End Fatigue
Answers to Your Questions
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Needs Xyrem and it helps, but upsets stomach.
Al asks:
Dear Dr. Teitelbaum,
I am having significant stomach side effects with Xyrem and was wondering if you have any suggestions for alleviating these side effects?
I have had to resort to Xyrem due to failures with numerous other sleep therapies. I started with 2.25 grams twice a night about 2 months ago. While I felt some of my muscles loosen up, I still felt tired due to me only sleeping about 2-2.5 hours per dose (i.e., 4-5 hours per night). I gradually raised the dose in 0.25 gram increments to 3.0 grams twice a night and began feeling very nauseous/had acid indigestion when I woke up after my first dose and then throughout the day. I had to cut out some very helpful supplements, which were worsening the acid indigestion symptoms (i.e., fish oil, adrenal stress end, borage oil, green tea). I still have some acid indigestion/heartburn (especially first thing in the morning) and my stomach feels like it's taken a beating.
I briefly tried increasing stomach acid (a gastric analysis showed I had low stomach acid 2 years ago and my physician had me take betaine HCL) with acid cider vinegar and then betaine HCL. The apple cider vinegar seemed to help my acid indigestion, but sent me into a horrible fibromyalgia flare. The betaine HCL (a low dose) seemed to help, but I felt some stomach pain and stopped because I thought the combo of betaine HCL and Xyrem were too hard my stomach lining.
I really want to stay on Xyrem as I believe a higher dose will substantially improve my fibromyalgia, but am not sure if I can literally stomach it. Any suggestions you could provide would be most helpful.
Thanks and Happy New Year!
Al
ANSWER
Dear Al,
Nausea is common, but stomach pain is an unusual side effect from Xyrem.
Xyrem is unusual in that when it causes side effects, the best approach is usually to increase the dose (so you sleep through the nausea) instead of lowering it. You are on a low dose as is, and if raised to 4-5 grams a dose, you may find you sleep the 4-6 hours and sleep through the nausea so it becomes a non issue (unlike motrin family medication, it is not actually doing any harm). My concern is that you also have stomach pain for a while after waking. With the higher dose, this may also wear off with the nausea by the time you wake, but a reasonable option is to try the higher dose for the first dose each evening and take the lower dose for the second dose if you wake during the night. This way you can sleep through the night and hopefully also avoid morning stomach pain.
If the problem persists despite the higher dose, I think the other stomach treatments you tried were reasonable, and would also use the indigestion regimen described at Eliminating Chronic Acid Reflux & Indigestion for 4-6 weeks to see if this helps as well.
Frankly, I do not start people at less than a 4.5 gram dose of Xyrem as they get too many side effects. Better to start with the higher dose and sleep through the side effects. Just do not take other sedating sleep meds (besides ¼ tab Ambien and perhaps a low dose of any Klonopin or other addictive drug you may be on to avoid withdrawal ) with your first dose of Xyrem. Your physician may then add some sleep meds back to to the Xyrem (though the company says not to) if needed.
L&B
Dr. T
Why can't I get deep restorative sleep?
You stress the importance of improved sleep. I've had several sleep studies and I don't get stage 3 & 4 and I have 14-18 arousals per hour with no restless leg issues. I haven't been able to get an explanation for why I have so many arousals. I suspect they are what is preventing me from getting into deeper sleep.
Is there any way to determine the reason for absent stage 3 & 4? Dr. Pierre Flor-Henry recently gave a talk where he shows how he can use EEG to identify people with fatigue vs. depression (click here to see the podcast). Is there any research into the use of EEG to explain what is occurring in the brain immediately prior to an arousal being recorded that might shed light on the cause (i.e., is it a pain signal)?
As an aside, I never used to get REM sleep either. Since I started the Wheldon/Stratton protocol for treating C pneumonia, especially with the use of Metronidazole, my brain fog is lifting and I now get REM sleep. On one hand it's nice to see my brain waking up but all the dreaming that is coming with the REM is leaving me more exhausted than normal when I wake up. It would be nice to see an article in the newsletter about C pneumonia and this treatment protocol.
Thanks.
ANSWER
It there are no issues with restless legs or sleep apnea (including "central" apnea and UARS both having been looked for and excluded in the sleep study; see UARS—A Common Cause of CFS & Fibromyalgia) and you eat a high protein bedtime snack to avoid low blood sugar at night and add melatonin at bedtime, then we are left with hypothalamic dysfunction (which is simply part of the CFS). Adding meds that may help stage 4 sleep (e.g., gabitril, lyrica if you have pain, and Ambien) are worth a trial. If without benefit, the most effective med to increase stage 4 sleep that I've seen is Xyrem.
L&B
Dr. T
Much less pain on Ribose and Anti-Yeast herbals, but now with severe sweats.
Linda asks:
I have been battling FM for 6 years. I've been following your protocol from your From Fatigued To Fantastic! book for about 8 months. The addition of Ribose & Cymbalta has done wonders to control my pain. However, it seems that since eliminating obvious sugar from my diet (which I was craving) and starting the Anti-Yeast and Acidophilus Pearls, (I have IBS and chronic sinusitis).
I have been experiencing episodes of hot flashes associated with extreme (dripping) sweating followed by chills. I have counted between 20-30 of these episodes daily. I am only aware of about 3-4 episodes a night, since I take several sleep meds. Another new symptom is that I am so thirsty throughout the day, even awaken thirsty, and am drinking about 1 1/2 gallons of weak Crystal Light iced tea daily. My urinary output does not measure up to my fluid intake. It seems I need to replace the fluids lost in sweating, which is why I am drinking so much. My doctor, who I am trying to educate on FM and request he assist me with following your protocol, is blaming it on menopause. I went through surgical menopause 14 years ago!! This is unlike the hot flashes I experienced then. Is this some sort of "dying off" reaction?
Your book is proving to be a lifesaver.
Thank you, thank you, thank you.
ANSWER
Dear Linda,
There are a number of causes of both day and night sweats in CFS. Though they eventually tie back to the autonomic dysfunction (which the SHINE Protocol generally helps over time), there are several very common causes for the hot flashes:
 | 1. | Certainly the low estrogen in women and low testosterone in men can play a role. Though with surgical menopause 12 years ago this is not likely the current trigger — but may still be an aggravating factor. |
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| 2. | Infections, and infection die off as you kill off the yeast, are very common causes. The die off changes will settle over time. |
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| 3. | Low adrenal is a major cause — especially if worse on the ribose which helps energy, but increasing your function and energy production may unmask low adrenals. Treating the low adrenal (see The Adrenal Gland) can not only help the hot flashes, but also the CFS/FMS overall. If the flashes hit at night, this can also be an issue, and eating a protein snack before bed and taking a low dose of cortisol (2 1/2 mg of cortef/cortisol or 1 pellet of Isocort) can also help this by keeping your blood sugar form dropping during the night. |
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| 4. | Acid reflux — this is especially if you have sweats at night, as when laying flat gravity isn't helping to keep the acid down in your stomach where it belongs. Simply taking an antacid (e.g., OTC Pepcid) for a few nights at bedtime to see if the sweats decrease will tell you if this is playing a role |
I would also stop the Crystal Light ice tea (it may have sugar, caffeine or artificial sweeteners that could drive the sweats) and replace with water (or make lemonade with 1/4 cup lemon juice, 3 and 1/2 cups of water and add Stevia to taste — I like the Body Ecology brand from 1-800-4-STEVIA and would add ~ 50 drops or to taste to the above). If sweats persist, as your body heals, your immune system may now be responding to one of the chronic viral or antibiotic sensitive infections common in CFS. How to treat these is discussed in my book and on my website. For these, though, it may be helpful to do a consultation with a CFS expert (visit the Fibromyalgia and Fatigue Centers website).
Hope this is helpful ;-)
L&B
Dr. T
Treating light and sound sensitivity.
Dear Dr. T,
Your help is much appreciated!
My partner with CFS has extreme light sensitivity. Light causes head pain and other issues. She requires lights off and windows blocked off. Very sound sensitive also. MRI normal. Neurologist wasn't useful. Nutritional, hormonal and GI treatments have helped many issues, but these have not changed yet. Any thoughts on what may be causing this or how to approach it?
Best regards,
Blake
ANSWER
Dear Blake,
Light and sound sensitivity are not uncommon, as it takes energy to sort the pertinent sensory information from the non-pertinent. Adding the medication neurontin (gabapentin) often helps these symptoms. In addition, if taste and smell sensitivity also are present, it is worth looking for carbon monoxide poisoning (from natural gas, gas lights and ovens, etc). Visit the Multiple Chemical Sensitivity website for more info on this.
L&B
Dr. T
How about Pituitary Adenomas? Treatments for PMS?
Michelle asks:
Dear Dr. T
You address adrenal issues in your book From Fatigued to Fantastic! and on this website. What can you tell me about pituitary adenomas? I was recently diagnosed with one and am wondering how this may be affecting by FMS. I plan to go to the Pituitary Center at Johns Hopkins soon for some follow up, but would love your take.
Initial tests do not indicate any issues with my thyroid. My DHEA-S was about 70 when tested recently. (I'm 35 and female.)
I'm on Yaz due to severe PMS and I've not had a menstrual cycle for 6 months. My FMS is out of control. I've started to try some of the supplements that you recommend, but want to move slowly as I'm unsure how this can affect any additional hormone tests.
Thanks.
ANSWER
Dear Michelle,
Pituitary adenomas are small benign growths in the pituitary. They do not become cancer, and the key concerns are if they become large enough to:
| 1. | Push on the optic nerve, causing a loss of peripheral vision. This is uncommon, but the Hopkins doctor will do simple visual field screening tests to monitor for this. |
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| 2. | Cause problems with pituitary function. This is where the problems I discuss with lab testing occur. Put simply, the normal range will say you have no problem unless you drop below the lowest 2% of the population. To use a simple analogy, the average household income in the U.S. is ~ $50,000 a year but you have to drop under $8,000 a year to be in the lowest 2 % (under $16,000 a year is poverty level). So if you dropped your income from $50,000 to $9,000 a year, the way that out-of-date medicine uses the tests would define you as having no problem! So they may say your tests are fine and no problem — even though the adenoma is contributing to major hormone deficiencies — and causing your CFS/FMS. |
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| 3. | It may cause an elevation of the hormone called "prolactin" which can then cause a host of problems including low dopamine, infertility, mood issues, and others. They may want to give a medication called "bromocriptine" for this (OK to use) but simply taking vitamin B6 at 250 mg a day will often lower the prolactin after 6 weeks (eliminating the problems caused by the high prolactin) — without the side effects. We find treating with our SHINE protocol also usually lowers the prolactin level in CFS/FMS. |
We often see pituitary adenomas in those with CFS and FMS and suspect this is because the adenoma compresses the pituitary, causing the hormonal deficiencies (despite normal tests — I'd prefer your DHEA-S be 150 Mcg/dl — Hopkins may be OK with as low as 35). Removing the adenoma will not help the symptoms and is not needed (unless it is endangering vision — if they recommend surgery, do it). Simply optimize hormone function based on symptoms (using the labs to check that they are in the normal range for safety after you find the optimal hormone levels as discussed in my book) and treat with the rest of the SHINE protocol.
