VIDEO: METHYLATION: WHY YOU SHOULD BE CONCERNED
This video is an introduction to methylation and how the methylation cycle is inhibited by various genetic mutations in patients with neuro-immune diseases like ME/CFS. There's some extra noise at the start, but it settles down. The ideas presented here form the basis for the Yasko protocol. It is 52 minutes long.
VIDEO: METHYLATION: WHY YOU SHOULD BE CONCERNED
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Brain Res Bull. 2011 Jul 28. [Epub ahead of print]
Epigallocatechin gallate ameliorates behavioral and biochemical deficits in rat model of load-induced chronic fatigue syndrome. Sachdeva AK, Kuhad A, Chopra K. Source Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study, Panjab University, Chandigarh 160 014, India. Abstract Chronic fatigue syndrome is a heterogeneous disorder with unknown pathogenesis and etiology, characterized by tiredness, difficulty in concentration and memory, and concomitant skeletal and muscular pain, thus affecting both mental and physical domains. The pathogenesis of chronic fatigue syndrome is multifactorial and involves increased oxido-nitrosative stress along with generation of pro-inflammatory cytokines such as TNF-α. In the present study chronic fatigue was produced in rats by plunging a load of 10±2% body weight and subjecting them to forced swim inside a rectangular jar daily for 28 days. Endurance capacity and post-swim fatigue were assessed on 1st, 7th, 14th, 21st and 28th days. EGCG was administered daily by oral gavage 30min before forced swim session. On the 29th day, after assessment of various behavioral parameters, blood was collected through tail vein, and animals were sacrificed to harvest the brains, spleens and thymus. Chronic fatigue group exhibited significant behavioral alterations along with enhanced oxido-nitrosative stress and serum TNF-α level as compared to naive group. Chronic treatment with EGCG restored all the behavioral and biochemical alterations associated with chronic fatigue syndrome. The present study signifies the therapeutic potential of EGCG for the treatment of chronic fatigue syndrome. by Richard A. Van Konynenburg, Ph.D. ([email protected]), February 21, 2006
For the past ten years I have been studying chronic fatigue syndrome as an independent researcher. Over the course of several years I developed a hypothesis for the pathogenesis of this disorder that prominently featured the depletion of glutathione. I presented a poster paper on this hypothesis at the AACFS (now the International Association for Chronic Fatigue Syndrome) meeting in October, 2004, in Madison, Wisconsin. Anecdotal experience of people with CFS who acted upon my hypothesis suggested that while some were able to raise their glutathione levels by various means and experienced benefit from doing so, others were not able to do so. At the time I wrote my poster paper, I was aware of this, and I acknowledged in the conclusions of the paper that there appeared to be factors that were blocking the raising of glutathione in CFS. At that time, I was not sure specifically what they were. I also knew that there was evidence for a genetic predisposition in CFS, but I did not know the details of the genetic variations involved. Shortly after that, I became aware of the work of S. Jill James et al. in autism (American Journal of Clinical Nutrition 2004 Dec; 80 (6):1611-7). They found that glutathione was also depleted in autistic children, that this was associated with a partial block in the methylation cycle (also called the methionine cycle), that this partial block was associated with genetic variations in the genes for certain enzymes and other proteins associated with the sulfur metabolism, and that it interfered with the synthesis of glutathione. They also found that by using certain supplements (methylcobalamin, folinic acid and trimethylglycine) they could lift the block in the methylation cycle and restore the glutathione level. Upon learning of this work, I became very interested in possible parallels between chronic fatigue syndrome and autism. I attended the conference of the Defeat Autism Now! (DAN!) project in Long Beach, California in October, 2005, sponsored by the Autism Research Institute, headed by Dr. Bernard Rimland. As a result I became convinced that the genetic predisposition found in autism must be the same or similar to that in a major subset of chronic fatigue syndrome, and that the resulting biochemical abnormalities were also the same or similar. As far as I know, the genetic variations in people with chronic fatigue syndrome have not yet been studied in detail or published, but I am optimistic that this will occur soon, because of the rapid advances in the technology for doing so, and because of the current active interest of at least three groups in the U.S. and the U.K. in genomic aspects of CFS. There are obviously major differences between chronic fatigue syndrome and autism. I believe that these result primarily from the different ages of onset. Autistic children experience onset early in life, before their brains are fully developed. I believe that this gives rise to the very different brain-related symptoms seen in autistic children from those seen in adults with CFS. However, there are many similarities in the biochemistry and symptoms of these two disorders as well, including oxidative stress, buildup of toxins, immune response shift to Th2, and gut problems, for examples. The triggering factors for autism and chronic fatigue syndrome are also largely different. Although this subject remains controversial, there appears to be substantial evidence that vaccinations (containing either a mercury-based preservative or live viruses, many given within a short period of time) were responsible for triggering many of the cases of autism in genetically susceptible children (D. Geier and M.R. Geier, International Journal of Toxicology 2004 Nov-Dec; 23(6):369-76; and A.J. Wakefield, several publications beginning in 1997). In CFS, a variety of triggering factors (physical, chemical, biological, or psychological/emotional) have been found to be involved in various cases, as reviewed in my poster paper, cited above. All these factors have in common that they place a demand on glutathione. It appears that genetically susceptible persons are unable to maintain normal glutathione levels when the total demand for it is high, and that once glutathione drops sufficiently in a genetically susceptible person, the sulfur metabolism becomes disrupted. In many cases the methylation cycle (part of the sulfur metabolism) becomes partially blocked, and the result can be a depletion of some or all of several important sulfur-containing metabolites, including S-adenosylmethionine (SAMe), cysteine, glutathione, taurine and sulfate. A vicious circle is thus formed, and the depletion in these metabolites causes an avalanche of pathogenesis, since they all have very important functions in the body. I think that much of this pathogenesis is common between autism and CFS. In autism, the loss of methylation capacity because of the drop in SAMe appears to be responsible for much of the interference with normal brain development. There is also a major difference in the sex ratio between autism and CFS. In the book mentioned below, Dr. Jon Pangborn discusses possible reasons why autism is more prevalent in boys. In my poster paper, cited above, I suggested a hypothesis to explain the female dominance in the prevalence of CFS in adults. I think that the reason why the people who have developed CFS as adults did not develop autism as children (even though I suspect that they have the same or a similar genetic predisposition) is that when they were children, not as many vaccinations were required. The schedule of vaccinations required for children in the U.S. has grown substantially over the past two or three decades, as has the incidence of autism. This is also true in the U.K. Shortly after attending the DAN! conference, I also learned of the work of Dr. Amy Yasko, primarily in autism, but extending to a number of other disorders as well. Working independently of the DAN! project, Dr. Yasko develops her treatment recommendations by analyzing the specific gene variations in each patient. In addition to studying effects on the methylation cycle, Dr. Yasko has gone on to consider the effects on associated biochemistry, including folate metabolism, biopterin, the urea cycle and the synthesis of neurotransmitters. My main message is that a great deal has already been worked out in autism by the researchers and clinicians associated with the Defeat Autism Now! project, and also by Dr. Yasko, and that I believe that the CFS community would benefit greatly by looking carefully at what they have already done. The doctors associated with the DAN! project treat autism by the use of nutritional supplements that compensate for genetic mutations in the sulfur metabolism. These include such supplements as magnesium sulfate, taurine, molybdenum, vitamin B6 and its active form P5P, magnesium, methylcobalamin, folinic acid, trimethylglycine, and dimethylglycine. They also use certain diets, and they perform chelation treatments to remove heavy metals. The results in many autistic children have been astounding, as can be seen in the webcast cited below, where several are interviewed. Dr. Yasko, in cooperation with Dr. Garry Gordon, uses many of the same supplements as are used by the DAN! project doctors as well as some additional ones, including RNA supplements, and she is also reporting great success. So I want to encourage everyone who has an interest in CFS to look at the results of the DAN! project and of Dr. Amy Yasko in autism. To view videos of the talks given at the latest two DAN! conferences on the internet at no cost (unless you are paying for the internet time!), go to this site. You can choose the more recent Long Beach conference or the earlier Boston conference. They cover much of the same material, but both are worthwhile to watch. If you want to see and hear a good explanation of the methylation cycle research, go to the Boston meeting first, so you will be able to view the talk by Jill James, who did not attend the Long Beach meeting. After selecting one of the conferences, go to the lower left and register. This is free. They will email a password to you right away, and then you can choose a talk to watch. Beyond this, I also want to recommend a book entitled Autism: Effective Biomedical Treatments. This is a new book (Sept. 2005). It is by Jon Pangborn, Ph.D. and Sydney Baker, M.D., a biochemist and an autism clinician, respectively. The cost for the book is $30 U.S. This is an excellent book. It is a reference book, full of good information and good science, explained clearly. This book deals very practically with developing a treatment program for an individual child. I think that most of it will turn out to apply directly to adults with CFS as well. In addition, I want to recommend the book by Amy Yasko entitled Genetic ByPass as part of the "Nutrigenomics Educational Starter Packet." The price is $49.95 US [note: Benetic ByPass is no longer available, though Autism: Pathways to Recovery is an excellent book by the same author a applicable to all illnesses]. It discusses treatments specifically tailored to the particular combinations of genetic variations found in different patients. I think these two books complement each other. I would recommend reading the Pangborn and Baker book first, as it provides a good basis for understanding the technical aspects of the genetics found in the Yasko book. Although I have been suggesting consideration of the DAN! treatments and the Yasko testing to people with CFS for only a short time, and it is too soon to draw conclusions, early feedback is very encouraging. While I am going out on a limb to some extent in announcing this now, I don't want to wait any longer, because I think this could help a lot of people. Of course, we should all keep in mind that with the current case definition of CFS we have a very heterogeneous population, and the autism treatments will very likely not help everyone who has CFS, but I am convinced that they will help a substantial subset. So I want to encourage those who have CFS and those who treat it to look into this in the strongest way I can. It could be the answer for many of you. [Disclaimer: I have no financial interest in anything recommended in this article.] Rich Simplified Methylation Protocol Q&A with N Nathan MD, Including Actual 5-Supplement Protocol6/22/2011 ProHealth.com
by Neil Nathan, MD June 22, 2011 Dr. Nathan reported to ProHealth readers recently on his successful trial of a promising protocol for ME/CFS and fibromyalgia patients. (See “A Simplified Methylation Protocol is Effective for the Treatment of Chronic Fatigue Syndrome and Fibromyalgia.”) As Dr. Nathan explained: • Every ME/CFS and FM patient he tested showed signs of abnormal methylation chemistry, • But this chemistry began to normalize, and most of the patients got much better, on a regimen of nutrients that the body employs in methylation. The regimen is “simplified” in that it has been pared down over time from a long list of possibilities to just a few, with formulas refined collaboratively by Drs. Nathan, Rich Van Konynenburg, Amy Yasko, and Jacob Teitelbaum. Now, to answer questions from readers about the protocol, Dr. Nathan has provided the following Q&A. ___________________________ Dr. Nathan’s Preface: I would like to emphasize that although the individual ingredients in the protocol are all natural and safe, when they work, there is the very real risk that improved methylation will dramatically improve the body’s ability to detoxify, and if the individual’s system cannot deal with a sudden release of toxins, they can get quite sick. That’s why I emphasize the need to find a health care provider who understands this and can work with you. More information is available in the chapter on methylation in my book, On Hope and Healing: For Those Who Have Fallen Through the Medical Cracks. But unfortunately that information is not sufficient for patients to do this by themselves. _____________________ Q: Specifically what are the vitamins that you mention in the article? Dr. Nathan: The supplements we used in the trial are:
Q: Do you offer a "package" that includes all the required supplements together, as described in the article? A: At my office (at Gordon Medical Associates), we have put this package together, and I believe that ProHealth has just arranged to offer the package as well.* * * * * Q: Is there specific information on this protocol in a form that I could submit to my doctor so she could monitor it? A: You could copy the chapter in my book (pp. 153-167, “Methylation: a Key to Understanding Chronic Illness”), and you could Google “Rich Van Konynenburg” to get copies of his groundbreaking papers which outline the scientific basis for this program. * * * * Q: Advice on finding a doctor or type of doctor who would be open minded about this protocol and willing to work with me in trying it? A: Many holistic, integrative practitioners are somewhat knowledgeable about this protocol, but many not have experience with it directly. I have presented our work to a number of scientific groups, and hope that more physicians will get interested. In the meantime, you might look at members of ACAM (the American College for Advancement in Medicine), AHMA (the American Holistic Medical Association), or AAEM (the American Academy of Environmental Medicine) for practitioners who are more likely to know something about this. * * * * Q: Is Dr. Nathan's treatment ministered through any doctor or specialist here in the UK that you know of? Suggestions for those in the UK and elsewhere? A: I’m sorry, but I am not aware of any specific individuals in the UK to recommend. In fact, I have heard that several UK holistic practitioners have been reprimanded recently for their work (which is distressing) – such as Dr. Sarah Myhill, who has done some excellent work in the field of chronic fatigue and fibromyalgia. * * * * Q: Is the protocol a regimen recommended to maintain as long as you can as a part of a daily regimen? A: What we have found is that it takes 4 to 6 weeks to start seeing improvement, and then that improvement continues over a 9-month period of time, probably longer. Some of my patients, in the study, discontinued the supplements and relapsed (and then improved again). Others discontinued the supplements and did well. So I suspect the results are dependent on individual biochemistry and that each patient will need to elucidate for themselves their optimal use of these materials. * * * * Q: Thanks for the encouraging report. Would the results of the 30 patients treated with Dr. Teitelbaum's program have had an increased chance of realising a good response to Dr. Nathan's treatment due to the fact they had a 'good start' having benefited from Dr Teitelbaum's treatment? A: That's an excellent question, and we don't really know the answer, since it hasn't been studied yet. It is possible that addressing problems with the adrenal, thyroid, gut, sex hormones, food allergies, infections and heavy metal toxicity allowed the treatment to work much better. It is also possible that the Methylation Protocol would have value in a patient who had not been treated with any of these methods.... we just don't know. * * * * Q: Would there be any point in starting on just one supplement, and if so which one? A: In terms of our study, which is the only scientific data I have, it's a package deal in terms of effectiveness. I have seen really sensitive patients who cannot take the entire program, and for them I start with the sublingual B-12 and phosphatidyl serine, then slowly add the Folapro and Actifolate next. * * * * Q: Is one supposed to discontinue your methylation supplements before doing a methylation panel test, and if so, how long would you need to be off them before the test? It seems to me that I would be more interested in how my body is doing while on them, since I plan on continuing to take them, but perhaps they interfere with the test? A: I agree, it would be much more useful to get the panel done while ON the supplements, since that tells you where you are in space and time, and guides us in modifying the protocol. Because of the expense of the test, I usually will start patients on the protocol and reserve the use of the test for those who have not responded to it as I would expect. * * * * Q: If the problem is low glutathione in ME/CFS, why not just take that? A: Also a good question, and an important one. Many practitioners don't agree on this. From my perspective, if you give glutathione (which often helps, by the way), that sends a message to the body that it doesn't need any more, and it stops making it. It makes more sense to me to give the body the raw materials it needs to stimulate it to make more glutathione, and our research indicates that this approach works. * * * * Q: I have fibromyalgia for 13 years, and am interested in your simplified Methylation Protocol, but my doctor tested me recently for folate and B-12, and they were at "normal" levels. Would this be an indication that the protocol probably wouldn't do much for me? A: Absolutely not. Those numbers have nothing to do with this protocol. The problem for most people is that they cannot methylate properly because of toxic, or genetic, effects. The full methylation panel offered by Vitamin Diagnostics** measures 11 parameters that we can evaluate, which show how well the body makes glutathione and SAMe, which is what this is all about. Most physicians are only aware of, or prescribe, cyanocobalamin (one form of B-12) and folic acid, neither of which is particularly good at improving methylation. What we have learned is that hydoxycobalamin and methylcobalamin (other forms of B-12) and 5-methyl tetrahydrofolate and folinic acid are what are needed to start moving the cycle around. So just looking at folate and B-12 levels does not give you what you need to figure this out. * * * * Q: I have suffered from fibromyalgia for over 33 years. I continue to search the Internet for new treatments and must admit that I have hope for the first time in many years of frustration and defeat. I’ve noticed new treatments in many different trial phases at this point. While reading about your discovery I wondered about where this stands regarding trial stage for the FDA approval process. Is it possible to try your new discovery without FDA approval? Please let me know… how I may benefit from this discovery now if possible. A: We were not looking for FDA approval of this material. We were looking for answers for how to help a lot of patients like yourself. Since these are natural materials, they can't be patented, and a pharmaceutical company cannot charge exorbitant amounts for the product... Hence, it will never be profitable enough for anyone to seek FDA approval in the usual way. Find someone who understands this chemistry and let them help you with it. * * * * Q: I have been doing the simplified methylation protocol and believe it has helped me. But I think I have reached a plateau. Do you suspect this is as good as it gets, or might there be something I could add to improve more? A: You may be ready to check your methylation chemistry test results now. OR you may need to look at heavy metal (particularly mercury) toxicity as something that may be preventing it from working optimally. * * * * Q: I have chronic fatigue syndrome, and POTS is an important symptom for me. Might a methylation problem be involved in this? A: It may help. To my knowledge no one has looked at this yet, but every biochemical piece of the puzzle may ad to the possibility of healing. * * * * Q: I have purchased your book [On Hope and Healing: For Those Who Have Fallen Through the Medical Cracks] and am underlining/making notes in the margin. Thanks for this wonderful book with its compilation of treatments. I have had CFIDS for 23 years. My new DO practices holistic medicine. Although she does not know the many specifics of this illness, she is willing to work with me on treatment modalities. I looked up the products for methylation [pp. 153-167]. The General Vitamin Neurological Health Formula has citrate compounds (e.g., calcium citrate) which I have never been able to tolerate. What alternative product(s) would you recommend for citrate-sensitive individuals? A: The General Vitamin formula was chosen for some of its unique ingredients, but is probably the least essential part of the program, so I suspect you could benefit without adding that specific product. * * * * Q: I would like to know if you have heard other people say that the B vitamins in this protocol cause migraines. A: I am not aware that these B vitamins (primarily B-12) have ever been associated specifically with migraines. The only way that might happen would be if the release of toxins in that individual was greater than they could deal with. That might set off migraines. But having treated several hundred patients with the protocol now, I have not personally seen that reaction. * * * * Q: Dr. Nathan, if you add sufficient vitamin D3 (5,000-10,000 IU/day) to your protocol your patients will see an additional incremental improvement. Go to the Vitamin D Council website at www.vitamindcouncil.com for more information. A: Measuring vitamin D levels and treating with D3 is an integral part of our program. I agree