Although ribose is the most promising energy nutrient, others are also worth looking at. Most of these only need to be taken for four to nine months, though some people choose to take them longer: I take my ribose every day even though I feel great. It makes me feel even better! You will know whether to keep taking them by how you feel on them.
These other energy boosters are discussed at length in the notes section of my Web site (www.vitality101.com) and include:
Aspartates and malic acid. Aspartates and malic acid are compounds that are needed to “rescue” part of the Krebs energy cycle, a series of chemical reactions that take place in the body’s cells and allow glucose to be used for the production of energy. Malic acid is a compound that occurs naturally in foods, in fruits in general, and in especially high levels in apples. (Remember the old saying: An apple a day keeps the doctor away.) When levels of malic acid and the other compounds discussed in this chapter are low, the body often has to shift to an inefficient anaerobic means of generating energy. This causes muscle pain, achiness, and fatigue. Malic acid and magnesium can easily be found in several vitamin powders, as discussed in Chapter 6.
L-carnitine and acetyl-L-carnitine. Low levels of the carnitine compound acylcarnitine in the blood or muscles of people with CFS/FMS have been found by two different research centers.57, 58 Carnitine plays many roles in the body. It has the critical function of preventing the mitochondria from being shut down when the system backs up. Also, without sufficient carnitine, the body cannot burn fat (and, in fact, makes excess fat), resulting in large weight gains. L-carnitine is a naturally occurring form of carnitine that is only found in animal flesh (think “carni-vore”), and any brand is fine as long as it is pure acetyl-L-carnitine. Although you may not see a marked effect, it helps lay the foundation for your getting better and may help you lose any weight you have gained. Take 500 milligrams twice a day for four months.
NADH. Because of the cost, hassle, and modest effectiveness, I rarely use NADH and prefer to simply use ribose. I will sometimes consider it for those with pure CFS without pain who have failed other treatments.
Coenzyme Q10. Coenzyme Q10 is critical for the electron transport system (ETS) to do its job of harvesting more than 75 percent of the ATP energy from food. Because of this, it is important in energy production. Although a lot is found in the diet, it can become depleted during periods of excessive energy demands. Levels of coenzyme Q10 are also significantly lower in women who use oral contraceptives59 or Premarin and Provera, which may in turn increase the risk of cardiovascular disease.60 In addition, most cholesterol-lowering drugs deplete coenzyme Q10.61 This is especially tragic because this deficiency can cause or aggravate the congestive heart failure (CHF) seen in some patients with heart disease—and doctors are largely unaware of this, simply blaming it on the heart disease. Giving ribose, coenzyme Q10, magnesium, and acetyl-L-carnitine should be done routinely in almost everyone with heart disease. In fact, a review of more than a dozen studies showed that coenzyme Q10 increases heart function significantly in heart-failure patients.62, 63 I have seen patients on the heart transplant list (or even too sick to make it that far) go back to normal function with these nutrients.
In addition to helping energy and heart disease, studies have demonstrated that coenzyme Q10 can:
Enhance immune function.64–69
Assist weight loss when dieting.70
Decrease the frequency of migraine headaches.71
Raise low sperm counts.
Help slow Parkinson’s disease.
Improve exercise tolerance in sedentary people.72
Decrease allergies.73
Treating Mitochondrial Dysfunction Summarized
To sum up, following is my recipe for treating mitochondrial dysfunction and jump-starting your body’s energy production. The supplements are listed in order of priority, if cost is an issue (some of them can be expensive).
Take D-ribose (CORvalen) 5,000 milligrams three times a day for three weeks, then two times a day. It’s a powder that looks and tastes like sugar and does not act as food for yeast. It can be added to food or drinks, even hot tea.
Take the Energy Revitalization System vitamin powder (by Enzymatic Therapy) or a similar multivitamin with B-complex vitamins.
Take 500 to 1,000 milligrams of acetyl-L-carnitine a day for four to nine months, and then as needed.
Take 200 milligrams of coenzyme Q10 daily for four months (Vitaline, Enzymatic Therapy, or Ultraceuticals brand).
I would recommend the first two for everyone, and I’d take them long term (this is what I still take daily). Add the acetyl-L-carnitine for three to four months. If you can afford the cost, add the coenzyme Q10 for a three-to four-month trial. If you do not feel better in six to nine months, consider adding magnesium-potassium aspartate and NADH.
Important Points
Like blowing a fuse, CFS and fibromyalgia actually protect your body from harm. Unfortunately, if you don’t know how to “turn your circuit breaker back on,” this doesn’t do you much good.
Solid research has shown that more than 91 percent of people on the SHIN protocol report significant improvements.
Sleep. Because your sleep center is not working, you need aggressive treatment to be sure that you can get at least eight hours of deep sleep each night.
Hormonal support. This includes treatment with bioidentical hormones for thyroid, adrenal, and ovarian/testicular support—even if your blood tests (which are very unreliable) are normal.
Infections. Because your immune system is working poorly, there are many infections present that need to be treated.
Nutritional support. Make nutritional support easy without taking handfuls of supplements throughout the day by taking the Energy Revitalization System vitamin powder (see Chapter 6) and D-ribose powder.
