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Doctor Recommended Supplements for Chronic Fatigue What is it?*What can I do?*Definition*Symptoms*Causes*Therapies Take back your life! Contact us at AWW for an appointment and personalized help. “Our goal is your health and personal fulfillment in the face of chronic problems without clear causes. We do this by helping your body’s innate ability to restore health (physical, mental, and spiritual) with integrated traditional and alternative holistic therapies.” AWW See Detailed information below TABLE. NOTE: It is important to check with a physician if you experience out-of-the-ordinary symptoms especially if they persist for more than two weeks or if you have vague symptoms that persist over a long time. The symptoms of CFS can mimic the fatigue and other symptoms caused by diseases (some of which could be life-threatening) such as viral infection, depression, cardiovascular disease, thyroid dysfunction, diabetes, food allergies, depression, cancer, anemia, etc. and some reactions to medications. Prompt diagnosis is important.
*WHAT IS CFS? AWW views Chronic Fatigue Syndrome as a valid medical condition and, while it may be similar to or share underlying causes with other conditions, it is not to be confused with other specific illnesses or conditions that cause fatigue. The exact cause or causes of the CFS and its symptoms have not been identified. The good news is that the healthcare community is focusing on what you can do to support your body and lessen the impact of CFS on your life. Nutritional therapies are targeting what your body needs to support your immune system, sleep quality, circulation, mental and neurological functions, and to maintain hormone balance etc. "After years of research, a critical mass of scientific data is providing solid evidence that CFS is a valid medical condition", said CDC Director Julie Gerberding, MD, MPH. American Medical News November 27, 2006. See the Table and Nutritional Therapies for CFS management below. Chronic Fatigue Syndrome (CFS) “In 1994, the CDC convened…to draft a definition of CFS. *Unexplained persistent or relapsing fatigue for at least 6 months’ duration that is of new or definite onset, is not the result of ongoing exertion, is not substantially alleviated by rest, and causes substantially reduced levels of activity. *The simultaneous occurrence of four or more of the following symptoms-persistent or relapsing-for at least 6 months: sore throat: tender cervical or axillary lymph nodes; muscle pain; multi joint pain without joint swelling or redness; headaches of a new type, pattern or severity; unrefreshing sleep; and postexertional malaise lasting more than 24 hours. The symptoms must not have predated the fatigue.” “Major depression and fibromyalgia have similar diagnostic criteria and can be difficult to distinguish from CFS, Dr. Pocinki (Washington,D.C. internist) said. They can also coexist. A careful review of symptoms and the relative severity make the distinction possible. “And patients with depression or fibromyalgia don’t come in with sore throats and swollen glands.” he adds. Family Practice News. May 15, 2001 Chronic Fatigue Syndrome:Fighting the Battle. *WHAT CAN I DO? Help yourself heal naturally! The key to boosting the body’s innate ability to maintain and restore health in the face of chronic conditions is the support of all the body’s interrelated processes. Two approaches are paramount: Key Nutrients & Life Management 1. A comprehensive supply of all-natural nutrients in the diet and supplements is foundational. See the TABLE above for specific nutrients. 2. Focus on whole life management (body, soul and spirit) which helps implement lifestyle changes and includes therapies, coping skills, social support and environment modification. Recently, the American Medical News November 27, 2006 highlighted CFS. “After years of research, a critical mass of scientific data is providing solid evidence that CFS is a valid medical condition”, said CDC Director Julie Gerberding, MD, MPH. What’s more, she said, it affects about 1 million people in the nation. She unveiled a national CFS public education and awareness campaign. Get Informed. Get Diagnosed. Get Help… Thousands of research studies provide abundant evidence that CFS is a physiological illness, not a form of depression or hypochondriasis, according to the agency.” A table reprinted in the Center for Disease Control and Prevention’s CFS Toolkit for Health Care Professionals which appeared in the November 27, 2006, American Medical News reports “A chronic fatigue syndrome diagnosis often results from excluding other disorders, including mononucleosis, Lyme disease, lupus, hypothyroidism and major depressive disorders.” “In one recent study of CFS patients treated in primary care