CFS and Fibromyalgia From Fatigued to Fantastic

The "perfect storm" for American health is preparing to hit. A combination of poor nutrition, decreasing sleep, increasing stress and environmental toxins has created a human energy crisis of unprecedented proportions.

Over the past 10 years, the incidence of chronic fatigue syndrome (CFS) and fibromyalgia (FMS) has exploded by 400 to 1000 percent, as documented in five separate studies. The numbers for those with CFS in the U.S., previously estimated at 500,000, are now being re-tallied at closer to 2.5 million. Previous estimates placed the number of Americans with FMS at 6 million. Studies worldwide suggest this has likely gone up in the last decade to 12-24 million Americans! Meanwhile, one quarter of Americans suffer with chronic pain and most are fatigued.

The publication of the best-selling book on this topic ever, From Fatigued to Fantastic! ( FFTF -which is like a detailed textbook) and the recently published The Fatigue and Fibromyalgia Solution (easy reading, for those with brain fog) provides a timely solution following the recognition by the CDC, NIH, and FDA that CFS and FMS are bona fide and devastating illnesses. This information is now even being presented on "Oprah and Friends" with Dr. Oz and was recently discussed on the "Oprah Winfrey Show" as well. Newly updated in a third edition, FFTF provides a comprehensive understanding of CFS/FMS and the latest research, as well as a step-by-step guide to the "SHINE protocol" that has helped so many of these patients get their lives back.

So what does the research show?
The lead article published in an issue of the Journal of Chronic Fatigue Syndrome is titled, "Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia-the Results of a Randomized, Double-blind, Placebo-controlled Study." After decades of hard work by hundreds of researchers in the field, we have progressed to the point where effective treatment is now available for these illnesses. In our study, over 90 percent of patients improved with treatment.

In the average patient, after two years of treatment, the average improvement in quality of life was 90 percent. Pain decreased by over 50 percent on average. Many patients no longer even qualified for the diagnosis of CFS or fibromyalgia after treatment. Interestingly, many of the same principles for treating fibromyalgia also apply to myofascial pain syndrome (MPS-muscle pain).

That the vast majority of patients improved significantly in the active group while there was minimal improvement in the placebo group proves two very important things. The first is that these are very treatable diseases. The second is anyone who now says these illnesses are not real or are all in your head are clearly both wrong and unscientific. The full text of the studies can be seen at www.vitality101.com.

A new day is dawning in how CFS/fibromyalgia/MPS will be treated. In support of our work, an editorial in the April, 2002 American Journal of Pain Management noted, "The comprehensive and aggressive metabolic approach to treatment detailed in the Teitelbaum study are all highly successful approaches and make fibromyalgia a very treatment responsive disorder. The study by Dr. Teitelbaum et al. and years of clinical experience make this approach an excellent and powerfully effective part of the standard of practice for treatment of people who suffer from fibromyalgia and myofascial pain syndrome."

It is important to recognize these syndromes can be caused and aggravated by a large number of different triggers. When all these different contributing factors are looked for, and treated effectively, patients improve significantly and often get well.

What is causing these illnesses?
As we noted above, CFS/FMS/MPS is not a single illness. Our study has shown it is a mix of many different processes that can be triggered by many causes. Some of you had your illness caused by any of a number of infections. In this situation, you can often give the time that your illness began almost to the day. This is also the case in those of you who had an injury (sometimes very mild) that was enough to disrupt your sleep and trigger this process. In others the illness had a more gradual onset. This may have been associated with hormonal deficiencies (e.g., low thyroid, estrogen, testosterone, cortisone, etc.) despite normal blood tests. In others, it may be associated with chronic stress, antibiotic use with secondary yeast overgrowth, and/or nutritional deficiencies. Indeed, we have found dozens of common causes of, and factors that contribute to, these syndromes.

What these processes have in common is that most of them can suppress a major control center in your brain called the hypothalamus. This center controls sleep, your hormonal system, temperature, and blood flow/blood pressure. When you don't sleep deeply, your immune system also stops working properly and you'll be in pain. When we realized this, the myriad symptoms seen in CFS/fibromyalgia suddenly made sense. It also gave us a way to effectively treat you.

Five main categories of problems need to be treated.
A half-century of work by Dr. Janet Travell, the White House physician for Presidents Kennedy and Johnson, and author of the Trigger Point Manual showed that the same problems caused by hypothalamic suppression resulted in muscles getting stuck in the shortened position. Chronic muscle shortening then causes myofascial and fibromyalgia pain. As she laid the groundwork for effective treatments of these processes, our research team dedicated our published study to her memory. These are the five key areas that need to be treated for chronic fatigue syndrome, fibromyalgia and muscle pain to resolve. We call this the "SHINE Protocol."

