Chronic Fatigue Syndrome (CFS) is described as a severe, debilitating fatigue, lasting at least six months (of new and definite onset), associated with at least 4 of the following symptoms: impaired memory or concentration, sore throat, lymphadenopathy, muscle pains, joint pains, new headaches, unrefreshing sleep, and malaise after exertion. Other medical and psychiatric conditions that can produce fatigue should be ruled out, including Lyme’s disease. After demanding physical exercise, CFS patients show impaired cognitive processing.
Fibromyalgia Syndrome (FM) is a pain disorder associated with multiple tender points, sleep disturbances (insomnia and nonrestorative sleep) and fatigue. Hypothalamic dysfunction, immune dysfunction, and nutritional inadequacies can all cause or perpetuate this sometimes severe syndrome. CFS and FM may be opposite ends of the same disorder, with the emphasis on fatigue in CFS and pain in FM.The key symptoms are disabling fatigue, diffuse achiness that is worse with exercise, disordered sleep, brain fog (decreased memory and/or concentration), and perhaps increased thirst, all for more than six months. If these symptoms are persistent and not caused by other untreated organic problems such as anemia, cancer, diabetes, lupus, polymyalgia rheumatica, or a chronic infection such as sinusitis or Lyme’s disease, then a comprehensive treatment approach will likely help. CFS and FM are not “all or nothing” problems. Like arthritis and many other illnesses, they occur in varying degrees of severity.
No single causative agent has been found. Many viruses have been considered and may play a role in CFS including the Epstein Barr virus (EBV) and Cytomegalovirus (CMV). Human Herpes Virus 6 (HHV6) is under investigation.
Based on a study by the University of Washington of over 1400 individuals, it was found that those who drank well water on a regular basis during childhood were 10 times more likely to develop FM than those who did not. Since many wells contain environmental toxins such as pesticide run off, we feel there could be a definite link, especially since FMS seems to be a central nervous system disease.
In one study, 75% of urine specimens obtained from CFS patients contained elevated levels of 5HIAA, (5 hyroxyindole acetic acid), a breakdown product of serotonin. This finding also showed that 70% of those taking NADH returned to normal levels of 5HIAA, while 70% of placebo patients continued to show elevated or increasing levels of 5HIAA. The urinary measurement of 5HIAA may help predict which CFS patients respond to NADH therapy. However, if a person is taking guaifenesin, levels of 5HIAA may be falsely elevated.
Both CFS and FM can be difficult to diagnose. There are currently no lab tests to confirm this clinical diagnosis. Many doctors encourage a comprehensive approach. There are many treatment choices available in alternative medicine so it is necessary to find what works best for you. Fibromyalgia develops slowly over many years, making the condition very difficult to diagnose in the early stages. It usually is well advanced before it is suspected. Educating yourself about this condition is the best way to catch it early. If any other family members have it, your chances of having it are increased. This is an important clue, for successful early diagnosis and treatment.
All underlying problems should to be treated simultaneously; otherwise a vicious cycle can be kicked into action in which each problem can trigger the others. Some call this the “fatigue cycle.”
Since the treatment of this disorder requires a careful review of several body systems and the use of many nutrients, you may wish to participate in an established program of supplements. The Fibromyalgia Recovery Program offers a comprehensive natural approach to the complex problem of Fibromyalgia. Their home page can be viewed at fibrofree.com
A randomized, double-blind, placebo-controlled study by Teitelbaum et al. validates the work of Drs. Travell and Simons. Titled “Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia – a Randomized Double-blind Placebo-controlled Study” , the study found that treating Fibromyalgia patients for the perpetuating factors below resulted in a dramatic improvement vs. placebo (P<0.0001):
1 – Hormonal deficiencies. Dr. Teitelbaum postulated that hypothalamic dysfunction is a key process in the etiology of Fibromyalgia. Patients with lab tests for thyroid, adrenal and ovarian/testicular function that fell in the normal range were still treated if their clinical picture suggested a hormonal deficiency.
2 – Opportunistic infections. As a number of infections can perpetuate MPS, and since FMS is associated with immune dysfunction and opportunistic infections, possible parasitic and fungal infections were treated.
3 – Sleep disorders. Lack of adequate deep sleep has been shown to be a factor in chronic pain disorders and FMS. Dr. Teitelbaum treated this very aggressively.
4 – Nutritional inadequacies. Nutritional deficiencies were suspected to contribute to chronic, pathologic muscle shortening despite lab testing sometimes being in the normal range. In this study, nutritional needs were aggressively considered and treated.
Signs, symptoms & indicators of Chronic Fatigue / Fibromyalgia Syndrome
Major fatigue for over 12/major fatigue for over 3/minor fatigue for over 3 months
Poor recovery from exertion
Constant fatigue
Dizziness when standing up
People who are lightheaded or drink more water than normal (most CFIDS/FMS patients) may be low in vasopressin. This can cause low blood pressure and secondary fatigue. Vasopressin, which is also known as the antidiuretic hormone (ADH), is secreted by the pituitary gland and keeps the body from losing too much water by increasing the amount that is reabsorbed by the kidneys. The simplest treatment for a low vasopressin level is to use plenty of salt and drink plenty of water.
Fatigue on light exertion
Counter Indicators
(No) history of fatigability
Not having constant fatigue
Chronic fatigue now resolved
History of CFS diagnosis
(Frequent) cervical node swelling
The lymph nodes involved in CFS are small, moveable, not tender and most commonly involve the neck, axillary region or inguinal region. A single lymph node that is very large, tender or immovable suggests a diagnosis other than CFS. Similarly, generalized adenopathy suggests a diagnosis other than CFS.
