As a physician, treating CFS and fibromyalgia (CFS/FMS/ME) can be personally satisfying, because with proper treatment even those who are severely ill usually improve, sometimes to a complete recovery. But treatment can be remarkably complex, and both patient and practitioner can easily suffer burn out if not using the proper tools to simplify care.
I've frequently discussed effective CFS/FMS treatments in my health blog, and published with much more detail in my books From Fatigued to Fantastic (better suited to those with a scientific bent) and The Fatigue and Fibromyalgia Solution (an easier read for people with the illness). CFS and fibromyalgia result when people essentially "blow a fuse" (the hypothalamus), which causes an energy crisis in their bodies. My approach to resolving this condition is a treatment protocol I developed that I call the S.H.I.N.E.® Protocol. S.H.I.N.E.® is an acronym that stands for Sleep, Hormones, Infections, Nutrition, and Exercise as able. Optimizing these five key health areas can restore energy production and "reset your system." In a randomized placebo-controlled study we published, 91% of those with CFS/FMS improved by an average 90% increase in quality of life through following S.H.I.N.E.®. So we know that these are very real and very treatable conditions.
In this first of a two-part series, I'm presenting my first 5 tips for simplifying and lowering the cost of recovering from CFS/FMS. I'll send the second 5 tips in my next newsletter.
Tools to Simplify Care (Tips 1-5)
1. The Energy Analysis Program
The Energy Analysis Program is a free online tool that can analyze your symptoms to identify probable factors that may be contributing to your fatigue. Based on its analysis of answers you provide to a questionnaire, it recommends lifestyle, dietary and other changes that can improve your energy. The program is based on my S.H.I.N.E.® Protocol and algorithms I derived from over 35 years as a medical practitioner and researcher in the fields of CFS, fibromyalgia, sleep and pain. This helpful tool takes only about 10 minutes to complete.
2. Treat the Pain
In the early stages, pain in CFS/FMS is usually due to muscles that shorten because of inadequate energy. Then as it becomes chronic, the muscle pain triggers a central sensitization of the pain that I refer to as "brain pain." Think of pain as being like the oil light on your car's dashboard, though in this case it's on your body's dashboard and it's warning you that something needs attention. Put oil in your car and the light goes out. In the same way, give your body what it needs and the pain will go away (though what it needs differs according to the type of pain). If your body's need isn't addressed, your brain will amplify the pain, which can become self-sustaining (because of increased microglial cell activity in your brain).
The pharmaceutical industry has unfortunately focused on three modestly helpful medications that are not only very expensive, but also have significant toxicity. Fortunately, there are three much cheaper alternative medications you can use that can significantly decrease the central sensitization that causes "brain pain." These are:
- Low-dose naltrexone (3-4.5 mg per day). This medication has been shown to help rebalance immunity and decrease central sensitization and microglial cell activity. You should take 3-4.5 mg at bedtime each night for at least two months to see results. It may initially disrupt sleep, in which case starting with a lower dose and taking it in the morning instead can help your body adapt. It's available from compounding pharmacies for about a dollar a day. If it was still patentable, I'm certain the drug companies would be charging $20,000-$120,000 per year for it and every physician would know about it. A good book to read on this is The LDN Solution by Linda Elsgood. I would use this treatment for most autoimmune and severe chronic pain conditions, including fibromyalgia. Unfortunately, it can't be used if you are also taking narcotics, in which case the two treatments below may help.
- Minocycline (100 mg 2x per day). This antibiotic medication also helps to rebalance microglial activity, even in the absence of infections. I also treat to prevent Candida overgrowth while people are on it.
- ACE inhibitors (10-20 mg per day). Examples of this include enlapril or vasotec.
3. Other Tips for Treating Pain
- For those of you requiring narcotics, be aware that these will routinely cause both B vitamin and testosterone deficiency, which will amplify your pain. Be sure to take a high potency B complex (e.g., the Energy Revitalization System vitamin powder by Enzymatic Therapy includes this) and have your doctor optimize your testosterone to keep it at least midrange normal.
- hCG. Research by pain specialist Dr. Forest Tennant showed that giving 25-500 units of hCG sublingually (daily for several months) to patients who required very high-dose narcotics resulted in decreasing the narcotic dose they needed by 30-40%.
- Natural remedies can be very effective for managing pain, and can be combined with prescription pain medications as well. The most effective I've seen for this is a pain relief miracle called Curamin (by EuroPharma). In head on studies, Curamin was shown to be more effective than Celebrex in treating arthritis. I also recommend trying topical comfrey (e.g., Traumaplant). Although this works very quickly, you should give it six weeks to see the full effect.
Except for the low-dose naltrexone (which cannot be used with narcotics or Ultram), all of the above can be taken with any pain medications.
4. The Free Smartphone App "Cures A-Z"
"Cures A-Z" is a free smartphone app and and health resource I developed for people who prefer to use natural therapies to manage health issues when they can, but are content to use prescription therapies when they're the better choice. It includes advice on the best ways to treat various kinds of pain, as well as over 100 other conditions often seen in CFS/FMS, such as pelvic pain syndromes, sinusitis, dry eyes and mouth, and many more. Available for iPhone and Android, it's like having my brain in your pocket ... but a lot less messy :-)
5. Treat Mold Neurotoxins
Eliminating mold neurotoxins is an important factor in treating some people. This is the research focus of Dr. Ritchie Shoemaker, who is brilliant — so much so that he can sometimes be nearly unintelligible. I once tried to get him to "dumb down" his explanations by getting him drunk, but that only slightly helped :-) Dr. Neil Nathan succeeded where I failed in this, and recently came out with a brilliant and very simple "how to" book for treating neurotoxins titled Mold & Mycotoxins: Current Evaluation and Treatment 2016. It can be read in under an hour, and will give you all the information you need to immediately begin effectively treating these conditions. Dr. Nathan has jokingly nicknamed it "Shoemaker's neurotoxins for Dummies." I highly recommend it for both you and your physician if you suspect that mold neurotoxins may be playing a role in your illness!
Here's one additional bonus tip: No one wants to be part of the "handful club," where you have to take handfuls of pills each day to meet your nutritional supplement needs. And no one will stick with that kind of regimen anyway. I make this much easier on people — and they're delighted when they see the quick results they experience — by recommending they drink a morning powder-mix energy drink called the Energy Revitalization System (by Enzymatic Therapy). It replaces over 35 supplement pills with one low-cost flavorful drink (replacing their multivitamin and sometimes dozens of other pills). I also have them add a 5 gm scoop of ribose (S.H.I.N.E.® D-Ribose) in the drink. Studies we published showed a 61% average increase in energy after just three weeks of this. I also also recommend you take one Vectomega® tablet each day, which replaces eight fish oil capsules. I drink the energy drink with ribose and take a Vectomega pill every morning as my own daily regimen.. Try it for yourself and you'll find that it turbocharges you with healthy energy.
I sincerely enjoy helping people with this illness get well, and we offer three-hour consultations with people worldwide (in person or over the phone). For more information, or to make an appointment, contact Sarah from my office at firstname.lastname@example.org.
Love and blessings,
Jacob Teitelbaum MD