B2, B3, B6, lipoic acid, manganese, zinc, CoQ10, glucose, fatty acids, and amino acids. Mitochondrial function can be tested with an organic acid test, which has provided evidence that mitochondrial DNA is damaged much more easily and is more susceptible to environmental toxins and other stressors. As chronic fatigue symptoms progress, the mitochondria often need nutritional support of their own.
Jacob Teitelbaum, M.D., a specialist in CFIDS and fibromyalgia, speculates that this is a mitochondrial and hypothalamic disorder. Viral infections can disrupt hypothalamus and mitochondrial function. The hypothalamus controls sleep, autonomic nervous system function, body temperature, and hormone balance. When energy stores in the hypothalamus are depleted, all of these systems become imbalanced.
With the blood pressure test used with a tilt table, researchers have found that many people with CFIDS have low postural blood pressure. Complementary medicine physicians have long used reclining and standing blood pressures to detect poor adrenal function. Individuals with healthy adrenal function experience only a five-to ten-point rise in blood pressure when they move from a reclining to a standing position. In people with poor adrenal function, blood pressure remains the same or drops. So, is the tilt-table hypotension the primary culprit or an indicator of poor adrenal function? In any case, some people with low blood pressure respond to an increase in salt intake to at least 1,000 mg daily or by taking medication to increase blood pressure.
There aren’t any panaceas for CFIDS, but there are therapies that can gradually help restore people to health. It’s important to address detoxification, viral load, digestive function, dysbiosis (including candida and parasites), mitochondrial function, intestinal flora, environmental contaminants, heavy metals, underlying allergies, and hormone imbalances (especially thyroid and adrenal), as well as to restore functioning of the immune system. If this seems daunting, it can be. The causes and specifics are different for each person. Careful partnership between practitioner and patient will give the very best results. CFIDS is one area in which conventional, mainstream medicine has little to offer. If you’ve tried everything that your doctor has recommended and still aren’t any better, you need to broaden your approach.
Restoration of digestive competency and nutrition go a long way toward normalizing CFIDS. Work with a nutritionally oriented health professional to design a program that meets your specific needs. The first steps are discovering any underlying problems that aggravate and drive the condition using the tests listed. It’s important to check carefully for parasites; one study found giardia in 28 percent of subjects with CFIDS. Develop and follow a diet based on foods that are healthful for you and a nutrient-rich program designed to boost immune, brain, and cellular function. When you are ready, add exercise, a little bit at a time. People with CFIDS often feel worse after exercise, so go slowly. Several researchers link elevated cytokines and TNF-alpha and low levels of antioxidants and heat shock proteins in people with chronic fatigue. Increasing anti-inflammatory nutrients and antioxidants could be really beneficial. (See Chapter 9 on inflammation and the immune system.)
Physical therapy, counseling, occupational therapy, acupuncture, chi gong, Emotional Freedom Technique, and mind-body techniques can all be of great benefit.
The biological, rather than medical, approach to chronic fatigue saves money and works better. In one study of cost-effectiveness it was determined that a nutritional approach costs $2,000 compared to $10,000 for a medical approach. The patients on nutritional programs reported greater improvements in function and subjective well-being. They were able to significantly reduce the amount of medication they used.
Comprehensive digestive stool analysis with parasitology
Testing for food, environmental, mold, and chemical sensitivities
Food allergy testing
Liver function profile
Intestinal permeability screening
Organic acid testing
Blood analysis for nutrients
Fatty acid analysis
After testing, you’ll have a better idea of any underlying problems. Look up related sections in this book to help you with the specifics.
Investigate food and environmental sensitivities. Try an elimination diet. Use shampoos, soaps, and toiletries that are hypoallergenic for your specific needs and natural household cleaning products that are healthier for you, your family, and the environment. Some people are sensitive to their mattresses, gas stoves, carpeting, and upholstery. If you are, you may need to wear 100 percent cotton or other natural fiber clothes and use 100 percent cotton sheets and blankets. Cotton is one of the largest genetically engineered crops, and some people are so sensitive to manmade substances that they can tolerate only organic cotton. Work with a health professional who can help you thread your way through the details.
Try an alkalizing diet. See Chapter 17 for details.
Supplement with probiotics. Supplemental use of beneficial bacteria can make a tremendous difference in your ability to digest foods. Beneficial flora can help reestablish the normal microbial balance in your intestinal tract. A recent study of people with CFIDS found that 6 of the 15 participants reported cognitive improvements in the four-week study.
