What makes treatment complicated, however, is that even if a gland is underactive, blood testing can often mistakenly suggest that the gland is technically normal, albeit in the low range (more on this in Chapter 4). Patients are then often told that their thyroid and/or adrenal glands are healthy when indeed they are not. You’ll find more information on finding a doctor who can correctly interpret blood tests and identify subclinical hormonal deficiencies in Chapter 12.
The drop-dead flu also causes many people to develop poor immunity, facilitating repeated bladder, respiratory, or sinus infections. I have found that patients who then take repeated courses of antibiotics for any reason often end up with an overgrowth of yeast in the bowel. Bowel parasites and other infections are also common in CFIDS patients.7, 9 Some of these infections can sneak up on you slowly. Suppressed hypothalamic function from chronic infections can then trigger disordered sleep, continuing the fatigue cycle.
GRADUAL ONSET—YEAST /CANDIDA OVERGROWTH
If you have chronic sinusitis/nasal congestion or spastic colon (gas, bloating, diarrhea, or constipation), you probably have yeast or candida overgrowth. This overgrowth may have triggered your CFS/FMS. In other cases, the immune suppression caused by the illness may result in the yeast overgrowth itself. Most of the overgrowth occurs in the bowels. In my experience, it is worth treating everybody who has chronic fatigue syndrome and/or fibromyalgia for possible yeast/candida overgrowth.
POOR SLEEP
As discussed earlier, chronic fatigue and fibromyalgia sufferers may not have slept effectively for several years. I suspect that poor sleep further suppresses the hypothalamus. Poor sleep can then cause immune suppression, with secondary bowel infections.26–28
Many people enter the fatigue cycle directly through disrupted sleep. Chronic fatigue syndrome and fibromyalgia can be triggered by anything that suppresses the hypothalamus, disrupts sleep, or causes tight muscles. These include a trauma, such as an accident; a parasitic or other infection; chronic emotional or physical stress; hormonal imbalances; and/or recent childbirth. They can also be triggered by a number of other problems, such as an anatomic problem (for example, having legs of different lengths) or temporomandibular joint (TMJ) syndrome, which is characterized by tenderness and clicking in the jaw.
THE AUTOIMMUNE TRIAD AND HORMONAL DEFICIENCIES
Another common pattern seen in severe chronic fatigue states is the autoimmune triad. In autoimmune disorders, the body mistakes parts of itself for outside invaders. The autoimmune triad seen in CFIDS patients involves the thyroid and adrenal glands, as well as the cells in the body that assist in the absorption of vitamin B12. When the body attacks these “invaders,” the resulting low levels of thyroid and adrenal hormones and vitamin B12 trigger fibromyalgia and poor sleep. This can then suppress the hypothalamus gland, setting the fatigue cycle in motion. Multiple other hormonal problems, especially low estrogen in the ten to fifteen years before one is “officially” in menopause, can also trigger CFIDS/FMS.
So How Do I Determine Which Treatments I Need?
Fill out the questionnaires I’ve placed at the end of many chapters. Based on the answers, you will be directed to check off certain treatments on the SHIN Treatment Worksheet in Appendix B. This will tailor a treatment protocol based on your symptoms. If you have lab results, the educational program on my Web site (www.vitality101.com) can analyze both your symptoms and lab results to help you and your physician determine which treatments are likely to be needed in your case.
Because the best results seem to come from treating all of the symptoms of CFS/FMS simultaneously, it can sometimes be difficult to tell exactly which treatment is producing the main benefit. However, once you are feeling better, you and your doctor can taper off the treatments to see which ones are still needed. If you would like to go more slowly with your treatment, especially if you have a history of being very sensitive to natural or prescription therapies, be sure to let your health-care practitioner know.
Why Have CFS and Fibromyalgia Been Ignored by Doctors?
