End Fatigue

An Overview of CFS/ Fibromyalgia, and Effective Therapies

By Jacob Teitelbaum M.D.

For years, many of us have dreamt of the day when we would see the headline "EFFECTIVE TREATMENT FOR CHRONIC FATIGUE SYNDROME, FIBROMYALGIA (CFS/FMS), AND MYOFASCIAL PAIN SYNDROME (MPS) DEVELOPED!" We are very excited to report that that day has arrived!

One of our studies published in the Journal of Chronic Fatigue Syndrome is titled "Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia -- the Results of a Randomized, Double-Blind, Placebo-Controlled Study"! After decades of hard work by hundreds of researchers in the field, we have progressed to the point where effective treatment is now available for these illnesses! In our study, over 90 percent of patients improved with treatment.

In the average patient, after two years of treatment, the average improvement in quality of life was 90 percent. Pain decreased by over 50 percent on average. Many patients no longer even qualified for the diagnosis of CFS or fibromyalgia after treatment! Interestingly, many of the same principles for treating fibromyalgia also apply to myofascial pain syndrome

That the vast majority of patients improved significantly in the active group while there was minimal improvement in the placebo group proves two very important things. The first is that these are very treatable diseases. The second is that anyone who now says that these illnesses are not real or are all in your head are clearly both wrong and unscientific.

A new day is dawning in how CFS/fibromyalgia/MPS will be treated. In support of our work, an editorial in the April, 2002 journal of a major multidisciplinary medical society for pain management in United States noted " the comprehensive and aggressive metabolic approach to treatment detailed in the Teitelbaum study are all 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.

It is important to recognize that these syndromes can be caused and aggravated by a large number of different triggers. When all these different contributing factors are looked for, and treated effectively, patients improved significantly and often get well!

What is causing these illnesses?

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/circuit breaker in a house). This center controls sleep, hormones, temperature, and blood flow/ blood pressure/sweating. When you don't sleep deeply, your immune system also stops working properly and you'll be in pain. In addition, if your muscles do not have enough energy, they will get stuck in the shortened position and you will be in pain (think rigor mortis). This "Energy Crisis" can be caused by any of a number of infections, stresses, or injuries.

Some of you had your illness caused by any of a number of infections. In this situation, you can often give the time that your illness began almost to the day. This is also the case in those of you who had an injury (sometimes very mild) that was enough to disrupt your sleep and trigger this process. In others the illness had a more gradual onset. This may have been associated with hormonal deficiencies (e.g. low thyroid, estrogen, testosterone, cortisone, etc.) despite normal blood tests. In others, it may be associated with chronic stress, antibiotic use with secondary yeast overgrowth, and/or nutritional deficiencies. Indeed, we have found well over 100 common causes of, and factors that contribute to, these syndromes.

Understanding this helps us understand the symptom complex seen in CFS/fibromyalgia. Restoring energy production so that your hypothalamic circuit breaker turns back on and eliminating what blew your fuse in the first place also gives us a way to effectively treat you!

To turn your circuit breaker back on, four main areas need to be treated.

A half-century of work by Dr. Janet Travell, the White House physician for Presidents Kennedy and Johnson and author of the Trigger Point Manual showed that the same problems caused by hypothalamic suppression resulted in muscles getting stuck in the shortened position. Chronic muscle shortening then causes myofascial and fibromyalgia pain. As she laid the groundwork for effective treatments these processes, our research team dedicated our published study to her memory. These are the four key areas that need to be treated for Chronic Fatigue syndrome, fibromyalgia and muscle pain to resolve:

1. Disordered Sleep Most patients with these illnesses find that they are unable to get 7-8 hours of deep sleep a night without taking medications. In part, this occurs because hypothalamic function is critical to deep sleep. Unfortunately, many of the most common sleep medications actually aggravate the sleep problems by decreasing the amount of time spent in deep sleep. For patients to get well, it is critical that they take enough of the correct sleep medications to get 8 to 9 hours sleep at night! These medications include Ambien, Desyrel, Klonopin, Xanax, Soma and, if you don't have Restless Leg Syndrome, Flexeril and/or Elavil. In addition, natural remedies can help sleep. An excellent one (which I developed) Revitalizing Sleep Formula (30ct or 90ct) by Enzymatic Therapy -- 100 percent of my royalty for all products I develop is donated to charity) includes Sun Theanine, Jamaican Dogwood, wild lettuce, valerian, passion flower, and hops. Other natural sleep aids include Krebs Calcium Magnesium Chelates (1-5 at bedtime), 5-HTP (100-300mg), Kava (125-375mg-do not use if you have liver disease), and melatonin (3/10-1mg). Some patients find that over-the-counter antihistamines such as doxylamine (Unisom for sleep) or Benadryl can also help. In the first six months of treatment, it is not uncommon to sometimes need to take even six to eight different products simultaneously to get 8 hours of sleep at night. After 6-18 months of feeling well, most people can come off of most sleep (and other) medications. I'm starting to believe that, to offer a margin for safety during periods of stress, it may be wise to stay on 1/2 to 1 tablet of a sleep medication for the rest of your life. Your doctor may initially be uncomfortable with this. Nonetheless, our experience with over 2000 patients and 2 research studies have found this approach to be safe and critical to people getting well. When one recognizes that CFS/FMS is a hypothalamic sleep disorder -- not poor sleep hygiene -- this approach makes sense. Otherwise, it is as if your doctor would immediately try to stop blood pressure or diabetes medicines every time the patient was doing better!

