What It’s Like When Everybody has a Plan in Life Except You

What’s your plan for retirement? Does nothing concrete come to mind? What about in 10 years, or maybe just five? What about tomorrow, or this evening? I admit to drawing a blank in my mind to most of these questions. As someone who lives with chronic illnesses (like ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), fibromyalgia, Lyme disease, and more). Life’s just more unpredictable than it’s already reputed to be.

So what do we do? Everyone has a life plan; isn’t that supposed to be important? It’s easy to spiral down into despair, frustration, and self-loathing when we can’t plan for and reach these standard milestones in life. Everyone seems to be adulting, while it feels like you’re just some helpless kid.

The Frustration of the Unpredictable Life with Chronic Illness

The only steady companion throughout my journey with chronic illness thus far is fear; how can it not be when pain and uncertainty fill your days? It’s natural as human beings to seek out some sort of stability in life. To have a broken boat for a permanent home is stressful. My eyes are always on the horizon watching out for the next storm that I know will come. It’s just a matter of “when.” Surrounding me is a vast expanse of gloomy unknown, with hidden predators lurking beneath.

My life definitely comes with higher chances of unpredictability. Yet the average person’s life can also change in an instant, and sometimes in even bigger ways. As much as I fear the days of my “retirement,” I must say that I’ve made it through life pretty okay so far. I have supportive people to thank for this, but the decisions I’ve made, and the struggles I’ve endured have played a part, too.

Let’s take a look at some ways to cope with an uncertain future.

1. Do Not Become Your Own Biggest Obstacle.

Life has a sense of humor and wisdom beyond feeble mortal reasoning. Dealing with pain is hard enough work as it is without the added stress of over-expectations and self-imposed rules! I find it helpful to redefine my expectations according to my current capacity and not someone else’s, if I am to begin living a fulfilling life at all.

In a bid to remove as many obstacles along my path as possible, I need to be careful of not becoming my own biggest hindrance. It is a constant process of learning how to take down these self-erected barriers of guilt and blame. Padding my shoes with self-care is essential for going further. Life is a marathon, yet I often forget to keep myself hydrated with self-belief. Looking at the lanes to my left and right aren’t helpful either — how does it help with my journey forward?

“There are plenty of difficult obstacles in your path. Don’t allow yourself to become one of them.”

– Ralph Marston

2. There is No Right or Wrong Way to Live Your Own Life.

Another point I’d like to highlight is that there’s more than one way to live your life. There are billions of people on this planet, and every single one of us has variable ideas of what a good life looks like. In fact, you might not even agree with a majority of these views.

Some people call life a journey, some call it a dream, an art, or even a joke. I think it’s a combination of them all; life is what I want it to be. We all have our own balls to juggle no matter who we are. But living with chronic illness is like having more balls to juggle, or doing so with an injured hand. It can be tough but I have to try, and it will get better with practice.

3. There is Magic in the Unknown, Too.

Sometimes, to not know where I’m going to end up can be a pleasant surprise, too. It adds a bit of magic to the journey and spices things up. It can create extraordinary memories that are worth remembering. It also fills the gaping holes of drab routines with the colors of meaning. What I fill these holes with is up to me — there is no right or wrong way to color. But I want to encourage you to take life by the hand and let her lead the way, because she will never lead you astray.

“If you don’t know where you’re going, any road will get you there.”

– Lewis Carroll

“Do not go where the path may lead, go instead where there is no path and leave a trail.”

– Ralph Waldo Emerson

This article was first published on ProHealth.com on November 22, 2017 and was updated on October 21, 2020.

Sheryl runs “A Chronic Voice”, a health, wellness, and chronic illness blog. She had a mini stroke at 14, followed by multiple blood clots, seizures, heart rhythm dysfunctions and surgeries over the years. She also has a gore-tex band in replacement of a heart valve. She shares her experiences in hope that it raises awareness on silent disabilities and to let others know they are not alone in this. You can follow her on social media here:

Facebook: https://www.facebook.com/achronicvoice
Twitter: https://twitter.com/AChVoice
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What Life With Lyme Is Like: America’s Silent Pandemic

Editor’s Note: This article was written primarily to create awareness about chronic Lyme disease, one of the fastest-growing infectious diseases in the United States and Canada, and possibly worldwide. We encourage you to spread the word and share this article, far and wide, to educate others about the dangers of this serious, insidious disease, and the need for improved diagnosis, testing, and treatment. 

Chronic Lyme Disease: America’s Silent Pandemic

Imagine that you awaken every day of your life feeling as though you have the flu. Imagine exhaustion like lead weighing down your limbs, and stabbing, burning, aching pain continually assaulting your joints and muscles. Then imagine that you can no longer focus, think, or remember to do such simple things as read a book or drive a car.  Imagine that you suddenly become allergic to every food and chemical out there and can no longer go out into public places because you’ll get even sicker.  Then, imagine crying for hours, day after day, month after month, year after year, from severe depression and anxiety.  And then, picture another 10-20 symptoms on top of that.

Then, imagine losing your job, home and everything you once loved about your life—because you can no longer function. Imagine being isolated and confined to your house, for years. Imagine no longer being able to go anywhere except an occasional trip to the grocery store, attend gatherings, parties or events, travel or essentially “have a life.”

It might all be tolerable if you knew that it was temporary; if you understood what was happening in your body and that, like the flu, there would be an end to it all in the near future. You might be able to remain hopeful and hang in there if you knew that the pain, fatigue, grief, cognitive problems and the rest, would disappear with time and the right treatments.

But then imagine that it doesn’t all go away, day after day, year after year and nobody knows what’s wrong with you, including you. You go to your doctor and tell him or her what is happening; he or she runs some tests, finds nothing wrong, gives you an antidepressant and tells you to go home and get more exercise, or change your diet. Thus begins your journey, from doctor to doctor, as you do test after test, and spend all of your savings, your 401K and then some, only to get no closer to the real diagnosis.

As you are now unable to work, you run out of money for basic necessities and put your home up for sale. You call on family and friends for help, expecting they might understand your desperate plight. Yet because you haven’t been diagnosed with cancer or some other horrible disease that is widely understood, the doctors don’t know what’s wrong, and (with the exception of some hair or weight loss) you seem to look and act pretty normal—they don’t extend a hand to help.

In fact, many of your loved ones don’t even believe you are that sick. They insinuate that you’re depressed; that you need to exercise or get out more, or just take a pill and get over it. Besides, the doctors have said there’s nothing wrong with you, because you, and your labs, look fantastic. And occasionally, you can go out for a social event; or maybe you are even well enough to get on a plane to visit friends or family in another state. You might even still be managing to work part-time. So what’s the big deal? Many think. Everyone is tired. Everyone hurts. Everyone has bad days…right?

Except you now have a bad day, every day of your life. And your bad days aren’t just about a sore back, tiredness from a sleepless night or a temporary flu. Daily, every organ and system of your body malfunctions and affects basic bodily functions that others take for granted. Things like, being able to breathe, go to the bathroom, or stand up for more than a few minutes at a time. This is in addition to the fatigue, pain and other more obvious symptoms that you have.

Some days are better than others, but symptom-wise, none of your days are great. You seldom, if ever, awaken with energy; pain is your daily companion, as are brain fog and other problems. Other symptoms come and go, and they vary from day to day, or month to month, in their intensity. But they never go away.

Then, finally, one day, you find a doctor who knows what’s wrong with you. He says, “You have Lyme disease.” The diagnosis is a welcome relief from all the uncertainty, but the relief is quickly replaced by dismay, as you find that the road to recovery is longer and harder than you ever dreamed. It involves thousands of dollars, difficult detox reactions, hours of pills and therapies, and more time, energy, money, determination and discipline than you have ever spent on anything else in your entire life. It may be the most difficult trial you have ever faced.

