End Fatigue
Answers to Your Questions
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Daniel asks:
What`s your opinion on the article that was published recently in the "Journal of Clinical Pathology" finding special gene expression in people with CFS?
In addition, do you really believe that it may lead to a blood test that could diagnose someone as having CFS or not?
Here are the 2 links to the articles:
Thank you for your time.
ANSWER
Dear Daniel,
This is simply one of many studies looking at the genomics of CFS and fibromyalgia. What we are seeing is that there is not a single gene but rather a mix of a number of different genes that are involved. In addition, it is not only the presence of the gene, but rather its expression based on the impact of your environment with your genetics.
Although this area is promising, I would not expect it to lead to a single blood test to diagnose CFS or fibromyalgia. On the other hand, there are a number of abnormalities which are seen on lab testing that do hold promise for a more reliable test in the future. There is no shortage of laboratory abnormalities in this disease—simply of abnormalities that are ONLY present in this disease (analogous to an elevated blood sugar in diabetics) which then would result in a clear diagnosis. When such a test is available and generally accepted (expect resistance from the insurance companies and physicians on their payroll that would rather make believe this illness does not exist) it will change the entire political dynamics of the illness. I am old enough to remember when blood testing first became available for lupus, and this illness went from being a "psychological disease" to a real illness in the medical world.
Love and blessings,
Dr. T
Dear Dr. Teitelbaum,
Thank you so much for writing your book. After years of disabling fatigue that prevents me from earning a living, and seeing doctors who either dismissed me or were able to help me improve but not recover, I had a really good cry (and a tantrum) when you described my experience without ever having met me. I have now put a treatment protocol together for myself based on your book and my experience. It's only day 2 but I'm feeling optimistic. My question is about heavy metals. You make no mention of them on your website or in your book but I've been told by more than one doctor that I have high levels of lead, mercury, arsenic and cadmium which are contributing to my fatigue and that they have to be removed. When I found your book, I had put a hold on going through a second course of chelation therapy (using DMSA orally) because I simply didn't have the strength. Can you enlighten me on this issue? Is it possible that my body can naturally get rid of the heavy metal toxicity once it's functioning properly? Are you aware of a gentler method of successfully removing heavy metals?
Thank you again for your work.
Bola
ANSWER
Dear Bola,
This is an important issue. The role of chemicals and toxic metals in contributing to chronic fatigue syndrome and fibromyalgia is significant. On the other hand, many people seem to be handling them just fine. So the questions become:
 | 1. | How can you tell if somebody has heavy metal or chemical toxicity? The answer medically is that you really can't. The current testing (which is usually a urine test after being challenged with the chelating agent) has not had any appropriate normal ranges developed. Instead, most doctors simply use the normal range for a non-challenge test—which is simply totally unreliable. In fact, the lab reports will often state in bold type "normal range is not to be used for challenged testing." I suspect that almost everybody would test positive with that kind of testing—even if they're totally healthy. Nonetheless many excellent doctors continue to use this kind of test. In fact, I put out a challenge grant from our foundation to have somebody derive appropriate normal ranges for this testing—but nobody has taken me up on it yet. |
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| 2. | Will chelation help me to feel better? There is a good chance it will. Regardless of the test results, detoxification can be helpful in CFS and fibromyalgia (and in general for folks). I prefer, however, to begin detoxification by eliminating infections (especially in the intestines), restoring nutritional support, eliminating unnecessary toxins in the environment, and using saunas or other approaches to stimulate sweating—which has been shown to eliminate many toxins from the body (in addition to the heavy metals that chelation would eliminate). |
I think chelation is a helpful and underused approach to the treatment of heart disease. When it comes to CFS and fibromyalgia, I think it can be helpful but I find other treatments to be more effective and cost-effective. In addition, medical boards like to take away the licenses of doctors who do chelation (not for any good medical reason—it's simply politically unpopular and medical boards have the right to do whatever they want—no matter how irresponsible). Because of this, it is not something I recommend routinely for patients or physicians. I suspect you'll find that you can get better without the chelation, and I am not at all convinced that most people who have been told they have heavy metal toxicity based on urine testing actually do.
Love and blessings,
Dr. T
Liz asks:
Dear Dr. T,
I have a friend who has had 2 sinus obliterations and 11 sinus surgeries total. She now has a chronic staph infection and is very sick all the time. Her blood pressure has been 205/168. She is on meds but she is sick all the time and never has a day where she does not feel horrible—but she keeps going. I have watched her though all of this and am so frustrated that all the doctor does is keep giving her antibiotics that never work. This has been a 9 year process. I am at my wits end on how to help her. It seems like one big vicious cycle and she never feels well enough to get a handle on where to start. I am a firm believer in helping your body heal itself, but where do you begin when you have no idea where to start. If you can contact me, I would so appreciate it. She has almost given up on ever getting better.
Thank you so much.
ANSWER
Dear Liz,
I recommend you read the section on yeast infections in my book "From Fatigued to Fantastic!" If she was seeing me, I would have her on Diflucan 200 mg a day for 12 weeks, the sinusitis nose spray which I discuss in my book (for one bottle and then as needed—mailed from ITC Pharmacy by prescription, phone 888-349-5453) plus the Argentyn 23 silver nose spray available on my website.
For more information, below is some information on treating chronic sinusitis from the treatment protocol on my website, which your friend might find helpful. However, she may need to find a holistic doctor to work with. The American Board of Holistic Medicine might be able to help her find one near her.
In addition, she likely has a biofilm component to her sinusitis (see my article, Infection Update—Biofilms, HHV-6, Valcyte and CFS).
In the future, adding Bismuth (which breaks up biofilms) to the sinusitis nose spray may make it even more effective.
Here is how to use the nose sprays and nasal rinses.
Chronic & Acute Sinusitis
| ___ 143.* | Sinusitis Nose Spray (Rx)—Contains Sporanox, Xylitol, Bactroban, and triamcinolone. Use 1-2 sprays in each nostril twice a day for 6-12 weeks. If it irritates the nose, use nasal saline spray just before using the prescription. Use with silver spray below. Available by prescription from ITC Compounding Pharmacy by mail (303-663-4224). |
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| ___ 144.* | Silver Nose Spray—5-10 sprays in each nostril three times a day for 7-14 days until the sinusitis resolves (available at my website). |
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| ___ 145. | Nasal Irrigation (Rx)—Get 1 liter of normal saline with 100 mg Amphotericin B and a second liter with 80 mg gentamycin. Use 1 ounce of each in each nostril as a nasal rinse twice a day as needed. Use Cape Apothecary (available from 800-248-5978 or 410-757-3522). |
L&B,
Dr. T
Nancy asks:
What do you know about the effects of Ribose on cervical dystonia (CD)? My doctor told me about effects of ribose on muscle fatigue and I've been taking 2 teaspoons once a day for 2 months and all my CD symptoms have gone!!
ANSWER
Dear Nancy,
It's amazing how things in the body heal when energy production is restored. I have not used ribose in any cervical dystonia cases, but very much appreciate your feedback. I will pass your comments along to the company that makes ribose to see if they have any experience with using it for dystonia and also put it in my newsletter to see if any other readers have experience with this as well.
Please keep me informed on how you're doing. If it continues to help, it may be worth doing a study on ribose and dystonia. If symptoms recur, I can let you know how to augment the ribose's effectiveness further.
If any readers have cervical dystonia, please let us know whether or not you've found the ribose to be helpful (give it two to three months).
L&B,
Dr. T
Kathy asks:
Dear Dr. T,
Love your book and newsletters. My Naturopath, Dr. Judy Hiel, uses your methods for my CF/FM treatment. Many have been helpful. A few months ago, based on consult with you at a seminar, and your website, she recommended the Valcyte for me at one 450 mg tab, twice daily. I have a sensitive system, and into the 3rd week, I was feeling very tired, sick and weak—sleeping during the day and nights. A blood test showed my viral titers "way higher." I'm on Monolaurin, NK-Stim, IgG 2000 DF, and Proboost to fix it. Feeling better now, but still low energy. WHAT HAPPENED, AND WHAT MORE CAN I TAKE FOR MORE ENERGY? I continue to see my Naturopath, but would so appreciate your counsel. Thanks so much.
ANSWER
Dear Kathy,
The reaction that you're having is exactly what we would expect and are looking for. People often feel worse at about two to four weeks into the Valcyte (often much worse) as they have a die off reaction. Fortunately, when people are on the SHINE Protocol, which your Naturopath is applying, the die off reaction is significantly decreased or eliminated. It is not until 4-5 months into treatment that one routinely sees improvement, although some people improve more quickly.