(History of) swollen axillary nodes
The lymph nodes that are associated with CFS are small, moveable, not tender and most commonly involve the neck, axillary region or inguinal region.
(Often) swollen inguinal nodes
The lymph nodes that are associated with CFS are small, moveable, not tender and most commonly involve the neck, axillary region or inguinal region.
Counter Indicators
(Often) painful inguinal nodes
(History of) painful axillary nodes
(Frequent) painful cervical nodes
Irritated eyes
Vision disturbances
(Very) dry mouth
Metallic taste in mouth
Abnormal tastes in mouth
Low stamina
Afternoon headaches
Temple-based headaches
(Occasional) daytime sweating
Cold spells
Counter Indicators
High stamina
Short-term memory failure
Tender muscles
Tight/rigid muscles
Leg/foot cramps
Counter Indicators
Absence of muscular problems
Brittle fingernails
Numb/tingling/burning extremities
Constant hot flashes or hot flashes between period
Joint pain/swelling/stiffness
(Prolonged) morning stiffness
Tender lumps
Being a light sleeper
Based on doctors’ estimates, sleep disturbances are experienced by approximately 75% of Chronic Fatigue and Fibromyalgia sufferers.
Unsound sleep
(Frequent) difficulty falling asleep
Counter Indicators
Being a deep sleeper
Based on doctors’ estimates, sleep disturbances are experienced by approximately 75% of Chronic Fatigue and Fibromyalgia sufferers.
Foamy urine
Strong-smelling urine
Dark urine color
Counter Indicators
Absence of urine odor
Conditions that suggest Chronic Fatigue / Fibromyalgia Syndrome
Environmental Illness / MCS
MCS is a distinct illness that many times is diagnosed secondarily to CFS and/or fibromyalgia.
Raynaud's Phenomenon
Raynaud’s phenomenon is found in between 30% and 50% of CFS/FMS sufferers.
Hypotension
Researchers at Johns Hopkins University in Baltimore, Maryland, have carried out the first study to show that CFS symptoms can be improved when treatment is aimed at neurally mediated hypotension, a blood pressure regulation disorder also called the fainting reflex. Peter Rowe, MD, is the pediatrician at Johns Hopkins who first made the link between CFS and neurally mediated hypotension. Hypotension is the medical term for low blood pressure. Neurally mediated hypotension occurs when there is abnormal reflex interaction between the heart and the brain. The condition can cause fainting, lightheadedness, headaches, mental confusion, and chronic fatigue.
Findings from the Hopkins study, which were published in the Journal of the American Medical Association, revealed that such symptoms cleared up after the neurally mediated hypotension was diagnosed and treated.
Twenty-two of 23 patients with CFS tested positive for neurally mediated hypotension. After treatment, nine patients reported almost complete recovery from fatigue, while others noted some level of improvement.
Neurally mediated hypotension cannot be detected through routine blood pressure testing, but rather through what’s known as the Tilt Table Test. Each patient in the Hopkins study underwent the test, which is performed by having the patient lie down on a table. The table is then gradually raised to a near vertical position and the patient’s blood pressure is monitored.
In a person without CFS, the blood pressure will not change much while on the table. But those who have CFS eventually experience a drop in blood pressure. The same change that occurs on the tilt table also occurs when the person stands up. Normally when we stand up we experience a surge of adrenalin that makes the heart beat faster, allowing the blood returning to our heart to be pumped more efficiently. But people with neurally mediated hypotension experience more pooling of blood in the legs which keeps blood away from the areas where it’s needed. When blood pressure levels are inadequate and organs do not receive needed oxygen or nutrients, the result can be extreme fatigue and fainting.
If blood pressure is low in CFIDS / FMS, try Florinef, Prozac, Dexedrine, or ephedrine; and increase salt and water intake.
Counter Indicators
IBS (Irritable Bowel Syndrome)
Research has shown that IBS frequently co-exists with CFS and fibromyalgia. Depending on the study quoted, between 34% and 73% of CFS/FMS sufferers have Irritable Bowel Syndrome.
Hyperprolactinemia
Prolactin levels are sometimes elevated in CFIDS patients. Levels will often come down to normal after successful CFIDS treatment.
Weakened Immune System
Immune dysfunction has been documented in CFS. CFS has been called chronic fatigue immune dysfunction syndrome (CFIDS). The immune dysfunction may result in recurrent infections, often with normally nonpathogenic organisms such as Candida albicans or bowel parasites. Treat any bowel infections or imbalances and any sinusitis or nasal congestion.
Counter Indicators
Lyme Disease
Lyme disease should be a differential diagnosis for all fibromyalgia patients who could have been exposed to a tick bite. Despite antibiotic treatment, a sequel of Lyme disease may be a post-Lyme disease syndrome (PLS), which is characterized by persistent arthralgia, fatigue, and neurocognitive impairment. [Journal of Rheumatology 23(8): pp.1392-1397, 1996] Although patients with CFS and PLS share many features, including symptoms of severe fatigue and cognitive impairment, patients with PLS show greater cognitive deficits than patients with CFS compared with healthy controls. This is particularly apparent among patients with PLS without premorbid psychiatric illness.
According to an informal study conducted by the American Lyme Disease Alliance (ALDA), most patients diagnosed with Chronic Fatigue Syndrome (CFS) are actually suffering from Lyme disease. In a study of 31 patients diagnosed with CFS, 28 patients, or 90.3%, were found to be ill as a result of Lyme disease.