settings, at least 40% of patients had some improvement, said Dr. Debra Buchwald of the University of Washington, Seattle.” Family Practice News. May 15, 2001 Target your overall health, support your immune system and incorporate supportive therapies into your lifestyle to improve your prognosis. *DEFINITION CFS is also called Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS). To meet the Centers for Disease Control and Prevention’s (CDC) definition CFIDS, a patient’s fatigue must be “unexplained, of new onset, last for at least 6 months, and not be relieved by rest.” “The only difference in diagnostic criteria for fibromyalgia and CFS is the requirement of musculoskeletal pain in fibromyalgia and fatigue in CFS. Murray, Michael, N.D., and Pizzorno, Joseph, N.D. Encyclopedia of Natural Medicine. New York, NY:Three Rivers Press,1997. Phyllis and James Bach define CFS criteria as “persistent fatigue that does not resolve with bed rest and that is severe enough to reduce average daily activity by at least 50% for six months.” Bach, Phyllis, CNC and Bach, James, MD. Prescriptions for Nutritional Healing. New York, NY:Penguin Putnam Inc. 2000. Dr. Teitelbaum, MD in the Ask Your Doctor leaflet on Chronic Fatigue Syndrome and Fibromyalgia says that “FMS is basically a sleep disorder characterized by many tender knots in the muscles. Approximately 80 percent of chronic fatigue syndrome patients have received an overlapping diagnosis of fibromyalgia syndrome.” *SYMPTOMS The simultaneous occurrence of four or more of the following symptoms-persistent or relapsing-for at least 6 months: sore throat tender cervical or axillary lymph nodes muscle pain multi joint pain without joint swelling or redness, headaches of a new type, pattern or severity unrefreshing sleep and postexertional malaise lasting more than 24 hours. The symptoms must not have predated the fatigue.” Other reported Symptoms: Vitality Digest. December 2001. “Other symptoms may include muscle and joint pain, headaches, tender lymph nodes, and cognitive problems.” Other symptoms such as loss of appetite, environmental sensitivities, mood swings, recurrent upper respiratory infections, nasal congestion, candida albicans infection, low blood pressure, intestinal problems and pain are reported by Phyllis Bach, CNC and James, Bach, MD. Prescriptions for Nutritional Healing. New York, NY:Penguin Putnam Inc. 2000. Michael Murray, N.D., and Joseph Pizzorno, N.D list re-occurring headache, depression, excessive irritability as symptoms and call CFS a widespread disorder that is twice as common in women as in men.” Encyclopedia of Natural Medicine. New York, NY: Three Rivers Press,1997. *DIAGNOSIS American Medical News November 27, 2006 reported that “Fewer than 20% of people who have CNS have been correctly diagnosed with it, the CDC says.” This AMN article highlights the CDC’s Requirements for Clinical Evaluation of CFS. It highlights patient history and physical plus mental status screening along with clinical and laboratory tests to exclude other disorders. The American Medical News. November 27, 2006. *CAUSES “Although the bad news about CFS is we still don’t know what causes it, we do have 4,000 studies that show underlying biological abnormalities in patients with this illness, said Anthony Komaroff, MD, professor of medicine at Harvard Medical School who has studied the disease for 20 years.” The American Medical News. November 27, 2006. Dr. Teitelbaum, MD in the Ask Your Doctor leaflet on Chronic Fatigue Syndrome and Fibromyalgia says “current research is looking at the roles of neuroendocrine dysfunction, viruses, environmental toxins, genetic predisposition, food sensitivities, yeast overgrowth, faulty digestion, or a combination of these factors.” Phyllis and James Bach in Prescriptions for Nutritional Healing list a dizzying list of possible causes which include: Epstein-Barr Virus (EBV) and cytomegalovirus CMV (there is no conclusive proof), anemia, arthritis, chronic mercury poisoning from dental fillings, hypoglycemia, hypothyroidism, Candida albicans fungal infection, and sleep problems. “A poor diet, nutritional deficiencies, allergies, thyroid dysfunction, candida, anemia, and stress all compromise the immune system, and can contribute to CFS.” Phyllis Bach, CNC and James, Bach, MD. Prescriptions for Nutritional Healing. New York, NY:Penguin Putnam Inc. 2000. Nutritional Deficiency “A deficiency of virtually any nutrient can produce the symptoms of fatigue and render the body more susceptible to infection.” The benefits of herbs and key nutrients are in the spotlight as more and more research is validating their use. Supply the body what it needs to combat viral invaders, toxins, stress, etc. with optimal nutrition. Murray, Michael, N.D., and Pizzorno, Joseph, N.D. Encyclopedia of