As you kill off the infection, and your immune system improves, we frequently see the HHV 6 IgG titers actually increase—just as occurs when one initially had the infection and the body fights it off. This is actually a good sign. Because of this, it is not really necessary to follow the infection blood tests—but rather simply follow how you feel.
I would continue with the treatments you are on. I think you will continue to improve well beyond where you were when you started the Valcyte, but I would give it six months.
Please give Dr. Hiel my regards. It sounds like she is taking good care of you;-)
L&B,
Dr. T
P.S.—For more info, see Viral Infections.
Laurie asks:
I have been taking your Energy Revitalization System and B vitamins and find it most beneficial. However I am experiencing very high blood pressure. I am currently on Diovan HCT 160/12.5—2 tabs twice day and Toprol XL—50 mg day. My blood pressure is very erratic, sometimes low and then very high. Can you suggest a new blood pressure medication. I read about Coreg CR a new medication. My weight is low and I exercise daily. Can you help? My MD is lame on BP conditions.
ANSWER
Dear Laurie,
I would recommend you begin with my article on hypertension (it is on my website and is the lead article in today's newsletter). The supplements discussed can be very helpful, as can the vitamin powder.
Medications that you are using are reasonable, although the Toprol will occasionally cause fatigue in CFS. Stopping it suddenly however can cause a sharp rise in blood pressure, so if it were causing fatigue, I would have your doctor taper it gradually. Otherwise it is a reasonable medication for you. The Diovan is a good choice in chronic fatigue syndrome.
Because of the wide fluctuation in your blood pressure, it is important to look for underlying causes. Because of the hypothalamic dysfunction seen and chronic fatigue syndrome, low blood pressure is very common. This can also cause the pressure to fluctuate quite a bit. I would recommend that you begin with the following:
| 1. | Rule out that you have "white coat hypertension." Some people's blood pressure shoots up whenever they see a doctor. For many people, this is the only time their blood pressure goes up, so they'll end up being treated for high blood pressure when they don't have it. I recommend that you get a blood pressure cuff that you can use at home to see what their blood pressure is often high at home or only in a doctor's office. Alternatively, many grocery store and drugstore pharmacies have a blood pressure machine for the public (you actually sit in it) which you can use as well. Check three readings each visit (one right after the other) to make sure that they are consistent. After you get used to the blood-pressure machines, you may find that your blood pressures are lower. |
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| 2. | Rule out sleep apnea with a sleep study. Although you may be thin, making the risk of obstructive sleep apnea less common, you may have what is called "Central sleep apnea," which is also sometimes seen in CFS or as a cause of high blood pressure. |
Meanwhile, begin the supplements discussed in the article above and give them six to eight weeks to work. I would do all of this before changing your medications around, as the ones you are taking are reasonable. The Coreg is basically a cousin of Toprol.
Love and blessings,
Dr. T
John asks:
You recommend 100 IU of vitamin E. Many others recommend between 400-800 IU. Why is this, and what are the problems with taking more than 100 IU?
ANSWER
Dear John,
Certain nutrients that come in families of many different molecules present a problem when only a single member of the family is given in a very high dose. This is because it creates a relative deficiency of the other nutrients. It is for this reason, I believe, that very high doses of beta-carotene and vitamin E have actually been shown to increase cancer risk. In the studies looking at vitamin E dosing, patients did best at a dose of 100 units.
This does not mean that I will not use higher vitamin E doses to treat a specific problem. In these cases I will, however, use natural mixed tocopherols which contain all of the different types of vitamin E.
Love and blessings,
Dr. T
Kollene asks:
After 3 months on the Energy Revitalization System and feeling better my symptoms have returned. The achiness and fatigue have returned as big as ever. Did I do something wrong ? Do I need a cleanse? If so what do I need to do?
ANSWER
Dear Kollene,
You did NOT do anything wrong.
You improved function in some key areas by optimizing nutrition, but other areas (e.g., adrenal and other hormone function) have not been able to keep up, so you are slumping. Treat with the entire "SHINE Protocol" to feel even better and have it be sustained. In addition, have you increased your function/activities too quickly, trying to make up for lost time?
When people have been doing better (often for years) on "SHINE" and then call with a drop in energy, 3 key factors usually isolate the cause:
| 1. | Did sleep worsen and you can't get 8 hours a night? Optimize sleep and look for new stresses or infections flaring the illness. |
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| 2. | Did they stop the vitamin powder (not in your case)? |
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| 3. | Do they have recurrent yeast overgrowth (symptoms flared after antibiotics or increased sugar intake, or have yeast symptoms such as spastic colon or nasal/sinus congestion)? |
That you felt better, even for only 3 months, shows you can improve and recover. Do the free online questionnaire at our website. It will tailor a treatment regimen to your case so you can get well again. After 6 months of feeling better, most people can wean off of most treatments (but stay on the vitamin powder—even 1/2 a scoop) forever. Be sure to add the Ribose (Corvalen) to your regimen.
L&B,
Dr. T
Betsy asks:
Dear Dr.T,
Thank you for all your work on behalf of CFIDS sufferers. I have a question I hope you can help me with. My CFIDS started with a terrible stomach virus involving nausea and vomiting. The nausea has stayed with me daily for the 2 1/2 year course of my illness. I am on 100 mg of Anzemet a day and still have severe break through nausea many days a month. Besides the Anzemet, I have tried ginger, peppermint oil, probiotics daily, digestive enzymes, and DGL. None help significantly. My doctor is going to run the Genova stool test and SIBO test next week, but I have tested negative for parasites in the past and have had major GI work ups. I don't have yeast either. Could you please suggest any other prescriptions and/or natural remedies that could help with the severe nausea or avenues I could pursue as to its cause? I would greatly appreciate it.
Thank you.
ANSWER
Dear Betsy,
The nausea may have many causes and would need a more thorough evaluation. Consider:
| 1. | Cape Pharmacy has a nausea cream applied to the wrist which can be very helpful. Your physician can call the prescription in to 410-757-3522 and ask for Tom the pharmacist, who can guide them. |
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| 2. | Does the nausea decrease briefly after an ounce or 2 of Maalox? If yes, gastritis is playing a role. |
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| 3. | Are there muscles that are tender around your lower rib cage and abdomen? Many of these can trigger nausea. If the nausea is better in a hot bath (which relaxes muscles—though it may initially briefly flare the nausea as the muscles release) it may be coming from the muscle spasm/trigger points. Find a physical therapist that does Dr Janet Travell's Spray and Stretch technique a lot. If they know how to do it, next time you have severe nausea see them. They can spray the various muscles. If that immediately makes the nausea go away, that isolates the cause of the nausea and they can treat it. If you find tender spots that trigger nausea (see the section on abdominal pain in my book, Pain Free 1-2-3) then Lidoderm patches and other therapies to those areas can help—alot. |
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| 4. | Follow the directions in my article Treating Indigestion Naturally. |
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| 5. | As your problem began with a stomach virus, take Quercitin 500 mg 2x day (a bioflavonoid vitamin) as this can kill enterovirus. |
L&B,
Dr. T
Hi,
I just read Dr. Teitelbaum's book, Pain Free 1-2-3. I am trying to avoid a second spinal surgery but I am running out of plays in my playbook. I have acute pain in my lower back that radiates into my buttock and upper right thigh. It is not sciatica but diagnosed as a radiculopathy. I now have noticeable atrophy in my right thigh. Pain medications I have tried do not work effectively and I am concerned about their side effects. I saw this product in your book, Megazyme, but the book was written 2 years ago. Can you advise a supplement/treatment that you have had recent success with in dealing with this kind of pain/inflammation?
Thank you.
Bob
ANSWER
Dear Bob,
The IV colchicine discussed in the book is the best treatment, but sadly (and I feel very inappropriately) the FDA pulled it off the market. I would use the Lidoderm patches over the area and add the End Pain or Pain Formula herbal mix 2 tabs 3x day plus glucosamine sulfate 750 mg 2x day plus MSM 3,000 mg a day and chondroitin 400 mg a day (except for the Lidoderm patch, the rest are in health food stores or at www.vitality101.com). In addition, if a holistic doctor can give the IV nutritional therapies (Myers cocktails) discussed in my book From Fatigued to Fantastic! and you do the rest of the treatments for muscle pain in my book Pain Free 1-2-3 (including those in the "Nerve Pain" chapter) these can also help a lot. Give the regimen 2 months.
L&B,
Dr. T
Dear Dr. T,
I will be seeing my first teenager (15 year-old girl) with CFS soon. Per Mom she gets bad headaches when trying to read and can't attend school. Apart from a thorough neuro exam, any suggestions or advice as to how this age group needs to be approached differently from adults? Is Dr. T's medical web record applicable to kids? Would the short form suffice?