Anxiety
Depression or anxiety may occur as a result of the chronic pain and fatigue, or the frustration felt with this condition. It is also possible that the same chemical imbalances in the brain that cause fibromyalgia also cause depression and anxiety. Some 24% of patients suffer from anxiety.
Headaches
Severe headaches are experienced by 44-56% of fibromyalgia sufferers.
Restless Leg Syndrome (RLS) / Periodic Limb Movement Disorder (PLMD)
Secondary causes of RLS are associated with dopamine receptor blockers, end-stage renal disease, fibromyalgia, iron deficiency, discontinuation of opiates, pregnancy, use of spinal anesthesia, and uremia.
Cold Hands and Feet
Raynaud’s phenomenon (severe cold hands and feet) affects about 16% of fibromyalgia sufferers.
Nasal congestion
History of fibromyalgia diagnosis
Vulvodynia / Vestibulitis
Dr. St. Amand, MD, specializing in fibromyalgia and author of What Your Doctor May Not Tell You About Fibromyalgia believes that all women with chronic vulvodynia have a form of fibromyalgia. He discovered that at least 11% of his female patients with fibromyalgia also have vulvodynia (painful genitals). The guaifenesin therapy for chronic fatigue enhances oxalate crystal excretion which has been shown to be beneficial in vulvodynia also.
Risk factors for Chronic Fatigue / Fibromyalgia Syndrome
Hypercoagulation (Thickened Blood)
Studies show that 79-92% of CFS/FMS patients have a hypercoagulation defect.
Muscle pains in family members
Chronic fatigue in family members
Low HGH (Human Growth Hormone)
It has been known for 25 years that FM patients have an abnormal sleep pattern involving stages 3 and 4 of non REM sleep. As GH is secreted predominantly during stages 3 and 4 of non-REM sleep, it was originally hypothesized that FM patients may have impaired GH secretion. IGF-1 levels are abnormally low in some fibromyalgia patients. In an analysis of IGF-1 levels in 500 female FM patients and 152 age matched non-FM subjects the mean IGF-1 level in the FM patients was 137±58 ng/ml versus 216±86 ng/ml in controls. Eighty-five percent of the FM patients had IGF-1 levels below the 50th percentile of the control population and 56% fell below the 20th percentile.
Growth hormone deficiency in adults has been associated with many symptoms that are similar to those described by FM patients: low energy, poor general health, reduced exercise capacity, muscle weakness, cold intolerance, impaired cognition, dysthymia and decreased lean body mass. IGF1 levels are often found to be low in FM patients. The few studies done so far have found symptomatic improvement of CFS and FM patients with GH injections.
It is likely that the problem in FM is a physiologic GH deficiency. Evidence was provided by a study in which FM patients were exercised to voluntary exhaustion on a treadmill; this is a standard test of GH secretion. Unlike healthy controls, FM patients were unable to mount a GH response to exercise, despite reaching an anaerobic threshold (an indication of an adequate exercise workload). However, when fibromyalgia patients were given pyridostigmine 1 hour prior to exercising, they were able to mount a reasonable GH response. As pyridostigmine is known to reduce somatostatin tone in the hypothalamus, this result is compatible with the notion that GH deficiency in fibromyalgia is a potentially reversible problem that has a physiologic basis i.e. increased hypothalamic somatostatin tone. [Eduardo S. Paiva, Atul Deodhar, Kim D. Jones, Robert Bennett; Oregon Health Sciences University, Portland (press release)[]
Immune System Imbalance (TH2 Dominance)
CFS patients are Th2 activated. This means they over-respond to toxins, allergens, normal bacteria and parasites, and under-respond to viruses, yeast, cancer and intracellular bacteria.
Epstein-Barr virus (EBV)
EBV, and other viruses, may ultimately be found to play some role in CFS in many patients. At the same time, many CFS patients have had no exposure to EBV at all.
Antioxidant Need/Oxidative Stress w/ Supplements
The mitochondria are the energy power houses of the cell. Due to their critical role in producing the energy that drives every
physiologic process, mitochondrial function is an area of intense interest and study. It has been suggested that certain chronic illnesses related to muscle pain and chronic fatigue, e.g., myofascial pain syndrome (MPS), fibromyalgia syndrome, and chronic fatigue immunodeficiency syndrome (CFIDS), are disorders in which there is an aberration or dysfunction of mitochondrial energy production.
It has been suggested that mitochondrial dysfunction is related to damage caused by ROS produced as a consequence of increased oxidative stress and insufficient antioxidant defenses. Levels of ROS produced within the mitochondria are reported to increase with age. Consequently, oxidative damage to mitochondria would also appear to increase with age. This damage results in a decrease in energy production by some of the cell’s mitochondria. Mitochondrial function is supported by a broad spectrum of nutritional modulators including antioxidants and antioxidant support systems.
Antioxidant Need/Oxidative Stress w/o Supplements
The mitochondria are the energy power houses of the cell. Due to their critical role in producing the energy that drives every
physiologic process, mitochondrial function is an area of intense interest and study. It has been suggested that certain chronic illnesses related to muscle pain and chronic fatigue, e.g., myofascial pain syndrome (MPS), fibromyalgia syndrome, and chronic fatigue immunodeficiency syndrome (CFIDS), are disorders in which there is an aberration or dysfunction of mitochondrial energy production.
