From Fatigued to Fantastic!

by Jacob Teitelbaum

  ____3.

  **Vitamin B12—1 I. M. injection (1 cc = 3,000 micrograms) three to seven times weekly for fifteen doses, then as needed(e. g., one to twelve times a month). This needs to be made by a compounding (holistic) pharmacy (e. g., ITC Pharmacy; 303-663-4224). If unable to get injections, take 5 milligrams (5,000 micrograms) a day by mouth for three months.

  ____4.

  *NAC (N-Acetyl-L-Cysteine): 500 to 650 milligrams a day for two to three months. Makes glutathione.

  ____5.

  **Iron (e. g., Chelated Iron by Ultraceuticals—29 milligrams plus 100 milligrams vitamin C): one tablet a day. Do not take within six hours of thyroid hormone preparations or Cipro (antibiotic), as this can prevent their absorption. Take on an empty stomach (i. e., take between 2 and 6 p. m. on an empty stomach). It is okay to miss up to three doses a week. Stop in four to six months or when your ferritin blood test is over 40. If afternoon fatigue or hair loss are problems, consider continuing iron supplements until your ferritin level is over 100. Iron may turn your stool black. If nausea is a problem, Floradix iron is much easier on the stomach and is not constipating (supplies 10 milligrams of highly absorbable iron per dose of 2 teaspoons).

  ____6.

  *Eskimo-3 fish oil (Enzymatic Therapy) or Omega-3 fish oil (Ultraceuticals): 1 to 2 teaspoons (or three to six capsules) a day for three to nine months until the dry eyes and mouth resolve, and then as needed. Use these brands, as most others are rancid and often contain mercury, lead, or other toxins. Dry eyes and mouth, pain, inflammation, depression, or excessive hard earwax suggest a need for this.

  For Anxiety—Natural treatments

  ____7.

  **Calming Balance from Health Freedom Nutrition, or Tranquility from Ultraceuticals, or similar products containing 500 milligrams vitamin B1, passionflower, theanine, magnolia, B vitamins, and magnesium: one to three capsules one to three times a day is outstanding for anxiety (the effect increases with one to four weeks of use). Both are also available from www.vitality101.com.

  Mitochondrial Energy Treatments

  Use these for four to nine months. Then drop the dose to the lowest dose that maintains the effect (or stop it if no benefit).

  ____8.

  *Acetyl-L-carnitine: 500 milligrams, one capsule once or twice a day for three months. Then 250 to 500 milligrams a day or stop it. Although important in CFS/FMS, it is even more important to take this if you also have mitral valve prolapse, MS, and/or elevated blood triglycerides. This helps with weight loss.

  ____9.

  Coenzyme Q10: 200 milligrams once a day. Especially important if taking cholesterol-lowering prescriptions (e. g., Mevacor). Take it with vitamin E, with a meal that has fat, with oil supplements, or in an oil-based form to improve absorption. Vitaline/Enzymatic Therapy makes the best form, and this is the one I recommend. It also already contains vitamin E to enhance absorption.

  ____10.

  ***D-ribose (CORvalen): One scoop (5 grams) of powder three times a day for three weeks, then two times a day. If too energizing, take with milk or food or lower the dose. Effects are usually seen within two to three weeks. This is a key treatment. Take it with #1 (the vitamin powder). Can be found at www.vitality101.com.

  **Sleeping Aids for Fibromyalgia

  You can try these in the order listed or as you prefer based on your history. Adjust dose as needed to get eight to nine hours of solid sleep without waking or hangover. If unable to find a combination from the treatments below that does this, see the extensive treatment protocol at www.vitality101.com for many more options. No going to the bathroom if you wake up unless you still have to go five minutes later. Mixing low doses of several treatments is more likely to help you sleep without a hangover than a high dose of one medication. You can take up to the maximum dose of all checked-off treatments simultaneously. Do not drive if you have next-day sedation (adjust your treatment to avoid this). If you’re not sleeping eight to nine hours a night without waking on the checked-off treatments, do not wait until your next appointment to contact your physician. Ambien and Klonopin are considered potentially addictive, but in the dose and form that we use this is rarely a problem. If you have next-day sedation, try taking the medications (except the Ambien) a few hours before bedtime. You can try the natural products in combination first to see if they give you eight hours of sleep a night. Add them in this order: #12, 16, 23, 15. If you have restless leg syndrome or pain that keeps you up at night, I would add treatments in the order #11, 12, 14, and 17. Otherwise, I would use the order #12, 11, 13, 16, 17, 23, 15, 14, 18, 20, 21, and 24.

