Chronic Fatigue Syndrome and Fibromyalgia

There is no one, sure-fire, effective treatment either complementary or conventional for ME or Fibromyalgia. Much can be done usually to meaningfully improve symptoms, sometimes to radically improve and sometimes almost to ‘cure’ the situation. However, be very cautious about promises of an instant magical ‘cure - It simply does not exist. Also be careful on the internet if you are tempted to buy products which promise miracles.

My Advice on Tackling Fibromyalgia

• Do not self-diagnose. Get a proper diagnosis from your GP and/ or specialist before diagnosing Chronic Fatigue Immune Disorder or Chronic Fatigue Syndrome. Part of this process is to have appropriate medical testing to rule out life-threatening medical disorders needing urgent treatment.
   

• If you do not consider yourself to be depressed then maybe you are not depressed! Although you may be told "You're just depressed" if your condition is not responding well to appropriate antidepressant therapy then perhaps other causes for your fatigue or pain need to be sought.

 

MY ‘Toolkit’ for investigating Chronic Fatigue and Fibromyalgia

A Proper Medical History: The most important and useful investigative and diagnostic tool is an in-depth medical history and to obtain that I usually quite a while taking a full, expanded, medical history.  
 

The Investigations which I use:

I am selective about investigations and only use those which are necessary to guide treatment for a particular patient.

Comprehensive Digestive Stool Analysis and Comprehensive Parasitology (Doctors Data Laboratories): Untreated low-grade persistent bowel infections whether bacterial or fungal are frequently a part of the problem. Sometimes treatment yields an excellent response. This test also enables us to look at the adequacy of digestive enzymes, hydrochloric acid in patient’s digestive tract since some patients have problems absorbing and until this is fixed there will be very little progress.

Other Important Biochemical and Hormonal Investigations

• ATP Profile: ATP is the currency of the energy in patients cell. If you cannot produce enough ATP and are unable to recharge it in an efficient manner then the cells have no energy. More information below at HELPING CELLS PRODUCE ENERGY

• CoQ10 Level, NAD, SODase STUDIES: these are also important in basic energy production

• Cell-free DNA: Gives an estimate of how damaged the patients biochemical system is.

• Sweat Test for Minerals (BioLab): Without the correct minerals we cannot function properly. Some individuals take tons of supplements but do not absorb. This helps clarify issues such as these.

• Essential Fatty Acids: Omega 3 and Omega 6 essential fatty acids are important for everything from skin to brain and lots of other things in between.

• White blood cell Zinc, Red Blood cell Magnesium, Vitamin Profile including various B Vitamins and also fat-soluble vitamins.

• Kelmer test for Body Mercury Load: I consider Mercury is a toxic metal. Occasionally it may be important to advise mercury removal. I try not to do this often because it is expensive and not without its hazards.

• Hormonal Profiles: Free thyroid hormone levels including free T3 and free T4, salivary cortisols, Testosterone levels, estrogen and Progesterone levels,

• Neurotransmitter Profiles (occasionally): Serotonin, Dopamine, Nor-Adrenaline, Adrenaline levels etc

• More ‘run-of the-mill’ hospital laboratory testing: B12, Folic Acid, Ferritin, Full Blood Count. Occasionally we will pick up an undiagnosed pernicious anemia or low thyroid.

Other investigations as appropriate.

Treatments

 At the risk of sounding simplistic; Fix what seem to be wrong having taken a proper history and performed appropriate investigations, is the basic methodology:

In a nutshell my most useful interventions are:

Ultraviolet blood therapy, diagnosing and treating undiagnosed bowel infections, helping people to stop eating junk food all the time, recognizing and treating vitamin and mineral deficiencies, realizing that some individuals are not absorbing properly and helping them to do so, recognizing and treating multiple chemical sensitivity and organizing resources to help people deal with any longstanding emotional issues whether from their home environment, relationships or form their past.

My medical credo is that people usually need a ‘blend’ of several treatment approaches rather than ‘lots’ of one particular approach.

Very occasionally there may be an undiagnosed straightforward medical illness which has not shown itself despite previous investigation.

• If there is a persistent low-grade bowel infection then treat it. This may dramatically help fatigue, brain fog or irritable bowel syndrome. It is most important to get rid of any unwanted gut bacteria and re-inoculate the bowel with ‘good’ bacteria. Also people may need digestive enzymes etc to help them to absorb properly.

• If there is a vitamin or mineral deficiency particularly Magnesium Chromium or Zinc or the B Vitamins then treat it. Subtle B vitamin deficiencies may de diagnosed. Important to treat via supplementation. B Vitamins (despite being water-soluble) are best absorbed with a fatty meal.

• Address any omega-3 and omega-6 essential fatty acid deficiencies.