The doctors at Hopkins will do a good job of evaluating your adenoma (they are very good at this) but may be clueless about CFS/FMS. So tell them thank you when they say the adenoma is OK and has nothing to do with your fibromyalgia, follow their instructions for monitoring the adenoma, and then go to a CFS/FMS expert to get well. I would recommend Dr. Andre Garabedian at the Philadelphia FFC or Alan Weiss M.D. in Annapolis Maryland as 2 excellent CFS/FMS doctors near Baltimore/Hopkins. It is OK to do our treatment approach as in my book or the online program now while going through the adenoma evaluation, except I would hold off on thyroid or adrenal treatments (including DHEA) until they finish their initial evaluation. Once they say the hormone tests are OK you can have your FMS expert start the hormones. If the Hopkins folks find a hormone abnormality severe enough for them to treat, I would still consider having the fibromyalgia expert treat it so it can be done properly for your FMS.
For the premenstrual syndrome (PMS), add:
| 1. | Fish oil 1-3 teaspoons a day for 3 months then 1 tsp (or 3 capsules) a day. |
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| 2. | Evening primrose oil (use Efamol or Linus Pauling brands) or borage oil (cheaper) 3,000 mg a day for 3 months, then just in the week before periods. |
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| 3. | Vitamin B6 at 250 mg a day. |
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| 4. | Consider a trial of natural progesterone 200 mg at bedtime. |
It takes 3 months to see the full benefit of the above for PMS (though it often starts working more quickly).
One other thought. Though the Yaz is OK and it is reasonable to be on birth control pills without stopping them each month, I do recommend stopping them at least 1 week each 6 months, so ask your doctor about this.
I hope this is helpful.
L&B
Dr. T
Recovering from eye surgery (one eye for distance and one for near vision).
Judith asks:
I have fibromyalgia, and extreme chronic fatigue. In the last month, I have undergone cataract surgery on both of my eyes. My left eye was corrected for farsightedness and my right eye was corrected for nearsightedness. I have a problem becoming adjusted to the correction, and my eyes have become extremely sensitive. I have also found that I have a problem waking up from sleep. I also had two basal cell carcinomas removed from my back, and face. Do you believe that I may be extra sensitive to any procedure that I undergo, because of suffering from fibromyalgia? Is recovery time affected as well? I truly am going thru am extremely difficult recovery. Do you have any opinions or suggestions? I would appreciate all the advice that you can offer me.
ANSWER
Dear Judith,
Although people with CFS and fibromyalgia often recover more slowly from surgery, this is usually when general anesthesia is used. The basal cell removal is too minor of a procedure to have caused a problem. More likely, your having one eye corrected for distance and one for near vision is likely leaving you feeling disoriented.
Although this was a good thing for your eye doctor to do (in the long run), I recommend the following: Have your optometrist make glasses for reading that only have an active lens in the eye used for distance. Also have a make a pair of glasses for seeing at a distance that only corrects your "reading" eye. Use these glasses most of the day, but leave them off one hour a day so your brain can slowly begin to adapt. When it feels comfortable having them off one hour day, lengthen the time you leave the glasses off so that your brain can slowly adapt. When it feels comfortable to do so, stop using the eyeglasses entirely.
Because of the vision changes seen in fibromyalgia, it is a little harder to adapt to the surgery but you will be able to in time. Then you won't be needing glasses at all, and will be happy that the surgery was done the way it was.
Because of your question, I will add "Vision Difficulties in CFS and Fibromyalgia" to my list of articles for my newsletter.
Also, apply the rest of the SHINE protocol treatments by doing the free "short form" online questionnaire at my website.
Let me know how this works for you.
Love and blessings,
Dr. T
What about dental cavitations causing CFS?
Dear Dr. Teitelbaum,
I would like to ask your opinion on cavitations. I was just diagnosed with cavitations by my dentist and have read that you should beware of anyone who believes in cavitations. Do you feel they are real and could they be the cause of my CFS?
Thank you.
Kevin
ANSWER
Dear Kevin,
I think you should beware anyone who says that you should beware of anyone who believes in cavitations ;-)
The question is what the cavitations mean and whether they have associated infections. I usually will not look for this issue though, unless people have signs of a dental infection (e.g., bad taste or smell in their mouth or inflammation of their gums) or have persistent CFS symptoms despite the other issues in my book being treated. It is discussed on page 145 of my book From Fatigued to Fantastic!
This is an issue best addressed by a holistic dentist.
L&B,
Dr. T
Sensitivity to electric fields & computers.
Clint asks:
Dr.T,
I had a relapse with CFS and have been out of work for a year. I notice that this time around a few months into the illness, that I am now sensitive to sitting in front of a computer screen. Symptoms: Get hot, nauseated and if I stay on long enough, racing heart. I notice that I'm really sensitive to it in the morning versus the evening. Any ideas?
Thanks.
Clint
ANSWER
Dear Clint,
There are those who get electromagnetic sensitivity with CFS. I begin by adding the medication Neurontin, as this is often helpful. There are devices available that some find helpful for this problem, which are made by the Clarus company (see the Clarus Transphase Scientific website). In some cases, turning off the electric circuit to your bedroom before you go to bed (use a wind up alarm clock or a battery one kept away from your head) and leaving the electricity off at night can help (you would be amazed at some of the electromagnetic fields found in the bedroom ) can also help — especially since you are worse in the morning.
In severe cases, there are specialists that can evaluate a home for electrical pollution and assist in remediation.
If the electrical sensitivity is associated with a heightened sensitivity to light, sound , taste and smell and/or Multiple Chemical Sensitivity (MCS), consider carbon monoxide poisoning. This is being researched by Albert Donnay, who feels it is a very treatable cause of CFS when MCS and environmental sensitivities are present. See the Multiple Chemical Sensitivity website for more information on MCS and Donnay's work.
L&B,
Dr. T
Dizziness in CFS.
Dear Dr. T,
My Chiropractor and I have been following your protocol in your book and the test I took for seven months now and though I feel better on given days but still have recurring symptoms like many viruses and now three bacteria infections (I used Genova Labs in Asheville), weakness and take numerousness supplements as long as needed. I have not taken any med's. My Chiropractor is also a kinesiologist and is top notched at prescribing supplements.
When I get up in the morning, I loose my balance — which comes and goes during the day. Sometimes it takes the form of cloudiness behind the eyes and that even moves around. I have had my vision, ears and inner ears checked. The dizziness is not like vertigo. If I get nervous, tired or have brain fog it gets worse.
My next step is to do the post menopausal test at Genova. All my so called lab tests are "normal." I read your article today. My chiropractor also agrees.
Last May when this began, I had just moved into a new painting studio. There were gas leaks. Within two weeks I was ill. Four years ago when I lived in my old studio and became ill with similar symptoms as I am having now but they were not as bad. After a lot of investigations I found out that I was allergic to ammonia (as the paintings dry they give off gases) and formaldehyde. I did most of my own carpentry using plywood, etc., sanding and cutting. I sought out Dr. Cortini, NAET practitioner. She helped do a lot of clearings which was very helpful. By the way she said she knows you and your wife.
I am very sensitive to my environment and what I eat. I need to exercise and try to walk a little, etc. but I suffer the next day. Before this happened I exercised and was in good shape. I am now 77 and feel like I am falling apart. I have abnormal eruptions on my dry skin.
Any advice would be greatly appreciated. Your well worn book and newsletters have been so helpful to me.
Thank you so much.
In love and peace,
Pat C
ANSWER
Dear Pat,
Dizziness in the form of disequilibrium is not uncommon. If no vertigo is present (vertigo in CFS is much less common and is where you feel like you or the room are spinning in a circle), the key likely causes are:
| 1. | Autonomic dysfunction — Increasing salt and water intake and adrenal support are important here (unless one has high blood pressure of heart failure) as would be proper chiropractic adjustment of the atlas area in the neck. |
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| 2. | Intermittent drops in blood sugar from low adrenal. If this is the cause, dissolving 1/2-1 teaspoon of sugar under the tongue during an attack should eliminate the attack in under 2 minutes (and usually quicker). The sugar is not a long term solution (though sucking one tic tac during an attack is helpful) but simply tells you to treat for low adrenal issues. The Adrenal Stress End natural mix is very helpful, and as your chiropractor cannot prescribe cortef, they may choose to use Isocort glandular instead (no more than 6 pellets a day!). Sounds like you likely have an excellent chiropractor though who can guide you here. |
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| 3. | Neck muscle spasm can trigger episodic dizziness, which your chiropractor can help with. |
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| 4. | Have your internist rule out heart problems (abnormal rhythms or valve issues, etc). |
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| 5. | Spend a few days at a friend’s house and see if the problem resolves. If so, look at sick building syndrome issues. |
In those with vertigo in CFS/FMS (much less common than dizziness), I am likely to presume an infection (e.g., Lyme) that is affecting the nerve to the ear and give a trial of long term antibiotics.
I would start with issues 1 and 2 above, which are easier to treat and most common.
L&B,
Dr. T
How to deal with stupid articles that say people with CFS & FMS are crazy. Also, finding good stuff on YouTube.
Hi,
I am a CFS patient and I am writing to bring a matter of concern to Dr. Teitelbaum's attention. I frequently watch or listen to free podcasts/vodcasts from the Apple iTunes store. Yesterday I got on the iTunes podcasts section and searched "Chronic Fatigue Syndrome." The first item that came up was a free video lecture on CFS by a Dr. Carmelia Chirculescu. I downloaded it and started watching. I got less than half way through before I had to turn it off because it was too upsetting. But in the section I watched, the good Dr. stated that CFS patients become weak because they won't exercise, that M.D.s perpetuate the patient's perception of illness by running multiple tests, and that CFS patients are often seeking attention or financial gain by claiming to be ill.
