Miscellaneous Advice

Often, people come in to my office complaining of longstanding fatigue that is not quite as disabling as the fatigue seen in chronic fatigue syndrome or fibromyalgia. I never cease to be amazed at how often these people improve dramatically by simply cleaning up their diets a little — cutting down on their sugar, caffeine, and alcohol intake; substituting whole grains for white flour; and adding simple yet powerful nutritional support to their daily regimens. So let us start with the easy things first.

Vitamin and Mineral Supplements

The argument about people not needing vitamin tablets 500 years ago simply does not apply to the average modern American. One study that was reported in the American Journal of Clinical Nutrition showed that fewer than 5% of the study participants consumed the recommended daily amounts (RDAs) of all their needed vitamins and minerals.8 What is frightening is that this study was conducted in Beltsville, Maryland, on U.S. Department of Agriculture (USDA) research center employees.

Despite this, some cynics still like to say that the vitamins go out in your urine, so all you’re doing by taking vitamin supplements is making expensive urine. Using this line of reasoning, these cynics can stop drinking water (it just goes out in their urine!). That way, they’ll soon stop annoying people who are in the process of getting themselves well!

Why are vitamins and minerals so important? Dr. Janet Travell, White House physician for Presidents John F. Kennedy and Lyndon B. Johnson and professor emeritus of internal medicine at George Washington University, co-wrote Myofascial Pain and Dysfunction: The Trigger Point Manual, which is acknowledged as the authoritative work on muscle problems. In one chapter alone, Dr. Travell and coauthor Dr. David Simons reference 317 studies showing that problems such as hormonal, vitamin, and mineral deficiencies can contribute to muscle disorders.9

In fact, when I had figured out how to effectively treat CFS/FMS as a young physician and was all full of myself, one of my patients brought in The Trigger Point Manual and asked “Hey Doc, have you seen this?” Dr. Travell had figured out all of these things when I was still in diapers! As the godmother of pain management, I am proud to dedicate this book to her memory.

Patients often ask me “What vitamin or mineral do I need?” The answer is that all of them are critical. In addition, higher levels than normal are often needed to compensate for the poor absorption of nutrients caused by the bowel infections as well as the increased needs that result from the illness. For example, as discussed below, optimal zinc levels are critical for proper immune function, and zinc deficiency likely contributes to the immune dysfunction seen not just in CFS, but in AIDS as well. Chronic infections result in large zinc losses, which then further suppress immune function—resulting in more infections and zinc losses. In AIDS, zinc levels are as low as in a genetic zinc deficiency (called "Acrodermatitis Enteropathica" or "AD"). This zinc deficiency results in the hormone that regulates immunity (thymulin) not functioning—resulting in the same immune deficiencies in AD that are seen in early AIDS. Very low zinc levels have also been demonstrated in FMS (likely because of the chronic infections), contributing to further immune dysfunction.

Numerous other studies have shown that adequate amounts of many vitamins, minerals, amino acids, and nutritional cofactors are critical. In addition to zinc, vitamin A, beta-carotene, vitamin B6, vitamin C, vitamin E, and iron have been found to be very important in keeping the body’s defenses strong.10-15

Sugar and White Flour

The average American’s diet includes over 140 pounds of added sugar per year.1 This added sugar accounts for 18% of the average American’s caloric intake. Since a healthy diet without added sugar may have only a 5-15% margin of safety for supplying optimum amounts of vitamins and minerals, the added sugar alone makes the average American diet a disaster.

Sugar also suppresses the immune system and stimulates yeast overgrowth in the intestines. Yeast grows by fermenting sugar and the yeast say thank you by making billions of baby yeasties. Physicians working in this field have found that although most sugar is usually absorbed before it gets to the intestines, excess sugar can still markedly aggravate yeast overgrowth.2 Yeast can also aggravate sugar craving. This may mimic hypoglycemia, which is commonly found in people with an under active adrenal gland.

I often hear people express skepticism about the importance of nutritional supplements. A typical comment that I hear is, “Five hundred years ago, there were no vitamin tablets, and people seemed to do just fine.” Well, 500 years ago, sugar was expensive and not readily available. The King of England might have sprinkled a teaspoon of sugar on his food as a sign of power, but when he wanted sugar and had none left, he had to send someone to the West Indies to get it!

Another dietary disaster is white flour. Vitamins were supposedly discovered by a settler who went on sailing expeditions with Dutch explorers. Soon after the settler helped a group of colonists establish their new home, he found that the colonists were becoming ill. He also noticed that the colony’s chickens were looking unusually healthy. Being a curious fellow, this man began feeding the chicken food to the people. Over a period of several weeks, the people became stronger and healthier. Since the settler was also a good businessman, he (incorrectly) named the chicken feed vital amines, meaning “vital proteins,” and began selling it. The name was later shortened to vitamins.

