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Dr. Paul Cheney’s Treatment Pyramid for Chronic Fatigue Syndrome (CFIDS)

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By Dr. Paul Cheney • • March 10, 2000

This is a treatment pyramid. The bottom is the most important: Limit setting. These [CFIDS] patients are very susceptible to push-crash phenomena and they need to learn to stay within certain boundaries. To the extent they do that, they tend to do better. To the extent they don’t do that, they will not do well.

Elimination diet. The more I get into the issue of diet and food sensitivities, it’s obvious to me that the single most common antigen to which we are exposed is food proteins. …Elimination diets, and improving digestion and gut epithelial function can pay huge dividends…I’ve seen people in 30 days have huge clinical responses simply by this very simplest of moves.

Rebound exercise. It’s very easy, it’s non-weight bearing, it does a very important job I think in autonomic tone in a population that has difficulty with exercise. The most important thing…is to not have them do aerobic exercise. I even believe progressive aerobic exercise, especially in Phase 1 disease—is counter-productive.

Stress management. They have a defect in the HPA axis, in response to stress, so they have to be stress limited. The need to learn how to handle stress better, …there’s all kinds of ways to do that.

Belief systems. A change in orientation from “doing” as a definition of themselves to “being” as the definition of themselves. And to orient from recovery to healing. As soon as they orient toward “being” and healing, interestingly they are far better able to “do,” and I think far better able to heal—and recover.

Magnesium is an important element. They are magnesium depleted.

Klonopin is my most effective drug over the years. We use very low doses in the daytime. And at night we use higher doses.

Doxepin elixir. An antidepressant with POTENT anti-histaminic properties. I suspect that this is the most powerful antihistamine known to man and it gets into the central nervous system. We use very small amounts of this. [Also] small doses at night.

Taurine. Taurine is very important in brain protection.

Neurontin. We’ve been using Neurontin sparingly. Neurontin could be a very potent weapon in resistant cases, but I’m a little bit concerned about the extremely high doses that are being used in some patients.

Mitochondrial DNA protection. We use a mix of things—multi-vitamin chelated mineral complex.

Plant bioflavonoids are very important. Examples of plant bioflavonoids are proanthocyanadins, pycnogenol®, silymarin, quercetin, and there are many others..

CoQ10 is a critical item in protection of the DNA. I think the more the better, but realistically 200 mg. We tend to use it crunched under the tongue…since it’s not very well absorbed, although there are other absorbable forms that can be swallowed.

Lipoic acid may be one of the most important of all of these, in high doses, particularly for the central nervous system.

Extra vitamin E because they’re vitamin E depleted.

And melatonin may be helpful also. It’s a potent antioxidant in the brain, particularly.

Detoxification. In chronic fatigue syndrome patients, two thirds of them have no detectable B-12 in their brains, even though their blood levels are normal. We use high doses. We prefer hydroxycobalamin, and perhaps methylcobalamin.

Root canal extraction, and particularly careful regarding bone excavation—this could be a big issue in some people. Heavy metal issues could be very prominent in some people.

Chemical detoxification—some of these people are loaded with all kinds of pesticides and things and they may need to be detoxified ultimately to see success.

The “3-R” program to bring back gut ecology. Remove the bad guys; support and repair the epithelial integrity, and then replace with friendlies.

Liver-gut resuscitation. Again, the undenatured whey protein concentrate, I think, is the most important element. Silymarin, to recycle glutathione between it’s reduced and oxidized states.

This pyramid is an integrated program. No one element suffices—it’s everything working together. It’s a stepwise program, meaning you move up the scale every one or two weeks. You don’t start it all at once. Patience is required.”

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