Building on what I have learned since 1975, my research partner, Barbara Bird, and I initially completed an open study (in 1993) of sixty-four patients with disabling chronic fatigue.1 In 1999, we completed a randomized, double-blind follow-up study, and appreciate the assistance given by National Institutes of Health researchers in developing the study protocol. This study showed that 91 percent of you can improve with proper treatment, and half of those with fibromyalgia were pain free at ninety-nine days.2 Our recently published study showed an average 45 percent increase in energy in CFS/FMS by simply taking ribose (see Chapter 2).3 My staff and I have treated more than three thousand CFS/FMS patients, and tens of thousands more have been treated by doctors at the Fibromyalgia & Fatigue Centers (www.fibroandfatigue.com) and by many other physicians worldwide. More than 50 percent of our patients are much better—that is, their symptoms are no longer a major problem—with our treatment, while most of the remainder have shown significant, albeit incomplete, improvement. Only 10 to 15 percent have had no significant improvement.
We have found that, on average, patients begin to feel better in two to three months.1, 2
If you suffer from CFS, FMS, or ME, this book will provide you with the tools and information you need to move beyond fatigue and into wellness. If you are a physician, it will teach you how to help—often dramatically—your patients who experience chronic exhaustion, including those frustrating cases in which no treatment has thus far been successful.
If you have researched chronic fatigue and immune dysfunction syndrome (CFIDS—also called chronic fatigue syndrome, or CFS, and I use CFS and CFIDS interchangeably), you will find some information here that is familiar, but you will also discover much that is new. For instance, to restore energy production and recover, it is usually necessary to treat many different problems simultaneously. Most sufferers of chronic exhaustion have a mix of at least five or six underlying problems (out of more than a hundred possible problems), which vary from person to person. This occurs because each problem can cause several others. You may have found some relief in the past by treating one, or a few, of these problems; I think you will be pleasantly surprised at what happens when you treat all your underlying problems simultaneously.
Certainly, we still have much more to learn in this area. However, we have now crossed a threshold and can effectively treat the illness. As the Journal of the American Academy of Pain Management noted in an editorial, “This study by Dr. Teitelbaum et al confirms what years of clinical success have shown—that the treatment approach described in Chapter 4 of The Trigger Point Manual (by Dr. Janet Travell) is effective, that subclinical abnormalities are important, and that the comprehensive and aggressive metabolic approach to treatment in Teitelbaum’s study is highly successful and makes fibromyalgia a very treatable disorder. The study by Dr. Teitelbaum et al and years of clinical experience makes this approach an excellent and powerfully effective part of the standard of practice for treatment of people who suffer from FMS and MPS [myofascial pain syndrome]—both of which are common and devastating syndromes. It is very exciting that this research helps to usher in a new, more effective era in medical care by treating the patient and not only the laboratory tests!”4
It’s time for you to get well! Ready?
PART 1
Your Body’s Energy Crisis
A curious thing happened during the rigorous process I went through to become a physician. By the time I completed my formal training, I presumed that if an important treatment existed for an illness I had been taught about it in medical school. I understood, of course, that physicians need to continue their education to stay abreast of new information and treatments. But I felt sure that if someone claimed he or she could effectively treat a “nontreatable” disease, that person was a quack.
I was wrong.
As I have developed as a physician and have spent countless hours exploring the scientific literature, taking notes of effective treatments for a wide range of illnesses, and observing the often flawed process that prescription drugs go through as they become commonly used in the United States, I’ve discovered that natural remedies can work just as well as prescriptions and with fewer or less serious side effects and at a significantly lower cost to the consumer. I’ve also learned that some natural remedies and prescription drugs can work better together than either one can alone.
My preference is to practice what is called “comprehensive medicine,” which uses the best of natural and pharmaceutical therapies. It’s like having a complete tool kit at your disposal. The approach you will learn about in From Fatigued to Fantastic! is well-grounded in the scientific literature and patient practice. The program within these pages treats the underlying, perpetuating factors of your illness that keep you from feeling better.
Although readers with chronic fatigue syndrome and those with fibromyalgia will find that this book feels like it was written just about them, those of you with general fatigue without CFS will also find that this book will help you to restore your vitality and regain control over your life.
1
What Are Chronic Fatigue Syndrome and Fibromyalgia?
Chronic fatigue and immune dysfunction syndrome (abbreviated CFIDS or CFS) is a group of symptoms associated with severe, almost unrelenting fatigue. Some of the more common symptoms are:
poor sleep
difficulties with short-term memory, concentration, word finding, word substitution, and orientation (a group of symptoms collectively known as brain fog)
increased thirst
bowel disorders
recurrent infections and sinusitis
exhaustion after minimal exertion
A related problem, fibromyalgia syndrome (FMS), is present if you also have widespread pain and achiness. If this sounds like you, I would assume that you have CFS/FMS unless it can be proven otherwise. For most people, fibromyalgia and CFIDS/CFS are the same illness, so I use the terms CFIDS and CFS interchangeably to refer to all of these. Myalgic encephalomyelitis and myalgic encephalomyelopathy (ME) are other names sometimes used to refer to these syndromes.
