IN 1975 I was in my third year of medical school, supporting myself working as a neonatal intensive care unit nurse in the Children’s Hospital. And this was the easy part of my life. My family, made up largely of concentration camp survivors from Auschwitz was going through an emotional meltdown. As is often the case with people with CFS/FMS, I was and am pretty empathic, making me the “family problem solver.” Putting myself in the middle of this battle was like getting between a group of drunks fighting. I got emotionally pounded to death. Like the sitcoms on TV, my uncle literally had a heart attack in my apartment while trying to convince me to manipulate my cousins, and landed up in the intensive care unit.

In this context, I came down with a very severe viral infection. Although they could not identify the specific virus, the blood testing showed severe changes. Six weeks later though, when they felt that I should be fully recovered; I was still disabled and nonfunctional. My professors were very sympathetic, but after a while presumed that I must have, “depressed med student disease.” My being brain fogged and disabled continued for months, and I finally had to drop out of medical school. As my father had died years before, and I was paying my own way and could not work, or keep my student loans or scholarship, this also meant that I was homeless.

Being homeless was not the worst of it. My whole life had been geared to being a physician and healer. With this destroyed by my illness, I suddenly was left with no purpose. For a while, I lived out of my old Dodge Dart, which broke down and was towed away by the police. After that, I was sleeping in parks, and ate when people were kind enough to feed me. I would note that the people I met in Tulsa during this time were incredibly loving and gracious.

But something else happened. Something unexpected. It was as if the Universe had put a “Homeless Medical Student” sign on my park bench. Healers of many backgrounds, physicians, naturopaths, herbalists, energy workers, and countless others would come by and sit with me. We would talk and they would offer me their perspective on my illness. I was able to put together an integrated treatment protocol from these numerous different practitioners. In doing so, I was able to recover from my CFS/fibromyalgia. I had no idea that returning to medical school was even possible, but found out that it was. I was able to return, and do very well.

But I never forgot my experience, and the numerous lessons that I learned living on a park bench.

I am a science geek, and as a physician I have reviewed tens of thousands of studies. I also find that the realities of our current medical monopoly severely limits information to physicians, basically feeding them slick advertising masquerading as science. Simply put, most physicians are not aware of most of the treatments that can help people because they are simply not profitable. And they don’t even know that they don’t know.

I have spent the last 40 years effectively treating thousands of people with CFS and fibromyalgia, getting the information to countless others, and training numerous health practitioners. We have also published four studies on effective treatment of CFS and fibromyalgia, including a randomized double-blind placebo-controlled study showing that the protocol discussed below resulted in 90 percent of people improving with an average 91 percent increase in quality of life (p<.0001 vs. placebo). We call the treatment the SHINE Protocol, optimizing:

Sleep
Hormonal function
Immunity/Infections
Nutritional support
Exercise as able

I will be doing a series on how to get from where you are, to getting your life back. I will begin with an overview article on each of the five areas above. We will then go into more depth in each area. For example, sleep issues include not only natural and prescription things to help sleep, but also treating sleep apnea, restless leg syndrome, nasal congestion and upper airway resistance syndrome.

Basically, I will make you an expert so you can get yourself well. We will also point you to the tools and resources that can help you.

We combine the best of natural and pharmaceutical treatments in the protocol. Put simply, the cost of a treatment bears NO relationship to its effectiveness. It only impacts how likely you are to hear about it in advertising and promotion. So don’t worry if some of the treatments we recommend are not an option for you financially. We will also be discussing low-cost alternatives, and how the overall treatment protocol can be done at very low cost as well.

1. Finding a physician. Although I do phone consults with people from all over the world (410-573-5389), many people simply cannot afford this. Find a local physician who is more likely to be familiar with CFS and fibromyalgia. (Find one that is holistically trained. There are over 2000 of these.) Begin at https://secure.endfatigue.com/cfs-fibromyalgia/find-a-practitioner—if there is not one near you there go to www.ABIHM.org. Sadly, insurance will not cover holistic treatments or the time needed to properly take care of these illnesses, meaning that most holistic physicians will not participate with any health insurance, making this not an option for many people. There is help though. Our goal has been to make effective treatment available for everyone. So here’s another tool that can help you.

2. Basically, what is needed to help people get their lives back is to optimize energy using SHINE. I computerized the approach I used when I treated people, evaluating their symptoms and lab testing. I then computerized this in a complex program that burnt out three computer programmers over three years, and made it available online. I actually hold the U.S. patent for a computerized physician, which I designed specifically for people with CFS and fibromyalgia. Initially, we charged people $400 to use the computer program, but told people that if they couldn’t afford this, they could do it for free. Over 80 percent of people said they could not afford anything because they were disabled, so we have now made the program available free for everyone. It can be found at http://energyanalysisprogram.com/. It will analyze your symptoms in a series of quizzes, and if they are available, even analyze your pertinent lab tests. The lab testing, however, is not critical and can always be added later.

3. For an overview of treating the illness, a lecture in CFS and fibromyalgia that I gave to several hundred physicians at their board review course can be found at https://www.youtube.com/watch?v=KuIRDzUDO3o.

4. I invite you to read my book, The Fatigue and Fibromyalgia Solution, if you would like an “easy reading” overview. If you want more detail and the study references, I recommend From Fatigued to Fantastic.

I will be contributing regular articles to TotalHealth Online to guide you on the specifics you need to reclaim your health. I will begin with an overview of each of the SHINE components, and then go into key topics in detail. I invite you to join me in this journey of recovery.

Please share this article with your friends, so they can also get their lives back. To sign up for the free newsletter that will have these articles, go to www.EndFatigue.com.

Treating POTS, NMH, Low Blood Pressure And Orthostatic Intolerance

As we have discussed earlier, the energy crisis seen in CFS and fibromyalgia triggers malfunction in a main control center called the hypothalamus. This controls:

1. – sleep
2. – hormonal function
3. – temperature regulation—so 98.6 is a fever in this illness, and
4. – autonomic function.

Autonomic function regulates blood pressure, pulse, sweating, and gut function. This is why many of you find that you have weird sweating issues along with irritable bowel syndrome (gas, bloating, and alternating diarrhea and/or constipation) and acid reflux.

Treating with the overall SHINE protocol can help all of these. But it is important to specifically also address the low blood pressure problems, as this is a very important contributor to the postexertional fatigue that limits your activity. For more information on treating irritable bowel syndrome and acid reflux, see the free smart phone app Cures A-Z.

Diagnosing Orthostatic Intolerance
These are often called POTS or postural orthostatic tachycardia syndrome and NMH or neurally mediated hypotension. This means that when you stand up, the blood pools in your legs, essentially starving your muscles and brain. Normally, the autonomic nervous system tells the legs to send the blood back up to your brain, where it is needed. But this doesn't work very well in fibromyalgia.

The classic way of diagnosing this is by doing a tilt table test. This is expensive, uncomfortable, and often unreliable, and I don't generally recommend it. There are two easier ways to make the diagnosis.

The easiest is to do a simple quiz. This is the one that we use as part of our free Energy Analysis Program (www.Energyanalysisprogram.com) that analyzes people's symptoms and lab's to determine what is causing their fibromyalgia "energy drain" and how to best address it. Here is the quiz. Circle the number in front of what best describes your situation, and add the totals. A score of nine or higher suggest a very high probability of orthostatic intolerance. I find that those with CFS or fibromyalgia who have a score of six or higher feel better when it is treated.

Self Report Orthostatic Grading Scale
Mayo Clin Proc. 2005;80(3):330–334
("Orthostatic symptoms" include worsening dizziness, fatigue, Racing heart or brain fog when standing)

Circle 0 –4 below as best applies to you

A. Frequency of orthostatic symptoms

0 I never or rarely experience orthostatic symptoms when I stand up

1 I sometimes experience orthostatic symptoms when I stand up

2 I often experience orthostatic symptoms when I stand up

3 I usually experience orthostatic symptoms when I stand up

4 I always experience orthostatic symptoms when I stand up

B. Severity of orthostatic symptoms

0 I do not experience orthostatic symptoms when I stand up

1 I experience mild orthostatic symptoms when I stand up

2 I experience moderate orthostatic symptoms when I stand up and sometimes have to sit back down for relief

3 I experience severe orthostatic symptoms when I stand up and frequently have to sit back down for relief

4 I experience severe orthostatic symptoms when I stand up and regularly faint if I do not sit back down

C. Conditions under which orthostatic symptoms occur

0 I never or rarely experience orthostatic symptoms under any circumstances

1 I sometimes experience orthostatic symptoms under certain conditions, such as prolonged standing, a meal, exertion (e.g., walking), or when exposed to heat (e.g., hot day, hot bath, hot shower)

2 I often experience orthostatic symptoms under certain conditions, such as prolonged standing, a meal, exertion (e.g., walking), or when exposed to heat (e.g., hot day, hot bath, hot shower)

