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Chronic Fatigue Syndrome & Fibromyalgia are Real!

by Dr. Jill Pitcher

Chronic fatigue, and it’s painful counterpart fibromyalgia, are real disorders that cause physiologic changes in the body and that can be effectively helped by an integrated approach to treatment. They are steadily becoming a recognized disorder after having historically been down played or ignored by many doctors. The difficulty in gaining this recognition is due to the lack of ability to objectively identify a reproducible cause of all the varied symptoms associated with it. Western medicine has a need for a test that proves the existence of any particular disease or disorder to validate it. Despite this barrier to recognition, the Center for Disease Control did formally recognize Chronic Fatigue Syndrome in November of 2006. They defined it as:

Persistent or relapsing fatigue lasting 6 months or longer and not alleviated by rest that has no other discovered cause

The fatigue results in substantial reduction of prior levels of activity

professionally or personally

Four or more of the following symptoms:

1. Sore throat

2. Tender lymph nodes

3. Muscle pain

4. Multi-joint pain without swelling or redness

5. Headaches

6. Un-refreshing sleep

7. Pain and/or fatigue lasting more than 24 hours after exertion

8. Impaired memory or cognition that results in substantial reduction of activity

Fibromyalgia is defined as wide spread pain lasting at least 3 months, significant pain located in at least 11 of 18 defined tender points on the body, constant exhaustion, constant or intermittent flu like symptoms, cognitive impairment often called “brain fog”.

Evidence is growing that supports a central brain dysfunction that upsets the communication process with the rest of the body resulting in disorders or malfunction in several key areas. These areas include sleep, the immune system, the gastrointestinal system, the energy producing mitochondrial cells and hormone balance. Nutritional insufficiencies and testing along with symptoms indicating potential chronic infections are frequently found as a result. This central dysfunction can be triggered by a particular event such as a severe infection, accident, head trauma, pregnancy, or a severe stressor in life. It can also be triggered by a length of time with multiple events essentially adding up to overcome an individual’s ability to keep all the complex systems of the body in correct balance.

An approach addressing the major areas of dysfunction can result in dramatic improvement. Nutritional issues occur often due to both long term diet choices and gastrointestinal absorption problems. Comprehensive vitamin and essential fatty acid replacement is the cornerstone of treatment. Vitamin choices must provide for replacing key nutrients the body uses and needs in times of increased stress and pain in a form that will be the most easily absorbed. Essential fatty acids often in the form of fish oil provide building blocks for cells we cannot make ourselves and act as important anti-inflammatories. IV vitamins have been used for many years to rapidly treat nutrient insuffiencies having the advantage of avoiding absorption issues and the ability to use doses that can be very helpful clinically but impossible if taken by mouth.

Another critical dysfunction is found within the mitochondrial cells. These cells are found often by the hundreds inside virtually every cell in the body. Their sole purpose is to be an assembly line for the molecule that supplies the energy to run all the functions that cell has. If this function is compromised, the cell becomes tired and does not function effectively, and eventually the tissue or organ cannot as well.

D-Ribose is a sugar that has recently been discovered to be a very important part of this production line. It is also used in large quantities in our DNA. Other key elements have been found and are continuing to be discovered as insufficient in this process. Replacing these elements can provide a very significant benefit for both chronic fatigue and fibromyalgia.

Sleep is one of the most rapidly advancing aspects of medical research and clinical knowledge occurring at this time. It is often seen as the initial dysfunction in the brain that can lead the cascade of other problems and becomes a critical area to correct. While doctors have several tools to help people with consistent sleep problems, the understanding of the serious medical conditions that can result from chronic lack of quality sleep and the training of the use of these tools is inadequate. Using prescription medication, herbal and nutrient approaches has proven very helpful in overcoming this complex disorder. Sleep is often also integrally involved in dysfunctions in the nutrient and hormone system making corrections here necessary early in the treatment.

Hormone problems often seen include the thyroid, adrenal and reproductive systems as well as more specific hormones including pregnenolone, DHEA and growth hormone. Issues these hormones help with include energy, reproductive problems, cognitive issues often known as “brain fog”, sleep and high cholesterol. Growing understanding of how each contributes to helping the symptoms associated with both fatigue and fibromyalgia have provided guidance in evaluation of levels and efforts needed to help balance them correctly. The use of bio-identical compounds has further improved the ability of knowledgeable physicians to replace and balance especially those hormones that require tight dosing and those unavailable by regular prescription at all.

Exercise is an often misunderstood aspect of fatigue. Typically, the body’s response to exercise will be an improvement in sleep quality, daytime alertness, strength and stamina.

When the body’s systems are not prepared to respond to the stress of activity or exercise as is the case in chronic fatigue and fibromyalgia, it only further drains its ability to recover from the stress at all. Taxing the muscle and organ systems by just “pushing through it” as is often recommended only digs the hole deeper making it more difficult and longer to recover at all. The worsening of symptoms associated with this is called post-exertional fatigue and can often last several days. Aiming at only attempting activity for the day that approaches 75-80% of what you think you could do will avoid this worsened fatigue and pain it produces.

An area of great importance is the potential for chronic infections becoming intermittently more active but which may contribute to the daily symptoms of fatigue and pain. This is a more controversial issue due to the lack of specific testing that can prove who has a lingering viral or bacterial infection that could be helped by proper treatment.

There are reliable clinical findings and clues in a detailed history that help predict who may benefit from an approach to treatment that will focus on these possible infections.

Chronic fatigue and fibromyalgia are real, debilitating, difficult conditions. An approach integrating nutrients, hormones, sleep management, appropriate activity and possibly treatment for chronic infections can provide a way to navigate out of the debilitating results it can cause.

Jill Pitcher, DO, Fibromyalgia & Fatigue Center of Denver Clinic JPitcher@fibroandfatigue.com

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