Your doctor tells you that you’ll be on intravenous or oral antibiotics, herbs, vitamins and supplements, hormonal treatments, rabbit food diet, and two dozen other therapies—for anywhere from 2-5 years, although you find that many others in your boat end up doing treatments indefinitely, once they are more functional.

You begin to realize, from the stats, that you may or may not fully heal. The treatments will definitely help you, but you’ll be happy if you recover 70-80%. What nobody tells you at the outset, but what you learn down the road, is that treating Lyme disease will cost you anywhere from $15,000-30,000 per year, or more…for the rest of your life.

Because even if you are fortunate enough to attain remission, you may have to do a lot more than you once did to stay well. You’ll have to take lots of supplements, do detoxification treatments, and other things, just to stay functional. This is because the Lyme disease has damaged your body so that your organs don’t work as well they once used to.

You may heal enough to be able to return to work part-time or full-time, but not enough to maintain much of a social life or a life that includes other things. Yet even though you have less energy to work than before, you have to find a way to make a lot more money than before, because you now have an ongoing health maintenance regimen that chews up a huge chunk of your income. You might have to forget about saving for retirement, buying a new car, or that vacation to Europe. Or, perhaps you will be more blessed, and able to return to the life that you had before…and while this should be everyone’s hope and goal, the reality is that not everyone will get to that place.

You aren’t the only one living this nightmare scenario, but do your friends and family know what you, and so many others, are living? Does your community know? If not, I encourage you to share your story, and the following with them.

First, the Centers for Disease Control (CDC) estimates that there are over 329,000 new cases of Lyme disease every year in the United States alone, although these numbers are likely to be much higher; as much as one million per year, by some researchers’ estimates. This is because this statistic doesn’t account for the unreported and misdiagnosed cases, as well as many other factors. Yet Lyme disease is a worldwide pandemic, but remains improperly diagnosed because it mimics symptoms of other illnesses, such as Parkinson’s, Multiple Sclerosis, chronic fatigue syndrome, fibromyalgia, lupus, arthritis, and many others.

What’s more, conventional tests such as the Western blot and ELISA are unreliable, inaccurate and don’t detect most cases of Lyme.  These tests look for antibodies to Lyme, but many people do not produce antibodies in the later stages of disease. Lab tests have also not yet developed for many species of Borrelia, Babesia, Bartonella, Mycoplasma and other infections involved in Lyme. Instead, sophisticated, outside-the-box testing methods such as Borrelia culture tests, electrodermal screening, dark field microscopy, Applied Kinesiology, PCR tests and others, are needed to detect it but few doctors use these.

Diagnosis is complicated by the fact that most doctors are not taught how to identify chronic Lyme disease and are even taught that it doesn’t exist. Instead, the Infectious Diseases Society of America and the Centers for Disease Control maintain that chronic Lyme disease—the fastest growing infectious disease in the United States, Canada, Australia, Europe and perhaps worldwide—can be cured with just two weeks of antibiotics. Any symptoms that continue after that time are attributed to “Post-Lyme Syndrome”, an imaginary condition created by the medical establishment to explain away the presence of ongoing infection, which they refuse to recognize, despite much evidence to the contrary.

Those doctors who dare to treat it, risk persecution and their licenses being revoked. So many people with Lyme disease must travel, even to other states, to find doctors and practitioners who understand it. These doctors’ waiting lists are many months’ long, and their services often pricey, since most insurance companies will not cover treatment.

Further, Lyme disease is a political disease, and research study results published in the worldwide medical database PubMed.org are distorted to favor the political agendas of some, while other studies reveal the truth. Yet because all of these studies, including those that tell a lie, are published in well-respected medical journals, medical practitioners are left in a sea of confusion about chronic Lyme. Others know the truth but don’t want to touch this complicated disease with a ten-foot pole, because of the challenges of diagnosis and treatment, and because they risk persecution for doing prolonged antibiotic therapy and other valuable treatments.

What remains then, is for those of us who are canaries in the coal mine, to tell the truth. To spread the word, far and wide, about the reality of a severe, disabling disease that isn’t just spread by the bite of a tick, but by other insects such as mosquitoes, fleas and mites; as well as from person-to-person, congenitally, via body fluids, blood transfusions, and other means. We must tell the truth to our local government representatives; to the CDC and IDSA, to doctors, to everyone that we know, so that the current diagnostic and treatment guidelines will get overturned, and new, accurate methods of diagnosis and treatment will get created and embraced.

In the meantime, be encouraged: you can get better with perseverance and the right treatments. Be encouraged, because more and more people, including doctors, are becoming aware of chronic Lyme disease and learning about how to treat it. More and better resources are becoming available, and knowledge is power. Be encouraged, and keep going; putting one foot in front of the other, and fighting to create awareness as you also fight to recover your own health.

This article was first published on ProHealth.com on May 22, 2017 and was updated on October 19, 2020.

Connie Strasheim is the author of multiple wellness books, including three on Lyme disease. She is also a medical copywriter, editor and healing prayer minister. Her passion is to help people with complex chronic illnesses find freedom from disease and soul-spirit sickness using whole body medicine and prayer, and she collaborates with some of the world’s best integrative doctors to do this. In addition to Lyme disease, Connie’s books focus on cancer, nutrition, detoxification and spiritual healing. You can learn more about her work at: ConnieStrasheim.

Tying Together Fear and Pain: The Parabrachial Nucleus of the Brainstem and Fibromyalgia

Reprinted with the kind permission of Cort Johnson and HealthRising.

The Brainstem

The brainstem – a small area at the base of the brain that contacts the spinal cord – has become of ever more interest in chronic fatigue syndrome (ME/CFS). Barnden’s studies suggest brainstem involvement is present. VanElzakker believes brain scans focused on upper areas of the brain have missed a crucial aspect of ME/CFS.

Then there’s craniocervical instability (CCI). Surgical procedures that stopped the skull from impinging on the brainstem in some people with ME/CFS have led to recoveries – which have made it clear that brainstem issues have the potential to produce every symptom found in ME/CFS.

The Brainstem and Fibromyalgia

The Brainstem

We know the brainstem is heavily involved in the regulation of basic processes that we need to survive, including autonomic nervous system functions such as heart rate, breathing, sleep and in conveying sensory and other signals to the brain. It turns out, though, that the a small area of the brainstem called the parabrachial nucleus also plays a role in chronic pain.

The finding that the brainstem matters in chronic pain illuminates two things: (a) how complex a process pain production is; and (b) how much researchers are learning about it. Several years ago, Alan Light, PhD noted that he aimed to do for the production of fatigue what we already knew about the production of pain. We know quite a bit about how pain in fibromyalgia (FM) is produced.

We know, for instance, that two kinds of small nerve fibers in the body that transmit pain signals to the spine, and ultimately the brain, have become hyperactivated in FM. We know that another process called “windup” results in other nerve fibers becoming hypersensitive to pain. We know that several neurotransmitters that upregulate pain production are increased in FM, that the pain inhibitory pathways are underperforming in the disease, and that areas of the brain that produce pain have become hyperactive.

So much is going on that it seemed as if every aspect of the pain producing process has gone sideways in FM, but researchers are not done learning about how pain is produced – not all.

Parabrachial Nucleus (PBN)

“This tells us that chronic pain is manufactured by the brain. It’s not a one-way process driven by something coming up from the periphery; the brain is not a passive recipient. ToMary Heinricher me that’s what’s exciting: The brain is actively constructing a chronic pain state in part by this recurring circuit.”

Another part of the brain that has not been assessed in fibromyalgia may play a key role in the pain found in the disease.