3 I usually experience orthostatic symptoms under certain conditions, such as prolonged standing, a meal, exertion (e.g., walking), or when exposed to heat (e.g., hot day, hot bath, hot shower)

4 I always experience orthostatic symptoms when I stand up; the specific conditions do not matter

D. Activities of daily living

0 My orthostatic symptoms do not interfere with activities of daily living (e.g., work, chores, dressing, bathing)

1 My orthostatic symptoms mildly interfere with activities of daily living (e.g., work, chores, dressing, bathing)

2 My orthostatic symptoms moderately interfere with activities of daily living (e.g., work, chores, dressing, bathing)

3 My orthostatic symptoms severely interfere with activities of daily living (e.g., work, chores, dressing, bathing)

4 My orthostatic symptoms severely interferewith activities of daily living (e.g., work, chores, dressing, bathing). I am bed or wheelchair bound because of my symptoms

E. Standing time

0 On most occasions, I can stand as long as necessary without experiencing orthostatic symptoms

1 On most occasions, I can stand more than 15 minutes before experiencing orthostatic symptoms

2 On most occasions, I can stand 5–14 minutes before experiencing orthostatic symptoms

3 On most occasions, I can stand 1–4 minutes before experiencing orthostatic symptoms

4 On most occasions, I can stand less than 1 minute before experiencing orthostatic symptoms

If you scored six or higher, you will likely find that the treatments below will help you.

Treating Orthostatic Intolerance
These simple treatments from our treatment checklist can be very helpful.

1. Treat adrenal fatigue. I do this if people have symptoms of irritability when hungry (what the commercials call "Hangry") or a morning cortisol level of 11 mcg/dL or less. This can be done with a supplement called Adrenal Stress End and/or by using the medication Cortef at a very low dose (20 mg a day or less). This medication is very toxic at high doses, but has been shown to be very safe at these low doses. This was discussed in my earlier article on adrenal problems.
2. Increase your salt and water intake—a lot! If your mouth and lips are dry (and you're not on Elavil) you're dehydrated— drink more water (or herbal tea or lemonade sweetened with Stevia), not sodas or coffee. Celtic Sea Salt is an excellent form to use. I know you already drink like a fish, but you also pee like a racehorse! Drink more water and eat more salt. The main benefit of following the government guidelines for salt restriction, for people in general, is that they die younger—and the Social Security system thanks you. Unless you have high blood pressure or congestive heart failure, eat more salt!
3. Get medium pressure (20–30 mm) thigh high compression stockings. People find that this often results in a dramatic increase in stamina. Wear them whenever you are upright for an extended period or doing significant activity. There are many videos on YouTube that will teach you about how to use these (search on "compression stockings"). Do not get the medical ones, as they will make you look like an 80 year old. Instead, go to a sporting goods store and get fashionable ones. Low-cost, no side effects, and dramatic benefit.
4. Midodrine (Rx, Proamatine)— 5mg. ½ – 2 tablets. Take up to one hour before ‘exercise/activity' up to three times a day (for NMH/POTS) but do not take later than 5 PM. Lower the dose or stop it if it makes you feel overstimulated.
5. The hyperactivity medications Adderall, Ritalin, or Dexedrine can be very helpful. These are in the amphetamine family and therefore tightly controlled. I do not see addictive problems as long as the dose is kept under 20 mg a day, and most adults do best on 2 ½ to 12 ½ mg daily. These can also be taken intermittently instead of daily.
6. Interestingly, the antidepressants Prozac and Zoloft also helps orthostatic intolerance. These simple treatments can markedly improve your function—especially the first three, which you can do on your own.

It's time for you to Get Well—NOW!

Having had Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FMS), with the medical system having no idea how to help, I understand what you are going through. I also know you can get well!

I came down with what I call the “Drop Dead Flu” in 1975 while in medical school, which triggered my CFS/FMS. As I was working to pay my own way through school, the illness left me homeless and sleeping in parks in Oklahoma. It is exciting, though, to see how life magically brings us what we need. I met many natural health practitioners while homeless, each of whom taught me bits and pieces of what I needed to learn to get well. And I did!

After returning to medical school, I have spent the last 30 plus years researching and treating chronic fatigue and chronic pain (especially CFS and fibromyalgia). Our published research shows 91 percent improve using our “S.H.I.N.E. Protocol,” and hundreds of thousands have been helped.

You can be one of them!
Let's do it now.

Our study titled “Effective Treatment of CFS and Fibromyalgia” (published in Journal of CFS) showed that 91 percent of patients improved with treatment, with an average improvement in quality of life of 90 percent. Many patients no longer even qualified for the diagnosis of CFS or fibromyalgia after treatment! In support of our work, an editorial in the Journal of the American Academy of Pain Management (the largest multidisciplinary society of pain specialists in the United States) noted, “the comprehensive and aggressive metabolic approaches to treatment detailed in the Teitelbaum study are highly successful approaches and make fibromyalgia a very treatment responsive disorder. The study by Dr. Teitelbaum et al., and years of clinical experience make this approach an excellent and powerfully effective part of the standard of practice for treatment of people who suffer from fibromyalgia and myofascial pain syndrome.” These same principles work wonderfully for optimizing energy in those with day-to-day fatigue.

What is Causing These Syndromes?
CFS/FMS acts as a “circuit breaker,” with the hypothalamus decreasing its function to protect the individual in the face of what is perceived to be an overwhelming stress (just like blowing a fuse or circuit breaker in a house). This center controls sleep, hormones, temperature, blood flow, blood pressure and sweating. In addition, if your muscles do not have enough energy, they will get stuck in the shortened position and you’ll be in pain (think rigor mortis). This “energy crisis” can be caused by any of a number of infections, stresses or injuries.

Five Main Categories of Problems Need to Be Treated—Think “S.H.I.N.E.!”
These are the five key areas that need to be treated for your “circuit breaker to turn back on” and for fatigue and pain to resolve:

1. Sleep. Because the hypothalamic “circuit breaker” that is offline controls sleep, most patients need a mix of natural and prescription sleep treatments. For you to get well and pain free, it is critical that you take enough of the correct natural and prescription sleep treatments to get eight to nine hours sleep at night! I recommend starting with natural therapies and supplements.
2. Hormonal deficiencies.The hypothalamus is the main control center, via the pituitary, for most of the glands in the body. Most of the normal ranges for our blood tests were not developed in the context of hypothalamic suppression or these syndromes. Because of this (and for a number of other reasons) it is usually necessary to treat with natural thyroid, adrenal, and ovarian and testicular hormones — despite normal blood tests! These hormones have been found to be reasonably safe when used in low doses. Low thyroid, which reflects as fatigue, weight gain, cold intolerance and even unexplained infertility, is especially common, and the majority of those who benefit from thyroid have normal lab tests, so treatment trial should be given (using natural thyroid hormones) if symptoms are suggestive.
3. Infections. Many studies have shown immune system dysfunction in CFS/FMS, which can result in many unusual infections. These include many different viral infections (the recently reported XMRV virus is one of many), parasites and other bowel infections, antibiotic sensitive infections, and, most importantly, fungal/Candida infections.
4. Nutritional supplementation. Widespread nutritional deficiencies are common, and require dozens of nutrients. I recommend a good daily multivitamin. Ribose supplementation should also be taken as it can powerfully jump-start your energy. In our initial study, ribose increased energy an average of 45 percent in just three weeks. A second, larger study conducted by 81 physicians (currently being prepared for publication) showed an average of over 59 percent increase in energy in those with chronic fatigue and fibromyalgia.
5. Exercise as able. Do not push to the point of crashing the next day. Start by walking as long as you comfortably can (even if that is only two minutes). After 10 weeks on treatment, start to increase your walks by up to one minute more each day as able. When you are up to an hour of walking, you can increase intensity.

Think about it this a moment. We are a big bag of water. Ever wonder why it doesn't just all flow down to our legs when we stand up?

The answer is, that it does. Because of this, our autonomic nervous system has to direct the blood vessels in our legs to contract and send the blood back up to our brain and muscles where it is needed. Otherwise, the effect can be similar to rapidly losing several units of blood.

When this system is not working properly, people's blood pressure can drop significantly when they are upright for an extended period. This can result in low blood pressure (Neurally Mediated Hypertension-NMH) or a compensatory rise in heart rate called Postural Orthostatic Tachycardia Syndrome (POTS). Whatever name you choose to call it, it falls under the umbrella of orthostatic intolerance. When people stay upright, they can get dizzy, exhausted, and brain fogged.

Orthostatic intolerance is a major and very treatable part of what causes disability in CFS and fibromyalgia. And research has shown that many people diagnosed with NMH and POTS actually have CFS or fibromyalgia.

