From Fatigued to Fantastic!

by Jacob Teitelbaum

  TYROSINE (500 TO 1,000 MILLIGRAMS A DAY )

  Tyrosine is critical for the production of adrenaline and dopamine, two neurotransmitters that are often low in CFS.

  Cofactors

  CHOLINE (100+ MILLIGRAMS A DAY )

  This nutrient is critical for brain function and production of the neurotransmitter acetylcholine, which is also often low in CFS.

  MALIC ACID (900 TO 1,600 MILLIGRAMS A DAY )

  Malic acid is critical for energy production. This becomes especially important when added to magnesium or a powerful energy-producing compound called ribose (see Chapter 2).

  INOSITOL (500 TO 1,000 MILLIGRAMS A DAY )

  Inositol is a key component of your nerve coverings called the myelin sheath, and losses of inositol in the urine of diabetics likely contributes to their nerve pain and may contribute to fibromyalgia pain as well. Inositol is also helpful in treating anxiety. For CFS, inositol is critical to the production of SAMe, an expensive nutrient that has been shown to be helpful in CFS/FMS, depression, and arthritis. In fact, it has been estimated that combining the nutrients discussed in this chapter (which are in the Energy Revitalization System) results in your body making the equivalent of more than 400 milligrams of SAMe a day—a much more effective and less costly way to get this nutrient.

  TRIMETHYLGLYCINE (BETAINE; 750 MILLIGRAMS A DAY )

  Betaine acts as a methyl donor, which can be very helpful in CFS and for overall health, and also helps lower elevated homocysteine, a compound associated with increased risk of heart attacks and strokes.

  Getting Optimal Nutritional Support Easily

  All of the above key nutrients, in optimal levels, can be found in the Energy Revitalization System vitamin powder made by Enzymatic Therapy (see Appendix E: Resources). It has been designed to make optimal nutritional support easy and affordable for everyone, supplying more than thirty-five tablets’ worth of nutrients in one drink and one capsule. I recommend you stay on it long term and adjust the dose to the level that feels best to you, using 1/2 to 1 scoop a day. Of course, you can also put together your own supplement strategy using these recommendations yourself, or in conjunction with a health practitioner.

  As mentioned earlier, there are three other nutrients that are helpful in some situations. These are iron, calcium, and fish oil. In Chapter 2 we also discussed key energy nutrients that are used specifically to fire up your body’s energy furnaces, especially my favorite new nutrient—ribose.

  IRON

  Iron is important because an iron level that is too high or too low can cause fatigue, poor immune function, cold intolerance, decreased thyroid function, and poor memory. I routinely recommend that all my chronic fatigue patients have their iron level and total iron binding capacity (TIBC) checked. Although not helpful by themselves, the iron level divided by the TIBC gives you a percent saturation, which is a useful measure. In addition, I recommend that patients have their ferritin blood level checked. These three tests all measure iron status. Some insurance companies balk at paying for all three tests, but the data and my clinical experience strongly support having them all done. Even if a person’s iron percent saturation is low but still normal, he or she will often feel fatigued, despite not being anemic. The ferritin level, however, will pick up subtle deficiencies. Unfortunately, even minimal inflammation, such as a bladder infection, will falsely elevate the ferritin measurement, making it appear falsely normal. This is why all three tests are necessary to determine iron deficiency. Your holistic doctor should be able to help you read the results of these tests properly.

  Once again, a “normal” iron test does not mean that you have enough iron. For example, one study reported in the British medical journal The Lancet showed that infertile females whose ferritin levels were between twenty and forty—a ferritin level over 9 is technically normal—were often able to become pregnant when they took supplemental iron.121 Other research shows that low-normal iron levels cause poor mental functioning and immune function. This suggests that levels considered sufficient to prevent anemia are often inadequate for other body functions.

