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Dr. Jacob Teitelbaum on Hormonal Issues in Chronic Fatigue Syndrome and Fibromyalgia

  [ 1086 votes ]   [ Discuss This Article ] • February 20, 2006

By Jacob Teitelbaum, M.D. In previous newsletters, we've talked about how chronic fatigue syndrome and fibromyalgia represent an energy crisis in the body. If you're not able to make enough energy relative to the demands being put on your system, the areas that use the most energy go off-line first. We use the model of a circuit breaker in a house. “If the energy demands on your body are more than it can meet, your body “blows a fuse”. The ensuing fatigue forces the person to use less energy, protecting them from harm. On the other hand, although a circuit breaker may protect the circuitry in the home, it does little good if you do not know how to turn it back on or that it even exists.” This analogy actually reflects what occurs. In addition, the next most energy demanding area in your body would be your muscles. When they do not have the energy they need, they get stuck in the shortened position, similar to what is seen in rigor mortis. This results in chronic widespread pain. Therefore, restoring adequate energy production and eliminating the stresses that over-utilize energy (e.g., infections, situational stresses, etc), restores function in the hypothalamic “circuit breaker” and also allows muscles to release-allowing pain to resolve. Our placebo controlled study showed that when this is done, 91% of patients improve, with an average 90% improvement in quality of life, and the majority of patients no longer qualified as having FMS by the end of three months(see our published studies at We have talked about how restoring energy and turning your circuit breaker back on requires four key areas that we call the “SHIN Protocol”. This stands for: S-sleep
H-hormonal support
I-infections and
N-nutritional support. We have talked about sleep and nutritional support in previous newsletters. We will now begin to review how hormonal deficiencies – despite normal blood tests – can cause major problems with energy production and trigger symptoms. In this and upcoming newsletters we will discuss how inadequate thyroid, adrenal, and ovarian/testicular function plays a role in CFS/fibromyalgia, why blood tests are unreliable in determining the need for hormonal support, how to determine what treatments you need, and what you need to do to get well. We will also talk about how hormonal and other problems seen in CFS/fibromyalgia contribute to anxiety, depression, and the average 32 lb. weight gain that these patients experience. More importantly, we will tell you how to feel great as well as how lose this weight! Let’s start with blood testing for hormonal problems, why they are unreliable, and how to use them properly by interpreting them in combination with your clinical symptoms. Why do CFS/FMS patients have hormonal deficiencies? As the pituitary controls the body's hormonal systems and is controlled by the hypothalamus, widespread subtle but important hormonal deficiencies are more the rule than the exception in these syndromes. Other sources of imbalance include adrenal exhaustion from chronic stress, environmental toxins, and autoimmune processes such as Hashimoto’s Thyroiditis. But the hormonal blood tests are usually normal. This is true, but normal and healthy are not the same thing. To explore this critical concept further, let’s look at thyroid blood testing as an example. The problem with thyroid tests Many blood tests use two standard deviations to define blood test norms. By definition, only the lowest or highest 2.5 % of the population is in the abnormal (treatment) range. This does not work well if over 2.5 % of the population has a problem. For example, it is estimated that as many as 20% of women over 60 are hypothyroid. Other tests use late signs of deficiency such as anemia for iron or B12 levels to define an abnormal lab value. The goal in CFS/FMS management is to restore optimal function while keeping labs in the normal range for safety. One way to convey the difference between the “normal” range based on 2 standard deviations and the optimal range which you would maintain if you did not have CFS/FMS is as follows. “Pretend your lab test uses 2 standard deviations to diagnose a “shoe problem”. If you accidentally put on someone else’s shoes and had on a size 12 when you wore a size 5, the normal range derived from 2 standard deviations (~95% of people have a shoe size between say 5 and 13) would indicate you had absolutely no problem. You would insist the shoes did not fit although your shoe size would be in the normal range. Similarly, if you lost your shoes, the doctor would pick any shoes out of the “normal range pile” and expect them to fit you.” To make matters more difficult, if the thyroid is under active because the hypothalamus is suppressed, the TSH test, which most doctors rely on for thyroid function, is almost useless and may appear to be normal, or even suggest an overactive thyroid in a hypothyroid patient. Fortunately, more doctors are finally starting to catch on. In two studies done by Dr. G.R. Skinner and his associates in the United Kingdom, patients who were felt to have hypothyroidism because of their symptoms had their blood levels of thyroid hormone checked. The vast majority of them had technically normal thyroid blood tests. Dr. Skinner then did another study in which the patients with normal blood tests who had symptoms of an underactive thyroid were treated with thyroid hormone. A remarkable thing happened when this was done (well, maybe we’re not surprised!). The large majority of patients, despite being considered to have a normal thyroid on blood testing, had their symptoms improve upon taking thyroid hormone. These two studies, plus another one showing that thyroid blood tests are only low in about 3 percent of patients whose doctors sent blood tests in (and this is at an HMO—where the doctor really suspected that the patient had thyroid problems!), confirm what we have been saying all along. Our current thyroid testing will miss most patients with an under active thyroid. If you suffer from chronic fatigue, pain, heavy periods, infertility, constipation, easy weight gain, cold intolerance, dry skin, thin hair, or a body temperature that tends to be on the low side of normal, you should consider a therapeutic trial with a low dose of thyroid hormone. Our current blood testing is equally unreliable in determining when patients need adrenal, ovarian, testicular, or growth hormone support. In upcoming issues we will discuss, in-depth, how to diagnose and treat hormonal dysfunction using both prescription and non-prescription natural therapies. Doctors of decades ago were on target when they knew that one has to treat the patient and not the blood test! Dr. Teitelbaum is a board certified internist and director of the Annapolis Center for Effective CFS/Fibromyalgia Therapies. Having suffered with and overcome these illnesses in 1975, he spent the next twenty-five years creating, researching, and teaching about effective therapies. His office is in Annapolis, Maryland (410-573-5389). He is the senior author of the landmark study "Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia -- a Placebo-controlled Study". He lectures internationally. He is also the author of the best-selling book From Fatigued to Fantastic!, Three Steps to Happiness! Healing through Joy, and the recently released Pain Free 1-2-3 -- A Proven Program to Get YOU Pain Free!. His web site can be found at: He accepts no money from any company whose products he recommends and 100% of his royalty for products he makes is donated to charity. (c) Jacob Teitelbaum, M.D. All rights reserved. Reprinted with permission.

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