Many pieces of the CFIDS/FMS puzzle are still missing. The outlook is bright, however, with new research continually providing important clues on how to improve treatment. For the vast majority of people with CFS/FMS-related symptoms, effective treatment is now available. Unfortunately, the medical community often refuses to acknowledge an illness until there is a definitive test for it. In the early days of polio, for example, before a blood test was developed, some physicians intimated that the children on iron lungs were simply having a psychosomatic illness. The same thing occurred with lupus, even though many women died of the disease. Indeed, relief came for lupus sufferers only when a blood test was developed. The same thing is now occurring with CFS and fibromyalgia. Fortunately, the CDC and the National Institutes of Health (NIH), the two main governmental agencies responsible for CFS and fibromyalgia research, are now getting more serious about making it clear to physicians that these are very real and devastating syndromes—and not simply psychosomatic. The CDC is spending millions of dollars in advertising to help correct misimpressions about CFS and to educate both physicians and the public about how real and devastating these syndromes are. This recognition is coming just in time, as the prevalence of these syndromes is skyrocketing.
You’re Not Alone
Let’s look at the numbers. Fibromyalgia was conservatively estimated to affect 6 million Americans in a major study published in 1995.29 However, in our study sixty-nine of seventy-two patients with fibromyalgia (approximately 95 percent) also had CFIDS. In another study by Dr. Dedra Buchwald, 64 percent of her FMS patients also had CFIDS. By extrapolating these percentages, you might expect at least 4 to 5 million cases of CFIDS. In addition, about 10 to 20 percent of CFIDS patients do not have fibromyalgia, so again using these figures, there should be almost 6 million cases of CFIDS. Yet some researchers still believe that only a few hundred thousand people are affected by these syndromes.
To show that CFS/FMS is much more common than the current estimates of five hundred thousand to 1 million Americans, let’s break it down further. A study by Dr. Leonard Jason, the world’s foremost epidemiologist for CFS, found4 that:
11.9 percent of the population currently had “severe fatigue, extreme tiredness, or exhaustion” lasting more than one month.
4.2 percent had these symptoms for more than six months.
2.2 percent also had no other medical or psychological diagnosis that could cause fatigue (approximately 2 percent of Americans have FMS).
0.4 percent is all that was left over after doctors and a psychiatrist looked for any problems that could be used as an excuse to account for fatigue (now or in the past).
These numbers suggest a CFIDS-related illness likely affects at least 2 to 4 percent of the population, and perhaps as much as 12 percent. However, when Dr. Jason applied the rigid criteria that the CDC uses, which rules out cases where other possible causes of fatigue may be present, he found that less than one million Americans would be diagnosed with CFIDS.
Chronic fatigue and fibromyalgia appear to be becoming much more common. Four studies published in 2006 suggest that, using the same diagnostic criteria, fibromyalgia has gone from affecting approximately 2 percent of the European and African population ten years ago30–34 to approximately 8 percent just a decade later. When individual country data from these studies are analyzed, the surge in diagnoses tops 400 percent. It seems that effective treatment has arrived just in time.
Important Points
Chronic fatigue syndrome (CFS or CFIDS) is characterized by the paradox of the inability to sleep despite being exhausted, brain fog, and, if fibromyalgia (FMS) is also present, widespread pain. You may have a variety of other symptoms as well. Common symptoms include increased thirst, weight gain, low libido, spastic colon, nasal congestion/sinusitis, and frequent infections.
Chronic fatigue syndrome and/or fibromyalgia occur when you expend more energy than you can make. This overloads your
circuits, causing you to “blow a fuse” called the hypothalamus. This gland controls sleep, hormonal function, autonomic function (blood pressure, pulse, sweating), and temperature regulation. In essence, although the symptoms can be devastating, chronic fatigue syndrome and fibromyalgia keep you from causing yourself any permanent harm when you’ve overdrawn your body’s energy account.
“Blowing a fuse” can occur because of overwork, infections, poor sleep, hormonal problems, toxic work or home situations, pregnancy, injury, or many other causes.