• I may advise some amino acid therapies to help normalize brain neurotransmitter chemistry particularly where there is sleep problems or anxiety. It is my belief that viral infections may be associated with seeming deficiency of brain chemical such as serotonin, dopamine etc. B vitamins also have an important role to play here. Neurotransmitters also control the immune system.

• Persistent Viral Illnesses and Ultraviolet B Blood Therapy (UVB): Sometimes a patient will complain of symptoms which are akin to a recurrent flu-like illness: Swollen Glands, sore throat, muscle aches and pains, fuzzy head. Or, sometimes, a patient will have improved a lot with the nutritional biochemical approach but not be truly better. Sometimes I meet an adult or teenager who had a ‘terrible infection’ of some kind whether bacterial, viral or mixed. In cases such as these UVB may be very useful. For more extensive information please follow this link to the Ultraviolet Blood Therapy information section.

• Detailed Help with Food Choices, Eating Plans: Some groups, particularly teens, may need help in this area.

• Far-Infra Red Sauna Detoxification: There are now infra-red saunas available which are totally portable, can be used in the home. I will sometimes ask patients to purchase one of these if I feel it will be helpful.

• Stress Management and Pacing: Occasionally individuals may be under a lot of strain or just plain doing too much to allow themselves to recover. Learning stress-management techniques and also learning to pace themselves so that they ‘budget’ their energy appropriately may be helpful.

• Counseling Sometimes patients have life circumstances which are blocking their recovery and they need help to deal with these.

• Acupuncture: Occasionally I will use some advanced acupuncture techniques to help with relaxation, sleep or pain management.

 

Brain Chemistry in Pain and Fatigue

Depression, Fatigue, Fibromyalgia, Chronic Pain and Mood problems are closely related to brain chemistry and hormonal status.

The brain ‘pulls the strings' in many aspects of the body’s functioning. Brain chemistry may contribute to chronic pain problems, anxiety, insomnia, low mood etc.

Consider the analogy of a car:

• Neurons (the cells in the brain) use some neurotransmitters as an accelerator (i.e. to produce a signal) and some as a brake (i.e. to dampen down or block a signal).

• The accelerator is equivalent to the excitatory neurotransmitter system which includes the neurotransmitters glutamate, epinephrine, norepinephrine, and PEA to name a few. When these chemicals are released, the hypothetical accelerator is pushed, and the nervous system revs up. The excitatory neurotransmitter system is responsible for sending a signal.

• The brake is equivalent to the inhibitory neurotransmitter system which includes the neurotransmitters GABA and serotonin. When these chemicals are released, the hypothetical brake is pushed, and the system slows down. The inhibitory neurotransmitter system is responsible for ‘blocking’ a signal.

 

There are also many other transmitters and modulators that factor into the effectiveness of the two systems and they include glutamine, glycine, histamine, glutamate, taurine and various hormones.

Just like in a car, the brakes must be maintained or the car will not be able to stop. If the inhibitory system isn't maintained or replenished, then the excitatory system will be allowed to go out of control, and eventually, it too will become exhausted.

How do we treat neurotransmitter imbalances?

We use amino acid precursors and Vitamin supplementation and also sometimes low doses of prescription medicines to increase levels of specific neurotransmitters. The amino acids and the vitamins and mineral are to increase the amount of ingredients available to the body and the medicines, if needed, are used to slow down the breakdown of the neurotransmitters

Dopamine is a major neurotransmitter and serves as a precursor to norepinephrine and epinephrine. It plays a significant role in cognitive function and emotion, as well as roles in the cardiovascular, renal, hormonal, and central nervous systems. Long-term excess is often associated with increased blood pressure whilst long-term deficiency may result in impairment of some movement, memory problems and mood swings.

Adrenaline (Epinephrine) is a neurotransmitter and hormone essential to the body's metabolism. Epinephrine raises the concentration of free fatty acids in blood and releases glucose from the liver. Long-term excess may result in anxiety, cardiovascular problems and problems with glucose utilization. Long-term deficiency can be associated with fatigue, depression and digestive problems.

GABA is the major inhibitory neurotransmitter of the brain, occurring in 30 -40% of all synapses. Insufficient GABA neurotransmission has been associated with increased anxiety and sleep problems.

Norepinephrine (Nor- Adrenaline) is most active in the waking state and is important for focus and attention. It also seems to contribute to anxiety and its turnover is increased during stress. Patients with depression appear to have lower levels of norepinephrine.

Serotonin is an amine neurotransmitter synthesized by enzymes that act on tryptophan and/or 5-HTP. Serotonin has been extensively studied and is a therapeutic target for conditions like depression, compulsive disorders, anxiety, insomnia, and migraines.

Acetylcholine is one of the major neurotransmitters and has been shown to be essential for brain development. Learning ability, mental awareness and memory function tend to decline with lowering levels of acetylcholine whilst long-term excess may be associated with exhaustion of pancreatic activity and activation of destructive processes.