* * *
Unfortunately, most doctors don’t know how to find and check the tender points, which are not necessarily the same as trigger points. And many of the major researchers in the field are recognizing that there is an intermediate form of fibromyalgia where people have fewer than eleven of the eighteen tender points. The tender-point exam will probably be eliminated when we have a good blood or urine test for FMS available.
The good news is that the pain can usually be eliminated, or at least markedly improved, by using the SHIN protocol, as discussed in this book. In our studies, the majority of people were pain free at the end of a ninety-nine-day treatment period.7, 9
As with chronic fatigue syndrome, the first and foremost component of fibromyalgia is disordered sleep. If you are not getting seven to nine hours of solid, uninterrupted sleep, you will be in pain. When we sleep, we usually have periods during which we stop moving and go into deep, very restful slumber. Unfortunately, the little muscle knots of fibromyalgia make it uncomfortable to lie in one position for an extended time, and people with fibromyalgia do not stay in the deep stages of sleep (stages 3 and 4) that are integral to renewing one’s energy. Although a fibromyalgia patient may sleep for twelve hours every night, he or she may not have slept effectively for many of those hours. A good indication that you are not experiencing enough deep-stage sleep is a morning “hangover” feeling. A critical part of making your pain go away will be correcting your sleep deficiency.
In addition, treating underlying infections (especially yeast infections), an underactive thyroid (regardless of whether the blood tests are normal or not), and deficiencies of magnesium and ribose will be key to your recovery.
So Why Do I Have Pain?
When muscles do not have enough energy you might think that they would go loose and limp, but that is not the case. Think about writer’s cramp, when your muscles stop getting enough energy. When this happens, the muscles become tight—often stiff as a board—and they will hurt. The multiple little painful knots (called trigger points) are in the belly of the muscles where they have bunched up. As you feel pain from these knots, your muscles will start shifting your weight to take the strain off the uncomfortable areas. Unfortunately, this puts more strain on other areas, and the pain starts moving around your body. In addition, when you’re not able to get deep sleep your muscles do not heal from the day’s activities, and this also contributes to pain. To add insult to injury, once you develop this chronic pain, the brain actually starts to amplify the pain signal, and can become the source of much of the pain you feel. This is called “central sensitization.” You’ll be amazed at how dramatically your pain can be decreased and usually eliminated as you get eight to nine hours of deep sleep a night, restore energy production in your muscles, and stop sending excessive pain signals to your brain.
PERPETUATING FACTORS
It never ceases to amaze me how quickly a case of fibromyalgia can resolve once the underlying problems are treated. In fact, the duration of the disease does not seem to affect how responsive it is to treatment. Two of the top authorities on muscle pain, Drs. Janet Travell and David Simons, have devoted much of their study to trigger points, their causes, and their resolutions. They have noted in their talks and writings that hormonal, nutritional, infectious, and even major structural problems, such as a short leg or short hemipelvis (an uneven pelvis), as well as other factors cause the trigger points to persist.10
I have found that my fibromyalgia patients tend to recover when all of the major underlying perpetuating factors are treated.7, 9 It is important to understand that fibromyalgia is both a common endpoint for many of the problems we have discussed thus far and a cause for these problems. Infections, nutritional deficiencies, and hormonal deficiencies can all, individually and in concert, trigger and perpetuate fibromyalgia. Fibromyalgia can also cause the hormonal and immune dysfunctions and, perhaps by leading to malabsorption, the nutritional deficiencies. Fibromyalgia becomes self-perpetuating as soon as sleep is disrupted. Even if the underlying trigger, such as a trauma that occurred years before, has resolved, the sleep deprivation of the illness can cause suppression of the hypothalamus (discussed in Chapter 3).
What Causes CFS/FMS?