My initial response was that I should let the matter go and not expend any of my precious limited energy on it. After all, I know my truth and Ms. Chirculescu's words can't hurt me. However, I am very bothered by the fact that this information is out there for all the public to access. If any person, medical professional, patient, or otherwise, searches iTunes for CFS info, this is the first thing they will find. It certainly needs to be corrected with accurate information from a professional source, so I wanted to let Dr. T know about it.
Thanks so much for all you do!
Rachel
CFS/Fibro patient at the Portland FFC
ANSWER
Dear Rachel,
Your first reaction of ignoring it is an excellent one.
Part of getting happy in a world where there are so many divergent views (including some that are annoying ) is to learn to ignore the ones you don't like and focus on the ones you do. It's kind of like being at a buffet table with 30 foods you like and 5 you hate (or even the other way around). Just take the ones you like and ignore the others. For ignorant videos like the one you mention, it helps to remember the wise old saying "Don't let the turkeys get you down ;-)" This is easier when you realize you can get treated now, and misguided folks (a.k.a., idiots) like the one who did that video can't stop you!
You always have the option also of giving the video a low rating (1 star). A few folks do that and it will drop down the list from #1 pretty quickly.
I find that simply putting out accurate and helpful info is a better use of our time that trying to correct every bigoted statement we hear ;-) I invite you also to see my 7 part series on CFS and fibromyalgia at YouTube. Click here to watch Part 1.
L&B,
Dr. T
CFS & Fibromyalgia Thoughts for the Holidays
Dear Dr. T,
Thank you for continuing to inspire me. Based on all of your insight and experience, I wanted to request that you indulge those of us who would love you to paint a portrait with words so that we may see a bright day for people with FM.
If this sounds like fun for you, I would be delighted to see what you create. However, if you would not have fun with this, please just delete this email. I will not be at all offended.
Of course I know that you are a doctor and not an artist, so I appreciate any attempt that you might make in this creative pursuit.
Here are the questions I have which may allow you to do this for us (feel free though, to make this portrait your own masterpiece without being confined by any of these questions):
| 1. | What would a cure for FM look like? |
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| 2. | What chemical elements would be included in its composition? |
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| 3. | Would it cure other ailments as well as FM? |
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| 4. | Would it be discovered on accident or deliberately? |
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| 5. | What medical discoveries would assist in the development of this cure for FM? |
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| 6. | What common denominator of all of these FM symptoms might be discovered? |
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| 7. | Who would discover this cure? a single individual or a team of scientists? |
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| 8. | Would you discover it someday or, maybe a colleague of yours would discover a cure? |
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| 9. | Would the person who discovered this cure win a Nobel Prize, or maybe, would this genius be sadly, unrecognized for such a great accomplishment? |
Heather
ANSWER
Dear Heather,
The good news is that most people can already recover enough with the treatments available to live a fairly healthy life, and especially to get pain free. Nonetheless, more work is being done day in and day out to improve our treatments and get closer to the root cause. Whether 1 person takes the final step to put us over the finish line, or it comes out of many efforts (for example, we have the Sonoma group of the 30 leading scientists working together researching it now, with an open ended likely multi-million dollar grant — I am honored to be the chair of the protocols committee), it will be the work of many (including many giants who have come before us), that will be what helps us create the cure. Don't expect any Nobel Prizes, as the politics of the field does not smile on those in it, but as a worker in the field, know that we see that kind of recognition as being irrelevant. What is relevant to us (and there are many hands working together) is that everyone get the opportunity to heal.
And this is already begun...
Over half a million people have used my book "From Fatigued to Fantastic!" and online program to reclaim their lives. Thousands more have seen a Fibromyalgia and Fatigue Center physician who can guide them further.
Beyond the physical, the illness has been a teacher for many, teaching them to reclaim their own truth — instead of only doing what they were told they should do. In reclaiming physical health, they learned to explore their own soul/psyche to find and be themselves. It was in becoming homeless with this illness that I found the way home to my own soul space.
The time to reclaim your life is now ;-)!!!
Love and Blessings and Happy Holidays.
Dr. T How to lose the excess weight caused by CFS & fibromyalgia?
Janice asks:
I have the weight issue so many people with CFS/fibro have. This year I went into complete remission for the CFS, so I finally have the energy to be active. The fibro flares occasionally but I'm finding and eliminating foods that appear to trigger it.
That said, I've gone from being completely sedentary to far more active. I even take a belly dancing class weekly for 1 1/2 hours. I use a bowflex in my home to build muscle strength and walk on a treadmill or in a local park several times a week.
I've had hypoglycemia since I was 14, so sugar hasn't been in my diet for 30+ years. I generally follow a high protein/low carb diet.
Yet, even with my careful diet and the additional exercise I've been getting, I've put on weight this summer rather than lost weight.
Everyone says lose weight to control insulin resistance and prevent or control diabetes. How???? My weight is massively resistant to being lost, and I've even had days where I've gained after a long walk rather than lost. I'm at my wits ends.
Thank you.
Janice
ANSWER
Dear Janice,
See the section on weight issues from my book, From Fatigued to Fantastic!
Your problem is common (the average weight gain in CFS is 32 pounds) — and treatable ;-)
In Addition, consider NAET to look for and eliminate your food allergies.
L&B,
Dr. T
Treating severe pain in Multiple Sclerosis.
Hello,
I have an extremely difficult, debilitating, and harrowing pain problem. The exact diagnosis for this problem is "chronic dysesthetic paresthesia with cold allodynia and hyperalgesia" which at worst, results in intense body shuddering paroxysms. The main reason for this is MS for which I've had Tysabri among other treatments all with no effect on the pain. I've seen several neurologists and pain specialists all to no avail. All they've done is put me through a bunch of pain medications, opioid and otherwise, that have given me more side effects than relief. Currently I'm on Neurontin 800 mg 4x day, Lyrica 100 mg 4x day, and Nortriptyline 25 mg once a day. This cocktail isn't too bad as far as side effects but doesn't help too much either. So the obvious question is: do you have any advice for such an intractable case of nerve pain? Thank you very much.
Tony
ANSWER
Dear Tony,
Your case is complex enough that it would be best addressed by a pain specialist (see below — I know you've seen a bunch) who can have a proper overview of your case. Nonetheless, there is a lot that can be done.
I think your physicians have you on a good mix, so they are doing better than most. The problem, of course, is that you still have marked pain. Realize that the diagnoses you have been given are simply a technical way of describing your symptoms as opposed to a description of the pain's cause. So I would recommend you:
| 1. | Go after symptomatic relief, and |
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| 2. | Go after the cause of the pain. |
For the first recommendation — If the pain has areas that are especially bad that are localized, I would consider the pain gels/creams discussed in my book Pain Free 1-2-3 (and read the chapter on RSD and neuropathic pain in general). I would also give IV (intravenous ) B vitamins , magnesium and lidocaine as discussed in the book for a series of 6 to see if they help (relief tends to be longer lasting after each injection). Though the book will give much more information, these book notes will review some key points.
For the second recommendation — One needs to see if the pain is mostly from the MS or is coming from a secondary fibromyalgia (which tends to be muscle spasm which responds well to IV magnesium as well as the fibromyalgia protocol combined with nerve pain common from MS). If the latter (if you are tired and can't sleep well at night and have widespread pain, a secondary fibromyalgia is likely), you may well find that the "SHINE Protocol" and my book From Fatigued to Fantastic! can offer marked relief after a few months. If sleep is OK and it is predominantly MS, get a sense of whether the pain comes from the muscles as well (do you have tender knots in the muscles — if yes, think muscle) or is purely allodynia (all reproduced by light touch and stroking of the skin) or neuropathic (burning , shooting pain without even being touched) caused by the MS. You may have a mix. For the allodynia, ask your doctor to add the medication Namenda. Though not discussed in the books, it can help refractory allodynia.
Once you have ruled out or treated any secondary fibromyalgia, go after the MS. See Antibiotics May Be Beneficial For Multiple Sclerosis to start. Also add 4,000 units a day of vitamin D — critical in MS but often overlooked.
I suspect that there is much more that can help, but it would take a more thorough review. Consider a consultation with a Fibromyalgia and Fatigue Center physician to look for and treat a secondary fibromyalgia. For pain specialists (though I know you've seen several), I find the ones belonging to the American Academy of Pain Management have a broader training and a broader range of treatment tools — making them more effective.
These will give you a good start. I hope it is helpful, and let me know how you do.
L&B,
Dr. T
Blood pressure is going up with treatment.
Beverly asks:
I started treatment at an FFC in Sept, 2008 with normal B/P and suddenly my B/P became very high 175/82 when I went in for my second round of 2 viral plus IV's and a pain and memory IV on Nov. 4th. What is in all the oral supplements and IV's that might cause or exacerbate high B/P and what should I avoid? Thanks for your great website and all the educational info you provide.
ANSWER
Dear Beverly,
The increasing blood pressure may be indicating that your body is recovering (the illness causes low blood pressure). In CFS/FMS, this is usually a good thing.
The key causes of blood pressure rising with treatment:
| 1. | The salt in the IV — shown to help CFS, but could transiently and mildly raise BP and I would ignore the BP if transiently up. |
| | |
| 2. | Hydrocortisone or rarely Adrenal Stress End or adrenal support herbs like licorice. |
| | |
| 3. | Being at a new doctor. |
| | |
| 4. | Thyroid too high. |
| | |
| 5. | Weight gain and sleep apnea. |
I would simply check your BP at a supermarket/drug store machine a few times. It not over 150/90, I would ignore it for now. If higher and persistent, let your FFC doctor know. They will look at the issues above to modify treatment if needed and as they know your case very well, can better guide you than I can. But I hope the above gives you a good starting point to explore.
L&B,
Dr. T
Should CFS patients get the shingles vaccine?
Hi,
Do you recommend the Shingles vaccine, which is live, in CFS and Fibromyalgia patients?