  Although cosmetic issues may seem small relative to the debilitating nature of CFS, they are still important, as few of us would be happy with the severe hair thinning often seen in CFS/FMS. A review of forty years of research shows that iron deficiency contributes to hair loss and, according to Cleveland Clinic dermatologists, treatment of iron deficiency is important for restoring hair growth. In their opinion, “treatment for hair loss is enhanced when iron deficiency, with or without anemia, is treated.”122

  The Cleveland Clinic isn’t alone in this opinion. George Cotsarelis, director of the University of Pennsylvania Hair and Scalp Clinic, has studied iron supplementation in women with various forms of hair loss. Cotsarelis and colleagues have found that women with hair loss have significantly lower iron stores than women without hair loss. Cotsarelis and Trost agree with our recommendations, saying that what most doctors consider a normal ferritin level is, in fact, too low. Ferritin levels of 10 to 15 ng/mL are within the “normal” range. Yet Cotsarelis says a ferritin level of at least 50 ng/mL is needed to help replenish hair. Trost and Bergfeld (from the Cleveland Clinic) shoot for 70 ng/mL. Iron supplements are not a cure for baldness. But as part of a multipronged approach, Cotsarelis and Trost say, supplements can be a big help.123

  Because the normal lab ranges are not optimal, anyone whose ferritin level is below 40, or whose iron saturation is less than 22 percent, should be considered a prime subject for a trial treatment of iron therapy. Because too much iron can be very toxic, you should take a multivitamin without iron unless these blood tests show that you are low in that mineral (using my normal ranges—not the labs). In that instance, your doctor can help you raise your iron levels safely and without risk of developing toxicity. Although iron is important, it is also pro-oxidative (that is, it promotes free-radical activity) and can cause inflammation, arthritis, and liver and heart disease if the level is too high. This helps remind us that more is not always better. Nonetheless, although excessive iron can increase the risk of heart attack and stroke, so can low iron levels.124

  A surprisingly large number of people display early hemochromatosis, or excess iron, in their iron studies. Early in the disease, fatigue and pain are often the only symptoms. If caught soon enough, hemochromatosis is remarkably easy to treat. Later, however, it is disabling and can be life-threatening. This is another reason to have your iron levels checked carefully.

  Iron must be taken on an empty stomach; otherwise you will lose 85 percent of the absorption. Do not take calcium or iron supplements within six hours of your thyroid dose, as they block thyroid absorption. It is normal for iron to cause constipation and a black stool. You do not need to be alarmed unless it is overly foul-smelling, in which case it may indicate a bleeding ulcer and you should alert your doctor. Fortunately, if you take the iron every other day, you get almost as much benefit as taking it daily—with lower side effects. One good brand is Chelated Iron by Ultraceuticals.

  CALCIUM

  Although companies selling calcium would have you believe that every woman should be on it, it is actually a minor player in treating osteoporosis, and many other nutrient, hormonal, and lifestyle factors are much more important. In fact, the countries with the highest dietary calcium intakes also have the highest levels of osteoporosis. Many factors other than calcium intake cause osteoporosis, including high protein intake and inadequate exercise.

  Since most people do not need it, and since it blocks thyroid absorption, I left calcium out of the vitamin powder. However, if you have loss of bone density through osteoporosis or osteopenia, I would then take 1,000 to 1,500 milligrams a day of calcium. The other time I recommend calcium is for those with plantar fasciitis (pain along the soles of your feet that is worse in the morning). Although the treatment protocol in this book usually makes the sole pain resolve, people have also found calcium supplementation to help plantar fasciitis. Since man
y calcium tablets do not dissolve properly in the stomach, chewable forms are best.

  Many nutrients other than calcium are even more helpful in building bone density. An excellent approach is to use the vitamin powder plus a product called Bone Health, from Ultraceuticals, or use the ingredient list on Chapter 6 to guide you in adding bone health to your supplement regimen.

  FISH OILS

  The two key omega-3 essential fatty acids in fish oil are eicosapentaenoic acid (EPA) and docohexaenoic acid (DHA), the latter being a major component of brain tissue. Perhaps the old wives’ tales were right in calling fish “brain food.”