Research shows that effective therapy is available for 91 percent of patients with CFIDS/FMS by simply treating symptoms with the SHIN (Sleep, Hormones, Infections, and Nutrition) protocol.
2
Create Your Individual Treatment Protocol—Beginning with Ribose for Energy Production
Although many physicians use this book as a guide, From Fatigued to Fantastic! is for you, the person suffering from chronic fatigue syndrome and/or fibromyalgia. After giving an overview of the possible causes and patterns of chronic fatigue states in Chapter 1 and discussing how they represent an energy crisis in your body, we will then teach you how to get well, starting at the end of this chapter.
As discussed in Chapter 1, it’s good that you have a circuit breaker to keep you from “burning out your wiring” and hurting yourself, but it doesn’t do you much good if you don’t know how to turn your circuit breaker back on. This requires optimizing energy production and eliminating the things that are draining your energy. We call this the SHIN protocol, which stands for the four main treatment areas:
Sleep
Hormonal deficiencies
Infections
Nutritional deficiencies
Our placebo-controlled study shows that when you treat these four building blocks of health, 91 percent of you can improve your energy levels and decrease your pain—often dramatically.1, 2 Part 2 will go into the specifics of each treatment area, and in Part 3, you’ll learn how to overcome other problems, such as chronic pain, weight gain, low libido, pregnancy concerns, and mind-body issues. Several appendices offer additional or supporting information, including an overview of this illness for your physician and a treatment checklist that you can use as you read the book to help you tailor a treatment protocol to your specific case.
Your doctor may not be familiar with the research on effective treatment of chronic fatigue and fibromyalgia. If this is the case, you may want to show your doctor Appendix G: For Physicians (which I wrote specifically for medical professionals) and the abstracts of my clinical studies that are available in Appendix A and on my Web site. The full text of two of the studies done in our research center using the treatments discussed in this book can also be found at www.vitality101.com. These will be helpful to your physician. Feel free to download the studies from the Web site and give him or her a copy.
If you are looking for a new doctor, turn to Chapter 12 for more information on what to look for and how to choose a practitioner. In addition, I have become the medical director of the national Fibromyalgia & Fatigue Centers, which use the protocol described in this book. More information can be found in Chapter 12 and Appendix E: Resources.
Regardless of which physician you choose, it is essential that you work with a doctor to monitor your treatment, guide your use of natural remedies, and help implement the strategies you’re going to read about here.
If you finish the book and find yourself wishing for more information, check my Web site (www.vitality101.com):
For more detailed information on many of the topics covered in this book, go to the From Fatigued to Fantastic! notes and use the password FFTF;
Visit the question-and-answer section, where you can see the answers to thousands of questions and ask your own questions;
Sign up for the free e-mail newsletter so you can stay on the cutting edge of new research information;
Sign onto the computer program that can do a more detailed analysis of not only your symptoms, but also your lab tests, to help you tailor a treatment protocol specific to your case. If you like, you can even use the “long program” to make a complete medical record of your case for your doctor (so he or she can use your appointment time far more effectively);
Visit the Web site shop for useful products.
How to Follow the SHIN Protocol
As you read this book, you’ll find questions at the end of most chapters; answer the questions and check off the appropriate numbers on the SHIN Treatment Worksheet (see Appendix B). When you are done reading the book, you will have a treatment protocol tailored to your specific case. A fair number of treatments will be a recommended. Each treatment will be marked by level of importance as a top, middle, or low priority. This way, you can choose how aggressively you want to proceed. You’ll want to bring this treatment worksheet to a doctor specializing in CFS/FMS and consult with him or her on how best to proceed.
Once you are ready to begin your treatment, you can follow this basic timeline, adjusting as needed.
WEEKS 1 THROUGH 3
Nutritional therapies, specifically vitamin and ribose supplementation
Treatments for pain if needed
Sleep aids
WEEKS 4 THROUGH 8
Hormonal therapies, continuing to use nutritional therapies and sleep aids
WEEKS 9 THROUGH 20
Anti-infection treatments, adding one new treatment every one to three days, if necessary. Continue nutritional therapies, sleep aids, and hormonal therapies as needed.