A
ANSWER
Dear A,
I am not quick to offer shingles vaccine in CFS. I am quick, at first sign of a painful one sided (can't cross the body vertical midline ) rash suggestive of early shingles, to treat with Valtrex 1,000 mg 4-5x day for 5-10 days. If begun early, it usually aborts the attack very quickly (add some B12 shots to decrease the risk of persistent nerve pain).
L&B,
Dr. T
Is kelp causing neck pain?
Thought you might find this interesting. Powell has read your books and knows about Dr. Jorge Flechas' work. I think Powell is brilliant — not right about everything — but pretty smart. I think you may have met him.
Powell has no idea why 1,200 mg of kelp caused my Adam's apple to ache. He thinks I might be allergic to something in kelp. The pain went away when I stopped the kelp.
Another potential issue in my case, always overlooked by other doctors, has been my slightly high ferritin levels. My mother was the same. Dr. Powell is concerned that I may have a genetic problem with hemocromatosis. I will have lab tests run for this.
Paula
ANSWER
Dear Paula,
A few thoughts —
Kelp is a large iodine source, and the thyroid is by the Adams apple (which tends to be less prominent or absent in women as well) and a more likely source of the discomfort in the neck. It raises a question of thyroiditis being present, or even simply the thyroid being stimulated by the iodine. If tender over the thyroid, consider thyroiditis as a possibility. Even if not, do an anti-TPO antibody. If elevated, this most often means Hashimoto's Thyroiditis and though these folks need iodine, it can initially cause side effects.
If the iron percentage saturation is under 40%, it makes hemochromatosis much less likely and I would look at inflammation as a cause of the elevated ferritin (can tell this by an elevated sed rate, or CRP blood test, or a thyroid inflammation test) and then treat the inflammation itself. If the iron percentage saturation is over 45% definitely check for hemochromatosis.
L&B,
Dr. T
Treating Lyme in CFS.
Dear Dr. T,
I can't believe your incredibly fast response, I can't thank you enough!
I don't want to abuse your kindness but if I could tap your wisdom once more, I have another issue that is concerning me deeply. To add to my already chronic CFS/FM and systemic candida, I got bit by a tick on Aug 28th but didn't get the reaction until Sept 1st (bullseye, etc). I saw my doctor and she put me on 100 mg of Doxycycline twice a day for 21 days (finishing this Monday coming). I'm concerned as many of the symptoms of Lyme are similar to what I'm already experiencing and I am not sure if the meds have worked. My immune system is in a weakened state so I think it wouldn't be difficult for this condition to proliferate. While it was about 35 years ago, I was on tetracycline for about 8 years for acne (guess where the candida problem began) and am also concerned that my body may have some sort of resistance to this Doxycycline. Obviously taking these meds is playing more havoc with the candida but I'm taking a lot of high quality acidophilus/probiotics to counteract this. I want to start your candida protocol but believe this needs to be taken care of first. It's a real Catch 22.
My doctor is new to this situation and I was hoping once again to get your advice as to how best to ensure myself against getting Lyme. Should I go on for a longer term of meds; should we change to amoxicillin or the like? I'm very worried.... I also might mention that I live in Toronto, Canada and some tests and such are not always available here.
Thank you so much once again for your kindness and compassion!
Sharon
ANSWER
Dear Sharon,
You're welcome ;-)
When caught early (as in your case) the 21 day doxycycline course does a good job, though I would likely extend it to 6 weeks given the immune dysfunction. It's when the Lyme infection has been there months to years that it is harder to eradicate.
Resistance is not an issue here. It is the infection/bacteria that develops the resistance — not the body. As the Lyme infection was not in your body when you used the antibiotic in the past, this is not an issue.
I would add the probiotics after you are done with the antibiotic, and consider taking the Anti-Yeast and Diflucan with the antibiotic (whenever you can get it — stay on the antibiotic now), continuing the diflucan for 6 weeks after and the Anti-Yeast for 3 months after the antibiotic is completed.
L&B,
Dr. T
What can I take if I am breast feeding? Is Ribose OK? Postpartum depression? Balancing adrenal and thyroid?
Hi Dr. T,
I hope that you can help me or at least answer my question.
I am a 41 year old lactating woman and feel that I have CFS based on all of my symptoms. My symptoms started 6 months postpartum. I believe I "blew a fuse" after chronic sleep deprivation and the stresses of having a colicky newborn round the clock with little help. I have been nursing for almost 3 years.
I have been working with a naturopath for the last 2 1/2 years, and I have been on a low dose of natural thyroid (1 grain per day) since then. My body temperature is still very low at 96.8, but when I try to increase my thyroid meds, my hair starts falling out and I get the full feeling in my throat. I don't seem to be able to handle more than 1 grain per day. I have also been diagnosed with Hashimoto's Disease. A year and 1/2 ago my adrenal saliva test showed my cortisol was below normal first thing in the morning (which was why I felt like I couldn't get out of bed) and was highest at midnight. For a while I seemed to do better but now I am back to feeling like I got hit by a mack truck every morning and don't have the energy to get out of bed. We recently tried treating my adrenals with a glandular (CORTOL ACE) however, it seems too much for me (1 capsule 350 mg) and I can't sleep as a result. Last July I had a short time where I felt slightly better and tried to exercise on the treadmill only to find that I couldn't sleep that night. I get tested every 3 months for my thyroid and sometimes I encounter a "storm" where I my TSH level goes from 1.75 to .5 and I show signs of hyperthyroidism. This has happened twice. But 99% of the time I show signs of the classic hypothyroid person.
My last hormonal panel showed my estrogen all over the map — sometimes high, sometimes very low, and my progesterone always low. I don't know if this is because of my age and this is peri-menopause or it is related to the dysfunction of the hypothalamus, I was on a bioidentical progesterone to help regulate my period and to assist with PMS. I have since stopped because my periods got regulated.
Currently, I have severe brain fog — many times I can't find the right word (or any word!) no memory, no libido, low blood pressure, am gaining weight (despite nursing!) unrefreshing sleep or the inability to sleep at times, inability to handle stress, and cannot exercise without the consequences of not being able to sleep as a result.
I would like to start your protocol and the supplements that are recommended. However, I hesitate because of lactating and I'm not sure if they are safe. I have been taking the End Fatigue Daily Energy B Complex for several months and wanted to try the Ribose, but is it safe while nursing? I looked it up on the web but found conflicting answers as to its safety while lactating.
I know this is a lot of information and you are a busy man. I am just desperate and want get my life back and feel better. Any information you could provide as to safety of supplements, recommendations etc. would be greatly appreciated. I think what you are doing for people is amazing and you are to be commended ten fold. Thank you for your time.
Sincerely,
Laura C
ANSWER
Dear Laura,
Sorry it took so long to respond , but I have been happily swamped. I would note that during pregnancy, I recommend using mostly thyroid, adrenal support and nutritional support and am very cautious with most herbs. I feel a bit more comfortable adding some things during lactation (basically, those things safe for children or shown to be safe in lactation). This means I would add the progesterone, ribose, and some sleep herbs.
I would be OK with adding the Revitalizing Sleep Formula, Ribose (Corvalen 1 scoop 2x day), and The Energy Revitalization System vitamin powder when lactating. The vitamin powder has 85 mg of vitamin B6 in the capsule, so I would NOT add other supplements with B6 as vitamin B6 doses over 200 mg a day may inhibit lactation (though the doses that do this are closer to 600 mg but I prefer to be cautious). See the specific answers to your questions below. I hope they are helpful.
| A. | Postpartum CFS is common, associated with the hormonal changes. |
| | |
| B. | We sometimes see swings between high and low thyroid in thyroiditis, and we lower the thyroid dose or even give thyroid blockers in severe cases — but this problem is rarely severe with Hashimoto's. I would use the cortef (your naturopath can use Isocort by Bezwekian ) but not more than 2-3 pellets or 10-15 mg cortef and only in the morning. In addition, a mix of herbs called "Sleep Tonight" by Enzymatic Therapy is especially helpful for those with switched cortisol levels that are high at night and low in the morning (see More Help for Insomnia). I would also consider resuming the progesterone at bedtime as this can help sleep. |
It sounds like your naturopath is doing a good job. Please pass him or her my regards.
Love & Blessings,
Dr. T
Doing much better having added adrenal support to her thyroid. Does she need estrogen/progesterone? Why did she get worse when the thyroid dose was raised? (Follow up to the question above.)
Dear Dr. T:
Let me first send you a THANK YOU from the bottom of my heart for responding to me. I know that you are an extremely busy man, so that being said, I realize that taking the time to respond to me personally is pretty unbelievable. I am truly appreciative. I thought I'd let you know that things have changed dramatically since this first email that I proposed to you. I have no idea why, but suspect it has to do with the Hashimoto's aspect of what I am dealing with.
Please know that if you are unable to respond to this email, I completely understand. I will try to keep this as concise as possible...
Soon after this email I had another blood draw and found out my TSH was indeed high (again) 5.68 with my antibodies sky high. This accounts for my dead tired feeling again. As I mentioned previously, every time I exercised I found I couldn't sleep, etc. and despite trying everything, could never lose weight. I always thought that I wasn't on enough thyroid meds but every time I increased it, I inevitably exhibited signs of hyperthyroidism.
I recently started on Isocort and the results have been AMAZING. The weight dropped off within 2 weeks time. I am currently on 1 grain of thyroid first thing followed by 2 pellets of Isocort and then 1/2 grain thyroid at noon followed by two more pellets of Isocort. My theory is that my T3 was pooling in my blood and every time I exercised or stressed my adrenals, the T3 "dumped" into my cells causing hyper symptoms. I also had a adrenal saliva test recently. No major deficiencies in the a.m. (borderline normal) but slight depression in the late afternoon and evening. So I guess that you could say I am using the Isocort mostly to help the thyroid meds get to my cells???
Here are my questions: For someone with Hashimoto's who seems to have difficult getting the T3 to their cells, is it safe/advisable to stay on the Isocort indefinitely? Is the there any other way of addressing this issue (poor T3 cell usage)? My fear is if/when I go off the Isocort, my thryoid meds will once again be "inadequate."
And the last question — Is it dangerous to treat only the adrenals and thyroid without addressing all of the hormones together (e.g., progesterone, estradiol, testosterone, etc.)? The reason I pose this question is I seemed to have stabilized a bit with PMS symptoms, hormonal headaches, etc. over the last year or so, however, since starting the Isocort, I have noticed an feeling of hormonal unbalance much more so.
I know I have taken much of your time, so let me say thank you and apologize at the same time.