  * * *

  Fish Oil and Pregnancy

  Although I do not recommend that women become pregnant while on the SHIN protocol, I would like to take a little time to discuss the importance of fish oils during pregnancy. When you are ready to conceive, you’ll be taking prenatal vitamins or the vitamin powder to help promote healthy growth in your baby. It’s a good idea to discuss with your holistic doctor how valuable fish-oil supplementation can also be during this time.

  In a study of more than 11,580 pregnant women, high omega-3 fatty-acid intake late in pregnancy was shown to boost a baby’s growth rate. However, a fish-rich diet does not seem to lengthen the pregnancy or cause preterm deliveries. In addition, infants born to moms with high blood levels of DHA at delivery had advanced attention spans (considered an indicator of IQ in babies) well into their second year of life.130

  The benefits of fish oil continue to follow children throughout their lives. High fish-oil intake during pregnancy and lactation decreases the risk of the baby developing breast cancer as an adult. And, mothers who eat foods rich in omega-3 fatty acids during pregnancy and while nursing, and who continue to feed their babies such a diet after weaning, may dramatically reduce their daughters’ risk of developing this cancer later in life, according to research presented at the American Association for Cancer Research. Remarkably, pregnant women with a history of asthma can also decrease the risk of their child getting asthma by 80 percent by taking fish oil during pregnancy.131

  Omega-3 fatty acids also significantly decrease the risk of postpartum depression,132 depression, schizophrenia, attention-deficit-hyperactivity disorder, (ADHD),133 and bipolar disorder, yielding benefits for mom as well as baby.134

  * * *

  Fish oil levels are low in CFS/FMS125 and a series of patients with chronic fatigue syndrome was treated solely with a high EPA-containing essential fatty acid supplement. All showed improvement in their symptomatology within eight to twelve weeks.126 Even in healthy people, fish-oil supplements decreased anger, anxiety, and depression, and increased vigor—while also improving various types of attention, cognitive, and physiological functions, and mood.127 Fish oils were also shown to significantly decrease stroke risk.128 In addition, fish oil fights dry eyes,129 often a major problem in CFS/FMS. If you have dry eyes or dry mouth, this is a good indicator of fish-oil deficiency. Because of high levels of mercury found in many types of fish, it is likely better to simply take mercury-free fish-oil supplements. Two excellent brands are Eskimo-3 fish oil by Enzymatic Therapy and omega-3 fish oil by Ultraceuticals.

  Intravenous Nutritional Therapies

  One of the most powerfully effective treatments that I have found for treating chronic fatigue syndrome and fibromyalgia is the use of intravenous nutritional support. As you know, less energy is produced in certain regions of the body, especially muscle tissue, when you have CFS/ FMS. In fact, blood flow is actually shut down to those regions,135 which then become starved for nutrients and loaded with toxins, leaving you achy and in pain. High-dose intravenous injections of magnesium, B vitamins, glutathione, vitamin C, and other nutrients force the blood vessels open in these closed-down areas, flooding them with nutrients and washing away the toxins. You’ll find that when your doctor administers these injections, you’ll feel a warm flush in the areas that have been most significantly affected by your illness.

  I recommend that, if possible, all patients with CFS/FMS receive these IV therapies at least once a week for six weeks and then as needed. Along with ribose and the other supplements I’ve recommended (which should be continued while on the IVs), they can dramatically “jump-start” some of the body’s systems and can markedly shorten the time it takes to begin feeling better. Many physicians refer to these therapies as Myers cocktails. If you have a physician who is willing to give them, I strongly recommend that you have them. This is a standard part of the treatment protocol at the Fibromyalgia & Fatigue Centers and is called the Standard IV. Physicians can see Appendix G for details on mixing and giving these IVs.

  Don’t Forget a Healthy Diet

  Although I strongly recommend taking nutritional supplements to ensure obtaining the necessary nutrients, I also want to stress that a healthy diet is important. Eat a lot of whole grains, fresh fruits (whole fruit, not fruit juice), and fresh vegetables. Many raw vegetables have enzymes that help boost energy levels. You do not have to cut out all foods that might be bad or eat a diet that is impossible to follow. All you need to do is consume a diet that is reasonably healthy and low in caffeine and added sugar. The more unprocessed your diet is, the healthier you will be. Your body will tell you what’s good for you by making you feel good.

