While we all over‐extend ourselves and feel tired from time to time, between 1 and 4 million Americans suffer from Chronic Fatigue Syndrome, or CFS, a debilitating condition characterized by a number of life‐disrupting symptoms that last for longer than 6 months. Other names for CFS include chronic fatigue and immune deficiency syndrome (CFIDS) and myalgic encephalopathy (ME). CFS affects nearly every system in the body, either directly or indirectly, leading to symptoms such as:
- Un‐refreshing sleep
- Difficulty concentrating or with memory
- Muscular pain and tenderness
- Swollen or enlarged lymph nodes that are tender to the touch
- General malaise
- Inability to exercise or recover from exercise, also known as post‐exertional malaise
- These symptoms have a dramatic impact on both young and old alike. For children and teenagers, CFS can disrupt their schooling and ability to complete class work. In addition, they may now be unable to participate in sports that they previously enjoyed. This often leads to social isolation and even further depression. For older adults, their ability to work becomes compromised; in many cases, they are unable to work at all and must file for disability. This can have a significant impact on all members of the family, especially if the unaffected members do not understand the illness. In fact, it may lead to isolation and depression regardless of age.
If you read the official CDC and other governmental websites, they will all state that no cause has been discovered for CFS. That’s because there is not just ONE cause! There are multiple contributing factors, as in most illnesses. Traditional medicine put us in the mindset of thinking A causes B, and you take C to cure it. The body doesn’t work that way. You are a system of systems. Common contributing factors include, but are not limited to:
- Chronic infections, such as Lyme, Bartonella, Babesia, Mycoplasma and viruses, such as HHV‐6, Epstein‐Barr Virus, Cytomegalovirus, Parvo Virus, Coxsackie A and B viruses, and others.
- Adrenal and thyroid hormone imbalances. Cortisol, produced by the adrenal glands, should be highest in the morning to wake us up and lowest in the evening so that we can sleep. Oftentimes in those with CFS, morning cortisol may be low and evening cortisol may be elevated, disrupting sleep. Or the total day’s cortisol load could be low, leaving you feeling exhausted all day long. As for thyroid imbalances, a number of scenarios are common. One of these situations is high reverse T3 (think brake pedal for your body), and low free T3 (think gas pedal for your body). Sometimes, one’s immune system mounts an attack against the thyroid which shows up as anti‐thyroglobulin a n t i b o d i e s and/or TPO antibodies. This prevents the thyroid hormone from working at the cellular level. The thyroid has effects on every system of the body, so if function is suboptimal, system‐wide disruption occurs. One may experience low body temperature, decreased tolerance to cold, decreased bowel movements, both mental and physical fatigue, hair loss, and more.
- Gut dysbiosis: A healthy human large intestine should have between 7,000 and 10,000 bacterial species. Due to the popularity of C‐sections, a rapid decline in breast feeding, overuse of antibiotics, artificial sweeteners, Round‐up TM, processed foods, meats containing antibiotics and several other factors, the average human microbiome—the collection of bacterial species in the colon—has drastically decreased in diversity. This has far‐reaching implications, affecting everything from blood sugar balance to immune function. Researchers have just scratched the surface in determining the roles and functions of our gut microbiome. Every species plays an important role in the overall niche. Some species help to decrease inflammation while others directly contribute to it. But, they balance one another out. Decreased levels of “good” bacteria leave space for harmful bacteria, yeast or parasites to set up shop in the large intestine. Common gut infections include C a n d ida Albicans, H. Pylori, Giardia, Blastocystis hominis, several species of Streptococcus bacteria and many more. Some of these are classified as gram‐negative bacteria and release lipopolysaccharides from their outer cell wall into the bloodstream. This creates a pro‐inflammatory immune response and raises cytokines (immune molecules), such as tumor necrosis factor‐alpha, interleukin‐1 Beta, and interleukin‐6. These are the same molecules that make you feel like you’ve been hit by a truck when you have the flu or a cold. If these molecules remain elevated for long‐enough, they begin to punch holes in the blood‐brain barrier. So, what started out as a leaky gut has now led to a leaky blood‐brain barrier. This further contributes to brain fog and short‐term memory loss.
