From Fatigued to Fantastic!

by Jacob Teitelbaum

  How do you more directly and effectively ask for what you need and want? You may wish to begin by cultivating self-acceptance. Your wants and needs are valid. Articulate those needs and wants to yourself. Then approach the person you are asking for help with candor and respect. This is obvious, but it is amazing how often we forget it. You may also want to think about the possibility that there may be a number of ways for you to get what you need and want. Be open to brainstorming with others.

  Of course, just because we know what we need and want and are able to express those needs in a clear and effective way does not necessarily mean that we will always get those needs met. Those who we ask have their own needs, time constraints, and difficulties, and it is unlikely that they will always be able or willing to come to our aid every time we ask for help. No one person has the time, knowledge, understanding, patience, sensitivity, intelligence, and will to minister to all of our needs. Therefore, it is helpful to develop a network of resources, information, and people that we can rely upon. Ideally, this network would include friends, family, a significant other, some kind of spiritual community, and health-care providers. It is best not to exclude any possible source of help. I have on many occasions received comfort and even inspiration from total strangers whom I encountered on a given day.

  As you learn to ask for what you need, you may want to explore the related issue of setting limits and learning to say no. Most of you know that this is one of the things that can be gravely difficult. You may have a long history of trying to be all things to all people. This can frequently cause setbacks in your recovery. I would simply like to recommend a book that addresses this predicament in an effective, humorous, and enjoyable manner: The book for people who do too much, by Bradley Trevor Greive. And while you are at it, you might practice what I have been talking about by asking someone close to you, very sweetly, if they would be a dear and pick it up for you the next time they are in a bookstore.

  The importance of achieving a mind-body-spirit balance cannot be underestimated for those struggling with CFS/FMS. Working with a counselor may help you better define your needs and goals and communicate them effectively with those in your support network.

  I end with a quotation that I learned many years ago. It is not meant to serve as advice but rather as a thought to be contemplated and an idea to be played with.

  The secret is to be

  And not to wonder

  How to be.

  Stop trying

  To be

  And realize

  That you

  Are!

  * * *

  Important Points

  CFS and fibromyalgia are physical processes with physical causes. However, like most illnesses, they also have psychological components that must be treated.

  CFS patients both with and without depression and anxiety have been helped by the new generation of antidepressants, such as Zoloft, Prozac, Paxil, and Effexor. Natural remedies, however, can be more effective with many fewer side effects.

  Consider therapy for emotional support and guidance. The Reverend Bren Jacobson does superb counseling by phone (410-224-4877).

  Get into a “centered” space, then constantly shift your attention and actions to things that (in that centered space) feel good.

  11

  Losing Weight with CFS and FMS

  In addition to the myriad other problems you have to bear, two recent studies of ours found that fibromyalgia and CFS patients have an average weight gain of thirty-two pounds. Because of the metabolic problems that occur in these syndromes, it is almost impossible to lose weight and keep it off until you receive proper treatment. It is much easier to lose the weight and keep it off, however, when one understands that there are many things that contribute to this problem. For people with CFS/FMS, simply altering your diet is not enough to lose weight. A large percentage of you have found that it is impossible to lose weight and keep it off no matter what you do.

  There are several ways that CFS/FMS is contributing to your inability to lose weight. Both physical stresses (e. g., infections, nutritional deficiencies) and emotional/situational stresses can result in a metabolic chain reaction that results in weight gain. With effective treatment of their CFS/ FMS, most people find that their weight gain stops and that usual weight-loss measures will finally work.

  So What Caused the Weight Gain?

  Let’s begin with poor sleep. The expression “getting your beauty sleep” actually has a basis in fact. Deep sleep is a major trigger for growth hormone production. Growth hormone stimulates production of muscle (which burns fat) and improves insulin sensitivity (which decreases the tendency to make fat), while also decreasing fibromyalgia symptoms. Thus, getting the eight to nine hours of sleep a night that the human body is meant to have can powerfully contribute to your staying young-looking and trim. Poor sleep also causes lower levels of the hormone leptin, which regulates hunger.

  In addition, as we’ve noted elsewhere, the hypothalamic “circuit breaker” that gets suppressed with stress also controls our hormone system. This results in inadequate levels of thyroid and adrenal hormones. The thyroid is like your body’s gas pedal—regulating how many calories you burn—and low thyroid can dramatically trigger weight gain. The adrenal glands are the body’s stress handlers. In the beginning of your illness, chronic stress and depression result in elevated cortisol levels, which can directly cause weight gain. Continuing excessive stress may result in exhaustion of the adrenal glands over time. As it is the job of the adrenal glands to maintain blood sugar levels in the time of stress, adrenal exhaustion can result in episodes of hypoglycemia (low blood sugar). If you get periods where you feel that somebody had better feed you NOW or you’re going to kill them, you are likely hypoglycemic and would benefit from adrenal support. Unfortunately, an underactive adrenal gland causes people to become hypoglycemic and to crave sugar and eat more than they normally would. This leads to further weight gain.