Some Background
Just a quick refresher. Fibromyalgia essentially represents an energy crisis in the body. When this happens, the area that uses the most energy for its size, called the hypothalamus, malfunctions. Basically, it is like tripping a circuit breaker when one has an energy crisis. Just as there are hundreds of ways to blow a fuse; there are numerous triggers for the energy crisis that precipitates fibromyalgia.

So what does the circuit breaker that goes off-line control? The hypothalamus controls:

1. Sleep. Which is why insomnia despite exhaustion is a hallmark of this condition
2. Hormonal function
3. Temperature regulation
4. Autonomic function

We have addressed these other components in earlier articles. To summarize, our research showed that by treating with the SHINE Protocol, 91 percent of people with fibromyalgia improved with an average 90 percent increase in quality of life (p<.0001 vs. placebo). SHINE stands for:

• Sleep
• Hormonal support and Hypotension (Dysautonomia)
• Infections
• Nutritional support
• Exercise as able

To make this easier, there is a free Energy Analysis Program at www.EndFatigue.com that can analyze your symptoms and even lab tests. I had this illness in 1975 and it left me homeless. So my goal is simple. Helping to make effective treatment for people with this illness available—to everyone.

Orthostatic Intolerance
So basically, autonomic dysfunction is a routine part of fibromyalgia, and contributes markedly to its symptoms. People are upright for a few minutes, the blood rushes to their le.g.s, their tissues don't get adequate blood flow, and they feel wiped out and brain fogged.

Simple so far. It gets simpler

How to Diagnose It
The standard approach to diagnosis is to use a Tilt Table Test. It is unreliable, will make the person miserable, and the insurance tends to not cover it leaving them with a $2000 bill. An easier approach? A wonderful study in the Mayo Clinic Journal showed that this simple quiz could be quite reliable. It is free and takes about two minutes.

Self Report Orthostatlc Grading Scale Mayo Clin Proc. 2005;80(3):330-334 ("Orthostatic symptoms" include worsening dizziness, fatigue, Racing heart or brain fog when standing)

Circle 0 –4 below as best applies to you

A. Frequency of orthostatic symptoms
0. I never or rarely experience orthostatic symptoms when I stand up
1. I sometimes experience orthostatic symptoms when I stand up
2. I often experience orthostatic symptoms when I stand up
3. I usually experience orthostatic symptoms when I stand up
4. I always experience orthostatic symptoms when I stand up

B. Severity of orthostatic symptoms
0. I do not experience orthostatic symptoms when I stand up
1. I experience mild orthostatic symptoms when I stand up
2. I experience moderate orthostatic symptoms when I stand up and sometimes have to sit back down for relief
3. I experience severe orthostatic symptoms when I stand up and frequently have to sit back down for relief
4. I experience severe orthostatic symptoms when I stand up and regularly faint if I do not sit back down

C. Conditions under which orthostatic symptoms occur
0. I never or rarely experience orthostatic symptoms under any circumstances
1. I sometimes experience orthostatic symptoms under certain conditions, such as prolonged standing, a meal, exertion (e.g., walking), or when exposed to heat (e.g., hot day, hot bath, hot shower)
2. I often experience orthostatic symptoms under certain conditions, such as prolonged standing, a meal, exertion (e.g., walking), or when exposed to heat (e.g., hot day, hot bath, hot shower)
3. I usually experience orthostatic symptoms under certain conditions, such as prolonged standing, a meal, exertion (e.g., walking), or when exposed to heat (e.g., hot day, hot bath, hot shower)
4. I always experience orthostatic symptoms when I stand up; the specific conditions do not matter

D. Activities of daily living
0. My orthostatic symptoms do not interfere with activities of daily living (e.g., work, chores, dressing, bathing)
1. My orthostatic symptoms mildly interfere with activities of daily living (e.g., work, chores, dressing, bathing)
2. My orthostatic symptoms moderately interfere with activities of daily living (e.g., work, chores, dressing, bathing)
3. My orthostatic symptoms severely interfere with activities of daily living (e.g., work, chores, dressing, bathing)
4. My orthostatic symptoms severely interfere with activities of daily living (e.g., work, chores, dressing, bathing). I am bed or wheelchair bound because of my symptoms

E. Standing time
0. On most occasions, I can stand as long as necessary without experiencing orthostatic symptoms
1. On most occasions, I can stand more than 15 minutes before experiencing orthostatic symptoms
2. On most occasions, I can stand 5–14 minutes before experiencing orthostatic symptoms
3. On most occasions, I can stand 1–4 minutes before experiencing orthostatic symptoms
4. On most occasions, I can stand less than I minute before experiencing orthostatic symptoms

_____Total Score

Scores of 9 or higher suggest Orthostatic Intolerance In fibromyalgia, I consider a score of seven or higher to be suggestive.

In addition, the instructions for how to do NASA 10-minute lean test checking blood pressures can be found at https://batemanhornecenter.org/assess-orthostatic-intolerance/ So whether you simply want to diagnose it by history, checking blood pressures, or both, the diagnosis can be fairly simple.

Treatment

Basically, these simple treatments can markedly improve function:

1. Increase salt and water intake. I know. You are already "drinking like a fish." But you are also "peeing like a race horse!" This occurs because one of the hormone deficiencies is antidiuretic hormone (vasopressin—the anti-peeing hormone), which leaves you dehydrated. In addition, salt is the sponge that holds water in our body. You need to eat large amounts of salt, sometimes even licking sea salt. You can simply do this from the palms of your hands. If you notice, you will find that your body is craving salt. You will sometimes find that in an attempt to be healthy, many of you are salt restricting. That misguided advice is a good recipe to crash and burn.
2. It is remarkable how much improvement many people will see by simply using medium pressure (20–30 mm) compression stockings. They should use ones that go at least to mid thigh, but if they can't wear those, then kneehigh ones will still be fairly helpful. You should wear them during the day when you are active (not when you are lying down for extended periods). Although low cost, these first two treatments are very helpful. Wearing something that constricts the abdomen, such as a corset or a girdle, may also be helpful.
3. Improve adrenal function. This is a critical part of our holding onto salt and water. As discussed in earlier articles, some will benefit a prescription from low dose hydrocortisone (do not go over 20 mg daily). In addition, natural adrenal support with Adrenaplex or Adrenal Stress End is very helpful for optimizing adrenal function.
4. Salt and water retaining hormones (prescription). Florinef .1 mg each morning can be helpful, but is most helpful in those under 20 years of age or those with more severe orthostatic intolerance. DDAVP .1 mg 1–2 tablets once or twice daily (basically vasopressin or antidiuretic hormone) can also be quite helpful. These replace the hormones that are low because of the hypothalamic dysfunction. It takes six weeks to see their effect. Rapid shifts in fluid levels can trigger headaches and migraines in some people. In these, it is best to slowly raise the dose, increasing by a quarter tablet every one to two weeks.
   
   For those with problematic frequent urination during sleep, giving a dose of the DDAVP at bedtime can help with this as well. This is the same medication that is given to children who bed wet.
5. Increasing sympathetic/adrenaline tone. The medication midodrine (ProAmatine) 5–10 mg twice daily (morning and early afternoon) can be fairly helpful after six weeks of use. Do not use the medication after 5 PM, or when lying down, as it can drive blood pressure too high. Lower the dose or stop if it causes too high of a blood pressure or shakiness. I will occasionally increase the dose to a maximum of 10 mg three times daily, with the last dose at 4 PM.
6. Medications that increase serotonin and dopamine. Prozac, Zoloft, and Dexedrine have all been shown to help autonomic dysfunction.
7. Some people find that a gluten and milk free diet is also helpful.

Although all of these treatments can be combined, I would begin them in the order listed as needed.

Finding the Missing Link

Although we have given a simplified version, you will find that it serves very well clinically. But there is much more to the story. Those of you interested in a bit more of the science can read on.

Excellent research by Dr. Mark Sivieri in Maryland is showing that many people with fibromyalgia also are showing IgG1 and IgG 3 antibody deficiencies (deficiencies in our body's defense function) on blood testing. This expectedly contributes to the immune dysfunction, but research and clinical experience are additionally showing that these immune deficiencies are also associated with Small Fiber Neuropathy, which is common in fibromyalgia. This is one of many factors contributing to the pain, and also seems to cause a "shrinking" of the nerves involved in autonomic function.

Studies are showing that treating with IV gamma globulin actually can result in a growing back and recovery of these nerves, helping both the small fiber neuropathy pain and autonomic dysfunction.

So we are now finding a missing link between immune dysfunction, autonomic dysfunction, and small fiber neuropathic pain.