- Toxicity: Humans are now exposed to more synthetic environmental chemicals than at any time in recorded human history. Only a small fraction of these chemicals have been tested for long‐term safety. And scientists ultimately have no idea the danger that these chemicals pose when they interact with one another and bio‐accumulate in human tissue over many years. Obvious culprits are mercury, aluminum, lead, persistent organic pollutants, industrial solvents, and many more. While some scientists claim that small amounts of these chemicals are safe, they fail to realize that no one has that level of ONE chemical in their body. We are a walking chemical soup. Some of these we inherited in utero from other mothers. Others we acquire during our first few years of life. Many of these compounds are stored in the adipose (fat) tissue. Others are stored in the lymphatic system. Today, many people suffer from a congested lymphatic system. The lymph serves as our toxic waste dump but also where several immune cells are located. When the lymphatic system is not moving properly, the body becomes increasingly toxic. Lymph fluid requires muscular contractions to move it back toward the heart. Thus, exercise and movement are crucial to keep this fluid moving. Because of the toxic overload the average person is exposed to on a daily basis, the lymph is frequently overburdened. When this happens, it becomes viscous and thus does not move well throughout the body. Therefore, toxins aren’t excreted through the kidneys at the rate that they should be.
- Neurotransmitters: These are the chemical messengers used both in the brain and peripherally to communicate within the nervous system. They also communicate between the nervous system and the endocrine and immune systems. They include serotonin, dopamine, norepinephrine, epinephrine, histamine, acetylcholine, phenylethylamine (PEA), and GABA. Imbalances amongst the neurotransmitters can lead to depression, fatigue, insomnia, issues concentrating, decreased motivation, anxiety, short‐term memory loss, irritability and more. Very commonly, those with CFS have multiple neurotransmitter imbalances. Sometimes, the energizing neurotransmitters, like norepinephrine, dopamine, PEA, and epinephrine may be low. This can lead to decreased energy, malaise, brain fog, short‐term memory loss and decreased motivation. Very commonly, the calming brain chemicals—serotonin and GABA—may be low, leading to poor sleep quality and quantity. Lack of restorative sleep may contribute to decreased energy, brain fog, malaise, decreased motivation, and an inability to complete basic daily tasks. Thus, a vicious cycle begins.
As discussed above, the causes of CFS/CFIDS/ME are multi‐factorial. Therefore, the treatments must address dysfunction on multiple levels in order to restore homeostasis, or balance to the body. A full assessment should include a complete thyroid panel, an adrenal stress index, which measures cortisol at 4x throughout the day and DHEA 1‐2x, a comprehensive stool analysis, titers for the common viruses, mycoplasma, Lyme, and co‐infections, and possibly a provocation heavy metal test. This is where most doctors and providers go wrong: they only test for and address one layer of dysfunction. It should be more appropriately thought of as peeling away the layers of an onion. In most cases, it is only possible—and advisable‐‐to address one or two systems at once. It is important to remember that these issues took time to develop and will take some time to resolve.
I generally begin by assessing the adrenals and thyroid in order to provide further stabilization for the other interventions. If cortisol is too low or too high, it can interfere with thyroid function. When the body is under any type of stressor, it increases the production of reverse T3, the body’s brake pedal. It slows everything down and directly opposes the function of T3, the active form of thyroid hormone. It is important to also examine for the presence of thyroid antibodies, as these will functionally decrease the effectiveness of thyroid hormone. Providing short‐term support to the adrenals and thyroid allows the body to stabilize somewhat and better tolerate the other aspects of the program.
Next , I typically assess gut function. A good stool test will examine pancreatic enzyme levels, fat absorption, “good” bacteria levels, look for the presence of pathogenic yeast, bacteria, or parasites, provide a general overview of microbiome diversity, and list the sensitivities of any pathogens found. A good gut restoration program will address biofilm, a slimy substance produced by pathogens to hide from the immune system and to exchange DNA with one another in an effort to become more virulent. Breaking this substance down allows the antimicrobials to work more effectively. Antimicrobials may be needed anywhere from 8 to 12 weeks, depending on the amounts used and whether combinations of nutrients and/or prescription antimicrobials are employed. A plan should also be in place to repair the gut mucosal lining. Many nutrients help repair the gut mucosa and often they are used in combination, on an empty stomach for 10‐12 weeks. This helps to soothe any irritation to the gut lining caused by inflammatory foods, infections, stress, etc. To repair the gut mucosa long‐term, any pathogens discovered must be eradicated as they will cause significant irritation. Any deficiencies of stomach acid, pancreatic enzymes, or bile should be addressed to optimize digestive chemistry. If the pH of the digestive tract is not optimized, it becomes a haven for pathogens of all types and makes it easier for them to exist. It can also cause “good” bacteria to behave badly.
