Beyond Fatigue Exploring the Roots of Chronic Fatigue, Fibromyalgia & Other Syndromes Fatigue is one of the primary complaints that doctors hear from their patients, day after day, week after week. Not only is it a symptom of many health conditions, it is also a result of lifestyle factors such as poor diet, dehydration, high stress and too little sleep. Thus, it is not surprising that reporting fatigue as a symptom often sends both practitioners and their patients on a scavenger hunt for a diagnosis, especially when fatigue occurs in conjunction with other generalized symptoms such as pain, trouble sleeping and “brain fog.” But chronic fatigue is very real, as is chronic fatigue syndrome (CFS). Just ask the more than one million American adults (approximately 80% of which are

women) that the Centers for Disease Control and Prevention (CDC) now believe may be affected by CFS. Add to that over five million adults (as reported by the CDC in 2005) who may suffer from chronic fatigue associated with fibromyalgia syndrome (FMS). And the millions more that have symptoms of chronic fatigue but do not quite meet the CDC guidelines for a CFS diagnosis (see box on page 5). As of 2013, Dr. Jacob Teitelbaum, who specializes in the treatment of both CFS and FMS, estimated that the combined incidence of CFS and FMS is in the range of 12

to 24 million Americans. That statistic represents a lot of lost productivity, both socially and economically, not to mention a severe hampering of personal quality of life.

Why So Much Fatigue?

In The Fatigue and Fibromyalgia Solution, Dr. Teitelbaum explains that a modern day “perfect storm” of energy-draining circumstances has created an epidemic of fatigue. First and foremost, he points out that the average American consumes a high-calorie, low-nutrient diet. We are “both obese and malnourished, for the

Dr. Jacob Teitelbaum... estimated that the combined incidence of CFS and FMS is in the range of 12 to 24 million Americans. 1

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first time in human history.” Dr. Teitelbaum continues “Dozens of nutrients are critical for our energy-producing machinery, and without these, fats and other calories cannot be converted into energy. This leaves people both overweight and exhausted.” The second energy drain is sleep deficiency, says Dr. Teitelbaum. With the advent of electricity, light bulbs, television and computers that keep us awake after dark, the average night’s sleep has been reduced from over nine hours per night to under seven hours per night. We are pushing our bodies to do

more, with less sleep. In addition, “restless leg syndrome and sleep apnea are also much more common in people with CFS/FMS,” according to Dr. Teitelbaum, further diminishing good solid sleep. An overburdened immune system is the third factor contributing to Dr. Teitelbaum’s “perfect storm” scenario. Our ancestors did not have to deal with the abundance of environmental toxins that now exist, and which constantly bombard our immune system. Any “foreign invader” triggers the immune system to respond, gradually depleting our adrenal

glands, potentially to the point of exhaustion. Compounding both the nutritional deficiencies and a burdened immune system is poor digestion or absorption due to the use of antibiotics and acid blockers, “leaky gut” due to candida overgrowth, and other gastrointestinal flora imbalances. Dr. Teitelbaum recognizes hormone imbalances or deficiencies as another major factor contributing to the fatigue epidemic. He notes that increased stress not only exhausts our adrenal glands, but also suppresses the hypothalamus,

But My Hormone Lab Test Results are “Normal”... Dr. Teitelbaum shares a humorous but useful analogy to explain what “normal” means when referring to lab test results. He likens it to a “shoe problem” where the normal range for adult shoes might be size 5 to size 13, and a “shoe doctor” could randomly assign you a shoe anywhere within that range and consider it a good fit, no matter what size your foot actually is. You might then tell your shoe doctor that the shoe just doesn’t feel right, and he’d tell you that you’re fine because you are within the “normal” range (perhaps leading you to believe that “it’s all in your head”). But hormone levels, just like shoes, are not “one size fits all,” admonishes Dr. Teitelbaum. Being within the “normal” range may not be “normal” for you. When trying to optimize hormone levels, it is important to know your baseline, and whether your lab results are up or down from that baseline. Working with a practitioner—and a reliable lab—to establish your baseline and monitor hormone levels is well worth the effort.

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Dr. Teitelbaum recognizes hormone imbalances or deficiencies as another major factor contributing to the fatigue epidemic. which is the hormone control center. “In CFS/FMS, hormone problems are widespread,” according to Dr. Teitelbaum, even when the lab test results come back “normal,” as they often do (see box on page 2). The “perfect storm” is a combination of factors that can lead to a major “energy crisis” throughout the body, causing the hypothalamus to eventually shut down, which Dr. Teitelbaum calls the biological equivalent of the circuit breaker “blowing a fuse.”