it is another important area to evaluate and treat, but was not specifically a part of the original protocol. * * * * Q: For Dr. Garth Nicolson’s “ATP Fuel” Trial (of a supplement with NT Factor, NADH, and CoQ10) now recruiting, would I have to stop the methylation protocol before starting it? I was accepted and didn't think to ask about other meds or supps I'm taking. A: When doing research, it is important that you follow the research protocol being offered to you. I am aware of Dr. Nicolson's study, and would suggest you ask him that question before you proceed. * * * * Q: Do you have any thoughts on whether a methylation defect might affect thyroid or other hormonal balances? A: Everything is interrelated. For example, we have to methylate serotonin to make melatonin, so there is an important interaction between our neurotransmitters and methylation... And I think, as we learn more, that all of our important endocrine relationships will be connected in some way to methylation. Methylation is central to over 150 important chemical reactions (that we know of, so far). More is yet to be revealed. * * * * Q: Do you think a methylation cycle problem could contribute to allergies, and if so might your simplified protocol help? A: Again, everything is inter-related in the body. Improving methylation will help detoxification, but I wouldn't recommend it as a first-line treatment for allergy. * * * * Q: Would the Methylation Protocol be of any benefit for individuals with Lyme disease? Would the vitamin B-12 and folic acid be good for it? My girlfriend has had Lyme disease for the past 7 years. She was diagnosed 5 years ago and has been on antibiotics for the past 4 years as of June 2011. Do you have any suggestions or directions regarding the continued use of antibiotics for the treatment of chronic Lyme disease? Any help would be much appreciated. She has been through hell and is better but not cured of the Lyme. A: We treat a large number of patients with Lyme disease, and we have found that most of them (as with patients chronically ill with virtually any condition) do not methylate properly. Many of them do respond to a methylation protocol, but again, I must warn you that most of our Lyme patients wrestle with problems of toxicity and are at high risk of reacting to the protocol, initially. So I would go VERY slowly and carefully, work with someone who understands this. * * * * Q: For someone with a diagnosis of Lyme pathogens, would you recommend treating the Lyme first or doing the Methylation Protocol first? A: Treat the Lyme first. If you try the methylation protocol first, you will release toxins that the individual cannot handle and you have a high risk of making them worse. * * * * Q: Rich Van Konynenburg wrote several years ago in the ProHealth ME/CFS/FM message board that he had a hypothesis that “Lyme disease is one route of entry into CFS for people who are genetically susceptible.” What is your current thinking on whether ME/CFS and Lyme may sometimes be linked or otherwise associated? A: As we continue to study this, it becomes clear that many patients who have been diagnosed with ME/CFS have Lyme disease that hadn't been looked for or diagnosed. The numbers are much higher than we had thought, so that some Lyme specialists think most patients with "CFS" actually have Lyme. I would not take it that far, but I would agree that we should check all CFS patients for Lyme disease. We don't want to realize three years down the road that we missed a treatment component. * * * * Q: What can help with the cellular detoxification that the methylation protocol vitamins encourage? Something like milk thistle? Or chlorella? What do you think the toxins are, mostly? Heavy metals, or other? A: The toxins include heavy metals, mold, pesticides, chemicals, and the results of a wide variety of infections (Lyme, Bartonella, Babesia, viruses, mycoplasma, Chlamydia, etc.). We do use milk thistle, chlorella, and a wide variety of other materials to assist with the detoxification process - each adjusted to individual patients' needs. * * * * Q: I heard a video piece by a man who was doing a mini-beet protocol for detoxification. He told of eating apple directly after drinking a beet juice combination. He said that the raw apples stopped the detox effects. Have you heard of this and do you think it would be a possibility following your protocol? A: I am not specifically aware of this, but neither do I know that it is true. * * * * Q: Would soluble fiber be good to help while detoxing? A: One valuable detoxification material is pectin; fiber does help. * * * * Q: In May 13 Science there’s an article on DNA methylation and epigenetics. [Note: Epigenetics is the study of changes in gene expression produced by environmental factors.] It indicates this phenomenon adds methyl groups to specific genes, “usually silencing their expression.” This is susceptible to environmental influences, and is reversible, so silenced genes can be reactivated. Could something like this DNA methylation be affecting gene expression in ME/CFS and fibro people, and might the methylation protocol be reversing something? A: Yes, of course. One of the many vital functions of methylation is that it is central to repairing DNA. Part of our study related to the SNPs that represent genetic "tendencies" to impair methylation (more than 13 are known and are measured by Dr. Yasko) and the ability of this protocol to improve this. * * * * Q: It has been established in other studies that glutathione levels are low in ME/CFS. The question of whether ME/CFS is due to impaired methylation is doubtful. The immune signature of ME/CFS is now better understood and widely accepted by key researchers in this field. We need to be wary of simplistic biochemical explanations like this but by all means supplement with folate and B-12 as well as glutathione, even N-acetyl cysteine. A: There is no reason to throw the baby out with the bathwater. Yes, we are learning more of the immune signature of ME/CFS, but why presuppose that methylation "blocks" are not an integral part of that story? * * * * Q: My Lyme doctor put me on the Methylation Protocol (I have had chronic fatigue for more than 10 years)… It made me feel like I was on speed. Any insights on this? A: Yes. It was too strong for you. You may need to cut it way back for it to be of benefit. * * * * Q: I have problems with IBS and have heard that introduction of glutamine can sometimes rid these problems. In your study did any of your patients have IBS and did your methylation therapy help their IBS? A: Glutamine is tricky: Although it may be useful for 'leaky gut' or IBS, glutamine is excitotoxic to the brain and may make autism or other conditions that have an irritated autonomic nervous system worse. * * * * Q: Dr. Nathan, I have your book and have been encouraged by your your stories and your dedication. I've even done cranio-sacral work [discussed in the book]. Awesome! I have been on the full Yasko Protocol about 7 months and I believe I am progressing, but slowly. My question: Is it because I am 51 years of age? Does it make sense that someone older might take longer to recover? A: I am not aware that age is an issue in methylation treatment. I had great results in my study with an 82-year-old woman, and poor results in a 27-year-old. * * * * Q: How can I get in touch with Dr. Yasko? I have a family member with autism and would like to have Dr. Yasko see him. [Note: Biochemist Dr. Amy Yasko pioneered the concept of addressing methylation problems in autistic children using specially formulated nutrients that she developed, with promising results. Her suggestion that methylation problems might play a role in other conditions was what inspired Rich Van Konynenburg, another biochemist, to work diligently for years adapting the protocol for ME/CFS and fibromyalgia.] A: Dr. Yasko is unfortunately no longer seeing patients directly. She decided several years ago that she could help more patients (since the need is great) by testing them with the genomic assays available through her website, and going on line to help them understand the results of those tests and guide them with suggestions. ProHealth Concluding Note Along with their questions, readers have expressed sincere gratitude to Drs. Nathan and Van Konynenburg for their untiring "commitment to healing." In their words, "This is so very exciting. Thanks to you and Dr. Rich. You guys are heroes!" For readers who have further questions for Dr. Nathan, he may be reached at his office with Gordon Medical Associates near Mendocino, California (www.gordonmedical.com, Email: [email protected]). Dr. Van Konynenburg may be reached at [email protected] ____ * For information about the Simplified Methylation Protocol nutritional supplements mentioned above, which ProHealth has arranged to make available soon, contact our helpful Customer Service Specialists. ** Now Health Diagnostics and Research Institute, South Amboy, NJ. Phone 732 721-1234. Their Methylation Pathways Panel requires an order from a medical doctor or chiropractor and costs $300 plus cost of shipping blood sample to lab, according to Rich Van K. Note: This information has not been evaluated by the FDA. It is general information, and is not meant to prevent, diagnose, treat or cure any condition, illness, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team. Adrenal Fatigue by Dr. Roger Murphee DC, CNS
The adrenals are a pair of pea-sized glands located atop each kidney. The adrenal gland consists of two sections: the medulla (inner portion) and the cortex (outer portion). The adrenal glands release certain hormones that allow us to be able to deal with immediate and long term stress. These glands and the hormones they release allow us to be resilient to day to day stress. Under-active adrenal glands are evident in about two-thirds of CFS patients. The majority of patients I see for chronic illnesses, including are suffering from it. They have literally burned their stress-coping organ out. Amid years of poor sleep, unrelenting fatigue, chronic pain, excessive stimulants, poor diet, and relying on a plethora of prescription medications, the adrenal glands and the hormones they release have been used up. Once adrenal exhaustion sets in, it’s not long before the body begins to break down. Getting “stressed out” and staying “stressed out” is the beginning of chronic illness. Adrenal fatigue is known to cause: • hypoglycemia (low blood sugar) • hypotension(low blood pressure) • neural mediated hypotension (become dizzy when stand up) • fatigue • decreased mental acuity • low body temperature (a sign of low thyroid function) • decreased metabolism • a compromised immune system • decreased sense of well-being (depression) • weight loss • hyperpigmentation (excess skin color changes) • loss of scalp hair • excess facial or body hair • vitiligo (changes in skin color) • auricular calcification (little calcium deposits in the ear lobe) • GI disturbances • nausea • vomiting • constipation • abdominal pain • diarrhea • crave salty foods • muscle or joint pains The Adrenal Gland The MedullaIn the inner region of each adrenal gland is what’s known as the medulla. The adrenal medulla produces norepinephrine and epinephrine (adrenaline). These hormones are known as catecholamines. The medulla hormones are primarily involved in acute (immediate) responses to stress. Epinephrine… • increases the speed and force of the heart beat. • increases systolic blood pressure (the top number -120/80) • increases pulse rate • increases cardiac (heart ) function • dilates (opens) the airways to improve breathing • increases the rate and depth of respiration to allow more oxygen to reach the bloodstream • mobilizes sugar from the liver to the blood stream in preparation of the fight or flight response • regulates circulatory, nervous, muscular, and respiratory systems when needed. • inhibits the muscle tone of the stomach, so you may feel a “knot” in your stomach during times of stress. Restoring adequate epinephrine levels is important. This can be done with SAMe However, I’ve found that by restoring the adrenal cortex and its hormones, cortisol and DHEA, adrenal fatigue can be overcome. The Cortex The adrenal cortex is primarily associated with response to chronic stress (infections, prolonged exertion, prolonged mental, emotional, chemical, or physical stress). The hormones of the cortex are steroids. The main steroid is cortisol. Chronic over secretion of cortisol leads to adrenal exhaustion, which accelerates the downward spiral towards chronic poor health. Once in adrenal exhaustion your body can’t release enough cortisol to keep up with the daily demands. Eventually you become deficient in cortisol and then DHEA. Chronic headaches, nausea, allergies, nagging injuries, fatigue, dizziness, hypotension, low body temperature, depression, low sex drive, chronic infections, and cold hands and feet are just some of the symptoms that occur with adrenal cortex exhaustion. Abnormal Circadian Rhythm Cortisol levels are affected by stress and the body’s circadian rhythm (sleep-wake cycle). Cortisol secretions rise sharply in the morning, peaking at approximately 8 a.m. After its peak, cortisol production starts to taper off until it reaches a low point at 1 a.m. Fluctuations in cortisol levels can occur whenever normal circadian rhythm is altered (a change in sleep-wake times). Traveling through different time zones (jet lag), changes in work shifts, or a change bed time can cause drastically alter normal cortisol patterns. Some patients will report that their symptoms began when they began working at night. Some will begin to have symptoms after staying up several nights in a row to take care of invalid family members or newborn babies. Changes in circadian rhythm can lead to insomnia and poor sleep. An example of this occurs when a person tries to go to sleep at a certain time but can’t wind down. They may catch a second wind when their cortisol levels kick-in. This is why it is important for you to try to go to bed (preferably before 11:00 p.m.) and wake-up at the same time each day. Establishing normal sleep and wake times is crucial in restoring normal circadian rhythms. Adrenal Burnout People often experience stress reactions every few minutes when bombarded by stimulus coming from our radios, driving in traffic, cell phones, pagers, and from electromagnetic pollution. Studies show that chronic noise exposure, for example, can significantly raise cortisol levels. This leads to fatigue and problems with concentration. Persistent, unrelenting stress will ultimately lead to adrenal burnout. Not Enough DHEA The adrenal cortex, when healthy, produces adequate levels of dehydroepiandrosterone (DHEA). DHEA boosts: • energy • sex drive • resistance to stress • self-defense mechanisms (immune system) • general well-being and helps to raise: • cortisol levels • overall adrenal function • mood • cellular energy • mental acuity • muscle strength • stamina DHEA is notoriously low in FMS and CFS patients. Chronic stress initially causes the adrenals to release extra cortisol. Continuous stress raises cortisol to abnormally high levels. Then the adrenal glands get to where they can’t keep up with the demand for more cortisol. As the cortisol levels continue to become depleted from ongoing stress the body attempts to counter this by releasing more DHEA. Eventually they can’t produce enough cortisol or DHEA. Aging makes holding on to DHEA even tougher. Even in healthy individuals, DHEA levels begin to drop after the age of 30. By age 70, they are at about 20% of their peak levels. Stress and DHEA DHEA helps prevent the destruction of tryptophan (5HTP), which increases the production of serotonin. This helps provide added protection from chronic stress. Studies continue to show low DHEA to be a biological indicator of stress, aging, and age-related diseases including neurosis, depression, peptic ulcer, IBS, and others. DHEA and Immune Function The decrease in DHEA levels correlates with the general decline of cell-mediated immunity and increased incidence of cancer. DHEA protects the thymus gland, a major player in immune function. Billie Jay Sahley, PhD, writes, “over secretions of the stress hormones [cortisone, cortisol, and corticosterone], caused by long-term mental or physical effort, could lead to cancer, arthritis, and susceptibility to infections. Many psychosomatic disorders are transmitted from the brain to the skeletal muscle system. Anxiety, stress, anger, or any other psychic state can greatly change the amount of nervous stimulation to the skeletal muscles throughout the body, and either increase or decrease the skeletal muscular tension.” These same stimulatory responses that affect the muscles also cause changes in various bodily organs: abnormal heartbeats, peptic ulcers (too much stomach acid), hypertension, spastic colon, and irregular menstrual periods. This is why you can’t separate emotional stress from physical stress. Testing for DHEA levels is recommended. However, I often place my patients on a trial of 25mg (women) or 50mg (men) of DHEA prior to testing. Testing for Adrenal Fatigue Self Test Methods A quick blood pressure test that monitors lying and standing systolic numbers can help us begin a trial treatment of adrenal boosting supplements. Orthostatic Blood Pressure Ragland’s sign is an abnormal drop in systolic blood pressure (the top number) when a person arises from a lying to a standing position. There should be a rise of 8–10 mm. in the systolic (top) number. A drop or failure to rise, indicates adrenal fatigue. Example: Someone takes your blood pressure while you’re lying on your back. The systolic number is 120 and the diastolic number is 60 (120 over 60). Then take your blood pressure again after immediately standing up. The systolic number (120) should go up 10 points (from 120 to 130). If it doesn’t increase 10 points, this indicates adrenal fatigue. Note: It’s not unusual for the systolic number to drop 10 or more points, a sure sign of adrenal fatigue. Pupil Dilation Test Another way to test for adrenal dysfunction is the pupil dilation exam. To perform this on yourself, you’ll need a flashlight and a mirror. Face the mirror, and shine the light in one eye. If after 30 seconds the pupil (black center) starts to dilate (enlarge), adrenal deficiency should be suspected. Why does this happen? During adrenal insufficiency, there is a deficiency of sodium and an abundance of potassium, and this imbalance causes an inhibition of the sphincter muscles of the eye. These muscles normally initiate pupil constriction in the presence of bright light. However, in adrenal fatigue, the pupils actually dilate when exposed to light. Rogoff’s Sign Rogoff’s sign is a definite tenderness in the lower thoracic (mid-back) spine where the ribs attach. Adrenal Fatigue Protocol 1. I Make sure my patient’s are consistently going into deep restorative sleep each night. 5HTP or Melatonin therapy may be needed. 2. I replace my patients on a good optimal daily allowance multivitamin/mineral formula. 3. I also start my patients on adrenal cortical extracts. These help repair and restore normal adrenal function: “Adrenal extracts have been recommended and successfully used for a variety of conditions that involve low adrenal function, including asthenia, asthma, colds, burns, depletion from infectious diseases, from colds, coughs, dyspepsia (poor digestion) early Addison’s disease, hypotension (low blood pressure), infections, infectious diseases…neurasthenia (low energy/weakness), tuberculosis, light-headedness and dizziness, and vomiting during pregnancy.” Adrenal cortical extracts are used to replenish and eventually normalize adrenal function. They have an advantage over prescription cortisol hormone replacement in that they can be instantly discontinued once they have done their job of repairing adrenal function. Adrenal extracts have been successfully used to treat many conditions related to adrenal fatigue, including many symptoms of FMS and CFS. They can increase energy and speed recovery from illness. Adrenal extracts are not a new treatment. In the 1930s, they were very popular, used by tens of thousands of physicians. They were still being produced by leading drug companies as recently as 1968. Today, these extracts are available without a prescription as adrenal cortical glandular supplements. Adrenal Cortex Glandular Supplements I recommend my start with 500 mg of adrenal cortex glandular twice a day with food. Patients usually notices improvement from taking adrenal cortex glandular supplementation (along with the steps above) within one–two weeks. 4. I recommend my patient’s drink at least 70 ounces of water each day. If my patient’s continue to experience adrenal fatigue symptoms even after taking the steps above: 5. I’ll recommend DHEA if needed. It’s best to be tested before taking DHEA supplements. However, most females with FMS or CFS will usually need 10-25mg. daily and males 50–100 mg daily. I’ve found sublingual (dissolving under the tongue) to be the best form of DHEA, but micronized (much easier to absorb) forms of DHEA are also a good choice. I normally wait to see patients respond to adrenal cortex supplementation before recommending DHEA. 6. Increase vitamin C intake if necessary. It’s perhaps the most important nutrient in facilitating adrenal function and repair. Dr. Wilson writes that “The more cortisol made, the more vitamin C is used. Vitamin C is so essential to the adrenal hormone cascade and the manufacture of adrenal steroid hormones that before the measurement of adrenal steroid hormones became available, the blood level of vitamin C was used as the best indicator of adrenal function level in animal research studies.” Vitamin C DosingI recommend all patients take a minimum of 1,800 mgs a day of vitamin C. Much larger amounts of vitamin C may be needed for adrenal restoration, but it’s best to begin with 1,800-2,000mg daily and increase by an additional 1,000–2,000mg a day, up to 10,000 mgs or until a person has a loose bowel movement. If a loose bowel movement occurs, I recommend they reduce their dose by 1,000 mgs. They should keep reducing the dose by 500–1,000 mgs daily until they no longer have loose stools. This is the ideal dose of vitamin C. I encourage my patient’s to always eat breakfast and to never skip meals. Individuals with low adrenal function are usually not hungry when they wake up. They instead rely on chemical stimulants (coffee, sodas, cigarettes, etc.) to get them going. These stimulants raise blood sugar levels as well as serotonin levels. However, these stimulants also increase adrenaline and cortisol levels. This curbs their appetite even further. However, the body needs to break the eight hour fast (breakfast) it has been under. The brain especially needs to fed; forty percent of all food stuff fuel goes to maintain proper brain function. This is one reason a person may have problems with “Fibro fog” and mood disorders (anxiety and depression). Cortisol levels are at their highest around 8:00 a.m. A person may be hypoglycemic (low blood sugar) and their cortisol levels will be extremely high in the morning. They may feel nauseated, mentally and physically drained, jittery, suffer from headaches, and eating is the last thing they want to do. They need to eat anyway! A small snack (avoid simple sugars) is all they need until hunger comes, usually a couple of hours later. Then they should eat another balanced snack to tie you over until lunch. They should never skip lunch! It’s best to eat little meals throughout the day. Slowly Reduce Caffeine ConsumptionI encourage my patients to eliminate—or at least limit—all caffeine, nicotine, sugar, and alcohol. I know this can be tough. But if they are really sick and want to get well, this is really not an option. At the very least, they will need to drastically reduce their consumption of these adrenal hormone robbers. I recommend they wean off caffeine slowly to avoid headaches. It’s best to wean off caffeine over a period of two to three weeks. via ProHealth.com