Here's what I know from Dr. T's workshops. Yeast overgrowth, milk allergies and autonomic dysfunction are common. Consider dexadrine up to 30 mg daily. Consider Prozac, Zoloft, Florinef. What dose for florinef? For what symptoms would you give the SSRIs? If dexadrine fails to increase energy? Can you add it to dexadrine? Also consider SR T3 60-100 ug, which shouldn't decrease BMD.
Have you used heparin? I assume that's a last resort. So I may get back to that if needed.
I suspect there wouldn't just be thyroid and adrenal dysfunction. Do you check and supplement, if needed, sex hormones in this age group, too?
What about antibiotic/yeast dosing for a 15 year-old?
Dosing IV nutritional support differently? What dose for Dr. T's Energy Revitalization System vitamin powder? I assume the vitamin B capsule can be taken as is since the B vitamins are water-soluble.
Sorry for all these questions, but I haven't done pediatrics since med school.
I want to thank you in advance for your input. I very much appreciate it!
Dr. W
ANSWER
Dear Dr. W,
At 15 years of age, children are largely treated like adults. The exceptions:
| 1. | Do not use testosterone or DHEA till they stop growing (no increase in height documented for at least 1 year) as testosterone signals the growing edges of the bones to stop growing (permanently). |
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| 2. | I am quicker to use florinef .1 mg (good in kids—not very effective in adults) along with dexedrine in the kids as they have more autonomic dysfuction causing their symptoms, and these are very helpful for this. I am slower to use SSRIs unless other treatments are ineffective. |
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| 3. | If they have abdominal cramps, treat yeast, of course, but also look for milk allergies (do a 10 day elimination diet to diagnose). |
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| 4. | No cipro in kids under 18 and no tetracyclines in kids till the adult teeth are in (9 years old). |
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| 5. | See page 95 of the new edition of FFTF (Treating Kids under 16 yo) for more info. |
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| 6. | Heparin is a last resort. Consider antiviral therapies with ProBoost, IV Vit C and Valcyte (if labs positive—see pages 140-141 of the new FFTF). Though Montoya's placebo controlled study showed modest benefit (significant for the brain fog component), experience suggests that the small subset that test positive do very well with it when combined with the entire "SHINE protocol" we use. |
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| 7. | Once the child is ~ 100 pounds or more and over 13 years old, dosing for the rest of the protocol is largely the same. Kids are more likely to need 30 mg of dexedrine (the maximum dose I usually use) where in adults, 5-12.5 mg is usually enough. Kids need more salt and water loading for adrenal and autonomic support as well. |
L&B,
Dr. T
Irene asks:
Hi! This is something I still don't get. If my TSH is getting lower and lower (now well below normal and out of range), but my T4 and T3 are not getting higher, what is going on? My T4 and T3 levels are where they were PRIOR to thyroid supplementation several years ago (slightly lower, actually)! I have gone from 30 mg of Armour to 60 to 75, 90 and now I am on 120 mg, and still the low T3 and T4. The TSH started to decrease when I was on 90 mg. Am I going to switch it off and still not raise my other levels?
Thanks for your help!
ANSWER
Dear Irene,
Several possibilities.
The most common is that you are suppressing your own thyroid production either because of the thyroid replacement or progression of the CFS and hypothalamic dysfunction. If it is from the medication, this is short term and generally goes away quickly after the medication is stopped down the road.
Most likely, I suspect that you are checking blood levels in the morning either before you take your thyroid hormone or within 90 minutes of taking it before you've absorbed it. It would then be expected to be low (called a trough level). When this occurs, ask the doctor to have you check a level 2-3 hours after taking your morning dose. If it is still low, then you may be taking the thyroid hormone along with something that is blocking it's absorption (calcium, iron, food, coffee, etc). In this case, take the thyroid an hour before any food or supplements.
The time of day the TSH is checked is NOT relevant (it slowly changes over 6 weeks) and it will normally be low if there is adequate thyroid treatment in CFS/FMS. It is the T4 level that drops ~ 24 hours after you take the dose and T3 drops 3-6 hours after taking the dose. So check the free T3 and Free T4 level ~ 2-3 hours after taking your thyroid hormone.
I also recommend that you do not check TSH levels when you are taking thyroid hormone (it will normally be low in CFS/FMS if you are on adequate replacement). The key is how you feel on the thyroid hormone. You want to adjust it to the dose that feels best while keeping the Free T4 in the normal range for safety. If you feel shaky or hyper, lower the dose.
L&B,
Dr. T
Dr. T,
Thank you for responding so promptly. I am taking into consideration all that you have said. I have two follow-up questions: Is it ever appropriate to divide the thyroid medication dose during the day, say once in the AM, then another dose at noon? The other question has to do with blood pressure. I have found that since going up to 120 mg Armour and then 120 mg bio-identical hormone, my blood pressure has gone down quite a bit—from 110/70 to 90/60. I have heard that this is an indication that my adrenals are weak and that the thyroid dose is too much for them. Can you explain this?
Thanks again,
Irene
ANSWER
Dear Irene,
It is absolutely reasonable to split the dose, especially if using Armour Thyroid or other T3 containing products. You can take the second dose any time 4 or more hours after the first dose. This is especially helpful to do if your energy starts to drop as the day goes on.
Thyroid increases metabolism, including the breakdown of the adrenal hormone cortisol. If the adrenals are exhausted and unable to increase cortisol production to compensate, you can see the symptoms of cortisol/adrenal deficiency. This is not a problem with normal adrenal function, so if the adrenal function is low, we simply supplement that along with the thyroid.
L&B,
Dr. T
Cheryll asks:
Dear Dr. Teitelbaum, I've enjoyed receiving your newsletter for quite awhile. You were recommended to me by one of your former students who is currently a very successful naturopathic doctor in Alaska. Have you had a chance to do any research on the vast field of information regarding sodium bicarbonate, Dr. Hamer and "The German New Medicine," Dr. Tullio Simoncini, and/or Dr. Robert Young's "New Biology?" These resources are telling me that there is growing data proving how important alkalization is for the body to prompt and sustain healing. I would be very interested to know your views on this body of work. Thank you.
Sincerely, Cheryll
ANSWER
Dear Cheryll,
This is a difficult question to address, as there are no definitive ways to determine a person's acid-base status. Checking the acidity (Ph) of your saliva and urine, and even the bicarbonate level on a general chemistry blood test, offers some information about your acid-base balance, but is not an exact approach.
The body has very strong buffering mechanisms to deal with changes in acid base intake. Given the increasing meat intake in our diet and the increased acidity of groundwater, it is reasonable to suspect that people do have more acid intake than in decades past. There are concerns, however, with using bicarbonate to alkaline eyes the body. For starters, one must be sure that their blood calcium levels are not too high, magnesium levels are optimized, and that their vitamin D levels are moderate. Beyond that, modest use of alkalinizing procedures may be helpful. My preference, however is to have people eat a more alkaline diet and see how this feels, as a safer approach.
Love and blessings,
Dr. T
Linda asks:
I just read that someone who has had kidney stones should watch how much vitamin D they take. Can too much cause more kidney stones???
Linda
ANSWER
Dear Linda,
Good question. This is another example of how people get misled about natural therapies by selectively supplied information.
Vitamin D helps to maintain calcium levels along with having over 200 other important functions. (See more on the importance of vitamin D.) In fact, vitamin D deficiency is estimated to cause 85,000 excess cancer deaths a year in the US, as well as increasing the risk of diabetes, osteoporosis, hypertension, multiple sclerosis and a host of other ills. If the dose of vitamin D goes too high, one can see an increased risk of kidney stones. The key is at what dose this can occur.
The research showing increased kidney stone risk was in people getting 50,000 units a day for long term and I have found NO evidence that this occurs at doses of 10,000 units a day or less. Because of this, I would not worry about taking 5,000 units of vitamin D or less a day.
The next question asked is does taking calcium cause calcium kidney stones, and again the answer is no. What can increase stones are foods that increase oxalate levels (e.g., tea). Instead of restricting these healthy foods in the diet, I offer a different option. Placebo controlled studies have shown that taking vitamin B6 at 25 mg a day plus magnesium at 200 mg a day (both are in the Energy Revitalization System—in part for this reason) decreased recurrent calcium stones by 90%! These nutrients, plus staying hydrated and treating any bladder infections, are keys to avoiding calcium kidney stones (the most common type). For those with recurrent bladder infections contributing, a nutritional supplement called "mannose" can often prevent most bladder infections.