Recent animal studies indicate that the brainstem also plays a role in pain production. Pain starts off as a sensory signal that gets interpreted by the brain. Because pain usually denotes some sort of injury, the brain has given pain signals a special emotional resonance to do something about the situation. So while a pain signal starts off as a kind of sensory signal, over time it becomes more than that. The first place the process of turning a pain signal into a complex response starts is at the parabrachial nucleusin the brainstem.

Studies have shown that PBN has a windup problem of its own: i.e. in chronic pain, nerves in the PBN remain active and ready to punch out pain signals long after they’ve calmed down in non-pain states. That suggested that some sort of inhibitory pain control had been lost.

The Amygdala and Fibromyalgia

The main excitatory neurotransmitters in the brain – glutamate – were lacking in the part of the PBN involved in pain production. Careful studies indicated that projections from the amygdala – generally known as the fear center of the brain – were responsible. They weren’t the projections that the researchers expected, though. Through its interactions with PBN, the amygdala was turning down pain – not ramping it up.

While it’s mostly known for producing sensations of fear, the amygdala was shooting calming signals straight to the PBN in the brainstem. It was also doing it using different neurotransmitters such as dynorphin and somatostatin. Surprisingly, it was the loss of amygdala signaling that was leaving the PBN in a hyperactive state – and the subject in more pain.

In fact, one animal study, which painstakingly stimulated nerves known to carry inhibitory pain and hunger signals from the hypothalamus to other parts of the brain, found that only the activation of nerves leading to the PBN reduced pain behaviors.

Once again, but in a new way, we can see how vitally important pain inhibition process is to our experience. The researchers had found a new way to heighten pain signals – and create a chronic pain state.

Going Defensive

The twitchy PBN wasn’t producing just pain, though. Researchers have thought that the brain does most of the emotional processing, but it turns out that the PBN – the main processing center of pain signals coming from the body and up the spine – is doing some emotional processing of its own. The PBN determines whether brain regions involved in escape or aversive behaviors (yelling, hitting, getting angry) are alerted or not. Above all, the PBN is involved in defensive reactions; e.g. aversion.

Nerve projections to other parts of the brain indicate that the PBN plays a key role in our emotional responses to pain. In fact, it and the amygdala appear to be the two general alarm centers of the brain.  A recent review called the PBN “a ‘hub’ for pain and aversion” that responds to any potentially dangerous situation. Not surprisingly, PBN neurons have been associated with the “freeze response”. One researcher likened the PBN to a home alarm:

“The alarm goes off while you’re away, and you don’t know if it’s a broken window, an intruder, or a fire—you just know that something bad has happened.”

Interestingly, given the possibility produced by Bob Naviaux that people with chronic fatigue may exist in a kind of hibernation-like metabolic state, the vast convergence of different sensory inputs (cardiovascular, respiratory, metabolic, and pain) at the PBN appears to give it a key role in determining whether an organism enters into hibernation. Inhibiting the activity of some PBN neurons prevented anorexia (e.g. the starvation phenotype) and malaise in laboratory animals.

It’s connected with several brain areas associated with FM, including the hypothalamus, insula and the periaqueductal gray area. The PBN also regulates autonomic nervous system functioning (respiration, blood pressure, heart rate, water balance).


Once again we see a part of the brain that has been largely ignored possibly playing a major role. The PBN used to be thought of as a passive relay center for sensory signals, but it’s clearly not. Not only does it determine to some extent how the brain will react to pain signals – with aversion or escape – but it’s also at the tail end of an inhibitory pain process.

We don’t know if the parabrachial nucleus in the brainstem plays a role in the pain in fibromyalgia, but it’s hard to imagine that it doesn’t. As the PBN discovery fleshes out our understanding of how pain is produced, it also illuminates how complex the process of pain production is – and helps us understand why producing a good pain drug has been so difficult. (I was unable to find any drug associated with the PBN.)

We know that the pain in FM is associated with numerous issues in pain processing, neurotransmitter production and brain activation but we still don’t know what starts the process off. Even so, it’s good to know that researchers are continuing to produce new insights into how pathological pain (i.e. inappropriate pain) is being produced. Given that FM occurs in some people after an infectious event, it’ll be interesting to see if the research into the COVID-19 long haulers provides some insights in chronic pain.

About the Author: ProHealth is pleased to share information from Cort Johnson.  Cort has had myalgic encephalomyelitis /chronic fatigue syndrome for over 30 years. The founder of Phoenix Rising and Health Rising, he has contributed hundreds of blogs on chronic fatigue syndrome, fibromyalgia and their allied disorders over the past 10 years. Find more of Cort’s and other bloggers’ work at Health Rising.

Press Release: ProHealth, Inc. Becomes Authorized Distributor of Uthever® NMN by Effepharm

Leading Longevity Company Teams Up with Leading Global Biotechnology Manufacturer to Offer World’s Best NMN

Carpinteria, CA: ProHealth, Inc. announced that they have been selected to be an authorized distributor of Uthever® NMN by Effepharm. When it comes to NMN, Uthever® NMN by Effepharm is the gold standard—unsurpassed in quality, purity and potency.

Of the selection, ProHealth founder, Rich Carson, said, “We’re honored that Effepharm recognized ProHealth’s stellar reputation and 32-year history of offering only the highest quality supplements and chose us to be a distributor for what I believe is the world’s best and purist NMN.”

NMN has taken the anti-aging world by storm, even being hailed by some as the “fountain of youth.” But this sudden increase in popularity has unfortunately given rise to numerous unscrupulous companies who are selling products they claim are NMN, but in fact contain little to no NMN. Even worse, they’re often tainted with contaminants and heavy metals. In this market flooded with fake and adulterated NMN, Uthever® NMN stands out as a product people can trust to be of exceptionally high quality, purity and potency.

From research through production, Effepharm has put together an all-star team to oversee and guide each step of the Uthever® NMN development process.

  • The Research and Development Team is led by U.S. doctors from GlaxoSmithKline, a research-based pharmaceutical and healthcare company that has established itself as a world-class leader in both medicine and healthcare.
  • The Production Management Team is led by senior managers from Mars Wrigley, one of the world’s largest food producers with numerous world-renowned brands.
  • The Scientific Quality Standard Setting Team is under the direction of a former USP scientist who ensures that Uthever® NMN is in strict accordance with USP quality standards. (USP is the U.S. Pharmacopoeia and the globally recognized quality standards agency that establishes standards for pharmaceutical development and manufacturing.)

Then even beyond Effepharm’s strict in-house quality control, every batch of Uthever® NMN sold by ProHealth is third-party tested in an independent U.S. lab to verify its authenticity, high quality and purity.

If that wasn’t enough, Effepharm is the only NMN raw material manufacturer in the world to conduct human clinical trials. Effepharm’s multicenter, randomized, double-blind, parallel design, placebo-controlled study to evaluate the efficacy and safety of Uthever® NMN is the largest and most comprehensive human clinical trial on NMN to date. The study is expected to be completed by the end of 2020.

About NMN: Nicotinamide mononucleotide (NMN) is a derivative of the B-vitamin niacin that dramatically improves health and longevity by serving as a precursor to NAD+, a compound that plays a crucial role in energy production, metabolism, and gene expression in the body. NMN works by replenishing diminished NAD+ levels, which naturally fall at a rate of about 1% per year; a 50-year-old person, for example, has about half of the NAD+ they had in their youth. NAD+ is important because it is a coenzyme found in all living cells and is required for all of the body’s fundamental biological processes. It is absolutely essential for life.

