From Fatigued to Fantastic!

by Jacob Teitelbaum

  As you can see, many problems can occur when the body’s glands do not function properly. The good news is that most can be effectively treated. In my experience, this often results in dramatic improvement. It is important, though, to treat the whole person, not simply the hormonal problems.

  Important Points

  Because the hypothalamus controls many hormones, CFS/FMS patients often need supplementation with adrenal, thyroid, and reproductive hormones.

  Blood testing is not a reliable way to tell if you need hormonal support. The normal range for most blood tests does not tell you whether your hormone levels are adequate; rather, it measures only whether you are in the lowest 2.5 percent of the population.

  Underactive adrenals are common in CFS. Treat low or borderline adrenal function with very low-dose hydrocortisone (e. g., Cortef at under 20 milligrams daily) and natural adrenal support (e. g., Adrenal Stress End). If DHEA-S blood levels are suboptimal, add DHEA supplementation.

  Hypothyroidism is also common in CFS. Treat symptoms of low or borderline thyroid function with a thyroid product that contains a mix of T4 and T3 hormones or high-dose pure T3—even if your blood tests are normal.

  If your blood pressure is low, you get dizzy upon standing, and you crash after exercising, you might have NMH (neurally mediated hypotension). If so, increase your water intake and make sure you consume a high-salt diet; Dexedrine and Prozac can also be helpful. If you are twenty-two years of age or younger, consider a therapeutic trial of Florinef.

  For both men and women, if the testosterone blood level is in the lowest quarter to third of the normal range, consider treatment with natural testosterone.

  If you are menopausal or if your CFS/FMS symptoms are worse around your period, consider a trial of the bioidentical estrogen and progesterone.

  If other hormone treatments do not work for you, you may have growth-hormone deficiency. Growth hormone can be raised by deep sleep, exercise, sex, growth-hormone injections, or the medication Mestinon.

  Questionnaire (See Appendix B for treatments to check off.) Adrenal Checklist

  ____ 1. Hypoglycemia

  ____ 2. Shakiness relieved with eating or irritability when hungry

  ____ 3. Recurrent sore throats/infections that take a long time to go away

  ____ 4. Low blood pressure or frequent dizziness on first standing

  ____ 5. Long-term prednisone (cortisone) usage since illness began, and feeling better when you took it

  If the answer to any of these (1 through 5) is yes, check off #28, 29, and 30.

  Thyroid Checklist

  ____ 6. Weight gain of more than ten pounds

  ____ 7. Low body temperature (under 98 degrees F)

  ____ 8. Achiness

  ____ 9. Cold intolerance

  ____ 10. Dry skin or thin hair

  ____ 11. Females only: heavy periods

  If the answer to any of these (6 through 11) is yes, check off # 25 (unless your free T4 blood test is elevated).

  Iodine deficiency

  ____ 12. Breast cysts or tenderness

  If yes and your physician has ruled out breast cancer, check off #26.

  Estrogen

  ____ 13. Decreased vaginal lubrication

  ____ 14. Did your CFS/FMS begin within three years after you had a hysterectomy, ovaries removed, or a tubal ligation?

  ____ 15. Are your symptoms worse the week before your period?

  If the answer to any of these (13 through 15) is yes, check off #31 (unless you have a history of breast cancer or blood clots).

  Vasodepressor Syncope (NMH)

  ____ 16. Frequent dizziness on standing or low blood pressure (under 100/60)?

  ____ 17. Did you ever have a positive tilt-table test?

  If the answer to either of these (16 and 17) is yes, check off #30 and 57.

  5

  I—Infections: Destroy Your Body’s Hidden Invaders

  Medical science has known for quite some time that chronic fatigue syndrome is associated with changes in the body’s immune system. In fact, the acronym CFIDS stands for chronic fatigue and immune dysfunction syndrome. People with CFIDS (which can be used interchangeably with CFS) usually have many different and unusual infections at the same time. Some of these infections need to be treated directly. Others will go away on their own as your immune (defense) system comes back “online” as a result of using the effective treatment protocol detailed in this book. In this chapter, we will look at some of the more common, yet often missed, infections.

  What kinds of infections are people with CFIDS/fibromyalgia most at risk for? Although there are literally dozens of infections implicated in CFS, the most important ones to deal with fall under four categories:

  Yeast or fungal infections

  Parasites

  Antibiotic-sensitive infections

  Viral-infections

  In some cases, it is not the infection itself but your body’s reaction to it that causes your symptoms. For example, the body produces interferon to fight viral infections. When a person with cancer or hepatitis is injected with interferon, he or she becomes achy, fatigued, and brain-fogged—all symptoms of CFS/FMS.1 Underactive adrenal glands, commonly associated with CFS/FMS, can also cause interferon levels to become elevated.2 Because of this elevation, it is more accurate to say that the body’s immune system is not functioning properly than to say that it is underactive. Indeed, in many ways, the immune system may be in overdrive early in the illness and then exhaust itself. The immune system malfunctions in many other ways as well, decreasing the effectiveness of the body’s natural killer cells, which are an important defense mechanism.3, 4