Sincerely,
A THOUSAND THANK YOU'S...
Laura C
ANSWER
Dear Laura,
It is OK to stay on up to 6 Isocort tablets a day, even if long term. The issue is likely more straight forward than it seems. It is common for low thyroid (or even low alternating with high thyroid) to occur with low adrenal. Increasing the thyroid is good, but causes an increased stress on the adrenals, which are already weak. Because of this, raising your thyroid dose caused the symptoms of low blood sugar/low adrenal which you are interpreting as (I suspect incorrectly) being too much thyroid. This is why I had recommended Isocort in my earlier email and why your naturopath gave it. Adrenal function can be normal on testing, despite being inadequate for your body's needs.
Once the thyroid and adrenals are balanced as your naturopath has done, the estrogen/progesterone only need to be treated if symptoms suggest the need.
Glad you're feeling better ;-)
L&B,
Dr. T
Symmetrel helping CFS and widespread rash—dermatologists don't know cause.
Hi Dr. T.
Thank you for all that you do in relationship to CFIDS.
My journey has been amazing, as I look back in retrospect. I am on Symmetrel now and feel like I received my life back at least compared to the last decade plus. I am even back to work full time. It has only been a month but I am trying and able. Of course I am not cured but I have the ability to function most part of the day without collapsing to my bed. I have a question for you and it has to do with a strange skin eruption on my hands and feet and is now spreading up my legs. It had been benign for a decade or so. Until I started taking the symmetrel. I don't know if it is a coincidence or not. This skin issue was small dots on my palms and soles of feet. They had a black dot center. No one seems to know what this is. I think it is a virus of some sort and when I took ill it appeared and stayed. I had doctors back then say it's nothing. I have doctors thinking (now) it might be scabies (NOT), acne (NOT), blockage of my sweat glands (NOT). I have not been to a dermatologist this time around (have been in the past). and then I thought I would see if you have any ideas.
It could also be fungal in nature because it is itchy. I have tried different creams but no success (Kenalog, lotrimin, etc.). Also, no matter how much I soak my feet and apply cream they are really really dry. If you have any thoughts on this I would appreciate it. My faith in doctors is very limited, since I find it a waste of my time and energy and money to go to see someone, such as a specialist and I leave not having any success. Not one doctor has taken a scraping and looked at it under a microscope? Why? Maybe they would be able to fix it if they had an idea of what they are looking at. Is this a coincidence and could it be related to this virus related to CFIDS? Any thoughts and suggestions would be very much appreciated.
Thank you for your time and energy.
Loretta
ANSWER
Dear Loretta,
There are 2 key effects of the Symmetrel:
| 1. | Antiviral, so the rash could be: |
| | |
| | | A. | A die-off reaction seen when chronic infections are killed off. |
| | |  |
| B. | Your immune system recovering and now fighting something else (such as the yeast/Candida). |
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| 2. | Raising dopamine—unlikely to cause the rash. |
I would consider stopping the Symmetrel and see if the rash starts to go away.
If yes, then:
| A. | It is likely the symmetrel (could retry the symmetrel and see if the rash recurs to confirm). If so, I would add the treatments (especially Valcyte and IM Gamma Globulin ) in my article on eliminating viral infections. These approaches are more likely to kill off the infection permanently, and give the same benefit as the Symmetrel. Interestingly, a recent study by Dr. Liv Bode, German scientists showed that stomach Borna virus infections are very common in CFS, and often improve with the use of Symmetrel (amantadine). |
| | |
| B. | I would add tyrosine 500 mg each morning (a nutrient that can raise dopamine) and consider other dopamine raising medications (wellbutrin, dexedrine). |
If no improvement in the rash occurs while off the symmetrel, then it likely is not the symmetrel and you can resume it. The most common cause of unexplained rashes in CFS/FMS is Candida. A 6 week trial of Diflucan 200 mg a day (may also get a die-off reaction when treating this) will tell you if this is the case (also do the rest of the yeast/Candida treatments discussed in my book From Fatigued to Fantastic! or in my article Candida—Eliminating Yeast/Fungal Overgrowth. The rash itself will be negative for the yeast (it is a skin reaction to yeast elsewhere in the body—called an "ID Reaction") so a skin biopsy/scraping is unlikely to help (but won't hurt) but the Diflucan usually makes the rash improve within 6 weeks if it is caused by yeast/Candida.
I hope this is helpful.
Love & Blessings,
Dr. T
Is Hyperbaric oxygen safe and helpful in CFS?
Betty asks:
In the newsletter about the recent seminar you attended you mentioned work by Dr. Paul Cheney showed that oxygen is toxic in CFS. Does this include hyperbaric oxygen treatment?
Thanks, Betty
ANSWER
Dear Betty,
This is controversial. Paul feels it is, but Professor De Meirleir's work has shown it to be helpful. I think Paul has a very different type of CFS patient group than the rest of us see. I would be open to trying hyperbaric and see how it feels to you.
L&B,
Dr. T
QUESTION
Are CFS and FMS autoimmune illnesses?
Lisa asks:
Dr.T,
First, thank you so much for being one doctor that recognizes this as a true illness with treatment that gives us hope for a normal life again.
My question is: Isn't this condition essentially an autoimmune disease that impairs hypothalamus function? Aren't fibromyalgia and chronic fatigue just two of the conditions that result from disease? Has this overarching disease/condition been named or recognized as a distinct condition?
I have been to over 13+ doctors demanding an answer to the actual cause of the condition as well as treating the symptoms. Why hasn't the medical community at large from rheumatologists to neurologists recognized the complexity of this condition?
I will be visiting your center in Ohio next week. I am looking not only to feeling better, but to bring awareness to others. What do you recommend, how can I get involved?
Thank you,
Lisa
ANSWER
Dear Lisa,
CFS/FMS are immune illnesses where the multiple secondary infections or other stresses can suppress hypothalamic function. Autoimmune illnesses make up 1 of many triggers that can also cause stress which suppresses the hypothalamus, so some call this a "secondary fibromyalgia."
Physicians have not been trained in part because there is no definitive test to diagnose these syndromes (though there are many abnormalities). In addition, it takes hours to treat properly, and insurance companies will not pay for the time. Because of this, it is good that you are seeing someone who specializes in the illness. Dr. Goldfarb at the Cleveland FFC is wonderful, and you will enjoy working with him.
Once you get well with his treatment (give it 3-4 months to start working), you will then have something to teach others!
Love & Blessings,
Dr. T
Feels better on thyroid, but her doctor won’t give enough.
Sharon asks:
I have been on thyroid therapy since I bought your first book "From Fatigued to Fantastic!" My doctor now wants to decrease my dosage because he says my t4 levels are 4 times what they should be. However, on 100 mcg and 112mcg doses, I can hardly put one foot in front of the other. I went back to the 125 mcg dosage and am feeling better. What can I tell my doctor so as not to decrease the dosage?
Thanks for all the great info you provide for all of us. It is great to know we don't just have to "live" with this condition, but can do something about it and hopefully recover. Thank you, in advance.
Sharon
ANSWER
Dear Sharon,
Tell him that a significant body of fibromyalgia/CFS research supports the difficulty with converting T4 to T3 hormone, and ask if he'll switch you to Cytomel (T3—see the instructions in my book for dosing T3). In addition, T3 receptor resistance is often present, with doses as high as 120 mcg of T3 sometimes being needed. If he won't switch, and it is a good way to first begin as well, ask him to add 25-30 mcg of T3 (called Cytomel) to your T4 dose or to even 100 mcg of the T4/synthroid. This way you'll get what you need and your blood test for T4 will go down, making him happy. If he is closed to all of these ideas, find a physician familiar with CFS/FMS who can treat you properly. I would look at the Fibromyalgia & Fatigue Centers to find one.
One thought though. It is unusual for T4 to go "4x normal" on 125 mcg of thyroid. It may be worth double checking to be sure you do not have an OVER active thyroid.
Love & Blessings,
Dr. T
What does a funny smell in my house mean?
Diane asks:
I noticed an unpleasant odor in my house, and then started to smell it everywhere I went. Then I realized that this "dirty dish rag" smell was only perceived by me! I am not stuffed up, but my nasal passages and one ear are sensitive to the air I breathe in.
Could this be a fungal or yeast infection in my sinuses? I do use your Energy Revitalization System.
Thank you.
ANSWER
Dear Diane,
If you only smell it in your house, it is likely to be in your house rather than your nose/sinuses. Look for mold exposure in your home as it could cause CFS. For more on "Sick Building Syndrome" visit the Visual Contrast Sensitivity Test Center. If you are now smelling it outside your house, a few things:
| 1. | If it is associated with light and sound sensitivity, it is likely part of the CFS sensitivity. Neurontin is good for this. If associated with MCS (multiple chemical sensitivity) consider carbon monoxide poisoning (even from years ago). See research by Albert Donnay. |
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| 2. | Take zinc 25 mg 2x day for 3-6 months. Low zinc, common in CFS/FMS, can affect smell. |
| | |
| 3. | Bacterial infections can do this, and the prescription sinusitis nose spray from ITC Pharmacy can help, as can silver nose spray. The treatment of sinusitis in general is discussed in Chronic Sinusitis—Actually a Yeast Infection. |
Love & Blessings,
Dr. T
Is there help for Collagenous Colitis?
Donna asks:
I have been diagnosed as having collagenous colitis. Is this the spastic colon you refer to when talking about yeast? I have FM and probably chronic sinusitis and am just very confused about what tack to take next. I am seeing a doctor at a FFC, so am already taking Corvalen, etc. I have not had a sinus infection in several years, but have very frequent drainage down back of my throat, lots of trying to get the mucus down my throat, and waking up to a half filled throat feeling like I am about to choke. Anyway, what's next, SIBO, or Diflucan? Or tests? Thanks so much for your help to all of us.
ANSWER
Dear Donna,
No. This is a very rare colon inflammation resulting in severe repeated diarrhea.
The yeast is not its cause (if the diagnosis was made by biopsy) nor is SIBO, but either or both can aggravate the colitis. I would clearly take the Diflucan for 6 weeks (at least).