At the end of each chapter, fill out the relevant questionnaire. It will tell you which treatments to check off in Appendix B: SHIN Treatment Worksheet. When you finish reading the book, you will have tailored a treatment protocol to your specific case.
Many of the treatments will be natural remedies that you can use on your own. However, to get the full benefit, you should apply the SHIN protocol with the help of a physician. (See Chapter 12)
The mitochondria are the energy furnaces in your cells that burn food for energy. Many studies and findings suggest that these furnaces are functioning inefficiently in CFS/FMS.
Due to mitochondrial dysfunction, a person with CFS/FMS becomes unable to make the “tools” the furnace needs to work well—a problematic cycle that occurs throughout the body, affecting the brain (fatigue, brain fog), liver (chemical and other sensitivities), bowel (malabsorption of nutrients), and muscles (pain and postexertional fatigue).
D-ribose (CORvalen) supplementation can jump-start the body, getting it ready for the SHIN protocol. Take 5,000 milligrams CORvalen or CORvalen M three times a day for three weeks, then lower the dose to twice a day. Take it at least four months, though many people choose to take it long term.
Take 500 to 1,000 milligrams acetyl-L-carnitine a day for four to nine months, and 200 milligrams coenzyme Q10 daily for four months.
Questionnaire (Items to be checked off are in Appendix B.)
Do you have CFS/FMS, pain, or fatigue? If yes, check off #10.
Are you on cholesterol-lowering medications (related to Mevacor)? If yes, check off #9, and consider switching to natural cholesterol-lowering herbs instead (see Chapter 8).
Do you have any heart problems? If yes, check off #8, 9, and 10.
Have you gained weight you don’t want? If yes, check off #8.
PART 2
Restore Energy Production with the SHIN Protocol
As we discussed earlier, chronic fatigue syndrome and fibromyalgia represent a bodywide energy crisis. As the hypothalamus uses more energy for its size than any other area in your body, it malfunctions first. This results in insomnia, hormonal deficiencies, low body temperature, and low blood pr
essure. Inadequate energy also may contribute to immune dysfunction and your muscles getting stuck in the shortened position—resulting in chronic pain. As energy runs all of your body systems, other problems such as immune dysfunction and difficulties with detoxification are also common. Restoring optimal energy production and eliminating those things that drain your energy are critical to your recovery. Your checklist for doing this and getting well is the acronym SHIN.
Sleep
Hormonal deficiencies
Infections
Nutritional support
Sleep is where we recharge our batteries and restore immune function. It is also critical for tissue repair, and therefore the elimination of pain. Hormonal control is also essential. For example, the thyroid acts like your body’s gas pedal. If it is sluggish, you will simply not produce adequate energy. In addition, most of you will find that there are numerous infections that you picked up over the years because of your immune dysfunction, and all of these can drag you down. The most important of these in treating CFS/FMS is the chronic candida/fungal/yeast overgrowth (same infections, many names). Treating candida not only will help resolve your chronic fatigue and fibromyalgia, but also will likely resolve other chronic conditions like sinusitis and spastic colon. Nutrition, of course, is the key to health and energy production. We will teach you how to get outstanding and optimized nutritional support—without taking handfuls of tablets for the rest of your life.
At this point, you’re already aware of the importance of ribose supplementation and have started filling out the SHIN Treatment Worksheet (see Appendix B). The next section of the book will lead you through the steps to getting well.
3
S—Sleep: The Foundation of Getting Well
The most effective way to eliminate fatigue and pain in CFS/FMS is to get eight to nine hours of solid, deep sleep each night on a regular basis. Disordered sleep is, in my opinion, one of the key underlying processes that drive CFS/FMS. Usually, when I lecture, I ask, “How many of you who have CFS/FMS can get at least seven to nine hours of solid sleep a night without medications?” Generally, out of three hundred to four hundred people in the audience, only one or two people, if any, raise their hands. When I speak with these people later, I usually find that they have sleep apnea, narcolepsy, or another treatable cause for their fatigue besides CFS/FMS. Research shows that poor sleep quality is reported by 99 percent of fibromyalgia patients, and the degree of poor sleep quality was able to predict the degree of pain, fatigue, and poor social functioning in patients with FMS.1
Hypothalamic dysfunction affects sleep, as well as blood pressure, hormonal systems, and temperature regulation. In animals with hypothalamic dysfunction, sleep is either disordered or, in very severe cases, simply no longer occurs. In animal studies done by Carol Everson, Ph. D., at the University of Tennessee, sleep deprivation resulted in immune suppression, resulting in multiple infections (including yeast overgrowth in the gut).2, 3 Many other abnormalities also occurred based on the sleep disorder. These same processes seem to occur in people with CFS/FMS.3 Other sleep disorders are also common in CFS/FMS, including sleep apnea, upper airway resistance syndrome (UARS), and restless leg syndrome (RLS). These will be reviewed after the discussion of natural and prescription sleep aids.