About ProHealth, Inc.: ProHealth, Inc. is a supplement company based in Carpinteria, CA. Currently celebrating 32 consecutive years as a Better Business Bureau A+ rated company, ProHealth

was founded with the goal of helping improve the lives of people suffering with chronic diseases by providing them with world-class nutritional supplements as well as the latest research and treatment news. As the company grew, so did its mission. ProHealth expanded to include ProHealth Longevity, a company on the cutting edge of anti-aging science and focused on helping people add more healthy years to their lives – to Live Better, Longer. ProHealth is proud to have raised over $4 million for medical research and patient advocacy.

In order to facilitate the expansion of the new ProHealth Uthever venture, ProHealth created the new website UtheverNMNBulk.com.  This website contains more information about ProHealth’s Uthever NMN and a contact form for potential partners.


What is the Value of a Symptom?

A symptom can be defined as “something that indicates the existence of something else, especially of an undesirable situation.”  For example, if your car suddenly has a flat tire, this is a symptom of that tire not having enough air in it to function.

The medical definition of a symptom is “a noticeable change in the body or its functions that indicate the presence of a disease or other disorder.”  For example, if you experience heartburn or gastric reflux, this is a symptom of your stomach not being able to digest or break down food properly.

Simply put, a symptom is a very helpful tool in identifying dysfunction of some sort and allows us to determine what is needed to correct the dysfunction. Where our body is concerned, a symptom is a valuable message that signals “we have trouble and need help or support.”

If your tire is suddenly flat, what the tire needs is to have the correct amount of air added  or repair the source of air leaking, right?  We wouldn’t continue to drive down the highway knowing that a tire is flat and needs air, hoping that the symptom will stop.  Our car will no longer be able to move at some point if we do not repair the flat tire.

What Symptoms Tell You About Chronic Illness

Interestingly, when our body experiences heartburn or gastric reflux, what it needs is to find the source of the indigestion.  Is it an infection? Is it a food allergy or sensitivity causing inflammation of the stomach lining and esophagus?  Unfortunately, we do not first try to identify the cause of the symptom, give the system rest, and correct the dysfunction.  Instead, we have been programmed in this country to immediately look for a way to turn the symptom off or stop it.  The result of this approach actually puts up a roadblock for our body to do its work in digestion and healing itself.  To stop the symptom of reflux or indigestion, most drugs’ main action is to stop acid production in the stomach.  These are called proton-pump inhibitors or PPIs.

Our digestive system is actually a very tightly regulated system where stomach acid is produced by cells in our gastric (stomach) glands.  This acid plays a key role in digestion of proteins by activating digestive enzymes.  The cells in the lining of the stomach are coupled in an amazing feedback system to increase acid production when needed.  Other cells in the stomach produce bicarbonate, a base, to buffer the fluid, ensuring that it does not become too acidic.  These cells produce mucus, which forms a viscous physical barrier to prevent gastric acid from damaging the stomach.  This system keeps the pH of our gastric acid at 1.5 to 3.5, which is essential for digestion.  Our proton pump is what regulates and keeps this acidity maintained.  Interfering with or turning off this pump’s action causes a cascade of miscommunication in our body’s natural process.  It does not actually correct or “fix” the problem!  The problem is what is creating the excess acid production, not the actual acid.

The excess acid our stomach produces is actually protecting itself and sending signals to other organ systems to “help out.”

In my Flowtrition practice, we teach clients that the value of a symptom is priceless.  This is an opportunity to actually listen to our body, evaluate the current condition, then determine what is needed to support the body’s immune system in its work of repairing and healing.

A fever can be a symptom of our body fighting a bacterial or viral infection.  This is evidence of the immune system working overtime to protect from the intruders (virus or bacteria).  To turn this system off is much like knowing you are being robbed and turning off your security system and turning out all of the lights!  Instead of shutting off the fever, what most bodies need is extra support in the form of increased fluids and rest to prevent dehydration and to allow the body ample energy stores to continue to fight off the infection.

Pain can be a symptom of multiple disorders and have multiple origins, but it is basically a message stating “I am stressed or strained and having difficulty functioning.”  This is certainly not a message we want to turn off!  If some part of our body was having difficulty functioning, therefore causing pain, wouldn’t it make sense to stop using this area as it is in danger of breaking or giving out?  Or at the very least, wouldn’t this cause us to take a break, evaluate the body’s situation and determine what is needed to support the immune system in its efforts to repair and heal?

Unlike a car, our body will still continue to move or run if a dysfunction is not corrected right away (in most instances, that is).  The human body is such an amazing self-regulating system that it has the ability to continue operating even with multiple systems having dysfunction.  Our body instinctively knows how to handle inflammation or trauma and redirects energy where it is needed the most to keep functioning.  That is, for a period of time of course.  Eventually, as other organ systems have to work harder to make up for the dysfunction of another system, the body begins to have breakdown.  This breakdown can come in the form of diseases and disorders such as fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, GERD, high blood pressure, diabetes, heart disease and cancer, just to name a few.

Flowtrition is an approach to encourage total body wellness by dropping tension throughout the body and increasing awareness within the nervous system (central control). The more perceptive the nervous system is, the more a person can be aware of what they are doing, why they are doing it, and how it can be influencing their life.  We encourage clients to look at a symptom in an entirely different way. Not as something that is “good” or “bad” or something we want to turn off, but as something we want to take note of and honor the message our body is sending us.

This is not a symptom-based approach and is not about “fixing” or “correcting” anything in particular, such as back or neck pain.  Flowtrition is about allowing a body to change or drop tension from within by creating clear communication via our central nervous system.

Everything that we experience is communicated to us through the nervous system.

Sometimes we are holding a pattern of tension (which can create symptoms such as pain, tenderness, fear, anxiety, etc.) due to an emotional or physical trauma from long ago.  Even though the event or trauma is over and we are safe and have moved on, the body may be responding or protecting as if it is still occurring.  This reaction can be a result of the nervous system being profoundly affected.  These patterns of tension can be seen in disorders such as PTSD, chronic fatigue syndrome, fibromyalgia, depression and anxiety.

Flowtrition gives the nervous system the opportunity to change, which is extremely beneficial to the body on a physical and emotional level.  Allowing this change from within is much more empowering for a body than trying to force something to change when the body is not ready.

We must learn to listen carefully to our body’s messages — symptoms — without judgment and see the perfection of our system.  If we provide support when and where it is needed, we will once again learn to trust in the body’s own intelligence and ability to heal.

“The body cannot begin to heal while in a constant state of tension.”
~ Lisa Adams ~
This article was first published on ProHealth.com on March 9, 2017 and was updated on October 15, 2020.

Lisa Adams is a Certified Flowtrition Practitioner, nurse, and health and wellness educator who has combined over 24 years of experience as a registered nurse with training in Flowtriton as well as therapeutic massage and bodywork to provide her clients with the most comprehensive and holistic approach to preventive healthcare.  Lisa believes that wellness starts from within and that if we have trust in our body’s ability to heal as it is designed, amazing things happen.  She also believes that optimal health is achieved in a multi-system approach that includes body, mind and spirit.  Lisa’s passion to increase awareness in individuals about they way their body functions.  This is essential to making changes.

There is Hope! My Story of Overcoming Depression and Anxiety

Perhaps one of the greatest challenges of chronic Lyme disease, chronic fatigue syndrome, fibromyalgia and other neurological conditions, are the debilitating emotional and mental symptoms that they cause. Indeed, depression, anxiety, brain fog, memory loss, slowness of mental processing and speed, among other mental-emotional issues, are common among the afflicted.