Natural Medicine. New York, NY: Three Rivers Press,1997 Immune Dysfunction “The cause is unknown, but one leading theory is that the illness is rooted in the central nervous system and immune system.” Vitality Digest. December 2001. An healthy immune system is needed to combat pathogens and stress. Michael Murray and Joseph Pizzorno in a quick review of CFS reports that “A disturbed immune system plays a central role in chronic fatigue syndrome.” “There is little argument that a disturbed immune system plays a central role in CFS.” “This search for a viral agent is consistent with the mainstream medical approach of focusing on the infectious organism rather than on reducing susceptibility and supporting the individual’s immune system to deal with the organism effectively.” Murray, Michael, N.D., and Pizzorno, Joseph, N.D. Encyclopedia of Natural Medicine. New York, NY: Three Rivers Press,1997 Inflammatory An overview of studies reported in the Family Practice News. May 15, 2001 suggests that the “hypothalamic pituitary axis is down regulated in CFS documenting low levels of cortisol and corticotrophin-releasing hormones and may be the result of a chronic inflammatory process.” “Further evidence for an inflammatory process comes from findings of reduced killer cell function, elevations of inflammatory cytokines, and increased numbers of CD8-activated “cytotoxic” T cells, said Dr. Nancy Klimas of the University of Miami. “The pattern of immune activation and types of cytokines involved suggest persistent antigen exposure.” Viral Infection Epstein-Barr Virus (herpes group or like viruses) “EBV is a member of the Herpes group of viruses, which include Herpes simplex Types 1 and 2, Varicella zoster virus, Cytomegalo virus, and Pseudorabies virus. A common aspect of these viruses is their ability to establish a lifelong latent infection after the intial infection. *When the immune system is compromised in any way, these viruses can become active as viral replication and spread increase… By the end of early adulthood, almost all individuals demonstrate detectable antibodies in their blood to the Epstein-Barr virus, indicating past infection. When the primary infection occurs in childhood, there are usually no symptoms, but when it occurs in adolescence or early adulthood, the clinical manifestations of infectious mononucleosis develop in approximately fifty percent of the cases. …*EBV antibody testing (and antibody testing for other Herpes-group viruses and measles) may be useful as a measure of immune function and overall host resistence but should not be relied upon for diagnosis.**” Murray, Michael, N.D., and Pizzorno, Joseph, N.D. Encyclopedia of Natural Medicine. New York, NY: Three Rivers Press,1997. Digestive System and inability to detoxify the body may be another reason for chronic fatigue. Depression or Psychiatric or Cognitive Function Disorder “The cognitive function seen in some Chronic Fatigue Syndrome patients does not seem to be caused by depression or psychiatric disease. Dr. John De Luca of the New Jersey Medical School, Newark, said cognitive difficulties are worse-as are MRI and single-photon emission computed tomography scan abnormalities- in CFS patients with no existing depression or psychiatric disorders.” Family Practice News, May 15, 2001. Many focus on depression as one of the causes of chronic fatigue, and it is certainly a common symptom, but it is not clear if it is a cause or caused by Chronic Fatigue Syndrome. Depression may not be the primary cause of CFS at all, but be a result of one or multiple primary disorders that cause Chronic Fatigue Syndrome and its many symptoms. More research is justified to answer the questions: Does depression lead to chronic fatigue or does chronic fatigue lead to depression? Can CFS have depression as a symptom or is CFS a co-existing, but separate, disorder from depression? Sleep Disorders FPN May 15, 2001. “Sleep abnormalities are an important part of Chronic Fatigue Syndrome, but there are few studies of sleep in this population… The first step is to manage sleep with sleep medications,” explains Dr. Lapp MD, an internist and pediatrician. “The next step is to manage fatigue with a combination of antidepressants and stimulant drugs. Antidepressants are used because most patients with chronic illnesses and chronic pain are low in serotonin and dopamine, which makes for sleep disruption, low pain thresholds and irritability. This treatment makes patents feel more motivated and alert. The third step is to treat pain and the fourth is to treat autonomic dysfunction which has been demonstrated in 96 percent of the patients with CFIDS. In all these areas we have reasonable successes.” Vitality Digest. December 2001. Allergies Food Allergies. As far back as 1930, chronic fatigue was recognized as a