How Is Chronic Fatigue Syndrome Defined?
The U. S. Centers for Disease Control and Prevention (CDC) has put together an updated list of criteria for the diagnosis of chronic fatigue syndrome (see the box on page 7). Although the CDC’s criteria have helped researchers define groups for studies, its original criteria for chronic fatigue syndrome excluded all but about five thousand to twenty thousand people in the United States.1–3 However, more than 25 million Americans have severe fatigue, lasting at least one month, at any given time.4 Of these, around 6 million people currently suffer from fibromyalgia.5 Research has shown that people with disabling fatigue who do not fit the CDC criteria often have the same immunologic changes and responses to treatment as those who do fit.6 My experience, too, suggests that the underlying causes of patients’ chronic fatigue and their responses to treatment are not affected by whether they strictly meet the CDC guidelines.7
Because of problems defining chronic fatigue syndrome and fibromyalgia, I prefer to use the following definition: Unexplained fatigue that significantly interferes with your functioning and is associated with any two of the following symptoms:
Brain fog
Poor sleep
Diffuse achiness
Increased thirst
Bowel dysfunction and/or
Recurrent and/or persistent infections or flu-like feelings
If this describes how you are feeling, then you probably have CFS. If any of the above symptoms are accompanied by widespread pain, you may have FMS, as well.
What Chronic Fatigue Syndrome and Fibromyalgia Feel Like
Chronic fatigue syndrome and fibromyalgia occur in varying degrees of severity. Many people have mild to moderate fatigue with achiness and poor sleep. Often, these people attribute the symptoms simply to aging or stress—for example, they may say they feel like they’re fifty years old when they’re only thirty. Others h
ave fatigue so disabling that they cannot even get out of bed, let alone participate in regular daily activities.
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CDC Criteria for Chronic Fatigue Syndrome
A case of chronic fatigue syndrome is defined by the presence of the following:
Clinically evaluated, unexplained, persistent, or relapsing chronic fatigue that is of new or definite onset (has not been lifelong); is not the result of ongoing exertion; is not substantially alleviated by rest; and results in substantial reduction in previous levels of occupational, educational, social, or personal activities.
Concurrent occurrence of four or more of the following symptoms, all of which must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue:
A. Self-reported impairment in short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social, or personal activities
B. Sore throat
C. Tender cervical [neck] or axillary [underarm] lymph nodes
D. Muscle pain
E. Multijoint pain without joint swelling or redness
F. Headaches of a new type, pattern, or severity
G. Unrefreshing sleep
H. Postexertional malaise lasting more than twenty-four hours
Adapted from Annals of Internal Medicine 121 (14 December 1994). Used with permission.
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The most common complaints among chronic fatigue and fibromyalgia patients are:
Overwhelming fatigue. Most of these patients are fatigued most or all of the time. Occasionally, they experience short periods during which they feel better. However, after several hours or days of feeling energetic, they typically crash back down into severe fatigue.
Most CFS patients wake up feeling tired and often have the most energy between 10 p. m. and 4 a. m., in part because their day/night cycles are reversed. In addition, exercise often makes the fatigue worse. When CFS patients try to exercise, they feel worse that day and as if they were “hit by a truck” the next. The postexertional fatigue occurs because they can’t make enough energy to condition their bodies when they exercise, simply depleting their energy instead. This causes further deconditioning and discouragement. A better approach is to walk as much as you can, but only to the point where you feel “good tired” after the exercise and better the next day. After approximately ten weeks of gentle, slow walking, most people find that they can start to increase their walking by up to one minute a day as their energy levels increase with the treatments we’ll discuss. Once they can walk for about an hour a day, they then can start slowly increasing the intensity of exercise through an activity such as biking, rowing, or tennis.
Frequent infections. Many CFS patients have recurrent sinus or respiratory infections, sore throats, swollen glands, bladder infections, and/ or vaginal, bowel, or skin yeast infections. These are usually best treated without antibiotics (see “Treating Infections without Antibiotics,” Chapter 5). Some also have a recurrent rash that is resistant to treatment. Abdominal gas, cramps, and bloating are also very common, as is alternating diarrhea and constipation. These digestive complaints are attributed to spastic colon, and are often triggered by bowel yeast or parasitic infections. People often find that their rash, as well as the sinusitis and spastic colon, goes away for the first time in years when they have their bowel fungal overgrowth treated (see Chapter 5). Poor food absorption and food sensitivities may also play significant roles in bowel symptoms and go away with treatment (see Chapter 9).