From there, I generally move to testing for and addressing chronic infections, including, but not limited to, HHV‐6(Human herpes virus 6), Epstein Barr Virus, CMV(Cytomegalovirus), Coxsackie B Virus, Mycoplasma, Lyme, Babesia, and Bartonella. I test a person’s IGG and IGM response to the previously mentioned pathogens. The typical thinking in traditional medicine—and even in some integrative medicine circles—is that an elevated IgG response indicates a past infection. But based on the work of Dr. Alex Vasquez, D.O., N.D., D.C. and Dr. Jacob Teitelbaum, M.D., an elevated IgG response that is 3‐4x the top end of the “normal” range suggests an active infection. Some people with immune imbalances may not be able to mount an adequate IgM response. The take‐home message is that you are NOT in the clear just because your IgM titers are in the normal range. Most of the pathogens listed above are chronic, nagging infections that contribute to symptoms such as brain fog, insomnia, trouble concentrating, decreased energy, the development of thyroid antibodies, microglial activation in the brain (the microglia are the resident white blood cells in the nervous system and, when chronically activated, produce damaging compounds that irritate the other neurons), joint pain, mood swings and many more. Some of these bugs have even been connected to certain types of cancers. Others, such as Coxsackie B Type IV Virus, increase your risk of heart disease by as much as 33%. There are many natural and prescription antivirals available. As a general rule, viruses take longer to treat than Candida (yeast) and most bacteria. So, whether you choose a natural program or a prescription one, you will need to be on the anti‐viral compounds at least 4‐6 months. Technically, we’re not killing the viruses because they were never alive in the first place. But we are working to lower the total viral load (amount) and to silence the expression of viral DNA. As a mentor of mine once said, “you can’t kill your way to health!”. By this, he meant that you must address the other imbalances in the body and any immune insufficiencies in order to balance the body as a whole. In other words, how and why did our bodies allow those infections to thrive in the first place?
And I’ll let you in on a little secret—you never find just ONE pathogen but multiple that have synergistic effects and often hide underneath biofilm. Biofilm is a slimy substance created by microbes to hide them from the immune cells, exchange DNA fragments with other pathogens, and collect toxic metals. Most of the time, it proves helpful to incorporate some form of biofilm disruptor, such as Serrapeptase, Boluoke, or Nattokinase. This allows the antimicrobials that you take to work better by being able to get closer access to the pathogens. Without breaking up the biofilm, you can think of the infections as having a shield around them to hide from the antimicrobials. My personal preference for addressing the bugs differs depending on which pathogens we find. There are some broad antimicrobials that will likely have a positive impact on most pathogens. But some microbes, such as HHV‐6, require more specific attention. I have people start on ½ of the suggested dose of ONE antimicrobial at a time to minimize any Herxheimer‐like reactions. A Herxheimer reaction is essentially an inflammatory cascade created when you attempt to kill or lower the body’s pathogen load. It can include symptoms ranging from fatigue, nausea, fevers, aches and pains, headaches, indigestion, insomnia and many others. A Herxheimer reaction should never be the goal. By starting at low doses of the natural or prescription antimicrobials, the chances of this type of reaction significantly decrease. Another trick is to use anti‐inflammatories, such as Curcumin, to manage inflammation.
Then, I have them gradually increase the dose as tolerated. After reaching the max dose of one antimicrobial, I have them start on a very low dose of the 2nd antimicrobial. The number of anti‐viral/anti‐bacterial agents that I use depends on the person’s immune system and their total body load of these pathogens. It is important to maximize a person’s Natural Killer Cell level, helper and suppressor T‐cells, glutathione levels, their total IgG (and we check the subclasses 1‐4 levels), their total IgM, their total IgA (and the 2 IgA Subclasses) to make sure their immune system is robust and ready at a moment’s notice. There’s also a nasty compound called nagalase that is produced by many viruses and most cancer cells. There is only 1 European Lab that I know about that tests for it (there was one in the U.S., but they discontinued their testing of it). When this compound is elevated, it essentially disarms your immune system. In fact, it makes your macrophages almost completely unable to respond to invading microbes. There are a few therapies that I suggest to clients to help lower this compound.