  ____11.

  **Ambien (zolpidem): 10 milligrams—half to one and a half at bedtime. If you tend to wake during the night, leave an extra half to one tablet at bedside and you can take it as needed to help you sleep through the night, or use the Ambien CR sustained-release form.

  ____12.

  **Revitalizing Sleep Formula (by Enzymatic Therapy, Integrative Therapeutics): 200 milligrams valerian, 90 milligrams passionflower, 50 milligrams L-theanine, 30 milligrams hops, 12 milligrams piscidia, and 28 milligrams wild lettuce. Take two to four capsules each night thirty to ninety minutes before bedtime. It can also be used during the day for muscle pain and/or anxiety (up to four capsules three times a day). If valerian energizes you (occurs in 5 to 10 percent of people) use the other components for sleep. Do not take more than twelve capsules a day. Or use a similar herbal mix.

  ____13.

  *Desyrel (Rx; trazodone): 50 milligrams—half to six at bedtime. Although sedating, it can be used (50 to 250 milligrams at a time) for anxiety. Do not take more than 450 milligrams a day (or 150 milligrams a day if on other antidepressants).

  ____14.

  *Klonopin (Rx; clonazepam): ½ milligram—begin slowly and work your way up as sedation allows. Take half a tablet at bedtime, increasing up to six tablets at bedtime as needed. Can be very effective for sleep, pain, and restless leg syndrome. Klonopin may be addictive. Taking one-quarter to one-half tablet in the morning (not more) can actually decrease brain fog in some CFS patients.

  ____15.

  *5-HTP (5-Hydroxy-L-Tryptophan): 200 to 400 milligrams at night. Naturally stimulates serotonin. Don’t take more than 200 milligrams a day if you are on Prozac, Paxil, Zoloft, Desyrel, or Celexa. Can help with pain and weight loss at 300 milligrams a day for at least three months.

  ____16.

  Calcium (500 to 1,000 milligrams) and magnesium (100 to 200 milligrams) at bedtime help sleep.

  ____17.

  *Neurontin (Rx; gabapentin): 300 milligrams—one to two capsules at bedtime. Also helps pain and restless leg syndrome.

  ____18.

  *Zanaflex (Rx; tizanidine): 4 milligrams—Take half to two at bedtime. For pain and sleep. If it causes nightmares, stop taking it. Do not take while on Cipro (raises blood levels of Zanaflex too high).

  ____19.

  Sonata (Rx; zaleplon): 10 milligrams—Take one to two capsules during the night if you wake after 3 a. m. or if you only have trouble falling (versus staying) asleep. Its sedation lasts only three to four hours.

  ____20.

  *Flexeril (Rx; cyclobenzaprine): 10 milligrams—half to two at bedtime. A muscle relaxant, it can cause dry mouth.

  ____21.

  *Sinequan (Rx; doxepin): 5 to 10 milligrams, one to three capsules at bedtime or doxepin liquid, 10 milligrams/cc. If a lower dose is needed you can start with one to three drops at night. A powerful antihistamine. Some people get the greatest benefit with the least next-day sedation with a dose of less than 5 milligrams a night.

  ____22.

  Elavil (Rx; amitriptyline): 10 milligrams—half to five tablets at bedtime. May cause weight gain or dry mouth. Good for nerve pain and vulvodynia.

  ____23.

  Melatonin: ½ to 1 milligram at bedtime. If you feel wide awake at bedtime, try 5 milligrams taken three to five hours before bedtime. Don’t use a higher dose unless you find it more effective (0.5 milligrams is usually as effec
tive as 5 milligrams and may be safer).

  ____24.

  Gabitril (Rx; tiagabine): 2 to 6 milligrams at bedtime. The main side effects are sedation, dizziness, and gastric upset.