1. Disordered sleep. Most patients with these illnesses find that they are unable to get seven to eight hours of deep sleep a night without taking medications. In part, this occurs because hypothalamic function is critical to deep sleep. Unfortunately, many of the most common sleep medications actually aggravate the sleep problems by decreasing the amount of time spent in deep sleep. For patients to get well, it is critical they take enough of the correct sleep medications to get eight to nine hours sleep at night. These medications include Ambien, Desyrel, Klonopin, Xanax, Soma and, if you don't have Restless Leg Syndrome, Flexeril and/or Elavil. In addition, natural remedies can help sleep. An excellent one (which I developed-the Revitalizing Sleep Formula by Enzymatic Therapy. One hundred percent of my royalty for all products I develop is donated to charity) includes theanine, Jamaican dogwood, wild lettuce, valerian, passionflower, and hops. Other natural sleep aids include calcium, magnesium, 5-HTP (100-300 mg), and melatonin (3/10-1 mg). Some patients find that over-the-counter antihistamines such as doxylamine (Unisom for sleep) or Benadryl can also help. In the first six months of treatment, it is not uncommon to sometimes need to take even six to eight different products simultaneously to get eight hours of sleep at night. After 6-18 months of feeling well, most people can come off of most sleep (and other) medications. I'm starting to believe that, to offer a margin for safety during periods of stress, it may be wise to stay on one-half to 1 tablet of a sleep medication for the rest of your life. Your doctor may initially be uncomfortable with this. Nonetheless, our experience with over 3000 patients and two research studies have found this approach to be safe and critical to people getting well. When one recognizes that CFS/FMS is a hypothalamic sleep disorder-not poor sleep hygiene-this approach makes sense. Otherwise, it is as if your doctor would immediately try to stop blood pressure or diabetes medicines every time the patient was doing better.

2. Hormonal deficiencies. The hypothalamus is the main control center for most of the glands in your body. Most of the normal ranges for our blood tests were not developed in the context of hypothalamic suppression or these syndromes. Because of this (and for a number of other reasons) it is usually necessary, albeit controversial, to treat with thyroid, adrenal (very low dose cortef; DHEA), and ovarian and testicular hormones-despite normal blood tests. These hormones have been found to be reasonably safe when used in low doses. Growth hormone has also been shown to be helpful in fibromyalgia. We don't always use it because, unfortunately, it can cost over $10,000 a year and is given by injection. Fortunately, there may be a cheaper way to raise your low growth hormone. Most growth hormone is made during deep sleep. This may be another reason why getting eight to nine hours of deep-sleep a night can be critical.

3. Unusual infections. Many studies have shown immune system dysfunction in FMS/CFS. Although there are many causes of this, I suspect that poor sleep is a major contributor. The immune dysfunction can result in many unusual infections. These include viral infections (e.g., HHV-6, CMV, and EBV), parasites and other bowel infections, infections sensitive to long-term treatment with the antibiotics Cipro and Doxycycline (e.g., mycoplasma, chlamydia, Lyme's, etc.) and fungal infections. Although the latter is controversial, both our study and another recent placebo-controlled study found treating with an antifungal to be very helpful with the symptoms seen in these syndromes. Avoiding sweets (stevia is okay) and taking Acidophilus Pearls (healthy milk bacteria-two pearls twice a day for five months) can be very helpful. It is also very helpful to add Diflucan, a prescription antifungal, at a dose of 200 mg a day for six weeks. A new antiviral (Valcyte) has also been extremely beneficial in those whose testing suggests HHV-6 or CMV viral infections.

4. Nutritional supplementation. Because the Western diet has been highly processed, nutritional deficiencies are a common problem. In addition, bowel infections can cause poor absorption, and the illness itself can cause increased nutritional needs. The most important nutrients include:

a) Vitamins-especially the B vitamins (most at 25-50 mg/ day), vitamin B12 (50-3000 mcg/day), antioxidants (e.g., vitamin C and E).

b) Minerals-especially magnesium, zinc, and selenium.

c) Amino acids (proteins). To replace the 35 tablets a day that people needed to take, I developed a good tasting product that contains 50 key nutrients in one capsule and one scoop of a good tasting powder taken daily. It is called "Energy Revitalization System" by Enzymatic Therapy, and is available at health food stores or at www.vitality101.com.