Today, scientists understand what happened to those colonists. Polishing off the brown outer coat, or bran, from rice had become fashionable. The rice bran was then used as chicken feed. The bran, however, contains most of the vitamins and minerals that are present in rice. The colonists therefore quickly became nutritionally deficient, while the chickens flourished.

In the United States, approximately 18% of the average person’s calories come from white flour. However, white flour, just like white rice, has had the bran removed and therefore is also significantly depleted of vitamins and minerals.3,4 Although some foods made of white flour are now fortified with vitamins and minerals to make up for this, most of the nutrients that were removed continue to be missing.

As you can see, from just the use of white flour and added sugar, Americans often reduce their vitamin and mineral intake by around 35%. Add to this the nutrients that are lost in the canning of vegetables, which can cause vitamin losses of up to 80%, and in the processing of other foods.5 As Dr. S. B. Eaton noted in his study in the prestigious New England Journal of Medicine, “Physicians and nutritionists are increasingly convinced that the dietary habits adopted by Western society over the past one hundred years make an important etiologic [causative] contribution to coronary heart diseases [angina], hypertension, diabetes, and some types of cancer.6 This is the same conclusion that was reached by the authors of Western Diseases: Their Emergence and Prevention.7

Caffeine and Alcohol

I am constantly astonished at the number of people who complain about being tired who drink more than ten cups of coffee a day. Caffeine is a loan shark for energy and also accentuates hypoglycemic symptoms. Many chronic fatigue patients fall into the trap of drinking ever increasing amounts of coffee to boost their energy so that they can function. What these people do not realize is that as the day goes on, caffeine takes away more energy than it gives. Coffee drinkers are often caught in a vicious cycle. I advise all my coffee drinkers to stop ingesting coffee completely for two to three months. After this initial period, I tell them that they can add back up to eight ounces of coffee a day if they are feeling better. Black and green teas, in leaf and teabag forms, are high in antioxidants, however, and are much more healthful than coffee. It is OK to drink 1-2 cups of brewed tea a day (not the sugar loaded ones sold in bottles) to get your “caffeine-kick.”

If you drink more than three cups of coffee a day, you should remove it from your diet gradually. To begin, cut your coffee consumption in half every week until you are down to about one cup a day. For example, if you generally drink four cups of coffee a day, cut your intake to two cups a day the first week, then to one cup a day the second week. The final week, continue on or switch to caffeinated tea, which contains many antioxidants which improve your health. I usually tell my patients that I do not want to see them until ten days after their last cup of coffee. Caffeine is an addictive drug and removing it from the diet brings withdrawal symptoms—grouchiness, headache, and fatigue. Once the withdrawal symptoms are gone, however, my patients usually feel much better and are very happy that they went through the process. By tapering the coffee as just described, it takes a little longer to feel well, but the withdrawal symptoms are not as severe.

Limit alcohol to one to three drinks a day. One drink equals six ounces of wine, twelve ounces of beer, or one and a half ounces of whiskey. If you drink more than these amounts, you should stop drinking alcohol completely for three months. If you decide to return alcohol to your diet at the end of that time, make two drinks a day your limit. Some people with yeast overgrowth find that even the smallest amount of alcohol makes them feel poorly.

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. This consists of giving magnesium, high-dose B-vitamins, glutathione, vitamin C, and other nutrients intravenously. You'll find that when you take these, you'll feel a warm flush in the areas that have been most significantly affected by your illness. Because of the decreased energy production in these areas, blood flow is actually shut down to those regions, and decreased blood flow to muscles has been documented in CFS/FMS.251

Because of this, they become starved for nutrients and have trouble with the buildup of toxins. High-dose intravenous magnesium forces the blood vessels open into these closed down areas. flooding them with nutrients and washing away the toxins. causing the warm flushed feeling. I recommend that, if possible, all patients with CFS/FMS receive these IVs therapies at least once a week for six weeks and then as needed. They can dramatically "jump start" some of the body systems and can markedly shorten the time it takes to begin feeling better. Although I have not seen the actual study report yet, I have heard that a placebo-controlled NIH study by Dr. Katz on using these therapies in fibromyalgia patients showed them to be significantly effective. If you have a physician who is willing to do these, I strongly recommend that you have them done. This is called the "Standard IV." These IVs have also been called Myers Cocktails elsewhere.

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 eating a good 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 eat 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.


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