How Do You “Cure” Fatigue? Considerable research over the past 50 years supports a theory that acquired mitochondrial dysfunction (as opposed to inherited or genetic mitochondrial dysfunction) may be an underlying

cause of not only CFS and FMS, but also a wide range of seemingly unrelated disorders including but not limited to diabetes, Parkinson’s disease, coronary artery disease, Alzheimer’s disease, migraine headaches, epilepsy and hepatitis C, as well as mental disorders such as bipolar disease and schizophrenia. As you might remember from biology class, mitochondria are the “power supply” part of the cell that turns fuel into energy. The mitochondria convert nutrients into energy so that the various cells in the body can do their jobs. Cells harvest the energy stored in food through a multi-step biochemical process called cellular respiration. In simple terms, cells burn food in the presence of oxygen to produce a “high-energy” molecule called adenosine triphosphate (ATP), the primary 3

energy “currency” in the body. The chemical energy stored in ATP molecules is used to drive various metabolic processes such as biosynthesis and cell division. If the mitochondria are not healthy or are damaged by toxins from infections, heavy metals, pollutants and solvents, the energy supply suffers, the cells don’t function properly, and fatigue sets in at all levels—from the cellular level on up. Damaged mitochondria require additional energy to “heal” or repair, adding to the mitochondrial dysfunction and further compounding the energy crisis. In this way, “mitochondrial dysfunction can result in a feed forward process, whereby mitochondrial damage causes additional damage,” according to an article in Experimental and Molecular Pathology.

Protocols Supporting Mitochondrial Function Dr. Sarah Myhill, a leading authority on CFS and FMS in the United Kingdom, has had considerable success treating her patients with a protocol based on improving mitochondrial function. This protocol essentially involves: 1. Eating a Stone Age diet (similar to a Paleo diet). Continued on Page 4

2. Taking nutritional supplements, including CoQ10, acetylL-carnitine, D-ribose, magnesium and niacinamide (Vitamin B3). 3. Getting a good night’s sleep on a regular basis. 4. Achieving a balance between work, exercise and rest. Dr. Teitelbaum’s S.H.I.N.E. protocol, which also promotes healthy mitochondria, purports to have a remarkable success rate of over 80% among his patients. His approach is similar to Dr. Myhill’s, but it also includes specific attention to hormone balance. The S.H.I.N.E. protocol involves: 1. Sleep, with the goal of eight to nine hours of solid, deep sleep per night. 2. Hormones, with the goal of optimizing the adrenals (cortisol and DHEA), thyroid (T3 and T4), testosterone, estrogens and progesterone, using bioidentical supplements as needed. Dr. Teitelbaum also notes that vitamin D, which is actually a hormone, is “critical for regulating immune function.” A vitamin D deficiency can trigger autoimmune illness and increase the risk of infection, also contributing to reduced energy.

3. Immune Support, with the goal of clearing the body of yeast, candida and fungal infections that can lead to a “leaky gut,” and adding probiotics to keep the gut healthy. Dr. Teitelbaum suggests that anyone with CFS should also be checked for bowel parasites and viral infections that can affect the gastrointestinal tract. 4. Nutrients, with the goal of optimizing the body’s healing powers by eating a healthy diet of whole foods, avoiding processed foods and sugar, taking vitamin supplements and fish oil. Dr. Teitelbaum recommends D-ribose, CoQ10 and acetyl-Lcarnitine to “jump start” the mitochondrial energy production.

5. Exercise, as able, with the goal of reconditioning, so that the body of someone with CFS or FMS can gradually make the energy needed to do conditioning exercise. The S.H.I.N.E. protocol is described in further detail in an easy-to-read, “do it yourself” manner in The Fatigue and Fibromyalgia Solution: The Essential Guide to Overcoming Chronic Fatigue and Fibromyalgia, Made Easy! There is a chapter devoted to each of the five areas, complete with questionnaires and worksheets to guide patients through the protocol.