5. Exercise as tolerated. In the beginning, walk as much as you can so you feel "good tired" after, and better the next day. Because you do not yet have the energy to condition, do not push beyond what is comfortable. Otherwise, you're likely to crash. After 10 weeks on the program, your energy production will increase, and then you'll be able to condition by increasing your walking by one minute a day as able. When you get to one hour a day, you can increase the intensity of your exercise.

There are many other treatments available as well. Although space does not allow for a full discussion of these in this article, I discuss them at length in my book From Fatigued to Fantastic! and at my website www.vitality101.com (click on the "Treatment Protocol" link for detailed instructions on treatments for each of these problems).

Ribose: An exciting new discovery!
SHINE D-Ribose, (using the research grade ribose made by Bioenergy Life Sciences, Inc.) is an outstanding nutrient (a special sugar-even okay for those who need to avoid sugar) for those of you who want a powerful energy boost. In addition to its role in making DNA and RNA, those of you familiar with biochemistry remember Ribose as the key building block for making energy. In fact, the main energy molecules (like "energy dollars") in your body (ATP, FADH, etc.) are made of ribose plus B vitamins/phosphate. That makes these energy molecules similar to the paper that money is printed on-kind of like being able to print your own energy currency.

Ribose has many uses, including treating heart muscle weakness (congestive heart failure). We were so impressed with this product that our research center completed 2 studies reported on in the national news services. Two thirds of CFS/Fibromyalgia patients improved, with an average increase in quality of life of 37 percent, outstanding for a single nutrient. Take one scoop three times a day for two weeks, then decrease to a scoop twice a day, but lower the dose or take it with food if you get hyper from being too energized. The use of Ribose) is a major step forward in treating fatigue with the average CFS/FMS patient in the study having a 61 percent improvement in energy after two to three weeks. In our study, pain, sleep, and "brain fog" also improved. The full text of the second, and larger, study can be seen at http://benthamopen.com/contents/pdf/TOPAINJ/TOPAINJ-5-32.pdf

So can I make my pain go away?
Absolutely, fibromyalgia and myofascial (muscle) pain and associated nerve entrapments are now very responsive to treatment. In many cases, they usually will improve dramatically and often even go away if you simply get the eight hours of sleep a night I discuss above, take the vitamin powder, take thyroid hormone, and treat the underlying yeast infections. Other patients require the more thorough evaluation and treatment. Localized myofascial pain also requires an evaluation for structural causes.

Aspirin family medications (including ibuprofen) are not very effective for most fibromyalgia and myofascial pain patients. I avoid Tylenol because it can markedly deplete a critical antioxidant (glutathione). Helpful natural treatments include Curamin, an amazing pain mix that includes a special curcumin, Boswellia, DLP A, and nattokinase. In addition,the End Pain formula, an herbal remedy that includes Boswellia, willow bark, and cherry, can also be helpful. these combinations can be more effective than Celebrex and Motrin and are much safer. I recommend one to two tablets three times a day. Although some effect can be seen immediately, improvement continues to build over six weeks. At that time, the dose can be lowered. The medications I find to be most helpful for myofascial pain include Ultram, Skelaxin, Neurontin, Lyrica, and Zanaflex. Lidocaine patches and creams creating a mixture of medications can also be highly effective for local areas of pain without significant side effects. Topical comfrey (called Trauma Plant) can also be very helpful. There are many other medications and other effective ways to treat pain as well. These can be used to help keep you comfortable while we go after the pain's underlying causes.

How do I go about getting well?
My books will supply you and your physician with all the information that you need to get treated effectively. I would begin with The Fatigue and Fibromyalgia Solution, an easy read. Then, for more information, consider FFTF.

Because determining which treatments are needed by any given individual and then teaching them how to use them can be very difficult and time consuming (even for doctors that are very skilled in treating these syndromes-an initial consultation in my office usually takes at least three hours of my "one on one" time), I've created a sophisticated free computer program on my Web site (www. EndFatigue.com) called the "Energy Analysis Program". Like a computerized CFS/Fibromyalgia specialist, it can analyze your history and lab tests to tailor a treatment protocol to optimize energy production in your case using both natural and prescription therapies. The good thing about it being a computer program is that it has both the time and ability to guide almost everyone with these syndromes back to health.