L&B,
Dr. T
Sherry asks:
I was interested in hearing about the potential increased sensitivities in persons with FM. About 7 years ago, I had a very deep root canal in an upper right molar tooth, and even though dental x rays show it continues to be fine, from time to time it hurts and is very sensitive. Is teeth sensitivity more common in persons with FM and is there anything one can do about it if so? Thanks so much.
I continue to be amazed by how much help Dr. T has provided to soooo many people. THANK YOU!
ANSWER
Dear Sherry,
Thanks—and you're welcome ;-)
Dental pain, including hot and cold sensitivity, can often come from:
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| 1. | Referred pain from facial muscles, which can be felt in a healthy tooth. Many healthy teeth get root canals for pain referred from face muscles, and face muscle pain (including TMJ and jaw joint problems) is more common in FMS. What is called TMJ is also often simply spasm of the masseter muscle in front of the ear and responds to the treatment below as well. If you do not have a dentist or pain specialist familiar with this problem (most are not), you can check yourself. If the tooth that is sensitive is: |
| | | A. | In the lower jaw: press hard on the face muscles directly below the affected tooth. |
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| B. | In the upper jaw: a) For your front teeth, push along your upper lip just below your nose. b) For the 3-4 teeth on the right or left side of your upper jaw, push on the muscles along that side of the face between the ear and eyes from top of your forehead to the bottom of the ear lobe on the side of the affected tooth. | |
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| When you find tender spots, push on them for ~ 45 seconds to see if they affect the tooth discomfort. If yes, that muscle is the likely pain trigger. Injecting the tender belly of the muscle with lidocaine (Novocain) to see if the dental pain stops for a few hours is a confirmatory test. I would ask your doctor to order the prescription pain gel/lotion discussed in my book, Pain Free 1-2-3, and apply it to the tender muscle (over the skin is OK) 3x day for 3-6 weeks to see if it helps. | |
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| 2. | Chipping teeth, from acid reflux which occurs during the day and sometimes even at night, can weaken the tooth and is also common. |
L&B,
Dr. T
Please answer my question. I have had hypothyroidism for 10 years. After finally "regulating my thyroid" (my TSH is 0.7), I am still gaining weight, losing eyebrow hair, having mental fog, and all the other symptoms that go with a thyroid deficiency. My doctor says everything is good and I am on the proper dosage of Synthroid (100 mcg). What is the problem then if I have been told I am in the good range?
Thanks.
Cindy
ANSWER
Dear Cindy,
Welcome to the 2/3 of thyroid patients on standard treatment who are unhappy with their treatment. The problem is that the tests are horribly unreliable (especially TSH and especially in Fibromyalgia) but the physicians are not aware of the research showing this. In addition, Synthroid is often not effective if you (like many) have trouble converting it to the active T3 hormone.
Ask your doctor to switch you to Armour thyroid (by prescription) and allow you to adjust it to the dose that feels best as long as your Free T4 stays in the normal range for safety (do not check TSH) and you keep the dose to 3 grains or less.
See my book, From Fatigued to Fantastic, or this article for more info and to see how I dose the thyroid medications in my patients.
If your physician won't treat this way, consider seeing a doctor at Fibromyalgia & Fatigue Centers, Inc. (FFC) if you also have CFS or fibromyalgia, or find a holistic doctor at the American Board of Holistic Medicine if you simply need someone who knows how to adjust thyroid hormone.
L&B,
Dr. T
Richard asks:
I recently visited Dr. Wilson's website and learned about "Wilson's Syndrome" and his protocol that generally uses only T3. Do you have any thoughts about this protocol—has it been helpful? The website implies that the T3 eventually "heals" the Wilson condition and can be discontinued at a point in time. My wife currently takes Armour Thyroid, and is treated by Dr. Hal Blatman in Cincinatti.
Our reason for continued exploration is that, even though Dr. Blatman's protocols (which as you probably know are similar to yours) have been EXTREMELY helpful in effecting what we'd call a "95%" recovery in less than six months, she still has symptoms such as brittle fingernails, itching skin (hive-like), and somewhat severe tinnitus. As these are often thyroid-related, we wondered if a trial of straight T3 might help.
Thank you for all that you do to help people with CFS/FMS.
ANSWER
Dear Richard,
You're working with an excellent physician and I am glad that you're doing better. Instead of the Wilson protocol, which I have found to be more difficult than is necessary and not as effective as other T3 protocols, I recommend instead the approach by Dr. John Lowe, which can be seen on his website.
I find his approach to using T3 to not only be more effective and easier than Dr. Wilson's, but also much safer. A modified form of his approach is discussed in my book "From Fatigued to Fantastic!"
Love and Blessings,
Dr. T
P.S.—Dr. Blatman is a wonderful pain specialist and I highly recommend him. Click here to visit his website.
Dr. T.,
I have been recovered from CFS/FMS for about two years. The FFC is great! I used to take 50+ pills a day, and now I just take a multi, a probiotic, and Xyrem! I saw my PCP about two weeks ago for a check-up and she ordered some blood tests as a general screening (CBC, CMP, T3, etc.). Below are the results for a few of them. Do you have any recommendations? The only issues I am currently experiencing are tremor, anxiety, and a Reynaud's-type flushing of my hands and feet.
Coincidently, I had been on bio-identical T3 for years for LOW THYROID. I stopped it about a year ago. Why would my T3 be high now?
Thanks for your kindness and help!
John
| TEST | | RESULT | | REFERENCE |
|  | | | | |
| FREE T3 | | 3.7 | | 2.0 – 3.5 pg/mL |
| | | | | |
| MAGNESIUM, RBC | | 3.1 | | 4.0 – 6.4 mg/dL |
| | | | | |
| VITAMIN D,25 HYDROXY TOTAL | | 31 | | 25 – 80 ng/mL |
| | | | | |
| TSH | | 1.05 | | 0.34 – 5.60 MIU/ML |
ANSWER
Dear John,
Glad to hear that you're feeling better. When one is doing well, I am inclined to leave things be;-)
I would recheck the free T4 and Free T3 to see if they are staying elevated (sometimes the tests are not accurate or will pick up a transient elevation). If they are both high (or even if the T3 alone is still high), I would evaluate for an overactive thyroid (it can go back and forth intermittently high and low as discussed in my book). This can cause the tremor and is treatable. High thyroid, however, is unusual and tremor common in CFS/FMS. Your low magnesium is a more likely cause of tremor. I would switch multivitamins. The addition of the 200 mg of magnesium in the Energy Revitalization System vitamin powder (still the best multi;-) will help over time—and help raise your Vitamin D as well.
Let me know how the tests turn out.
L&B,
Dr. T
Dear Dr. T,
For the past two years I have been suffering from CFS and MS type symptoms. I have been treated for vitamin B12 deficiency and Hashimoto's thyroiditis. Currently both B12 and TSH blood tests have shown both to within the normal range. Also, my neurologist didn't find evidence of MS.
It has been a year since starting Levoxyl and I still haven't found relief. (Actually, the joint pain didn't start until after I started taking the medication.) A high dose ACTH stimulation test was borderline normal.
After a year of repeat calls to my endocrinologist, she decided to treat my continued symptoms with tapering doses of Prednisone based on my "off the charts" high levels of antithyroidal antibodies. She also mentioned that high antibodies could be the cause of brain dysfunction. Could this be the cause of the MS type symptoms (tingling, forgetfulness, dizzy spells etc.)?
I am hesitant to take the Prednisone because of the potential side effects. A friend told me of your book and wondered if T3 treatment is a better option. I would very much appreciate your opinion.
Thank you,
Eden
ANSWER
Dear Eden,
Sounds like your treatment program is confused. It seems you have:
| 1. | CFS |
| | |
| 2. | Hashimotos thyroiditis |
| | |
| 3. | Suboptimal adrenal function |
Your tingling, forgetfulness and dizzy spells sound more like standard CFS. With MS, I look for loss of vision in 1 eye (not the blurred vision on CFS) and very localized severe loss of movement or sensation (e.g., can't move 1 hand to even hold a pen or lift a leg for weeks at a time or have localized numbness of the type where you could stick a needle deep in the area and not feel it at all).
For the thyroiditis, I find levoxyl poorly effective and recommend Armour thyroid, or better yet a compounded T3/T4 thyroid hormone combo adjusted as feels best, keeping the free T4 blood test in the normal range and ignoring the TSH (TSH is not reliable in CFS). Meanwhile, add cortef 5-15 mg a day. This is very safe and can be very helpful and much better than prednisone (5 mg cortef ~ 1 mg prednisone).
Then do the rest of the SHINE protocol discussed at my website (do the website Online program; the Short program is free) to tailor a treatment protocol to your case. I also recommend you see a Fibromyalgia and Fatigue Center physician. They have centers nationwide and see patients form all over the world.
