Dr. Dale Guyer, MD, is a family physician and the Director of The Advanced Medical Center located in Indianapolis, Indiana,* where patients are offered a unique blend of traditional and integrative therapies for a number of health-related issues, with a focus on ME-CFS and FM.
In the following Q&A with ImmuneSupport.com, Dr. Guyer explains his holistic, evidence-based approach to testing and treatment - which involves use of selected pharmaceutical drugs as an additive to appropriate nutritional support and other measures "to normalize a complex internal bio-chemical milieu."
Question: Dr. Guyer, do you see many patients with Chronic Fatigue Syndrome and Fibromyalgia?
Dr. Guyer: Yes, I have seen probably several hundred patients who have been given this diagnostic category.
Q: How do you go about treating a patient with a weakened immune system?
Dr. Guyer: Generally, these individuals require a detailed laboratory analysis to evaluate what components of their immune system are out of balance. For example many individuals have depleted Natural Killer Cell Function and imbalances in the TH1 and the TH2 immune responses. Additionally I like to see a baseline analysis for RNase-L, apoptosis, 2-5A-Synthetase, alpha-interferon, and associated lab work to get a more complete picture.
Ultimately, strategies to improve immune system function would include anything that supports overall body health. An essential focus, in my experience, is to identify chronic infections and work to reduce immune burden - either with nutraceutical or anti-infective medication as clinically warranted.
I also rely heavily on natural immune modulators such as transfer factor, probiotics,** and immune supporting herbals.
Q: What are the most effective treatments you have found for supporting and strengthening the immune system?
Dr. Guyer: After the evaluation from a laboratory analysis I can determine what areas of weakness or imbalance lie within the immune system, and an appropriate treatment regimen is then detailed. Sometimes prescription medicines, such as TagametR and/or the opiate-blocking drug naltrexone are useful adjunctive therapies.
Q: If a patient’s primary complaint is devastating fatigue, what test do you perform to try to determine the cause?
Dr. Guyer: This is certainly a broad question and a common focus, as most [CFS and FM] patients fit this category. Unfortunately, there are no simplistic answers. Almost always in these cases there is a complex interplay of many causative factors - in terms of:
n Chronic infections which could be fungal, bacterial, viral, even parasitic,
n Toxin exposure such as mercury, cadmium, aluminum, and lead,
n Digestive dysfunction and poor absorption,
n Coagulation abnormalities,
n Metabolism abnormalities,
n Immune system dysfunction,
n Food allergies,
n And significant endocrine or hormonal abnormalities - especially for thyroid, adrenal, testosterone, DHEA [a type of hormone produced primarily by the adrenal glands] and growth hormone.
Therefore, selectively from the patient history and past medical record, I am able to take that information and determine which types of tests would be most appropriate for the individual, and then from those results determine an appropriate treatment course.
Q: What might a comprehensive treatment program include for a patient whose main symptoms are those typical of Chronic Fatigue Syndrome?
Dr. Guyer: In a general sense that would depend, of course, on the laboratory analysis [so that] the physician - myself in this case - would know specifically what types of problems we are dealing with.
n As indicated above, the CFS patients I have seen almost always have immune dysfunction.
n In addition, most are nutritionally depleted, so we often utilize intravenous vitamin therapies for replacement, adjunctively adding in Vitamin B12 shots of which we use a special formulation with high dose Hydroxycobalamin that includes Glutathione to help with the body’s energy reserves. For more recalcitrant cases, I will utilize a special version of vitamin B12 which includes trace minerals, selenium, and potassium-magnesium aspartate in injectable form.
n Also, most of these people will have a sub-clinical low thyroid function and adrenal problems, which need to be addressed pharmaceutically and/or nutritionally.
n They often have detoxification impairments and evidence of heavy metal toxicity.
n They almost always have chronic infections that I treat as noted above,
n And, especially for the Fibromyalgia patients, chronic pain and sleep issues must be dealt with. In that context, I use special topical pharmaceutical preparations that utilize a special gel, which penetrates into painful areas to relieve discomfort and support healing. I also work on reestablishing normal sleep patterns, which can be simple in terms of deficiencies of calcium or magnesium - or hormonal, such as deficiencies of melatonin or thyroid. Some patients respond to a simple therapeutic regimen such as a combination of 5-HTP and tryptophan, which we have formulated for patients by a compounding pharmacy.
Q: How do you feel about treating a patient with heavy metal toxicity?
Dr. Guyer: In my experience, 90 percent of patients with FM and CFS will always have elevated toxic metals, as determined by a provocative challenge test. Most commonly this is mercury, but often other metals such as lead, cadmium, and arsenic can be present as well. Some patients will have many types of metal exposure depending on their functional detoxification efficiency, as well as the historical component of exposure.
In any event, it has been my experience that it is absolutely important to work on the detoxification of heavy metals, and of course, the detoxification of the entire body. In addition, supportive detoxification therapy such as massage therapy and lipoceutical glutathione [L-Glutathione], and intravenous glutathione, high dose vitamin C, and infrared saunas all tend to be selectively and additively helpful.
Q: Where do you think traditional pharmacological interventions fail in patients with CFS and FM? What do you think of antibiotic therapies for such patients?