  Important Points

  Remove excess caffeine from your diet.

  Limit alcohol consumption to one to three drinks daily.

  Remove sugar and other sweeteners from your diet. Stevia, a sweet-tasting herb, and even saccharin (I do not recommend aspartame) can be used as substitutes. They taste good and are healthy.

  Use whole-grain flour instead of white flour whenever possible.

  Increase water intake so that your lips and mouth are not dry. Use pure water such as Dasani (in the United States—not the European brand) or a high-quality water filter (e. g., Multi Pure; see pure water, Appendix E).

  Take half to 1 scoop of the Energy Revitalization System vitamin powder (and B complex) by Enzymatic Therapy daily. This has more than fifty key nutrients in one drink and one capsule, and replaces more than thirty-five capsules of supplements. It is available in most health food stores and at www.vitality101.com. Or create your own supplement strategy using the recommendations in this chapter as a guide.

  Vitamin B12 injections can be helpful.

  Treat a too-low iron level with an iron supplement. A too-high iron level also needs to be treated properly.

  If you have osteoporosis or osteopenia, take Bone Health to increase bone density.

  Do not take calcium or iron supplements within six hours of your thyroid dose, as they block thyroid absorption.

  If you have dry eyes, dry mouth, depression, or inflammation, take mercury-free fish oil (e. g., Eskimo or Ultraceutical).

  In addition to taking supplements, eat a healthy diet that includes lots of fresh fruits and vegetables and a minimum of processed foods. Eat what makes you feel the best.

  Questionnaire (Check off treatments in Appendix B: Treatment Protocol)

  1. Do you have fatigue or pain? Check off #1—the vitamin powder—and #54—Myers/Standard IV.

  ____ 2. Do you have dry eyes or dry mouth?

  ____ 3. Do you have depression or inflammatory problems? If yes to #2 or #3, take fish oil; check off #6.

  ____ 4. Is your blood ferritin under 40 (or 70 if you have hair thinning) or is your iron percent saturation under 22 percent? If yes, check off #5—iron.

  ____ 5. Is your B12 level under 540? If yes, check off #3—B12 shots.

  ____ 6. Do you have osteoporosis or osteopenia (loss of bone density)? If yes, check off #56—bone health.

  ____ 7. Do you have plantar fasciitis (pain along the soles of your feet that is worse in the morning)? If yes, check off #16—calcium.

  ____ 8. Do you have frequent infections or do you use Tylenol often? If yes to either, check off #4—NAC.

  PART 3

  Pain Relief and Other Health Issues

 
7

  Natural and Prescription Pain Relief for Fibromyalgia

  As noted earlier, treating sleep loss, hormonal dysfunctions, underlying infections, and nutritional deficiencies can get rid of most, if not all, fibromyalgia pain. Unfortunately, though, sometimes we cannot get to the underlying cause of the pain. This may be because of a viral infection we cannot fully treat yet or because we simply don’t know what the trigger was. In such cases—and even in routine cases—it is important to have tools early in treatment that can be used to decrease or eliminate your pain. If needed, these can also be used long term.

  The source of fibromyalgia pain varies from person to person. In most cases, it is triggered by a lack of energy in the muscles that leads to muscle shortening, stiffness, and pain. In such cases, muscle relaxants can be very helpful. Other times, pain is caused or aggravated by elevations in spinal fluid levels of substance P, the chemical messenger that transmits the sensation of pain. Changes in cell structures called N-methyl D-aspartate (NMDA) receptors in the brain, which play an important part in sensing pain, can also be involved in FMS, and may give us another avenue to fight the pain. Sometimes nerve pain, at times because tight muscles pinch the nerves, is the cause. The prescription medications Elavil, Neurontin, and lidocaine are especially helpful for treating nerve pain.