It has been suggested that mitochondrial dysfunction is related to damage caused by ROS produced as a consequence of increased oxidative stress and insufficient antioxidant defenses. Levels of ROS produced within the mitochondria are reported to increase with age. Consequently, oxidative damage to mitochondria would also appear to increase with age. This damage results in a decrease in energy production by some of the cell’s mitochondria. Mitochondrial function is supported by a broad spectrum of nutritional modulators including antioxidants and antioxidant support systems.
Liver Detoxification / Support Requirement
In one evaluation of 200 Chronic Fatigue and Fibromyalgia patients it was found that 80% had a significant impairment of liver detoxification function.
Patients suffering from toxic burdens may experience a wide range of symptoms, among them fatigue and poor tolerance for exercise. These processes have been postulated to be a central factor in the development of CFS. Oxidative damage to mitochondria and the detoxification process itself is being considered as a fundamental mechanism in the development of CFS. [1 Bland JS, HealthComm Inc., 1997; Int Clin Nutr Rev 1988;8(4): pp.173-5]
Low/high/moderate alcohol consumption
History of tinnitus
Absence of short-term memory loss
History of tender muscles
History of leg/foot cramps
History of tender lumps
Sleeping less than necessary
Chronic Fatigue / Fibromyalgia Syndrome suggests the following may be present
Allergy / Intolerance to Foods (Hidden)
The uncovering of hidden food allergies can be important in dealing with CFS and FM and should not be overlooked.
Microscopic Colitis (Collagenous Colitis / Lymphocytic Colitis)
Both fatigue and fibromyalgia have been associated with microscopic colitis.
Hypercoagulation (Thickened Blood)
Studies show that 79-92% of CFS/FMS patients have a hypercoagulation defect.
Low HGH (Human Growth Hormone)
It has been known for 25 years that FM patients have an abnormal sleep pattern involving stages 3 and 4 of non REM sleep. As GH is secreted predominantly during stages 3 and 4 of non-REM sleep, it was originally hypothesized that FM patients may have impaired GH secretion. IGF-1 levels are abnormally low in some fibromyalgia patients. In an analysis of IGF-1 levels in 500 female FM patients and 152 age matched non-FM subjects the mean IGF-1 level in the FM patients was 137±58 ng/ml versus 216±86 ng/ml in controls. Eighty-five percent of the FM patients had IGF-1 levels below the 50th percentile of the control population and 56% fell below the 20th percentile.
Growth hormone deficiency in adults has been associated with many symptoms that are similar to those described by FM patients: low energy, poor general health, reduced exercise capacity, muscle weakness, cold intolerance, impaired cognition, dysthymia and decreased lean body mass. IGF1 levels are often found to be low in FM patients. The few studies done so far have found symptomatic improvement of CFS and FM patients with GH injections.
It is likely that the problem in FM is a physiologic GH deficiency. Evidence was provided by a study in which FM patients were exercised to voluntary exhaustion on a treadmill; this is a standard test of GH secretion. Unlike healthy controls, FM patients were unable to mount a GH response to exercise, despite reaching an anaerobic threshold (an indication of an adequate exercise workload). However, when fibromyalgia patients were given pyridostigmine 1 hour prior to exercising, they were able to mount a reasonable GH response. As pyridostigmine is known to reduce somatostatin tone in the hypothalamus, this result is compatible with the notion that GH deficiency in fibromyalgia is a potentially reversible problem that has a physiologic basis i.e. increased hypothalamic somatostatin tone. [Eduardo S. Paiva, Atul Deodhar, Kim D. Jones, Robert Bennett; Oregon Health Sciences University, Portland (press release)[]
Low Adrenal Function / Adrenal Insufficiency
Underactive adrenals are common in CFIDS.
Immune System Imbalance (TH2 Dominance)
CFS patients are Th2 activated. This means they over-respond to toxins, allergens, normal bacteria and parasites, and under-respond to viruses, yeast, cancer and intracellular bacteria.
Liver Detoxification / Support Requirement
In one evaluation of 200 Chronic Fatigue and Fibromyalgia patients it was found that 80% had a significant impairment of liver detoxification function.
Patients suffering from toxic burdens may experience a wide range of symptoms, among them fatigue and poor tolerance for exercise. These processes have been postulated to be a central factor in the development of CFS. Oxidative damage to mitochondria and the detoxification process itself is being considered as a fundamental mechanism in the development of CFS. [1 Bland JS, HealthComm Inc., 1997; Int Clin Nutr Rev 1988;8(4): pp.173-5]
Chronic Fatigue / Fibromyalgia Syndrome can lead to
Depression
70% to 100% (different studies show various numbers) of fibromyalgia patients are found to have depression, though many consider that this is more likely to be a result of the muscular pain rather than part of the cause.