A recent study (rare to find because your process is rare) showed that the herb Boswellia (frankincense) was very helpful for collagenous colitis. You can get Boswellia separately, and find a form standardized to 70-80% Boswellic acids. Another way to get the Boswellia is with the End Pain Formula product at my website. I would double the dose of Boswellia used in the study, taking 2 tabs 3x day for 6-8 weeks till symptoms improve, and then the dose can drop to 3-4 tabs a day as needed. This contains the boswellia in the optimal form, potency and dose as well as willow bark, an herb helpful as well for colitis. I would also add Pepto Bismol and Probiotics, and read my article on ulcerative colitis.
Love & Blessings,
Dr. T
What does low cholesterol mean?
Mary asks:
Hi Dr. Teitelbaum, What does it infer if your cholesterol is abnormally low? My husband's level is 114,and he is 60 lbs. overweight and has high blood pressure. His CRP (c-reactive protein) is 12 times the normal range and fibrinogen is high too.
I remember you talking about a too low cholesterol. Will you expound on it again?
Thanks,
Mary
ANSWER
Dear Mary,
If the cause is not clear once liver and overactive thyroid issues are ruled out, then it may simply be genetic. I have seen low cholesterol (at 64—lower than here) be associated with severe recurrent intestinal bleeding (we were able to stop it).
Beyond this, if he feels fine I would ignore it.
If fatigued, check a pregnenolone level. If under 40, I would add 100-200 mg of pregnenolone at bedtime. Low cholesterol problems may arise because cholesterol is the main building block of many hormones—being the source of pregnenolone. If pregnenolone is OK, no problem. If low, the cholesterol being low can cause hormonal deficiencies for lack of pregnenolone—so we give the pregnenolone 100-200 mg at bedtime as a supplement.
Love & Blessings,
Dr. T
Help for Ankylosing Spondylitis (AS).
Deb asks:
My 55 year old brother has ankylosing spondylitis w/morphine daily for pain. Doctors have different surgical options. He is very hesitant—to the point of needing anxiety meds. He is in constant pain, stiffens up if inactive, and cannot sleep more than a few hours. Has just started omega 3 capsules, cats claw, and probiotics as suggested by friend w/Enzymatic Therapy Co. Can you recommend a doctor or clinic and nutritional advice? Every doctor wants major surgery (cutting or removing vertebrae). With ankylosing spondylitis, any such invasion might worsen his condition. Family history of general Arthritis.
Thank you.
Sincerely,
Deb
ANSWER
Dear Deb,
Ankylosing Spondylitis (AS) can be a very difficult process to treat. There is a genetic component, but it is important to also take into account the effect of environmental factors interacting with the genetics. This interaction is seen for example in people with a specific genetic (also HLA) who respond especially poorly after having Lyme infections. Most doctors ignore how autoimmune processes similar to AS are markedly impacted by the environment. The good news though is that this gives us several avenues of treatment that can be helpful.
If I were your brother I would consider the following treatments:
| 1. | A therapeutic trial with the antibiotics doxycycline and or Biaxin for at least six months. A number of studies have implicated a variety of infections as been implicated in flaring AS in those that are genetically predisposed. |
| | |
| 2. | The chemical load on the immune system. For more information on this I refer you to a book called The Auto Immune Epidemic by Don Jackson Nakazawa. Click here to read an interview I did with her. |
| | |
| 3. | I would use the Pain Formula herbal mix that is available on my website at two tablets three times a day. Give it at least three months because of the severity of his condition. In addition, I would recommend fish oil at a dose of at least one to two teaspoons a day or at least three servings of salmon and/or tuna weekly. Fish oil is an excellent anti-inflammatory. |
| | |
| 4. | Several studies have suggested that using anti-osteoporosis medications can be helpful in AS, especially if given intravenously and should be looked into. I would also recommend using the natural treatments that I discuss on my website (see Osteoporosis and Osteopenia—Loss of Bone Density). |
| | |
| 5. | To find a pain specialist more open to using alternative therapies, visit the American Academy of Pain Management website. |
I hope this is helpful for your brother.
Love & Blessings,
Dr. T
What do you recommend for lupus?
Dear Dr. T,
What should a patient should do when they have systemic lupus and fibromyalgia? I do take prednisone for my lupus flareups on occasions due to inflammation around my lungs and heart. However, the stress of those symptoms can cause problems with fibromyalgia.
Sincerely,
Jerri
ANSWER
Dear Jerri,
Lupus is very often associated with a secondary fibromyalgia and is one of many triggers. The treatment for the fibromyalgia is the same in cases of lupus, except that several studies show that DHEA at a dose of 200 mg daily significantly improves how people with lupus do. The main problem with this high a dose of DHEA is that it can increase testosterone and results in acne or darkening a facial hair in some women (although in the studies it was not a major problem), so I prefer to begin with smaller dosing and work up. In addition, because of the inflammation seen in lupus, I am quicker to recommend the use of ultra-low-dose Cortef (up to 20 mg daily every day instead of only during flares), fish oil, and the Pain Formula herbal mix on my website, as all of these help to settle down the inflammation.
Many of the symptoms however, which are attributed to your lupus, are likely coming from your fibromyalgia and will respond to the rest of the SHINE Protocol.
Love & Blessings,
Dr. T
Should I do steroid shots for my arthritis and bone spurs?
Dear Dr. Teitelbaum,
I was diagnosed with bone spurs on my back and bone on bone in my knees. My bone doctors want to give me steroid shots, but I am afraid of the side effects. But I am in such pain all the time and don't know if I should get them. Is there any other thing I can do to help get rid of some of my pain?
Thank you.
Melva sitting in pain from Texas (~_*)
ANSWER
Dear Melva,
I think it is reasonable to occasionally do the steroid shots to see if they give you some relief from the pain while doing other treatments to help heal the arthritis. It is important to know that many people who have bone on bone or bone spurs have absolutely no pain at all—and this has been shown in research studies and is the experience of many pain specialists. So you can get relief regardless.
I would go ahead and begin the steroid shots, but meanwhile also begin the arthritis remedies discussed in my article ( see the link below). Or you may simply prefer to give the natural remedies time to work first. Give those six weeks to start working, although they likely will start to kick in earlier. I think you'll find when you have done this your arthritis pain will be markedly decreased. There are many other treatments that can be helpful as well, but these are usually enough to get most people very comfortable. For more information, I invite you to read my book Pain-Free 1-2-3 which you can find in most bookstores or on my website. Start, however, my reading my article Arthritis—A 6 Week Program to Help Heal Your Achy Joints and following the guidance in it.
Let me know how things work for you!
Love & Blessings,
Dr. T
She felt worse after taking vitamin D.
Merrijean asks:
My doctor tested my vitamin D blood level and it was in the hypovitaminosis range so she supplied me with a supplement—2,000 IU per drop. She thought it would help with many of my symptoms. So with optimism I took the first drop and soon felt so somnolent. I thought, boy these doctor visits are hard on me... The next drop added symptoms of weakness, loss of appetite, unusual thirst, palpitations and a general malaise. I stopped the vitamin D. Several days later, I developed a stiff neck and then low back spasm—symptoms I have not had for years. It took me over a month before I was feeling "normal" again. Have you ever run into this kind of reaction and do you have any idea what caused it?
Also, you mentioned the use of topical pain-relief cream over the jaw muscle for hot/cold tooth sensitivity. Is there a specific one you recommend?
I appreciate so much your medical ministry and your newsletter. I am blessed by the light... and also by the warmth. Thanks.
ANSWER
Dear Merrijean,
Although it was a good idea for your physician to give you the vitamin D, it sounds like what you had was a die off reaction to an infection that was being killed off by your body when you took the vitamin D. Vitamin D is a powerful immune modulator, and is critical for proper function. I would recommend that your physician check a 1,25 hydroxy vitamin D level( 1,25 OHD) in addition to the 25 hydroxy vitamin D level (25 OHD) which was checked. If the 1,25 level is more than twice the 25 vitamin D level, it suggests that you have an underlying infection (usually antibiotic sensitive), which can also cause CFS/fibromyalgia. Anything that kills off the infection (such as antibiotics and immune stimulants—like vitamin D) can cause a "die off" reaction (also known as a Herxheimer reaction medically), suggested by the symptoms that you had.
I presume that your physician also made sure that your calcium blood level was normal. If not, that would offer an alternative explanation.
I recommend that you read the chapter in my book From Fatigued to Fantastic! on treating infections, and have your physician add the antibiotics in very slowly to make sure that you do not repeat the die off reaction. Sometimes people have to go through the reaction, but keep it mild enough that it is not too uncomfortable.
Dr. Trevor Marshall, who proposed what is called the "Marshall Protocol" recommends avoiding vitamin D in fibromyalgia. Unfortunately, his protocol is very difficult to follow (because sunshine must be strictly avoided) and the large majority of my patients did not benefit from it (only one did), so I no longer use it. Nonetheless, his theories also may help explain your reaction and can be found online.
Love & Blessings,
Dr. T
Fibro is much better with “SHINE” but now has thigh pain and high iron.
Paula asks:
Several years ago I used your labs and internet program and went from coming close to not wanting to live to following all your advice and living a great life in SPITE of fibro! I have even caddied for my husband in some of his Champions Tour qualifiers! Thank you so much Doc!
My question is one that puzzles both me and my doctor. Recently I began getting a "sharp burning" in my right thigh. Started in back and now on side and front of thigh. I have woke my husband screaming. It has ONLY happened when I am lying down... any ideas? We are stumped. (I don't know if this is relevant but my Epstien-Barr is active and over 2,000.) Other than that my only abnormal blood test is that my blood ferritin level is always high... this puzzles doctors too.
Thank you.
ANSWER
Dear Paula,
Without doing an exam (and possibly even with an exam because of the pain's intermittent nature), I can only speculate.
The nature of the pain suggests that it is a pinched nerve causing the pain. Being intermittent, it is most likely a muscle or ligament pitching on the nerve, but again I recommend your physician do a physical examination (and also a pelvic CAT scan) to rule out other causes.
If the examination and CAT scan x-rays are negative, I would then look for spasm in the muscles of the right lower back. When you get to pain, I would also feel around to see if there are any areas where pushing on them affects the pain. If so, those areas may be causing the pain. I would also recommend that you sit in a cross legged position (like when you see people meditate or do yoga on TV) for 10-15 minutes to see if this brings on the pain. If so, look up a condition called Meralgia Paresthetica. This condition, however, usually affects the side of the thigh and not the front or back (it also causes decreased hair growth on the side of the thigh). It can be treated with an injection to the pinched nerve.