I do not view these syndromes as the enemy. Rather, I see them as attempts on the body’s part to protect itself from further harm and damage in the face of any of a number of overwhelming stresses. A simple way to look at fibromyalgia and CFS would be to view them as circuit breakers in a house. These breakers disconnect the electricity from the home’s wiring when electrical systems become overstressed. To solve the problem, you just reset the breakers. Your body’s “circuit breaker” does much the same thing, resetting after a stress with rest and proper nutrition. In CFS/FMS, however, it is as if a major circuit breaker, in this situation the master gland in the brain called the hypothalamus, has gone off-line and is not able to reset itself. When this occurs, rest is no longer enough to restore proper function. The ensuing fatigue forces the person to use less energy without the accompanying benefits that rest brings to a healthy individual.
Just as there are hundreds of ways that you can blow an electrical fuse in a house, there are also many diverse triggers that can cause these syndromes in the body. Nonetheless, most patients’ symptoms seem to come from a common endpoint—decreased energy production or increased energy needs with secondary dysfunction or suppression of the hypothalamus.11–14
HYPOTHALAMIC DYSFUNCTION
You’ve no doubt heard the old story of the blind men who stumbled upon an elephant. One felt its trunk and believed it was a snake. Another felt its leg and thought it was a tree trunk. Yet another, missing the elephant entirely, was certain nothing was there and told his friends they must be crazy. This seems to be the current state of affairs in our understanding of CFS/FMS.
Even so, we are lucky to be at a point where we have as many pieces of the puzzle as we do. Let’s examine what we do know, beginning with two assumptions that I believe to be true:
CFS/FMS are the same illness in most cases.
CFS/FMS represent a common endpoint of a large number of possible underlying triggers—that is, many different things can trigger these syndromes. Once triggered, the process is similar and self-perpetuating, regardless of what the triggers were and whether or not the triggers are now gone. For example, either an auto accident or a viral syndrome can trigger CFS/FMS in different people.
Furthermore, we know that several processes are common in people with CFS/FMS:
Disordered sleep
Hormonal dysfunction
Infection and immune dysfunction
Autonomic nervous system dysfunction, with neurally mediated hypotension (NMH), a problem with blood pressure regulation that results in weakness and dizziness when rising
Low body temperature
Things simplify a bit when one realizes that all of the above processes are controlled or affected by the hypothalamus—our bodies’ master gland, controlling the activity of most other glands in the body. Let’s look at each of these problems individually.
DISORDERED SLEEP
When we look at sleep-deprivation research, several things stand out. Among other things, sleep deprivation can cause:
Immune dysfunction, with multiple opportunistic infections.
Decreased metabolic activity, specifically in the hypothalamus, limbic system, and thalamus. This, as well as low estrogen levels, could account for the decreases in blood flow to the brain, causing brain fog.
Autonomic and temperature-regulation dysfunction. When given the choice, sleep-deprived test animals will often choose a higher room temperature. Higher nighttime room temperatures may further worsen sleep quality.
Chapter 3 discusses sleep problems in detail.
HORMONAL DYSFUNCTION
The effects of hypothalamic dysfunction on the body’s hormone levels can include:
Low thyroid hormone. This can cause decreased metabolism, with weig
ht gain and low body temperature, which can cause poor enzyme and metabolic function.
Low vasopressin (antidiuretic hormone). This causes decreased ability to hold onto fluid, resulting in frequent urination and increased thirst.
Low growth hormone. This also causes low levels of dehydroepiandrosterone (DHEA), a hormone produced by the adrenal glands. DHEA is used by the body to make other hormones, including estrogen and testosterone, and is tied to energy levels and a general feeling of well-being.
Decreased cortisol. Low levels of this stress hormone cause immune dysfunction, hypotension, and the tendency to “crash” in stressful situations.
Low ovarian and testicular function. Low estrogen can contribute to the decreased blood flow to specific areas in the brain that is seen in CFS/FMS. Low testosterone in both males and females can cause immune dysfunction. Although total testosterone levels are often normal, the levels of active (free, or unbound, serum) testosterone are suboptimal in the majority of people with CFS/FMS. In both women and men, bringing free testosterone levels back to mid-to high-normal often dramatically improves symptoms after two months.