A sample of 69 patients with FM underwent a standardized tender point examination and a semistructured psychological interview and completed a set of self-report inventories. Of the sample, 39 met criteria for depressive disorder and 30 did not. [Evaluation of the Relationship Between Depression and Fibromyalgia Syndrome: Why Aren’t All Patients Depressed? Akiko Okifuji, Dennis C. Turk, Jeffrey J. Sherman]
Recommendations for Chronic Fatigue / Fibromyalgia Syndrome
Creatine Monohydrate
The use of creatine monohydrate improved body pain, strength, and physical fibromyalgia impact scores in a study of 19 patients with fibromyalgia. There was no improvement in fatigue or total fibromyalgia impact scores. Patients were given 20gm per day for 5 days which was reduced to 5gm per day thereafter. [European Congress of Rheumatology, June12-15, 2002, Stockholm, Sweden]
Colostrum / Transfer Factor
Many CFS and Fibromyalgia (FM) patients have reported great benefit with the use of transfer factors. In one small study of FM, Natural Killer (NK) cell activity increased by 169%, and patients reported feeling much better. [Rob Robertson, M.D. 2066 South 950 East, Provo, UT 84606 ]
Thymic Factors
Oral administration of thymic protein A was associated with normalization of immune function and improvement in clinical symptoms in a pilot study of 23 patients with CFIDS. [J Nutr Environ Med 2001;11(4): pp.241-247]
Ginseng, Korean - Chinese / Asian (Panax ginseng)
Adaptogenic herbs like Asian ginseng may be useful for people with chronic fatigue syndrome. This may be because these herbs are thought to have an immuno-modulating effect and also help support the normal function of the hypothalamic-pituitary-adrenal axis, the hormonal stress system of the body. [Quart Rev Natural Med 1996;Summer: pp.95-7]
While studies have been conflicting regarding Korean ginseng use and athletic performance, there are many people struggling with fatigue who have reported a renewal of energy after only a few days use.
Medicinal Mushrooms
Many CFIDS patients feel more energetic after taking mushroom formulas. Medicinal mushrooms may have anti-viral effects as well.
Herbal Combinations
ViaViente has helped some people resolve fibromyalgia pain and improve their energy levels.
Chlorella / Algae Products
Fifty-five subjects with fibromyalgia, 33 with hypertension, and 9 with ulcerative colitis consumed 10gm of pure chlorella in tablet form and 100mL of a liquid containing an extract of chlorella each day for 2 or 3 months. Daily dietary supplementation with chlorella was seen to reduce high blood pressure, lower serum cholesterol levels, accelerate wound healing and enhance immune functions. Researchers concluded that the potential of chlorella to relieve symptoms, improve quality of life, and normalize body functions in patients with fibromyalgia, hypertension, or ulcerative colitis suggests that larger, more comprehensive clinical trials of chlorella are warranted. [Altern Ther Health Med. 2001 May-Jun; 7(3): pp.79-91. Review]
Dental Metal Removal
Hypersensitivity to dental metals and nickel is frequent in patients with CFS and MCS-like syndromes. Ongoing metal-induced inflammation can be present in the oral cavity and/or in any other place of metal deposition. Metal-driven chronic inflammation may affect the hypothalamic-pituitary-adrenal axis (HPA-axis) and trigger a myriad of non-specific symptoms characterizing CFS, MCS and other related diseases. The removal of metallic restorations can reduce lymphocyte sensitization and improve the health of patients. [Neuroendocrinology Letters, 20: pp.289-298, 1999]
Raw Food Diet
In one study, the effect of a strict, low-salt, uncooked vegan diet rich in lactobacteria in 18 fibromyalgia patients both during and after a 3-month intervention period was evaluated. 15 patients continued their omnivorous diet as controls. The results revealed significant improvements in pain reduction, joint stiffness, quality of sleep, and overall scoring in all 3 questionnaires which were used. The majority of patients were overweight to some extent at the beginning of the study and shifting to a vegan food caused a significant reduction in body mass index. Total serum cholesterol showed a statistically significant lowering and urinary sodium dropped to 1/3 of the beginning value indicating good diet compliance. It can be concluded that a raw vegan diet has beneficial effects on fibromyalgia symptoms at least in the short run. [Scand J Rheumatol 2000;29(5): pp.308-13]
In another study, thirty people participated in a dietary intervention using a mostly raw, pure vegetarian diet. The diet consisted of raw fruits, salads, carrot juice, tubers, grain products, nuts, seeds, and a dehydrated barley grass juice product. 19 of 30 subjects were classified as responders, with significant improvement on all measured outcomes, compared to no improvement among non-responders. This dietary intervention shows that many fibromyalgia subjects can be helped by a mostly raw vegetarian diet. [BMC Complement Altern Med 2001;1(1): p.7]
Vegetarian/Vegan Diet
See the link between Chronic Fatigue / Fibromyalgia and Raw Food Diet.
Artificial Sweetener Avoidance
According to researchers and physicians studying the adverse effects of aspartame, chronic fatigue syndrome and fibromyalgia among other conditions can be triggered or worsened by ingesting aspartame.
Chocolate
If you suffer from Chronic Fatigue Syndrome you may well find that your symptoms are significantly reduced if you regularly consume dark chocolate – that means chocolate with a high cocoa content and without any milk in it. A pilot study carried out on patients with chronic fatigue syndrome found that their symptoms were alleviated when they consumed dark chocolate, much more so than when they consumed milk chocolate that had brown dye added to it.
According to the scientists from Hull York Medical School (2007) who carried out the pilot study, it is possible the dark chocolate is boosting levels of serotonin, a brain chemical. They also stressed that Chronic Fatigue Syndrome (CFS) patients should consume moderate amounts of chocolate.
Team leader, Prof. Steve Atkin, said that a patient had commented to him that she felt much better after eating dark chocolate with a high cocoa content. She had mentioned that her habit had been to consume milk chocolate, which did nothing for her. This comment got him interested in high cocoa (dark) chocolate, which led to the pilot study.
Prof. Atkin and team carried out a trial with ten patients. Half of them received 45 grams per day of high cocoa content dark chocolate while the other half received 45 grams per day of milk chocolate which had been dyed to look like the other one. This went on for two months. Then they all had a month without any chocolate. Then another two months, eating the other type of chocolate.
