Chronic Fatigue Syndrome and Fibromyalgia
Chronic Fatigue Syndrome (Chronic Fatigue and Immuno-Deficiency Syndrome, CFIDS) and Fibromyalgia (FM) are illnesses that often coexist and affect millions of Americans. Symptoms vary but commonly include severe fatigue, sleep disturbances, cognitive problems commonly called brain fog, muscle pain and multiple infections. CFIDS and FM often seem to begin after an infection or a severe shock (physical or emotional), and the symptoms are very similar. The difference seems to be that for some people the fatigue element is the most dominant while for others the muscular pain symptoms are more severe.
The medical literature is now clear that these are legitimate diseases and individuals with CFIDS/FM have measurable hypothalamic, pituitary, immune and often thyroid dysfunction. The hormonal dysfunction results in multiple deficiencies that are often not detected with standard blood tests. Neurotransmitter abnormalities and nutrient deficiencies have also been shown to occur with CFIDS/FM.
Due to their complexity, these conditions often have been inadequately treated, partly due to the intensive evaluation and follow-up that is required, which can not be addressed in a short office visit. When multifaceted treatment addresses the entire spectrum of these diseases, truly remarkable success can be obtained. Treatment needs to be individualized, ultimately each patient should have a maintenance program with the minimal medications and supplements that are necessary to remain symptom-free.
Treatment for infections and enhancement of immune function is key. Komaroff et al. of Brigham and Women’s Hospital, Harvard Medical School, have concluded that CFIDS “is an illness characterized by activation of the immune system, various abnormalities of several hypothalamic-pituitary axes, and reactivation of certain infectious agents.” Multiple infections either may cause or contribute to CFIDS/FM. Immunological defects may underlie CFIDS/FM, and if a poor immune system is not addressed, successful eradication of the organisms is not likely. Also, if an infective organism produces neurotoxins, these substances can remain in the body and continue to cause symptoms long after the infection is gone.
Hormone balance is essential for optimal therapeutic outcomes. Therapy should be individualized with multiple hormonal deficiencies addressed concurrently to assure successful treatment. Studies have reported that there is an altered hypothalamic-pituitary-adrenal axis (HPA axis) in CFIDS/FM, leading to altered function that is often overlooked when interpreting standard blood tests.
Adrenal insufficiency is very common in patients with CFIDS/FM, and is often the cause of serious fatigue. Sophisticated tests are required for an accurate diagnosis. Proper supplementation can often have profound effects. However, if only the adrenal deficiency is treated without addressing deficiencies of other hormones, results will be disappointing. And, if poor adrenal function is missed, it can mean the difference between treatment success and failure.
Thyroid Problems/Pituitary Dysfunction often requires treatment with several hormones. Normally, Thyroid Stimulating Hormone (TSH) is secreted by the pituitary in the brain, telling the thyroid to secrete T4, which must then be converted in the body to the active thyroid hormone T3. When T4 and T3 levels drop, TSH should increase indicating hypothyroidism. This is the standard way to diagnose hypothyroidism. There are, however, many things that result in hypothyroidism but are not diagnosed using the standard TSH and T4 and T3 testing. Standard methods and interpretation often miss thyroid problems with CFIDS/FM patients. Pituitary dysfunction in CFIDS/FM may have a variety of causes, including viruses, bacteria, stress, yeast, inflammation, toxins, pesticides, plastics and mitochondria dysfunction. These problems result in low normal TSH levels along with low normal T4 and T3 levels. Low normal values are significant, and can cause fatigue, depression and difficulty losing weight and also increase the risk of heart disease.
In addition, most CFIDS/FM patients do not adequately convert T4 to the active T3, resulting in low levels of active thyroid hormone; therefore, they suffer from low thyroid despite having a normal TSH. Another problem is that T4 is converted to reverse T3, which is inactive and blocks the thyroid receptor. The conversion of T4 to reverse T3 is increased in times of stress and illness. Reverse T3 causes fatigue, difficulty losing weight, brain fog, muscle aches and all the other symptoms of hypothyroidism. Reverse T3 can be increased by chronic illnesses such as CFIDS/FM, yo-yo dieting (often responsible for the quick weight gain after losing weight), stress, heavy metals and infections commonly present in CFIDS/FM. There are only a few labs that can accurately measure reverse T3, and interpretation of results can be difficult.
Thyroid resistance is present in many CFIDS/FM patients, so endogenous thyroid hormone does not appropriately stimulate thyroid receptors. A study published in Clinical Rheumatology in May, 2007 showed that although basal thyroid hormone levels of FM patients were in the normal range, 41% of the patients had at least one thyroid antibody. Treatment for thyroid resistance can include eliminating the cause, such as an infection or toxin, or overcoming thyroid resistance by giving higher doses of thyroid while monitoring the effect.
The combination of pituitary dysfunction, high reverse T3, and thyroid resistance, leads to inadequate thyroid effect in most, if not all, CFIDS/FM patients. T4 (levothyroxine) preparations are often ineffective for CFIDS/FM patients. A T4/T3 combination preparation or straight T3 (triiodothyronine) may be preferable. T3 works the best for many of these patients, but Cytomel®, a very short acting T3 available at retail pharmacies, is also a poor choice because the varying blood levels cause problems such as heart palpitations. Compounded, sustained-release T3 may be the best treatment. However, standard blood tests may lead one to dose incorrectly and not obtain significant benefits. Ultimately, it is the expertise and dosing of the T3 or T4/T3 combinations and the makeup of the medications that determines the success of treatment.
Natural Therapies: Proper nutritional supplements, proteins, and hormones can protect and enhance the immune system. Antioxidants may also be beneficial because free radicals play a role in causing damage to the immune system.
Vitamin B-12 levels are often low in patients with CFIDS/FM. A malfunctioning thyroid or adrenal gland can decrease the ability of the body to absorb and utilize vitamin B-12. Vitamin B-12 is necessary for a healthy nervous system; it has been known for many years that depression and fatigue can be caused by low B-12 levels.
Co-Enzyme Q-10 (CoQ10) plays a vital role in the production of energy in the cells of the body. Many patients with chronic fatigue and muscle pain have found this supplement to be very beneficial. Higher doses of 100mg to 200mg two to three times daily may be necessary and the dosage form is important.
D-ribose significantly reduced clinical symptoms in patients suffering from fibromyalgia and chronic fatigue syndrome, with an average increase in energy on the VAS of 45% and an average improvement in overall well-being of 30%.
Ask us how individualized hormone replacement therapy and proper supplementation can be integrated into a comprehensive treatment program for Chronic Fatigue Syndrome or Fibromyalgia. We can also recommend quality formulations of beneficial nutraceuticals.
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