We have found IV gamma globulin to be very helpful in a small subset of the most critically ill people retreat that has fibromyalgia and orthostatic intolerance. Essentially, these are people who are often housebound and bedbound. Getting insurance coverage for this expensive treatment can be difficult, and I will have my patients consult with Denise Haire to help guide them through the process of getting insurance authorization. She does an excellent job and is highly recommended. It is important to start with a low dose of gamma globulin and work up to the half-gram per kilogram IV each three weeks. Otherwise significant Herxheimer (infection die off) reactions can be seen. Treatment benefits, often dramatic, usually begin at about four months on the optimal dose.

Addressing the autonomic dysfunction and orthostatic intolerance seen in fibromyalgia can be fairly simple using the above quiz for diagnosis, and the treatments listed above. In combination with the rest of the SHINE protocol, and even done on its own, the clinical benefits can be marked.

Fibromyalgia can be effectively treated. And you now have one more easy and powerful tool in your toolkit!

For a superb 27 page orthostatic intolerance information sheet written by my favorite orthostatic intolerance specialist, Dr. Peter Rowe at Johns Hopkins, see http://www.dysautonomiainternational.org/pdf/RoweOIsummary.pdf

It's time for you to get well NOW!

Night Sweats are very common in fibromyalgia, and even in the general population. In two recent articles we talked about the role of reproductive and adrenal hormone deficiencies. Today we will talk about another very common problem triggering night sweats—infections.

In fibromyalgia, or even in the general population, Candida is a major player. Unfortunately, there is no test for this and the diagnosis is made clinically. Which to most doctors means that it doesn't exist. You can't diagnose and treat something if you don't even know it exists!

So how can you tell? In those with nasal congestion/sinusitis or irritable bowel syndrome without other apparent causes, it is reasonable to suspect and treat for Candida overgrowth. This not only helps these processes, but can also help eliminate the night sweats, while decreasing pain, fatigue, and brain fog.

Balancing Candida is critical. Here's how!

Candida/Fungal Overgrowth
Candida, an overgrowth of yeast/fungi (I use the two terms interchangeably in this article), occurs largely in the gut and can make toxins; spark inflammation; trigger chronic sinusitis and spastic colon; further weaken the immune system, and generally cause ill health.

When people have CFS/fibromyalgia, I recommend they simply assume they have Candida and then address it. This often not only dramatically helps the CFS and fibromyalgia, but often also makes the sinusitis and spastic colon go away! Take the quiz on the previous page to learn the probability that yeast overgrowth could be significant to your feeling poorly. Then I will tell you how to take care of the problem.

Do You Have Candida? It's Easy to Find Out!
There's no lab test that I find reliable for Candida. But a simple questionnaire can give you a pretty good idea. As I noted above though, if you have CFS/FMS, chronic sinusitis, or unexplained spastic colon, it is reasonable to simply assume you have Candida, and get it addressed.

Link to: Night Sweats Candida Fungal Overgrowth Questionnaire

Optimizing Candida Balance in Your Body
Candida is a normal part of our body's flora. It does not need to be completely eliminated. Simply put back into balance. Give these at least two months. Here's how to rebalance Candida:

Step 1: Probiotic Supplement

The healthy bacteria in a probiotic supplement can help balance Candida. We are currently seeing a marketing tendency towards very high potency probiotics. The problem with most of these is twofold. First, stomach acid kills 99 percent of them, and dead bacteria do not put up much of a fight. If too many of them get through, they can cause overgrowth of gut bacteria in the small intestine and actually aggravate symptoms.

So I would limit probiotics to ones that contain no more than 20 billion units.

After five months, the research suggests you can decrease from one a day, to taking it every other day, and usually maintain all the benefits.

Step 2: Herbal Support:
A Natural Replacement for Nystatin Nystatin is an anti-fungal medication typically used to address Candida, but only in the gut. For those of you whose insurance covers medications, it is a reasonable alternative to the herbals to help keep your costs down.

If your doctor will not prescribe nystatin for the three to six months that it takes to work, or if you prefer to go natural, a number of herbals can be very helpful.

These include:

• coconut oil (50 percent caprylic acid)
• grapefruit seed extract—helpful but use the liquid form
• berberine sulfate—an excellent herb that also helps optimize blood sugar and cholesterol levels. The dose is 200 – 500 mg three times a day, but it can be a bit hard on the stomach

Step 3: Diflucan
The nystatin, herbals, and probiotic will address Candida overgrowth in the gut. But they are not absorbed and will not take care of the problem in the sinuses. They are also not as effective in the short term as the following medication. Ask your holistic doctor for the medication Diflucan (fluconazole) 200 mg a day for six weeks. Regular physicians are not familiar with this area and generally will not prescribe it, so you'll likely need a holistic doctor to write this prescription for you. Be sure to get the generic and if not insurance covered, be sure to use the free GoodRx phone app ($54 for a 6-week course instead of over $180 for self-pay). This wonderful free app can cut medication costs by over 90 percent for most medications, for those who don't have insurance!

Step 4: Stay Away From Sugar
This tip isn't new, but it's crucial. Why? Because yeast eats sugar, 24/7. If you feed them, they live and multiply. If you don't feed them, they die off more easily. If you can't do without sweetening your foods, use stevia. Stevia is a natural and healthier sugar substitute.

Start by cutting out sodas and fruit juices, both of which have a devastating ¾ teaspoon of sugar per ounce. Eating the whole fruits are okay in moderation. Diet sodas will not feed the Candida, and Zevia has an excellent line that you can find in health food stores and even in Safeway.

A delicious, healthy, sugar-free sweet treat is sugar-free chocolate. Russell Stover makes a good one that you can find in most grocery stores. Abdallah Candies also makes an excellent one. The site has mostly chocolate with sugar, so stay with the ones shown on Abdallah's sugar-free chocolate page. Do you have gas from loose stools when you eat sugar-free chocolate? This comes from the maltitol used to sweeten it. There is an excellent Stevia sweetened brand made by Lily's LilysSweets.com/, which won't cause this problem.

Rebalancing Candida in your body is great for getting rid of night sweats. But it can also help your gut and sinuses, as well as your whole body, feel dramatically better!

Dear Readers,

Welcome to the November 2018 issue of TotalHealth Magazine.

Charles K. Bens, PhD, "How Do Genes Influence Our Health?" Bens shares with us information on how we don't inheirt diseases like cancer and others—we inheirt a genetic predisposition. Many environmental factors are controllable, such as what we eat and drink, and other lifestyle factors, such as alcohol or tobacco consumption. Bens includes a list that illustrates most of the factors that can influence genetic expression.

"The 5 Radical Rules For Healthy Weight Loss," by Ann Louise Gittleman, PhD, CNS. Long-time weight loss, detox, and anti-aging expert continues to write on the nutritional landscape. If you have an over 40 sluggish metabolism or a thyroid issue, then follow these 5 Radical Rules to lose weight and feel great! In new book "Radical Metabolism," Ann Louise shares with readers how to be successful on this plan.

Gene Bruno, MS, MHS, "Premenstrual Syndrome: Nutraceutical Relief." Twenty to 50 percent of all women are believed to experience at least one symptom of PMS regularly; only five percent of these women are estimated to have symptoms severe enough to interfere with normal activity. Whether a woman is in the 50 percent or the five percent Bruno gives us a number of nutraceuticals which have been found to be helpful.

Jacob Teitelbaum, MD, "Recovering From Fibromyalgia—Am I Crazy?" Having worked with thousands of severely ill patients over the last thirty-five years, I have found there are three steps that will leave you feeling happy, no matter how ill you are: 1. Be authentic with your feelings. 2. Make life a "no-fault" system. 3. Learn to keep your attention on what feels good. Read on for a detailed explanation of the three steps and more information on CFS and Fibromyalgia.

Sherrill Sellman, ND reports "How To Choose The Most Effective CBD Hemp Extracts." Sellman says "I am always searching for the very best products to recommend to my patients. For the past year, I have been researching all aspects of the Hemp Extract story." Sellman includes information on the health conditions this product may be helpful in treating, how it is grown and harvested.

Gloria Gilbère, CDP, DAHom, PhD, presents "Colorful Holiday Beet Salad Recipe Extraordinaire!" This Beet and Red Grape salad recipe is sure to be a winner during the holidays and beyond. Be sure to read the options, this salad is so versatile you can make it with your own signature. The extensive list of the health benefits of beets is included.

Shawn Messonnier, DVM, this month brings us Part 2 of "Arthritis In Pets." The focus is on Glucosamine and Chondroitin constitute the major GAGs in the joint cartilage: glycosaminoglycans serve as major components of articular cartilage. If your pet is showing signs of arthritis you'll find this series helpful.

Thanks to all the authors who make TotalHealth possible.

Best in health,

TWIP—The Wellness Imperative People

Click here to read the full November 2018 issue.

