The most frequent chronic complaint is fatigue. Patients never feel right, can't get out of bed, are also usually depressed and anxious, and suffer from insomnia, poor memory and concentration, and frequently dizziness. The origins of chronic fatigue are truly vast. Recently, a 32-year-old, 4-foot-10, 95-pound woman presented with a history of sexual abuse, loss of both parents, very stressed mother during pregnancy, on disability with complex regional pain syndrome (CRPS), fibromyalgia, and multiple drug regimen failure, asthma, globus hystericus, gastroparesis, and gastritis. I knew I had my work cut out for me. Building trust with a totally fearful, energyless woman with absolutely no self-esteem and no money is an art form. One has to go with one's best and least expensive therapy which gives gentle results quickly. Incidentally, her globus hystericus was immediately and permanently relieved with one treatment of neural therapy using procaine and Spascupreel from Heel in intradermal wheels (quaddles) to her suprasternal notch and in a ring around her neck and over the dorsal processes of the associated cervical vertebrae.1 Likewise, the gastroparesis abated with the overall therapy and several of the same neural therapy treatments (thank you, Dr. Klinghardt) to the epigastrium, painful sternal points, and Chapman lymphatic points between rib heads parasternally (see Figure 1).
The readers of the Townsend Letter are old hands with the importance of thinking outside the box with regard to adrenal and thyroid support. Everyone who is chronically ill has adrenal dysfunction and generally thyroid dysfunction. This is such a very deep issue and is part of the great divide between strictly allopathic practitioners and integrative, alternative practitioners. Patients can have every sign and symptom of adrenal fatigue and hypothyroidism, but with a single normal blood cortisol and TSH, their symptoms are written off as a deficiency of antidepressants, benzodiazepines, and much worse. It's a tough world of medicine out there for the patient who is chronically fatigued with anxiety, depression, insomnia, panic attacks, and inability to think clearly, as well as chronic pain from fibromyalgia. After multiple allopathic treatment failures, patients finally seek us out after years of being experimented on by their local physicians with frequently disastrous side effects. Even integrative practitioners of various stripes criticize support of adrenal and thyroid as Band-Aid procedures that ignore underlying pathology. However, as with my patient above, who has many chronic health issues that all need to be addressed and no knowledge or money to straighten them out initially, giving her hope, energy, and relief immediately is our first duty. Supporting adrenal and thyroid function gives patients a new lease on life.
In addition to an extended regular history and physical, it is also important if you have learned to do Chinese pulses and facial diagnosis, German iridology, tongue diagnosis, root canal and amalgam evaluation, scar evaluation, and musculosketal deformities and dysbalance evaluation: if one shoulder is 3 inches higher than the other, it tells you something. We all should learn to enjoy the painfully repetitive dietary history; extensive handouts on lifestyle are not, in my experience, as effective as the doctor's involvement in this initial important process, backed up by literature. For many patients, it is a game changer to avoid fluoride toothpaste, tap water, sugar, high-fructose corn syrup, aspartame, table salt, milk, gluten, soda, gum, fast food, soy, coffee creamers, nonorganic everything, stomach acid blockers, statin drugs, cigarettes, microwave ovens, aluminum cooking utensils, excessive alcohol, and so many other environmental toxins. I just started a new patient a couple of months back who looked at me absolutely incredulously when I told her that there were over 300 different neurological syndromes associated with aspartame ingestion up to multiple sclerosis. She was consuming 8 to 10 diet sodas with 5 Xanax through the day "just like my mother did." Her husband was nodding his head through the entire visit, as she had terrific fatigue, anger, and little memory.
Low adrenal and thyroid always mean poor metabolism. When your adrenals are weak, you leak, is one of my favorite platitudes. Low mineral corticoids, aldosterone, and so on, cause wasting of sodium, chloride and, according to some authors, neurotransmitters. Thyroid weakness causes hypochlorhydria and inability to absorb minerals and proteins. Getting these two organs back on track has an immediate normalizing effect on the entire organism.
Adrenal support dosing has a very long therapeutic curve. It is nice to start with sleeping 8 to 9 hours per night and enjoy occasional vacations when the stress is off. Reducing stress at the workplace, at home, and with the kids is important, but how to resolve the stress of estranged spouses bent on revenge, sick relatives, crazy siblings battling over the inheritance, financial collapse, and loss of drive to do anything is much more difficult. These people need adrenal help. I always begin adrenal support with good nutrients important for the adrenal gland, especially vitamin C, B vitamins (pantothenic acid, B5), vitamin A, chromium, EFAs, and good sources of cholesterol such as egg yolks, butter, and animal protein if possible. Vegans need to lead a less stressful life or supplement if they are very stressed. I understand that the liver makes cholesterol, but many livers are very toxic and all the adrenal hormones are made from cholesterol, which can only be consumed from animal sources. Acupuncture, psychological counseling, chiropractic, musculoskeletal therapies, energetic support, colorpuncture, and every therapeutic modality can help the adrenals to rebuild.
