When it comes to addressing Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM), patients often find themselves caught in a frustrating cycle. Many healthcare professionals struggle to pinpoint the root causes of these conditions, which can lead to dismissive attitudes and even the labeling of CFS and FM as vague, catch-all diagnoses. However, these disorders affect an estimated 4 to 7 percent of the population and are characterized by distinct physiological abnormalities. It's time for a multi-system approach to treatment, which is now recognized as the standard of care, and it can be highly effective in up to 80 percent of patients with CFS and FM.
To receive a FM diagnosis, patients must experience pain for at least three months and exhibit tenderness at 11 out of 18 designated tender points. However, this criteria has been criticized for not considering crucial elements such as fatigue, sleep disturbances, and cognitive dysfunction. In contrast, CFS is characterized by persistent fatigue that doesn't improve with rest and significantly impairs daily activities. Patients must also experience four or more of the following symptoms: cognitive dysfunction, sore throat, joint pain, muscle pain, headaches, non-refreshing sleep, and post-exertional malaise. These conditions lack accepted laboratory markers, making diagnosis challenging. Despite differences in diagnosis methods, CFS and FM share a substantial overlap in symptoms, including fatigue, sleep disturbances, muscle pain, cognitive dysfunction, gastrointestinal issues, headaches, and post-exertional malaise.
The hallmark physiological features of CFS and FM do not appear in other fatiguing illnesses. These syndromes are complex, involving dysfunction in the pituitary and hypothalamus, immune system, sleep stages, mitochondria, hormones, coagulation, and chronic infections. Moreover, these physiological abnormalities often create a cascading effect, leading to a wide range of perplexing symptoms.
A Multi-System Approach
Traditional treatments for CFS and FM often fall short because they target individual symptoms with single-drug therapies. Common medications, such as nonsteroidal anti-inflammatories (NSAIDs), antidepressants, and muscle relaxants, are largely ineffective and may come with significant side effects, including anxiety and insomnia. Muscle relaxants can also be habit-forming. While serotonin-norepinephrine reuptake inhibitors (SNRIs) and anticonvulsants like Pregabalin may provide some relief, they often fail to deliver expected results, and many patients struggle with side effects. Given these limitations, a multi-system approach is essential to address the root causes of CFS and FM effectively.
Component One: Stabilize the Patient
Physicians commonly begin treatment for CFS and FM by addressing pain and sleep disturbances with medications. While these drugs can help some patients, the majority require more comprehensive treatment. Reduced glucose metabolism can lead to weight gain and reliance on anaerobic metabolism, resulting in fatigue, muscle pain, cognitive issues, gastrointestinal problems, headaches, and post-exertional malaise. Mitochondria dysfunction, often poisoned by various factors, has a significant impact on active tissues like the hypothalamus, pituitary, muscle, nerve, and immune cells. This dysfunction contributes to the major symptoms of CFS and FM. Supplying mitochondrial intermediates and nutrients, including magnesium, carnitine, D-ribose, CoQ10, and glutathione, can improve mitochondrial function and alleviate symptoms.
Component Two: Mitochondrial Enhancement
Mitochondria serve as the body's energy factories, producing adenosine-tri-phosphate (ATP) from sugar. When mitochondria malfunction, cells and tissues are deprived of energy. This deficiency may be the root of all dysfunctions in CFS and FM. Mitochondria can be poisoned by various substances, including toxins, infections, and nutritional deficiencies, causing a wide range of symptoms. Enhancing mitochondrial function with these nutrients and intermediates can improve CFS and FM symptoms.
Component Three: Balance the Hormones
Numerous studies have shown that pituitary and hypothalamic dysfunction is prevalent in CFS and FM patients, leading to multiple hormonal deficiencies, including thyroid, growth hormone, and cortisol. Standard blood tests often lack the sensitivity to detect these central deficiencies, but they are essential to address. Low thyroid function, even when standard thyroid function tests are normal, is widespread among CFS and FM patients. Emerging evidence suggests that measuring the free T3/reverse T3 ratio may provide a more accurate reflection of tissue thyroid levels. In contrast to standard T4 supplementation, which often proves ineffective, T3 therapy has demonstrated safety and effectiveness in improving the symptoms of FM. Cortisol deficiency is also a common issue in these patients, often due to pituitary and hypothalamic dysfunction. The use of physiologic cortisol replacement at doses of 5mg to 15mg daily is safe and effective in treating adrenal dysfunction without the side effects associated with pharmacological corticosteroids. Growth hormone deficiency is another hormonal problem commonly seen in CFS and FM patients. Growth hormone replacement has been shown to improve energy, strength, cardiac and cognitive function, immunity, and overall quality of life with minimal side effects.
Component Four: Treat the Infectious Component
Research indicates that infections, such as Epstein Barr (EBV), cytomegalovirus (CMV), human herpes virus 6 (HHV6), and intracellular bacterial infections (e.g., mycoplasma, Chlamydia pneumonia, and Borrelia burgdorferi or Lyme disease) may play a role in CFS and FM. These conditions often come with immune dysfunction, allowing opportunistic infections to thrive. Antimicrobial treatments aimed at these infections can be significantly beneficial.
Component Five: Address Unique Etiologies
CFS and FM patients may develop unique pathologies due to the cycles of dysfunction present in these conditions. Chronic infections can activate coagulation, leading to a fibrin coating in blood vessels that impairs oxygen and nutrient transfer, resulting in fatigue, muscle pain, and cognitive dysfunction. Testing for soluble fibrin monomer, thrombin-antithrombin complex, D-dimer, and plasminogen activator-inhibitor-1 can help diagnose coagulation dysfunction. Neurotoxins may also be responsible for some CFS and FM symptoms. Visual contrast sensitivity testing and serum C3(a) and C4(a) levels can help assess exposure to neurotoxins.
Component Six: Maintenance
As patients improve, therapies can be adjusted and medications gradually reduced. Patients can be seen less frequently, and medications are usually weaned before supplements. In many cases, patients can be taken off narcotic pain relievers, and the improvement in cortisol, growth hormone, and thyroid levels may correlate with symptom improvement. Continued thyroid supplementation is often recommended to prevent relapses.
A multi-system approach is gaining recognition as the standard of care for CFS and FM. Several studies support this approach, highlighting substantial improvements in patients' well-being. With hope and the right treatment plan, individuals with CFS and FM can regain control of their lives.
If you are experiencing undiagnosed or mistreated Fibromyalgia or CFS, contact us today to see how we can help you!