Brain fog. Chronic fatigue patients often suffer from poor short-term memory, difficulty with word finding and word substitution, and, occasionally, brief episodes of disorientation, lasting thirty seconds to two minutes, that occur despite being in a familiar place. Brain fog is one of the most frustrating symptoms for some people and is often the scariest. Many people are afraid that they are developing Alzheimer’s disease, but this is not the case. A simple way to differentiate between brain fog and dementia is that with brain fog you may constantly forget where you left the keys. However, with Alzheimer’s you may forget how to use your keys. They are not the same, and brain fog also routinely resolves with treatment.
Achiness. Achiness in both muscles and joints is also common in chronic fatigue patients. For most, this achiness comes from disordered sleep, low thyroid function, yeast infections, and nutritional deficiencies. It is important to remember that pain is your body’s way of telling you that something desperately needs attention—kind of like the oil light on your dashboard. When you give your body what it needs, you’ll find that the pain often disappears—just as the oil light goes out when you add needed oil to a car. This does not mean that you have to put up with pain, however, while you treat the underlying causes of chronic fatigue and fibromyalgia. We will also discuss how to use both natural and prescription therapies to keep you comfortable.
Increased thirst. Because of hormonal problems, people with chronic fatigue and fibromyalgia often have decreased fluid retention, which increases urine output and thirst. A classic description of a CFS/FMS patient is that they “drink like a fish and pee like a racehorse.” Drinking a lot of water, therefore, becomes important. In fact, many CFS patients find that they may need to drink up to four times as much liquid as the average person. When people ask me how many glasses of water to drink a day, I tell them a much better approach is simply to check your mouth and lips. If they are dry you need to drink more water.
It is important to note that dry eyes and dry mouth that do not improve when you drink more water (called sicca syndrome) are also common. These symptoms can often be resolved by taking fish-oil supplements, B vitamins, and magnesium.
Allergies. Fatigue patients often have a history of being sensitive to many foods and medications. Fortunately, severe environmental sensitivity is much less common. I find that food sensitivities and other sensitivities usually improve when the adrenal insufficiency and yeast or parasitic overgrowth are treated. Desensitization techniques can also be helpful (more about this in Chapter 9).
Anxiety and depression. Approximately 12 percent of people with CFS have marked anxiety, with palpitations, sweating, and other signs of panic. These symptoms, too, often improve with treatment. We will discuss how to treat these naturally in Chapters 8 and 10.
Weight gain. Despite no change in diet, studies done in our research center show that people with CFS and fibromyalgia gain an average of thirty-two pounds with their illness. I suspect this occurs because of changes in metabolism caused by low thyroid function, yeast overgrowth, a deficiency of acetyl-L-carnitine, insulin resistance, and poor sleep. Many patients are thrilled not only to feel better and have their pain go away, but also to find their weight dropping (see Chapter 11).
Decreased libido. When I ask CFIDS patients how their libido is, most answer, “What libido?” In addition to pain and a general “yucky” feeling, hormonal deficiencies also contribute to this symptom. However, libido often also improves with treatment, though it often takes about six months.
You may have recognized yourself as you read through this list. If you did, please be assured that you are not alone. You are part of a large group of more than 50 million people worldwide. Many support groups exist, including the National Fibromyalgia Association (www.fmaware.org) and the International Coalition for the Advancement of Fibromyalgia/Chronic Fatigue Syndrome Treatments (ICAF; www.icafcoalition.org). For support groups around the world, see Appendix E: Resources.
What Is Fibromyalgia?
We often talk about chronic fatigue syndrome and fibromyalgia together, because the two syndromes often coexist and share many of the same symptoms. Fibromyalgia is basically a sleep disorder characterized by many tender knots in the muscles. These tender knots, called tender points and trigger points, are a major cause of the achiness that fibromyalgia and CFIDS patients feel. For most patients, it is easier to consider fibromyalgia and CFIDS as the same i
llness. However, in addition to fatigue, pain is a major and defining symptom in fibromyalgia. Fibromyalgia is a cousin to other muscle diseases, called myofascial pain syndromes.
The diagnostic criteria developed in 1990 by the American College of Rheumatology8 are much more clinically useful than the chronic fatigue diagnostic criteria the CDC developed, which were meant largely for research. The criteria for fibromyalgia are as follows:
Feeling pain both above and below the waist in both the left and right sides of the body
Feeling pain somewhere down the middle of the body (e. g., headache, back, chest, or abdominal pain)
Being tender in eleven out of eighteen arbitrarily chosen locations on the body, called tender points
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Fibromyalgia Tender Points
Figure 1. 1.
Criteria and illustration adapted from F. Wolfe, et al, “The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia: Report of the Multicenter Criteria Committee,” Arthritis and Rheumatology 33 (1990): 160–172. Used with permission.
From Fatigued to Fantastic! Page 2