Try digestive enzymes. Pancreatic or vegetable enzymes supply the enzymes that your body needs to digest fats, proteins, and carbohydrates. Products differ. See Chapter 3 for more information. Take one to two capsules with meals.
Take a multivitamin with minerals. Because people with CFIDS have difficulty with absorption and utilization of nutrients, a highly absorbable, hypoallergenic nutritional supplement is necessary. Although products that contain herbs, bee pollen, spirulina, and other food factors are good for many people, people with CFIDS often feel worse after taking food-based supplements. Make sure you buy the supplements that are herb and food free. Choose a supplement that contains the following nutrients: 25 to 50 mg zinc, 5,000 to 10,000 IU vitamin A, 10,000 to 25,000 IU carotenes, 200 or more IU vitamin E, at least 200 mcg selenium, 200 mcg chromium, at least 25 mg of most B-complex vitamins, 400 to 800 mcg folic acid, and 5 to 10 mg manganese.
Take vitamin C. Vitamin C boosts immune function, helps detoxification pathways, and has been shown to have antiviral effects. Clinicians, including me, have found it useful in people with CFIDS. Take 3,000 to 5,000 mg daily. Do a vitamin C flush (detailed in Chapter 10).
Increase magnesium. Magnesium is found in the ATP complex. Found in green leafy vegetables and whole grains, magnesium is involved in more than 300 enzymatic reactions in the body. It is essential for energy production, nerve conduction, muscle function, and bone health. People with CFIDS are often deficient in magnesium. Supplemental magnesium can improve energy levels and emotional states, while decreasing pain. Most people improve with use of oral magnesium supplements, but some need intravenous injections. Physicians can give 1,000 mg magnesium sulfate by injection. In one study, magnesium injections improved function in 12 out of 15 people, compared to only 3 receiving the placebo. Magnesium can be hard for many people to use. Adding 1 teaspoon of choline citrate daily for each 200 mg of magnesium taken can significantly improve magnesium uptake. Take 500 to 2,000 mg magnesium glycinate, potassium aspartate, malate, or ascorbate. Caution: too much magnesium causes diarrhea.
Try coenzyme Q10 (CoQ10). CoQ10 is necessary for energy production, immune function, and repair and maintenance of tissues. It also enhances cell function. CoQ10 is widely used in Japan for heart disease and has been researched as an antitumor substance. Take 60 to 300 mg daily.
Take essential fatty acids. Several studies have shown people with CFIDS to have fatty acid imbalances. In a recent study, a combination of evening primrose oil (primarily omega-3) and fish oil (primarily omega-6) or a placebo of olive oil was given to 70 people with CFIDS. Of the people taking fish and evening primrose oils, 74 percent showed improvement at 5 weeks, and 85 percent showed improvement at 15 weeks. In comparison, the placebo group showed 23 percent improvement at 5 weeks and 17 percent at 15 weeks. Another study of the use of supplemental fatty acids showed improvement in 27 out of 29 people with CFIDS over 12 to 18 weeks. Twenty people who had previously been unable to work full-time for an average of more than three years were able to go back to work full-time after an average of 16 weeks. Sixteen months later 27 out of 28 remained improved, and 20 were still progressing. Do fatty acid testing, and then adjust doses to match your needs.
Add methionine. Methionine, an essential sulfur-containing amino acid, is commonly deficient in people with CFIDS. It acts as a methyl donor for transmethylation reactions throughout the body, especially in the brain. It also helps sulfoxidation for liver detoxification pathways and is a precursor for other sulfur-containing amino acids such as cysteine and taurine. People with CFIDS probably have an increased need for methionine. Some people find improvement with a general amino acid supplement that supplies methionine, lysine, and carnitine simultaneously. Take 500 to 1,000 mg daily.
Try SAMe. S-adenosylmethionine (SAMe), a compound that is naturally found in every cell in our body, is made from methionine. Research on SAMe shows it to have powerful antidepressant effects without the side effects of pharmaceutical antidepressant medications. SAMe has also been shown to be as potent an anti-inflammatory drug as indomethacin without the negative side effects in people with arthritis.
Try acetylcarnitine. The vast majority of people with CFIDS have low levels of acetylcarnitine, although their levels of free carnitine are normal. Carnitine, vital for the conversion of fats into energy, also plays some role in detoxification and is believed to be essential for heart function. Finally, carnitine helps transport long-chain fatty acids into the mitochondria. Carnitine deficiencies result in muscle weakness, aches, and poor tone. Take 500 mg of carnitine two to four times daily for three months. For those on a budget, L-carnitine will also work.