• How Do Genes Influence Our Health?
  Charles Bens, PhD
• The 5 Radical Rules For Healthy Weight Loss
  Anne Louise Gittleman, PhD, CNS
• Premenstrual Syndrome: Nutraceutical Relief
  Gene Bruno, MS, MHS
• Recovering From Fibromyalgia—Am I Crazy?
  Jacob Teitelbaum, MD
• How To Choose The Most Effective CBD Hemp Extracts
  Sherrill Sellman, ND
• Colorful Holiday Beet Salad Recipe Extraordinaire!
  Gloria Gilbère, CDP, DAHom, PhD
• Arthritis In Pets
  Shawn Messonnier, DVM

Click here to read the full November 2018 issue.

Olive leaf complex is quite simply one of the most useful natural compounds I’ve ever encountered. It’s a powerful health tonic that’s fantastic for general well-being and enhanced immunity.

Let me explain.

The olive plant is a rich source of such beneficial plant compounds as tocopherols, flavonoids, anthocyanins, sterols and polyphenols. “The real benefit of olive oil is that it delivers these amazing polyphenols,” says David Rubin, MD, MSc, an Israeli researcher and biochemist.

What are Polyphenols, Anyway?
Polyphenols are a group of valuable chemicals found throughout the plant kingdom primarily in berries, walnuts, olives, teas, grapes and other fruits and vegetables. They have a wide variety of health benefits. And the fresh leaves of some olive trees are loaded with them.

These polyphenols also have antimicrobial activity against a wide variety of viruses, bacteria, yeasts and fungi.

Scientific advances have shown there are at least 30 distinct polyphenols in fresh-picked olive leafs and that the full spectrum of these polyphenols in fresh-picked olive leaves gives a synergistic effect greater than any individual isolated compound alone. This is why the most bioeffective olive leaf products on the market today are always made directly from fresh-picked, whole olive leaves which provide the whole spectrum of natural polyphenolic antioxidants just as nature intended. This also enables them to work together in natural synergy to maximize the health benefits.

How is Your Immune System Functioning?
Immunity is one of the keys to good health. Think for a moment about the last time something was “going around” your office. Some people got really sick but others probably didn’t. And even among those who did, whatever “bug” was going around probably laid some people out for two weeks while others were back to work after a day or so.

The difference? The performance of the Immune System.
We can’t do much about the bugs and microbes we’re all exposed to—but what we can do is strengthen and support our immune system.

Olive Leaf Complex Can Help.
Here are some of the questions you might ask yourself if you’re interested in evaluating just how well your immune system is functioning:

• Do you get infections frequently?
• Do you have frequent colds?
• Do you get the flu?
• Do you experience inflammation or infection in the
• upper respiratory tract?
• Do you suffer from bronchitis frequently?
• Do you have recurrent skin infections?
• Have you ever suffered from recurrent infections of
• Candida or “yeast infections”?
• Have you been diagnosed with Epstein-Barr or chronic fatigue syndrome?
• Do you experience a reduction in stamina and resistance, especially when under stress?
• Are your energy levels less than you would like them to be?

Any or all of these can be symptoms of compromised immunity.

What about Olive Leaf for Bacteria and Viruses?
Your best defense against the potential damage of bacteria and viruses is to have a strong, robust immune system that will prevent them from taking root and doing harm in the first place.

Fresh-picked olive leaf complex can be a powerful weapon in the battle between your immune system and invading microbes. The bitter substances in olive leaves—since identified as the polyphenols we’ve been talking about throughout this article (oleuropein, hydroxytyrosol, caffeic acid, verbascoside, etc.) have been found to be particularly helpful in resisting bacterial damage. In fact, early research by the drug company Upjohn found extracts from olive leaves to be effective in treating infection caused by a large number of viruses as well as bacteria and parasitic protozoans.

According to James R. Privitera, MD, these are some of the unique properties possessed by the olive leaf compound for the broad killing power:

• Olive leaf has an ability to interfere with critical amino acid production essential for viruses.
• Olive leaf has an ability to control viral infection and/or spread by inactivating viruses or by preventing virus shedding, budding or assembly at the cell membrane.
• Olive leaf extract has the ability to directly penetrate
• infected cells and stop viral replication.
• Olive leaf can stimulate a process called phagocytosis, an immune system response in which cells act like little Pac-Man, ingesting harmful microorganisms and foreign matter.

In vitro studies have found olive leaf extract is effective against over 50 common disease causing organisms including viruses, bacteria, fungi and protozoa such as herpes, influenza A, Polio 1, 2, and 3; Salmonella typhimurium, Candida Krusei and Coxsackie A21.

Biochemist Arnold Takemoto, talking to the Townsend Newsletter for Doctors and Patients put it this way: “(I have) yet to discover another herbal substance that accomplishes antimicrobially what this substance achieves.”

But not just any old olive leaf…

One brand I particularly like is Barlean’s olive leaf complex. It’s made 100 percent from fresh-picked leaves; it’s never reconstituted, it has no artificial preservatives, no added sugar and it comes in a fast-acting, great-tasting liquid. Every batch has been thoroughly analyzed using High Performance Liquid Chromatography (HPLC), the global standard to scientifically identify and measure the healing compounds in herbal medicines. In Australia, consumers already spend up to three million dollars a month on this incredible olive leaf product.

Barlean’s olive leaf complex comes from trees that have been farmed naturally on virgin land in Australia. Organic vermiculture (worm created) fertilizers and pristine irrigation water are coupled with early morning harvesting and immediate transfer of the freshly harvested leaves to the processing plant.

What dosage is best?
Though there is really no “official” recommended dose for taking olive leaf complex, many experts recommend a basic maintenance dose for general use and a “therapeutic” dose for special cases. Generally, the consensus is one tablespoonful (15ml) one to two times a day taken right before eating is ideal for maintenance.

For conditions such as the common cold, flu, sinus infections and basic respiratory tract infections, the recommended dose is 2 × 5ml teaspoons every six hours, says naturopath Jack Ritchason, ND. For acute infections such as sore throat, swollen glands or fever, Ritchason recommends three teaspoons (15ml) every six hours.

On a personal note, I take a capful of olive leaf complex on a daily basis as a general tonic and immune system booster. Although this is hardly a scientific statement, I can tell you I rarely get sick and on the few occasions I do, it’s very mild and I’m back to my routine in record time. Apparently, I’m not alone in being a fan of olive leaf complex. Experts agree taking this wonderful supplement can be a valuable part of anyone’s health routine.

Says Ritchason: “From all indications—research, case studies and widespread use—olive leaf extract appears to be an extremely safe supplement that can effectively aid the body in improving immune function and fighting infection by various microbes.”

After dealing with an insane medical system, people with CFS/FMS, and even those with simple day-to-day fatigue, often come away wondering if they are crazy.

The simple answer?

NO!

At least not any more than anybody else!

Nonetheless, with all that you have been through, let's take a look at this issue in a little more depth. We have a bad habit in medicine. If a doctor cannot figure out what is wrong with the patient, the doctor brands that patient a "turkey." Imagine calling an electrician because your lights do not work. The electrician checks all the wiring, can't find the problem, and says, "You're crazy. There's nothing wrong with your lights." You flip the switches and they still do not work, but the electrician just says, "I've looked. There's no problem here," and walks out the door. This is analogous to what many people with CFS/FMS and day-to-day-fatigue experience. I apologize on behalf of the medical profession if we've called you crazy just because we cannot determine the cause of your problem. It is inappropriate, abusive, and downright cruel.

Unfortunately, some patients become so frustrated by being told that their CFS/FMS or day-to-day-fatigue is "all in their head" that they are in a catch–22. They feel if they acknowledge that they also have emotional issues, just like everyone else, they are validating the wacko doctors who say that their illness is all emotional. Rest assured, however, that extensive research proves that CFS/FMS and day-to-day fatigue are real and physical.

One of many studies that proved CFS and fibromyalgia are real was our placebo-controlled study. This is so because 90 percent of the people who received the active SHINE treatment improved dramatically (90 percent average improvement in the quality of life) and those receiving placebo did not. (See the full text of the study and detailed free info and tools on how to get well at www.Vitality101.com.) If it were "all in your head," the placebo group would have improved as much as the active group. This means that anyone who says it's all in your head is no longer simply a nitwit. Now they are unscientific nitwits. Give yourself permission to be human. You are no more and no less crazy than anyone else.

People often ask if they should get counseling. The simple answer is, as in any other severe illness, the time to get counseling is if and when you feel like it.

How to Tell If You Are Depressed
Research has shown that there is a very good way to tell if people are depressed. It is as effective as or more effective than many of the complicated depression questionnaires such as the Beck Depression Inventory.

• What is this new high-tech technique?
• Simply ask the person if they are depressed.
• Not sure if you're depressed?