Although a number of medications can be helpful, it sounds like the problem is intermittent enough to not make medications worthwhile. I would begin with massage, chiropractic or other therapies to release the muscles and ligaments in the low back and pelvis as well as in the thigh.
Sorry that I cannot be more specific without being able to do an exam, but hopefully this will give you a start.
Regarding the elevated ferritin (iron) level, if your iron percent saturation is also elevated you should see a liver specialist to rule out a genetic disease called hemochromatosis. This is easy to treat if caught early and can disable you if ignored too long. If the iron percent saturation is under 40%, I would check three blood tests looking for inflammation:
| 1. | ESR |
| | |
| 2. | CRP |
| | |
| 3. | ANA (anti nuclear antibody; OK if 1;160 or lower) |
Ferritin blood tests go up with inflammation as well as with a high iron, but the iron percentage saturation does not. If one of the above tests is positive for inflammation, it could also add clues to your thigh pain. If you are no longer of childbearing age, take a vitamin A 25,000 units a day for three months as vitamin A deficiency can also cause a high ferritin and normal percent saturation. Do not take the vitamin A if you may get pregnant, as more than 8 thousand units of vitamin A a day can cause birth defects.
Love & Blessings,
Dr. T
A chiropractic treatment flared her CFS.
Joanne asks:
Hello Dr. T,
How are you? I am a former patient of yours. I saw you in 2006. You saved me! Although I have yet to FULLY recover, I will say that I recovered about 75%. Which I'll gladly take! I'm just a little scared. I developed some back problems, which I wouldn't associate with my CFS, but more from having a 2 year-old son. I began massage therapy, and my therapist recommended I see a chiropractor because of the abnormal spacing of my shoulders. I had one spinal manipulation about three days ago, and now I feel I am having a CFS flair (brain fog, nausea, disorientation)! What are your thoughts on this?
ANSWER
Dear Joanne,
It will pass.
Sometimes spinal manipulation (especially in the neck) can flare autonomic dysfunction because of spinal cord stimulation if the space in the spinal cord is tight. I suspect the muscle tightness you were being treated for reflected that the CFS was beginning to act up again as well just a little—even before the manipulation.
This is not a big deal and simply requires a tune up. Begin with taking (or continuing) the Energy Revitalization System vitamin powder and Ribose (Corvalen) and add natural remedies or medications (Ambien, Desyrel, Klonopin) as needed to get your eight hours sleep a night. Ask your doctor to increase your thyroid dose to see if it helps and if spastic colon or nasal congestion symptoms are present, re-treat for candida. Add in vitamin B6 at 200 mg a day for 6-12 weeks as it can help recovery from the chiropractic manipulation.
Usually chiropractic can be very helpful—especially when combined with SHINE to treat the metabolic issues (discussed in my book). In your case though, I would hold off and treat with SHINE instead. Also, ask your therapist or chiropractor to check to see if your hip heights are even. If not, a $15 heel lift can do wonders (if it is the right size heel lift, you'll feel better and more balanced immediately when you use it. If not, it is not the right size).
Love & Blessings,
Dr. T
Is it OK to not be “superwoman?”
Cindy asks:
You spent 4 and 1/2 hours with us tonight on the teleconference and I am simply blown away. Doctors do not do this sort of thing. I have no questions, only gratitude. One comment you made during the teleconference was especially helpful. Fibro is the gift our bodies gave us so we can finally put ourselves first. In the seventies we were told we could "Bring home the bacon, fry it up in a pan, and never let you forget you're a man." So we did.
We built our careers, demanded equal pay. And when we divorced we raised the kids alone and made the house payments alone. We treated our body like our servant. We blew a fuse. Now you tell me my body won't heal to the point that I can go back to cleaning the house at night while every one else is asleep.
Thank you. You are in my prayers.
ANSWER
Dear Cindy,
You're very welcome ;-)
I am glad you feel you have permission to listen to your body when it tells you that you are overdoing—instead of to media hype and images that are nuts!
Wishing you a life you love.
Love & Blessings,
Dr. T
Hi Dr. T.
I started DHEA 20 mg for 10 days, 10 mg/day for 1 week and now I am taking 5 mg/day. I feel cured of the CFS symptoms. I have a ton of energy but my breasts are tender. I have no history of breast or ovarian cancer in my family. I also have increased abdominal fat since I started it, but I don't want to harm myself. I am getting a level checked on Tuesday. My last level was 50 before starting it. I know to keep my DHEA-S level 150-180 mcg/dl. Is the breast tenderness bilaterally anything to worry about? How long would you advise to stay on DHEA. I read Christian Northrup's book and she said to wean off when levels reach normal but I wanted to see what you thought.
Thanks!
Mary
ANSWER
Dear Mary,
If it is helping your CFS that much, and the 5 mg works as well, I would stay on it if the blood levels are OK. For breast tenderness, have a breast exam and mammogram as a precaution (likely fine—it is very rare for bilateral breast tenderness without overt masses to be a cancer—but best on the safe side). I would add iodine for the breast tenderness (Iodoral 1 tab a day for 1 bottle, then 1 a week—available on my web site). I would continue the low dose DHEA long term to keep levels ~ 150 mcg/dl (I take it every day myself—likely will the rest of my life—I think it promotes health.)
If the breast tenderness continues as a problem despite 6 weeks on iodoral and being checked by your physician, goes away when you stop the low dose DHEA and recurs when you restart it, you may be getting increased estrogen conversion. This is usually fine, but if it causes persistent breast tenderness (which persists despite also stopping caffeine for 6 weeks) and is otherwise very helpful, the problem may be helped by adding the medication Arimidex 1 mg 1/3 tab 3x week to block its conversion to estrogen.
L&B,
Dr. T
Dear Dr. T,
Is there help for Polymyalgia Rheumatica and Temporal arteritis?
Bernadette
ANSWER
Dear Bernadette,
This inflammatory illness of the muscles and blood vessels (Giant Cell Arteritis or Polymyalgia Rheumatica—PMR) will very often trigger a secondary fibromyalgia/Chronic Fatigue Syndrome (CFS)—which then may cause most of the symptoms. The doctor may then attribute the fibromyalgia symptoms to the PMR and raises your dose of Prednisone, which can then cause toxicity. If you are having trouble sleeping at night, you likely have a secondary fibromyalgia—which most physicians are not familiar with and will miss.
We find that treating with the SHINE protocol (which we discuss in From Fatigued to Fantastic!) will often eliminate many of the symptoms of PMR. People can be kept on cortef 20 mg (equivalent to ~ 4 mg of prednisone but safer and more effective) forever without the toxicity seen with prednisone (it is in fact quite safe at this low dose as discussed in From Fatigued to Fantastic!) along with the other treatments we discuss, so there is not this constant pressure to need to wean down the prednisone (so you can avoid the flares). When feeling better, people find it easier to lower the cortef dose—simply because it is not needed. For an excellent but technical report of the safety and use of Cortef in CFS (which overlaps fibromyalgia ) which your physician may find helpful, click here.
In addition to standard SHINE protocol approaches to treat the secondary fibromyalgia/CFS caused by the PMR, some find the PMR is caused by a wheat allergy, and in severe or refractory cases I will do a wheat/gluten elimination trial (but this is a difficult diet, and usually not needed). I will optimize DHEA hormone levels (getting the DHEA-S blood test to 150-200 mcg/dl in women and 450 in men) as this tends to lower the toxicity of the prednisone and allow a lower dose, and add natural anti-inflammatory nutrients such as fish oil, and Boswellia and willow bark combos (both are in the herbal "Pain Formula" on my website; use 2 tabs 3x day for 6 weeks or pain is controlled as comes first, then take as needed—it can be taken with the prednisone).
L&B,
Dr. T
M asks:
Dear Dr. T,
This is sort of embarrassing to bring up, but bring it up I must. I've had CFS for two years, and throughout the illness I've had dark green, extremely malodorous stools that I'm quite certain are not caused by the supplements and medications I'm taking. I also have gas and bloating. My doc had me on nystatin, but it did nothing for me. I've now just started taking Diflucan. My doctor thinks yeast overgrowth is the cause of my problem, but I'm wondering if it might be something else. I've not been tested for parasites or SIBO. What do you think?
Thank you,
M
ANSWER
Dear M,
Though the yeast can cause all kinds of bowel problems, green smelly stools are usually bacterial or parasites. Green stools are usually bacterial (though rarely they can reflect yeast) and though yeast cause a lot of gas, it is usually not smelly like the gas caused by bacteria or parasites. If your doctor does by mail stool tests for bacterial cultures and parasite testing at a specialty lab like Genova Labs or DiagnosTechs (standard labs are useless for this), I would obtain the stool samples first to see if a specific bacteria or parasite can be isolated. If not convenient to do this testing (or it comes back negative) I would still treat without the tests. I would begin treatment as soon as the stool samples are obtained (with Cipro 500 mg 2x day for 7-10 days or if allergic or under 18 years old I would substitute Septra DS [a sulfa] 1 twice a day for 7-10 days) and not wait for the stool test results as these take 3-4 weeks (the results are used to guide future treatments if needed). I would probably stop the Diflucan till after the antibiotic is completed, and then take the Diflucan for 6 weeks after the antibiotic is done—so you may want to discuss this with your physician.
L&B,
Dr. T
Dear Jacob,
It was great seeing you on British television last week. You said lots of thing that badly needed saying—thank you so much.
I have a quick question for you though. I understand that the upper reference value for TSH in the UK has recently been increased to 10. If a reference range is to include 95% of the population (2 standard deviations), how can such alterations to reference ranges be justified? Either they are arbitrary or they are two standard deviations, but they can't be both. What is going on here? Also, given that different labs have different reference ranges anyway, how can you just say that the upper reference value will be 10 for all the UK? Is this just endocrinologists being illogical and unscientific again?
Best wishes,
Peter Warmingham,
Thyroid UK
ANSWER
Dear Peter,
If the TSH test normal range is being raised to 10 for the upper limit of normal, the best justifiable defense would be insanity.
Though labs set the reference range, and usually do so based on 2 standard deviations, specialty groups can write normal ranges that override this (e.g., cholesterol levels which may define most people as being abnormal—helps sell a lot of unneeded cholesterol medication).
I have attached an old press release showing that the AACE lowered the upper limit of TSH to 3 in 2002. If you look at my newsletter archives at my website you'll see many recent studies suggesting that if anything this is high.