Dr. Guyer: In general, conventional medicine often fails to recognize CFS and FM. Unfortunately, those patients often get relegated to a category suggesting that all of their problems are purely psychological, which is far from the case.
It does, however, lead the patient to a frustrating position - as few doctors are well-versed in the appropriate treatment of these illnesses. Unfortunately, the few therapies that are provided from a pharmacological basis and conventional medicine are often no more than symptomatic cover ups. In a general sense they are medicines prescribed to ease pain, to improve sleep, and reduce depression; all of which can be helpful, but none of which get to the core of the problem.
As for antidepressants specifically, many of my patients have stated that when their other doctors have put them on antidepressants, it only helps them to “feel better about feeling bad,” but never really improved their functional status.
As for antibiotic therapies for such patients, I have seen those to be dramatically helpful. There are usually subtle clues to delineate which patients are going to benefit most, such as those who tend to have elevated viral antibodies, including the Epstein-Barr virus [Human Herpesvirus-4], HHV6 [Human Herpesvirus-6], and CMV [cytomegalovirus, a member of the herpesvirus family].
Other good candidates are those who obviously have a positive serum analysis on a PCR screen [to detect presence of infectious organisms] for viruses, bacteria, or fungal organisms. The selection of the antibiotics has to be specifically tailored to the individual in terms of tolerance and the nature of the organism being treated. And sometimes the dose needs to be adjusted or varied over time and even changed to different pharmaceutical regimes.
All in all, I have found these therapies [pharmacological] to be very effective additively, not as a stand-alone therapy without appropriate nutritional support and other efforts to normalize a complex internal bio-chemical milieu in order to be totally effective.
Q: What are the main mistakes you have noticed among patients who self-treat with vitamins and supplements?
Dr. Guyer: Generally, the frustrating challenges are that many of the supplements that are available over-the-counter are often of poor quality and the wrong combination. So the patients who have not had the luxury of the clinical training, background, or experience often engage in a hit or miss proposition, and sometimes feel a little better but often times feel worse.
To make the matter more of an insurmountable challenge, most doctors are ill-equipped from an educational standpoint to be able to specifically recommend avenues for the patient to navigate through nutritional supplementation successfully.
Q: Do you have any theories about the causes and development of Chronic Fatigue Syndrome?
Dr. Guyer: I generally feel that the name “Chronic Fatigue Syndrome” is not particularly diagnostically helpful since it just tends to imply that a person is fatigued for a period of several months, and it erodes their ability to live their normal life.
If these patients have sleep disturbance and pain in addition to severe fatigue, they often get lumped into the Fibromyalgia camp. As a diagnostic label it carries meaning, but in terms of describing what is really going on physiologically, it is not of much help.
In my experience, these people who acquired these diagnoses have a complex interplay of many different elements as discussed above, relating to nutritional dysfunction, environmental sensitivities, toxin accumulation, chronic infections, normal human aging issues, excess stress, depleted hormone levels, and of course, the basic genetic structure with which they came into the world which may have areas of weakness that have made them vulnerable, given the right set of circumstances, to the emergence of these symptomatic patterns.
Q: Any additional comments of advice regarding the value of a holistic approach to help in healing?
Dr. Guyer: One particular element of advice would be the Latin phrase ‘caveat emptor’ or “buyer beware.” There seems to be a lot of media hype regarding “fluffy information,” most of which is not particularly helpful to patients. On the other hand, there are enormous amounts of clinical data and very high quality products available that truly do make a profound difference in one’s overall health. So the value of the holistic approach is exceedingly high. Unfortunately, modern medicine in its current state has not yet learned to fully recognize that reality.
However, the medicine of the future will make a more integrated effort to bring into the play the entire body, mind, and spirit connection to facilitate a patient achieving their optimal health potential. That will include elements of psychological services, structural attention through adjustments such as chiropractic and osteopathic techniques, as well as the biochemistry of a nutritionally based doctor who can reestablish the normal internal chemical balance for each individual patient.
Q: What are some of the newer avenues you are finding useful to treat Chronic Fatigue Syndrome in your practice?
Dr. Guyer: In the subset of patients with clinical documentation of chronic viral infection, the selective use of anti-viral agents has emerged as an effective adjunct. While oral agents such as acyclovir, FamvirR and ValtrexR often have good benefit, the recent utilization of ValcyteR [valganciclovir] has been a significant step forward.
To date I have treated about 30 patients with ValcyteR and most have demonstrated very encouraging results. In the future I hope to be able to put this collective data together, as I believe it could be a significant help to others.
* The Advanced Medical Center in Indianapolis, Indiana, was founded in 1997 by Dr. Guyer. New patients are welcome. For more information, including glossaries explaining some of the therapies, nutritionals and tests mentioned, visit [note: the following links are no longer active]. http://www.daleguyermd.com, or call (317) 580-9355. To listen to a detailed lecture on CFIDS/FMS, log onto Dr. Guyer’s website.
** For more information on transfer factor and probiotics, see recent articles in the ImmuneSupport.com Library such as "Transfer Factor and the Importance of a Healthy Immune System" and "What You Should Know About Probiotics and Prebiotics."
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