2. Hormonal Deficiencies The hypothalamus is the main control center for most of the glands in your 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, albeit controversial, to treat with thyroid, adrenal (very low dose cortef; DHEA [5mg or 25mg]), and ovarian and testicular hormones -- despite normal blood tests! These hormones have been found to be reasonably safe when used in low doses. Growth hormone has also been shown to be helpful in fibromyalgia. Unfortunately, it can cost over $4,000 a year and is given by injection. Fortunately, there may be a cheaper way to raise your low growth hormone. Most growth hormone is made during deep sleep. This may be another reason why getting 8 to 9 hours of deep-sleep a night can be critical!

3. Unusual Infections Many studies have shown immune system dysfunction in FMS/CFS. Although there are many causes of this, I suspect that poor sleep is a major contributor. The immune dysfunction can result in many unusual infections. These include viral infections (e.g. HHV-6, CMV, and EBV), parasites and other bowel infections, infections sensitive to long-term treatment with the antibiotics Cipro and Doxycycline (e.g. mycoplasma, chlamydia, Lyme, etc) and, most importantly, fungal/Candida infections. Although the latter is controversial, both our study and another recent placebo-controlled study found treating with an antifungal to be very helpful with the symptoms seen in these syndromes. Avoiding sweets (stevia is OK) and taking Acidophilus Pearls (30ct or 90ct) (healthy milk bacteria pearls twice a day for 5 months) can be very helpful. We often also add prescription antifungals as well. See Treating Infections Without Antibiotics.

4. Nutritional Supplementation Because the western diet has been highly processed, nutritional deficiencies are a common problem. In addition, bowel infections can cause poor absorption, and the illness itself can cause increased nutritional needs. The most important nutrients include: a) vitamins -- especially the B vitamins (most at 25-50 mg/day), vitamin B12 (50-3000mcg/day), antioxidants (e.g. -- vitamin C and E). b) Minerals -- especially magnesium, zinc, and selenium and c) amino acids (proteins). To replace the 25 - 35 tablets that people needed to take, I developed a good tasting product that contains 50 key nutrients in 1 capsule and 1 scoop of a good tasting powder taken daily. It is called Energy Revitalization System (Berry or Citrus) by Enzymatic Therapy, and is available at health food stores or on our web site.

Ribose (Corvalen)-An Exciting New Discovery!

Corvalen (D-Ribose by Valen Labs) is an outstanding new nutrient (a special sugar-even OK for those who need to avoid sugar!) for those of you who want a powerful energy boost! In addition to its role in making DNA and RNA, those of you familiar with biochemistry remember Ribose as the key building block for making energy. In fact, the main energy molecules (like Energy dollars) in your body (ATP, FADH, etc.) are made of ribose plus B vitamins/phosphate. That makes these energy molecules similar to the paper that money is printed on- kind of like being able to print your own energy currency!

Corvalen has many uses, including treating heart muscle weakness (Congestive Heart Failure). We were so impressed with this product that our research center recently completed a study(to be published Nov 2006) reported on in the national news services. Two thirds of CFS/Fibromyalgia patients improved, with an average increase in quality of life of ~25 improvement in energy after 2-3 weeks. In our study, pain, sleep, and "brain fog" also improved.

There are many other treatments available as well. Although space does not allow for a full discussion of these in this article, I discuss them at length in my books Pain Free 1-2-3! (McGraw Hill 2006), From Fatigued to Fantastic! and on our Treatment Protocol .

So can I make my pain go away?