Chapter 4 discusses hormonal deficiencies in detail.
INFECTION AND IMMUNE DYSFUNCTION
Chronic fatigue patients typically have multiple opportunistic infections, that is, infections caused by organisms that usually do not cause illness in most people, as well as other recurrent infections. These persistent infections are probably a result of immune dysfunction. Hypothalamic dysfunction, poor digestion, a “leaky gut,” and poor sleep likely play major roles in suppressing the immune system. The resulting infections can cause CFS/ FMS to persist. Some common types of infections that affect people with CFS/FMS are:
Yeast (candida) overgrowth. This overgrowth, along with secondary bacterial infections, then can cause chronic sinusitis.
Bowel infections. These types of infections are major players in CFS/ FMS. Parasitic, fungal, and bacterial overgrowths are common in the bowel, and often account for irritable bowel syndrome. They can cause CFS/FMS and contribute to the nutritional deficiencies by causing malabsorption and a leaky gut. The liver and the immune system then must detoxify and break down many large molecules that would otherwise have been properly digested in the stomach and intestines. These problems in turn can lead to food, chemical/environmental, and medication sensitivities; immune dysfunction; decreased adrenal function; and liver overload.
Infections caused by rickettsia, mycoplasma, chlamydia, and other unusual organisms. Several organisms that are difficult to test for may both trigger and perpetuate CFS/FMS. Antibiotics such as minocycline (Minocin), azithromycin (Zithromax), or ciprofloxacin (Cipro) given for anywhere from six months to years at a time may eradicate these, but also may cause yeast overgrowth, necessitating the use of an antifungal medication.
Viral infections. Some viruses can cause hypothalamic suppression. Although in most people this resolves when the virus goes away, if you have CFS/FMS, it may not. Because many patients get well without antiviral treatments, I suspect that the triggering viral infection is often long gone by several months after the illness begins, or is eliminated when the immune suppression is treated and resolves. In other cases, antiviral therapy may be needed. Post-polio syndrome, herpes-virus 6 (HHV-6), cytomegalovirus (CMV), and the Epstein-Barr virus are four of many suspected culprits.
Chronic prostatitis. This is common in men with CFS.
Chapter 5 addresses how to eradicate infections and boost the immune system in more detail.
AUTONOMIC NERVOUS SYSTEM DYSFUNCTION
The autonomic (sympathetic/parasympathetic) nervous system, the part of the nervous system that controls such basic bodily processes as circulation and sweating (among others), is controlled by the hypothalamus. Improper functioning of the autonomic nervous system can cause a variety of problems, among them:
Neurally mediated hypotension (NMH). This can cause dizziness and weakness, especially when rising.
Night and day sweats. The night sweats can disrupt sleep.
LOW BODY TEMPERATURE
A low body temperature causes the body’s energy and enzyme systems to work inefficiently, as enzyme function is temperature-sensitive. If the body temperature is returned to 98.6°F (using different types of thyroid hormones), people often feel better.15 Stress, including that caused by infection or dieting, may trigger persistently low levels of triiodothyronine (T3), the active form of thyroid hormone, and cause low body temperature. Unfortunately, since T3 is mostly made inside the cells, low T3 levels often do not show up on standard blood tests for thyroid function. Altered temperature regulation may also further contribute to impaired sleep.
(For a visual representation of the interrelationships among all these factors, see Figure 1. 2, The CFIDS/FMS Cycle.)
THE GOOD NEWS
As you see, hypothalamic dysfunction can cause a cascade of problems that may account for many, if not most, of the abnormal findings seen in CFS/ FMS. These processes can then perpetuate hypothalamic suppression. They also explain the multitude of symptoms seen in these illnesses.