It became clear to the researchers that those consuming the high cocoa content dark chocolate were experiencing a significant alleviation of their chronic fatigue symptoms. Two of the patients, who had been off work for six months, managed to get back to work.
Prof. Atkins explained that polyphenols are present in large quantities in dark chocolate. Polyphenols have been linked to reductions in blood pressure, as well as other health advantages. Atkins and team believe the polyphenols are having an impact on levels of serotonin in the brain.
The researchers stressed that none of the trial participants put on any weight during the pilot study. They added that patients with chronic fatigue syndrome may derive benefit from consuming small quantities of high cocoa content dark chocolate each day.
Sugars Avoidance / Reduction
Do not consume any sweets, alcohol, or caffeine for 3 to 6 months, and then limit them to moderate amounts. Expect withdrawal symptoms during the first week.
Vinegar
May be an effective aid in the destruction of lipid-enveloped viruses, such as HIV, HHV-6 (strains A and B), EBV, CMV, and herpes.
Therapeutic Fasting
Fasting is reported to help in cases of fibromyalgia, but probably not chronic fatigue syndrome.
Guaifenesin
Diagnosis and treatment of CFS and FN are combined in the use of the decongestant guaifenesin (often called “guai” by users). Dr. St. Amand in his book What Your Doctor May Not Tell You About Fibromyalgia gives an excellent presentation on the subject with full details of guai use. He does not distinguish between Chronic Fatigue Syndrome, Fibromyalgia, or Candida, using guai for them all. This protocol requires the careful avoidance of all salicylates and a hypoglycemic diet if low blood sugar is a factor. There are extensive web sites on its use.
GHB (Gamma-Hydroxybutyrate)
GHB, as expected, has been reported to help decrease pain and improve sleep in fibromyalgia patients.
LDN - Low Dose Naltrexone
According to Dr. Bahari, people with fibromyalgia and chronic fatigue syndrome have had marked improvement using LDN, suggesting that these entities probably have an important autoimmune dynamic as well. Many have reported improvement – some noticing an immediate difference and others only after a prolonged period of use.
Conventional Drugs / Information
If prescriptions medications are needed to maximize sleep, Ambien, Desyrel, and Klonopin are more helpful than other sleep medications when CFS / Fibromyalgia is present.
Plant Sterols / Sterolins (Phytosterols)
Although the exact cause is unknown, people with CFS show several immune system abnormalities, which may include:
Glyconutrients
Testimonies such as this one support the recommendation of trying a glyconutrient product.
“I have CFS in addition to the allergies, and for that I rate them very highly – a 9 or so for effectiveness (one of the best, indeed one of the only products I have found that provide a noticeable increase in my stamina). In fact they work so well at boosting energy that I often find my sleep is affected if I take one at lunch, which is why I usually just take 1 at breakfast. But for allergies I’d have to say they’ve been a disappointment.”
Rye Grass Extract
Oralmat has been used successfully in some cases of chronic fatigue.
Aerobic Exercise
A comparison of 50 subjects with fibromyalgia found those who underwent an exercise program for 30 minutes per day, 3 day a week, experienced an improvement in mood and function and a reduction in pain compared with controls. [Arthriti Care Res December 2001;45(6): pp.519-529]
DHEA
It is possible that many of the benefits of growth hormone use in CFS / Fibromyalgia can also be achieved by simply optimizing DHEA levels.
Tests, General Diagnostic
Testing for urinary growth hormone levels could be helpful, as this important hormone is often low in those with CFS / fibromyalgia.
MSM (Methyl Sulfonyl Methane)
According to Dr. Stanley Jacobs, MD, MSM can be helpful in most musculoskeletal pain and inflammation conditions, including fibromyalgia.
Iodine
Low iodine may also contribute to fatigue and CFS. A study showed that those with low body temperature and fatigue felt better on Iodine 1,500 mcg a day – even though their temperature did not rise with treatment. It is reasonable for those with chronic fatigue, CFS and fibromyalgia to try added iodine (Iodoral) for 3 months to see if it helps. Dr Jacob Teitelbaum MD.
Lithium (low dose)
One small study examined three women suffering from fibromyalgia, none of whom had responded to conventional treatment. When researchers added lithium (lithium carbonate 300mg two to four times daily) to the women’s current treatment, all three noticed a marked reduction in their symptoms of pain and stiffness. Laboratory testing in these patients showed no evidence of lithium toxicity to the thyroid or kidneys.
Magnesium
Fatigue is sometimes reduced with magnesium (and potassium) supplementation. The many enzyme systems that require magnesium help restore normal energy levels. Treat any magnesium deficiency preferably with magnesium malate. Sometimes magnesium by injection or IV is used.
Increased Salt Consumption
Many CFIDS/FMS patients may be low in vasopressin. The simplest treatment for a low vasopressin level is to use plenty of salt and drink plenty of water.
Reading List
The Maker’s Diet by Dr. Jordan Rubin, NMD.
DMAE
DMAE increases the body’s release of energy.
Hydrotherapy
Feb. 2008. REUTERS reports that European researchers have found that swimming can significantly ease the debilitating pain of fibromyalgia. According to the report, researchers studied 33 women, having one group exercise in warm water for more than an hour three times a week for eight months while the others did no aquatic training.
Narcis Gusi at the University of Extremadura in Spain and Pablo Tomas-Carus of the University of Evora in Portugal, who conducted the study, said that the women who swam said the workouts helped ease their pain and they reported an improved quality of life.