In addition, our Web site also contains:

• Copies of both of our research studies demonstrating effective treatment for these illnesses. The first one, published in 1995, was an open (not placebo-controlled study in which over 90 percent of patients improved.
• The second is the placebo-controlled study I've discussed above. Feel free to make copies of this study for your physicians, friends, and for anybody in the news media you think might be interested.
• How to find a physician.
• A question, answer, and comments area.
• A sign up section for a free e-mail newsletter to keep you on the cutting edge.
• A shop where you can order supplements or books.
• Articles of interest, and more.

So how do I get help?
It's critical to find somebody who specializes in CFS and fibromyalgia to treat you. People often ask me, "How can I talk my doctor into giving me the treatment that I need?" In most cases, the answer is that you can't. Most doctors, appropriately enough, will not do the things they are not properly trained in. This does not make them a bad physician. If you came to me and asked, "Dr. Teitelbaum, I would like you to do a heart bypass operation on me." I would say, "I'm sorry, I am not trained in this, and I can't." If you then gave me a copy of a book called From Bypass to Fantastic and a scalpel, you still would not want me performing surgery on you. This would not make me a bad physician, and your doctor not treating you for CFS or fibromyalgia does not make them a bad physician either. The best thing to do is to go to a physician who specializes in treating these complex syndromes. We do phone consultations with people worldwide, (call 410-573-5389 and leave a voicemail for more information). In addition, our "Find a Physician" Referral Guide http://www.endfatigue.com/resources/practitioners.html can help you find a trained doctor near you.

What if my symptoms persist despite treatments i've tried?
The good news is that many effective treatments are now available, and almost everyone can be helped. From Fatigued to Fantastic! reviews many different options and, more importantly, let's you know which ones are most likely to help YOU! As you read the book, it will have you fill out a series of questionnaires and check off treatments based on your answers. When the book is done, you will have a treatment protocol tailored to YOUR case. For those of you who have "tried everything," below are a few more (of many) options to consider:

• Be sure you are sleeping eight hours a night.
• Do a sleep study to rule out UARS, Sleep Apnea or Restless Leg Syndrome.
• Consider a high dose T3 trial (the active thyroid hormone).
• Repeat a set of six high potency nutritional IVs.
• Hydrocortisone trial 5-20 mg each morning for three weeks.
• If yeast symptoms (sinusitis, nasal congestion or mouth ulcers) persist, try Nizoral 200 mg/day for six weeks and the "sinusitis nose spray."
• If bowel symptoms (diarrhea, gas, bloating) persist despite yeast treatment, consider small intestinal bacterial overgrowth (SIBO)) and a trial of Rifaximin 400 mg twice a day for 10 days. If bowel symptoms still persist, consider Alinia 1 gm twice a day for 10-14 days (the standard course is four days but inadequate). Both of these are expensive.
• Check HHV-6 and CMV IgG and IgM blood tests by IFA. If IgM positive, or the IgG is 1:320 or higher for either, consider the Valcyte protocol discussed in my book.
• Take intramuscular injections of gamma globulin 2 cc weekly or 4 cc every other week for six doses, along with antiviral IVs and perhaps add Nexavir (a natural antiviral) if you have flu-like symptoms (even if your labs are okay).
• Consider antibiotics if suggested by labs or history.
• Be sure you are on the Energy Revitalization System multivitamin and ribose. If you have pure fatigue without pain, add NADH.
• If IgF-1 blood test is still suboptimal despite treatment, consider growth hormone.
• Add the neurotoxin six step protocol.
• Try heparin.
• Add the methylation defect protocol.

Most people improve without needing some of the more aggressive treatments listed above.

In the last 35 years, my associates and I have been successful in our quest to make the possibility of effective treatment available for everyone with CFS, and FMS related problems. Finding effective treatment, doing the research to prove its effectiveness, writing a book that teaches people how to get well (and their doctors how to treat them), and creating the Web site educational program that can help you tailor a treatment program for your specific situation has fulfilled this goal.

Jacob Teitelbaum, M.D., Director of the Practitioners Alliance Network, is one of the most frequently quoted integrative medical authorities in the world. He is the author of the best-selling From Fatigued to Fantastic!, Pain Free, 1,2,3!, the Beat Sugar Addiction Now! series, Real Cause Real Cure, The Fatigue and Fibromyalgia Solution, and the popular free Smart Phone app Cures A-Z. He is the lead author of 4 studies on effective treatment for fibromyalgia and chronic fatigue syndrome, and a study on effective treatment of autism using NAET. Dr. Teitelbaum appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and FoxNewsHealth. Learn more at www.endfatigue.com.