From Fatigued to Fantastic!

by Jacob Teitelbaum

  Any effective antifungal can initially make the symptoms of yeast infection worse. In addition, Diflucan can cause liver inflammation, although this is uncommon, and I have not seen it to be a significant problem in the more than three thousand patients I’ve treated. Nonetheless, if you are taking Diflucan or Nizoral for more than six to twelve weeks, blood tests should be performed to check liver function—specifically checking blood levels of alanine aminotransferase (ALT) and aspartate transaminase (AST), two compounds that are good indicators of injury to the liver. If you have preexisting active liver disease, you should be cautious about using Diflucan—or not use it at all. The Anti-Yeast herbal on Chapter 5 contains lipoic acid, milk thistle extract, and N-Acetyl-L-Cysteine, natural supplements that help protect and heal the liver. For that matter, I strongly recommend lipoic acid for anyone with severe active liver disease (for example, hepatitis), at a dose up to 1,000 to 3,000 milligrams a day, as it may prevent and/or help treat cirrhosis.

  If symptoms of yeast overgrowth are caused by an allergic or sensitivity reaction to the yeast body parts, symptoms may flare up when mass quantities of the yeast are suddenly killed off. This is called a die-off (Herxheimer) reaction and can occur with the treatment of any chronic infection. To decrease the risk of this reaction, start your treatment with acidophilus and a sugar-free diet for one to two weeks, followed by the herbals for two weeks before beginning the Diflucan. If symptoms flare up, take just 25 to 100 milligrams of Diflucan each morning for the first three to fourteen days. If symptoms recur after you stop the Diflucan, I recommend continuing the medication for an additional six weeks at 200 milligrams a day.

  As your doctor will inform you, when taking Diflucan, do not use the heart medicine quinidine or cholesterol-lowering medications in the statin family, which includes Mevacor, Baycol, Lescol, Lipitor, Pravachol, and Zocor, as these combinations can be deadly. In addition, these cholesterol-lowering medications can actually trigger fibromyalgia, and I almost never use them in my CFS/FMS patients. Cholesterol can usually be effectively lowered naturally using herbal treatments such as garlic, berberine, inositol hexaniacinate, and oats (as found in Life cereal or Cheerios). For more information on natural ways to lower cholesterol, see Chapter 8. I would note that the cholesterol medications also deplete coenzyme Q10, so I recommend that anyone taking cholesterol-lowering medications take coenzyme Q10 (Vitaline form) at a dose of 200 milligrams a day. Your holistic doctor can guide you on how best to safely treat high cholesterol.

  Once the yeast symptoms of sinusitis and spastic colon have been effectively decreased and kept that way for six to twelve months, you can try adding small amounts of sugar back into your diet. If symptoms recur, however, stop the sugar again. Continuing either to eat yogurt with live and active acidophilus cultures or to take Acidophilus Pearls is very helpful.

  Many books on yeast overgrowth advise readers to avoid all yeast. This information is based on the theory that an allergic reaction to yeast is the cause of the problem. However, the yeast that is found in most foods (except beer and cheese) is not closely related to candida, which is the predominant yeast that seems to be involved in yeast overgrowth.

  In my experience, trying to avoid all yeast in foods results in a nutritionally inadequate diet and does not substantially help most people. Although a few people do appear to have true allergies to the yeast in their food, they account for fewer than 10 percent of my patients with suspected yeast overgrowth. These people may benefit from the stricter diet recommended in Dr. Crook’s books. Interestingly, once adrenal insufficiency and yeast overgrowth are treated, most people find that their allergies and sensitivities to yeast and other food products seem to improve or disappear.

  Nutritional deficiencies such as low zinc or low selenium may also decrease resistance to yeast overgrowth.10 A good multivitamin supplement (see Chapter 6) should take care of these deficiencies. This is simply another example of how all the factors involved in CFIDS are closely interrelated.

  The best thing you can do to combat yeast overgrowth is to try to avoid it in the first place. When you get an infection, immediately begin treating it naturally (see “Treating Infections Without Antibiotics,” on Chapter 5). Hopefully, you will be able to prevent it from turning into a bacterial infection that might require an antibiotic. Ask your doctor what measures you can take before resorting to antibiotics. Many good over-the-counter remedies are available. A knowledgeable compounding pharmacist can also be a wealth of information. Your local bookstore or health food store also has books on natural infection-fighting measures.