The good news is that everything I have discussed above is treatable. The trick is to sort out which problems are most active in each individual and to treat them all. We certainly have much more to learn. I really do not think we have defined “the whole elephant” yet. As we continue to integrate what we learn, we may begin to see the whole picture. Nonetheless, hypothalamic dysfunction, secondary to your body’s energy crisis, explains why people with CFS/FMS can’t sleep, have low body temperatures, gain weight, and are prone to multiple and recurrent infections. The hypothalamic dysfunction by itself can therefore cause most of the symptoms we see in chronic fatigue and fibromyalgia.
I suspect that the root cause of the hypothalamic suppression can be found in the mitochondria, or the “energy furnaces” in the cells. The good news is that restoring adequate energy production using the treatments discussed in Chapter 2 can jump-start your healing process by getting at the root of the problem. We will then discuss how to use sleep and hormonal, anti-infectious, and nutritional support to further restore function in the hypothalamic circuit breaker, allowing it to resume functioning. There is no single magic bullet to get well, however. People who suffer from CFS/ FMS usually have a combination of several different problems. The exact combination varies considerably from individual to individual. There are dozens of major underlying factors, with individual people typically displaying more than five or six factors each. It is important to look for and treat all of the factors simultaneously. Chronic fatigue and fibromyalgia are unusual in that each separate problem can trigger other problems. Because of this, it is rare to need to treat only one single underlying problem.
So How Can I Tell What Triggered My Illness?
Although there are infinite ways to “blow your fuse,” many common subsets and patterns are seen. One of the most helpful clues is whether your illness began suddenly or gradually. Think back to what stresses were going on in your life when the illness began, and what symptoms you had at the onset of the illness. For example, if you had high fevers you probably had an infectious trigger. If you received antibiotics, especially several courses, and have spastic colon or sinusitis, you probably had a candida or yeast-overgrowth trigger. If you were traveling overseas and had diarrhea, you may have had a bowel-infection trigger such as parasitic infection.
Below are some of the most common triggers to consider if your illness began suddenly:
Viral, parasitic, or antibiotic-sensitive infections
Injury
Pregnancy (usually beginning soon after the baby is born)
Toxic exposures (especially if others around you also got sick)
If your illness came on gradually, consider:
Yeast (candida) overgrowth—especially if you have sinusitis/nasal congestion and/or spastic colon
Hormonal deficiencies (even if your blood tests are normal)—especially low thyroid or peri
menopause
Chronic stress, including both at work and within relationships. These syndromes commonly affect hardworking “adrenaline junkies.”
Autoimmune disorders (e. g., lupus, rheumatoid arthritis, Sjögren’s syndrome)
Anything that disrupts sleep, including sleep apnea, restless leg syndrome, or a spouse who snores
Let’s look more closely at a few of the most common triggers.
INFECTIONS
SUDDEN ONSET—THE DROP- DEAD FLU
The most notorious pattern seen in severe chronic fatigue states is one in which a person who is feeling fine suddenly comes down with a brutal flu-like illness that never goes away. In most of these CFS patients, an underlying viral or other infection is suspected.16–24 These infections can directly suppress the hypothalamus.25 For most people, the suppression of the hypothalamus ends when the flu is over. Dr. William Jefferies, a retired endocrinologist and assistant professor of medicine at Case Western Reserve University, has theorized that people who remain chronically ill after an infection have long-term hypothalamic suppression. He explains that the flu causes suppression of adrenocorticotropic hormone (ACTH), which is the hormone that causes the adrenal gland to make adrenal hormone. If the adrenal gland is suppressed and cannot make sufficient adrenal hormone, a variety of fatigue symptoms can result. Dr. Jefferies has found that treating such instances of adrenal suppression with additional adrenal hormone can safely bring about marked improvement, as long as those doses are normal for the body and do not exceed natural adrenal levels.25
From Fatigued to Fantastic! Page 3