“When extrapolated to the US population, our estimates indicate that as many as 800,000 adults may have CFS. Fewer than 20% of these individuals will have been diagnosed with CFS and received medical attention for their fatiguing illness,” said William Reeves, CDC. 4

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What’s in a Name? Is it Chronic Fatigue? Fibromyalgia? Depression? Or something else? Both chronic fatigue and fibromyalgia have been around for quite some time, and the fact that the medical field is still debating what to call these conditions, not to mention how to diagnose them, is telling in and of itself. We are still learning about these extremely complex syndromes with many overlapping symptoms.

characteristics that are very real, and not “all in your head.” CFS/CFIDS/ME/ME-CFS

As its name implies, chronic fatigue syndrome (CFS), also sometimes called chronic fatigue and immune dysfunction syndrome (CFIDS), is a condition characterized by persistent, debilitating fatigue Too often, well-intended peothat does not improve with ple (healthcare practitioners rest. But fatigue is just one asincluded) suggest that those pect of this complex condition. with chronic fatigue take a vaIn Canada and Europe, it is cation, or a sleeping pill, or get often called myalgic encephaa different job, or just “buck lomyelitis (ME) or myalgic up” and get on with life. If encephalopathy chronic faonly it were that easy … tigue syndrome (ME-CFS) The suggestion that “it’s all in to more accurately describe your head” can create a feeling the condition. For the sake of of helplessness, contributsimplicity, we will use CFS to ing anxiety or depression to represent all variations of this the symptoms already assocomplex syndrome. ciated with a fatiguerelated The CDC’s framework for condition. diagnosing CFS requires a It is unfortunate that many combination of: CFS/FMS patients undergo 1. Extreme, persistent fatherapy to address mental tigue that lasts longer than 6 health and depression, with months, coupled with the result that antidepressants 2. Four or more of the followare now frequently offered ing symptoms, also for longer as “treatment.” While some patients may “feel better” with than 6 months, but having this approach, it does not ad- started after the fatigue: dress the underlying cause(s). n Severe, prolonged exhausDr. Myhill notes that the ATP Profile, a multi-part lab test that measures mitochondrial function, is “an objective test of chronic fatigue syndrome which clearly shows this illness has a physical basis” that antidepressants do not address. Whatever you call it, the syndrome has physical

tion after physical or mental activity

n Unexplained muscle soreness (not from exercise or trauma) n Pain in multiple joints without swelling or redness

n Memory loss or impaired concentration n Frequent or recurring sore throat n Headaches of a new type or severity n Tender, mildly enlarged lymph nodes In addition to these diagnostic criteria, there are numerous other generalized symptoms that can coexist in people with CFS, including numbness, anxiety, dizziness, an irregular heartbeat, allergies and chemical sensitivities. FM/FMS According to Dr. Sarah Myhill, one of the leading authorities on CFS, fibromyalgia syndrome (FM or FMS) often occurs along with CFS. Fibromyalgia literally means “muscle pain.” Although the primary symptoms of FMS relate to pain, the second most common symptom is sleep disturbances and fatigue. Dr. Teitelbaum suggests that although CFS and FMS may be two names for the same condition, a diagnosis of fibromyalgia may be more “socially acceptable.” The reason for that may have something to do with the fact that the pharmaceutical industry has been spending approximately $270 million a year on marketing FDA-approved medications for treating fibromyalgia.

n Sleep disturbances, or sleep without rejuvenation

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References n The Fatigue and Fibromyalgia Solution: The Essential Guide to Overcoming Chronic Fatigue and Fibromyalgia, Made Easy! by Jacob Teitelbaum, MD; The Penguin Group; New York, NY; 2013. n “Mitochondrial dysfunction and molecular pathways of disease” by Steve R. Pieczenik and John Neustadt; Experimental and Molecular Pathology; 83 (2007) 84–92. n “Targeting mitochondrial dysfunction in the treatment of Myalgic Encephalomyelitis /Chronic Fatigue Syndrome (ME/CFS) – a clinical audit” by Sarah Myhill, Norman E. Booth and John McLaren-Howard; International Journal of Clinical and Experimental Medication; 2013;6(1):1-15. n “New Study Finds High Prevalence Of Chronic Fatigue Syndrome” by Melissa Kaplan in NCID Focus, Volume 13, Number 1, Winter 2004 (http://www.anapsid. org/cnd/diagnosis/cfscdc2004.html)

Connections is a publication of Women’s International Pharmacy, which is dedicated to the education and management of PMS, menopause, infertility, postpartum depression, and other hormone-related conditions and therapies.

This publication is distributed with the understanding that it does not constitute medical advice for individual problems. Although material is intended to be accurate, please seek proper medical advice from a competent healthcare professional. Publisher: Constance Kindschi Hegerfeld, Executive VP, Women’s International Pharmacy Co-Editors: Julie Johnson and Carol Petersen, RPh, CNP; Women’s International Pharmacy Writers: Kathleen McCormick, McCormick Communications Copyright © May 2014, Women’s International Pharmacy. This newsletter may not be reproduced or distributed without the permission of Women’s International Pharmacy. ® For more information, please visit www.womensinternational.com or call (800) 279-5708.

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