  If you find, however, that you must take an antibiotic, all is not lost. You can still lessen the severity of yeast overgrowth by avoiding sweets and by taking the Anti-Yeast herbal plus either taking acidophilus (again, not within three to six hours of an antibiotic) or by eating one cup of yogurt with live and active acidophilus cultures daily. Don’t eat yogurt or drink milk, however, if you have sinusitis or pneumonia, because the milk protein causes mucus to thicken and makes it hard for the body to fight these infections.

  WHAT I F THE YEAST COMES BACK?

  It is normal for yeast symptoms to resolve after treatment. After six weeks on Diflucan, most people feel a lot better. If not, you may have Diflucan-resistant candida, and a trial of Nizoral may be helpful. However, symptoms may recur soon after you stop taking the antifungal. If this happens, I recommend that you take Diflucan or Nizoral for another six weeks or for as long as is needed to keep the symptoms at bay. More frequently, people feel better after treatment and stay feeling fairly well. Although many people never need to be treated again for yeast, others need to repeat a course of antifungals after six to twenty-four months, especially after eating too much sugar or taking antibiotics.

  The best marker that I have found for recurrent yeast overgrowth is a return of bowel symptoms, with gas, bloating, and/or diarrhea or constipation; vaginal yeast; mouth sores; and/or recurring nasal congestion or sinusitis. If these symptoms persist for more than two weeks, especially if there is also even a mild worsening of the CFIDS/FMS symptoms, it is reasonable to re-treat yourself with six weeks of Anti-Yeast and Diflucan. If a second round of treatment resolves the symptoms, you may opt to repeat this regimen as often as is needed, usually every six to twenty-four months. By using some of the natural remedies listed earlier in this chapter, however, you may be able to avoid repeated use of antifungals and the possible risk of becoming resistant to them.

  Some people find that they need to stay on the antifungals for extended periods of time—years, in some cases—or the symptoms recur. If this is necessary, I recommend using the natural remedies. I do, however, also prescribe prescription medications when needed. The main risk of long-term use of the antifungals Nizoral and Diflucan is liver inflammation, and if these medications are used for extended periods, liver function should be monitored. Consider checking the ALT and AST liver tests (also called SGOT and SGPT tests) every three to six months and anytime a severe flu-like feeling or worsening of fatigue or pain occurs. As an alternative, instead of taking the antifungals every day, many people find they can get long-term suppression of the yeast by taking 200 milligrams of Diflucan twice a day, one day each week (for example, each Sunday). As HHV–6 viral infections can suppress immune function and your resistance to yeast, it is worth looking for an HHV–6 infection if you need long-term antifungals.

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  Treating Infections Without Antibiotics

  Many people do not realize how many things they can do before resorting to using an antibiotic to clear an infection. If you feel you are coming down with a respiratory infection such as a cold or the flu, I recommend that you try the following:

  Take natural thymic hormone. This is available as a product called Pro Boost (see Chapter 5), and it is an outstanding immune stimulant. Dissolve the contents of one packet under your tongue three times a day and let them absorb there (any that is swallowed will be destroyed by your stomach acid). A study i
n CFIDS patients with markedly elevated Epstein-Barr antibody levels showed a dramatic drop in the antibody levels after twelve weeks of treatment with thymic hormone. Many physicians are finding that thymic hormone has been helpful for CFIDS/FMS patients with persistent viral, yeast, bowel, or other infections. I have found that using it for two or three days at the onset of an infection can shorten the length of the infection dramatically, and often stops it on the first day. It should be in everyone’s medicine cabinet and should be begun immediately at the start of any infection.

  Take herbal immune stimulants. An excellent immune stimulant is Leuko-Stim by Ultraceuticals, which contains olive leaf extract, Beta 1, 3, glucan, maitake mushroom, Arabinogalactan (larch), and aloe vera powder extract.

  Take 1,000 to 8,000 milligrams of vitamin c a day—enough to stimulate diarrhea. Then cut back to a comfortable level.

