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

Autonomic Dysfunction

Low blood pressure and dizziness, increased thirst, polyuria, cold extremities, and night sweats axe a few of the symptoms that reflect autonomic dysfunction in CFIDS/FMS. A recent study at John Hopkins Hospital showed that a majority of CFIDS patients had neurally mediated hypotension (NMH) on tilt table testing. (22) This means that CFIDS/FMS patients can severely drop their blood pressure with standing or minimal exertion. If the patient has a low BP or dizziness or a positive tilt table test, a treatment trial is appropriate. I predominantly use clinical history and the poor man's tilt table test" (free instead of $1,800), which consists of having the patient stand and lean against the wall for ten minutes. If this aggravates symptoms, the test is positive. Treatment consists of markedly increasing salt and water intake. Treating adrenal insufficiency as discussed above is also helpful. For those familiar with applied kinesiology, using Autonomic Response Testing (developed by Dr. D Klinghardt) and other protocols can also be helpful. The medications Fluoxetine (Prozac), sertraline (Zoloft), ephedrine (not pseudoephedrine), and dextroamphetamine (Dexedrine) are also effective in treating NMH in CFIDS patients. I rarely use Florinef in anyone over eighteen years old.

Immune Dysfunction and infections

Although not as severe as AIDS, and not progressive, marked immune dysfunction is part of the process (CFIDS stands for chronic fatigue and immune dysfunction syndrome). Because of this, some of the opportunistic infections seen in AIDS are present in CFIDS/FMS. These include yeast overgrowth with secondary chronic sinusitis, bowel infections (with parasites, fungal, and bacterial overgrowth as in AIDS -- often with agents that are nonpathogenic in healthy people), UTIs, and chronic, low-grade prostatitis. These need to be treated.

In my experience, chronic sinusitis responds well to anti-fungals and poorly to antibiotics. Conservative measures (for example, saline nasal rinsing, avoiding milk products, and so on) are also helpful. These are discussed in my book, and are reviewed at length in the wonderful book Sinus Survival written by Dr. Robert Ivker (Tarcher Putnam, 2000). (23) Avoiding antibiotics also decreases the risk of secondary fungal overgrowth in the sinuses and GI tract. Many patients find that a nose spray containing Bactroban, Xylitol, and sporanox can also be very helpful (compounded by Cape Drug by prescription: 410-757-3522)

Bowel infections with alterations of normal bacterial flora, fungal overgrowth, and parasitic infections (parasites are seen in one-sixth of my patients) are the norm in this disease. This is reflected by the patient's bowel symptoms. Because of the lack of a definitive test for yeast overgrowth, I treat for yeast empirically based on the patient's history. Stool testing for all infections by Great Smoky Mountain Labs can also be very helpful.

A history of frequent yeast vaginitis, frequent antibiotic use (especially tetracycline for acne), onchomycosis, chronic sinusitis, or gas, bloating, diarrhea or constipation, in my experience with over 1,000 CFIDS/FMS patients, warrants an empiric therapeutic trial of anti-fungal therapy. Many CFIDS/FMS patients who failed other therapies for spastic colon have responded dramatically to anti-infectious treatments. This was also shown in our 1995 study. (24)