by Blake Graham, Clinical Nutritionist* June 8, 2011 The efficiency of mitochondrial energy production is highly dependent on adequate cellular oxygen concentration – a key issue for those with chronic fatigue syndrome and fibromyalgia. In this recently updated article, fatigue consultant Blake Graham describes simple breathing exercises to help break the dysfunctional cycle that’s involved. _______ I have heard about the supposed importance of breathing in chronic fatigue syndrome (and fibromyalgia) for many years, and never took it very seriously. Then I read an article in Alternative and Complementary Therapies journal titled “Clinical Roundup: How Do You Treat Chronic Fatigue Syndrome in Your Practice?” In the article, eight integrative/alternative medicine experts described how they treat ME/CFS. While they come from a variety of different backgrounds, four of the eight mentioned the importance of breathing. This inspired me to look into the role of breathing in more detail. After studying this topic, I have become completely convinced that this is a very important issue. The issues discussed here are all heavily interrelated. These relate to: - The rate and depth of breathing, - Dysfunction of the autonomic nervous system (ANS), and - Stress/tension. These issues collectively constitute a very important [cycle] which contributes to, and perpetuates, ME/CFS. And the treatment I’ll discuss is designed to break the cycle of these three issues. Some people have a bias against 'low tech', mind-body or free treatments, assuming they are not as potent as other treatments, so please keep an open mind as you read through this. One of the sources I read was the book Bursting With Energy, by Dr. Frank Shallenberger. In it, he describes “Breathing Right” as one of the “Eight Secrets for Improving Energy.” A brief summary of this chapter, explaining the difference between chest and diaphragmatic breathing, is found online HERE. Improper Breathing Retards Metabolic Energy Production While people with ME/CFS have normal blood oxygen, cellular oxygen levels are often inadequate. Optimal breathing improves cellular oxygen concentration, including to the brain. Mitochondrial function, a key issue for those with ME/CFS/FM, is highly dependent on oxygen levels for energy production. Shallenberger cites a case study in his book in which a person increased his metabolic energy production 20% after just half an hour of breathing instruction. Drs. Sarah Myhill and Charles Lapp are two CFS & Fibromyalgia experts who discuss the importance of breathing. Dr. Myhill, a co-author of “Chronic Fatigue Syndrome and Mitochondrial Dysfunction,” discusses the topic in “Hyperventilation – Makes you feel as if you can’t get your breath.” She writes: "Hyperventilation – the idea here is that for whatever reason, the patient over-breathes. One cannot increase the oxygen carrying capacity of the blood this way, so oxygen levels are not increased, but carbon dioxide is washed out. This changes the acidity of the blood in such a way that oxygen sticks more avidly to hemoglobin. “So oxygen is not released to the mitochondria where it is required, and so mitochondria go slow - so cells go slow, and this results in fatigue." And Dr. Lapp in his "Stepwise" treatment approach notes that in both CFS and fibromyalgia, most patients breathe shallowly, using the muscles in the upper part of the chest. He recommends deep breathing, through the lower part of the diaphragm, because "This type of breathing tends to relieve things like chest tightness, shortness of breath, as well as spasms in the postural muscles." Stress and Breathing The link between stress and breathing goes both directions. • Higher stress levels cause faster/deeper breathing, • And faster breathing causes higher stress levels. Read "Breathing Matters - Stress" by ear/nose/throat specialist Dr. Jim Bartley for an excellent article on the relationship between stress and breathing. The Autonomic Nervous System and Breathing to Restore Balance The autonomic nervous system (ANS) is the part of the nervous system which controls involuntary functions. It is composed of two sections, the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS). • The SNS activates our stress response (the ‘fight or flight' response) and is associated with higher energy utilization, • While the PNS counteracts the stress response and is associated with relaxation, energy conservation, digestion, etc. In many chronic illnesses, including anxiety disorders, this autonomic balance is impaired, with an over-active SNS response and under-active PNS response. Research on those with ME/CFS suggests that both the PNS relaxation response and the SNS SNS 'fight or flight' response are under-active, associated with exhaustion of the autonomic nervous system. As the autonomic nervous system is one of the major regulatory systems in the body, this is a huge problem. What does this have to do with breathing? Well, it turns out that our breathing rate is a key modulator of the balance between SNS and PNS activation, and certain breathing practices can be used therapeutically to restore balance in the autonomic nervous system. • Even if you feel mentally calm, if your breathing rate is overly fast, as it is for many people, this causes SNS activation. • Slow breathing (also called 'paced respiration') tones and normalizes activity of both the SNS and PNS. Read the fascinating article “The Science of Coherent Breathing” by Stephen Elliott, author of The New Science of Breath, for an in depth discussion of the link between breathing and autonomic nervous system balance. Breathing more deeply and expanding the diaphragm also stimulates the peripheral nervous system and influences autonomic status. It's also interesting to note that energy medicine practices such as qigong (which literally means ‘breathing exercise’) believe that slow abdominal breathing is critical for the balance and flow of energy in our system. For more information on the profound influence the diaphragm has on our body, see "Diaphragm Mediates Action of Autonomic and Enteric Nervous Systems," Jan 8, 2010, Psychophysiology, by Stephen Elliot. Using Coherent or Resonant Breathing - Daily Breath Training While breathing experts don’t agree on everything, they all agree that we generally breathe too fast and too shallow - and that predominantly breathing through our nose is ideal. While a typical person might have 15 to 20 breath cycles per minute, an ideal number is 5 to10 cycles per minute at rest. For example, five breath cycles per minute = one breath cycle per 12 seconds, or inhaling for 6 seconds and exhaling for 6 seconds. While we can’t quickly take up these new habits permanently, what we can do is daily breath training. A person can listen to an audio track which has a sound cue every six seconds. You simply inhale or exhale at each interval using the track like a metronome. Breathing at this rate is referred to as coherent or resonant breathing. What are the benefits of doing this? • On an immediate basis, this is deeply relaxing for most people. • Cumulative over several weeks, daily breath training has numerous benefits. It improves the function and balance of the autonomic nervous system, which carries with it a host of benefits. Our natural breathing rhythm gradually shifts in the direction of that during the training so we don’t just benefit during the breathing exercises. Coherent breath training is one of the best ways to reduce levels of stress. You can order a ‘breathing pacemaker’ CD called 'Respire I' or download the audio tracks as MP3s (free audio samples are available). I enjoy track 2, which has Tibetan bells as the breath cue. I recommend that people with ME/CFS/FM do this breath exercise, combined with the practices described below, for 25 minutes twice daily. Commit to two months of daily practice and then evaluate your response. 1. Breathe through your nose and you should be able to feel your abdominal region expand with each inhalation. Breaths should be gentle and relaxed, not forceful or high volume. This exercise is also preferably done with eyes close, as having one's eyes open favors sympathetic nervous system activation. 2. While performing the breathing exercise, mentally scan your body and release any obvious areas of tension, e.g., in your jaw, shoulders and chest. Throughout the day, periodically observe your breathing, slow your breathing rate and make sure you are breathing through your nose and abdominally. Also use this breathing technique, combined with Ujjayi (pronounced "oo-jai") breathing described below, in times of acute stress. Ten minutes of Ujjayi breathing at five breaths per minute is an excellent stress buster! When done in bed the combination of coherent breathing, Ujjayi breathing and progressive muscle relaxation described below is very beneficial for many people with insomnia. Ujjayi ("oo-jai") Breathing for Calming Anxiety In the excellent book How to Use Herbs, Nutrients, and Yoga in Mental Health Care, written by three psychiatrists affiliated with universities in New York, the authors recommend 'Respire I' from www.coherence.com, cited above. They also recommend combining this with a simple breathing technique called Ujjayi breathing (literally, 'loud breathing'), a yogic breathing technique. They write: "Those who are able to learn Ujjayi breathing can be instructed to use the Respire I CD with Ujjayi for even greater effects. Ujjayi breathing creates a sound using contraction of laryngeal muscles with partial closure of the glottis, permitting fine regulation of the respiratory rate while increasing airway resistance, intrathoracic pressure, baroreceptor stimulation, HRV, RSA (Calabrese, Perrault, Dinh, Eberhard, & Benchetrit, 2000), and stimulation of somatosensory afferents in the pharynx, lungs, chest wall, and diaphragm. When done at a slow rate (2 to 6 breaths per minute) ... Ujjayi is physically and mentally calming. "In clinical practice, the authors find that basic Ujjayi breathing is the single most rapidly effective breath intervention for anxiety symptoms in patients diagnosed with anxiety disorders... The patient who is taught Ujjayi breathing will usually experience a profound sense of physical and mental calmness within five to 10 minutes of doing this technique." Type in “Ujjayi breath” at http://www.youtube.com to watch videos on this breathing technique. Incorporate Ujjayi breathing along with the coherent breathing for the duration that suits your body and complete the duration of the breathing time by simply breathing along to the sound cues. You may need to start with just 5 minutes of Ujjayi breathing and build up over time as is comfortable. Make sure you keep your neck, throat, shoulders and chest relaxed as you breathe. It shouldn't feel strained or forceful, just relaxed and slow with a partial contraction of your throat muscles. Complementary Practices – More Options for Banishing Stress Start with the combination of coherent/resonant and Ujjayi breathing until it feels natural and easy. At this point, you can add aspects of other mind-body practices such as meditation or qigong for further benefit. A few options are as follows: • Progressive muscle relaxation. Created by Stephen Elliot of www.coherence.com and Stephen Hawley, the Six Bridges is a form of progressive muscle relaxation, focused on autonomic balance, which complements the basic Coherent balance exercises. ("Muscles throughout the body gradually relax, including those of the spine and the vascular system. Blood flow throughout the body increases, knots in the muscles gradually disappear...") Also see the June 2009 Coherence Newsletter for more information. The Six Bridges audio is available as an MP3 download or as a CD. • Mantra based or breathing meditation. For example, focus attention on the flow of your breath. • Qigong meditation. Qigong traditions believe the abdominal region between your navel and pelvic bone, called the lower dantian, is a key energy reservoir. Qigong practices often involve focusing attention, or meditating, on this area. Happy Breathing! - Blake Graham, BSc (Honours), AACNEM ____ * Clinical Nutritionist Blake Graham, practicing in Perth, Western Australia, specializes in nutritional and environmental medicine therapies for those with chronic medical conditions, such as ME/CFS, fibromyalgia, and environmental illness. His website – www.nutritional-healing.com.au . This article, last updated Jan 4, 2011, is reproduced with kind permission from Blake Graham’s Nutritional Healing e-newsletter. To sign up for the free newsletter, click here. Note: This information has not been evaluated by the FDA. It is not intended to prevent, diagnose, treat or cure any condition, illness, or disease and is not a substitute for personal medical care. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team. DHEA or Dehydroepiandrosterone is a steroid hormone produced mostly by the adrenal glands that is a precursor to male and female sex hormones (androgens and estrogens). DHEA levels in the body begin to decrease after age 30.The exact role DHEA plays in the body is unclear but is believed to have links to mood and energy and possibly immune competence.
Sex hormones are created via the following chain: cholesterol > progesterone > cortisol > DHEA > androstendione > testosterone > estrone > estradiol Since my recent salivary hormonal profile through ZRT Labs shows all my hormones (except progesterone) to be low I've decided to go ahead and purchase DHEA through Micron 5 DHEA, a site that delivers this illegal supplement discreetly to international clients. It would likely take a year to apply to Health Canada for a 'special status' exemption (and lots of unnecessary doctor's visits), so I'm choosing this path of least resistance. DHEA supplementation can also increase testosterone and estrogen, a side-effect that is a desired effect in my case. My current DHEA level is ≈1 (equivalent to that of a 100 year-old, yet I'm in my 30s). In the days when I was less ill, my DHEA measured ≈6, which was still low considering my age. Low cortisol along with low DHEA is indication of adrenal insufficiency. I will also continue a good adrenal support product like AOR Ortho-Adapt, 1 capsule qid. I will take DHEA for 3 weeks at 25 mg, be re-tested and then decrease to 5 mg if warranted by test results. No doctor is helping me with this decision presently, as one is on vacation (with the promise of an appointment 5 month's time) and the other refuses to read the e-mail I sent containing my lab results because it's 'not secure'. I am bed-ridden and have no other choice but to opt-out of the health care system whenever the need arises and take matters into my own hands. DHEA and Disease Reduced levels of DHEA and DHEA-S have been associated with adrenal insufficiency, coronary artery disease, memory impairment, and type 2 diabetes. Studies have examined the effects of DHEA supplementation in over 25 disorders including adrenal insufficiency, depression, cancer, AIDS and CFS. DHEA has been of some benefit in treating depression, obesity, Addison’s disease and lupus. The benefit in lupus may derive from DHEA’s ability to counteract some effects of steroid administration. Chronic Fatigue Syndrome (ME/CFS) and FM Studies At least 8 studies have measured DHEA/DHEA-S levels in CFS. Overall study quality is not reported to be high. Study results have been inconsistent with a tendency towards reduced DHEA levels. Citing the need for more research the Mayo Clinic gives DHEA a ‘C’ grade in treating CFS and a ‘D’ in treating FM. Protocol Because it is a powerful hormone WholeHealth MD recommends DHEA only be taken under the care of physician. They give the following recommendation: "Before starting to take DHEA supplements, have a blood test to determine your present level of this hormone. Only proceed if your level is low; healthy people under age 50 rarely need to take this supplement. Have another blood test three weeks after taking DHEA to determine if a satisfactory DHEA blood level has been reached. Once within the normal range, revert to a maintenance dose (typically 5 to 10 mg a week)." Dr. Ray Sahelian, M.D., the author of DHEA: A Practical Guide, Mind Boosters, and Natural Sex Boosters recommends that more than 5 mg./day of DHEA should not be taken on a long term basis. Many supplements contain more than 5 mgs. of DHEA. Warning Because DHEA is a hormone it could theoretically increase the risk of hormone sensitive cancers if supplementation increases DHEA levels higher than normal. Because DHEA could possibly increase the risk of prostate, breast, and ovarian cancers, the Mayo clinic does not recommend its use without the supervision by a licensed health professional. WebHealthMD recommends DHEA not be taken if you are risk for prostate or breast cancer. Supplements One analysis of DHEA supplements found that only 7 out of the 16 assayed products contained DHEA within a 10% variation of the labeled content. Some products contained no detectable DHEA at all. Long-term Effects No studies on the long-term effects of DHEA have been conducted. Side Effects High levels of DHEA can cause very oily skin, acne, increased facial hair in women, deepening of the voice, and mood swings and theoretically cancer. Dr. Logan on H2S, Fiber and the Gut
by CORT on JULY 2, 2009 Dr. Logan is a board certified naturopathic physician who graduated magna cum laude from the State University of New York. An invited faculty member at the Harvard School of Continuing Medical Education and published researcher he is the author of “The Brain Diet” and the co-author with Dr. Alison Bested of a recently updated book on chronic fatigue syndrome (ME/CFS) – “Hope and Help for Chronic Fatigue Syndrome.” He was willing to follow up a substantial comment he made to the “H2S Creator Speaks” blog with this full interview. Questions asked by Cort are underlined. This is an excellent article that really gets into specifics, addressing the gut/probiotic issue specifically for those with ME/CFS. _____________________________________________________________ A good number of chronic fatigue syndrome patients do experience gut pain but gut pain has never been considered the main or even a main symptom of the disease. It’s easy to see how something like there irritable bowel syndrome could emanate from the gut but given the sometimes enormous debility found in this disease shouldn’t we be in a lot more gut pain than we are if this disease is indeed centered in the gut? The gut is after all a very sensitive area is it not – it doesn’t take much to make gut problems very obvious to the person suffering from them. Indeed gut pain is not chief among the constellation of CFS symptoms. Yet the vast majority of CFS patients do experience some degree of gut related symptoms and indeed there are many other gastrointestinal (GI) signs and symptoms in CFS that are not pain-specific. For example, alternating constipation, diarrhea, bloating and so-called functional dyspepsia (upper GI discomfort soon after meals) may not involve significant pain per se, however they indicate that not all is right in the GI tract. It is also true that there may be issues with certain gut bacteria that, while producing no overt gut symptoms, they are still capable of provoking a body-wide immune response and intestinal permeability. From animal studies, we know that even a tiny amount of undesirable bacteria in the gut, at levels not even high enough to cause an overt immune response, can activate brain areas involved in emotions and ultimately influence behavior itself. While we are a long way from confirming that CFS is centered in the gut, early suggestions indicate that gut microbes may be the tail wagging the dog. On another very basic note – if we are all producing enough hydrogen sulfide gas this disease shouldn’t we all be belching and otherwise releasing enormous amounts of rotten egg smelling gas? No, not necessarily. It would only take miniscule amounts of H2S gaining access through the gut wall to cause fatigue and a host of other brain and body-wide symptoms. Small amounts of H2S can cause cognitive difficulties, and of particular interest to CFS symptoms, problems with tuning out unwanted environmental stimuli…the sort of “tired but wired” symptoms of CFS. Normally we can clear H2S quite efficiently, breaking it down with enzymatic activity and releasing it through the lungs. Yet there are many unknowns about H2S, including the amount of gut H2S the normal person can tolerate. In addition to the emerging work from Dr K DeMeirleir indicating that there are elevated H2S-producing gut flora in CFS, it may also be the case that in CFS there is a deficit in H2S disposal. A common remedy for bacterial overgrowth in the gastrointestinal system involves antibiotics. Yet antibiotics, paradoxically, are sometimes blamed for setting the stage for bacterial overgrowth in the first place. Many people are not surprisingly skeptical about taking antibiotics because of this. How do you go about ensuring that you’re not just making the problem worse? Indeed, there have been studies showing that antibiotics have reduced small intestinal bacterial overgrowth (SIBO) and improves a variety of symptoms (including brain-related symptoms) in CFS and fibromyalgia. Yet, these are very small studies of small duration. What happens when the antibiotics are stopped and the patients are followed in the long term? We do not know. Given that antibiotics and overuse of acid-blocking medications set the stage for SIBO, I would be inclined to worry about using antibiotics as a means of clearing SIBO. I would be more inclined to use probiotics and enteric-coated peppermint oil. There are quite a few different kinds of probiotics on the market that feature different kinds of bacteria. Are there certain kinds of bacteria that may be more helpful for the kinds of gastrointestinal issues that chronic fatigue syndrome (ME/CFS) patients face? Yes, the benefits appear to be strain-specific. If it is for symptoms that resemble that of irritable bowel syndrome (IBS) then I would suggest 2 strains of bacteria that have been shown to be helpful for gut-related symptoms – Align (Bifidobacteria infantis 35624) and LactoFlamX (Lactobacillus plantarum 299V). In our University of Toronto study, we used a probiotic made by the Japanese company Yakult. The strain, Lactobacillus casei Shirota had been found previously to improve mental outlook in healthy volunteers who had the lowest baseline mood scores. It also lowers propionate production in the gut. Recently propionate has been the focus of research in autism; once it gains entry to the brain, it can alter behavior. It is too early to tell, however I feel that bifidobacteria strains such as Align will become the probiotic of choice for CFS. Align has been shown to reduce inflammation systemically, beyond