key feature in food allergies. Murray, Michael, N.D. and Pizzorno, Joseph, N.D. Encyclopedia of Natural Medicine. New York, NY: Three Rivers Press,1997. *PROGNOSIS “A cure for CFIDS remains elusive. However, 50 to 60% of those with CFIDS return to normal activity with no treatment. For people who don’t improve, the strategy is to attack the symptoms.” Vitality Digest December 2001 “We don’t know the cause or cure, but neither do we know what causes or cures migraine or irritable bowel, yet we can make those better because we can treat what we do know about them,” says Charles Lapp, MD, an internist and pediatrician with Hunter-Hopkins Center in Charlotte, N.C. and Duke University.” Vitality Digest. December 2001. *MANAGING CFS Requires a comprehensive approach. Contact us at AWW for an appointment and personalized help. Therapies*Coping Skills*Social Support*Environmental Modification*Chronic Illness 1. THERAPIES a. Nutritional Therapies See the Table above for Key Nutrients that address specific fatigue components. Further Discussion: The periodical, Contemporary OB/GYN. September 15, presented an overview of results from the recent work of Teitelbaum, Bird and Greenfield as presented in the J. Chronic Fatigue Syndrome. 2001:3-28. “An integrated approach that combines nutritional therapy, hormone replacement, antidepressants, and the treatment of sleep disturbances may relieve chronic fatigue syndrome and fibromyalgia, according to this randomized, double-blind study (of 72 patients). The management protocol, which was based on the theory that CFS/fibromyalgia may result from a combination of nutrient deficiencies, immunological dysfunction, subclinical hormonal deficits, and disordered sleep.” The treatment included “melatonin and the herb valerian plus a prescription sedative as necessary, a daily multiple vitamin supplement, and magnesium. Then depending on laboratory assessment, select patients received ferrous fumarate (iron), vitamin B12 injections, levothyroxine, cortisol, estrogen replacement, and/or other medications. In the final analysis, 16 patients on the experimental program were much improved and 14 reported they were better” compared to 3 and 9 in the placebo group.” It is documented that “some patients try nutritional therapies (for Chronic Fatigue), which is targeted largely at correcting suspected deficiencies of magnesium and B vitamins.” Family Practice News. May 15, 2001 b. Sleep Therapies Dr. Lapp “The first step is to manage sleep with sleep medications,” he explains. “The next step is to manage fatigue with a combination of antidepressants and stimulant drugs. Antidepressants are used because most patients with chronic illnesses and chronic pain are low in serotonin and dopamine, which makes for sleep disruption, low pain thresholds and irritability. This treatment makes patents feel more motivated and alert. The third step is to treat pain and the fourth is to treat autonomic dysfunction which has been demonstrated in 96 percent of the patients with CFIDS. In all these areas we have reasonable successes.” Vitality Digest December 2001 c. Therapies for Emotional Support Keep a journal-summarize, pinpoint thoughts, release negative, write affirmations and post them. Someone suggested writing down negative thoughts and events and then burning the paper. Look for supportive people to help you develop positive feelings! Laugh!-helps oxygenate your blood, increases beta-endorphins (feel good hormones). Antidepressants/ SSRI/ NSAIDS can be prescribed by physicians for emotional help. “Among these (treatment modalities) are low doses of antidepressants for sleep improvement and pain relief. The drugs are believed to increase slow-wave sleep. Low doses of selective serotonin reuptake inhibitors also can relieve pain, as can NSAIDs for some.” d. Breathing Therapy “Breathing with the diaphragm, good posture, and bodywork (massage, spinal manipulation, etc.) are all important in helping relieve the stress that is a common contributor to fatigue.” Murray, Michael, N.D. and Pizzorno, Joseph, N.D. Encyclopedia of Natural Medicine. New York, NY: Three Rivers Press,1997. There are many self help breathing tapes and books available. e. Exercise Exercise and improves circulation and increases lymph drainage. “Research at the national Institutes of Health showed that moderate exercise caused the body to produce hormones called beta endorphins. (T)he big advantage the NIH showed, for our immune system, is that beta endorphins stimulate the natural killer cell’s ability to destroy invaders by an average of 63%! The natural killer cells are the ones that go after viral infected cells.” Miller, Dr. Bruce B. Understanding Chronic Fatigue Syndrome. Dallas, Texas:Bruce Miller Enterprises, Inc., 1991. f. Alternative Therapies “Other patients try magnetic