Chronic Lyme Disease and The Mental-Emotional Connection

Throughout my recovery from Lyme disease and environmental illness, I battled all of these symptoms, and more. Some days, I would arise and be in tears before I could even make it to the coffee maker. I’d spend hours lying on the floor, toilet roll in hand as tears flowed from my eyes, as I struggled to find the will do get up and sit at my computer, or do whatever needed to be done that day. My decision-making capability, desire to carry out basic daily tasks, and ability to think, socialize and were greatly affected by illness.  The isolation, financial struggles, and other circumstantial difficulties of chronic illness exacerbated the depression, anxiety and cognitive problems even further.

Even worse, the challenges of my recovery were compounded by the fact that I felt inadequately supported by well-meaning loved ones and people in my church, who seemed to struggle to understand why I just couldn’t “pull myself up by my bootstraps.” My doctor prescribed antidepressants; my friends told me to “just trust God” or pray more, while others admonished me to get counseling or exercise. All of these things were useful, but none addressed me as a whole person or the roots of disease, which weren’t just infections.

In any case, over time, I realized that while Lyme disease and illness were largely responsible for the mental and emotional symptoms I battled, they weren’t the only cause. The root of disease had actually started in my early childhood, and it was there that I had to begin my healing journey. By addressing the pain in my soul, and the early life traumas that set the stage for illness to take hold in my body, I was able to achieve a more complete recovery.

Depression, anxiety, and other mental-emotional conditions caused by Lyme and neurological disease are not easily resolved, because the root causes are often multiple. Even if a major part of the solution is to eliminate the infections, or take supplements to help balance the body’s chemistry, I have personally not found these things to be enough for many people.

Further, healthcare practitioners focus on healing different aspects of the person. Some will advocate medication or supplements to correct a chemical imbalance in the body, while others focus on cognitive and behavioral tools to address harmful beliefs and behaviors. Still, others focus on the spiritual side of things and developing a relationship with God to strengthen the spirit.

Yet my more than a decade-long battle with a severe neurological disease, fourteen years of medical research, and ministry to many dozens of others with chronic illness, especially Lyme disease, have taught me that depression, anxiety and other mental-emotional symptoms are caused by a combination of spirit-soul-body factors.  In addition, since our spirit, soul and body are interconnected, what happens to one part of us often affects the other two, so it’s often necessary to address healing on all three levels.

Fortunately, over the years, God and the many wonderful doctors and other practitioners that I have worked with, have helped me to largely overcome depression, anxiety, and the cognitive issues caused by Lyme disease, trauma, and the other factors that set me up for a lifetime of illness.  I have gone from crying daily and taking antidepressants and sedative drugs for over a decade, to now living most days with optimism, emotional stability and strength, peace and mental clarity. I no longer take medications (although I don’t judge anyone who does, as sometimes you just do what you need to do to survive!)—and I have largely resolved the underlying traumas, biochemical imbalances and infections that contributed to my emotional and mental challenges. So if you battle depression, anxiety, cognitive dysfunction, or other mental-emotional issues, be encouraged-there is hope for healing from these devastating, debilitating symptoms.

I wish I had known what I know today, fourteen years ago when I first became ill. I believe my recovery would have been much faster, but my hope is to now spare others from the same tremendous suffering that I endured by sharing all that I’ve learned over the years.

To that end, my newest book is called Healthy, Happy and Free: Spirit-Soul-Body Solutions for Healing from Depression.

While the book is focused on depression, the principles and tools I share in it apply to other mental-emotional symptoms common in people with Lyme, CFS, fibromyalgia, mold illness and other manifestations of environmental illness.  This book contains everything that I’ve learned over the past decade and a half about how to heal from depression and anxiety, and it is unique because it doesn’t just focus on providing solutions for the biochemical causes of depression, but the emotional and spiritual ones, too.

It’s also unique because it addresses the root causes of disease, so that you can be healed from the ground up, rather than simply giving you information on pharmaceutical medications and other treatments that only mask or manage symptoms. I also pepper the book with anecdotes of my own story and battle with depression, to encourage readers throughout.

Because of my experience and research, I believe that Healthy, Happy and Free provides hope and practical help to those who have not found it through the means that have been made available to them.

If you or a loved one battles depression, anxiety or other mental-emotional symptoms caused by neurological disease, I encourage you to check out Healthy, Happy and Free: Spirit-Soul-Body Solutions for Healing from Depression. I believe you’ll find new answers here that will help you to recover, on all three levels of your person: spirit, soul, and body.

In the meantime, if you are looking for some nutritional supplements to help support your mood, mental function and chemistry, I encourage you to check out the following article, in which I share some of the supplements that have helped me and others I know, to either manage or recover from depression, anxiety, and cognitive issues caused by Lyme and neurological disease.

May you be richly blessed in your healing journey!

Connie Strasheim

This article was first published on ProHealth.com on January 24, 2019 and was updated on October 13, 2020.

Connie Strasheim is the author of multiple wellness books, including three on Lyme disease. She is also a medical copywriter, editor and healing prayer minister. Her passion is to help people with complex chronic illnesses find freedom from disease and soul-spirit sickness using whole body medicine and prayer, and she collaborates with some of the world’s best integrative doctors to do this. In addition to Lyme disease, Connie’s books focus on cancer, nutrition, detoxification and spiritual healing. You can learn more about her work at: ConnieStrasheim.









The 11 Best Fibromyalgia-Friendly Foods for Beautiful Skin

“Gee, you don’t look sick.” That’s a common phrase heard in the fibromyalgia and chronic illness community. It’s frustrating to know that the outside doesn’t always reflect what’s going on inside. We may look “fine,” yet we wear the internal scars of relentless pain, fatigue, and cognitive dysfunction.

But, sometimes we don’t look all that great on the outside either. Sleepless nights, digestive dysfunction and other endless symptoms take their toll.

Have your friends ever said to you, “Wow, you look tired today!” or, “What’s eating you, you look wiped out!” Friends can get away with that. Good friends might even say something that’s cringe worthy. Not because of their intention to be cruel, but because of the honesty and truth behind the remark.

Nutrition professionals can get away with telling you how you look, too. They can read your skin like a story book. I once had a naturopath look at my face and tell me I had problems with digestion, insomnia, malnourishment, significant nutrient deficiencies, and severe food allergies. She was just getting warmed up. I won’t deny that she impressed and depressed me at the same time.

I had no idea that my exterior – namely, my skin – had that much to say.

This makes me think of cereal boxes I wanted my mother to buy when I was a kid. We rarely had packaged breakfast foods, and the colorful boxes lining the shelves at the grocery store looked as if they held wonders untold.

The kids and the cartoony characters printed on the box fronts looked cheerful and fun-loving. My naïve assumption was that their glee stemmed from their access to the plastic treasure inside. Who wouldn’t want a Honeycomb watch, a Josie and the Pussycats spoon, or a Kellogg’s baking soda powered submarine? I sure did.

What I wanted even more was a plastic yellow bowl shaped like a banana. It required 3 box tops of some such cereal (I simply don’t remember and won’t bother blaming it on fibrofog). What I do remember was painstakingly completing the cardboard form, writing the address on the envelope, affixing a stamp, and walking it downtown to mail.

Somewhere between 1971 and the turn of the century, I stopped hanging out at the post office waiting for its arrival. It never came.

And, at some point in those 28 years, I recognized that the outside of product packaging is a representation of what’s inside. Just like our skin, for example, which is one of our greatest “advertisements” of inner health. Our complexion has a lot to say about what’s going on with our digestion, hormones, our body’s ability to detoxify, and much more. We may display interesting features on the outside, but what’s truly remarkable is the inner workings of the human body.

This isn’t simple sentiment.

Our internal health – the health of our digestive system in particular – is reflected in exterior appearances such as our skin’s elasticity, thickness, dryness, wrinkles, rashes, discolorations, and more. Healthy foods not only keep our digestive system running smoothly, they help us to heal from the inside out.