  Infections can also contribute to weight gain. Clinical experience has shown that fungal overgrowth stirs sugar cravings and leads to weight gain. Although we do not know the mechanism for this, we have repeatedly seen excess weight drop off once this overgrowth is treated and eliminated.

  Another major problem is carnitine deficiency, a problem that is present in most CFS/FMS patients. Unfortunately, this deficiency forces your body to turn calories into fat, and makes it almost impossible to lose fat. Simply taking supplemental carnitine does not help adequately, however, as it does not transfer into cells optimally in this form. I do recommend that people take 1,000 milligrams of acetyl-L-carnitine daily for four months, as cells can absorb this form easily, leading to energy production and weight loss.

  Last but not least, many people with CFS/FMS have insulin resistance—meaning they need high blood levels of insulin to maintain a normal level of blood sugar. Unfortunately, high insulin levels increase your body’s production of fat. If weight gain is a problem, check a fasting blood insulin level. To do so, do not eat after midnight, then have your lab check your insulin level first thing in the morning. If the insulin reading is higher than ten, your doctor may decide to prescribe the diabetes medication Metformin, which improves insulin sensitivity even in nondiabetics. This drug can not only help weight loss, but also improve other symptoms of CFS/FMS. In females, if insulin levels are high, and DHEA-S and testosterone levels are also elevated, you may have PCOS (polycystic ovarian syndrome—another cause of CFS/FMS). I treat PCOS with Metformin and Cortef. Be sure to take the vitamin powder recommended earlier or B complex supplements if on Metformin; otherwise it will cause a vitamin B12 deficiency.

  So How Can You Go About Treating These Problems So That You Can Lose Weight and Feel Better?

  Cut down the sugar and simple carbohydrates in your diet and increase your water intake. If your mouth feels parched and you are not taking a medication that causes dry mouth, then you are thirsty and need to drink more water (even if you already drink like a f
ish).

  Sleep; get eight to nine hours of solid sleep a night.

  Treat low thyroid or adrenal function, if applicable.

  Treat yeast/candida overgrowth, if present.

  Get optimum nutritional support. When you are deficient in vitamins or minerals, your body will crave more food than you need, and your metabolism will be sluggish. As mentioned, take 500 to 1,000 milligrams of acetyl-L-carnitine daily along with the energy revitalization system.

  Treat insulin resistance, if present.

  It is not unusual for people to shed thirty to fifty pounds by simply treating these metabolic factors.

  12

  Finding a Physician

  Having developed an effective treatment protocol for fibromyalgia and chronic fatigue syndrome over the last thirty years, and having proven it to be effective in two studies—one a well-done randomized, double-blind, placebo-controlled trial—my colleagues and I have now turned our attention to our goal of making effective treatment available to the well over 50 million people worldwide who suffer from these illnesses. Training and encouraging physicians so that people will have proper access to care has been a full-time job—to the point that I am now a member of the “Two Million Mile Club” on a major airline. Fortunately, writing this chapter is now much easier than it was six years ago, and people all over the country can finally get the care they need.

  People ask me how they can talk their doctor into giving them the treatments they need. In most cases, the answer is that you can’t. Most doctors, appropriately enough, will not do the things that they are not properly trained in. This does not make them bad physicians. If you came to me and said, “Dr. Teitelbaum, I would like you to do a heart bypass operation on me,” I would say, “I’m sorry, I am not trained in this, and I can’t.” If you then gave me a copy of a book called From Bypass to Fantastic and a scalpel, well, you still would not want me performing surgery on you. This would not make me a bad physician, and your doctor not treating you for CFS/FMS does not make him or her a bad physician, either. The best thing to do is to go to a physician who specializes in treating these complex syndromes.

  Holistic Physicians

  In the past, these doctors were simply not available or, at best, were hard to find. This has changed. Now, as CFS/FMS is going mainstream, and more physicians are being trained in complementary medicine, it is getting easier to get the treatments you need. For example, there is now an American Board of Holistic Medicine that has certified more than one thousand practitioners, and part of their certification is in the treatments discussed in this book. In addition, more states are recognizing that naturopaths trained in four-year programs are competent as physicians, and should have the legal right to also give IV therapies and prescribe natural hormones and other medications.

  Most physicians who know how to help CFS/FMS patients are considered holistic. These doctors usually have advanced training in using natural therapies and also spend a lot of time exploring the scientific literature. They also allow the longer visits needed to treat CFS/FMS. Unfortunately, because of the way insurance company payments are made, many doctors cannot afford to sustain a practice based on just a few long visits per day. They need to fit as many patients in to their office as possible, in the least amount of time. Because of this, most physicians who can effectively deal with these illnesses do not participate with insurance. Fortunately, the biggest expense is for testing and medications, which are often covered.