the gut. It also does not contribute to the lactate load in the gut. What was not really emphasized in the reporting of Dr K DeMeirleir’s research is that his team also found elevated lactate producing bacteria and certain Lactobacilli are major manufacturers of D and L lactate. If I understand you correctly its possible that strains of Lactobaccilus bacteria that are frequently found in probiotic preparations could exacerbate lactic acid production. Apparently Lactobaccillus acidophilus turns sugars into lactic acid. Yes, but not all Lactobacillus strains produce the undesirable D-Lactate (for example, the well-researched Lactobacillus GG does not produce D-Lactate, but most strains of Lactobacillus have not been investigated for D-Lactate production. Its time to map that out properly). It’s generally true that L.acidophilus does turn sugars into lactic acid, but not all Lactobacillus strains produce the D-Lactate; the L-Lactate can be cleared with a fair amount of ease by most. Do you recommend staying away from the traditional formulations (L acidophilus)? Most probiotics marketed under the umbrella term “acidophilus” have not been researched for health outcomes (let alone stability!) and we have no idea of their D-Lactate potential. It is known from studies in short bowel syndrome that unspecified strains of L. acidophilus can be major promoters of D-Lactate. Kefir has a different bacterial makeup than yogurt. I did read that kefir grains make it deeper into the gut. What about kefir? Great question! There have been two studies that have looked at D-Lactate production in fermented milk, commercial yogurts and kefir. Interestingly the kefir did not form D-Lactate, yogurt had high concentrations of D-Lactate (over 40%). When you get to the store shelf there are probiotics that don’t need refrigeration, that do need refrigeration, that have X million or even billion bacteria ‘at the time of bottling’, that are in liquid or capsule form, etc. Dr. De Meirleir some years ago stated he was simply looking for a probiotics that was strong enough to fit ME/CFS patients needs. I noticed that Prohealth recently advertised a product that has over 50 billion bifidobacteria organisms in one capsule (at over a dollar a capsule). Do you have any advice to offer on specific types of probiotics for chronic fatigue syndrome (ME/CFS) patients? Until the research shows otherwise I would choose Align for the reasons cited above. There are very good clinical studies to support the product in IBS. If you do take probiotics are there any supplements that can help boost probiotics effects? In recent years so-called prebiotics have been touted for boosting levels of Lactobacillus and Bifidobacteria in the gut. It is quite clear that prebiotics (inulin, chicory root, fructo-olligosaccharides) can increase both Lactobacillus and Bifidobacteria, however it remains unknown if they are also promoting undesirable bacteria as well. There have been hints that they can. There are now two causes of concern for CFS patients and prebiotics – i. prebiotics have been shown to promote intestinal permeability, irritate the gut lining (this is a massive problem, especially when considering the new studies from Dr Michael Maes who documnented intestinal permeability in CFS) ii. prebiotics can increase the amount of lactate produced in the gut (now that we know there is already excess lactate production and/or inadequate lactate clearance, this is an obvious caveat). On a personal level your conjecture that fiber induced fermentation in the gut could be associated with increased anxiety and aggression was intriguing since I’ve always felt that ’edginess’ is a key factor in my version of ME/CFS. But how do fiber induced problems in the gut translate into central nervous system problems? A study by Dr. Shungu has suggested increased lactate production in the brain may be occurring in ME/CFS patients; could this have anything to do with lactate production in the gut? When too much fermentable fiber shows up in the large intestine there is a massive uptick in the production of D-lactate. Since, in CFS, we now know there is already over-production of D-lactate the blanket statements to eat more fiber may not be well suited to CFS. For example, animal studies show that excessive D-lactate production, due to excess fermentable carbohydrates showing up in the distant portion s of the gut, can increase aggressive an anxious behavior. It completely throws them off. The same phenomenon has been written up numerous times in cases of short bowel syndrome. These are individuals who have had a portion of the small intestine removed, they are more prone to the over-fermentation of fiber-rich carbohydrates in the large intestine and an excess amount of D-lactate is produced. They can experience brain fog, lowered mood state, hypothamic dysfunction and anxiety when transient elevations in D-lactate occur. Since we know that CFS patients have both bacterial overgrowth and excess D-lactate production (and/or lack of D-lactate clearance) a similar situation may be occurring. Ultimately, excess prebiotics and even excess Lactobacillus strains may worsen the situation in short bowel syndrome, and perhaps CFS as well. I was very interested in Dr Shungu’s work as well. It certainly suggests that if excess lactate is making it to the brain (and we already know that systemic lactate can cause anxiety in adults with no history of anxiety) it can have multiple implications. Obviously, we have just begun to scratch the surface of this research, however in moving forward we should be very selective of the stains we use for CFS clinical trials. Your statement that ‘fiber restricted’ diets can be helpful in this disease is a little jarring to hear given all the emphasis these days on high-fiber diets. You also noted that a fiber restricted diet cut the production of hydrogen and methane gas by more than half in one study. What is a restricted fiber diet look like? Are certain types of fiber worse than others? Yes, while most adults and children in developed nations may need more fiber, those of us with CFS may actually be adding fuel to the fire. An elemental (liquid food) diet has been shown to help eradicate small intestinal bacterial overgrowth and gut excess H2S production. At this point we need more concrete studies although the soluble fiber in oats, barley, rye and root vegetables will be more likely to fuel fermentation and increase lactate production. You noted that excessive fermentation in the large intestine can lead to the overproduction of lactic acid yet fermented lactic acid producing vegetable products such as sauerkraut, pickles and miso (as well as yogurt) are also sometimes recommended for gut issues. Do you recommend against using those products? No, generally these would be good choices if not in excess. There is a difference between foods that have been fermented, and foods that are awaiting fermentation by our own bacteria. Still, excessive dairy sugars arriving in the lower gut may be an issue and dairy has been associated with problems in short bowel syndrome with excess D-lactate production. If someone goes on a fiber-restricted diet how soon should they know if it is working for them? Within a few weeks What tests can patients take to assess the status of their small intestine with regards to bacterial overgrowth, hydrogen sulfide gas production, leaky gut and fiber problems? In addition to Dr K DeM’s exciting new H2S urine test, there is also a test for small intestinal bacterial overgrowth…it is called the lactulose-hydrogen breath test. Similar tests are available for assessment of intestinal permeability. In North America, Genova Diagnostics does the small intestinal bacterial overgrowth and intestinal permeability tests. There are blood tests for D-lactate; however, by the time a CFS patient sets up the testing the lactate may return to normal. That test is unique in that it is all about timing. Hopefully we will see some clinical investigations in CFS with patients consuming prebiotics and/or decent portions of fermentable carbohydrates and then evaluating both blood and urine lactate in the hours that follow. A study by Dr. Burnett several years ago suggested that chronic fatigue syndrome patients often suffer from ‘reduced gastric emptying’ it seems to refer to food products remaining in the gastrointestinal system for longer than normal. Would this contribute to fermentation and bacterial overgrowth problems ? It would certainly contribute to the upper gut symptoms after a meal. It also hints that there are electrical problems on GI tract in general. If there are any problems along the line, it can lead to stasis. We need more work in this area. What may be happening is similar to the folks with short bowel syndrome (although CFS patients may have a structurally intact small intestine, the SIBO may make it a functionally poor portion of the organ) where food material may be passing through the small intestine and then literally get “dumped” into the large intestine. When this happens with fructose, for those who do not absorb fructose well and it speeds through the upper gut, there is massive fermentation and mood related symptoms! One of the beneficial aspects of enteric-coated peppermint oil is that it helps regulate peristalsis. This is almost certainly why most of the dozen plus trials of ECPO (alone or combined with caraway seed oil) in IBS and functional dyspepsia have shown good results. Can one to some extent assess one’s bowel health simply by noting the consistency and quality of one’s bowel movements? That is could you say that someone who has one regular well formed bowel movement a day which was not accompanied by gas probably did not have problems with fermentation/hydrogen sulfide gas production? A regular, well-formed bowel movement will not exclude a potential problem with gut flora alterations. I would be much more inclined to work with the tests available. While these breath test and intestinal permeability tests are imperfect (and the new H2S test requires outside validation), they would tell us much more than bowel movements when it comes to the internal consequences of undesirable bacteria. I’ve always noticed that abstaining from food is helpful for me for short periods. On the converse many ME/CFS patients experience a considerable letdown 10 minutes or so after they eat. It seems that food does make a difference but this is occurring long before, one would think, food reaches the gut. Do you have any idea what’s going on here? A period of fasting may be lessening the load of lactate, propionate and H2S…but is not going to be the Rx here. I am not sure about the quick exacerbation of symptoms. I have heard from a number of patients that symptoms are worsened within an hour, and this may be indicative of the small intestinal bacteria having a feast in the upper gut. The ensuing increased intestinal permeability allows unwanted material to pass through the gut wall and fire up the flames of low-grade inflammation. For more on this topic I would urge visitors to your blog to further investigate the work of Dr Michael Maes and colleagues who have been doing great work in CFS, gut flora and intestinal permeability. Are there any books you recommend on irritable bowel syndrome or the gastrointestinal system for ME/CFS patients? I have yet to find one that is specifically suited to the needs and complexities of CFS. The problem is that CFS patients don’t have IBS per se, and the approaches don’t always apply. The findings in the CFS-GI connection (Drs K DeM, Maes in Europe, Dr Bested in Canada) are so new that a well-rounded gut-specific resource is still some distance away – hopefully soon, but we really need clinical trials to validate specific avenues of approach. As exciting as these gut findings have been, it is important to underscore that we are still on the bridge between hypotheses and true clinical guidance in CFS. Thanks Cort for your dedication and hard work to the amazing, resilient community of medical underdogs, the CFS patients. Dr. Logan’s website contains articles, his books, recommended supplements and ‘power foods’, links and more. Additional Follow-Up Comments by Alan Logan July 6, 2009 at 4:42 am Fructose and Powerfoods Yes, the powerfoods section listed on my website is directed at brain health for the general population and is definitely not a CFS-oriented list. I would concur that too much fructose can cause problems. Dr Max Ledochowski has authored 4 or 5 studies on what happens when fructose escapes absorption from the small intestine and gets dumped into the colon…depressive symptoms, brain fog and much lower blood tryptophan levels. Correcting this via a low-fructose diet has been shown to improve mood etc. Interestingly, only about 1/2 of those with fructose malabsorption present with the overt gut symptoms. Diet and Fruits My only concern with removal of all fruits is that we also take away much needed dietary antioxidants from the deeply colored berries. Blueberry and bilberry actually have anti-microbial properties that may be to the advanatge of CFS patients and cherries have significant anti-inflammatory activity…CFS patients are under increased oxidative stress, have lower levels of antioxidants due to the high demand, and in most studies, dietary antioxidants win vs. those from supplements. Consideration of some very small servings of berries is still warranted in my opinion. The other concern with nuts, yes, absolutely no doubt they can be a source of sensitivity. Candida and yeast can’t be ruled out of this emerging equation of gut flora. Over the years the Candida story has been, in my opinion, over-played. Still, there was a study in the journal Family Practice in 2001 which showed that in adults with “unexplained medical conditions” (symptoms typically over-lapped with CFS) Nystatin was helpful. There were significant improvements in anxiety, cognition, depressive symptoms and insomnia. Recently Dr Evengard’s team in Sweden found that Candida levels are much higher in stool during the early stages of CFS and are lower when patients are “in remission”. Since we know that stress and antibiotics can increase Candida in the gut, it possible that once established, it becomes a secondary contributing factor. Probiotics The dose used in the Sullivan probiotic study was 10 to the 8th power CFU twice daily…this was not a particularly high dose. The VSL#3 mentioned has a massive 450 billion CFU per sachet…and it is the kitchen sink of a variety of different strains. It may help some, however I know of cases where anxiety increased after taking the product, it may be a D-lactate connection. Gut Ph and D-Lactate – As Cort knows, we had this interview before the full text of the Dr K D paper on D-Lactate bacteria and CFS was released. Within the paper they note that alkaline therapy might be a future Rx in CFS. It would seem to make sense…we have high levels of acid-producing bacteria so it would appear rational to increase the pH and make it more alkaline. However, the gut is a complex environment and a study by Jiang in Digestive Diseases and Sciences (1997) showed that raising the gut pH in the alkaline direction increases D-lactate production. In the same study they also showed that if you really want to lower D-Lactate production, add Bifidobacteria to the mix. Bottom line, we have much to learn about gut pH. It has been shown since the 1920s that oral alkaline solutions can encourage small intestinal bacterial overgrowth and subsequent intestinal permeability (Arnold. Am J Hygiene 1928). Since CFS patients have both SIBO and intestinal permability, it is highly doubtful that alkaline solutions will be the answer. No financial ties I should have said that I have no financial ties to Align or any other probiotic company. Thanks for all the comments and feedback. I am sharing this email I received with you incase you are interested. I am not affiliated with Michael Mohoric in any way, except that I sign up for his monthly free healing sessions. I am going to sign up for this new offering (for $99) to see if it helps with my sleep issues: currently I'm taking codeine 30-45 mg, doxepin 10 mg and clonazepam up to 2 mg, yet on every second day I'm still not falling asleep until after the sun rises. The distance healings require nothing from the participant (this factor really appeals presently), are scheduled at my regular sleep time, and I have found his free sessions helpful in the past, so here goes .... The e-mail from Michael: It is very difficult to achieve optimal health if you are not sleeping well. Unfortunately in today's world insomnia is very prevalent. I attribute a major cause of sleep problems to our tremendous exposure to electromagnetic fields (EMF) that are produced by modern technology. A few of the sources for EMF include cell phones, cell phone towers, Wi-fi, and Blue tooth. We have a personal energy field in and around us. This energy field is recognized by many different ancient cultures and called by different names. In Western culture it is commonly known as the aura. When you have a strong energy field then you are healthy and can combat stress and illness easily. This is what practices like Qigong, Tai Chi and other methods are designed to do is help build a strong energy field. The energy sessions can greatly help you build a strong energy field or aura. Though some scientists say EMF is harmless many sensitive people know differently. When we are being continually bombarded by external EMF it can negatively affect our own energy field. This is why so many people feel much calmer in nature when they are away from the buzz of all the electromagnetic pollution. I believe the disturbances caused by EMF are a major contributor to insomnia and other dis-eases. "michael thanks for your healing sessions. As i said in the start I had not had good sleep in 20 years. but on the last session of the month on wed. I slept good and every night since it got better. I can not ever remember when I got 3 nights sleep in a row. In fact this morning I woke at 6 am. got up and then laid back down and slept 2 more hours. Iv never gone back to bed and slept. even though I was exhausted from lack of sleep I could not sleep once waking. my normal sleep 1=3 hrs not enough but now with your sessions I seem to be on a pattern of good sleep again.. thank you so much I now feel I can get on with my life.. thank you thank you" ART Scientists are taking a serious look at the possible harmful effects of long exposure that EMF can cause. One study in a peer-reviewed scientific journal (J.Aust.Coll.nutr.& Env.Med, 2007; Vol.26, No.2 ) shows evidence EMF may make the cell membrane hard & difficult for heavy metals and toxins to be excreted by the cells & difficult for nutrition to enter the cell. Dr. Carlo co-authored the study and headed the largest safety research project on cell phones in the late 1990's states "These findings tie in with other studies showing adverse cell-membrane responses and disruptions of normal cell physiology." The authors speculate increased EMF may be a factor in the increase of autism. 20 years ago only 1 in 10,000 children was diagnosed with autism and gov't statistics in 2002 show 1 in 150 children may be afflicted with autism. This is a startling statistic. Nowadays it is very difficult to get away from EMF pollution. Some cities are blanketing their city with Wi-fi signals and cell phone towers. The monthly healing program can go a long way in helping your system to neutralize the negative effects of EMF and help to restore your health, vitality and well being. The energy sessions help your body to come into balance so that it can heal itself. A great majority of people in the energy sessions see significant results but like any modality it won't work for everyone. Everyone has given permission to share their stories. How to Join the Healing Program Receive 4 weekly sessions of energy healing for only $99. Add your family members and pets living at home for only $39 or $138 for an entire household. This energy work can help to clear and balance the acupuncture meridians and chakras to assist the body and mind to heal itself. Most people know, who have worked with me before, that the energy works on many levels, mental, physical, emotional and spiritual. My main interest is helping people to clear out energy blockages so that they can realize their highest potential. Clearing the energy field can help people to become more intuitive, creative, healthy and more aware. With so many unusual things happening at this time, an expanded state of awareness is one of the most important things that one can achieve. The main sessions are on Wednesday nights, more details below. In addition to the main energy sessions there are unscheduled energy adjustments every day and you get that energy when your energy system is ready for more energy. You can receive this energy anytime day or night. There is a continuous energy flow throughout the month and not just on Wednesday nights. Energy starts going out to people when they sign up and often people report they can notice the effects right away. Dan from Michigan writes , "Have I told you before that I often sense, feel or see changes before the actual day and time you are transmitting energy. It starts after the initial contact is made by you and I." Please email me if you decide to join the session. Let me know how you are going to pay, and I will confirm that I have you on my list and I will send instructions on how to enhance the sessions. If you do not hear back from me within 24 hours, please write again as sometimes email gets lost. The first major session will begin Wed. and continue for three consecutive Wednesday's afterwards. The energy sessions go from 7- 8pm, Pacific or Los Angeles time (10-11pm New York time). In order to participate in the program I need to receive funds around the first session. You can pay by most credit cards by going to the purchase page. You can also pay by check. Send to; Michael Mohoric PO Box 6548 Laguna Niguel, Ca.92607 HOW TO PURCHASE Credit cards are processed by Paypal. It is a very secure way to pay with your credit card with millions of people using it for internet transactions. You do not need a PayPal account to pay this way. To pay by credit card click on the purchase button on my website: QigongEnergyHealing.com If you have a problem logging on to my website, you can also pay directly through my Paypal account by clicking on this link that will take you directly to my secure Paypal account. The $99 price does not include any other family members or pets. If you want to include your pets and family members then the additional cost will be $39 to include all your pets and family members living at home. The total cost to include everyone in your home would be $138. All the family members at home will a get the same energetic support for a month for $138. You need to get permission from any adults that will be included. Pets respond beautifully to energy work. Review of Program Cost: $99 Add $39 ($138 total) to include all family members and pets living in your house. You need to get permission from any adults to work on them. Payment needs to be made around the start of the first session by credit card or mailed checks. Dates and times. All sessions start at 7pm, Pacific ( Los Angeles, Ca.) Time and last about 1 hour. Dates-All on consecutive Wednesdays starting Session 1. Wed. 6/1 7pm-8pm Pacific or Ca. Time Session 2. Wed. 6/8 7pm Session 3. Wed. 6/15 7pm Session 4. Wed. 6/22 7pm This is not an automatic billing program and if you want to do more sessions you need to sign up again. www.QigongEnergyHealing.com Disclaimer: I, Michael Mohoric, am not a medical doctor and do not practice medicine. I do not diagnose, heal, cure, prevent or treat disease. I assist people in correcting energetic imbalances in their bio-field that assists the body to release its innate healing ability. When the energy of the body is balanced and moving correctly, the body's innate natural energy heals itself. All healing is self-healing. I recommend that clients continue to see their regular medical doctors and follow their advice and my work is a complement to regular allopathic medicine. My spiritual energy work is not a substitute for conventional medical diagnosis or treatment for any medical or psychological condition. For such issues, you should seek the proper licensed physician or healthcare professional. I am a minister and my work is spiritually based and I believe all healing is spiritual in nature. I do not make any promises, warranties or guarantees about results of my work or of the energy sessions. To sign up for the newsletter, please go to the website. SHINE Treatment Protocol for CFIDS/FibromyalgiaAdapted from the book "From Fatigued to Fantastic!" by Jacob Teitelbaum, M.D.