  Hormonal Treatments

  Several studies show that thyroid therapies can be helpful in CFIDS/FMS, even if your blood tests are normal. Thyroid supplementation is, however, controversial, even though it’s usually safe. All treatments (even aspirin) can cause problems in some people, though. The main risks of thyroid treatment are:

  Triggering caffeinelike anxiety or palpitations. If this happens, cut back the dose and increase by half to one tablet each six to eight weeks (as is comfortable) or slower. Sometimes taking 500 milligrams vitamin B1 (thiamine) one to three times a day will also help after about one to three weeks. If you have severe, persistent racing heart, call your family doctor and/or go to the emergency room.

  Triggering heart attack. For those who are already at high risk of having a heart attack or severe “racing heart” (atrial fibrillation), thyroid hormone can trigger a cardiac episode. In the long run, though, I suspect thyroid may decrease the risk of heart disease. If you have chest pain, go to the emergency room and/or call your family doctor. It will likely be chest muscle pain (not dangerous), but with heart attacks, it is always better to be safe than sorry. To put it in perspective, I’ve never seen this happen despite treating many thousands of patients with thyroid hormones. Increasing your thyroid dose to levels above the upper limit of the normal range may accelerate osteoporosis (which is already common in CFIDS/FMS). Because of this, you need to check your thyroid (free T4—not TSH) levels after four to eight weeks on your optimum dose of thyroid hormone. All this having been said, we find treatment with thyroid hormones to be safer than aspirin and Motrin. If you have risk factors for angina, do an exercise stress test to make sure your heart is healthy before beginning thyroid treatment. These risk factors include: diabetes; elevated cholesterol; hypertension; smoking; personal or family history of angina; gout; and age over fifty.

  There are several forms of thyroid hormone, and one kind will often work when another does not. A compounded mix of T4 and T3 hormone may be best if your doctor is familiar with these. Do not take thyroid hormone within six hours of iron or calcium supplements or you won’t absorb the hormone. It can take three to twelve months to see the thyroid’s full benefit.

  ____25.

  **Armour Thyroid or a compounded T4/T3 combination (Rx): 30 milligrams (½ grain = 30 milligrams) (natural thyroid glandular). If Cortef is checked, begin the Cortef and/or adrenal support one to seven days before starting the thyroid. See paragraph below and thyroid information above.

  Take half a tablet each morning on an empty stomach for one week and then one tablet each morning. Increase by half to one tablet each one to six weeks (until you’re on three tablets or the dose that feels best). Check a repeat free T4 blood level when you’re on three tablets a day (or your optimum dose) for four weeks. If okay, you can continue to raise the dose by half to one tablet each morning each six to nine weeks to a maximum of five a day and then recheck the free T4 four weeks later. Adjust it to the dose that feels the best (lower the dose if shaky or if your resting pulse is regularly over 88/minute). Do not go over five tablets a day without discussing it with your doctor (although it may take as many as ten a day to see the optimal effect). When on your optimum dose, you can often get a single tablet or capsule at that strength. If your energy wanes too early in the day, you can also take part of your thyroid dose between 11 a. m. and 3 p. m. Some people find that taking part of their thyroid dose at night feels better. You can divide your thyroid dose through the day to see what feels best.

  ____26.

  Iodine: 1,000 to 2,000 micrograms a day for two to four months if you have daytime body temperatures under 98.3°F or breast cysts or tenderness. Consider Iodoral, which contains 12.5 milligrams (5 milligrams iodine and 7.5 milligrams iodide). May flare Hashimoto’s thyroiditis and rarely suppresses thyroid function (with long-term use).

  ____27.

  *Cytomel (pure active T3) or compounded sustained-release T3 (Rx): In fibromyalgia, resistance to normal thyroid doses may occur, and patients often need high levels of T3 thyroid to improve. Dr. John Lowe’s research group feels that the average dose needed in FMS is 75 to 125 micrograms each morning, much higher than your body’s normal production. In the absence of resistance, 5 to 25 micrograms is often optimal. Because we are often going above normal levels with T3, the risks/ side effects noted above increase. Because of this, if you have risk factors, it is more important to consider an exercise stress test to make sure your heart is healthy (i. e., no underlying angina) before beginning this protocol. Also, consider a DEXA (osteoporosis) bone density scan every six to eighteen months while on treatment. There may be initial bone loss the first year, then increased bone density. This having been said, in our experience this treatment has been quite safe and, in some FMS patients, dramatically effective. Begin with 5 micrograms each morning and continue to increase by 5 micrograms every three days until you feel well, you feel shaky, or you’re at 75 micrograms a day (whichever comes first) and then increase by 5 micrograms a day every one to six weeks until (whichever comes first):

  You reach 125 micrograms each morning (or 60 micrograms if you’re over fifty, unless approved by your physician).