“The addition of an aquatic exercise program to the usual care for fibromyalgia in women is cost-effective in terms of both health care costs and societal costs,” they wrote in the journal Arthritis Research & Therapy.
Calming / Stretching Exercises
Studies from Texas Tech University found that the yoga postures helped increase circulation to the limbs and decreased physically related anxiety. FMS sufferers frequently complain about decreased energy, but the Tech subjects reported that the yoga exercises actually increased energy levels.
Massage
A study of people with fibromyalgia done by the Touch Research Institute at the University of Miami School of Medicine found that those who got 30 minutes of massage twice a week for 5 weeks had less anxiety, depression and lower levels of stress hormones. Eventually they reported less pain, stiffness, fatigue, and improved sleep.
Visualization / Relaxation Techniques
(2009) A study by UCLA psychologists suggests that just the thought of a loved one reduces pain, underscoring the importance of social relationships and staying socially connected.
The study, which asked whether simply looking at a photograph of your significant other can reduce pain, involved 25 women, mostly UCLA students, who had boyfriends with whom they had been in a good relationship for more than six months.
The women received moderately painful heat stimuli to their forearms while they went through a number of different conditions. In one set of conditions, they viewed photographs of their boyfriend, a stranger and a chair.
“When the women were just looking at pictures of their partner, they actually reported less pain to the heat stimuli than when they were looking at pictures of an object or pictures of a stranger,” said study co-author Naomi Eisenberger, assistant professor of psychology and director of UCLA’s Social and Affective Neuroscience Laboratory. “Thus, the mere reminder of one’s partner through a simple photograph was capable of reducing pain.”
“This changes our notion of how social support influences people,” she added. “Typically, we think that in order for social support to make us feel good, it has to be the kind of support that is very responsive to our emotional needs. Here, however, we are seeing that just a photo of one’s significant other can have the same effect.”
In another set of conditions, each woman held the hand of her boyfriend, the hand of a male stranger and a squeeze ball. The study found that when women were holding their boyfriends’ hands, they reported less physical pain than when they were holding a stranger’s hand or a ball while receiving the same amount of heat stimulation.
“This study demonstrates how much of an impact our social ties can have on our experience and fits with other work emphasizing the importance of social support for physical and mental health,” Eisenberger said.
One practical piece of advice the authors give is that the next time you are going through a stressful or painful experience, if you cannot bring a loved one with you, a photo may do.
Vitamin D
A study from the Mayo Clinic in 2003 looked at the prevalence of vitamin D deficiency in people aged 10-65 with chronic pain syndromes like fibromyalgia and chronic fatigue. It was reported that 93% of these were found to be deficient in vitamin D.
A new study from the Orthopaedic Hospital Speising in Vienna, Austria, brings hope for those suffering from fibromyalgia, finding that vitamin D supplementation may ease the nerves, bringing down inflammation in the body. Study leader Florian Wepner was excited about the results, suggesting, “Vitamin D levels should be monitored regularly in FMS patients, especially in the winter season, and raised appropriately.”
Although the study was able to find an association between vitamin D supplementation and an easing of fibromyalgia pain, it did not prove a cause-and-effect link.
However, two experts on the illness said the findings make sense.
“Fibromyalgia patients and those with chronic pain should certainly have their vitamin D blood levels checked and, if low, consider supplementation under the guidance of a physician,” said Dr. Kiran Patel, a pain medicine specialist at Lenox Hill Hospital in New York City who often treats people with fibromyalgia.
Dr. Houman Danesh, director of integrative pain management at Mount Sinai Hospital in New York City, agreed. “Vitamin D deficiency has been linked to chronic pain, and this study further strengthens the argument to [replenish] vitamin D in deficient individuals,” he said. [ Kiran Patel, M.D, pain medicine specialist, Lenox Hill Hospital, New York City; Houman Danesh, M.D., director, integrative pain management, The Mount Sinai Hospital, New York City; Elsevier, press release, Jan. 17, 2014]
Vitamin B12 (Cobalamine)
Although little controlled scientific research exists on the effectiveness of vitamin B-12 for the treatment of Chronic Fatigue Syndrome, many doctors and patients are trying this therapy. Two well-known CFS researchers and clinicians, Dr. Paul Cheney and Dr. Charles Lapp, believe that it can be helpful for some patients in managing the symptoms of CFS or fatigue.
Based on three studies in the New England Journal of Medicine which showed that vitamin B-12 injections were beneficial for people with “CFS-like neurological symptoms and normal blood counts,” Dr. Lapp and Dr. Cheney decided to try various doses in their own patients with the hope that this might become an effective treatment option.
They began treating patients with injections of cyanocobalamin, a form of vitamin B-12 that is easily accessible in the U.S. Their informal survey of patients showed that 50-80% of their patients improved to some extent. These patients reported increased energy and sense of well-being within 12-24 hours after administration, and the effects lasted an average of 2-3 days. However, results were highly variable; effective doses ranged from 1000mcg injected daily to 5000mcg injected three times a week; many patients required up to six weeks of treatment to receive consistent results. Dr. Lapp and Dr. Cheney now recommend injections of 3000mcg of cyanocobalamin every 2-3 days.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Weakly counter-indicative |
| Strongly counter-indicative |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Chronic Fatigue Syndrome
CFS (Chronic Fatigue Syndrome) is a disorder of unknown cause that lasts for prolonged periods and causes extreme and debilitating exhaustion as well as a wide range of other symptoms such as fever, headache, muscle ache and joint pain, often resembling flu and other viral infections. Also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), Chronic Epstein-Barr Virus (CEBV), Myalgic Encephalomyelitis (ME), "Yuppy Flu" and other names, it is frequently misdiagnosed as hypochondria, psychosomatic illness, or depression, because routine medical tests do not detect any problems.