You should continue this regimen for six months or until you begin to feel better. Then, slowly lower the doses of your treatments, without compromising how you feel. You may find that you need to continue some treatments, such as vitamin and ribose supplementation, indefinitely. In each chapter, I will discuss natural therapies first, as these are safer and often highly effective. However, it is helpful to have prescriptions available as well, and these will also be discussed.
Before we begin the SHIN protocol, however, let’s jump-start our energy and set ourselves up for success.
Jump-Starting Your Body’s Energy Furnaces
As we will discuss throughout this book, CFS and fibromyalgia reflect an energy crisis in your body. Although it can have numerous causes, the energy crisis will then trigger a host of downstream effects, including hypothalamic dysfunction (“blowing a fuse”), which causes multiple other problems, including muscle pain, insomnia, hormonal deficiencies, infections, poor liver detoxification, and decreased heart function. Although going after these many triggers and problems is important, it is also critical to go to the heart of the problem and treat your body’s “energy furnaces.” We will begin our discussion of treatments with those that directly increase energy production.
Each cell in your body contains structures called mitochondria, the tiny furnaces in each cell that produce energy by burning calories. Many problems, including Epstein-Barr viral infections, can suppress your energy furnaces.3 In this chapter, I will discuss treatments that can help your mitochondrial furnaces work properly, and explain how you can use this information to feel better.
THE ROLE OF ENERGY PRODUCTION
We simply can’t overcome fatigue if the cells and tissues in our bodies don’t have enough energy. Medical research shows there are many conditions that drain energy from the body, leaving us fatigued and with frequent complications such as muscle pain, heart problems, and even depression.
Of course athletes who participate in high-intensity, endurance-type exercise often face the fatigue and muscle pain associated with energy depletion. Typically, a few days’ rest will allow an athlete’s muscles to recharge with energy. For the rest of us, however, the physiological factors that drain the heart and muscles of energy are not as easily overcome. It is amazing how a special simple sugar, called D-ribose, can help the body restore energy, giving the heart and muscles the power they need to fully recharge, so they can recover from fatigue and chronic muscle pain.
As we age, our bodies go through many changes that affect our ability to efficiently metabolize energy. For some, these changes occur more rapidly and are more pronounced, while for others the impact is seemingly absent. People with fibromyalgia and CFS have almost 20 percent less energy in their muscles than normal, and this lack of energy causes poor exercise tolerance and lack of endurance, making it hard to perform even the most basic of life’s daily activities.4, 5
The metabolic changes that occur in our bodies over time or with the onset of disease are varied. Many patients experience thickening of the walls of capillaries that feed blood to muscles. These thickened capillary walls make it harder for oxygen to move from the blood to the muscle tissue, reducing the oxygen tension of the muscle and slowing the rate of energy synthesis.6, 7
In some, the mitochondrial energy furnaces are defective and cannot keep up with the energy demand of cells and tissues as they work through daily activities.8–10 For others, cells and tissues are deficient in certain nutrients that are needed to process food into energy, leaving the tissues energy-starved.11–13 In the most difficult conditions, the muscle itself is affected, leaking vital cellular constituents that include energy compounds and the fuels needed to restore energy levels in affected tissues.14
No matter the cause, the impact of energy depletion is to propel a downward spiral of fatigue, muscle pain, and stiffness that will not stop until the energy in the affected tissue can be restored. As energy is used faster than it can be restored, muscles become more painful, stiff, and fatigued. This causes even more energy to be used as the muscle struggles to recover, causing more fatigue, soreness, and stiffness,15–17 and the cycle continues. If the conditions leading to energy depletion are not arrested in time, the fatigue can become overwhelming and debilitating—as occurs in CFS/FMS.
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