  Many recurrent or unusual infections can occur when one has a malfunctioning immune system. Chronic sinus, bladder, prostate, and respiratory infections are common, and are often treated with repeated courses of antibiotics. The large amount of antibiotics introduced into the system can then lead to a secondary yeast overgrowth, as the antibiotics change the natural balance between the bowel’s healthy bacteria and yeast. The original immune dysfunction combined with a high sugar intake (which feeds the yeast) also contributes to the yeast overgrowth. Although the theory is controversial, many physicians believe that chronic yeast overgrowth due to overuse of antibiotics and sugar is a potential and strong trigger for chronic fatigue, fibromyalgia, and further immune dysfunction. What makes the theory controversial is that no definitive tests exist to distinguish fungal overgrowth from normal fungal levels. Nonetheless, a recent study showed that bowel candida levels are much higher in CFS patients when their illness is flaring,5 and most doctors who try treating yeast in at least three or four CFIDS patients see how well this treatment works and continue to utilize it.

  There are also other bowel infections. One-sixth of those with CFS/ FMS have bowel parasite infections.6 Bowel parasites can cause severe allergic or sensitivity reactions, which in turn can trigger fibromyalgia and fatigue. Often, a patient will finally recover from long-standing and disabling fatigue within a week or two after beginning treatment for bowel parasites.

  CFS that begins suddenly often seems to be triggered by viral infections—for example, infection with the Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6—not the same as genital herpes or cold sores), or cytomegalovirus (CMV). In some cases, CFS occurs when you first get the infection. In others, these infections occurred years before and are still present but no longer active (latent). When your immune system becomes weakened, however, they are able to resurface. This is fairly common. For example, most people still have chicken pox virus in their body from when they had it as a child. Shingles occur if that virus resurfaces when your immune system is suppressed. In the same way, old Epstein-Barr (mono), HHV-6, or CMV infections can reactivate during chronic fatigue syndrome. More than 90 percent of healthy adults have had these infections in the past, usually without even knowing it. In many cases, the fatigue caused by viral infections responds to the treatments discussed in this book. A
subset of people will, however, need antiviral treatments for their immune system to recover and their CFS to resolve (see Chapter 5).

  Antibiotic-sensitive infections with unusual organisms such as rickettsia, chlamydia, and mycoplasma may also be problematic. Unfortunately, there is also no effective test available for physicians to confirm these infections, so it is often necessary to rely on symptoms to determine the appropriate treatment. Let’s review each category of infection in more depth, beginning with the most important—yeast/fungal overgrowth.

  Yeast/Fungal Overgrowth

  Everyone’s immune system has strengths and weaknesses. For example, some people never get colds but have frequent bouts of athlete’s foot or other skin fungal infections. Others never get fungal infections but tend to get colds. However, many people seem to have a diminished ability to fight off fungal infections.

  I use the terms yeast, fungi, and candida interchangeably for this discussion. Fungal overgrowth may suppress the body’s immune system. It is suspected that this occurs in part because the bowel yeast infections cause what is called leaky gut syndrome. This means that food proteins get absorbed into the blood system before they are fully digested. Because of this, the immune system has to complete the digestion process, which often overtaxes it. Many physicians feel that yeast overgrowth causes a generalized suppression of the immune system. In other words, once the yeast gets the upper hand, it sets up a cycle that further suppresses the body’s defenses.7

  Yeast is a normal member of the body’s “zoo.” It lives in balance with bacteria—some of which are helpful and healthy, and others that are detrimental and unhealthy. The problems begin when this harmonious balance shifts and the yeast begins to overgrow.

  Many things can prompt yeast overgrowth. One of the most common causes is frequent antibiotic use. Antibiotics kill off the good bacteria in the bowel along with the bad bacteria. When this happens, the yeast no longer has competition and begins to overgrow. The body is often able to rebalance itself after one or several courses of antibiotics, but after repeated or long-term courses—and especially if the body has an underlying immune dysfunction—the yeast can get the upper hand.

  The body may also develop allergic reactions to components of the yeast. This allergic reaction was suggested in a study that connected the fungal organism Candida albicans with allergic skin dermatitis (eczema).8 It found that there is a significant correlation between the body having antibodies to Candida albicans and eczema. In addition, we have found that unexplained rashes that have lasted for many years often clear up with antifungal treatment.

  Other factors are also important. Studies have shown that animals that are sleep-deprived and/or have increased sugar intake develop immune suppression and bowel yeast overgrowth. Many physicians feel that eating sugar stimulates yeast overgrowth in people as well, so as you prepare your meals, remember—sugar is food for yeast.

  DIAGNOSING YEAST OVERGROWTH

  There are no definitive tests for yeast overgrowth that will distinguish yeast overgrowth from normal yeast growth in the body. In my experience, using Dr. William Crook’s yeast questionnaire is still the most reliable way to tell if a person is at risk of yeast overgrowth. (I’ve placed a modified one at the end of this chapter.)