Lymphadenopathy
A lymph gland enlargement in response to any foreign substance or disease.
Malaise
A vague feeling of bodily discomfort, as at the beginning of an illness. A general sense of depression or unease.
Fibromyalgia
(FMS): Originally named fibrositis, it is a mysteriously debilitating syndrome that attacks women more often than men. It is not physically damaging to the body in any way, but is characterized by the constant presence of widespread pain that often moves about the body. Fibromyalgia can be so severe that it is often incapacitating.
Anemia
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Diabetes Mellitus
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Arthritis
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Virus
Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
Epstein Barr virus
(EBV): A virus that causes infectious mononucleosis and that is possibly capable of causing other diseases in immunocompromised hosts.
Cytomegalovirus
(CMV): A member of the herpes virus family which may induce the immune-deficient state or cause active illness, such as pneumonia, in a patient already immune-deficient due to chronic illness, such as cancer or organ transplantation therapy.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Serotonin
A phenolic amine neurotransmitter (C10H12N2O) that is a powerful vasoconstrictor and is found especially in the brain, blood serum and gastric membranes of mammals. Considered essential for relaxation, sleep, and concentration.
Placebo
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Pituitary
The pituitary gland is small and bean-shaped, located below the brain in the skull base very near the hypothalamus. Weighing less than one gram, the pituitary gland is often called the "master gland" since it controls the secretion of hormones by other endocrine glands.
Lymph Nodes
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit and groin, but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Children’s nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's.
Inguinal
Pertaining to the region of the groin. Generally, the lowest lateral regions of the abdomen just above either side of the genitals.
Adenopathy
Swelling or enlargement of the lymph nodes, also known as lymphadenopathy.
Hypotension
Low blood pressure.
Irritable Bowel Syndrome
(IBS) A condition that causes upset intestines for a long period of time. It is very unpleasant to the sufferer but tends to be harmless and usually does not lead to more serious complaints. The symptoms vary from person to person and from day to day. In order to be diagnosed with IBS, a person must have at least three of the following symptoms: pain in the lower abdomen; bloating; constipation; diarrhea or alternating diarrhea and constipation; nausea; loss of appetite; tummy rumbling; flatulence; mucous in stools; indigestion; constant tiredness; frequent urination; low back pain; painful intercourse for women.
Prolactin
An anterior pituitary peptide hormone that initiates and maintains lactation.
Candidiasis
Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge.
Parasite
An organism living in or on another organism.
Arthralgia
Severe throbbing or stabbing pain along a nerve in one or more joints.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Dopamine
A neurohormone; precursor to norepinephrine which acts as a stimulant to the nervous system.
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Anesthesia
Loss of sensation caused by neurological dysfunction or a pharmacological depression of nerve function.
Uremia
Condition characterized by excessive urea and other nitrogen compounds in the blood due to renal insufficiency.
Raynaud's Phenomenon
Raynaud's disease or syndrome is a disorder of blood circulation, mainly in the fingers and toes. It is of unknown cause and characterized by changes of the skin that are aggravated by exposure to cold: first, becoming white with numbness and pain as a result of inadequate oxygenation of the blood, then red/purple with a burning sensation. The sudden constriction of blood vessels causes decreased blood flow to the extremities and can, in extreme cases, lead to gangrene. Also called "white finger", "wax finger" or "dead finger".
ng
Nanogram: 0.000000001 or a billionth of a gram.
Dysthymia
A milder but chronic form of depression.
Anaerobic
Of, relating to, or being activity in which the body incurs an oxygen debt (for example weight training or resistive exercises) and does not immediately burn off a lot of calories and fat.
Hypothalamus
An important supervisory center in the brain regulating many body functions. Despite its importance in maintaining homeostasis, the hypothalamus in humans accounts for only 1/300 of total brain weight, and is about the size of an almond.
Cytokines
Cytokines are chemical messengers that control immune responses. They are secreted by white blood cells, T cells, epithelial cells and some other body cells. There are at least 17 different kinds of interleuken and 3 classes of interferon called alpha, beta and gamma and various subsets. Interleukens and interferons are called “cytokines” and there are two general groupings, Th1 and Th2. Th1 (T-cell Helper type 1) promote cell-mediated immunity (CMI) while Th2 (T-cell Helper type 2) induce humoral immunity (antibodies).
Allergen
A substance that is capable of producing an allergic response in the body.
Bacteria
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Yeast
A single-cell organism that may cause infection in the mouth, vagina, gastrointestinal tract, and any or all bodily parts. Common yeast infections include candidiasis and thrush.
Mitochondrion
Structure inside a cell that is the location of the cell's energy production machinery. (Plural: Mitochondria)
ROS
Reactive Oxygen Species. Molecules including free radicals and other oxygen species.
Antioxidant
A chemical compound that slows or prevents oxygen from reacting with other compounds. Some antioxidants have been shown to have cancer-protecting potential because they neutralize free radicals. Examples include vitamins C and E, alpha lipoic acid, beta carotene, the minerals selenium, zinc, and germanium, superoxide dismutase (SOD), coenzyme Q10, catalase, and some amino acids, like cystiene. Other nutrient sources include grape seed extract, curcumin, gingko, green tea, olive leaf, policosanol and pycnogenol.
Allergy
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Colitis
Inflammation of the colon.