  Suck on a zinc lozenge five to eight times a day. Make sure that the lozenges have 10 to 20 milligrams of zinc per lozenge. Less than this will not be effective. Zinc lozenges have been known to speed the time it takes to recover from a sore throat by about 40 percent. The brands of zinc sold by General Nutrition Centers and the Vitamin Shoppe are the brands I recommend.

  Drink plenty of water and hot caffeine-free tea(or hot water with lemon) and rest!

  Take oscillococcinum, a homeopathic remedy available at most health food stores and some supermarkets, if you have flu-like symptoms such as chills, fever, achiness, and/or malaise. It speeds healing and eases discomfort. It is best taken early in the infection—as soon as you have any symptoms.

  If you have a sinus infection, try nasal rinses. Dissolve ¼ teaspoon of salt in a cup of lukewarm water. Inhale some of the solution about one inch up into your nose, one nostril at a time. Do this either by using a baby nose bulb or an eyedropper while lying down, or by sniffing the solution out of the palm of your hand while standing by a sink. Then gently blow your nose, being careful not to hurt your ears. Repeat the same process with the other nostril. Continue to repeat with each nostril until the nose is clear. Rinse your nasal passages at least twice a day until the infection improves. Each rinsing will wash away about 90 percent of the infection and make it much easier for your body to heal.

  Gargle with salt water, mixed as described above for the nasal rinse, to help a sore throat.

  If you use acetaminophen frequently, you should also take 500 milligrams of supplemental N-Acety-L-Cysteine (NAC) each day so you don’t deplete your glutathione levels.

  Try using a humidifier or vaporizer in your bedroom. You can also make a steam room by running a hot shower in your bathroom and then breathing in the steam. Or try using a steam inhaler, such as the one available from Sinus Survival (see Appendix E: Resources). This also helps alleviate chronic and acute sinusitis.

  Take at least 500 milligrams of vitamin c a day for prevention.

  There is a point where it is important to seek medical advice. If nasal and lung mucus is yellow after seven to fourteen days, or if you are feeling worse after three to four days, you may have to consider taking a course of antibiotics. If you do, you should take the Anti-Yeast formula or Diflucan while on the antibiotic. Erythromycin antibiotics such as azithromycin (Zithromax) and clarithromycin (Biaxin) are usually preferable to penicillin antibiotics. Interestingly, my patients have sometimes found that all their CFIDS symptoms (not just the cold) improve while they are taking an erythromycin or tetracycline antibiotic. If that happens, I recommend a twelve-week course of Zithromax 250 to 600 milligrams a day or 500 milligrams of Biaxin or 100 milligrams of doxycycline twice a day. If you feel better on the antibiotic (take thymic hormone and the Anti-Yeast herbal in conjunction with it), keep repeating six-week courses until the symptoms stay gone. For most of my patients who repeatedly get respiratory infections that take forever to go away, I also consider an empiric trial of prescription hydrocortisone, as their adrenal function is probably impaired (see Chapter 4).

  As a preventive for respiratory infections, the flu vaccine is a double-edged sword for people with CFS/FMS. In some patients, it can cause mild flu-like symptoms for a few days or, in rare cases, a severe flare-up of symptoms. Still, unless you are one of the 10 percent of CFS/FMS patients who feel worse after the flu shot or other vaccinations, I recommend that you get a flu shot each year. For most people, the benefit can significantly outweigh the risk. Taking at least 500 milligrams of vitamin C a day is also a good idea. It is also helpful to dress warmly during cold weather, as a cold breeze blowing across your muscles or neck can make fibromyalgia symptoms flare up.

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  CHRONIC SINUSITIS—THE YEASTY BEASTIES REVISITED!