My very favorite adrenal support over the last 36 years is an adrenal complex shot with B12 (hydroxycobalamin) and folic acid. I have it compounded with hydrocortisone 2 mg per cc, DHEA 0.2 mg per cc, pregnenelone 0.2 mg per cc in a sesame or cotton seed oil base for its time-release properties with 1 mg of B12 and 10 mg of folic acid.2 An average-sized woman usually responds well to 1½ cc of adrenal complex, smaller women 1 cc, and larger women and men 2 cc plus 1 cc of B12 and 1 cc of folic acid. This is an old feel-good shot that has been around since the 1950s from Hollywood (thank you, Alan Nittler, MD, and Garry Gordon, MD). Only they used adrenal cortex extract in those days, but it is no longer available and this adrenal complex bears a rough equivalency to that product. It gives a week of blood-sugar stability for most patients and can be done weekly, two or three times per week, or daily, depending on the needs of the patient and reducing the frequency of dosing as the patient gets better. Remember that the normal adrenal cortex makes 30 to 200 mg of hydrocortisone per day. Low-dose adrenal support is frequently very helpful for energy, sleep, headaches, gastritis, and antianxiety qualities and does not suppress the hypothalamic-pituitary-adrenal axis. This intramuscular shot needs to be given in the upper-outer quadrant of the hip; the time-release oil is not indicated in the quadriceps or deltoids. Isocorts or other oral adrenal tissue support is always great; be careful of whole adrenal extracts, as they may contain adrenal medullary catacholamines (or epinephrine/adrenalin), which are too stimulating for some patients. Adrenal-rebuilding, adaptogenic herbs are great such as Cordyceps, Rhodiola rosea, Ashwagandha, maca, Eleutherococcus senticosus (Siberian ginseng), and many more. Importantly, some patients are so adrenal-depleted that they really need hydrocortisone tablets à la William McK. Jefferies, MD, a codiscoverer of hydrocortisone in 1949. In his book The Safe Uses of Cortisone, he presents many cases of successful treatment of adrenal-deficient patients with 5 mg of cortisol (hydrocortisone/Cortef) four times per day or 10 mg four times per day when ill.3 Some patients prefer 10 mg morning and noon or some variation of this dosage regimen. Cortisol can also be compounded in a time-release preparation that needs to be dosed less frequently and is more convenient for patients. It is interesting that even when adrenal-fatigue patients need larger doses to maintain normal energy levels, they don't appear Cushingoid and feel great.
Thyroid supplementation, à la Broda Barnes, MD, in his book Hypothyroidism: The Unsuspected Illness and many other authors must be geared to the adrenal status of the patient: low adrenal, use little thyroid.4 I always use the "cup of coffee" rule of thumb: if a patient can drink a pot of coffee before bed and sleep easily, one can give higher doses of thyroid. If the patients sips a cup of coffee and is awake for two days or is obviously very sensitive to any stimulation, start with 1/16 of a grain of thyroid or less and increase by 1/16 grain every few days or week. The patient who can stand stimulation can be started with ½ grain and increase to 2 grains after two to four weeks. Overdose of thyroid because of insufficient adrenal cortical reserve causes adrenalin symptoms such as anger, nervousness, fast heart rate, and insomnia and, in cardiac patients, angina; but it can also create more calm, great energy, improved emotional tolerance, and relief of fatigue and fibromyalgia by improving nutrient absorption and mitochondrial status. I have used Nature-Throid, porcine thyroid that has fewer additives and more T3 than Armour, for 36 years. Sometimes with high reverse T3 or other high TPO or antithyroglobulin antibodies, L-thyroxine and/or T3 must sometimes be used. I avoid Synthroid; it is not bioidentical and may block L-thyroxine. I test everything on EAV to make sure that it is compatible with the patient.
Fibromyalgia can arguably be looked at as an energy deficiency syndrome in the musculoskeletal system. Both deficiency and toxicity issues are usually present. R. Paul St. Amand, MD, a UCLA endocrinologist, makes a good case for phosphate retention in the muscles and ligaments as the root cause of fibromyalgia. In his book What Your Doctor May Not Tell You About Fibromyalgia, he recommends that increasing dosages of guaifenesin, the cough expectorant, be taken to remove the phosphates.5 It has many successful patient responses but requires a diet avoiding salicylates, which involves more than 1000 different foods and herbs and inhibits patient compliance with his regimen. Committed patients have had moderate or good success with his program; but progress is usually gradual, and aggravations, especially early on in the therapy, require careful titration of the guaifenesin.