(The books & supplies can be ordered by calling 800-333-5287 or through our web site atwww.Vitality101.com) Dear patient, Below is a listing of the more common treatments used in treating CFIDS/FMS. I would use this list as a record of your treatments and have it with you for follow-up/phone visits. Put a line through the number in front of any treatment you stop and note the reason stopped and date. Put the date started in front of the other treatments. Although it can take 6 weeks to see a treatment's benefits, most of the medications' side effects will usually occur within the first few days of starting a treatment. Except for treatment #1 through 21 which can all be started in the first 1 to 3 days, add in 1 new treatment each 1 to 3 days. If a side effect occurs, stop the last 2 or 3 treatments for a few days and see if it goes away. If the side effect is acute and worrisome, call your family doctor (or go to the E.R.) immediately. Do not get pregnant on treatment or drive if sedated. It is normal for a woman's periods to be irregular during the first 3 to 4 months of treatment. On average, it takes 3 months to start feeling better. You can begin to slowly taper off most treatments when you feel well for 6 months. Stop things one at a time (e.g. one pill every 1 to 2 weeks) so you can see if you still need it. If needed, however, any or all of these can be used forever (usually not necessary). Some prescriptions can be obtained at a much lower cost from Consumers Discount Drug Company (323-461-3606). We priced 90 Sporanox tablets (100 mg) — they would cost $820 at a local food chain pharmacy vs. $600 at Consumers Discount Drug. Another good source for generic prescription drugs is www.costco.com (click on "Pharmacy"). Do not take any treatments below that you are allergic to or that have caused prohibitive side effects. Prescription items have "Rx" after their names. If a recommended (i.e., checked off) treatment has the number in front of it circled then it is a critical treatment. If it has a "**" by the number, it is a "most important" treatment. If it has an "*", it is an important treatment. If it has no "*", then the treatment is helpful but not critical. If you choose to simplify your program, you can begin with just the circled and **’d followed by the *’d items and then no *’d items that are checked off. Cheryl Alberto (410-573.5389) is available for protocol counseling for $45 per half hour. Having counseled Dr. Teitelbaum's patients for 7 years, she has the clinical experience and knowledge to help you organize and effectively utilize your protocol for maximum results. Only the items that are checked off are the ones recommended for you. Nutritional Treatments___ 1.** Energy Revitalization System - Daily Energy Enfusion Powder (Berryor Citrus): ½-1 scoop a day (as feels best) blended with milk, water or yogurt with 1 capsule of the included Daily Energy B-Complex (also available separately). If diarrhea occurs, mix the powder with milk and/or start with a lower dose and work your way up to the dose that feels best or divide the daily dose into smaller doses and take 2-3 times a day. These products are made by Enzymatic Therapies and are available in ou r web site store and most health food stores. ___ 2. * Complete GEST Enzymes (Enzymatic Therapies)/Similase GS (Integrative Therapeutics ): 2 capsules with each meal to help digest your food properly. If you have ulcers or they irritate your stomach begin with GS Similase. ___ 3. Calcium: 500 to 1000 mg daily with 400 units of vitamin D (a chewable calcium or Calcium Chelate is recommended). If you get a non-chewable tablet, see if it dissolves in 2 to 3 inches of vinegar over 1 hour (swirl a few times). If not, it won't dissolve in your stomach, and you need to get a different brand. (Do not drink the vinegar). You can also avoid this problem by using capsules or liquid filled gel caps. Taken at bedtime, it may help sleep. Calcium can block thyroid absorption if taken within 4 hours of each other. ___ 4. Lipoic Acid: 200mg a day (protects the liver) whenever you’re on Sporanox, Nizoral, or Diflucan (#94). If you have active Hepatitis or Cirrhosis, consider 300 to 2000 mg a day depending on it's severity. In addition, it has been shown to be helpful for diabetic neuropathy and burning mouth syndrome (200 mg 3 times day for 2-5 months) and is likely helpful for many kinds of nerve pain. ___ 5.* Vitamin B-12 (Rx): 1 I.M. injection (1 cc = 3000 mcg) 3 to 7 times weekly for 15 doses, then as needed (e.g. 1 to 12 times a month). This needs to be made by a compounding (holistic) pharmacy (e.g. Cape Drugs 800-248-5978). ___ 6.* NAC (N-Acetyl-L-Cysteine): 500-650 mg a day for 2-3 months. Makes Glutathione. ___ 7.* Iron (Chelated Iron) (Ultraceuticals): 29 mg plus 100 mg Vit C - Take one tablet a day. Or Chromagen Forte (Rx, iron) - one tablet a day. Do not take within 6 hours of thyroid or Cipro (antibiotic), as this can prevent their absorption. Take on an empty stomach (i.e.- take between 2 and 6 PM on an empty stomach). It is OK to miss up to 3 doses a week. Stop in 4 to 6 months or when your Ferritin blood test is over 40. If afternoon fatigue is a problem, consider continuing iron supplements until your Ferritin level is over 100. Iron may turn your stool black. If this is a problem, Flora Dix iron is much easier on the stomach and is not constipating ___ 8.* Eskimo 3 Fish Oil or Arctic Omega: ½ to 1 Tablespoon a day or 1 softgel 3 times a day for 3 to 9 months until the dry eyes and mouth resolve, and then as needed. Use this brand as most others are rancid and often contain mercury, lead or other toxins. Dry eyes, mouth, & hair, pain, and excessive hard ear wax suggest a need for this. FOR ANXIETY - Natural Treatments___ 9. Calming Balance (Health Freedom Nutrition) or Tranquility (Ultraceuticals): (Vitamin B1) 500 mg, passion flower, Theanine, magnolia, B vitamins, and magnesium 1-3 caps 1-3x day is outstanding for anxiety (the effect increases with 1-4 weeks of use). Mitochondrial Energy TreatmentsUse these for 4-9 months. Then drop the dose to the lowest dose that maintains the effect (or stop it if no benefit). ___ 11. * Acetyl-L-Carnitine: 500 mg - 1 capsule once or twice a day for 3 months. Then 250 to 500 mg/day or stop it. Although important in CFS/FMS, it is even more important to take this if you also have Mitral Valve Prolapse, MS, and/or elevated blood triglycerides. This helps with weight loss. ___ 12. Coenzyme Q10: 200 mg - 1x a day. Especially important if taking cholesterol lowering prescriptions (e.g. Mevacor). Take it with vitamin E or a meal that has fat, oil supplements or in an oil based form to improve absorption. Vitaline makes the best form and this is the one I recommend. It also already contains vitamin E to enhance absorption. ___ 12A.** D-Ribose(Corvalen): - 1 scoop of powder 3x day for 3 weeks, then 2x day. If too energizing, take with milk or food or lower the dose. Effects are usually seen within 2-3 weeks. ___ 13. Magnesium/Potassium Aspartate: two 500 mg capsules - 2 x a day (need to use a "fully reacted" brand) for 3 to 4 months. ___ 14. Daily Energy B-Complex: 1 capsule in the morning or mid day (by Enzymatic Therapies). (Already contained in # 1- The Energy Revitalization System Berry or Citrus.) ___ 15. NADH (Enada brand): 10 mg sublingual tablets - dissolve one under the tongue (or swallowed two 5 mg tablets) each morning. Take it on an empty stomach first thing in the morning (leave it by your bedside in the bottle or foil wrap with a glass of water) at least ½ hour before eating. It takes 2 months to see if it works. Other Nutrients___ 16. Betaine HCL (Hydrochloric Acid): 650 mg capsules. Take 3-7 capsules during each meal. Use less or stop if heartburn occurs. Do not use if you have ulcers. ___ 17. Magnesium Glycinate 75 mg/Malic Acid 300 mg (Fibrocare): 2 tablets 3x a day for 8 months, then 2 tablets a day (less if diarrhea is a problem. Start with 1 to 2 a day and slowly work up as able without getting uncomfortable diarrhea. You can take up to 10 a day for constipation. Taking it with food may lessen diarrhea. If pain or fatigue recurs on lowering the dose, increase it. Taken at bedtime, it helps sleep. ___ 18. Vitamin E: 400 units a day (natural). ___ 19. Physicians Protein Complex: 1-2 scoops a day. ___ 20. Potassium - Micro K Extentabs 10 MEQ (Rx): 1 capsule 1-2 times a day for 8 weeks. ___ 21. Inosine (from compounding pharmacists): Can raise a low uric acid (uric acid acts as a peroxynitrate scavenger and can be helpful in multiple sclerosis and other neurologic diseases). ** Sleeping Aids For FibromyalgiaYou can try these in the order listed or as you prefer based on your history. ADJUST DOSE AS NEEDED TO GET 8-9 HOURS OF SOLID SLEEP WITHOUT WAKING OR HANGOVER. No going to the bathroom if you wake up unless you still have to go 5 minutes later. Mixing low doses of several treatments is more likely to help you sleep without a hangover than a high dose of 1 medication. You can take up to the maximum dose of all checked off treatments simultaneously. Do not drive if you have next day sedation (adjust your treatment to avoid this). If you’re not sleeping 8-9 hours a night without waking on the checked off treatments, do not wait until your next appointment to let us know or contact your physician! Ambien, Klonopin, Xanax and Soma are considered potentially addictive, but in the dose and form that we use this is rarely a problem. If you have next day sedation, try taking the medications (except the Ambien) a few hours before bedtime. The antidepressants (e.g. Prozac/Paxil) can improve sleep a lot after 6 weeks. Taking calcium and magnesium at bedtime can help sleep. In addition YOU CAN TRY THE OTHER NATURAL&/OR NONPRESCRIPTION PRODUCTS IN COMBINATION FIRST TO SEE IF THEY GIVE YOU 8 HOURS OF SLEEP A NIGHT. ADD THEM IN THIS ORDER #23, 26, 27, 28, 37, 40, 41, 45A. ___ 22.** Ambien (Rx, zolpidem): 10 mg- ½ to 1½ at bedtime. If you tend to wake during the night, leave an extra ½ to 1 tablet at bedside and you can take it as needed to help you sleep through the night. ___ 23.** Revitalizing Sleep Formula (30 ct or 90 ct) (Enzymatic Therapies/Integrative Therapeutics ): Valerian 200 mg, Passion Flower 90 mg, L-Theanine 50 mg, Hops 30 mg, Piscidia 12 mg and Wild Lettuce 28 mg. Take 2-4 capsules each night 30 to 90 minutes before bedtime. It can also be used during the day for anxiety. If Valerian energizes you (occurs in 5-10% of people) use the other components. It is also excellent for anxiety. Do not take more than 8 capsules a day. ___ 24.* Desyrel (Rx, trazodone): 50 mg - ½ to 6 at bedtime. Although sedating, it can be used (50-250 mg at a time) for anxiety. Do not take over 450 mg a day (or 150 mg a day if on other antidepressants). ___ 25.* Klonopin (Rx, clonazepam): ½ mg - begin slowly and work your way up as sedation allows. Take ½ tablet at bedtime increasing up to 6 tablets at bedtime as needed. Can be very effective for sleep, pain and Restless Leg Syndrome. Klonopin may be addictive. Taking one quarter to one half tablets in the morning (not more) can actually decrease brain fog in some CFS patients. ___ 26.* 5 HTP (5 Hydroxytryptophan): 200 to 400 mg at night. Naturally stimulates Serotonin. Don’t take over 250 mg a day if you are on Prozac, Paxil, Zoloft, Desyrel or Celexa. Can help with pain and weight loss at 300 mg a day for at least 3 months. Or ___ Tryptophan 500 mg caps 1-6 at bedtime. Available at www.vitaganza.com ($65 for 180 caps). ___ 27. Calcium: 500-600 mg and Magnesium 100-200 mg at bedtime helps sleep. ___ 28. Doxylamine (Unisom for Sleep) or Benadryl: 25 mg at night (antihistamines). May also help pain. ___ 29.* Neurontin 300 mg (see #220A): 1-2 caps at bedtime. Also helps pain and restless legs syndrome. ___ 30.* Zanaflex: 4 mg ½-2 at bedtime for sleep (more for pain, see #230A). Stop if it causes nightmares. ___ 31. Sonata (Rx): 10 mg. Take 1-2 capsules during the night if you wake after 3 AM or if you only have trouble falling (vs. staying) asleep. It’s sedation only last 3-4 hours. ___ 32.* Soma (Rx, carisprodol): ½ to 1 at bedtime. This is very good if pain is severe. Soma may be addictive. ___ 33.* Flexeril (Rx, cyclobenzaprine): - 10 mg - ½ to 2 at bedtime. Muscle relaxant - can cause dry mouth. ___ 34.* Doxepin (Rx, Sinequan): 5-10 mg, 1-3 capsules at bedtime or Doxepin liquid 10 mg/cc. If a lower dose is needed you can start with 1-3 drops at night. A powerful antihistamine. Some people get the greatest benefit with the least next-day sedation with a dose of less than 5 mg a night. ___ 35. Elavil (Rx, amitriptyline): 10 mg - ½ to 5 tablets at bedtime. May cause weight gain or dry mouth. Good for nerve pain and vulvadynia. ___ 36. Remeron (Rx, mirtazapine): 15 mg - 1 to 3 tablets at bedtime (especially helpful if you feel like you're "hibernating" during the day). ___ 37. Melatonin: ½ mg - 1 mg at bedtime (available at health food stores). If you feel wide awake at bedtime, try 5 mg taken 3 to 5 hours before bedtime. Don’t use a higher dose unless you find it more effective (.5 mg is usually as effective as 5 mg and may be safer). ___ 38. Gabitril: 2 mg twice a day (see # 220B). Increase by a maximum 4 mgs daily each week to a maximum of 24 mg a day (optimal effect is seen at an average dose of 16 mg/day). Even 5 mg at bedtime can markedly improve deep sleep and can sometimes decrease next-day sedation. The main side effects are sedation, dizziness and gastric upset. ___ 39. Lyrica (Rx-Pregabalin): 50-250 mg a night (or 100-200 mg 3x day for pain). ___ 40. Delta Wave Sleep Inducing CD/Tape: This helps with no side effects. Play it to fall asleep and if you wake during the night. They can be played throughout the night if desired (order from 800-333-5287 or from our web site at www.Vitality101.com). You can use either of the CD's. ___ 41. Kava Kava: 30% extract - 250 mg capsules - 1 to 3 capsules at night (if a rash develops add a B-complex 50 mg at night, and stop/decrease the dose/frequency of use. If the rash persists, see your family doctor). Do not use if you have liver inflammation. May rarely cause liver inflammation. ___ 42. Xanax (Rx, alprazolam): ½ mg - ½ to 4 tablets at bedtime. This is short-acting and gives a good 3 to 5 hours sleep with less hangover in the morning. Xanax may be addictive. ___ 43. Permex (Rx): (see #240). For Restless Leg Syndrome and pain. ___ 44. Seroquel (Rx): 25 mg - 1 at bedtime (an anti-schizophrenic medication). ___ 45. Zyprexa: 10 mg - ½ -2 tabs at bedtime. After 6 weeks, also helps pain. Causes weight gain. (An anti-schizophrenic medication.) ___ 45A. Cuddle-Ewe Mattress Pad: Use if pain interferes with sleep (800-328-9493, ext. 000 - company may offer a 90-day money back guarantee). ___ 46. Xyrem (Rx, GHB): an excellent sleep medication in fibromyalgia. Because the DEA claimed that it was being used as a date rape drug, it has gone from being inexpensive and over-the-counter to being tightly regulated and costing approximately $500 a month. If all else fails, this often works very well. Be sure to rinse your mouth well and swallow after taking liquid. If the medication is left to sit on your teeth, it can dissolve your enamel and damage your teeth. Take nine cc (4.5 g) at bedtime and repeat approximately four hours later when you wake up if needed. The first night you use the Xyrem, take it by itself without other sleep meds. You can then add back in one tablet of any sleep medication with each dose until you’re getting good sleep for at least four hours with each dose. ___ 46A. Lunesta (Rx): 2-3 mg at bedtime. If taken with Sporanox, Nizoral, Diflucan or Zithromax a lower dose may be needed. Hormonal TreatmentsThyroid supplementation - several studies show that thyroid therapies can be very helpful in CFIDS/FMS - even if your blood tests are normal. This treatment is, however, very controversial - even though it's usually very safe. All treatments (even aspirin) can cause problems in some people though. The main risks of thyroid treatment are: 1. Triggering caffeine-like anxiety or palpitations. If this happens cut back the dose and increase by ½ to 1 tablet each 6 to 8 weeks (as is comfortable) or slower. Sometimes taking vitamin B1 (thiamine) 500 mg 1-3x day a day will also help after about a week. If you have severe, persistent racing heart, call your family doctor and/or go to the emergency room. 2. Like exercise (e.g. climbing steps), if one is on the edge of having a heart attack or severe ‘racing heart’ (atrial fibrillation), thyroid hormone can trigger it. In the long run though, I suspect thyroid may decrease the risk of heart disease. If you have chest pain, go to the emergency room and/or call your family doctor. It will likely be chest muscle pain (not dangerous) but better safe than sorry. To put it in perspective, I've never seen this happen despite treating many hundreds of patients with thyroid. Increasing your thyroid dose to levels above the upper limit of the normal range may accelerate Osteoporosis (which is already common in CFIDS/FMS). Because of this, you need to check your thyroid (Free T4 - not TSH) levels after 4 to 8 weeks on your optimum dose of thyroid hormone. All this having been said, we find treatments with thyroid hormone to be safer than Aspirin and Motrin. If you have risk factors or Angina, do an exercise stress test to make sure your heart is healthy before beginning thyroid treatment. These risk factors include: 1. Diabetes, 2. Elevated cholesterol, 3. Hypertension, 4. Smoking, 5. Personal or family history of Angina, 6. Gout, 7. Age over 50 years old. There are several forms of thyroid hormone, and one kind will often work when the other does not. Do not take thyroid within 6 hours of iron or calcium supplements or you won't absorb the thyroid. It can take 3 to 24 months to see the thyroid's full benefit. ___ 47. Levoxyl or Synthroid (Rx, L-Thyroxine): 50 mcg - (100 mcg = .1 mg). See paragraph below and thyroid information above. ___ 48.** Armour Thyroid (Rx): 30 mg (1/2 grain = 30 mg) (natural thyroid glandular). If #54 (Cortef) is checked, begin the Cortef and/or adrenal support 1-7 days before starting the thyroid. See paragraph below and thyroid information above. For each of these 3 forms (#47, 48, & 52), take ½ tablet each morning on an empty stomach for 1 week and then 1 tablet each morning. Increase by ½ to 1 tablet each 1 to 6 weeks (till you're on 3 tablets or the dose that feels best). Check a repeat Free T4 blood level when you're on 3 tablets a day (or your optimum dose) for 4 weeks. If okay, you can continue to raise the dose by ½ to 1 tablet each morning each 6 to 9 weeks to a maximum of 5 a day and then recheck the Free T4 4 weeks later. Adjust it to the dose that feels the best (lower the dose if shaky or if your resting pulse is regularly over 88/minute). Do not go over 5 tablets a day without discussing it with your doctor (Although it may take as many as 10 a day to see the optimal effect). When on your optimum dose, you can often get a single tablet at that strength. Interestingly, Armour thyroid hormone (or a similar one called ‘Bio-throid’) can be mailed to the U.S. without a prescription from www.biogenesis.co.za/pi-thyroid.asp or www.antiaging-systems.com. Only use thyroid under a doctor’s supervision. If your energy wanes too early in the day, you can also take part of your thyroid dose between 11 AM and 3 PM. Some people find that taking part of their thyroid dose at night feels better. You can divide your thyroid dose through the day to see what feels best. and/or ___ 49. Iodine: Iodoral tablets from Optimox ½-1 a day for 2-4 months if you have daytime body temperatures under 98.3 degrees or breast or ovarian cysts. It contains 12.5 mg iodine (iodine 5 mg & iodide7.5 mg). May flare Hashimoto’s Thyroiditis and rarely may suppress thyroid function (with long term use). ___ 50. Thytrophin PMG Thyroid Glandular (Standard Process): 1 tablet is the ~ equivalent of 15 mg Armour Thyroid. Take 1 tablet 3 times a day. and/or ___ 51. Dessicated Thyroid: 130 mg from www.nutri-meds.com - it is over-the-counter. ½-2 tablets each morning (caution - contains active thyroid hormone). ___ 52. Thyrolar (Rx): ½ (this equals T4 25 mcg plus T3 6.25 mcg). See thyroid information above. ___ 53.* Cytomel (Pure active T3) (Rx): 5 and 25 mcg tablets. In Fibromyalgia, resistance to normal thyroid doses may occur and patients often need very high levels of T3 Thyroid to improve. Dr. John Lowe’s research group feels that the average dose needed in FMS is 75-125 mcg each morning - much higher than your body's normal production. Because we are often going above normal levels with T3, the risks/side effects noted above increase. Because of this, if you have risk factors, it is more important to consider an exercise stress test to make sure your heart is healthy (i.e., no underlying Angina) before beginning this protocol. Also, consider a Dexa (Osteoporosis). Scan each 6 to 18 months while on treatment. There may be initial bone loss the first year, then increased bone density. Bone density may decrease at 6 months and then increase after that. This having been said, in our experience this treatment has been quite safe and, in some FMS patients, dramatically effective. Begin with 5 mcg each morning and continue to increase by 5 mcg each 3 days until you feel well, shaky or you’re at 75 mcg a day (whichever comes first) and then increase by 5 mcg a day each 1 to 6 weeks until (whichever comes first): 1. You reach 125 mcg each morning (or 60 mcg if you're over 50 years old unless approved by your physician). 2. You feel healthy. 