  Although we will be discussing some unusual infections, CFS/FMS patients also get more of the day-to-day variety of infections. These include chronic sinusitis, which in my experience is predominantly caused by the underlying yeast/fungal infection. The result is a stuffy nose, eventually leading to nasal passages swelling shut. In the body, any time something gets blocked (e. g., an appendix or gallbladder), it results in a secondary bacterial infection—and the sinuses are no exception. When this happens, your nasal mucus turns yellow-green, and you go to the doctor in pain. She or he then gives you an antibiotic, which knocks out the bacterial infection and leaves you feeling better. Unfortunately, the antibiotic worsens the underlying yeast infection in your nose, causing more swelling and blockages and therefore more attacks of bacterial infections. This is why sinusitis in the United States usually becomes chronic. An interesting study reported in the Mayo Clinic Proceedings supports this thought, noting that previously “fungus allergy was thought to be involved in less than 10 percent of cases…our studies indicate [that], in fact, fungus is likely the cause of nearly all of these problems and that it is not an allergic reaction but an immune reaction.”11 In the study, researchers found that most people with chronic sinus infections had fungal growth in their sinuses. This research is interesting because more and more studies are showing that treating chronic sinusitis with antibiotics doesn’t really do much and that shorter courses of treatment work just as well as long courses. I find that conservative treatments (e. g., nasal rinses) are more effective than antibiotics for chronic sinusitis.

  In my experience, sinusitis (even chronic) usually responds dramatically to yeast treatment with Diflucan and a compounded nose spray that my patients love. It contains Bactroban and xylitol, which kill the bacterial infections, low-dose cortisol to shrink the swelling, and an antifungal. I recommend patients use one to two sprays in each nostril twice a day while on the Diflucan. That is usually enough to knock out the sinusitis, although some patients like to stay on it long term or use it intermittently for recurrent infections. The spray is available by prescription and can be mailed from ITC Compounding Pharmacy (see Appendix E: Resources). Simply have your physician ask for the sinusitis nose spray. Another helpful over-the-counter treatment for sinusitis is silver nose spray (see Appendix E: Resources). In low doses, this mineral is an anti-infectious agent against both viral and bacterial infections, and liquid silver can even be used orally for many types of difficult-to-treat chronic infections (see Appendix B, items 33, 49, and 50). Silver also works well in combination with the prescription sinusitis nose spray.

  Besides the annoyance of your nose constantly running, sinusitis causes other problems. Work by Dr. Alexander Chester has shown that chronic nasal congestion can actually trigger chronic fatigue. In addition, having a chronic bacterial infection in the nose can drag your energy down. A fringe benefit of treating yeast overgrowth with Diflucan is that, especially when combined with the nose spray mentioned above, it also frequently eliminates chronic sinusitis and spastic colon/irritable bowel syndrome.

  For those few patients with persistent chronic sinusitis despite treatment, I recommend the book Sinus Survival by Robert S. Ivker, a physician whose heart embodies what it means to be a healer (see Appendix D: Recommended Reading). His Web site at www.sinussurvival.com has many helpful to
ols and resources.

  CHRONIC URINARY TRACT /BLADDER INFECTIONS (UTIS )

  The main symptoms of a UTI/bladder infection are dysuria (discomfort—for example, a burning sensation—when urinating), urgency (the feeling that you have to go very badly and right away when there is not much urine there), and frequent urination with low urine volume. This group of symptoms is also common in CFS/FMS patients in the absence of bladder infections and, when very severe, is called interstitial cystitis (IC). However, I would not say that a person has interstitial cystitis unless this is the major symptom of their CFS/FMS, because almost everyone with this illness has some urinary urgency and frequency. The few people who have IC need to be careful, as many vitamin supplements can cause bladder symptoms to flare up, and they should begin with very low doses to be sure they are tolerated. For more information on treating the disorder, see my book Pain Free 1–2–3 and/or contact the Interstitial Cystitis Association (www.ichelp.org).

  Taking antibiotics will kill a bladder infection but will also kill the healthy bacteria in the bowel. This sets you up for yeast overgrowth and other problems. So unless you have fever, blood in the urine, back pain over the kidneys, or a toxic feeling, it is reasonable to try natural remedies for one to two days before going with the antibiotics.

  Because bladder symptoms can be seen in both UTIs and CFS/FMS, it is important to have a urine culture done before initiating treatment with antibiotics to make sure it is an infection, and not just muscle spasms in the bladder, that is causing these symptoms. If there is an infection, more than 90 percent of the time it will involve Escherichia coli (E. coli ), a bacterium normally found in the intestines and, with the exception of a few rare, dangerous forms, a healthy part of normal bowel bacteria. The problem occurs when the E. coli gets out of the bowel, where it belongs, and into the bladder. Unlike most other infectious organisms, E. coli have little Velcro-like projections that stick to the bladder wall, so they cannot be washed out by urination.