At the risk of forgetting one of the hundreds of things that can cause CFS and/or fibromyalgia, here are a few of the more common causes that I see. One needs to have an extremely broad outlook on medicine. The causes can range from genetic defects, parasites, heavy metal intoxication, dental pathology, chronic sinus infection, chronic tonsil infection, circulatory damage/sticky blood, coagulation defects, multiple hormonal deficiencies, allergy, psychological issues, grief and loss, inherited weakness, leaky gut, digestive disturbances, candida, toxic liver, chronic viruses, XMRV, Lyme, musculoskeletal issues, autoimmune diseases, immune system weakness, endobiontic disturbance, other chronic diseases, chronic pain, surgical stress, acupuncture meridian dysbalances, scars, need for the proper homeopathic remedy especially for miasms and inherited constitutional weakness, overwhelming environmental stress in the home or workplace, physical or sexual abuse, the standard American diet (SAD), nutritional depletion, amino acid deficiencies, organic acid dysbalance, old injuries impeding full recovery, neurotransmitter deficiencies either stress-induced or drug-induced, toxicity from pesticides, herbicides, volatile organic hydrocarbons, PCBs and other industrial waste, plastics, solvents, fire retardants, and many more. Far-infrared sauna and sweating therapy is one of the only ways to rid the body of the hundreds of chemical toxins that we all carry, according to Sherry Rogers, MD, in her excellent book Detoxify or Die.6 EAV devices such as BioMeridian, Vega, Asyra, and LSA/Zyto with LED (laser energetic detoxification) and autonomic response therapy/kinesiology can help to unravel this very complex landscape. Regular laboratory testing is also important to diagnose or confirm diagnoses. Many great labs are deep into this process and are very important to your success in treating these patients.
W. A., a 48-year-old very pleasant female, had CFS and fibromyalgia since 1981. I had treated her for about two years with modest success. She had Trichinella spiralis (pork worms) successfully treated with albendazole, moderate yeast, extremely low total intestinal SIgA, and sensitivity to many common foods. After many tries at different regimens, we checked the MTHFR SNP (methylenetetrahydrofolate reductase single nucleotide polymorphism) blood test, which was positive for a single mutation of A1298C. Basically, this means that she lacks the genetic capability for normal methylation (CH3) involved in hundreds of metabolic processes in the human body. After supplementation with 3 mg of hydroxycobalamin IM twice per week with 5 mg of folinic acid orally daily, she was transformed. She had many good days, before she had none and no muscle pain. Methylation is an extremely deep issue and is abnormal in many of our chronic patients.7
A. D., a 42-year-old female, had a many-year history of CFS, fibromyalgia, migraine headache, insomnia, much recent grief and loss, and hypertension. She could sleep all day. I was the eighth doctor whom she had consulted. After starting all my above regimens, she was completely improved, "amazed at how good I feel," in two weeks. What was the most important thing? I asked. "It was the gluten!" All of her joint and muscle pain returned after eating a pizza and didn't resolve for about three days. She now sleeps well, has no headaches or pain, and great energy. It is not always this easy, but we love a good miracle.
D. C., a 57-year-old female with total body pain, diagnosed with fibromyalgia, severe fatigue, and migraine headaches, had been out of work for several years and basically stayed in bed most of the time. She survived on Soma, hydrocodone, Valium, Klonopin, and Imitrex. She had multiple surgeries in her history, including total hysterectomy, lumbar spine fusion at L3–4, and suffered from anxiety and depression, mental breakdown, and migraine headaches, and was scheduled for another back surgery in one month. During her first visit, I started the adrenal complex weekly IM shots, neurotransmitter supportive IV (vitamins, minerals, and amino acids) and neural therapy injections to her abdominal scars, back scars, root canal teeth (buccal membranes), and then lumbar spine injections with procaine, Discus Compositum, Zeel, and ozone, which relieved her pain greatly. In the first two weeks, she titrated her thyroid up to 1 grain and commenced estradiol gel with EstroDIM, progesterone, testosterone gel, Isocorts, vitamin C, and magnesium glycinate. EBV turned up on our EAV scan and we treated her SP-6 (Spleen-6 is four fingerbreadths above the medial maleolus of the ankle) with 12 days of homeopathic injections of EBV dilutions with Engystol from Heel.
Two week later, she said: "I am definitely better; everyone says so, even my husband, who hates spending money; and my old boss tells me to continue this new therapy because I look so much better and have more energy." Although she was still anxious and had some back pain, her overall body pain had disappeared, and she had new hope for recovery and postponed her repeat back surgery because she was so improved.
It is tragic how many people are so sick and damaged in our society. However, it is most gratifying when we can help those suffering from CFS and fibromyalgia.
1. Dosch P. Manual of Neural Therapy According to Huneke. Heidelberg: Karl F Haug; 1984.
2. Solutions Specialty Pharmacy. Henderson, NV; 702-792-3777.
3. JefferiesWM. Safe Uses of Cortisone. Springfield, IL: Charles Thomas; 1981.
4. Barnes B. Hypothyroidism: The Unsuspected Illness. Harper Collins; 1976.
5. St. AmandRP. What Your Doctor May Not Tell You About Fibromyalgia. Warner Books; 1999.
6. RogersS. Detoxify or Die. Prestige Publishing; 2002.
7. Contact my good friend Richard Kunin, MD, president of OHM (OHM.com), for a good flow chart on methylation defects and their clinical significance; or come to the Orthomolecular Health Medicine Conference next March in San Francisco.
Michael Gerber, MD, HMD