therapy, acupuncture, or physical therapy” FPN May 15, 2001 2. COPING SKILLS Lifestyle management involves incorporating coping skills to reduce stress. “Dr. Bruce Miller notes that stress happens when “the capacity to adapt has been exceeded. Whatever the situation, your capacity to adapt to it, solve it, or do anything with it has been exceeded. The “push” energy has been burned out. You feel stuck and become in some way overwhelmed by the circumstances.” Miller, Dr. Bruce B. Understanding Chronic Fatigue Syndrome. Dallas, Texas:Bruce Miller Enterprises, Inc., 1991. According to the Family Practice News, May 15, 2001 one must “budget energy…try to increase energy levels…” Jennie Spotila has learned ways to cope. “My coping focuses on lifestyle management; making good decisions on what I spend my energy on, how to recognize when I am running out of energy, and how to cope with the fall out and effect on my life…Emotions in chronic illness are cyclical and normal.” Vitality Digest December 2001. Many of the above therapies can be used by the individual to manage their illness and promote optimal health. Nutritional therapies offer effective ways to help your body’s immune system cope with stress. Life is to be enjoyed with or without illness or handicaps. Who is better than you to help your body cope? Everyone has limits. You can have limits without being disabled. A cheerful soul knows no boundaries. *Develop a plan for flare ups of fatigue. *Manage your time, energy and limit your responsibilities. *Do what you enjoy. *Cut yourself lots of slack. *Give to yourself first so you will have more to give to others. *Do those things that allow you to forget about your symptoms for a little while (reading, talking on phone, hobby, volunteering, a movie…). *Go to bed at the same time and get a consistent number of hours of sleep each night. *Control your sleep environment. *The amount of your doing should not be equated with quality of your being. * REDUCE STRESS! 3. SOCIAL SUPPORT Supportive people are crucial in managing any chronic illness. This quote by Dr. A. Earl Mgebroff emphasizes the important of social support in promoting health. “Healing is related to wholeness, and wholeness is experienced in connection with others. It’s the whole person who comes to us, and it’s our job, as physicians, to try to recognize that fact. It’s also our job to help the patient integrate the best of each aspect-physical, emotional, intellectual, social, and spiritual-to create a truly whole person. My patients taught me that illness can facilitate connection-with other people and with things around us. A healer is somebody who helps patients make those connections.” “You can be healed and still have a physically sick body. It’s possible to be healed without being cured. And, I suppose, the reverse can be true. You can have no objectively demonstrable disease process and yet not be healthy and whole.” Medical Economics, September 15, 2006 A. Earl Mgebroff, MD Chronic Fatigue patients need daily support, emergency support, periodic backup and assistance to avoid being overextended physically and emotionally. Support people can help the patient with FM keep a realistic assessment of their environment, their abilities and their worth. 4. ENVIRONMENT MODIFICATION Customize your environment to meet your needs. Reduce STRESS!!! *For some, modifying their sleep environment can be of great benefit. It often helps to insure a dark, quiet room, to keep the room a consistent temperature and the body from getting chilled (wearing warm clothing in a slightly cool room) and to provide freedom from stimuli which interrupt sleep such as jiggling the bed. Eating several hours before bedtime and avoiding vigorous exercise in the evening can aid sleep. *Avoid over extending yourself. DELEGATE. *Avoid congested malls or too many people in a room or any situation that saps your energy or drains you emotionally. *Avoid harmful substances such as tobacco, alcohol, saturated, trans fatty acids, caffeine, sugar… *Eliminate toxins: Drink pure (distilled water), breathe fresh air and eat all natural (unaltered, unprocessed foods). 5. CHRONIC ILLNESS: Click here or see AWW Health Topic: Chronic Illness As health advisors we will evaluate your health and symptoms. We will focus on your personal needs and help you formulate a plan to support your body and well being with information, specific nutrients, medications and therapies as you seek health and well being. "Smile a lot, laugh often, enjoy good things and good people, eat only good things, sleep well, have fun moving (include fun easy exercise as a part of your day), support any acute or any chronic symptoms and reduce emotional stress.!" AWW Let AWW Help You Put It Together-Naturally!
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