Try D-ribose. Ribose is a structural sugar that helps provide energy. Dr. Jacob Teitelbaum did a pilot study with 41 people with either fibromyalgia or chronic fatigue syndrome. Overall two-thirds reported benefits, with 45 percent reporting improvements in energy, and 30 percent reporting improvements in overall well-being after about 20 days; several also reported pain reduction. Take 5 grams three times daily, for three weeks, and then reduce to 5 grams twice daily. Mix in a cold, cool, or room temperature beverage.
Try lysine. Often people with CFIDS also have herpes infections. Some people find good results with a general amino acid supplement, which supplies carnitine, lysine, and methionine as well as other amino acids. Take 1 to 2 grams lysine daily at the first sign of an outbreak; 500 mg daily for prevention.
Try malic acid. Malic acid comes from apples and is important in energy production at a cellular level. Several physicians have found malic acid supplementation reduces fatigue and pain of fibromyalgia. Take 6 to 12 tablets daily, decreasing dosage over time. Each tablet contains 300 mg malic acid–magnesium hydroxide.
Use immune-modulating herbs and mushrooms. Echinacea, goldenseal, astragalus, phytolacca (pokeweed), licorice, and lomatium all have immune-stimulating properties. Also eat immune-balancing mushrooms, such as maitake, shiitake, or reishi. They can help prevent secondary infections while you are in a susceptible state. Take them preventively or therapeutically as directed.
Provide adrenal support. People with CFIDS often need adrenal support. Think first about rest and nurture. Then also consider supplements, such as adrenal glandular supplements or herbal supplements, such as licorice and Siberian ginseng. Vitamin C and pantothenic acid (vitamin B5) are also needed for proper adrenal function. If your blood pressure is low, you can use whole licorice; if not, use DGL, which will not affect blood pressure. It’s best to take adrenal support in the morning and at lunch. If taken too late in the day, adrenal support can stimulate energy when you want to be winding down.
Consider nicotinamide adenine dinucleotide (NAD). In a study monitoring the effect NAD has on people with CFIDS, 26 subjects were given the reduced form of it for four weeks and a placebo for an additional four weeks. Thirty-one percent showed improvement when on NAD, while only 8 percent improved when taking the placebo. Subjects were less fatigued and had improvement in quality of life. NAD is integral to the citric acid cycle of energy production. Once again, we are reminded that each person has unique needs. While most people did not benefit, NAD may be a useful treatment for some people. More research needs to be done to see if 10 mg daily, the amount given in the study, is the proper dosage; if a longer treatment program would be of additional benefit; and what, if any, the long-term benefits are.
Try Meyer’s cocktail. IV nutrients, given by a physician, can quickly help revitalize your nutrient status. Nutrients can be absorbed and used at higher concentrations. Meyer’s cocktail is a combination of magnesium, calcium, vitamins B12 and B6, pantothenic acid, and vitamin C. It has been used successfully in people with a variety of ailments.
Exercise. People with CFIDS find exercise to be totally exhausting and draining. It is common for one period of exercise to be followed within 6 to 24 hours by 2 to 14 days of exhaustion and muscle aches. Paradoxically, exercise is helpful for restoring function in people with CFIDS, so it’s advisable to begin with simple walking, swimming, or biking for five minutes daily. If you can, increase by one or two minutes a day each week. If you feel that you are at your maximum, maintain your present length of exercise time until your fatigue decreases. Don’t push yourself hard. Slow and steady wins the race. Studies have shown that two-thirds of people with CFIDS benefit through exercise, although it is critical to not overdo.
A new hypothesis suggests that those with CFIDS are functioning in an anaerobic state, so light anaerobic exercise may be most beneficial. Working with light weights, leg lifts, and use of weight machines to your capacity without causing fatigue may be more beneficial than aerobic exercise. As you begin to feel better, incorporate aerobic exercise—walking, biking, swimming, and dancing. Prioritize, so you have energy for what’s most important. Be patient, kind, and loving to yourself.
Practice stress-management skills. Development of strong support systems is vital. People with CFIDS often have the illness for a long time and can greatly benefit from support groups. Exchange of information and dialogue with others who understand what you are going through can expedite recovery. Take time for yourself, rest, and relax.