Fibromyalgia and Myofascial Pain and associated nerve entrapments are now very responsive to treatment! In many cases, they usually will improve dramatically and often even go away if you simply get the eight hours of sleep a night I discuss above, take the vitamin powder, take thyroid hormone, and treat the underlying yeast infections. Other patients require the more thorough evaluation and treatment. Localized myofascial pain also requires an evaluation for structural causes.

Aspirin family medications (including ibuprofen) are not very effective for most Fibromyalgia and Myofascial Pain patients. I avoid Tylenol because it can markedly deplete a critical antioxidant (glutathione). Helpful natural treatments include the Revitalizing Sleep Formula (30ct or 90ct) herbal discussed above which can be used during the day for muscle pain and/or anxiety and the End Pain Formula, an herbal remedy for inflammation and arthritis that includes Boswellia, Willow bark, and cherry. This combination can be more effective than Celebrex and Motrin and are much safer. I recommend 1-4 tablets three times a day for both herbal formulas. Although some effect can be seen immediately, improvement continues to build over six weeks. At that time, the dose can be lowered. The medications I find to be most helpful for myofascial pain include Celebrex (celecoxib) and Skelaxin (which are not sedating) and Ultram, Neurontin, and Zanaflex which can be sedating. Lidocaine patches (Lidoderm) and creams creating a mixture of medications can also be highly effective for local areas of pain without significant side effects. There are many other medications and other effective ways to treat pain as well. These can be used to help keep you comfortable while we go after the pain's underlying causes.

How Do I Go About Getting Well?

The great news is that there is now a national chain of Fibromyalgia and Fatigue Centers (see www.FibroAndFatigue.com) whose physicians are superbly trained in applying this protocol. I was so impressed with the organization that I offered to become their Medical Director and train their physicians. They see patients from all over the world.

My best-selling book From Fatigued to Fantastic! (Penguin/Avery 2001) and my book Pain Free 1-2-3 (McGraw Hill 2006) will supply you and your physician with all the information that you need to get treated effectively.

Because determining which treatments are needed by any given individual and then teaching them how to use them can be very difficult and time consuming, I've created a sophisticated computer program that is like a computerized CFS/Fibromyalgia specialist! It can analyze your history and lab tests to tailor a treatment protocol to your case using both natural and prescription therapies. The good thing about it being a computer program is that it has both the time and ability to guide almost everyone with these syndromes back to health!

The purpose of our web site is to supply, in one place, all of the resources that you need in order to get well.

How can I get treated if I don't have much money?

Although some of the treatments for these syndromes can be very expensive, it is often possible to do the treatment protocol in an affordable manner. The key tests that are needed include the blood count (CBC), ESR, general chemistry, free T4 level (thyroid test), vitamin B12, iron, and DHEA-S level. Although many other tests can be very helpful, one can often rely on symptoms alone to make the other treatment decisions. The following medications and supplements can be found fairly inexpensively, and will often be helpful. The Energy Revitalization Formula (Berry or Citrus) (even 1/2 scoop a day) gives outstanding nutritional support. For even more benefit, add the Corvalen, and estrogen, can also be found for a fairly low price. For infections, generic Diflucan (for Candida) is now available for $40 for a 6 week supply (42 tabs of 200 mg), and nystatin and tetracycline are also inexpensive. Most drug companies offer medications for free to those who cannot afford them. Although many of the other treatments can often be very helpful, these inexpensive ones may be enough to help you get well.

For the last 30 years, my associates and I have had a wonderful time in our quest to make the possibility of effective treatment available for everyone with CFS &FMS related problems. Finding effective treatment, doing the research to prove its effectiveness, writing books that teach people how to get well (and their doctors how to treat them),developing supplements to simplify treatment (my royalties go to charity), creating the web site educational program that can help you tailor a treatment program for your specific situation and now the availability of a national chain of Fibromyalgia and Fatigue Centers (see www.FibroAndFatigue.com ) whose physicians are superbly trained in applying this protocol has fulfilled this goal!

At this time, you now have all the tools you need to get well! We wish you all God's blessings and our best wishes in reclaiming vibrant health!

With appreciation for all you've been through,
Jacob E Teitelbaum MD


Dr. Jacob Teitelbaum is a board certified internist and medical director of the Fibromyalgia and Fatigue Centers. Having suffered with and overcome these illnesses in 1975, he spent the next 30+ years creating, researching, and teaching about effective therapies. He sees CFS/Fibromyalgia/Chronic pain patients from all over the world in his clinic in Kona,Hawaii (410-266-6958). He lectures internationally. He is also the author of the best-selling book From Fatigued to Fantastic!, Pain Free 1-2-3! and Three Steps To Happiness, Healing Through Joy.