I think doing these things you will feel much better.
L&B,
Dr. T
Cynthia asks:
Dear Dr. T,
I am writing on behalf of my 27 year old son who was diagnosed with acute prostatitis in January, 2008. After 4 months of antibiotic treatment there is little improvement. He is currently taking 500 mg Cipro twice a day and 100 mg of Doxycycline. He has also been hospitalized for the condition. Ten days after coming out of the hospital he felt better, but now he has relapsed. I heard you on Doctor Oz's program and I was hoping you could recommend an alternative course of action.
Sincerely,
Cynthia
ANSWER
Dear Cynthia,
It would depend on the cause of the persistent prostatitis. Though antibiotics get into the prostate slowly, these antibiotics should do the job if it is bacterial. Where physicians do a worse job is when there is a secondary fungal or viral infection, or if he has pelvic floor muscle pain causing symptoms (all contribute to a process called prostadynia, which is often mistaken for prostatitis). It would be necessary for me to do a prostate exam to give a more accurate answer, but I would recommend your son also see a holistic physician (click here to find one) who can treat for secondary fungal overgrowth (likely after the antibiotics—see Candida discussion in my book From Fatigued to Fantastic! ) with Diflucan 200 mg a day for 6-12 weeks and a low sugar diet as well as considering natural immune support. In addition, I would add Quercitin (in health food stores) 500 mg 2x day for 3 months as this can help prostate symptoms (it helps suppress enterovirus, which can be involved in the prostate). Standard medicine ignores fungal and viral issues in prostate problems and does a poor job of augmenting immune function in persistent infections.
Some pain specialists (click here to find one) are also familiar with pelvic floor pain and can assess for this.
Hope this is helpful. Let me know how things work out for your son.
L&B,
Dr. T
Brenda asks:
Dear Dr. T,
First, thank you so much for your Fatigued to Fantastic system! I am 40 years old and I have suffered from exhaustion and brain fog since I was pregnant with my now 13 year old son, and within two days of using the berry drink mix and B vitamins (Energy Revitalization System), I was awake and clear-headed like I haven't been for almost 14 years! I had a blood test a year ago that showed that my thyroid level was a little low, and hypothyroidism runs in my family. I have gained 30 pounds in the last year that I just can't lose. My doctor does not think my level is low enough to medicate. I had an allergic reaction to iodine contrast used in a test 25 years ago, and an allergic reaction to shellfish during my pregnancy with my son. Can I take a thyroid supplement that contains iodine? Can you suggest something that will help me lose this weight? Thank you again—I am telling everyone that I know about your website and products!
Brenda
ANSWER
Dear Brenda,
Glad it is helping.
Let me make a simple statement—If you were my patient, you would be on Armour thyroid, despite normal tests and despite the iodine allergy—period.
As iodine is critical to life, true allergies to dietary amounts (e.g., 200 mcg/day) are fairly rare. Some people with Hashimoto's Thyroiditis (the most common cause of low thyroid—check your Anti-TPO antibody test and see if it is elevated) have a "reaction" to iodine as it activates thyroid function. This usually passes with time and they feel better overall on the iodine. If one has had a severe reaction to iodine (anaphylaxis with throat swelling or trouble breathing) I would not take iodine supplements without a doctors OK—but would still use thyroid hormone if needed.
If your doctor will not give you thyroid, I recommend you see a holistic physician who will (visit the Fibromyalgia & Fatigue Centers or Holistic Board websites).
L&B,
Dr. T
After a sudden onset of FM 2 years ago, I still can not find a good practitioner in Belgium. Do you know a good specialist in Belgium?
Kind regards,
Kathleen
ANSWER
Dear Kathleen,
Professor Kenny DeMeirleir, MD in Belgium is a wonderful CFS specialist and I highly recommend him. Paul Van Meerendonk in the Netherlands is also excellent.
L&B,
Dr. T
Dear Dr. Teitelbaum,
"Hello from Scotland!" Hope you and your family are well. My husband Joe and I are OK, but he just lost his brother last week. I have been doing relatively well until two weeks ago. I am on all the supplements you recommend and have been on Lyrica for several months now after being on Gabapentin initially. I seem to be doing better, and I have gone without the daily 100 mg dose of Tramadol for pain. I just read on EIR that Cymbalta has been approved by the FDA for Fibromyalgia. Should I try this drug in lieu of Lyrica? Is it easy to switch drugs without any reactions? I am seeing my doctor this week, and wonder what you think. I take 300 mg of Tramadol at night with 25 mg of Elavil and Carisoprodol for bad muscle cramps in my legs. I am currently taking 300 mg per day of Lyrica. In the AM I take Citalopram and Lyrica. The most bothering problem is dry mouth, blurred vision, and not being able to remember words when I am speaking. I find that Joe is finishing my sentences quite a bit. I am wondering if the Cymbalta might cut down on these "senior moments."
The other problem which has recurred this week is multiple Candida outbreaks, with tongue sores, and breakouts on the trunk of my body with red, hot and itchy areas. After taking several weeks of an antifungal, I did not expect it to return again so soon. I have tried to cut down on sugars and carbs.
I look forward to hearing from you, and what you would advise me to do.
Blessings and Peace,
Linda
ANSWER
Aloha Linda,
Please extend Joe my condolences.
The Elavil is a major culprit for dry mouth and eyes, and the first medication I would aim to stop.
If the pain meds are largely for night time leg cramps, I would treat the cramps as follows:
| 1. | Calcium 500-1,000 mg chewable, plus magnesium 200-300 mg at bedtime. |
| | |
| 2. | Quinine pills at bed or at bedside to take if you wake with the cramps. |
| | |
| 3. | Here's an odd treatment, but it often works. No idea why. Put a bar of soap (or use 2 bars of different brands) under your bottom sheet by the foot of your bed. Stops many folk's night cramps. No one knows why. |
Given the fibromyalgia, be sure your leg "cramps" are not really "Restless Leg Syndrome" where your legs are jumpy/restless all night causing the pain. If this is occurring, see this section in my book, From Fatigued to Fantistic!
Cymbalta can be added to Lyrica, or added while the dose of Lyrica is lowered to 150 mg, to see if it helps the brain fog (but it may just be the fibro—see "brain fog" discussion in my book). The citalopram is more closely related to Cymbalta, so if on a high dose of this (over 20 mg) they may want to lower the dose or stop it. Cymbalta, tramadol, elavil and citalopram all raise serotonin levels, so combining them can cause serotonin to go too high. This situation, called serotonergic syndrome, is potentially dangerous (and rarely even fatal). Symptoms are fast pulse, anxiety, and when more severe, fever. CFS and fibro can cause all these symptoms as well, but when I see someone with racing heart, I recommend lowering the dose of serotonin raising medications for a week to see it comes down.
I would go back on the diflucan (fluconazole) 200 mg a day for 3-6 months, avoid sweets, and take probiotics and yogurt with live culture daily for the yeast/Candida.
L&B,
Dr. T
Cobi asks:
Dear Dr. Teitelbaum,
I bought your book and its great, you are very generous with your knowledge and I appreciate that. I also like your very informative newsletters. The recent one about viruses was jam packed with info. Can you do a newsletter article about chronic bacterial infections?
Some things I'd be interested in:
| A. | For the most common bacteria, what lab values are worth treating vs. those seen in the general population? |
| |  |
| B. | Treatment strategies—i.e. monotherapy with minocycline vs. cycling different drugs vs. using a few at a time (Marshall protocol, Dr. Stratton etc.)? |
| | |
If you can comment specifically about my case, i.e which results might be worth addressing and treatment possibilities, I would be grateful.
Thank you very much,
Cobi
My recent Bacteria/Parasite labs:
 | C. pneumoniae IgG 1:128 H |
| C. pneumoniae IgA 1:16 H |
| M. pneumoniae Ab (IgG) EIA 2.71 H: Ehrlichia chaffeensis IgG 1:128 H |
| Ehrlichia chaffeensis DNA, PCR: None Detected |
| Bartonella species: B. Henselae: IGG 1:64 H |
| Bartonella DNA, PCR: None Detected |
| Digestive Stool Analysis: Citrobacter freundii |
| Rectal Smear for Parasites: E. hartmani |
| IgeneX Western Blot (IGG, IGM): Normal |
 |  |
Thank You
ANSWER
Dear Cobi,
I will add the issue of antibiotic sensitive infections to my newsletter topic list—in fact it is the lead article this issue.
Because only the IgG and not IgM testing was positive, it is unclear if these are significant. Often, antibiotics need to be given without relying on labs, simply to see if they help as we discuss in my book, From Fatigued to Fantastic!.