3. You get shakiness, worsening significant palpitations (occasional "flip flops" are common), anxiety, racing heart, sweating or other uncomfortable side effects. If this happens, lower the dose a bit for 2-4 weeks and then try raising again till you note significant improvement WITHOUT uncomfortable side effects or you tried to raise it 3 times and still became shaky/hyper. Blood tests for thyroid hormone or TSH are not reliable or useful on this regimen. If you feel no better even on the maximum dose, taper off (decrease by 5 mcg each 3 days until you’re at 15 mcg a day. Take 15 mcg a day for 3 weeks and then drop to 5 mcg a day for 3 weeks, then stop). After being on treatment for 3 to 6 months, some patients can lower the T3 dose or stop it. Feel free to try dropping the dose. If you feel better initially and then worse (beginning more than 4 weeks after starting a new dose), you probably need to lower the dose. If you lose too much weight, try to eat more (and discuss this with your physician) and lower the dose. If using the compounded Sustained Release T3, get it from ITC Compounding Pharmacy by mail (303-663-4224) as there is a major problem with the reliability of compounded T3 if not made properly. If you lose too much weight, try to eat more (and discuss this with your physician) and lower the dose. Adrenal Hormones, Glandulars & SupportHelps your body deal with stress and maintains blood pressure. ___ 54.** Cortef (Rx): 5 mg tablets - ½ to 2½ tablet(s) at breakfast, ½ to 1½ tablets at lunch and 0 to ½ tablets at 4 PM. Use the lowest dose that feels the best. Most patients find that 1 to 1½ tablets in the morning and ½ to 1 tablet at noon is optimal. Take it with food if it causes an acid stomach. Do not take over 4 tablets a day without discussing the risks with your physician. Take Calcium (see #3) if on Cortef. If taken too late in the day, Cortef can keep you up at night. You can double the dose for up to 1 to 3 weeks (to maximum 7 tablets a day), during periods of severe stress (e.g. infections - see or call your doctor for the infection and let him/her know you're raising the dose). If routinely taking over 4 tablets a day(at your doctor’s direction), wear a "Med-Alert bracelet" that says "on chronic Cortisol treatment." After 9-18 months, you can try to wean off the Cortef (decrease by ½ tablet a day each 2 weeks) if you feel OK (or no worse) without it. OR 55 plus 56 ___ 55.** Adrenal Stress End: From Enzymatic Therapies or Integrative Therapeutics. Take 1-2 capsules each morning (or 1-2 in the morning and 1 at noon). Take less or take with food if it upsets your stomach. ___ 56. Isocort (Adrenal Glandular): Contains approximately 2½ mg Cortisol (Cortef) per pellet (see #54 above for directions). Order from (800) 743-2256. ___ 57. Hydrocortisone (Rx): 5 mg from natural sources. Hoyes pharmacy in Tampa (813) 835-5331 can make them. ___ 58. Drenamin (Adrenal Support): Take 3-6 tablets in the morning and 3 at lunch for 3-7 days. Then lower the dose (e.g. 3 a day) to what feels best. ___ 59. Panax Ginseng: 100-200 mg twice a day can help your adrenals to heal. ___ 60.* DHEA (5 mg or 25 mg): _____ mg each morning or twice daily (lower the dose if acne or darkening of facial hair occurs). Some experts recommend that the entire dose be taken in the morning. Keep your DHEA-Sulphate levels between 140-180 mcg/dL for females and 300-500 mcg/dL for males. If you have breast cancer, do not use without your physician's OK. See information sheet for dosing. ___ 61. Florinef (Rx, fludrocortisone): 0.1 mg - 1 each morning. Begin with ¼ tablet and increase by ¼ tablet each 3 to 7 days. Increase more slowly if headache occurs. Increase your water, salt and potassium (e.g. 12 oz V-8 juice and one banana a day) intake. See the NMH information sheet and check a potassium level and blood pressure each 6 weeks for 4 months and then each 3 to 4 months. Dexedrine is much more effective and I would use it first for NMH treatment. ___ 62.* Increase your salt and water intake a lot. If your mouth and lips are dry (and you're not on Elavil) you're dehydrated - drink more water (or herbal tea or lemonade sweetened with Stevia - see # 87), not sodas or coffee. Celtic Sea Salt is an excellent form to use (800-867-7258). Other Hormones ___ 63. Oxytocin (Rx): 10 units each morning; ____ by mouth or nose spray: ____ by I.M. injection - as is helpful. The injections may sting. If so, you can add Lidocaine 2/10 to 5/10 cc (without Epinephrine) to the Oxytocin. Try the tablets, nose spray and injections and use the one you prefer. ___ 64.* Natural Estrogen (Rx): _____ take Estrace (estradiol) 1 mg, 1 to 2 times a day, OR _____ put a Climara .05 to .1 mg patch on each Sunday, OR take a Biestrogen 2½ mg 1 to 2 times a day. If you have not had a hysterectomy, you must be on progesterone with the estrogen to prevent uterine cancer. If you are on the patch and it seems to stop working the last 1 to 2 days of the week, you can change the patch every 5 days. Use the Estrogen ____ every day; ____ day 1 through 25 of your cycle (day 1 of your period is day 1 of your cycle). It is normal for your periods to be irregular for 3 to 4 months. If your symptoms (including migraines and anxiety) worsen for the week you are off the Estrogen, we can add a Climara .025mg patch for that week. If they worsen a few hours before you take the Estrogen by mouth, divide the dose up through the day (e.g. ½ tablet - 4 times a day vs. 2 tablets each morning). Estrogen/Progesterone capsules are available from ITC Compounding Pharmacy by mail (303-663-4224). OR ___65.* Biest ____mg, plus Progesterone ____mg, plus Testosterone ___mg all in 1 capsule: Take one capsule 1-2x day. Available from ITC Compounding Pharmacy by mail (303-663-4224). OR ___ 66. Natural Non-Prescription Estrogen/Progesterone: ____ Phyto B - 8 pellets a day (= 2½ mg Triest + 50 mg progesterone); ____ Osta B3 - 8 pellets a day (= 2 mg Estradiol + 50 mg Progesterone) OR; ____ Osta Derm Cream ½ teaspoon a day (= 2 mg Triest + 66 mg Progesterone). Available from ITC Compounding Pharmacy by mail (303-663-4224). OR ___ 67. Black Cohosh: 2 tablets 2 times a day for 2 months and then you can lower to 1 tablet twice a day (for hot flashes). Can take 6 weeks to work. ___ 68. Ortho-novum 1/35 (Rx): Begin the Sunday after this period. It's effectiveness as birth control begins after you've been on it the first week. If you miss a pill, add alternate contraception that cycle. It's effectiveness as birth control is decreased while on Doxycycline or Amoxicillin/Augmentin family antibiotics. If you feel poorly the week off the pill, you can take it every day till you get your period (or 5 months, whichever comes first). Then stop the pill for 5-7 days and then repeat this cycle. ___ 69.* Natural Progesterone (Rx) - (Prometrium - available in most pharmacies) - 100 mg daily if over 48 years old OR 200 mg a day for the 16th to 25th day of your cycle if under 48 years old. Take it at night. Available without prescription from (800) 743-2256 as _____ Progerol Cream (66 mg/1/2 teaspoon) or _____ Progon B 12½ mg per pellet. ___ 70.* Testosterone (Rx) Females: 2 mg tablets or cream, 1 to 2 times a day - make 4 mg/gm of cream (less if acne or darkening of facial hair occurs). Rub the cream into an area of thin skin on the abdomen or inner thigh. Available from ITC Compounding Pharmacy by mail (303-663-4224). ___ 71.* Testosterone (Rx) Males: ____ 25 to 50 mg (order 100 mg/gm of cream) 2 to 3 times a day (less if acne occurs). Rub the cream into an area of thin skin on the abdomen, or inner thigh. The cream is available by prescription from ITC Compounding Pharmacy by mail (303-663-4224). Or ____ Androgel ___25 or __50 mg - apply gel 1-2x a day Or ____ Striant buccal system (30 mg). Apply to the gum region twice daily; morning and evening (about 12 hours apart). Striant® should be placed in a comfortable position just above the incisor tooth (on either side of the mouth). With each application, Striant® should be rotated to alternate sides of the mouth. Upon opening the packet, the rounded side surface of the buccal system should be placed against the gum and held firmly in place with a finger over the lip and against the product for 30 seconds to ensure adhesion. Striant® is designed to stay in position until removed. To remove Striant®, gently slide it downwards from the gum towards the tooth to avoid scratching the gum. Consider also checking estrogen and DHT levels when you check your testosterone blood levels. If the DHT goes too high it can cause hair loss - which can be prevented by Proscar (Rx) or Saw Palmetto 160 mg 2x day. If estrogen goes too high, this can be blocked by Arimidex (Rx) 1 mg a day. If you are taking thyroid tablets, be aware that adding testosterone can increase your thyroid blood levels. If you get moody, anxious, or racing heart, check a blood level for your thyroid and consider lowering the dose. ___ 72. Somatomed: Helps make growth hormone - take 2 tablets on an empty stomach (at least 2 hours after eating), 1 hour before bedtime on weeknights (don't take Saturday and Sunday night). After 3 months, stay off of it for 2 to 4 weeks. ___ 73. Mestinon (Pyridostigmine) (Rx): 60 mg - Take ½ tablet in the morning and before exercise (enhances exercise induced growth hormone release 8 fold). ___ 74. Relaxin (Vitalaxin 20): 20 mcg tablets. Take 1 to 2 tablets 1 to 2 times a day. Often takes 3 months to see the benefit (from 612-946-1550). May have morning sickness and/or ________ during the first month of use. Start with 1 tablet at night - if OK take 1 tablet twice a day for 5 days and then increase to the dose that feels best. Antiviral AgentsFor more information see Treating Respiratory Infections Without Antibiotics and for HHV-6, CMV & EBV Infections, see Vol. 4, Issue 1 of our newsletter. ___ 75. Colloidal Silver: (Use Argentyn 23 from our web store, or wholesale from www.natural -immunogenics.com or 888-328-8840). Take 2 tbsp by mouth in the morning, 1 tbsp before lunch, and 1 tbsp 20 minutes before dinner. Silver should be taken on an empty stomach (at least 10 minutes before eating or drinking). If you get a "die-off" reaction (flaring of symptoms) as the infection is killed, lower the dose to 1 tsp a day and increase more slowly. Although the higher dose can be taken safely for at least a year, 1 tsp a day is good maintenance dose after the infection resolves. ___ 76. Lithium (Rx): 300 mg ____ times a day. If tremor occurs, take 2 teaspoons of Expeller Pressed Safflower Oil from a health food store (uncooked - e.g. as salad dressing) daily or lower the dose. Check a Lithium level 1 month after beginning medication. Then check a Lithium and thyroid blood test (Free T4) each 6 to 12 months. ___ 77.* Anti-Viral (Ultraceuticals): 3-6 caps twice a day. This contains a mix of Milk Thistle Extract (80% Silymarin), Phylanthus amarius, Phylanthus uraria, Monoammonium glycyrrhizinate, L-Lysine, N-Acetyl L-Cysteine, Astragalus Herb Powder, Lactoferin, Olive Leaf Extract, Dionea (Venous Fly Trap extract), and Selenium (Selenomethionine). Available from www.Vitality101.com. ___ 78. Tamiflu: 75 mg 1-2x day. Effects are seen within three weeks if it is going to help ___ 79. Symmetrel (Rx, Amantadine): 100 mg 2 times a day. ___ 80. Monolaurin: 300 mg capsules. Take 9 capsules once a day on an empty stomach for 1 week, followed by 6 capsules once a day for 20 days. Take Lysine 1500 mg twice a day while on Monolaurin. ___ 81. Olive Leaf: 500 mg - 3 to 4 capsules 3 times a day for 10 to 14 days for respiratory infections or 3 to 4 capsules, 3 times a day for 6-24 weeks for chronic infections (e.g. HHV-6, Epstein Barr, etc). ___ 82. Nexavir (Rx, Kutapressin): 2 cc daily for 14 weeks by subcutaneous injection. If not better use 4 cc daily for 14 more weeks. (Costs approximately $160 for 20 cc.). Available from http://www.nexcopharma.com/mailorder.htm. ___ 83. Transfer Factor 540 for Epstein Barr, Transfer Factor 560 for HHV-6: 1-3 capsules each morning on an empty stomach. Consider the Immunity Today brand. ___ 84. Famvir (Rx): 750 mg 3 times a day. ___ 85. Valcyte: 900 mg (two tablets of 450 mg each) twice a day for 21 days with food followed by two tablets once daily with food long-term for maintenance. It can be effective against cytomegalovirus (CMV) and possibly HHV-6 but is potentially quite toxic and expensive. Check a CBC and platelet count blood test weekly on the medication. Anti-Yeast TreatmentsFor a non-prescription approach, use 86, 88, 89, & 90 ___ 86.** Avoid Sweets: this includes sucrose, glucose, fructose, corn syrup, or any other sweets until the doctor says that it is okay to include them in your diet again. Avoid fruit juices, which are naturally sweet. Having 1-2 fruits a day (the whole fruit as opposed to the juice) is okay. Stevia is a great sugar substitute. Inositol (#9 - helps anxiety and depression) & Xylitol (# 189 - helps osteoporosis) are also excellent and healthy sugar substitutes that look and taste like just like sugar. ___ 87. Stevia: A wonderful herbal sweetener. A great tasting one is "Body Ecology's" available from 800-478-3842. Use all you want. ___ 88.** Acidophilus Milk Bacteria - Acidophilus ‘Pearls’ form (30 ct or 90 ct)(by Enzymatic Therapy/ Phyto Pharmica). Take 2 twice a day for 5 months. Then consider 1 a day to help maintain a healthy bowel. Do not take within 6 hours of taking an antibiotic (e.g. take it midday, if you take the antibiotic morning and night). The Enzymatic Therapy/Integrative Therapeutics Acidophilus or Probiotic Pearls form contains ~ 2.8 billion units per pearl - even though box says only 1 billion. I use only this brand, as in many other brands the bacteria are not viable. ___ 89. Primal Defense Powder: 1-6 scoops 3x day for 3-5 months along with the acidophilus (contains "soil based organisms" that also fight yeast, but do not stay in the bowel long term like acidophilus). ___ 90.** Anti-Yeast (Ultraceuticals): a combination of natural products shown to aid in fighting yeast (candida) overgrowth and also provides important protection for the liver during yeast treatment. Take 2-6 capsules daily before meals, or as directed. Sensitive individuals may want to take with food. ___ 91. Citricidal: 100 mg (use the tablets) 1-3 times a day. ___ 92. Mycelex Oral Lozenges (Rx, for Thrush and/or "in the mouth" sores): Suck on 1 lozenge, 5 times a day for 1 to 4 days (as needed). After sucking on it awhile (e.g. 10 minutes), put pieces of the lozenge up against the sore(s) until you are tired of it being there. ___ 93.** Nystatin (Rx): 500,000 units- 2 tablets 2-4x a day. Begin with 1 a day and increase by 1 tablet a day until you are up to the total dose. Your symptoms may initially flare as the yeast die off. If this occurs, stop it and take Actos (Rx) 45 mg a day for 10 days. On the 7th day of taking Actos, resume the Nystatin and raise the dose more slowly or stop for awhile if die off is still severe. The Nystatin is usually taken for 5 to 8 months. If nausea occurs take 2 twice a day and/or switch to the Nystatin powder in capsules or mixed in water (available from Kronos Pharmacy 800-723-7455- in 1 million unit capsules which are much cheaper & better tolerated but need to be refrigerated). Repeat Nystatin for 4 to 6 weeks anytime you take an antibiotic or have recurrent bowel symptoms. Can use Phytostan instead. ___ 94.** Diflucan (Rx, fluconazole): 200 mg a day. Or, if not covered by insurance - Nizoral 200 mg a day. Take it for 6 weeks. IMPORTANT - begin taking the Diflucan 4 weeks after starting the Nystatin or Phytostan. See the paragraph below. or ___ ** Sporanox (Rx, itraconazole): 100 mg, take 2 each day (simultaneously) with food. Begin taking the Diflucan, Nizoral or Sporanox 4 weeks after beginning the Nystatin or Anti-Yeast. If the symptoms have improved and then worsen when you stop the antifungal, refill the prescription for another 6 weeks. (Note: A 6-week supply costs over $500!) If your symptoms flared when you began the Nystatin, begin with ¼ to ½ the above dose for the 1st week. Do not take cholesterol lowering agents related to Mevacor or antacids (e.g. Tagamet) while on Sporanox! Diflucan 200 mg a day may be substituted for Sporanox if you are on antacids. Do not take Mevacor family medications with Diflucan or Nizoral! Take Lipoic Acid (#4) any time you take Sporanox, Nizoral or Diflucan. Also, taking Betaine HCL (stomach acid to help digestion - available at most health food stores) at the same time as the Sporanox, can dramatically increase Sporanox's absorption and effectiveness. Lipoic Acid may decrease the risk of liver inflammation from the Diflucan, Nizoral or Sporanox. If you need to stay on these medications more than 3 months, check liver blood tests (ALT, AST) every 3 months. If you feel well and symptoms (especially bowel symptoms) recur over time, consider retreating yourself with Acidophilus Pearls 2 twice a day, Nystatin or Anti-Yeast and Sporanox (or Diflucan) for 6 weeks as needed. If you flare your symptoms on this treatment, take Actos (Rx) 45 mg a day for 10 days. Retry the Diflucan/Sporanox on the 7th day of taking Actos. ___ 95. Oregano Oil (enteric coated): Candida Formula from Enzymatic Therapies. 2 capsules on an empty stomach 1-2 times a day for 3 to 4 months, then as needed for yeast overgrowth. Immune Stimulants ___ 96.* Thymic Protein (a.k.a - Proboost and Bio Pro A): Dissolve the contents of 1 packet under your tongue - any that is swallowed is destroyed! Take it three times a day for 12 weeks, then 1 a day for 6 weeks. Also take it 3 times a day at first sign of any infection until the infection resolves (it is approximately $1.80 a packet). Available from our office (800-333-5287 or www.vitality101.com). Works in the first 24 hours for acute infections but takes 2-3 months to work for chronic infections. ___ 96A.* Colloidal Silver: (Available in our web store or wholesale from www.natural -immunogenics.com or 888-328-8840 ). See #75. ___ 97.* Leuko-Stim (Ultraceuticals): This mix mostly stimulates immune function, but the olive leaf may also have anti-viral properties. It contains Olive Leaf Extract, Beta 1,3, Glucan, Maitake Mushroom Extract, and Arabinogalactan. ___ 98. Maitake D Fraction 30 (Ultraceuticals): With 330 mg of maitake mushroom and extract (an excellent immune stimulant). ___ 99.** Gamma Globulin: 2 cc IM 1-2x week or 4 cc IM each 1-2 weeks for 6 weeks then as needed. Can "jump start" the immune system. Costs ~ $38 per 2 cc dose. ___ 99A. ImmPower: 500 mg capsules - Take 2 capsules 3 times a day for 3 weeks. Then take 1 twice a day. This natural product triples some important components (natural killer cells) of your immune system. It is expensive. ___ 100. Cold Water Therapy: see newsletter. ___ 101. Isoprinosine (inosine pranobex): 500 mg tabs: Weeks 1, 3, 5, 7, 9 & 11 take 2 tabs 3x day Monday through Friday. Weeks 2, 4, 6, 8, 10 & 12 take 2 tabs each morning Monday through Friday. For Brain Fog___ 102. Ginkgo 60 mg: 1 capsule 2-3 times a day. ___ 103. Remember - Mental Sharpness Formula (Enzymatic Therapy): Take 2 capsules daily. For mild memory problems associated with aging, this comprehensive formula is more powerful than ginkgo alone. It safely supports enhanced focus and brain function through its unique blend of powerful antioxidants, energizing B vitamins, high-potency alpha lipoic acid and clinically-studied herbal extracts. ___ 104. Niacin (not niacinamide or "flush free niacin): Take 100-500 mg of niacin 3-4 times a day on an empty stomach as needed to cause a "flushing" feeling, which occurs within ~ 10-20 minutes. The Flushing feeling is often intense, but not dangerous. It opens the blood vessels to your brain and other areas that have been deprived of blood flow. You may choose to let the pill dissolve in your mouth, and follow it with a glass of cold water. The flush can significantly help brain fog and pain and niacin is very inexpensive. Try to keep the dose at 1000 mg a day or less if this is enough to cause flushing, as higher doses can rarely cause liver inflammation or unmask diabetes. This treatment also helps to lower cholesterol. ___ 105. Piracetam (Rx): 1200 mg twice a day for 2 weeks, then take 2400 mg twice a day for 2 weeks. Then adjust to optimum dose (up to 4800 mg a day). Can be ordered from England. Take with Hydergine (#106) (www.antiaging-systems.com). ___ 106. Hydergine (Rx): 4 to 6 mg each morning. ___ 107. DMAE: up to 400 mg a day. For Migraines - PreventionFor migraine prevention, Magnesium (see #1 plus take an extra 200 mg at bedtime) is very important. I would add vitamin B2 and butterbur (or feverfew if the butterbur is too expensive). It can take three months to see the effect of these preventive measures! If your migraines are predominately around your period or associated with taking estrogen, they can often be eliminated by adjusting estrogen dosing. Many medications which are elsewhere on this form can also be helpful for the prevention of migraines when taken regularly. These include Neurontin, Topamax, Elavil, and Doxepin. Inderal XL can also be helpful but may aggravate fatigue, asthma, or depression. Food allergies should also be addressed. Other medications can also be helpful. For more information see A Comprehensive Medicine Approach To Migraines. ___108.** Food allergies are also very important to consider in the production of migraines. To tell if foods are playing a role, it is helpful to do a food elimination diet. Although a very limited diet is needed for five days (eat only pear and lamb, and drink only bottled spring or distilled water), this kind of strict elimination diet for five days will make it easier to tell if true food allergies are present and triggering your migraines when you reintroduce the foods into your diet. In one study, by avoiding the ten most common food triggers, there was a dramatic reduction in the number of headaches per month, with 85% becoming headache free. The most common reactive foods were wheat in 78% of patients, orange in 65%, eggs in 45%, tea and coffee and 40% each, chocolate and milk and 37% each, beef in 35% and corn, cane sugar, and yeast in 33% each when the patients were challenged with these foods . If you have severe and frequent migraines, it is worth exploring this. You may find that instead of avoiding these foods for the rest of your life, you can eliminate the sensitivities/allergies using an acupressure technique called NAET (see www.NAET.com). ___ 109.* Vitamin B2 (riboflavin): 400 mg each morning to prevent migraines. ___ 110.* Petadolex (butterbur): 50 mg 3 times a day for 1 month and then twice a day to prevent migraines. Can take 2 every 3 hours up to 6 capsules for acute migraines. Use only Enzymatic Therapy or ITI brands - others often have impurities and do not contain the amount of Butterbur the label claims. This can be highly effective. ___ 111. Feverfew: 250 mg 1 to 3 times a day to prevent migraines. ___ 112. Zonegran (Rx): 100 mg, an anti-seizure medication. Begin with 100 mg a day for two weeks and then increase to two tablets a day. The maximum dose is 400 mg daily, although most of the benefit occurs at the first 200 mg. Because there have been rare occurrences of a life threatening rash (most rashes caused by the medication are not however), stop the medication immediately if you get a rash. Acute Migraines ___ 113.* Petadolex (butterbur): 50 mg, 2 every 3 hours up to 6 capsules for acute migraines ___ 114.* Imitrex (Rx): For the treatment of acute migraines, medications in the Imitrex family still remain the first choice. Imitrex comes and 25, 50, and 100 milligram tablets, and up to 100 mg may be taken at a time. If pain persists at two hours, another dose of up to 100 mg can be taken. In addition, it is also available by nasal spray, using a dose of up to 20 mg initially, followed by one more spray of up to 20 mg 2 hours later if needed. Another alternative is a 6 mg subcutaneous injection which can also be repeated one-hour later if needed. It is reasonable to try these different forms to see what works best for your migraines. You may also want to try a newer cousin called Amerge. Use 2.5 milligrams initially. This dose may be repeated four hours later if needed. #114A below is more effective than Imitrex 50 mg in a head to head study, however, and much cheaper. ___ 114A.* Acetaminophen 500 mg, aspirin 500 mg, and caffeine 130 mg is more effective than Imitrex 50 mg in a head to head study, however, and much cheaper. ___ 115. Axert (Rx, Almotriptan): 6.5 or 12.5 mg. Can repeat after 2 hours. A cousin to Imitrex but less expensive. ___ 116. Magnesium: 1-2 grams intravenously over 15-30 minutes will usually knock out acute migraine attacks. ___ 117. Midrin. (Rx): Two capsules are taken immediately followed by one capsule every hour until the headache is relieved (to a maximum of five capsules within a 12 hour period). It can also be helpful for tension headaches in a dose of two capsules four times a day as needed. ___ 118. Metoclopramide 10 mg plus lysine acetylsalicylate (Rx) (compounded): 1620 mg or aspirin 900-1200 mg (chewed). Metoclopramide returns the absorption of aspirin to normal during migraine attacks and also combats nausea and vomiting. In 2 placebo-controlled studies, this combination (using lysine acetylsalicylate) was more effective then 100 mg of Imitrex by mouth and was better tolerated. OR ___ 119. Indomethacin (a "super-aspirin”), prochlorperazine (for nausea), and caffeine in suppository form (also compounded) eliminates an acute migraine in 49% of patients. ___ 120. ACTIQ (Rx, Fentanyl Lollipops): 200-1600 mcg. This powerful narcotic should only be used for breakthrough pain that is not relieved by other medications (i.e., used instead of going to the emergency room). Fentanyl lollipops should be sucked on, not chewed or swallowed. In between being sucked on, it should be left between the cheek and lower gum. Time it so that it takes approximately 15 minutes to be absorbed into your cheek. In doing it this way, it is most effective. It begins working within 5 to 10 minutes with pain relief lasting approximately three hours. Its effectiveness is similar to 2-16 mg of intravenous morphine. The most commonly used doses are 400 & 800 mcg. Because these medications are only approved by the FDA for use in patients who are on chronic narcotics, it is reasonable to have you (if you are not on chronic narcotic pain medications) take the first dose in a doctor’s office to make sure that it does not cause excessive sedation. Like other narcotics, this medication can be highly addictive. Because of this, it should only be used as a rescue medication when other medications have failed. Once you have tried the 200 and 400 mcg doses and know that they are not too sedating, begin with a 400 mcg dose over 15 minutes. If adequate pain relief is not achieved 10 minutes later (25 minutes after beginning the first lollipop), use another 200 or 400 mcg unit each 25 minutes until adequate pain control is achieved or you reach 1200 mcg. The average dose needed is 800 mcg. ___ 121. Phenergan Rectal Suppositories (Rx): For nausea, 25 mg- 1 every 4 hours as needed for nausea (up to 5 a day). ___ 122. Diamox (Rx) (a diuretic): 125-500 milligrams once or twice daily may decrease severe pressure headaches. Carbonated beverages will taste funny while you're on this medication. *Treatments for ParasitesIf your stool test shows parasites, recheck the stool test 3 to 4 weeks after finishing the treatment below. You can use the natural remedies #132 and #134 with either #135 or #136. ___ 123.* Vermox (Rx): 100 mg - Chew 1 twice a day for 3 days. 1 week later chew 1 twice a day for 1 day. Good as an "empiric" therapy if you suspect parasites but cannot isolate them. __ 124.* Neomycin (Rx): 500 mg - 3 times a day for 10 days. Used for small bowel bacterial overgrowth. ___ 125.* Multi-pure Water Filter: Most other filters except reverse osmosis are ineffective. Available from Bren Jacobson, 410-224-4877. Decreases the risk of reinfection. ___ 126.** Flagyl (Rx, metronidazole): 750 mg 3x a day for 10 days. It is followed by Yodoxin for many parasites. For Clostridium Difficile take 250 mg, 4 times a day or 500 mg, 3 times a day. It may cause nausea/vomiting (uncomfortable but usually not worrisome). Do not drink alcohol while on this medication as it will make you vomit. The SR (sustained release) form is easier on the stomach (as is the brand name form). If you get numbness/tingling in your fingers (or it worsens if you usually have it) stop the Flagyl. ___ 127. Yodoxin (Rx, iodoquinol): 650 mg - 3x a day for 20 days after Flagyl is completed. ___ 127A. For Blastocystis begin with Tinidazole 500 mg, Amphotericin B 100 mg, and Furazolidone 100 mg with each of these being taken twice a day for seven days. Take with psyllium - 1 tsp with any liquid - this will trap the pills so they do not get absorbed in the stomach but go right to the intestinal tract. Eat a low carbohydrate diet and do not take B-complex vitamins or anything containing folic acid during treatment. If not successful, they retreat bid for 14 days. 127B. Alinia (Rx, nitazoxanide): 1 gm 2 times a day for 10-14 days. This is longer than the standard recommendation for this medication and it is expensive but will be off patent soon, so there hopefully will be less expensive generics available soon. ___ 128. Paromomycin (Rx): 250 mg 2 tabs 3x day for 15 days (Cryptosporidium). For Blastocystis add Yodoxin (as in #127) &/or Tinidazole 500 mg 3 x day for 10 days. ___ 129. Bactrim DS (Rx): 1 twice a day for plus Yodoxin 650 mg 3 times a day with food for 10 days. Do not take Folic acid supplements (e.g. B Complex or multivitamins) for these 10 days (for Blastocystis). For Blastocystis, also be on a low carb diet and add glutamine 1000 mg/day. ___ 130. Amphotericin B (Rx): 100 mg twice a day plus Tinidazole 500 mg twice a day plus Furaxon (Furazolidone) 100 tablet twice a day. Take these 3 together with food for 7-14 days (Amphotericin B, Furaxon and Tinidazole are available from Clark's Pharmacy 800-480-3432 @ ~ $56/weeks supply) (treatment for refractory Blastocystis). ___ 131. Tinidazole (Rx): 2000 mg - ____ Once daily for 3 consecutive days with food (for Entamoeba Histolytica). OR ___ 3 doses each 2 weeks apart (for Giardia or Dientamoeba Fragilis) @ Clark's Prescriptions 800-480-3432. ___ 132. Parastat (Holarrhena Antidysenterica): 500 mg - you can take up to 8 capsules a day. From Premier Research Labs (800-325-7734). ___ 133. Zithromax (Rx): 250 mg 1 a day on an empty stomach for 10 days, along with Bactrim 1 tablet twice a day for 10 days (alternate treatment for Cryptosporidium). Add Artemesia (#135 or 136). ___ 134. Lactoferrin: 350 mg, 1 to 3 capsules at bedtime. ___ 135. Artemesia Annua (an herbal antiparasitic): 500 mg- 2 tablets 3x a day for 20 days. OR ___ 136. Tricyclin (an herbal antiparasitic): 2 tablets 3x a day after meals for 6-8 weeks (concentrated Artemesia). ___ 137. Colostrum (mother’s milk): 3 capsules 3x a day for 6-9 months. Then stop or use the lowest dose needed for symptoms. If nausea or indigestion occurs, lower the dose to a comfortable level for 1-2 weeks till it passes. Take on an empty stomach. May increase "Growth Hormone Effect" by raising IGF-1 - it takes 5 months to see this effect. ___ 138. Quinacrine (Rx): 100 mg a day for 5 days. May be useful for empiric therapy of suspected but not identified parasites. ___ 138A. Rifaximin (Rx): 400 mg 3x day for 10 days-a non absorbable antibiotic for SIBO. Treatment for Bacterial, Mycoplasma, Chlamydial, Bladder (E-Coli), Sinusitis, Chronic Lyme or Other InfectionsThese infections usually take months to years to eradicate. It is common to flare your symptoms (from the infection "die off") the first 2-6 weeks of treatment. Take the antibiotics for 6 months and, if better, then repeat 6 week cycles until your symptoms stay gone. Antidepressants, Neurontin, and/or Codeine may block the antibiotic's effectiveness. Be sure to take Nystatin 2 tablets twice a day and Acidophilus while on the antibiotics. If you have occasional low grade fever (i.e., if over 98.6 degrees F), check your oral temperature occasionally to see if the antibiotic reduces or eliminates the fever. If so, stay on that antibiotic. See Dr. Nicholson's web site (www.immed.org) for more information. YOU CAN ATTEMPT IMMUNE STIMULATION WITH #96-100 INSTEAD OF OR WITH ANTIBIOTICS. ___ 139. Cipro (Rx, ciprofloxacin): 500 mg - twice a day for 6 months. Do not take magnesium products (e.g. Fibrocare, some antacids, From Fatigued To Fantastic!Formula) within 6 hours of Cipro or you won't absorb the Cipro). OR ___ 140.* Minocycline (Rx, a tetracycline): 100 mg - 2x a day for 6 months. If symptoms recur when the Minocycline is completed, keep repeating 6 week courses until the symptoms stay resolved. Take Nystatin (at least 2 twice a day) while on the antibiotic. Your birth control pill may not work while on Minocycline. Do not take any Minocycline tablets older than its expiration date (very dangerous). OR ___ 141. Zithromax (Rx, azithromycin): 250 mg tablets - 1 tablet a day (take with food if it bothers your stomach). Don't take magnesium containing products within 6 hour of the Zithromax. ___ 142. Biaxin (Rx): 500 mg, 2 times a day. Chronic & Acute Sinusitis___ 143.* Sinusitis Nose Spray (Rx): Contains Sporanox, Xylitol, Bactroban, and triamcinolone. Use 1-2 sprays in each nostril twice a day for 6-12 weeks. If it irritates the nose, use nasal saline spray just before using the prescription. Use with silver spray below. Available by prescription from ITC Compounding Pharmacy by mail (303-663-4224). ___ 144.* Silver Nose Spray: 5-10 sprays in each nostril three times a day for 7-14 days until the sinusitis resolves (from our web store or wholesale from www.natural-immunogenics.com or 888-328-8840). ___ 145. Nasal Irrigation (Rx): Get 1 liter of normal saline with 100 mg Amphotericin B and a second liter with 80 mg gentamycin. Use 1 ounce of each in each nostril as a nasal rinse twice a day as needed. Use Cape Apothecary (800-248-5978 or 410-757-3522). Kills Many Infections ___ 146. Colloidal Silver: (Use Argentyn 23 from our web store or wholesale from www.natural-immunogenics.com or 888-328-8840). Take 2 tbsp by mouth in the morning, 1 tbsp before lunch, and 1 tbsp 20 minutes before dinner. Silver should be taken on an empty stomach (at least 10 minutes before eating or drinking). If you get a "die-off" reaction (flaring of symptoms) as the infection is killed, lower the dose to 1 tsp a day and increase more slowly. Although the higher dose can be taken safely for at least a year, 1 tsp a day is good maintenance dose after the infection resolves. E.Coli Bladder Infections___ 147. D-Mannose: 1 teaspoon (2 grams) stirred in water every 2 to 3 hours while awake for 2 to 5 days for acute bladder infections (may use up to 1-2 times a day long term if needed for chronic infections) caused by E.Coli (this causes approximately 90% of bladder infections). If not much better in 24 hours, get a urine culture and consider an antibiotic. Continue taking it for 2-3 days after the last symptom resolves.1 tsp. Taking it an hour before and immediately after intercourse can also prevent bladder infections. D-Mannose is available from BioTech (800-345-1199), our office or our web site Vitamin Shop. Food & Other Sensitivities___ 149.** NAET: Wonderful for elimination of sensitivities/allergies (see www.naet.comfor more information). In Annapolis see Laurie Teitelbaum at 410-266-6958. ___ 150. Food Allergy Elimination Diet: See Multiple Food Elimination Diet by Doris Rapp. ___ 151. MSM (sulfur = methyl sulfonyl methane): 2000-6000 mg - 2 times a day for 2-3 months, then as needed for allergies, wound healing, and arthritis. Vitamin C 500 mg with each dose may improve absorption. This is O.K. to take even if you are Sulfa allergic. I.V. Nutritional Support___ 152.** Myers Cocktail (Rx): I.V. nutritional therapies (very helpful). In the Maryland, Virginia, and Washington DC areas, an excellent IV nurse is Rhonda Kidd (443-994-0126). * Detoxification- There are several simple things that you can do that can be very helpful. ___ 153. Sweating can remove toxins: especially if you shower immediately after, and can be very helpful for health. Many of the newer saunas are what are called "far infrared," and a half-hour 3-7 times a week can help detoxification. See http://hightechhealth.com for more information. ___ 154. Some of you may be more comfortable with hot baths. This is one recipe that was given to me by a wonderful practitioner (Anette Mnabhi, DO in Montgomery, IL): Recipe for a detox bath — which helps a lot with general muscle aches and pains. Epsom Salt - 2 cups & Baking Soda - 1 cup & Hydrogen Peroxide - 1/3 cup Fill tub with hot water and add above ingredients. Soak for 20-30 minutes. You will sweat in the tub and Lose toxins (which causes you to lose some water as well). It is important to drink plenty of water while you soak. You can make fresh lemon juice and mix with water and drink, or plain water, but it is essential to drink while you take the bath. If you have a tendency to get light headed easily, be cautious when getting out of the tub, or have someone nearby the first time you take a detox bath. Take a lukewarm to cool shower after getting out of the tub to rinse off the salts or you may itch. Rest for 30 minutes after the bath. ___ 155. There are two excellent products that can be used intermittently to eliminate toxins. These are the ___ "Whole Body Cleanse" and ___ "Metal Magnet" by Enzymatic Therapy. Simply follow the labeled instructions. ___ 156. For pesticide detoxification (usually takes 3-10 months to start working and symptoms may initially flare). Add 50 gm choline and 25 gm vitamin C to 500 cc (1 pint) of flavored water. Take 10 cc (2 teaspoons) 3x a day for 1 month then 5 cc (1 teaspoon) 2 times a day. Choline can cause a fishy smell at a higher dose. If this a problem, lower the dose. Reference Journal of Chronic Fatigue Syndrome 6 (2) 2000 p11-21. ___ 157. D-penicillamine for heavy-metal elimination. Take 500 mg (two 250 mg capsules) 4 times a day for two days each week (e.g. Monday and Thursday) for 4-12 weeks on an empty stomach. NMH and/or Energy Boosters ___ 158.* Dexedrine (Rx, dextroamphetamine): 5 mg - 1 to 2 tablets in the morning; plus ½ to 1½ tablets at noon; or Concerta 18 mg take1-2 each morning and/or _____ Provigil (Rx) 200 mg. ½- 1 tablet in the morning and at noon, as needed for energy. Dexedrine is an amphetamine family stimulant similar to Ritalin and may be addictive. Take less if you have caffeine-like shakiness. Most patients use 1-3 tablets of Dexedrine in the morning and ½-2 at noon. If appetite suppression and/or weight loss is a problem you can add Periactin (Rx) 4 mg (antihistamine & anti-serotonin) up to 5 tablets a day. ___ 159. Strattera (Rx): 25 or 40 mg caps - 40 mg each morning. Can increase by another 40 mg in the AM or afternoon as needed. Raises Norepinephrine. May suppress appetite. ___ 160. Midodrine (Rx, Proamatine): 5 mg 1-2 tablets. Take up to 1 hour before exercise/activity up to 3 times a day (for NMH). Anticoagulants ___ 161.** Heparin (Rx, blood thinner): _____units ( _____cc) subcutaneously twice a day for 3 months. Then switch to Heparin in lozenge form (1000 units/dose more than you took by injection) and dissolve under your tongue 2-3 times a day. A heparin nose spray (10,000 units per CC with one spray equally 1000 units) is also available from University pharmacy 800-985-8065. Avoid any traumatic injuries. There are 10,000 units/cc of the injectable. If you have preloaded syringes (____units/cc) use 1 syringe 2 times a day. This is a blood thinner. Call immediately if you have any bleeding problems. Check the Platelet Count and PTT blood tests (#147) weekly for 1 month, then every 3 months while on Heparin injections. Inject it into the fat (not muscle) in your abdomen. Use a different spot each time (you may get a bruise where the injection is given). Can cause a (potentially fatal) bleeding problem or drop in platelet count. AND/OR ___ 162. Lumbrokinase (natural powerful blood thinner): Take 1 tablet at night or twice a day. AND/OR ___ 163.* Megazyme (see #202 below) Neurotoxin TherapiesRead the info sheets on www.Vitality101.com ___ 164. Questran (Rx): 1 packet or scoop 4 times a day mixed with water or apple juice. Take ½ hour before eating meal containing fat. Binds other treatments so take them at least 1 hour before or 4 hours after Questran if possible. Can cause severe and dangerous constipation. Take #180-186 as needed to have at least 1 bowel movement a day. If Questran flares your symptoms, stop it and take Actos (Rx) 45 mg a day for 5 days first and for 8 more days after resuming Questran and then retry Questran (and consider adding antibiotics). See the Neurotoxin information sheet for detailed instructions - also do the Vitamin C Flush and, if needed, the "Alkaline Way" Diet with it. Information sheets available on www.Vitality101.com. Antidepressants- helps pain, brain fog, energy - even if not depressed. And may be helpful in treating NMH. ___ 165. Happiness 1-2-3! (Hypericum/St. John's Wort), 5HTP, magnolia and more - It is outstanding for depression! Available from HFN (800-980-8780) or www.Vitality101.com. It takes 6 weeks to see the full antidepressant effect. Take 1-3 capsules 1-3x day. Do not take with other prescription anti-depressants without your doctor's permission. ___ 166. Effexor (Rx, venlafaxine): 37½ mg _____ tablets - _____ times a day. ___ 167. Prozac (Rx, fluoxetine): 20 mg - _____ capsule(s) each morning. Begin with 10 mg a day the first week if the full dose makes you hyper. ___ 168. Celexa (Rx): 20 mg ____ tablet(s) a day ___ 169. Zoloft (Rx, Sertraline): 50 mg - _____ tablet(s) each morning or evening. ___ 170. Paxil (Rx, paroxetine): 20 mg - _____ tablet(s) each morning. ___ 171. Wellbutrin (Rx, bupropion): _____ mg - _____ x a day. Not sedating. ___ 172. Meridia (Sibutramine): 10 or 15 mg each morning. Causes weight-loss. ___ 173. Pindolol (Rx): 5 mg - 1½ tabs a day for 3 weeks, then 3 tabs a day. Give 3 months to work. Blocks Norepinephrine/serotonin. Sexual Dysfunction/Loss of LibidoThis is a common problem, found in 73% of CFS/FMS patients. Make sure your testosterone levels are adequate. ___ 173A. For women Desire (Ultraceuticals) or Hot Plants-For Her (Enzymatic Therapy): Maca Root Extract 400-800 mg/day, Rhodiola Rosea Extract 150-300 mg/day, Ashwagandha Root Extract 250-500 mg/day, Siberian Ginseng Extract 150-300 mg/day,Ginkgo Biloba Extract 50-240 mg/day, Diindolymethane (DIM) 100-200 mg/day, Macuna Pruriens Extract (15% L-dopa) 100-200 mg/day. ___ 173B. For men, Potency Plus (Ultraceuticals) or Hot Plants-For Him(Enzymatic Therapy): Maca Root Extract 400-800 mg/day, Rhodiola Rosea Extract 150-300 mg/day, Epimedium Extract 100-200 mg/day, Longjack Extract 50-100 mg/day, Panax Ginseng 100-200 mg/day, Ginkgo Biloba Extract 50-240 mg/day, Diindolymethane (DIM) 100-200 mg/day, Macuna Pruriens Extract (15% L-dopa) 50-200 mg/day, Tribulus Terrestris Extract 100-200 mg/day. ___ 174. Antidepressant induced sexual dysfunction can be treated with___ ginkgo biloba 120 mg twice daily, ___ Dexedrine - 25 mg each morning, ___ Symmetral100 mg twice daily, or switching to Wellbutrin (see # 171) ___ 175. Viagra (Rx): 100 mg- take ¼-1 tab 1 hour before intercourse on an empty stomach for erectile dysfunction (do not use with nitroglycerin or underlying heart disease). Chew and dissolve under tongue for faster effect. ___ 176. Cialis (Rx): 20 mg - take one half to one tablet 15 minutes before intercourse for erectile dysfunction (do not use with nitroglycerin or underlying heart disease). VulvadyniaTreat with Elavil (or Doxepin) and Neurontin (oral or topical). Suboptimal testosterone can also cause Vulvadynia. Spastic Colon-IBSTreat the yeast and parasites and the IBS will usually go away. For symptomatic relief: ___ 177. Peppermint Oil: Enteric/stomach coated (2/10 =.2 cc) capsules, 1 to 2 capsules 3 times a day between meals (not with food) for spastic colon. Peppermint Plus from Enzymatic Therapies. Mentharil from Integrative Therapeutics . ___ 178. Simethicone (Mylicon): 40 to 80 mg, chew one tablet 3 times a day as needed for abdominal gas pains. ___ 179. Iberogast (digestive system herbal): Take 20 drops 3 times a day in warm water with meals. Very helpful for indigestion (takes 4 to 8 weeks to work). From Phyto Pharmica. ConstipationCan adjust these as needed for one soft bowel movement a day. Increasing your water, fiber (e.g. 1 bowl of whole grain cereal in the morning) and magnesium intake is also helpful. ___ 180. Miralax Laxative (Rx): 1 heaping tablespoon a day in 8 oz water (comes in 14 oz and 26 oz bottles). ___ 181. Prunes and/or Prune Juice ___ 183. Artichoke Extract: 160 mg by Enzymatic Therapies. Take 2 capsules 3 times a day. It can also helps spastic colon. Stimulates bile acid release and may also help gall stones. ___ 184. Sorbital 70%: 1-3 teaspoons 3 times a day as needed. ___ 185. Challenge Caps: up to 2 capsules 3 times a day between meals. ___ 186. Lactulose Liquid (Rx): Take as needed for constipation.(lowers ammonia levels as well). OsteoporosisIn addition to weight bearing and estrogen replacement, DHEA and testosterone replacement can also be very beneficial in the treatment of osteoporosis. In addition to calcium, numerous nutrients (e.g. magnesium, boron, etc) are critical for building bone strength. Except for calcium, strontium, and vitamin K, most of these are contained in the Energy Revitalization System (See #1 above) which contains over 50 nutrients. Take this plus calcium and: ___187. Bone Health (Ultraceuticals): Take 3 capsules 1-2 times per day as directed by a physician. Do not take calcium products within 2 hours of thyroid medications. Bone Health contains Strontium, which is much more effective than Fosamax for building strong bones, but safe. This product also contains vitamins D and K, Calcium, magnesium, and manganese for maximum benefit. It is outstanding for building bone density. Available at www.Vitality101.com ___ 188. Fosamax (Rx): 70 mg once a week on an empty stomach taken with a full glass of water. It is best to take it immediately on waking and then stay upright for 30 minutes so gravity helps it get past the stomach quickly (because it can irritate the stomach). For those of you on the 35 mg a week prevention dose, be aware that the 35 and 70 mg tablets cost exactly the same amount. So you can save half the cost by getting a 70 mg tablet and breaking it in half! ___ 189. Use Xylitol powder instead of sugar (increases bone density and tastes and looks like sugar). CholesterolStatin drugs like Mevacor can severely flare Fibromyalgia, and Co-enzyme Q10 200-400 mg a day should always be taken with it (see #11). Better yet, I substitute the natural formula below (which can also be taken with cholesterol lowering meds if needed). ___190.