Toxicity is another important component to almost every health issue we are faced with today. Several of the functional labs have tests for different environmental compounds, metals, toxicants, etc. I know everyone is toxic today, so typically I don’t even test levels in the beginning in order to conserve resources. Instead, I proactively open up and optimize your detoxification pathways and lymphatic system. This starts with a topic we’ve already discussed—the gut. The gut is involved in the removal of many toxic compounds. If there are imbalances in your gut flora, they need to be corrected to optimize detoxification. If there are too many gram‐negative bacteria in the colon, they will release a highly inflammatory compound known as LPS, or lipopolysaccharides. These compounds create a potent inflammatory response when they are released into the bloodstream. And when they make it to your liver, they cause congestion in your Phase I and Phase II Detoxification Pathways. In short, correcting any flora imbalances, optimizing stomach acid production, bile levels, and pancreatic enzyme amounts goes a long way toward successfully detoxing harmful compounds from your body. Another important aspect for detox is to get your lymphatic system moving. Your cardiovascular system has the heart muscle to help it distribute blood and nutrients to all areas of the body. The lymphatic system has no such pump: It relies solely on muscular contractions to push it back towards the heart. This is why exercise is so important. Something as simple as a brisk walk will help to mobilize your lymphatic fluid, which is basically the body’s garbage dump. Weight‐lifting is likely the most helpful for moving this fluid, especially lower‐body exercise that involves multiple muscle groups. Other modalities to encourage the movement of lymph include rebounders (mini‐trampolines), certain herbs (which we don’t have time to get into here), Chi Machines, manual lymphatic drainage, and Electro‐lymphatic Drainage, or ELT. ELT is relatively new on the scene and there are not a lot of providers who are using it. To give you an idea of how strong it is, 1 ELT treatment is equal to 9‐10 manual lymphatic drainage therapies. In summary, your detoxification efforts will be in vain if you don’t include some modalities that address stagnant lymph fluid.
Another important component to the detoxification formula is optimizing adrenal and thyroid hormone levels, which was discussed previously. Remember this: If you have a thyroid problem, there exists a strong possibility of an adrenal imbalance as well. And if the thyroid is not working optimally, your body temperature will drop below 98.6⁰ Fahrenheit. This means all of your body systems start to slow down because your enzymes have slowed down. Hopefully, you’re beginning to understand that fixing your detox pathways is way more complicated that doing a juice cleanse or taking some detoxification supplement. To successfully optimize your detoxification pathways involves managing the complex interplay between numerous body systems, including but not limited to: cardiovascular, lymphatic, endocrine/hormonal, and digestive systems. When these systems are adequately addressed, any detoxification supplements, chelating agents (to detoxify toxic metals), binding agents, drainage remedies and other programs are much more likely to be a success. Some general things that aid the detox process are Far‐Infrared Saunas, Biomats colon hydrotherapy, ionic footbaths (potentially, I’m not 100% sold on these yet), dry skin brushing, and exercise (because of its’ effects on the lymph system and the toxins that exit your body via sweat). I would be remiss if I didn’t mention optimizing your levels of minerals such as magnesium, zinc, iodine, silica, boron and others. There is a test called a Toxic and Essential Elements Test which will check your body for the good minerals and also the toxic metals, such as mercury, aluminum, cadmium, lead, and arsenic, etc. The most accurate test for your minerals are the RBC, or red blood cell tests. It is fairly easy to get your RBC Magnesium level and your RBC Zinc level tested at your local Labcorps.
The last component that we will discuss is the arena of neurotransmitters. Neurotransmitters are how the cells your nervous system communicates with one another. So, we have neurotransmitters in the Central Nervous Systems, or CNS. Technically, the most accurate way to test these is to do a spinal puncture to collect a sample of your cerebrospinal fluid, or CSF. This is an invasive procedure, causes discomfort, is costly, and just isn’t practical in the case of children with sensory issues. You also have neurotransmitters in the Peripheral Nervous System, which consists of all of the nerves and ganglia (groups of cell bodies) outside of the brain and spinal cord. The most accurate and least invasive way to check the amounts of these brain chemicals is a urine neurotransmitter test. There were a couple of studies that showed the validity of this method, and I believe one study that claimed it to be an inaccurate form of testing. What I can tell you is that I have had good success with testing for and balancing my clients’ neurotransmitter levels through either Pharmasan Labs or Sabre Sciences. Pharmasan Labs/Neuroscience has some neurotransmitter‐balancing products that they recommend. Sabre Sciences has a completely unique process to evaluating and balancing your brain chemistry. You can contact me if you’re interested in this.