Here is one more important tip. Ask yourself if you have many interests. If the answer is that you have many interests but are frustrated that you have no energy to do them, then you're probably not depressed. If you have no interests or have lost interest in the interests you used to have, then you likely are depressed and it is good to treat that along with the SHINE protocol. Depression can accompany any severe illness such as cancer, but we wouldn't dream of telling people with cancer that they were simply crazy.

Whether or not you are depressed, you may consider a type of therapist for emotional support and guidance. Be careful whom you choose, however. Make sure "psychotherapist" is one word—not two! Talk to your friends and relatives to find somebody who is good. Your physician may also be an excellent resource.

The Mind-Body Connection
I suspect that all illnesses have a psychological component. Although the highly stressed executive may have a bacterial infection such as Helicobacter pylori or excess acid causing their ulcer, it helps to remove the three telephones from their ear while treating the infection and excess acid.

I find that most people with CFS/FMS are mega-type-A overachievers. To some degree, this psychodynamic often applies to day-to-day fatigue as well. We are approval seekers who avoid conflict to avoid losing approval. We often grew up seeking approval from somebody who simply was not going to give it—no matter what. And we take care of everybody except one person—ourselves. Does this remind you at all of yourself?

Being empathic, we also often found ourselves being emotional toxic waste dumps for other people. It almost seems like we would attract every "energy vampire" in town. How do you tell an energy vampire? After an interaction with them, they tell you how much better they feel—and you feel like you were energetically sucked dry.

The Antidote
So how do you break the psychodynamic? It's pretty straightforward. In fact, it can be summarized in two letters.

N-O.

Learning to use this wonderful word can free you.

Here's how.

When somebody asks you to do something that will take you more than two hours, tell them that you are sorry but the doctor (that's me) told you that I would wring your neck if you took on anything more. Tell him that the answer is probably no, but you'll get back to them in the next twenty-four hours if you change your mind and are able to. Then walk away.

Most often, when you get home you will feel great like you have dodged a bullet. Since it was left as the answer being no unless you got back to them, you are now off the hook. If, on the other hand, you feel that you really wish you had said yes, and that it would feel really good to do it, you can always call them and change your mind.

Simple—yet effective.
In general, I encourage you to decide to say yes or no based on how things feel, more than based on your thoughts. Although it is good to do your homework and check into things, once you have finished this, see how things feel. If it feels good to say yes, then do so. Otherwise, say no.

Why is this so? Our mind is a product of our programming as a child. It basically feeds back to us what we were told that we should do to be accepted by and get approval from parents, our religious organizations, television, and God knows how many other authority figures. Our feelings, on the other hand, reflect our intuition and also let us know what is authentic to us.

So simply remember the wonderful word "no." It is a wonderfully versatile word. It is a complete sentence. It can be said gracefully or as a very firm "NO!"

There is even a great T-shirt that says, "What part of 'No' didn't you understand?"

Three Steps to Happiness

Having worked with thousands of severely ill patients over the last thirty-five years, I have found there are three steps that will leave you feeling happy, no matter how ill you are:

1. Be authentic with your feelings. This means to feel all of your feelings, without the need to understand or justify them. When they no longer feel good, let go of them.

2. Make life a "no-fault" system. This means No Blame, No Fault, No Guilt, No Judgment, No Comparing, and No Expectations, on yourself or anyone else. This means you'll be changing habits of thinking. For example, if you find yourself judging somebody, simply drop the judgment in mid thought when you notice it. And no judging yourself for judging others.

3. Learn to keep your attention on what feels good. We sometimes are given the misconception that keeping attention on problems is more realistic. That is nonsense. Life is like a massive buffet with thousands of options. You can choose to keep your attention on those things that feel good. You'll notice that if a problem truly requires your attention at any given time, it will feel good to focus on it. Otherwise, you're living your life as if you have two hundred TV channels to choose from, but you're only watching the ones you hate—to be "realistic."

For more on this, I invite you to read my e-book "Three Steps to Happiness!: Healing Through Joy."

I have treated thousands of people with Fibromyalgia worldwide. As with most illnesses, people do best by treating the physical, spiritual and mind/body components as a whole. It's time for you to Get Well-NOW!

Dear Readers,

Welcome to the September 2018 issue of TotalHealth Magazine.

Charles K. Bens, PhD, "Key Nutrients to Prevent and Reverse Chronic Illness." There are no scientific studies that say it is possible to obtain all of our nutritional needs from the food we eat. There are over 20,000 studies that prove the value of the Mediterranean Diet, combined with nutritional supplements, for the prevention and reversal of most chronic diseases. Bens supplies us with twenty-two illnesses and includes the supplements recommended to treat and prevent those illnesses.

"Rewriting the Rules of Nutrition," by Ann Louise Gittleman, PhD, CNS. A Long-time weight loss, detox, and anti-aging expert Ann Louise has been changing the nutritional landscape for decades. True to form, with this excerpt from her new book Radical Metabolism, Ann Louise unveils groundbreaking science about why the latest diet trends do not work for everyone—especially if you have a "toxic metabolism."

Gene Bruno, MS, MHS, "Cod Liver Oil & Pro-resolving Mediators: The Inflammation & Beauty Connection." The primary reason Bruno is reporting on Cod Liver has to do with inflammation. Chronic inflammation can be more destructive than beneficial and is a major component in many human diseases. Higher intakes of red and processed meats, sweets, desserts, French fries, and refined grains are associated with experiencing more inflammation.

Jacob Teitelbaum, MD, reports in "Night Sweats-Candida/Fungal Overgrowth" This is part three of a four-part series on night sweats. Night Sweats are very common in fibromyalgia, and even in the general population. In two recent articles we talked about the role of reproductive and adrenal hormone deficiencies. In this article Teitelbaum talks about another very common problem triggering night sweats—infections, and how to deal with them.

Gloria Gilbère, CDP, DAHom, PhD, a change of pace from the healthy nightshade free recipes Dr. G. presents "Jicama, Exotic And Exciting Nightshade Vegetable". Jicama spuds are part of the nightshade family, a group of vegetables that contain alkaloids, which have an impact on nerve-muscle function, joint function and digestive function—accelerating an existing inflammatory condition. Read on for preparing, storing and Jicama use.

Shawn Messonnier, DVM, this month focus is on "Chromium Use For Pets With Diabetes." Chromium is a trace mineral in the body and it plays a role in maintaining good health. Some researchers believe inadequate intake of chromium may be one of the causes for the rising rates of adult-onset diabetes.

Thanks to all the authors who make TotalHealth possible.

Best in health,

TWIP—The Wellness Imperative People

Click here to read the full September 2018 issue.

• Rewriting the Rules of Nutrition
  Anne Louise Gittleman, PhD, CNS
• Key Nutrients to Prevent and Reverse Chronic Illness.
  Charles Bens, PhD
• Cod Liver Oil And Pro-Resolving Mediators: The Inflammation And Beauty Connection
  Gene Bruno, MS, MHS
• Night Sweats-Candida/Fungal Overgrowth
  Jacob Teitelbaum, MD
• Jicama, Exotic And Exciting Nightshade Vegetable
  Gloria Gilbère, CDP, DAHom, PhD
• Chromium Use For Pets With Diabetes
  Shawn Messonnier, DVM

Click here to read the full September 2018 issue.

People often ask “Which vitamin or mineral do I need?” the answer, simply put, is “All of them!”

Fortunately, we do not have to become part of the “handful club”, where you are taking handfuls of pills each day, to get what you need. It can be done very easily with one drink and 2 to 5 pills daily.

Let’s begin with an exploration of why high potency nutritional support is so important to optimize health in those with CFS/fibromyalgia:

1. With half of the calories in our modern diet coming from sugar, white flour and fats, which are empty calories which have been stripped of nutrients, most Americans have lost over half of the vitamins and minerals they should be getting, before they even get out of the starting gate. In fact, this is the first time in human history where a very large percent of the population is both obese and malnourished at the same time.
2. Fibromyalgia is associated with increased nutrient needs. This occurs for a number of reasons which we discuss below. Because of this, the RDAs (which I call the Ridiculous Dietary Allowances) are often woefully inadequate for those with CFS and fibromyalgia
3. Because of the gut infections, poor absorption of nutrients is also a concern

• Increase salt and water intake! Especially with the adrenal fatigue and low blood pressure/dehydration issues routinely found, people who salt restrict in an attempt to be healthy will crash and burn. Salt is your friend, and I would especially recommend high quality sea salts such as Celtic or Hawaiian sea salt. Mediterranean sea salt can also be found at low-cost at Costco. Increase water intake as well.
• Most people with CFS/FMS do best with a high-protein diet and frequent small meals during the day. Everyone is different though, and eat what leaves you feeling the best.
• As much as it is convenient, add in whole unprocessed foods and cut down the junk food.
• Consider a 1 ounce protein snack at bedtime (e.g. a hardboiled egg, some meat, cheese, or fish), as this may prevent some of the 2–4 AM drops in blood sugar that wake people up. You will know if this is helpful for you in the first three days. A carb snack may worsen sleep.

