Dr. Jacob Teitelbaum's Column
...expert advice on CFS, Fibromyalgia and other Health Topics.
You can benefit from Dr. Teitelbaum's wisdom and experience by visiting us at The Environmental Illness Resource regularly to read articles from his latest newsletter!
Monday, September 26th, 2011:
30 Top Tips for Treating CFS & Fibromyalgia When All Else Fails: Part II30 Top Tips for Treating CFS & Fibromyalgia When All Else Fails
by Jacob Teitelbaum MD
Part 2 of a 3-Part Series
In part 1 of this series, I focused on the importance of rechecking the basics, and I described the first 10 of my top 30 tips for treatment.
In part 2, I discuss advanced approaches for optimizing hormonal and nutritional support — while also making sure the basics are covered — and I give you my next 10 top tips for treatment!
Part 2: Recheck the Basics — and then Add Advanced Therapies
Note: As in last week's installment, I've put an asterisk (*) next to treatments that are self-care/non-prescription. The other treatments require that you work with your doctor. Also, as I did in Part 1, I've listed treatments that require a blood test at the end of the article (a convenient summary in case you want to do all those tests at one time).
(Continuing the "30 top tips" numbering at 11, as numbers 1-10 are in Part 1...)
11. Consider a trial of high-dose T3 thyroid hormone.
If it hasn't been tried, consider a trial of high-dose T3 thyroid hormone. (For more information on this approach, see the Dr. Lowe website.) Many people with fibromyalgia are resistant to thyroid hormone — it's as if their body is "deaf" and has trouble "hearing" the hormone — and they need high levels to achieve normal function.
*12. Optimize your adrenals with Adrenal Stress End, Cortef, DHEA-S.
Is your adrenal functioning optimized? Probably not, if you have one or more symptoms of suboptimal adrenal functioning, which include low blood pressure, post-exertional fatigue, or becoming very irritable when hungry. You can optimize adrenal function with the Adrenal Stress End herbal mix, the adrenal hormone Cortef (5 to 15 mg daily by prescription), and DHEA (if DHEA-S is suboptimal). You should also drink more water and consume more salt (unless you have high blood pressure or heart failure).
*13. Stimulate hormone production with Pregnenolone.
Pregnenolone is the "mother hormone" — the main raw material your body uses to make other hormones, like cortisol, DHEA, estrogen, progesterone and testosterone. We have found that pregnenolone is often low in CFS and fibromyalgia. Have your level checked — and treat if you find it's suboptimal.
14. Consider growth hormone injections.
IgF is a biochemical marker for growth hormone (GH) — and we see GH deficiency over and over again in fibromyalgia. If your IgF levels are suboptimal, consider GH injections. (These are expensive, so this isn't an early choice for treatment.) In a recent study, the dose was .006 mg/kg/d of GH, adjusted based on IgF levels. Good news: exercise, sex, and sleep also raise GH. (You can read more about FMS and GH in one of this issue’s research briefs.)
15. Oxytocin can produce quick benefits in some cases.
Oxytocin is an important hypothalamic neurotransmitter, which is shown to be low in FMS. I suspect a deficiency is present in those with pallor and cold extremities. The typical dose (administered via intramuscular injection) is 10 units (add 0.2 cc lidocaine without epinephrine to minimize stinging). If it's going to help, the benefits will begin in 45 to 60 minutes and are clear cut. If the injection works, you can try a sublingual (under the tongue) or nasal spray, made by a compounding pharmacy, to see if there's a similar benefit — but these forms are less effective and more expensive than the injections. The injections can be used daily, or daily as needed.
16. In women, look for PCOS (Polycystic Ovary Syndrome).
Ten percent of American women have PCOS — a condition characterized by high blood levels of testosterone and DHEA associated with insulin resistance (blood sugar problems). The symptoms can include acne, increased facial hair, irregular periods and infertility. If those symptoms are present along with an elevated testosterone and DHEA level, and a fasting insulin blood level over 10, you might have PCOS triggering your CFS/FMS. Treatment consists of:
- The prescription anti-diabetes drug metformin, at 500 mg, 1 to 2 times daily. (Metformin can cause vitamin B12 deficiency, so be sure to take the Energy Revitalization System vitamin powder with it. Beyond that, it is an excellent and very safe medication.)
- Cortef, at 10 to 20 mg a day, can also improve PCOS.
- Cut sweets out of your diet — sugar flares PCOS.
- Some birth control pills can help regularize the menstrual cycle.
Make sure your foundations are covered by taking the Energy Revitalization System vitamin powder (1/2-1 scoop a day) plus ribose (Corvalen) 5 gm 2-3x day. I also recommend zinc (sulfate or picolinate) 20-25 mg a day for 3-6 months for everyone with CFS/FMS. After 3-6 months, the zinc in the vitamin powder is enough to maintain zinc levels. At a few cents a day, it offers remarkable immune benefits at very low cost.
*17. Take these additional supplements for first 3-6 months.
For 3 to 6 months, add:
- Coenzyme Q10, 200 mg a day.
- Acetyl L-carnitine, 1500 mg a day.
- Iodine, 6.25 mg a day.
- Vectomega (a special fish oil), 1 to 2 capsules a day.
- Zinc, 20-25 mg a day (zinc deficiency is incredibly common in CFS and FM. See Zinc Makes You Smile — Literally! to learn more about this mineral).
*18. Check for food allergies.
Food allergies can severely aggravate CFS/FMS. To see if food allergies are playing a role, go on a Multiple Food Elimination Diet. A wonderful technique to treat food allergies is a specially modified form of acupressure, called NAET. (For more information, and a list of the over 10,000 practitioners worldwide, visit the NAET website.) In addition, many food allergies settle down after you provide adrenal support and treat Candida.
19. Take high-potency nutritional IVs.
These are called Standard IVs at the Fibromyalgia and Fatigue Centers (which use a special advanced formula) and Myers Cocktails in holistic practice. I recommend taking a set of 6. You can find the recipe for Myers Cocktails in From Fatigued to Fantastic!, at IV (Intravenous) Nutritional Support Gets More Support, and at Fibromyalgia and Fatigue Centers.
20. Take iron.
Iron is critical for thyroid function, helping to convert T4 to active T3. It also helps produce dopamine, a key neurotransmitter. And it helps settle down Restless Legs Syndrome. So be sure your iron stores are optimized. Have your blood ferritin (a biomarker of stored iron) level checked. If the level is under 60, you should take 29 mg a day of iron, plus 100 mg vitamin C (which aids absorption). Important: the so-called "normal" range for "adequate" ferritin is anything over 12, which is frankly insane.
Summary of Blood Tests
There are a number of blood tests used in the treatments discussed in this three-part series. They are summarized below for your convenience:
Ferritin (treatment no. 3)
Anti-transglutaminase IgA and IgG antibody (treatment no. 7)
Serum ammonia level (treatment no. 8)
Fasting morning cortisol; DHEA-S (treatment no. 12)
Pregnenolone (treatment no. 13)
IGF-1 (treatment no. 14)
Free and total testosterone (treatment no. 16)
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
Learn more from Dr. Teitelbaum's books: