Highly effective treatment of Fibromyalgia and Chronic Fatigue Syndrome—results of a placebo controlled study and how to apply the protocol

Townsend Letter for Doctors and Patients, Oct, 2002 by Jacob Teitelbaum

Treating for fungal infections is critical in most CFS/FMS patients. Natural remedies include:

1. Acidophilus and other probiotics. Unfortunately, many have been found to not maintain their potency when tested. The product made by Enzymatic Therapies has, however been proven to have the labeled potency. Take 3-6 billion units (bacteria) daily -- preferably on an empty stomach.

2. Caprylic acid 650 mg 3 x day.

3. Oregano oil -- Must be enteric coated to avoid reflux

4. Citricidal, Pau D' Arco and lavender oil can also be helpful.

Prescription treatment consists of nystatin, two 500,000-IU tablets po bid or t.i.d. (start slowly) for five months. The patient's symptoms, especially fibromyalgia pain, may flare initially as the yeast die off. Therefore, begin with one 500,000-unit tablet of nystatin once a day and increase by one tablet every one to three days, as tolerated, up to two tablets t.i.d. After four weeks on the nystatin, add 200 mg of fluconazole (Diflucan) or itraconazole (Sporanox) qd for six weeks. Mild liver enzyme elevations are sometimes seen with Diflucan and Sporanox, but taking lipoic acid, 200 mg/d, seems to markedly decrease this side effect. The other major side effect of both Diflucan and Sporanox is the price -- a six-week course can cost more than $600. If symptoms recur after the first six weeks on Diflucan or Sporanox, I recommend repeating the 200 milligrams per day for another six weeks. If no benefit is derived from the first course, I do not recommend repeating it. Have your patient stay on the nystatin f or a total of five to eight months. I recommend patients be on nystatin while they are taking Sporanox or Diflucan to avoid development of resistant organisms.

Parasitic infections, often with "nonpathogenic" or normally self-limiting organisms (again, as seen in AIDS patients) are common. Stool samples can be sent to your local lab for antigenic and chemical testing for giardia, cryptosporidium, and especially clostridium difficile (which was present in approximately 22% of our CFIDS study patients versus approximately 1% of the healthy populace). The only labs I would use for microscopic O&P (parasite) testing, however, are the Great Smokies Diagnostic Laboratory or the Parasitology Center. Sending the O&P to most other labs is a waste of money. Most labs will often report stool O&P's as being negative, even if parasites are present. If the patient has any parasites (even if nonpathogenic) treat them. If he or she uses well water, I would recommend a water filter that eliminates parasites (most do not) such as the Multi-Pure filter.

In patients with low-grade fevers (anything over 98.6[degrees]F in CFIDS/FMS patients), occult infections (for example, Chlamydia and mycoplasma incognitus) are being found. Empiric therapy with doxycycline 100mg bid for six months to two years (while on nystatin) can be very helpful. Recent research is showing that HHV-6, CMV, and EBV are also commonly active in CFIDS/FMS. Natural therapies with olive leaf 500-2000 mg 3-4 x day may be helpful as is immune stimulation with Thymic Protein A (Pro Boost). The latter is a wonderful product and is my favorite way to stimulate thymic immune function. In my experience, it knocks out most acute infections within 24 hours!