What we eat determines how we feel and how healthy we look. In Chinese medicine, many diseases are primarily diagnosed based on notable clues found on the skin, hair, nails, and tongue.

When you think of food and healthy skin, what comes to mind? You’re probably thinking of using an avocado as a facial mask and cucumbers to reduce the bags around your eyes. The purpose of this article is to go beneath the surface. Many foods, when eaten, can target changes in the health and vitality of our skin. It’s said that beauty is only skin deep. But, true health is deeper than that. Dynamic health is reflected in beautiful skin, for certain. And whole body health is where it begins.

Would you like to have a healthy inner and outer glow about you?

The benefits of the following healthy, nutrient-rich foods impact more than just your skin, but why not take advantage of all that they have to offer? There are dozens of foods that help our skin to look its best.

Here are my top 11 favorites!

Fibromyalgia-Friendly Foods for Beautiful Skin

1. Water – Yes, water is a nutrient.  We’ve all become accustomed to lugging a bottle, jug, or jar of H2O everywhere we go, but why is it good for the skin? To start, water is a great detox. It flushes out toxins and wastes leaving our skin looking healthier and younger. By staying adequately hydrated on the inside, our skin has its best chance at looking healthy and hydrated on the outside.

2. Salmon –Have you had your omega-3’s today? We hear a lot about these essential fatty acids because they fight heart disease and are known for cancer prevention. But if you’re looking for results you can see, salmon combats dry, flaky skin, inflammation, and even helps to prevent sun damage to your skin. And salmon isn’t the only fish in the sea that’s a good catch. Herring, mackerel, and anchovies can be good choices, too.

3. Dark Greens (veggies) – I’ve lumped together a bunch of great veggies here because green veggies provide outstanding health benefits. Look for spinach, kale, broccoli, bok choy, and a whole variety of mixed greens to provide you with folate and vitamins A, B’s, and C for starters. They provide skin cell renewal benefits as well as energy and infection-fighting components. Don’t we all look better when we feel healthy and energized?

4. Nut and Fats – Here again, the omega-3’s boost the skin’s healthy appearance similar to expensive “plumpers” without the damaging effects of toxic ingredients. And another thing – have you ever noticed those nuisance bumps on the backs of your upper arms? What some call “chicken skin,” may be caused by an essential fatty acid deficiency. For me, increasing my healthy fat consumption made a big difference. Nuts (try walnuts, cashews, and/or macadamias) can help as well as the above-mentioned fish. Don’t forget to add quality healthy oils such as olive, avocado, flax, coconut, and walnut. Almonds happen to be a great source of vitamin E which is well-known for its moisturizing and antioxidant benefits. We don’t want to age any faster than we have to!

5. Seeds – At the risk of sounding like a broken record, flax seeds happen to be one of the healthiest sources of omega-3’s. Don’t care for fish? Add flax or the superfood chia seeds to salads, smoothies, berries or your use as a topping for roasted veggies. Essential fatty acids have even been known to unclog the pores of your skin preventing acne and other blemishes.

6. Sweet Potatoes – We haven’t talked much yet about antioxidants, so here we go. Free radicals might sound good (because they’re free), but they’re not good. Free radical damage causes premature aging. Antioxidants (found in many brightly colored veggies, fruits, and berries) help to reduce the causes of aging to our skin. Additionally, sweet potatoes are high in vitamin A making them a great choice for potential healing and reduction of skin blemishes and discoloration. To learn more about phytonutrients and the antioxidant benefits they provide, check out this article, “Phytonutrients for Fibromyalgia Recovery.”

7. Green Tea – The medicinal benefits of tea have been studied for decades. The catechins found in green tea, in particular, have been linked to protection from skin cancer as well as faster healing from skin problems. The antioxidant properties of tea are also reported to prevent premature aging, wrinkling, and sagging of skin. Some studies refer to topical application as well as drinking the tea.

8. Mangoes – As with sweet potatoes, mangoes contain powerhouse nutrients to fight the causes of aging. Besides the A, B’s, & C vitamins, mangoes provide vital minerals such as potassium, magnesium, calcium, and iron, making them a perfect addition to a post-workout salad or smoothie. The enzymes found in mangoes help the body to eliminate food wastes and toxins, also benefitting the look of the skin.

9. Berries – Dark berries such as blueberries, blackberries, boysenberries, and raspberries make a smart choice for those seeking to lower their sugar intake. Glycation (the result of excess sugar in the body) is responsible for skin damage (dryness, stiffness, and loss of elasticity) among other things. The antioxidant compounds in berries reduce inflammation and further deterioration of the delicate layers of the skin. They also play a strong role in the production of collagen, a strong building component to healthy skin.

10. Avocados – As mentioned before, you can use avocado topically as a great hydrating and nourishing skin mask. But why stop there? Avocados contain healthy fats, fiber, and an abundance of hydrating and nourishing nutrients for the skin. Vitamins like niacin and minerals such as potassium, magnesium, manganese, copper and zinc all provide vibrant skin health benefits. Enjoy avocados in your salads, smoothies, scrambled eggs and more. Here’s another great kitchen tip. Experiment with substituting mashed avocado in recipes that call for mayonnaise. Most store bought mayo contains unhealthy highly processed oils and avocado makes a powerfully healthy alternative.

11. Dark Chocolate – Look for dark chocolate with a minimum of 60% cacao and the least amount of sugar possible. Chocolate rich in minimally processed cocoa contains flavanols, which are known to preserve blood vessel health. Promoting a healthy blood supply to the skin can keep you looking vibrant and youthful to say nothing of the beautiful smile that comes from nibbling on a bit of rich, dark, delicious chocolate.

There you have it — 11 foods to help your skin look its best. Now that you know a bit more about the relationship between healthy food and healthy skin, make a point to browse your grocery store’s produce department. Stop by your local farmer’s market and select vibrantly colored vegetables and berries. Try new recipes at home with healthy fish, quality oils, nuts, and seeds. The benefits you’ll see in the mirror will match the benefits of how young these foods will make you feel. Enjoy!

The best and most efficient pharmacy is within your own system.
~Robert C. Peale

This article was first published on ProHealth.com on October 11, 2016 and was updated on October 8, 2020.

Sue Ingebretson is becoming a most sought after symptom-relief expert in the fibromyalgia and chronic illness communities. She’s known for getting to the root of her client’s health challenges and delivering long-term results using a light-hearted approach without quick-fix remedies that only mask symptoms. You can find out more and contact Sue at RebuildingWellness.

Would you like to find out more about the effects of STRESS on your body? Download Sue’s free Is Stress Making You Sick? guide and discover your own Stress Profile by taking the surveys provided in this detailed 23-page report.

5 Foods to Eat (And 5 to Avoid) When You Have Depression

Believe it or not, what you put in your mouth affects your mood. The better your diet, the less likely you are to develop depression. If you’re already diagnosed with depression, what you eat can either increase or decrease your symptoms.

Therapists and other mental health workers are starting to emphasize the importance of a healthy lifestyle for people with mental illness, but preparing healthy food from scratch can be like climbing a mountain for people with depression. Eating healthy is more about increasing the good food, rather than cutting out the bad. To avoid feeling overwhelmed, try focusing on small dietary changes, like adding in more nourishing foods and reducing foods that don’t support your recovery.

Another important tip is to eat something with protein, such as nuts, eggs, or lean meat, every three hours or so to keep blood sugars stable. When your blood sugar drops it can mimic a mood swing or panic attack.

What to Eat When You Have Depression

1. Avocados

You may be sick of hearing about how avocados are a superfood, but this is one food that deserves the hype. Our brain is made up of mostly fat and needs healthy fats as building blocks. Avocados are a good source of tryptophan, which we need to make serotonin, otherwise known as the happy chemical. Try adding one to a smoothie for your daily dose of this savory fruit.