** Chol-Less (Ultraceuticals): This natural mix of cholesterol lowering herbs is excellent. Give it 6 weeks to see the effects. Take 3 capsules a day. Available at www.Vitality101.com. Other Helpful Treatments ___ 191. For severe dry eyes: Use #1, #8 and Testosterone cream applied to eyelids. ___ 192. Parlodel (Rx, bromocriptine): 2½ mg - ½ tablet at night for 1st week, then 1 tablet at night. Lowers elevated Prolactin levels. Vitamin B6 200+ mg a day can also lower Prolactin. Pain Treatments(Antidepressants #165-173 or Lithium #76 often helps pain.) THE NATURAL TREATMENTS CAN BE SUBSTITUTED FOR OR ADDED TO THE PRESCRIPTION PAIN MEDICATIONS. If side effects occur, they often can be avoided by starting with a low dose and raising it each 3-7 days as your body gets used to the medication. It may take 2-6 weeks for a treatment to start working. Natural Pain Therapies ___ 193. Rolfing, Trager, Myofascial Release, Chiropractic, other body work & manipulation modalities, and/or Acupuncture. In Annapolis Maryland, Bren Jacobson (410-224-4877) does superb Rolfing. ___ 194. EndFatigue Pain Formula: Contains Willow Bark, Boswellia, and Cherry. Take 2 tabs 3x day. It takes 2-6 weeks to see the full effect. At that time, you can often lower the dose to 1 tab 3x day or 2 twice a day. Available from Integrative Therapeutics or Enzymatic Therapy. ___ 194A. Limbrel (Rx): 250 or 500 mg caps. This prescription flavonoid is a natural anti-inflammatory (similar in effects to Motrin) but much safer. Usual dose in 250-500 mg 2x day. ___ 195. NAET: Treat food and other sensitivities and pain often resolves. Seewww.NAET.com and the book "Say Goodbye to Pain" available on the site. Other related techniques such as JMT can be very helpful for rheumatoid and other arthritis problems. ___ 196. Niacin: (not niacinamide or "flush free niacin"). Take 100-500 mg (100 mg is usually enough to cause the desired flush) of niacin 3-4 times a day on an empty stomach as needed to cause a "flushing" feeling, which occurs within ~ 10-20 minutes. This can significantly help pain by flushing nutrients into and toxins out of painful areas, and is very inexpensive. Try to keep the dose at 1000 mg a day or less if this is enough to cause flushing, as higher doses can rarely cause liver inflammation or unmask diabetes. This treatment also helps to lower cholesterol and decrease brain fog. ___ 197. NF Joint Gel: Simply roll it on and rub it in. For best results, massage Joint Gel into your skin until absorbed. You can use Joint Gel up to 3 to 4 times daily. ___ 198. Lipoic Acid: 200 mg 3 times a day for neuropathic pain. Benefit usually begins to be seen by 2-3 months. It has been shown to be helpful for diabetic neuropathy and burning mouth syndrome (200 mg 3 times day for 5 months). ___ 199. Glucosamine Sulfate: 500 mg, 3 times a day (for arthritis). Takes 6 weeks to see if it will help. When the maximum benefit is seen, you can decrease to the lowest dose that maintains the effect. ___ 200. MSM: 3 grams a day for arthritis. ___ 201. Eskimo 3 Fish Oil or Arctic Omega: (see # 8) can markedly decrease inflammation and pain. Dry eyes and mouth suggest you need it. ___ 202.* Megazyme (Enzymatic Therapies) or Biozyme (Integrative Therapeutics): Like a super Wobenzyme. Take 2-4 capsules 3 times a day between meals. May dissolve clots in the blood vessels. Can be helpful for pain and other symptoms (takes days to weeks to work). Especially helpful with inflammatory pain. ___ 203. Purple Pectin for (especially arthritis) Pain: Purchase Certo in the canning section of your local grocery. It is the thickening agent used to make jams and jellies. Certo contains pectin, a natural ingredient found in plants. Take 1-3 tablespoons of Certo in 8 ounces of grape juice 1-2 times a day (1 to 2 tbsp a day is enough for most people, but you can try more). If it's going to help, you'll likely know in 7-14 days. As the pain disappears, the dose can be reduced to 1 teaspoon in grape juice once or twice a day as needed. Many people have found this simple, safe and cheap treatment to be very effective! ___ 204. Heel Lift: ______ inches for _____ foot (for uneven hip heights). ___ 205. John Sarno, MD's approach for localized pain. The mind can decrease blood flow to muscles to distract us from uncomfortable emotional feelings. When you feel pain, tell your mind you will use the pain as a signal to look for and feel uncomfortable feelings for 10-15 minutes, then do so. The pain will often leave within 6 weeks. Also read my book "Three Steps to Happiness - Healing through Joy!" available in our office as this will help you to let go of feelings that may be buried and causing pain. ___ 206. Rhus Tox (homeopathic treatment): Dissolve under the tongue as directed on the bottle as needed for muscle pain. ___ 207. Magnets: Start with spot magnets, insoles and seat. If they help in 2 months, consider a mattress pad. Available from Bren Jacobsen (410-224-4877) or Amy Podd (410-757-7295). ___ 208. Copper/Magnet Bracelet: Use nail polish remover to remove any coating on the inside of the bracelet so the copper is in direct contact with your skin. ___ 209. Quercetin: For prostate pain. 500 mg twice a day decreases symptoms in both prostadynia and prostatitis. ___ 210. Flexyx: Flexyx can be very effective. It is a brainwave biofeedback system (www.flexyx.com). ___ 211. Humibid (Rx, guaifenisin): 600 mg _____ tablets _____ times a day (see instruction sheet). No aspirin or herbals can be taken while on Guaifenisin. GuaiLife - a shorter acting form may be more effective. See www.fludan.com for more information. ___ 212. Cetyl Myristoleate: 385 mg capsules - 3 capsules 2 times a day for 10 days. You can raise the dose to a maximum of 17 gm a day. For pain - benefits often persist after the 10 days of treatment. Pharmacologic Pain TreatmentsIf you are not clear about the source/type of your pain, there are many reasonable sequences in which to try the medications. One reasonable order to try them in is the one listed below. It can take 2-6 weeks to see the full effect of the medication. When there are several medications with the same number (e.g. 215A, 215B, 215C), if the first medication helped but was not tolerated because of side effects, go to the next medication of the same number. If it simply did not help significantly, go to the next number. If you get partial benefit from a medication, continue it and add the next medication as needed to get pain-free. A reasonable order to try pain meds is : #......216, 215, 214, 222,221, 220A, 220C, 220B, 230A, 228A, 223, 231,235,237, 234, narcotics. ___ 213. Tylenol (acetaminophen): For many people, this can be a safe and effective pain medication. Simply be aware that chronic use at too high of a dose can cause liver and sometimes kidney problems. Do not take over 4000 mg a day, and for chronic use it is best to stay under 2000-3000 mg daily. If you are taking over 1500 mg of acetaminophen a day on a regular basis, get an extra 500-650 mg of NAC and take it each day along with the vitamin powder. Otherwise, you will deplete a key antioxidant (which is why Tylenol can damage the liver). ___ 214.* Ultram (Rx, tramadol): 50 mg 1 to 2 tablets up to 4 times a day as needed for pain. Side effects are less with 4 or less tablets a day. May cause nausea/vomiting. Caution: May very rarely cause seizures or raise serotonin too high when combined with antidepressants. Topical Treatments ___ 215.* Arizona Pain Formula Cream (Rx): Rub a pea size amount onto painful areas 3 times a day as needed. You can use this on up to 3 or 4 "silver dollar" sized areas at a time. Use ITC Compounding Pharmacy by mail (303-663-4224). ___ 216.* Lidocaine Patches (Rx, lidoderm): Can be cut into pieces to put over different areas. Leave the patch on for 12-18 hours then off the rest of the day. It can help localized pain (i.e., it helps pain that is right under the patch).Up to 4 patches can be used at a time each day. It can take 2-3 weeks to see if it works. NSAIDs ___ 217. Daypro (Rx): 600 mg - 2 each morning as needed. Aspirin family medications can cause stomach bleeding. Take with an antacid or food if it upsets your stomach. If gastritis persists, stop the medicine or lower the dose. If you have a black stool (and are not taking iron tablets or Pepto Bismol), this may represent a life threatening stomach bleed (the stool will often have a very foul smell). If this occurs, go to the Emergency Room immediately. ___ 218. Voltaren (Rx): _____ mg _____ times a day as needed. Aspirin family medications can cause stomach bleeding. Take with an antacid or food if it upsets your stomach. If gastritis persists, stop the medicine or lower the dose. If you have a black stool (and are not taking iron tablets or Pepto Bismol), this may represent a life threatening stomach bleed (the stool will often have a very foul smell). If this occurs, go to the emergency room immediately. COX-2 Inhibitors ___ 219A.* Celebrex (Rx, celecoxib): 100 to 200 mg 1 to 2 times a day for pain. Do not take if you're allergic to sulfa or Aspirin (e.g. hives). Do not use over the 200 mg a day while on Sporanox or Diflucan. FlexAgility (#112B) is a natural form and is safer. GABA Agonists ___ 220A.** Lyrica (Rx, pregabalin): 100 mg 2-3x day. After 2-4 weeks can increase to a maximum of 200 mg 3x day. Helpful for pain, increasing deep sleep, and restless legs syndrome. The main side effects are dizziness and drowsiness, which tend to decrease over time, and weight gain (in ~ 2-4% of those taking up to 300 mg/day. It is more common with higher doses). If too sedating, take the entire dose at night (up to 250 mg). ___ 220B. Gabitril (Rx): 2-4 mg twice a day and increase by a maximum 4 milligrams daily, each 3-7 days to a maximum of 24 mg a day. Helps both pain and deep sleep. The main side effects are sedation, dizziness and gastric upset. ___ 220C. Neurontin (Rx, gabapentin): ____mg ____ times a day (to a maximum of 3600 mg a day). Cut back and increase by 100 mg a day each 4-5 days if it causes any uncomfortable or unusual neurologic symptoms or excessive sedation. Begin with 100-300 mg at night, slowly increase to 300-900 mg 3 times a day as is comfortable. In some, pain relief is immediate, in others, it can take a minimum of 1200 mg a day. You can go up to 3600 mg a day. Muscle Relaxants ___ 221. Flexeril (Rx, cyclobenzaprine): 10 mg - ½ to 2 at bedtime. Muscle relaxant - can cause dry mouth. ___ 222.* Skelaxin (Rx, metaxolone): 400 mg 1-2 tablets 4 times a day as needed for pain. This is usually non-sedating. ___ 223. Baclofen (Rx): 10 to 20 mg 1 to 3 times a day (sedating). ___ 224. Norflex Tablets (Rx): 1 tablet twice a day. ___ 225. Dantrium (Rx): (25 mg) For muscle spasm take 1 a day for 1 week. Then one 3 times a day for 1 week, then 2 tablets 3 times a day for 1 week then 100 mg 3 times a day. Adjust to the lowest dose that feels the best. Stop or lower dose if severe diarrhea occurs. Check liver blood tests (#271) at 6, 12 and 24 weeks and then each 1 to 6 months to make sure there is no liver inflammation. ___ 226. Robaxin (Rx, methocarbimol): 750 mg - 1 to 2 capsules 3 to 4 times a day as needed for pain (sedating). Antidepressants Antidepressants can be very helpful in alleviating pain even you are not depressed! Do not presume that your pain specialist thinks that you have a psychological problem if you're offered an antidepressant. Tricyclic antidepressants (e.g. Elavil/amitriptyline, doxepin, etc.) can be dramatically beneficial (even at very low doses) for neuropathic pain. They also improve the sleep problems caused by the pain. SSRI antidepressants such as Prozac, Effexor, and Celexa can also be highly effective for pain. These medications raise serotonin, which lower levels of a major pain messenger (substance P). Tricyclics ___ 227A. Elavil (Rx, amitriptyline): 10 mg- ½ to 5 tablets at bedtime. May cause weight gain or dry mouth. Good for nerve pain and vulvadynia. ___ 227B.* Desipramine (norpramin - use 25-150 mg at bedtime) or ____nortriptyline (Pamelor - 10-25 mg at bedtime) cause less sedation and other side effects than Elavil, and may be as effective. If sedation is still a problem, consider switching to doxepin 10-40 mg at bedtime. ___ 227C.* Doxepin (Rx, Sinequan): 5-10 mg, 1-3 capsules at bedtime or Doxepin liquid 10 mg/cc. If a lower dose is needed you can start with 1-3 drops at night. A powerful antihistamine. Some people get the greatest benefit with the least next-day sedation with a dose of less than 5 mg a night. SSRIs ___ 228A. Effexor (Rx, venlafaxine): 37½ mg _____ tablets - _____ times a day. ___ 228B. Prozac (Rx, fluoxetine): 20 mg - _____ capsule(s) each morning. Begin with 10 mg a day the first week if the full dose makes you hyper. ___ 228C. Celexa (Rx): 20 mg ____ tablet(s) a day ___ 229. Cymbalta (duloxetine): a norepinephrine and serotonin reuptake inhibitor. It has fewer side effects and does not cause weight gain. It has been shown to be very helpful in treating FMS pain. Alpha 2 Adrenergic Agonists ___ 230A.* Zanaflex (Rx, tizanidine): 4 mg - Take with food - ½ to 2 tablets 1-2 times a day as needed for spasm and/or pain (sedating). Begin with 2-4 mg at night. If side effects occur raise dose more slowly, increasing by 2 mg at bedtime each 4 nights until you are on 8-12 mg at bedtime. Stop if it causes nightmares. ___ 230B. Catapres TTS 1 Patch (Rx): Wear 1-3 at a time and change patch weekly. Related to Zanaflex but cheaper and lowers blood pressure more. Helps pain and raises growth hormone. NMDA ReceptorAntagonists ___ 231.* Klonopin (Rx, clonazepam): ½ mg - begin slowly and work your way up as sedation allows. Begin with ½ tablet at bedtime increasing to 1-2 mg 3x day as needed. Can be very effective for sleep, pain and anxiety (it is in the valium family). Klonopin may be addictive. Taking one quarter to one half tablets in the morning (not more) can actually decrease brain fog in some pain patients. ___ 232. Dextromethorphan (Rx, DM): 25 mg - 2 times a day if on narcotics (e.g. codeine/Vicodin) makes the narcotic more effective and less likely to lose effectiveness. ___ 233. Amantadine (Rx): 100 mg 1-3 tablets each morning may help nerve pain and also is an antiviral. The most common side effects include visual blurring, dizziness, and nausea. Other Medications ___ 234. Keppra (Rx): Is another new anti-seizure medication that we are just starting to explore which has been effective when other treatments have not helped. The dose is 250 to 1500 mg twice daily. Can help "burning pain". ___ 235. Topamax (Rx, topiramate): Begin with 25-50 milligrams daily, and increase it by 25-50 milligrams a week until you get the desired effect. This medication is usually given twice a day at a total daily dose of 50-100 milligrams/day for migraines and 200-300 milligrams a day for nerve pain, although lower doses can be effective. This is a medication that I have seen work wonderfully in patients who failed numerous other treatments and sometimes starts working within a few days. If you get side effects, decrease the dose and perhaps later increase it more slowly until you get the desired effect. The most common side effects are diarrhea, loss of appetite, sedation, and nausea. The nausea will often go away after one has been on the Topamax for three months. It also has the benefit of causing weight loss as well as pain relief. Besides sedation, its most worrisome albeit unusual side effect is that it can make your body very acidic- to the point where it is dangerous. Because of this, it is reasonable to check a blood bicarbonate level every so often (especially if you start developing symptoms such as fatigue) to make sure that it is over 17. ___ 236. Benadryl: 25+ milligrams 3-4 times daily can often markedly decrease pain (worth trying). ___ 237. Lamictal (Rx, lamotrigine): 25 mg - 1 at bedtime for 1 week. Can then increase to 1 three times a day for 1 week. You can go as high as 100 mg 4 times a day. Although rare, it can cause a rash that, if you stay on the medication, can be fatal. Although most rashes would not be this, to be on the safe side. STOP LAMICTAL AT FIRST SIGN OF ANY RASH! ___ 238. Trileptal (Rx): 150 mg twice a day. Can go as high as 600 mg 2 times a day. ___ 240. Mirapex (Rx, pramipexole): ¼ mg - begin with 1 a night and increase by 1 tablet weekly as needed to a maximum of 6 mg. In one study it resulted in a 50% reduction in pain after 2 months at an average dose of 4.5 mg at bedtime. If stomach pain occurs, Nexium or similar medications are used during the first month. If restless leg syndrome worsens, Klonopin is also added at bedtime. Both of these side effects generally go away as the dose is increased. ___ 241. Risperdal (Rx, risperidone): ¼ mg to 1½ mg a day (not more). Begin with ¼ mg and increase by ¼ mg each 6 weeks. Going above optimal dose will cancel out the effect. Takes 2 weeks to work. Blocks Serotonin (not dopamine at this low dose). Helps pain, anxiety and sleep. Acetylcholine Raisers___ 242. Aricept (Rx, Donepezil): 5 mg in the AM (or 2½ mg AM and noon) to a maximum of 20 mg a day. Central acetylcholinesterase inhibitor - decreases both pain and opiate induced fatigue by 50% in cancer patients. Effects begin within 1 week. Rotate with #108C (Galanthamine) if tolerance occurs. Cannabinoids ___ 243. Marinol (Rx): 5 mg capsules 1-2 twice a day. As this is a THC extract it may cause sedation and increased appetite. For Opiate Side Effects___ 244. Constipation is common: (see #180-6). In addition, opiates can lower testosterone and this should be checked for and treated if loss of libido occurs. They can also cause B2 vitamin deficiencies, so be sure to take the B-complex (see treatment # 1). Provigil (#158) and Aricept (see #242) can also decrease opiate induced fatigue. I.V. Treatments___ 245. Lidocaine Intravenously (I.V) (Rx): _____mg (_____mg 1st dose) I.V. each 3 to 20 days as needed. Give 75 mg IV over 10-15 minutes, followed by up to 120 mg per hour (total dose 200-400 mg). Take with I.V. Myers - see #152. For the first dose, give 60 mg over ½ hour first and only continue if blood pressure is stable. For Interstitial Cystitis ___ 246. Elmiron (Rx): 100 mg 3x day is reasonable to try. It may take 3 months to work. Take with water at least 1 hour before or 2 hours after eating. ___ 247. MSM (Methyl Sulfonyl Methane): at a dose of 6-18 grams a day can mimic the effect of DMSO and may be helpful as well. ___ 248. Some practitioners have found that patients with interstitial cystitis often have chronic very alkaline urine. This can be aggravated by excessive coffee and cola intake. PH strip paper can be obtained cheaply at most pharmacies and one can test multiple urine samples at home to see if the pH is regularly over 7.0. Also take the enzyme product URT (enzyme product No. 24) 4 capsules five times a day between meals. During flares add the enzyme product called "kidney" two capsules every 20 minutes as needed. In two to four weeks the symptoms may subside and the products can then be taken just as needed. (Available from our office at 410-573-5389). ___ 249. L-arginine: 500 mg 3 times a day for 3 months ___ 250. Saw Palmetto: 160 mg twice a day for six weeks. If it helps, continue as needed. Goldstein Protocol Treatments ___ 251. Nimotop (Rx, Nimodipine): 30 mg 1 to 4 times a day as is beneficial for symptoms. ___ 252. Naphzoline .1% Eye Drops (Rx): 1 drop in each eye 3 to 4 times a day as needed for symptoms. ___ 253. TRH Eye Drops (Rx): 500 units in 9 cc artificial tears - 1 drop in each eye 3 to 4 times a day as is helpful. ___ 254. Tasmar (Rx, talcopone): 100 mg twice a day. Use if it helps mental clarity and energy. Heartburn, Indigestion or RefluxFor detailed information on getting off acid blockers, see Eliminating Chronic Acid Reflux & Indigestion. Using chronic acid blockers (e.g. Prilosec) is a poor long-term solution for these problems, as it worsens digestion and your defense against bowel infections. Use the treatment(s) checked off below. After 1 month you can stop your prescription acid blocker and switch to Tagamet (cimetidine - over-the-counter), up to 400 mg 3 times a day as needed, then taper off the Tagamet as able. Use #2 - Complete Gest Digestive Enzymes as well and sip warm liquids with meals instead of cold water (digestive enzymes work poorly at cold temperatures). Taking a minute to relax before eating and chewing your food will also help digestion. Coffee (including decaf), colas, Aspirin and/or alcohol can markedly worsen indigestion and reflux. ___ 255. Mastic Gum: 500 mg 2 capsules twice a day for 2 months - then as needed. ___ 256. Heartburn Free (Enzymatic Therapies): 1 every other day for 20 days (may initially aggravate reflux). ___ 257. Rhizinate (DGL Licorice): 380 mg (not the sugar free one). Chew 2 tablets 20 minutes before meals, from Enzymatic Therapies/Integrative Therapeutics. ___ 258. Saventaro Cat's Claw - 1 twice a day. Follow Up Testing ___ 259. Stool O&P (ova & parasite) at The Institute Of Parasitology in Arizona in _____ week(s). Call 480-767- 2522 to get a kit. ___ 260. Stool O&P plus cultures, and sensitivity - must be sent to Genova Labs (800-522-4762). ___ 261. Sleep apnea study (get insurance pre-authorization - it costs $2000. Be sure they also check for UARS-Upper Airway Resistance Syndrome). OR videotape yourself while sleeping to see of you snore and stop breathing or if your legs jump at night (This will not screen for UARS, but you are unlikely to have UARS if you do not snore). ___ 262. Blood Ammonia level if Brain Fog is severe. ___ 263. Elisa Act Technologies: The only one I would use - many others are very unreliable. ___ 264. DHEA: Sulphate level in _____ weeks (not DHEA level). ___ 265. Free T4 level in _____ weeks. ___ 266. ANTI TPO (Thyroperoxidase) level to look for Hashimoto's Thyroiditis. ___ 267. Potassium level in _____ weeks. ___ 268. Lithium level. ___ 269. Free testosterone level in _____ weeks. ___ 270. Prolactin level in _____ weeks. ___ 271. ALT, AST: in _____ weeks (liver tests - if taking Sporanox or Diflucan for more than 3 months, check every 6 to 12 weeks). ___ 272. HHV-6, CMV, and EBV PCR Testing. Call MDL for instructions at 877-269-0090. ___ 273. CFIDS Coagulation Blood Profile - must send to Hemex Labs (800-999-2568) (ISAC panel for CFS/FM = FIB, F1 & 2:T/AT, SFM, PA score - $335). ___ 274. Hereditary Thrombotic Panel - at Hemex Labs. ___ 275. Blood test for Mycoplasma & Chlamydia (General Screens). Call MDL for instructions at 877-269-0090. ___ 276. Platelet Count and P.T.T. Blood Test: Each 4 days for 3-4 weeks then 3 months while on Heparin. ___ 277. Dexa Scan for Osteoporosis. ___ 278. MRI of _____ head; _____ neck ___ 279. Blood Test (Elisa-Act) at Elisa/Act Biotechnologies (800-553-5472). We consider this the best lab for food allergies. ___ 280. 24-Hour Urine Kit: Be off all non-prescription treatments for 24 hours before and the 24 hours during the urine collection. Follow directions that come with the kit. Tests to see what enzymes are most likely to help you. ___ 281. Do vision test at www.chronicneurotoxins.com. Although approximately ½ of CFS/FMS patients test positive on the test, I found that approximately ½ of the healthy people that take the test also flunk the test. If test is positive, consider Questran treatment (#164). If you are going to do this treatment see the Neurotoxin Information Sheet, Vitamin C Flush and Alkaline Way Diet articles on our web site at www.Vitality101.com. ___ 282. Transglutaminase antibody blood tests for celiac disease. ___ 283. Urine Pyrroles @ Bio Center Lab 800-494-7785. If elevated, Rx Vit B6 1000 mg/day & Zinc ~ |
AuthorI have lived with ME/CFS for fourteen years, nine of them totally bed-bound. I post about ME/CFS and related health and advocacy issues such as vaccination, EMFs, radiation and GM foods from the perspective of a holistic practitioner interested in healing our bodies, relationships, societies and mother Earth. My approach integrates science and spirit and includes the best of alternative and allopathc healing modalities and research. Archives
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