Your rectal swab showed an amebic parasite infection, and I recommend treating ALL parasites, even those normally considered "non pathogenic" (i.e., not a problem) because of the immune suppression seen in CFS/FMS.
L&B,
Dr. T
Mike asks:
Dear Dr. T,
I am a 50 year old male with diagnosis CFS for 5 years. I try to follow your SHINE protocol and it helps. The question I have is this: When I catch a cold or infection, my energy goes up significantly. I have told my doctor and he has no explanation. I have an hypothesis that when I get a cold my immune system has something to go after, which makes me wonder if I should pursue valctye treatment. I am currently getting the HHV-6, CMV and EBV titers done. Any help or theory as to why I see such a boost in energy with illness would be appreciated.
ANSWER
Dear Mike,
You are not alone in having this experience. The infection stimulates your immune system which may temporarily help you fight other infections. This is similar to a program in Scandanavia giving weekly vaccines to do the same over years which has been successful. I agree with pursuing the testing to see if you are a valcyte candidate. I would also consider getting anti-viral IVs if you have a Fibromyalgia and Fatigue Center near you and ask your doctor to give you Gamma globulin (Gammar) 4 cc IM injection every 2 weeks for 6 doses, then as needed. Let me know how this works for you.
L&B,
Dr. T
John Michaels asks:
Dr. T,
I am a CFS patient and my doctor strongly suspects an ongoing chronic bacterial or mycoplasma type infection in my case. Unfortunately, my ferritin level (21) and iron saturation level (22) are both at the very bottom of the "normal" range. Because of the chronic bacterial infection, both my doctor and I are "conflicted" on whether to treat the iron deficiency with iron therapy. This is because several experts on chronic bacterial infections (including Garth Nicolson) sometimes recommend avoiding iron therapy when a chronic bacterial infection is suspected, as iron is known to feed the growth of bacterial pathogens. Would you recommend treating with iron in my case? Would you use iron therapy and antibiotic therapy concurrently?
Thank You!
John M.
ANSWER
Dear John,
I would use the iron and antibiotics together, though taken at different times of day. Low iron harms the bacteria (your body actually pulls iron out of the blood for this reason) but also suppresses immunity. If you had a ferritin over 40 I would pass on the iron. As it is under, I would use it.
L&B,
Dr. T
Diane asks:
Hello Doc: It's Diane, the reporter you met. I have a friend who has polyps in her sinuses and she has been sick for quite some time. She is very congested, been coughing, head pressure and pain, chest congestion, asthma, fatigue, low fevers, etc.
She was supposed to have surgery to remove the polyps and she canceled because she got bronchitis. Should she have polyps removed, or is there something she should do. She got worse after the hurricane in Florida. She also found out she has respiratory yeast, probably from all the antibiotics. Do you have any ideas—do you know anyone in South Florida she can see?
Should she see another ENT? She has seen some ENT's and they put her on nasal sprays with steriods and antibiotics, etc.
Any ideas for her?
Thanks so much.
Diane
P.S.—Hope all is well with you.
ANSWER
Dear Diane,
Without examining her, I cannot advise her, but this is what I would do if it were me:
| 1. | Have my doctor prescribe the "Sinusitis Nose Spray" from Cape Pharmacy (they mail it—call prescription to 410-757-3522) and use it 1-2 sprays on each side 2-3x day for 6-12 weeks, then as needed. |
| | |
| 2. | Be sure the polyps are not associated with aspirin induced asthma (if yes, let's discuss). |
| | |
| 3. | Add Diflucan 200 mg a day for 6-12 weeks. |
| | |
| 4. | Do nasal rinses, the vitamin powder, probiotics and ProBoost as discussed in my book, From Fatigued to Fantastic! |
| | |
| 5. | If blood IgE level is elevated, treat allergies and add cromolyn nose spray. |
| | |
| 6. | Make sure there was no toxic mold in the home or office from after the hurricane. |
| | |
| 7. | If the problems persist after 12 weeks, I’d then do surgery. |
| | |
L&B,
Dr. T
Linda asks:
Dr. Teitelbaum,
I met you last year at the Natural Products show in Anaheim and also spoke with you after your lecture in Salt Lake City last year. (We walked out to the parking lot with a few others). I have also recently visited with Dr. Whittaker.
My question is: It has been suggested recently by three heart surgeons that I have a pacemaker due to a slow heart rate and long pauses. In a 48 hour holter test my heart rate was as low as 31 beats a minute (BPM) with pauses as long as 4.9 seconds during sleep and 4.5 seconds while awake. 17% of the time my heart rate was lower than 50 with an average heart rate of 70 BPM over the 48 hour period. I cancelled the surgery a few days ago and am looking for the possibility of other options. I am 49 and have been diagnosed with FMS and likely Chronic Fatigue. It is not severe but limiting. I take good care of myself and am not overweight. Are there any connections that you know of to FMS and my problem with the heart?
Thank you!!!
Linda
ANSWER
Dear Linda,
Definitely do the surgery. If is fairly safe and easy to recover from and you'll likely feel so much better. CFS is associated with heart issues, but high degree heart block is not a common one. On the other hand, heart block can cause severe episodic fatigue and other symptoms.
You know I am not a big fan of medications or surgery—but go now and get the surgery :-) I bet you'll be glad you did!
L&B,
Dr. T
Dear Dr. Teitelbaum,
I contacted you last year . You were kind enough to help us. You have also helped my cousin Lydia.
I have another question for you, if you will. I am a pastor and I have given the link to your Vitality 101 page on managing depression naturally to a number of people whom I counsel. One of these is a post-partum mom who has a mix of anxiety and depression. She saw a nurse practitioner today at the Marino Center for Progressive Health in Cambridge who did not know whether the herbal ingredients would affect the baby. Can you tell me if the Happiness 1-2-3! formula is safe for a breast feeding mom? This woman has started taking the fish oil capsules. She is tempted by medication but her husband and I have dissuaded her so far.
Thank you for your assistance.
Christian
ANSWER
Dear Christian,
I tend to be very cautious about what mom's take during pregnancy and nursing, and most herbs (like most meds) have not been studied during pregnancy/nursing.
For postpartum depression, I recommend she use the fish oil and BIOIDENTICAL progesterone, both of which can be used while nursing. She can add in the Happiness 1-2-3! after the baby is weaned.
L&B,
Dr. T
Sheryl asks:
First I want to thank you for your book and for D-Ribose which have both helped me so much. The Ribose has really worked for me! (I took part in the Fall, 2006 study with Corvalen Labs.)
Question: I read in your newsletter that Ribose is not only good for CFS/FM but also for congestive heart failure which my 99+ yr. old father has. I know Ribose can lower blood sugar after taking it. However, being a sugar itself, what is its overall or long term effect on blood sugar? Will it raise it? Dad does not have Diabetes, but his blood sugar is gradually creeping up and being watched very closely by his doctor.
Thank you!
Sheryl
ANSWER
Dear Sheryl,
You're welcome;-)
Ribose has a zero glycemic index and does not trigger diabetes like other sugars. It would be good for him to use, and consider the heart failure treatment approach discussed in Treating Heart Problems Naturally.
L&B,
Dr. T
Michelle asks:
Dr. T,
YOU ARE MY LAST HOPE!!!!
I was diagnosed with narcolepsy about 4 years ago. I also have Fibromyalgia. I read your book and I am currently taking the Corvalen, the Energy Revitalization System, and also the Acetyl-L-Carnitine. I have been taking them for 2 weeks now. On top of that, I am also taking my narcolepsy medicine (adderall and cymbalta for the cataplexy). I was under the impression that people with narcolepsy never go into that stage 3 and 4 of sleep. So my question is, is it possible for me to get into those stages of sleep? This is really important for me to know because I have so much trouble sleeping, so to get one night of good solid sleep would be the greatest gift ever!! I have also been taking your Revitalizing Sleep Formula herbal (4 pills every night) and unisom. But it still doesn't make me sleep. It helps me relax a little, but not sleep. On top of that, all the doctors that I've ever been to tell me not to take any sleeping pills. So, I'm doing this against their wishes, because basically, I WANT TO SLEEP!!! So, is it possible for people with narcolepsy to actually get a good night sleep? This is very important for me to know because you said in your book that sleep was the most important thing to getting well. I completely agree with you. So, I need to know if there is any hope for a good night sleep for me.
Thanks for your help!
Sincerely,
Michelle
ANSWER
Dear Michelle,
In my Fibro patients with narcolepsy, I still give sleep meds as needed to ensure 8 hours sleep a night. One can begin with Xyrem (approved for narcolepsy) to keep your narcolepsy doctors happy, but I add in Ambien and other sleep meds that increase stage 3-4 sleep.