  When Looking for a Physician, Consider the Following Questions

  Does he or she specialize in treating CFS/FMS and recognize it as a real and physical illness?

  Will he or she prescribe the medications needed for you to get eight hours of sleep a night?

  Does he or she use bioidentical hormones based on your symptoms, even if the tests are normal?

  Will he or she treat for candida with Diflucan for six weeks?

  Does he or she give nutritional IVs (e. g., Myers cocktails)?

  If the answer to these five questions is yes, you have a physician who is likely to be able to help you.

  * * *

  Finding a Holistic Physician

  Holistic doctors are much more likely to know how to help CFS/FMS patients. To find these, I recommend the three organizations below.

  American Board of Holistic Medicine

  Certifies physicians as having advanced training in the use of natural therapies.

  Their Web site lists more than one thousand physicians.

  www.holisticboard.org

  American Holistic Medical Association (AHMA)

  4101 Lake Boone Trail, Suite 201

  Raleigh, NC 27607

  919-787-5146

  www.holisticmedicine.org

  American College for Advancement of Medicine

  P. O. Box 3427

  Laguna Hills, CA 92654

  http://www.apma.net

  * * *

  More Good News

  In addition to these resources, a national chain of Fibromyalgia & Fatigue Centers was established in 2004. Several years ago, Bob Baurys, a prominent businessman, came down with chronic fatigue syndrome. He went through the same difficult experience working with physicians that most of you have gone through. He was finally lucky enough to find a physician who was trained in using the protocols in this book and he recovered. This businessman was shocked that people with CFS and fibromyalgia did not have proper access to care—especially having gone through the process himself. Fortunately, what this businessman does is to set up health-care systems with his compassionate associate, Sue Hrim, RN.

  When I traveled to these centers in 2006 to evaluate their program, I was deeply impressed with the level of care they were able to provide. They had created what I have been working to see happen for decades, and it felt as if this was the culmination of thirty years of my work. I am now national medical director of the Fibromyalgia & Fatigue Centers (FFC), sixteen centers across the country (www.fibroandfatigue.com). The centers accept patients from around the world and, after an initial in-person visit, they can manage care via phone if you do not live near a center. Since opening their first center in Dallas in January 2004, the Fibromyalgia & Fatigue Centers have treated more than five thousand patients and have an 80 percent success rate within four visits to the centers.

  So that you have an idea of what you should expect from your doctor in CFS/FMS care, I will give you an overview of the treatment at the centers. Because CFS/FMS are complex diseases that involve multisystem disturbances and abnormalities, your physician should spend time with you, at least an hour at the new-patient visit, then dedicate at least thirty to sixty minutes for follow-up appointments. Your doctor should do a comprehensive evaluation and extensive lab work in order to develop a treatment plan unique to your specific needs.

  The approach at the FFC includes a six-step integrated program that works to address the underlying dysfunctions that cause your illness. They use a patient-centered, holistic plan of care that treats the whole body. No matter which physician you choose, you’ll want to be sure that he or she is similarly interested in your complete recovery, not just a remission of symptoms. As you know, successful treatment of these diseases requires a plan tailored to the individual. Your treatment, then, may occur in one order, while another person’s might occur in a completely different order. And of course, multiple steps are often initiated simultaneously. Be sure that your physician uses a similar flexible approach.

  At the FFC, we use steps that follow the protocol in this book. Generally, these can be broken down as follows:

  Stabilize the patient by addressing pain and sleep disturbances.

  Enhance the mitochondria by improving nutrition.

  Balance the hormones by evaluating hypothalamic, thyroid, adrenal, ovarian/testicular, and pituitary function.

  Evaluate infectious components and treat underlying infections.

  Address unique etiologies such as neurotoxins and coagulation defects.


  Provide an individualized maintenance program with the minimal amount of medications and supplements needed to keep you well.

  Use these steps as guidelines when talking with prospective health-care providers about their treatment methods and strategies. For more information on how to find a doctor, as well as on the Fibromyalgia & Fatigue Centers, see Appendix E: Resources and www.fibroandfatigue.com.

  Getting Insurance Coverage for Labs and Medications

  As I’ve noted, most physicians specializing in CFS/FMS do not work with health insurance companies. Nonetheless, I find that if people have prescription coverage, most of the medications will be covered. For those of you without prescription insurance coverage who have low incomes (common in CFS/FMS), many, if not most, of the medications you’ll need may be supplied for free by the drug companies. For more information on this important option, go to www.PPARx.org (see Appendix E: Resources).

  Lab tests are also usually, but if you have to battle with your insurance company, the information in Appendix C can be helpful. It tells you what tests your insurance should cover, based on your symptoms. If you do not have insurance, or your insurance does not cover the cost of the testing, it is a good idea to call different laboratories to see what they charge, as the price can vary markedly. With many labs you’ll be able to negotiate a 50 percent discount if you are willing to pay for the tests at the time of service, but this must be negotiated before they draw your blood.