Love and blessings,
Dr. T
Dear Dr. T,
I am currently pleased to have a Family Practitioner who is willing to work with me using MOST of your protocols, after having been diagnosed with a mitochondrial dysfunction. My doctor was impressed with Dr. T's SHINE protocol and we have begun following it. My doctor is willing to prescribe most everything EXCEPT Diflucan—he says he will not as it is too rough on my liver. He has prescribed Nystatin for one week—QID—or until the bottle runs out. Question: What then will help treat the Infection part if he won't give me Nystatin? My doctor is very willing to work with me. What can be suggested that he use instead?
I greatly appreciate your help as I try to get my "fantastic" back! Thank you very much!
Debra
ANSWER
Dear Debra,
In our experience with thousands of patients the Diflucan is much easier on the liver than Tylenol, but as your doctor has worked with you otherwise, I wouldn't push it. Though not absorbed into the system like Diflucan, using the herbal mix "Anti-Yeast" 2 twice a day along with the probiotic pearls 2 twice a day (both for 5 months) has been pretty helpful.
If you also have sinusitis/nasal congestion maybe the doctor would call in the "Sinusitis nose spray" from ITC pharmacy (888-349-5453 ) which will kill the yeast in the nose (use 2 sprays in each nostril 2x day for 1 bottle).
L&B,
Dr. T
Dear Dr. Teitelbaum,
I needed to express my appreciation of your free newsletter. It is first rate, and always contains valuable information. It is the most comprehensive information on FMS I have ever seen and the fact that you share this information for free is remarkable. Your heart is truly in the right place. I have had active FMS for 9 years, and am now a patient at FFC. You, however, remain my "guru" on FMS. From the bottom of my heart, I thank you.
Joyce
ANSWER
Dear Joyce,
You're welcome ;-)
It is very much a labor of love (not sacrifice) and gives me a lot of joy.
Love and blessings,
Dr. T
Keith asks:
Hi Dr. T,
A saliva test that was performed about a year ago indicated that my cortisol levels were at the very low end of normal throughout the day (sometimes a little below normal). I took low doses of Isocort, about 15 mg/day for a while, but never noticed any noticeable improvement. I started the SHINE protocol about a month ago, including the Energy Revitalization System, Ribose and the Adrenal Stress End Formula and seem to be feeling a little better already (YES!!). I was considering trying the Isocort again to see if any additional improvement might be gained now that the other supplements seem to be helping.
I'm a little confused about the Adrenal Stress End Formula which contains 33 mg of Adrenal Cortex Extract. The Bezwecken IsoCort I have contains 2.5 mg of freeze-dried Adrenal Cortex in each pellet. In reading From Fatigued to Fantastic!, my understanding was that recommended dosage would be less than 20 mg/day. If I'm taking the stress end formula, I'm already taking 33 mg/day, so should I avoid taking the Isocort? Or am I confused and these are two different things and it's ok to take 15 mg/day of Isocort in addition to the Adrenal Stress End Formula?
Thanks a lot for your help.
Keith
ANSWER
Dear Keith,
I know it seems confusing, and I am happy to clarify.
A few helpful points:
| 1. | Though I have reservations about saliva hormone testing, it may be reliable UNTIL one is on hormone supplementation. When on the hormones, I consider saliva testing to be quite unreliable. |
| | |
| 2. | I think taking up to 20 mg a day of cortisol (hydrocortisone or cortef), a key adrenal hormone, is often helpful in CFS/FMS. More than that runs the risk of toxicity. Do not confuse cortisol with adrenal glandulars though. The Adrenal Stress End, though it has the high level of adrenal glandular, has NO significant levels of cortisol. It simply supplies your body what it needs to heal so it can make its own. Therefore, the amount of glandular in it does not count toward the 20 mg daily maximum of hydrocortisone. |
| | |
| 3. | Although Isocort is a glandular, they have NOT removed the cortisol from the glandular (as most products do). This means it can add the extra benefits and risks of cortisol. The current GUESS is that it has 2.5 mg of cortisol per pellet, but the actual amount is uncertain and can vary from pill to pill. Because of this, for safety and efficacy, I prefer prescription cortisol (cortef) so we know the exact amount, COMBINED with adrenal glandulars that do NOT contain cortisol (e.g., Adrenal Stress End). Unfortunately, most physicians are not familiar with the CFS/FMS research and will not prescribe cortef (cortisol), so the public has been left with little choice but to self medicate with Isocort. As there are now Fibromyalgia and Fatigue Centers throughout the USA (and they see people from all over the world) and they know how to prescribe cortisol safely and effectively, this offers a better option. |
| | |
| 4. | It is ok to add the Adrenal Stress End to the Cortef or Isocort. I would add the adrenal support back in, now that you've addressed other issues—it may now be more helpful. |
| | |
| 5. | I recommend that Isocort be limited to 6 pellets a day. If also on cortef/hydrocortisone, decrease the 6 pellet maximum by 2 pellets for each 5 mg of cortef/cortisone you are taking. If on prednisone over 4 mg, only use Isocort with your doctors approval (other adrenal glandulars are ok). |
Love and blessings,
Dr. T
Dear Dr. Teitelbaum,
I'm sure you have received many of this kind of email since your appearance on ITVs "This Morning" (the equivalent of Good Morning America in England/UK), but I had to email and thank you.
I was off work with fatigue, pain and all the associated symptoms for the whole of 2007. (I also suffer with endometriosis and have done so for 5 years). I gradually started back to work, one day at a time, and now work 3 days a week, and even do floor exercises as well as my usual housework routine!
In order to recover, I built in plenty of rest periods, had 9 hours sleep a night, avoided sugar and yeast, took supplements (the very ones you have recommended) and practiced a conscious relaxation process. Obviously, I got a similar reaction at my GP as other people, and had no help with infection or hormones and was told "There's no point. Just deal with the symptoms." The local ME team, a dietician and occupational therapist, were very helpful even though constrained by NHS guidelines.
And now to my point, finally! I saw you on "This Morning" and cried. It was such a relief to have someone talk about all the things I have had to deal with in such a concise way, without any sense of being "scoffed"' at.
I have now bought your book, but wanted to say Thank You so much. I hope that many people will see your media appearances and will thus understand the condition and its recovery and make it a little easier on us all!
Your's thankfully,
Sandra
ANSWER
Dear Sandra,
You are very welcome!
Teaching people how to get well is very much a happy task for me and a labor of love. As you noted, just knowing what is happening and that they are not crazy helps people begin the healing process.
You can get your life back (likely even much more than you have). You may want to do the free online questionnaire as it will analyze your symptoms (and labs if you have them) to determine what you need to do to get well.
As you get well, use your energy for things that feel good to you (instead of "making up for lost time" doing things you hate). This way you are less likely to blow a fuse again ;-)
Love and blessings,
Dr. T
P.S.—The word is getting out to people. My book was the #7 best selling book on Amazon UK last week!
Hi Jacob,
This article is good but there is one serious problem: the example you use comparing brain fog (forget where I left my keys) and Alzheimer's (forget HOW to use the keys). This example is a problem because people with CFS-ME and MCS forget what things are for.
For instance: I have CFS and, of course, I forget where I have left everything, including my bank book. But I also forget, once I get to the bank, what the bank book is for and what the bank is (one could make poetic/political comments on this... but I'll skip it for now). I know of people with MCS who do not remember what a chair is for.
I use to work in Alzheimer's in a major Montreal, Canada hospital and when I would take patients to the bathroom, they would often now know what each object in the bathroom was for (sink, toilet, bathtub, etc). Well, imagine my surprise when, just last week I went to my bathroom and it took me 5 minutes to figure out what each object was for.
Over the past few years I have been noticing amongst fellow CFSers that the cognitive problems we have, some of them are very similar to Alzheimer's (except they do not seem to progress, or so we think/hope... no one is doing a long term study).
I suppose that the prevention/treatment you suggest could be useful for all cognitive problems, along with all the other CFS treatments (biochemical, immune, antiviral, etc).
Just thought I would share this with you.
All the best,
Clara
Barcelona, Spain
ANSWER
Dear Clara,
It is good to hear from you, and please give my regards to the CFS/FMS support group in Barcelona.
You have raised an interesting point in your email, and I would like to add some background that I think those with CFS/FMS will find helpful.
Although short term memory is the more common issue, there are times when people will have the kind of issue you note. The key though is that it is short term (minutes) and not long term. These episodes often are similar to the periods of episodic disorientation discussed in today's newsletter article on brain fog, and can also occur during episodes of low blood sugar, low blood pressure, and decreased blood flow, though other mechanisms also contribute. Fortunately, this usually improves markedly with treatment with the SHINE Protocol. For those who have this problem persisting for days to weeks instead of minutes (not knowing how to use the keys or recognizing common objects) without coming and going, this would be most unusual for CFS alone and other causes for the memory deficits should be sought.
L&B,
Jacob
Diane asks:
So far in my reading of your book Pain Free 1-2-3 you mention estrogen playing a role in fibro but I don't see anything about progesterone. In my searching and trial usage I am experiencing benefits from using a pure form of progesterone cream (Endau). Along with that I am following your supplement program and D-Ribose along with fish oil and coenzyme Q10. From my other searching they say most women these days are estrogen dominate, which is why I am confused that you suggested taking more estrogen but don't mention progesterone.
Thanks,
Diane
ANSWER
Dear Diane,
This is an area of controversy. We have the one camp promoting Estrogen (e.g., Elizabeth Vliet) and another camp promoting progesterone (the late John Lee).
I take a stand in the middle recommending and recognizing that as the body makes both hormones, it likely needs both hormones. This is why even though I speak more about the estrogen component, I recommend that women also get progesterone—even if they have had a hysterectomy. I do recognize that some woman do better with either estrogen alone or progesterone alone as there is a lot of biological individuality.
Of course, it is important that the Bioidentical hormones only be used, as these do appear to decrease the risk of heart disease and also decrease the risk of breast cancer as opposed to synthetics.
The reason this area was not discussed in more length in the Pain Free 1-2-3 book is because the publishers required that we shorten the book. Because of this, the discussion on both estrogen and progesterone is largely moved to the Book Notes section of my website. Click here to visit this section and read an excellent article by my friend and colleague, Dr. Kent Holtorf.
I hope this is helpful.
Love and blessings,
Dr. T
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