You may want to find a physician (www.fibroandfatigue.com) that can treat both the sleep and narcolepsy.
L&B,
Dr. T
I read from other Chronic Fatigue and FM forums that women, including my wife, suffer from loss of Libido. Is there any help that can be offered them?
My wife's estrogen, progesterone levels are "normal," testosterone levels are high normal. Even the PCP wondered if her sex drive was high but "NO... what sex drive?" was her answer. Is DHT a problem in women too?
Thanks in advance.
Brian
PS: Controlling the DHT with Saw Palmetto 160 mg BID seems to be working for me.
ANSWER
Dear Brian,
73% of those with CFS have loss of libido. Though low testosterone can contribute, it is one of many factors. Treating with the entire "SHINE Protocol" often helps libido as well as fatigue, but it usually takes ~ 6 months for libido to improve. A trial of Viagra or Cialis is sometimes helpful as well—even for women. Herbals and other treatments (see below from my treatment protocol) can help, though often take 6 weeks (viagra/cialis can work that day).
Does she have vulvar pain with intercourse? If yes, this needs to be treated as well. DHT is less of an issue in women, but could be present if her testosterone is high.
L&B,
Dr. T
Sexual Dysfunction/Loss of Libido—This is a common problem, found in 73% of CFS/FMS patients. Make sure your testosterone levels are adequate.
| ___ 173A. | For women: Desire (Ultraceuticals) or Hot Plants For Her (Enzymatic Therapy) | Maca Root Extract 400-800 mg/day, Rhodiola Rosea Extract 150-300 mg/day, Ashwagandha Root Extract 250-500 mg/day, Siberian Ginseng Extract 150-300 mg/day,Ginkgo Biloba Extract 50-240 mg/day, Diindolymethane (DIM) 100-200 mg/day, Macuna Pruriens Extract (15% L-dopa) 100-200 mg/day. |
| |
| ___ 173B. | For men: Potency Plus (Ultraceuticals) or Hot Plants For Him (Enzymatic Therapy) | Maca Root Extract 400-800 mg/day, Rhodiola Rosea Extract 150-300 mg/day, Epimedium Extract 100-200 mg/day, Longjack Extract 50-100 mg/day, Panax Ginseng 100-200 mg/day, Ginkgo Biloba Extract 50-240 mg/day, Diindolymethane (DIM) 100-200 mg/day, Macuna Pruriens Extract (15% L-dopa) 50-200 mg/day, Tribulus Terrestris Extract 100-200 mg/day. |
| |
| ___ 174. | Antidepressant induced sexual dysfunction can be treated with___ ginkgo biloba 120 mg twice daily, ___ Dexedrine—25 mg each morning, ___ Symmetral 100 mg twice daily, or switching to Wellbutrin (see #171). |
| |
| ___ 175. | Viagra (Rx) - 100 mg—take ¼ -1 tab 1 hour before intercourse on an empty stomach for erectile dysfunction (do not use with nitroglycerin or underlying heart disease). Chew and dissolve under tongue for faster effect. |
| |
| ___ 176. | Cialis (Rx) - 20 mg—take one half to one tablet 15 minutes before intercourse for erectile dysfunction (do not use with nitroglycerin or underlying heart disease). |
| |
Vulvadynia—Treat with Elavil (or Doxepin) and Neurontin (oral or topical). Suboptimal testosterone can also cause Vulvadynia.
Hannah asks:
I have CFS and I want to move to the more permanent and 5-year lasting contraceptive, Merena, which is an IUD that releases a small amount of progesterone into the uterus over time. I am currently on the patch that has progesterone and estrogen (works fine with me). I had been on the shot prior to that which was all progesterone and I hated it due to its side effects. My doctor suggested I research the effects of progesterone on people with CFS before committing to the merena since I had some nasty side effects from the shot that may or may not be because I have CFS. Do you recommend any place to read about such studies or do you have any information on the effects of progesterone on people with CFS. I really don't want to risk having kids, which is why I want to move to a more permanent and more successful birth control. Thank you!
ANSWER
Dear Hannah,
The issue in CFS is not so much the progesterone as whether it is the bio-identical progesterone (in which case it helps sleep and anxiety and muscle pain, but can worsen depression) vs. synthetic progestins (such as provera and what was in the injection) which tends to have nasty side effects in general and should not really be on the market for safety issues. The estrogen in the patches are bio-identical and better than premarin for safety, but I am not aware of patches with progesterone so I do not know the type that was in your patch.
In general, the bio-identical estrogen and progesterone are better for CFS/FMS symptom relief, but are not adequately reliable as birth control. Because of this, we do consider the synthetics for birth control.
I think the question to ask your OB is how much progesterone is released daily from the IUD relative to what you received in the past. If it is a very small amount, it may be worth the risk of trying it, realizing that the IUD can be removed if it causes problems and you could switch to barrier contraception or a tubal ligation vs. a low estrogen birth control pill. This is the approach I would look at in your case. For information on Provera (synthetic progesterone) vs. natural progesterone, see p 109-111 in the new edition of From Fatigued to Fantastic (and I invite you to give your doctor a copy of this section as well).
L&B,
Dr. T
Tammy asks:
Your new article regarding having a healthy pregnancy suggests taking the Energy Revitalization System. My OB/GYN has told me that it has too much vitamin A. I am taking prenatal vitamins, that upset my stomach quite a bit. In your opinion, can I just replace the prenatal with the Energy Revitalization System? Will I still get the needed vitamins? I have also just switched to Armour Thyroid.
ANSWER
Dear Tammy,
I recommend that people take the Energy Revitalization System plus calcium, iron and fish oil instead of their prenatal. I suspect that what your OB missed is that half the vitamin A is beta carotene (which is quite safe for pregnancy) and that the vitamin powder only has 3,500 units of vitamin A which is near the RDA of 2,500+ units for pregnant women and under the ~ 4,300 units a day RDA for breast feeding women. The vitamin A in pregnancy has been shown to also decrease iron deficiency anemia by helping mobilize iron.
On the other hand, over 8,000 units of vitamin A (NOT counting beta carotene which is not a problem) can cause birth defects, and this is why I caution to not over do it. Overall, the vitamin powder is MUCH more nutritionally optimized than the prenatals. Do add the calcium, iron (if needed) and fish oil though.
L&B,
Dr. T
QUESTION
HELP! I am finding how behind and rigid Mayo Clinic is here in Scottsdale. I'm there because of 5 sclerotic lesions that have been found in my right shoulder, 2 in my right knee and in both hands. They say it's of no significance. But each area has started with severe pain, and each one still hurts and big surprise they hurt where they found the lesions. Some have been called Fibroma, my hands bony islands, and my knee fibroma and something else. My hands have started to swell and hurt so bad, just bumping them into my side is excruciating. I've always tested negative for Rheumatoid factor.
I along with my GP have been following your protocol as much as my insurance will allow. With Levothyroxine we had my free T3 and T4 right where you recommend, as well the total numbers of both. (Armour and Cytomel caused my T3 to skyrocket.) The problem is my TSH is either < -0.02 or now 0.10. Which with Mayo treating only with TSH they want to cut back my Levo. I've seen an answer before when you said if your TSH is that low that other things should be checked. Can you please give me some ideas to give them. As with everything else you have done, I along with many, will be forever in your debt. I also found out I was low in Testosterone and we've now got it under control and where you recommend (don't know if this has any effect or not.)
My wife and I helped a young girl struggling to finish high school, spending day after day in bed, Doctor after Doctor. After I heard her symptoms, we had little doubt. With your Daily infusion, B complex and pearls, she is now in her second year of college. All the thanks we got was meant for you. For so many you offer what nobody else does and that's hope.
I can never thank you enough.
ANSWER
The first question of course is how they made the diagnosis of "fibrotic lesions." If not a biopsy, it raises the question of whether they are simply trigger points that respond to the overall treatments in the Pain Free 1-2-3! book and the pain gels discussed in the chapter on prescription therapies(and your doctor can begin with these—he can simply call ITC pharmacy and prescribe the "Pain Lotion" (303-663-4224). In patients with CFS and Fibromyalgia the TSH is clearly not a reliable test and should not even be checked when monitoring thyroid Rx (and I suspect this is so in general).In my patients, I recommend adjusting thyroid to the dose that feels best while keeping the free T4 in the normal range. Mayo will disagree and you are free to ignore them. I would read the section in the From Fatigued to Fantastic! book for more info and supporting references for your physician.