Disordered sleep was first demonstrated by Dr. Harvey Moldofsky, a Canadian researcher, who noted that the quality of deep sleep in fibromyalgia was poor.4 This was described as alpha wave intrusion into delta wave sleep. To put this into English, sleep has its own architecture and is not a single state. REM sleep, a light-sleep period during which we have our dreams, is the best-known part of the sleep architecture. There are other stages of sleep, designated simply by number. Stages 1 and 2 sleep are fairly light stages, while stages 3 and 4 (or delta wave) sleep are the deeper stages of sleep. My experience, and that of many other clinicians, suggests that stages 3 and 4 sleep are inadequate in CFS/FMS. This is supported by Robert Bennett’s research at the University of Oregon Health Services Center. Bennett is one of the world’s foremost researchers in fibromyalgia. He found that growth-hormone deficiency occurred in fibromyalgia, and that treating this deficiency resulted in improvement of symptoms after four to five months. However, he felt uncomfortable recommending routine growth-hormone treatment for fibromyalgia because of its high cost (approximately fifteen thousand dollars per year). What is interesting, though, is that growth hormone is released during stages 3 and 4 sleep. Therefore, the loss of these deep stages of sleep may be a significant contributor to the growth-hormone deficiency that has been observed. My own suspicion is that not only does hypothalamic dysfunction cause disordered sleep, but that the poor sleep then further suppresses the hypothalamus. It is because of this that breaking the cycle of poor sleep and maintaining quality sleep for at least six to nine months is critical to breaking the cycle of CFS and fibromyalgia.
Growth hormone is responsible for many of the repair processes that go on in our muscles and in the rest of our body. It may be that it is the loss of this repair function, which normally occurs during deep sleep, that contributes to the pain of fibromyalgia. Several studies have shown that if you wake people up whenever they go into deep sleep, or even shake them lightly, so that they go from deep sleep into light sleep, they will develop classic fibromyalgia-like pain within one to two weeks and often within one night.4, 5
In addition to causing growth-hormone deficiency (which we will discuss in more detail in Chapter 4), pain, and immune dysfunction, poor sleep also contributes to the average thirty-two-pound weight gain most patients with CFS and fibromyalgia report. In a study of 68,183 women, followed over sixteen years, those sleeping five or fewer hours per night had a 32 percent increased risk of gaining thirty-three pounds relative to those who slept seven hours per night.6
It is absolutely critical that people with CFS/FMS get eight to nine hours of solid sleep each night, without waking or without feeling “hungover” the next day. Sound sleep is the goal and, hard as this may be to believe, it is attainable using the suggestions I will give you in this chapter.
The Basics: Good Sleep Hygiene
Although poor sleep hygiene is not a major problem for most people with this disease, it is the major cause of poor sleep for most Americans, and it is important to address this first. The following are some things to consider:
Consume little or no alcohol before bedtime.
Do not consume any caffeine after 4 p. m.
Do not use your bed for problem solving or doing work. If you are in the habit of using your bed for doing work, it is best to change your work area to another area of the house. If it helps you to fall asleep, you can watch relaxing television (perhaps on a timer that turns the television off if you fall asleep while watching) or read a relaxing book in bed until you can no longer stay awake.
Take a hot bath before bed.
Keep your room cool.
If your mind races because your brain thinks it is daytime when it is really nighttime, continually focus your thoughts on things that feel good and do not require much “thinking energy.” If you find that you cannot help but continue to problem-solve, get out of bed and write down all your problems on a piece of paper until you can think of no more—then set them aside and go back to bed. Do this as often as you need to. It may be helpful to schedule thirty minutes of “worry time” early in the afternoon or evening when you can update a checklist of your concerns.
As CFS/FMS patients, we seem to think that we’re responsible for making everything happen, like making our bodies heal. That stress and anxiety can make a good night’s sleep difficult to come by. I certainly struggle with this and have devised a simple strategy that works for me. You may find something similar to be useful as well. When I feel overcome by details, I list my problems and projects on the left side of a page, and what I eventually plan to do about them (if anything) in the middle of the page. I consider these two columns to be what I leave in the hands of God, the universe, or what
ever you wish to call it. Every so often, I move a problem from the “universe’s” columns over to a third (“my”) column on the right side. The items in the third column are the one or two things that I want to work on right now. I am constantly amazed at how the things that I leave in the “universe’s” hands progress (on their own) as quickly as the things that I’ve put in “my” column.
I also have a separate list for day-to-day errands. I put a star by those items that must get done soon. I do other items if and when I feel like it. It is helpful to remember that neither you nor anyone else will ever get everything done. Just do those things that feel good to do on any given day, even if it’s nothing. It will usually feel good to do the things that really have to get done. When I was doing general hospital internal medicine, I never heard a dying patient bemoan not having worked enough, or not having completed all the errands on his or her checklist.
If your partner snores, get a good pair of earplugs and use them. The wax plugs that mold to the shape of the ear are often the best ones. It may also be useful to have either a sound generator that makes nature sounds or, better yet, a tape that induces stage 4 sleep (more about this later). Spouses of people with sleep apnea and/or snoring often also have severely disturbed sleep. You may need to sleep in a separate bedroom (after tucking in or being tucked in by your partner) until you find a way to sleep soundly through the snoring.
From Fatigued to Fantastic! Page 6