1. B-vitamins. These form the backbone of energy production in our body, and I recommend at least 40 mg of vitamin B1 to vitamin B6, 400 ìg of folic acid (with at least half of this being in a form that is methylation friendly, called 5 MTHF), and 500 ìg of vitamin B12 (as methyl or hydroxycobalmin, again to support methylation). These nutrients, especially vitamin B1 and B12, are also critical for having a clear mind. Research has shown that despite normal blood levels of vitamin B12, levels in the brain in CFS are very low or nondetectable. Because of this, very high levels of B12 are required to get optimal levels in the brain in this illness. Research suggests that very high levels of the other B-vitamins may also be important.
2. Magnesium. This is another key nutrient for both energy metabolism, calming, and relief of muscle and nerve pain. The average American diet only has 275 mg per day, where a healthy unprocessed your diet has over 600 mg. It is likely that the vast majority of Americans suffer the effects of inadequate magnesium levels.
3. Vitamin C, glutamine, glycine, and cysteine. These four nutrients are critical for making the key human antioxidant, called glutathione. It has been suspected that glutathione deficiency is one of the most important common denominators contributing to CFS/FMS. Although we hear a lot about antioxidants, it is important to realize that humans make just two antioxidants, glutathione and SOD, suggesting that these are the two that are most important for people. Having optimal levels of these antioxidants is critical for optimizing immune function.
4. Zinc and vitamin A. These are also critical for immune function, and zinc deficiency is routinely seen in people with chronic infections or inflammation. Zinc and copper are also critical for making the other key human antioxidant, super oxide dismutase (SOD). More is not better though, and I recommend 15 mg a day. Consider taking an additional 20–25 mg a day for 3 months to “fill your tank”
5. Vitamin D. In those with chronic pain and also those with immune dysfunction, vitamin D deficiency is routine and a significant player. Too much however can be problematic, as it can be converted to a form called calcitriol (1,25 hydroxy vitamin D) which may suppress immune function. Because of this, sometimes people have falsely low vitamin D levels on their blood testing, despite massive amounts being taken. I consider it ill-advised to chase these blood levels. Instead, I recommend that people simply take 1000 units of vitamin D daily and get sunshine.
6. Tryptophan, tyrosine, and serine—these amino acids are critical for a number of functions including optimizing neurotransmitter levels(e.g., serotonin and dopamine) that are low in fibromyalgia
7. Selenium. This mineral is critical for immune function, but has a very narrow optimal dosing range. For most people, I recommend 55 ìg daily, as higher doses can unnecessarily increase the risk of diabetes. For those with Hashimoto’s thyroiditis, taking the higher dose of 200 ìg a day can be helpful, with the benefits outweighing the risk of the diabetes.

To keep it simple, all of the above, and essentially all of the other key micronutrients that should be found in an optimal diet (except for calories, essential fatty acids, iron, and enzymes) can be found in a simple vitamin powder called the Energy Revitalization System by Enzymatic Therapy. This allows you to get them in one simple low-cost drink each day, instead of requiring 35 to 50 pills. Try getting get what’s in the one drink in less than 50 pills. Most people will not be able to! I designed the powder to be excellent for optimizing nutritional support in everyone, and it has recently been redesigned to improve methylation as well. I will note that all of my royalties for this product are donated to charity.

The other key nutrients that I recommend for everyone with CFS/FMS include:

• Ribose. This special sugar produced by our body is the backbone of the energy molecules ATP, NADH, FADH, etc. We have now published two studies showing a dramatic average increase in energy of 60 percent after three weeks of taking 5 g three times a day. http://benthamscience.com/open/topainj/EBM.htm Two thirds of the people taking it were helped. After three weeks, the dose can be dropped to 5 g a day. I personally take one scoop of the Energy Revitalization System vitamin powder plus 5 g of ribose each morning. Just add water and stir with a fork. It will be the best 30 seconds for energy production you spend each day! It also was shown to decrease muscle pain, improve cognitive function, and improve sleep. I recommend the ribose and Energy Revitalization System vitamin powder for everyone. More good news? SHINE Ribose is now available. The same Bioenergy ribose used in the studies—at the lowest cost for Bioenergy ribose—anywhere!
• Omega-3 support. Fish oil support is critical for mood, balancing inflammation, and a host of other processes. Fortunately, you no longer have to take eight big fish oil pills each day, while putting up with the “fish oil burps”. Using a pure omega-3 with phospholipids (such as Vectomega by EuroPharma), one small pill replaces eight big fish oil gels
• Coenzyme Q10 at 200 mg daily. Take this with a meal containing some oil to optimize absorption
• Acetyl l-carnitine 1500 mg daily for four months. Most people with CFS/FMS are carnitine deficient, but I would not bother with muscle biopsy needed to show it. Carnitine is critical for both energy production and the ability to lose weight (a topic we will discuss at length in the future). It also is helpful for helping the nerves to heal. Use the acetyl l-carnitine form, as this is better able to get into the parts of the cell where it is needed.
• If the ferritin blood tests is under 60, I strongly recommend supplementing with iron. Take at least 50 mg of vitamin C along with the iron to support its absorption, and do not take the iron within six hours of taking thyroid hormone

Using the above approach, nutritional support can be done very easily. Give it six weeks to see the effects. Most people find it to be very helpful!

TREATING CFS AND FIBROMYALGIA (CFS/FM/ME) can be very satisfying, because with proper treatment even these severely ill people usually improve, and sometimes completely recover, given the proper treatment. They are also remarkably complex, however, and it is easy for you and your practitioners to burn out if you don’t use the proper tools to simplify care.

We have discussed how to effectively treat these illnesses in previous articles, and more detail can be found in my books From Fatigued to Fantastic (for practitioners) and The Fatigue and Fibromyalgia Solution (an easy read for people with the illness).

To summarize, these illnesses represent an energy crisis where the person essentially blows a fuse (called the hypothalamus). This circuit breaker can be turned back on and function restored by optimizing energy production with the SHINE Protocol (Sleep, Hormones, Infections, Nutrition, Exercise as able). In our published randomized placebo-controlled study, 91 percent of people with CFS/FMS improved with an average 90 percent increase in quality of life (p<.0001 versus placebo). So we already know these are real and very treatable conditions.

Here are 10 more tools to simplify patient care, and to add new powerful treatments for those who do not improve or recover with SHINE:

TOOLS TO SIMPLIFY CARE:

2. Treating the pain
Although the pain most often begins with muscle shortening caused by inadequate energy, the chronic muscle pain then triggers “brain pain” or central sensitization. Think of pain as being like the oil light on your body’s dashboard telling you that something needs attention. If you put oil in the car, the oil light goes out. If you give the body what it needs, the pain goes away. What it needs varies by the type of pain. When the body’s need is not addressed, the brain amplifies the pain, and the pain can become self-sustaining. This occurs because of increased microglial cell activity in the brain.

The pharmaceutical industry has focused on three modestly helpful medications that are very expensive and have significant toxicity. Three other medications, however, can also decrease microglial cell activity, which causes central sensitization and can result in significant improvement. These are:

Treat the central sensitization (brain pain).
A. Low dose naltrexone. This medication has been shown to help rebalance immunity and decrease central sensitization and microglial cell activity. Give 3–4.5 mg at bedtime, and give it at least two months to work. It may initially disrupt sleep, in which case starting with a lower dose and giving it in the morning instead can help the body to adapt. It is available from compounding pharmacies at about a dollar a day. If it was still patentable, I’m certain the drug companies would be charging $20,000–$120,000 per year and every physician would know about it. Have the patient read the book The LDN Solution by Linda Elsgood. I would use this treatment for most autoimmune and severe chronic pain conditions. Unfortunately, it cannot be used in patients also taking narcotics, in which case the two treatments below may help.

B. Minocycline 100 mg 2 x day. This antibiotic medication also helps to rebalance microglial activity, even in the absence of infections. Be sure to also treat to prevent Candida overgrowth.

C. ACE inhibitors (e.g.,—Enlapril or vasotec) 10–20 mg a day.

3. Other tips for treating pain
A. For those of you requiring narcotics, be aware these will routinely cause both B vitamin and testosterone deficiency, amplifying the pain. Be sure you take a high potency B complex (e.g.,—the Energy Revitalization System vitamin powder by Enzymatic Therapy) and have your doctor optimize your testosterone to keep it at least midrange normal.

B. hCG, research by the pain specialist Dr. Forest Tennant in patients requiring very high-dose narcotics showed that giving 25 to 500 units of hCG sublingually daily decreased the narcotic dose needed by 30 to 40 percent after several months.