2. Fish

Speaking of fats, Omega 3 fatty acids are great for your brain and nervous system. Studies have shown that fish oil supplements can be as effective as antidepressants. It is speculated that Omega 3s reduce brain inflammation and increase serotonin production. If you are a vegetarian or vegan, tofu and walnuts are also high in Omega 3s.

3. Spinach and other dark leafy greens

Dark leafy greens are nature’s perfect food. Their depression-fighting properties come from folate. Low levels of folate have been linked to depression, so getting plenty into your diet will help increase those levels. Greens are also a natural source of iron, which carries oxygen to your brain.   

4. Berries

Raspberries, blueberries, blackberries, and strawberries are all packed with antioxidants, which help reduce inflammation at the cellular level. In fact, they have more antioxidants than any other fruit. They also contain many brain-healthy vitamins, such as A, C, and E, that are commonly lower in people with depression.

5. Dark Chocolate

Dark chocolate is a health food disguised as a delicious treat, especially when it comes to brain health. Cacao contains phytonutrients which fight and prevent inflammation. These specific phytonutrients also improve circulation, which means more blood to the brain. Milk chocolate doesn’t have the same healing power, due to heavy processing and the addition of dairy and sugar (see below). To reap the benefits, it must be high-quality dark chocolate. The higher percentage of cacao the better, so aim for at least 85%.

What Foods to Avoid When You Have Depression

1. Sugar

The brain needs glucose to function but gets plenty from the carbohydrate-heavy Standard American Diet (SAD). The recommended daily dose of sugar is 25g per day for women and 38g for men, which sounds doable until you realize that the average can of soda has about 35-40g of sugar in it. The problem isn’t necessarily sugar, it’s how much sugar we consume. Elevated levels of glucose in the blood impact cognition, memory, and the ability to process emotions.

2. Gluten

You’ve probably heard of celiac disease where gluten causes an autoimmune reaction, but you may not be familiar with the more common diagnosis of non-celiac gluten sensitivity. Studies have shown that removing gluten in people with either IBS or non-celiac gluten sensitivity decreases symptoms of depression. Maintaining a gluten-free diet is becoming easier as compliant foods are more accessible at grocery stores and restaurants. It may be worth a try to see if it helps improve your mood.

3. Processed Foods

Processed foods and the brain don’t mix. Studies have shown that people whose diet is high in processed foods are at an increased risk for depression. Processed food is anything you buy already prepared and usually comes in a package, can, or box at the grocery store. Processed foods usually contain excess sugar and other additives, which are all those things you can’t pronounce in the ingredients list. Part of improving mood through diet is being aware of what you are eating, which is challenging with processed foods.

4. Dairy

Dairy makes some people sluggish and slow, which is the last thing you need if you have depression. Gluten and dairy are considered the two biggest food culprits for inflammation, possibly due to many people being intolerant to both. It’s believed that a protein in cow’s milk called “casein” is to blame. You may not need to give up dairy entirely. Instead, try swapping cow’s milk to goat or sheep’s milk, cheese, and yogurt.

5. Caffeine

Caffeine isn’t exactly a food, but in some people, it can increase symptoms of depression and anxiety, so limiting your intake is something to consider. Caffeine is linked to increased symptoms of depression. The level of caffeine intake is correlated with the intensity of symptoms in people with mental health issues. In other words, the higher the caffeine intake, the worse the depression.

Furthermore, people with depression frequently report problems with sleep. Caffeine can disrupt sleep. If you are having difficulty sleeping or ruminating thoughts, consider switching to decaf or cutting back to 1-2 cups per day. Be cautious when transitioning away from caffeine. Caffeine withdrawal symptoms can make depression worse, so cut back slowly over a long period of time.

The bottom line? Don’t worry if you eat a hamburger or give in to your craving for ice cream. Stress is also a trigger for depression, so don’t become too rigid about your eating habits and practice a lot of self-compassion if you can’t resist that side of french fries.  

When it comes to depression, anything you can do to ease your symptoms is a positive, especially if it’s as easy as adding in a few more cruciferous vegetables.

This article was first published on ProHealth.com on February 19, 2019 and was updated on October 5, 2020.

Kerry J. Heckman is a freelance writer and therapist based in Seattle. She authors a wellness & lifestyle blog called Words Heal and writes about health, chronic illness, and travel. You can also follow her healing journey on Twitter and Instagram.




Continue reading “5 Foods to Eat (And 5 to Avoid) When You Have Depression”

Low Brain Blood Flows and Orthostatic Intolerance Ubiquitous in Chronic Fatigue Syndrome (ME/CFS)

Every once in a while a study comes along for which terms like “seminal” or “groundbreaking” seems appropriate. The 2020 Van Campen/Rowe/Visser study, “Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography“, is, for me, one of those. It’s a large study which carves out new diagnostic territory, clears up a mystery, and makes us look at chronic fatigue syndrome (ME/CFS) newly.

Visser, the senior author, is a well-published cardiologist who has been publishing studies for decades. Prior to his first exercise study on ME/CFS in 2010, he’d been pumping out study after study on all sorts of aspects of cardiology. After 2010, though, he’s devoted himself almost exclusively to ME/CFS research focused on exercise intolerance, orthostatic intolerance and dysautonomia. In 2013, he did a series of video interviews on ME/CFS.

Huge Study

The first thing to notice about the study is its huge size – over 400 patients. The study began with 714 possible ME/CFS patients seen from 2012-2018 at Stichting CardioZorg clinic in Hoofddorp, in the Netherlands. All 429 ME/CFS patients were given the opportunity to do an orthostatic stress (tilt table) test and/or an exercise stress test.

During the tilt table test (TTT), the patient lay supine for 20 minutes and then was tilted up to 70 degrees for a maximum of 30 minutes. During that time, their heart rate, blood pressure, and blood flows to the brain were measured. They were asked a wide variety of questions about their symptoms during the test.

In contrast to the “intracranial doppler” usually used to measure blood flows, something called “extracranial doppler” was used. Intracranial doppler doesn’t actually measure blood flows to the brain – it measures the velocity of blood flows to the brain.

Because extracranial doppler, on the other hand, measures velocity and takes into account blood vessel diameter, it’s able to give a more accurate assessment of blood flows. This technique, which is rarely used, may be critical in ME/CFS because reduced CO2 levels in ME/CFS may be narrowing the blood vessels – resulting in reduced blood flows even when blood flow velocity is normal.

This isn’t the first time CO2 levels have been assessed in ME/CFS during a tilt table test. In a smaller 2007 study, Dr. Natelson found hypocapnia in about 20% of people with ME/CFS. Low CO2 levels were also found in POTS patients in 2006, and way back in 1999, Novak found them in orthostatic intolerance.

In 2018, Novak found that a considerable number of possible postural orthostatic tachycardia syndrome (POTS) patients had normal hearts rates but reduced CO2 levels and reduced blood flows to the brain. He called this form of orthostatic intolerance hypocapnic cerebral hypoperfusion. Only Novak assessed blood flows to the brain in POTS.

This study has four things going for it: its size, its accuracy (the first-time use of extracranial doppler), its combined testing of CO2 levels and blood flows to the brain, and finally, its focus on chronic fatigue syndrome (ME/CFS).


As so often happens, at baseline – when both the healthy controls and ME/CFS patients were lying supine – no differences in cerebral blood flows were seen.

Once tilted, though, things radically changed. At mid-tilt, blood flows to the brain dropped by about 23% in the ME/CFS patients and just 5% in the healthy controls (HCs). By the end of the test, the ME/CFS patients’ blood flows to their brains has taken a 27% hit, while the HCs had declined by just 7%.