  You feel healthy.

  You get shakiness, worsening significant palpitations (occasional “flip-flops” are common), anxiety, racing heart, sweating, or other uncomfortable side effects. If this happens, lower the dose a bit for two to four weeks and then try raising it again until you note significant improvement without uncomfortable side effects or you tried to raise it three times and still became shaky/hyper.

  Blood tests for thyroid hormone or TSH are not reliable or useful on this regimen. If you feel no better even on the maximum dose, taper off (decrease by 5 micrograms each three days until you’re at 15 micrograms a day. Take 15 micrograms a day for three weeks and then drop to 5 micrograms a day for three weeks, then stop.).

  Some people do better on the timed-release form of T3 (Cytomel is immediate release). Because there is marked variation in potency from many pharmacies, I strongly recommend that you use ITC Pharmacy; 303-

  663-4224.

  After being on treatment for three to six months, some patients can lower the T3 dose or stop taking it. Feel free to try dropping the dose. If you feel better initially and then worse (beginning more than four weeks after starting a new dose), you probably need to lower the dose. If you lose too much weight, try to eat more (and discuss this with your physician) and lower the dose.

  ADRENAL HORMONES (GLANDULARS AND SUPPORT)

  Helps your body deal with stress and maintains blood pressure.

  ____28.

  **Cortef (Rx; hydrocortisone): 5-milligram tablets—half to two and a half tablet(s) at breakfast, half to one and a half tablet(s) at lunch, and none to half a tablet at 4 p. m. Use the lowest dose that feels the best. Most patients find that one to one and a half tablets in the morning and half to one tablet at noon is optimal. Take it with food if it causes an acid stomach. Do not take more than four tablets a day without discussing the risks with your physician. Take calcium if on Cortef. If taken too late in the day, Cortef can keep you up at night. You can double the dose for up to one to three weeks (to maximum seven tablets a day) during periods of severe stress (e. g., infections—see or call your doctor for the infection and let him or her know that you’re raising the dose). If routinely taking more than four tablets a day (at your doctor’s direction), wear a Med-Alert bracelet that says “on chronic cortisol treatment.” After nine to eighteen months, you can try to wean off the Cortef (decrease by half a tablet a day every two weeks) if you feel okay (or no worse) without it. Compounded sustained-release hydrocortisone is even better (available from ITC Pharmacy; 303-663-4224) if your energy drops in the afternoon.

  ____29.

  **Adrenal Stress
End (from Enzymatic Therapy or Integrative Therapeutics): One to two capsules each morning (or one to two in the morning and one at noon). If it upsets your stomach, take less or take with food.

  ____30.

  *Increase your salt and water intake a lot. If your mouth and lips are dry (and you’re not on Elavil), you’re dehydrated—drink more water (or herbal tea or lemonade sweetened with stevia; see #37), not sodas or coffee. Celtic Sea Salt is an excellent form to use (800-867-7258).

  OTHER HORMONES

  ____31.

  *Biest 2.5 milligrams, plus progesterone 30 to 100 milligrams, plus testosterone 0 to 5 milligrams all in 1 gram of cream (Rx): Apply 1 gram of skin cream at bedtime. Available from ITC Pharmacy; 303-663-4224). Vaginal preparations may be more effective.

  ____32.

  *Testosterone (Rx): Males 25 to 50 milligrams (order 100 milligrams/gram of cream) one to two times a day (less if acne occurs). Rub the cream into an area of thin skin on the abdomen or inner thigh. The cream is available by prescription from ITC Pharmacy; 303-663-4224) and can be mailed to you. Or Testim 1 percent 25 or 50 milligrams; apply gel one to two times a day. Consider also checking estrogen and DHT levels when you check your testosterone blood levels. If the DHT goes too high it can cause hair loss, which can be prevented by Proscar (Rx) or saw palmetto, 160 milligrams two times a day. If estrogen goes too high, this can be blocked by Arimidex (Rx) 0.5 milligram a day. If you are taking thyroid tablets, be aware that adding testosterone can increase your thyroid blood levels. If you get moody or anxious, or your heart races, check a blood level for your thyroid and consider lowering the dose.