L&B,
Dr. T
QUESTION
My daughter has CFS. She was diagnosed July 2005. She was 15. She has recovered somewhat and is able to do most things. She has a very supportive Dr. She has even been able to do light exercise this past two months without having a flare-up. Now it seems like she cannot get a hold of her weight. She eats very healthy but gains weight if she eats like a normal teen. She watches everything that she puts in her mouth. And once the weight is on it never comes off. She also feels bloated, has diarrhea when she overeats even a little and can only eat small amounts. She also craves carbs (but who doesn't). Her med's are as follows: 1000mg valtrex, L-carnitine, multi vitamin and a fiber pill. Her weight issue weighs on her mind and that STRESS we don't need. Again, it's not how much she weighs but rather the speed in which the weight goes on and does not come off.
ANSWER
See my article on treating the weight gain of CFS from my book, Pain Free 1-2-3!. What jumps out is she needs her thyroid hormone optimized (that the test is normal means nothing) and candida treated (also discussed in my books).
Sounds like your doctor has been a gem, but it is worth seeing a CFS expert. I recommend the Fibromyalgia and Fatigue Centers (see www.fibroandfatigue.com ). They see patients worldwide.
L&B,
Dr. T
QUESTION
I have been doing colonics. I went through 14 treatments and I plan on doing one every two weeks now. What do you think? I had IBS for 20 years and I feel younger and so good. I just do not know if it will last. In the past I took 30 supplements a day and still have yeast and fungus (as I found out through the colonic). Now my tummy is flatter. How do I stay this way without always doing colonics? (Lost 10 lbs too. I am 59 and 119 lbs.) Do you think colonics is good for me?
ANSWER
I think the colonics can be helpful, but would recommend you be under the guidance of a naturopathic physician (NP—see the AANP site www.naturopathic.org ) who can guide you on doing them safely and treating the underlying yeast issues as well.
L&B,
Dr. T
QUESTION
I have had CFS for nearly 2 years and currently use some of your recommended protocol from your online program combined with approaches recommended by my doctor. He has recommended Benfotiamine to increase TPP. Is this an effective therapy? Should it ne taken orally with meals, or in some other manner? What daily dose is recommended? Any guidance you can offer, or other therapy to increase TPP will be greatly appreciated.
ANSWER
I am not familiar with benfotiamine so I cannot comment on it. We stopped giving TPP injections as other treatments were much more effective. I'd recommend the Energy Revitalization System vitamin powder and B-Complex (which you are likely on) plus Ribose 5000 mg 3x day for 3 weeks then 2x day (called CORvalen) as a better way to increase TPP and energy production (TPP is basically thiamine plus energy). Both are in stores and at www.vitality101.com.
L&B,
Dr. T
QUESTION
I was diagnosed several years ago with graves and was given Rai. I was doing okay until around January. My levels have been in the hyper stage for about 9 months. My doctor told me to stop taking my synthroid for a couple days. Then my levels went to 17 hypo. I ended up in the hospital with severe anxiety and depression. Can it be my adrenals? Even though they did a 24 hour urine and blood test, they came back normal. In the AM I always feel so terrible but always feel better in the afternoon and evening. Sometimes when I wake up I feel like there is something missing in my brain. Is hard to explain. Any suggestions?? Thanks
ANSWER
It could be the adrenals or thyroid despite the tests being normal. I would recommend you read the sections on these in my book From Fatigued to Fantastic! as the symptoms can guide you. I also recommend doctors at the Fibromyalgia and Fatigue Centers.
L&B,
Dr. T
QUESTION
My mother has MAI, which is a bacterial infection of her lungs. After being misdiagnosed and not given the proper medication to fight and kill this infection she was treated by other doctors. Now the problem is her severe under weight problem. She use to be 100-110 pounds. Now she is barely 80 pounds with an appetite that varies. How can I supplement her diet with nutrients and vitamins to help her out so she can get better, get her appetite back and gain some of her weight back? Vitamin pills bother her stomach. Your help would be greatly appreciated.
ANSWER
I would use high fat (not high sugar) foods, eggs, pastas, chocolate, bread,etc to help her gain weight. A medication called periactin can also act as an appetite stimulant. Her doctor should also look for other causes of weight loss. MAI can be hard to eradicate, and I would want a second opinion from a university based infectious disease doctor given the continued weight loss. Seeing a nutritionist is also helpful. I would recommend 1/4-1/2 scoop of the Energy Revitalization System vitamin powder (available at www.vitality101.com) as tolerated 1-2x day. Powders can be easily adjusted and are better tolerated than pills. You can mix it in yogurt or make a smoothie with it as well.
L&B,
Dr. T
QUESTION
Is Proboost Thymic A contraindicated in chronic lymphocytic leukemia?
ANSWER
As it tends to balance immune function, it is likely OK. But because it has not been studied in this setting and this is a cancer of the immune system, I would err on the side of safety and not use it (or other immune augmenters) in CLL.
L&B,
Dr. T
QUESTION
I had a pituitary tumor removed ten years ago and have never been the same. Have had some sort of fibro/exercise intolerance thing ever since but no pain and very random. One day fine, the next day horrible. Can last for days or months. Not fatigued, just very weak. Have you ever seen something, a syndrome that looks like CFS or fibro in patients that have had this surgery?
ANSWER
Pituitary adenomas, with or without treatment/surgery, are common triggers for CFS/Fibro as they cause hormonal deficiencies with normal blood tests. These then can trigger the rest of the process. This responds very well to treatment. See www.fibroandfatigue.com for a doctor who can help you.
L&B,
Dr. T
QUESTION
I heard you on Conscious Talk on Monday and wondered what the green tea supplement is that you were talking about. I couldn't quite get the name of it.
ANSWER
I was speaking of L-Theanine (it must be the Sun Theanine form found in many companies' products) which is derived from green tea. The dose is 100-200 mg at bedtime for sleep or 100-200 mg 1-4x day for anxiety. It is also present in the Calming Balance formula on our web site store (www.vitality101.com).
L&B,
Dr. T
QUESTION
I am a pharmacy student on rotation in an anticoagulation clinic. One of our patients is taking your product (pain formula and revitalization formula). Is there any research on how your products affect other medications, specifically warfarin (coumadin)?
ANSWER
All products can potentially interact with Coumadin. We use these in our patients on Coumadin, but check INRs after several days (as we do when we make any change) for safety. We have not seen a problem. The main interactions to be aware of would be that the magnesium in the vitamin powder may modestly decrease neurontin or cipro absorption, but we simply modify the dose. Calcium or iron can block thyroid absorption, and have therefore been left out of the formulas. Although the sleep herbs may potentiate the effects of sleep med's, this is not at a level that has been clinically problematic (and is actually a clinically useful synergy). The pain formula ingredients do not have significant interactions, but I'd check INRs on Coumadin as above, especially because of the willow bark.
L&B,
Dr. T
QUESTION
Can you explain to me what positive IgG means in a blood test? I was tested for food allergies and came up IgG positive to every food except meat, citrus, rice and potatoes. I tried an elimination diet and found it impossible to stick to. I read on your site that you said to ignore IgG readings in blood tests? Does this mean these are not significant? I am suffering from numerous unexplained symptoms and am starting to wonder if I have a mild case of chronic fatigue. I was diagnosed with Gastroparesis earlier this year and my stomach was my main problem but I also suffer from fatigue, unexplained illness and feeling feverish, achy muscles all through my back (no joint pain), inability to exercise without feeling drained for days afterwards, heat intolerance and intolerance to sun exposure (makes me feel very sick), extreme motion sickness and I catch every single cold and virus going around. I had 6 colds in a row last year. Also occasional bladder spasms, reynaud's syndrome in my hands and toes, unexplained weight gain of 10 lbs, and one miscarriage in March of '06. My mother had lupus and passed away in 2003. I don't know if I have some unexplained autoimmune condition or possibly CFS? I had a negative ANA and normal thyroid reading. So far none of my other blood work has shown anything. Thank you so much if you are able to respond. I feel like I am going crazy not knowing what is going on in my body.
ANSWER
A positive IgG means that you had that infection sometime in the past when checking for infection. When checking for food I don't think it means much of anything, and food allergy blood tests are largely unreliable. I recommend instead using an acupressure technique to test for and eliminate food allergies. This technique is called NAET and information and a practitioner near you can be found at www.NAET.com. To give you an idea, this eliminated my lifelong hay fever in 20 minutes.
This certainly sounds like you have a chronic fatigue syndrome related process, especially if you also have difficulty sleeping. The blood tests are simply not reliable for diagnosing hypothyroidism in this condition (and I believe in general). I recommend that you see a physician at the Fibromyalgia and Fatigue Centers. They have clinics throughout the US and see patients from all over the world (www.FibroAndFatigue.com).
L&B,
Dr. T
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