  In addition, anyone with CFS/FMS meeting the following criteria should be treated with antifungals:

  Has chronic nasal congestion or sinusitis or

  Has spastic colon (gas, bloating, diarrhea, and/or constipation) or

  Has been on recurrent or long-term antibiotics (especially tetracycline for acne), or

  Who intermittently has painful sores in the mouth (not cold sores on the outer lips) that last for about ten days at a time and who has CFS/FMS.

  Sinusitis and bowel symptoms are some of the more overt symptoms that are caused by yeast—and both of these usually resolve with antifungal treatments. Since so many people suffer from these symptoms and there is no test available to determine yeast overgrowth, it is reasonable for everyone with CFS/FMS to be treated with an empiric trial of antifungal therapies.

  TREATING YEAST OVERGROWTH

  A number of effective treatments can be used to eliminate yeast overgrowth. I find that the best approach is to combine dietary changes, natural remedies, and prescription medications.

  DIETARY CHANGES AND NATURAL REMEDIES

  The most important part of treating yeast overgrowth is avoiding sugar and other sweets, although I will add the three magic words, “except for chocolate.” You can also enjoy one or two pieces of fruit a day, but don’t consume concentrated sugars like fruit juices, corn syrup, jellies, pastry, candy, or honey. Stay far away from soft drinks, which have ten to twelve teaspoons of sugar in every twelve ounces. This amount of sugar has been shown to markedly suppress immune function for several hours. Be prepared to have your CFS/FMS symptoms flare for about one week when you cut sugar out of your diet.

  Using stevia as a sweetener is a wonderful substitute for sugar. Despite some misconceptions, stevia is safe and natural, and you can use all you want. There are even cookbooks available for using stevia. The brand of stevia that you choose is important, however. Most brands of stevia are not filtered and therefore are bitter. The two that won the taste test in our office are made by Body Ecology (see Appendix E: Resources) and Stevita.

  Several books have been written on the yeast controversy and offer additional dietary methods to try. One of the best is The Yeast Connection and Woman’s Health by the late Dr. William Crook, a physician who advanced our understanding of CFIDS/FMS considerably.

  One of those dietary methods that can help restore balance in the bowel is the intake of acidophilus—that is, milk bacteria, a healthy type of bacteria. Acidophilus is found in yogurt that has live and active yogurt cultures. Indeed, eating one cup of yogurt a day can markedly diminish the frequency of recurrent vaginal yeast infections.9 Acidophilus is also available in supplement form, but the brand you use is important because many brands do not actually contain the amount that the label claims or contain dead bacteria—which do not put up much of a fight against yeast. I like to use Acidophilus Pearls by Enzymatic Therapy. The pearls act like little tanks that protect the milk bacteria while they pass through the acidic environment of the stomach. Once the pearls hit the alkaline environment of the small intestine, they dissolve and release the bacteria to fight the yeast. I recommend that you take two pearls twice a day for five months, after which time many people choose to continue taking one a day for prevention. Although the box claims 1 billion bacteria per pearl, the laboratory assays actually show that each of these pearls contains 2.4 billion bacteria. If you are on antibiotics (not antifungals), take acidophilus at least three to six hours before or after the antibiotic dose.

  In addition to using acidophilus against the yeast, chemical weapons can also be helpful, and I recommend that they be taken with the acidophilus. I find that grapefruit seed extract, such as Citricidal, is helpful. I recommend the capsule or tablet form, taking 200 milligrams twice a day for five months. Use less if it upsets your stomach.

  Many other natural antifungals may be helpful, but when used individually in a high enough dose to kill the yeast they also irritate the stomach. Because of this I like to combine multiple antifungal herbs. My favorite combination is Anti-Yeast by Ultraceuticals, which contains 240 milligrams of coconut oil powder (50 percent caprylic acid), 200 milligrams of oregano powder extract, 120 milligrams of uva ursi extract, 240 milligrams of garlic powder (deodorized), 160 milligrams of grapefruit seed extract, 80 milligrams of berberine sulfate, 200 milligrams of olive leaf extract, 50 milligrams of alpha lipoic acid, 50 milligrams of milk thistle extract, and 50 milligrams of N-Acetyl-L-Cysteine. Another antifungal supplement product that I recommend is Phytostan, by Integrative Therapeutics (see Appendix E: Resources).

  PRESCRIPTION TREATMENTS FOR YEAST OVERGROWTH

  It is critical to add a prescription antifungal, because the natural products only kill yeast in
the gut and are not as strong. I recommend that almost all of my CFS/FMS patients use Diflucan 200 milligrams a day for six to twelve weeks. If stool cultures (which are negative even in most people who need yeast treatment) show the yeast to be resistant to Diflucan, then your doctor may choose to substitute Nizoral at 200 milligrams a day for six weeks. Nizoral can lower adrenal hormone levels, so if your cortisol is low your doctor should consider adding adrenal support when prescribing Nizoral.

  Nystatin, an antifungal medication, has been helpful in treating yeast overgrowth in the past. Unfortunately, more and more fungi seem to be developing nystatin resistance. In addition, nystatin is poorly absorbed, which means that it has little impact on the yeast outside of the bowel. Because of this, I am now using the herbals listed on Chapter 5 instead.