C. Natural remedies can be more effective than medications for pain, and can be added to pain medications as well. The most effective? Curamin (by EuroPharma) has been a pain relief miracle. I also will add topical comfrey (Traumaplant). Although this works very quickly, give it six weeks to see the full effect. In head-on studies with Celebrex for arthritis, Curamin was shown to be more effective. Except for the LDN (which cannot be used with narcotics or Ultram), all of the above can be taken with any pain medications.

4. The free iPhone and android app “Cures A-Z” will give a brief overview of the best way to treat each kind of pain (as well as over 100 other conditions often seen in FMS, such as pelvic pain syndromes, sinusitis, dry eyes and mouth, and many more). It is kind of like having my brain in your pocket, but much less messy.

5. Treat mold neurotoxins
This can be an important part of the process in a selected subset of people. This is work developed by Dr. Ritchie Shoemaker, who is brilliant, but is so smart that he can be unintelligible. I once tried to get him to “dumb down” the information by getting him drunk, but this was only slightly effective. Dr. Neil Nathan succeeded where I failed in this, and has just come out with a brilliant and very simple ‘how to’ book for treating neurotoxins, called Mold & Mycotoxins: Current Evaluation and Treatment 2016. This is available on Amazon (Kindle), can be read in under an hour, and will give you all the information you need to immediately begin effectively treating these conditions. Dr. Nathan has jokingly nicknamed it Shoemaker/neurotoxins for Dummies. I highly recommend it for both you and your physician if you suspect that mold neurotoxins may be playing a role.

6. IV Gamma Globulin (and help with insurance and disability paperwork)
In about 10 percent of my sickest patients who have severe refractory CFS/FMS, often leaving them bedridden, I will check antibody levels of IgG 1–4 (available from Quest or LabCorp— order “Immunoglobulin G, subclasses 1–4, serum” and “Immunoglobulin, quantitative, IgA, IgE, IgG, IgM, serum”). Work by Dr. Mark Sivieri has shown that people with CFS/FMS often have IgG 3 or IgG1 subset deficiency, and this has been my experience as well. In these cases, IV gamma globulin (– 1/2 gm/kg each 3 weeks) often results in dramatic improvement after four months of use. It is very expensive, however, so they will have to get insurance coverage— which can be difficult. I use the services of Denise Haire (office"at"endfatigue.com), who can work with people to help them get insurance coverage. She also is excellent at helping people with CFS/FMS in applying for their disability insurance, and can review the medical records to help people put together the letters needed for their insurance company or Medicare, so that people that are disabled can get disability. This can be very helpful for you, while also making your doctor’s life much simpler.

7. Avoid getting raped by prescription prices
If people don’t have insurance to cover the medications, they often get charged 10 to 40 times what the insurance company is paying. A simple tool? Download the free app “GoodRx” or you can go to www.goodRx.com. Put in the name and dose of the medication, and print out a coupon that will often lower the price by 90+ percent (I’m not exaggerating—this is more the rule than the exception). Patients will be pleasantly shocked. For example, Ambien is eight cents a pill instead of $4.

Another helpful tip, as even men can get raped by pharmaceutical pricing. For erectile dysfunction, the medications can cost $70 a pill. Viagra (Sildenafil) should be available in generic, but pulled a legal ploy to avoid this. But there was a loophole that you will love. Order Sildenafil 20 mg tablets (available in generic for pulmonary hypertension). Using the GoodRx app, these are available for 50 cents a pill (one percent of the cost of Viagra). Some women also find it helpful for libido, and a small percent find it also helps their CFS!

For other medications such as fluconazole, compounding pharmacies can often make the medication at a small fraction of the regular pharmacy cost.

8. Treat the orthostatic intolerance (NMH, POTS)
Basically, when we stand up, gravity makes our blood rush down to our legs. If not for our autonomic nervous system telling our legs to send the blood back up to our brain and muscles, we would pass out. In most people, the autonomic system works well. This is not the case in CFS/FMS. A new medication just came out at a cost of $120,000 per year. An absurdity, and I will not even mention the medication’s name. My impression is that it is far more effective to simply have the person increase their salt intake dramatically (I like to use a tasty good quality sea salt like Celtic Sea Salts) and increase water intake. In addition, be sure to get medium pressure (20– 30 mm) thigh high compression stockings and wear them when you are walking around. People with CFS/FMS find these dramatically improve stamina. And for only $60/pair versus $120,000! Feel free to email me at EndFatigue@aol. com to ask for an excellent information sheet on treating orthostatic intolerance as well as a simple quiz that will tell you in one minute whether orthostatic intolerance is present (validated in the Mayo Clinic Journal—I find it much better than spending $1000 for a tilt table test).

9. For anxiety
A. Two new herbals called Anxiocalm and Maximum Stress Relief (both in the Terry Naturally line by EuroPharma) are excellent.

B. Severe anxiety is a clue that mycotoxins may be an issue (see #5 above).

C. check out the Buteyko Breathing Method.

10. Going gluten free
When people don’t respond to other treatments, I have them do a gluten and dairy free diet for three weeks to see if it helps (stay on it if it does). This is difficult to sustain long-term, so I do not begin treatment with it, as most people get well without having to avoid milk and gluten. It is not enough to simply avoid gluten and dairy, or you will become malnourished. Instead, do a consultation with a nutritionist. My favorite? The wife of Brad West ND, Chef Lauren Hoover-West has appeared and cooked on ABC Live in Chicago and Sacramento. She has cooked for four United States Presidents and is the author of No Wheat No Dairy No Problem cookbook and the blog site www.NoWheatNoDairyNoProblem.com. She can guide people via phone consultation.

Here is one bonus tip. People don’t like being part of the “handful club,” taking handfuls of pills each day. They also won’t stick with it.

I make this easy for everyone, and people are very happy because they see a quick response, I simply have them take a morning energy drink called the Energy Revitalization System (by Enzymatic Therapy) which replaces over 35 supplement pills with one low-cost easy drink (replacing their multivitamin and sometimes dozens of other pills). I have them add one 5 gm scoop of ribose (SHINE), which in two studies we published increased energy an average of 61 percent after three weeks. I add one Vectomega tablet, which replaces eight fish oil capsules. This is what I take each morning, and you will find that it turbocharges you and most people with healthy energy as well.

It’s a lot of fun helping people with this illness get well, and we do three hour in person or phone consultations with people worldwide. For info on making an appointment, contact Sarah at Appointments"at"endfatigue.com.

Hair loss or thinning is a common and important issue, especially in those who have chronic fatigue syndrome or fibromyalgia. If you’re experiencing hair loss in a generally thinning way (diffuse), then treating: nutritional deficiencies and an underactive thyroid are especially important.

Low iron is a key nutrient for hair growth, and standard testing misses most cases of iron deficiency. In fact, despite the fact that most physicians consider a ferritin blood test (the best measure of iron deficiency or excess) over 12 to show adequate iron, a recent study in patients with chronic illness and even mild anemia (a description fitting most people with CFS) showed that a ferritin under 100 was diagnostic of iron deficiency!

In addition, for those with Restless Leg Syndrome (RLS) and a ferritin under 60, iron can be more effective than the medication Requip, and can eliminate RLS as well as your iron levels optimize.

In CFS and fibromyalgia patients, as in any chronic illness, a very common cause of unusual hair loss is a condition called “Telogen Effluvium.” This is when the normal cycles of natural growing and falling out of the hair follicles become jolted out of their usual random phase due to illness. In this condition, a severe physical stress — such as pneumonia or a CFS flare up — can produce unusual hair loss which doesn’t begin until 3–9 months later. This type of hair loss is reversible, although it can take 3– 9 months. It often grows in more quickly than this, but it’s better to be pleasantly surprised than to feel disappointment and abandon the needed RX too quickly.

To treat hair thinning:

1. Optimize overall nutritional support. The Energy Revitalization System vitamin powder is excellent for this, plus take a 29 mg iron tablet for 6–12 months (until the ferritin is over 100). Do not take iron if the ferritin is over 200 (and have your doctor check for iron excess called hemochromatosis, which is easy to treat but life threatening if missed). 2. Optimize thyroid function—even if your thyroid labs are “normal.”

Treating with the S.H.I.N.E. Protocol overall will also help hair growth as well as dramatically improve the quality of life in CFS and fibromyalgia. Please note that the above applies only to stress-induced hair loss, which is evidenced by widespread thinning. Other patterns have a different cause. For example:

1. Autoimmune issues. In this condition, hair loss appears as multiple coin-shaped bald spots called alopecia areata.

2. Male pattern baldness. If present in a woman, this suggests elevated testosterone and DHEA. If these are present, and a fasting morning insulin blood test is over 10 (showing insulin resistance), this would suggest the presence of PCOS (polycystic ovarian syndrome). This improves by treating the insulin resistance with the medication metformin (very safe and helpful in PCOS) and eliminating excess sugar.