It wasn’t surprising to see dramatic declines in blood flows to the brain in the ME/CFS patients with POTS or orthostatic hypotension. While it’s not exactly clear how, those conditions are believed to reduce blood flows to the brain.

But what about the chronic fatigue syndrome patients without a diagnosis of orthostatic intolerance (OI)? Why did so many of them (78%) report symptoms associated with orthostatic intolerance in their daily lives if they didn’t have it?

This was not a small group. They actually made up the bulk (57%) of the large study. Eighty-two percent of the ME/CFS patients without POTS (postural orthostatic tachycardia syndrome) or OH (orthostatic hypotension) still had abnormally low brain blood flows. What was causing the decline in brain blood flows in them?

The low CO2 levels (hypocapnia) found in these patients may be the cause. Low blood CO2 levels are associated with narrowed blood vessels and hyperventilation.

One website reported that the hyperventilation associated with low CO2 levels is associated with many conditions we hear a lot about in ME/CFS: cellular hypoxia, chronic inflammation, lactic acid accumulation, anaerobic energy production, overactive nerve cells, shortness of breath, and others.

The low brain blood flow/low CO2 problem was not relegated to the non-POTS/non-OH patients, however. CO2 levels during the tilt were reduced in all the ME/CFS patients – including the POTS and OH patients – compared to the healthy controls. In fact, CO2 levels were lowest in the POTS patients.

It’s possible, but certainly not certain, that the low CO2 levels are playing a major role in reducing blood flows to the brain found throughout ME/CFS and in POTS. The patients with the lowest CO2 levels (<30 mmHg) had the lowest blood flows to the brain.

Plus, a symptom assessment indicated that the lower the blood flows to the brain, the more OI symptoms a person had – something that makes total sense.

More work needs to be done with the CO2 issue. In particular, the authors stated that dose-response data was necessary to pin down the effects the lower CO2 levels might be having.

The detailed symptom assessment taken found a voluminous and heterogeneous mix of symptoms showed up in the ME/CFS patients. Surprisingly, the chronic fatigue syndrome patients with just reduced brain blood flows (another form of OI) had more symptoms than those with orthostatic hypotension. It was the POTS patients, though, who really stood out: they had significantly more symptoms than either group.

One takeaway is that if you have symptoms of orthostatic intolerance – that is, if you experience symptoms of dizziness, fatigue, nausea, pain, cognitive issues, etc. while standing or sitting, but don’t meet the criteria for POTS, OH or other forms of orthostatic intolerance – you likely have a form of OI characterized by reduced blood flows to the brain. I fit in this group. I “passed” a tilt table test but felt awful while doing it.

The study also suggested that even if you don’t experience symptoms associated with orthostatic intolerance, you may still not be getting normal amounts of blood flows to the brain. ME/CFS patients who did not report symptoms associated with orthostatic intolerance still experienced, on the mean, double the drop in blood flows to their brains as did the healthy controls. Some patients without symptoms of OI experienced very high drops in blood flows, indeed, when tilted up (<46%).


No one knows why brain blood flows are commonly reduced in ME/CFS and POTS. Novak suggested that baroreceptor problems interfering with “respiratory drive”, compensation for metabolic acidosis, orthostatic ventilation-perfusion mismatch, problems with the respiratory centers in the brain and others (reduced blood volume) could be in play.

A POTS Option

A fascinating 2014 paper by Pozzi and Stewart, “Reduced Cerebral Blood Flow With Orthostasis Precedes Hypocapnic Hyperpnea, Sympathetic Activation, and Postural Tachycardia Syndrome“, (thanks to Peter Rowe for the tip). Every few minutes, this study tracked changes in HR, BP, CO2 level, sympathetic nervous system activity, etc. as POTS patients engaged in a tilt table test.

The researchers knew that when people with POTS stand up, blood tends to pool in the abdomen and lower body, thus reducing blood flows to the brain. They also knew that in healthy people, the very early stages of standing results in a short period of low blood pressure. After the arterial baroreflex and the autonomic nervous system kick in, all returns to normal.

The POTS patients (all suffering from shortness of breath) remained stuck in a state of low blood pressure – which caused the blood flows to their brain to plummet. That resulted (without their being aware of it) in their breathing more deeply than normal (hyperpnea), a reduction in their CO2 levels, and an uptick in sympathetic nervous system activity. The reduced CO2 levels further reduced their blood flows to the brain. The authors believed that the deep breathing and reduced CO2 levels resulted in a brain-wide narrowing (vasoconstriction) of their blood vessels and a state of hypoxia-ischemia (low oxygen levels/restriction of blood supply).

In this scenario, low CO2 levels are initially a reaction to reduced blood flows to the brain – not a cause of them. Once they show up, they make things worse, but they don’t start the process.

Communication Breakdown?

Another option may be a communication problem with the brainstem. When less blood (and oxygen) starts reaching your brain and/or your CO2 blood levels go squirrelly, chemoreflex receptors in your blood vessels tell your brainstem – a possibly problematic organ in ME/CFS – to increase your breathing rate. When CO2 levels get too high, those chemoreceptors tell your brainstem to decrease your breathing rate.

Both these auto-correction processes may be off in ME/CFS/POTS. The chemoreflex system in ME/CFS may be increasing breathing rates too much when brain blood oxygen levels fall, and then failing to reduce breathing rates enough when CO2 levels tank. The upshot of that could be hyperventilation and reduced CO2 levels.

The Phenylephrine Question

While treatment options are unclear, one small study funded by the National Institutes of Health (NIH) and the Solve ME/CFS Initiative (SMCI) used a drug called phenylephrine to attempt to increase blood flows to the brain. Phenylephrine stimulates the α-adrenergic receptors, leading increased in blood pressure, baroreflex stimulation, and a deep vagal stimulation with a reduction in heart rate.

When the ME/CFS patients were given phenylephrine, every physiological measure normalized during their tilt table test. Their heart and breathing rates, CO2 levels and blood flows to the brain all returned to normal levels. Even their performance on a cognitive test returned to normal. Their brain fog was gone.

Interestingly, phenylephrine is a vasoconstrictor – just the wrong drug one would think for a condition where low CO2 levels may be reducing blood flows to the brain. Because phenylephrine, though, does not make it to the brain, it could be vasoconstricting blood vessels in the body, thereby reducing blood pooling in the abdomen and legs, and increasing blood flows to the brain that way. It may also activate the baroreceptors.

Whatever it’s doing, it produced a fantastic effect.


The authors of the recent NASA Lean Study called this study “very important” and concluded that its findings were consistent with their own (very considerable) clinical findings.

Most tilt table tests do not assess blood flows to the brain, and when they do, they usually use intracranial doppler – which is likely not accurate in ME/CFS.

The authors of this study asserted that cerebral blood flows should be assessed during tilt testing in ME/CFS using extracranial Doppler – particularly in patients who have symptoms of orthostatic intolerance assessment, but normal heart rate and blood pressure results on a tilt test. This is the only way to show that orthostatic intolerance exists in people who do not test positive for POTS or OH on a tilt table test.

Dr. Peter Rowe, one of the study’s co-authors, stated that he believed that “extracranial measurement of cerebral blood flow will soon become the gold standard test for orthostatic intolerance”. Rowe reported that 90% of adult and pediatric ME/CFS patients have orthostatic intolerance and the study “helps us understand why people with ME/CFS are so symptomatic when upright”.

Extracranial Doppler measurements do not appear to have been widely adopted and Rowe said it will likely take some time for labs to adopt them as a standard practice. Rowe did say that labs which do vascular ultrasounds and carotid artery studies should be able to learn how to do them without great difficulty.

Just What is ME/CFS?

This huge study begs the question of what is ME/CFS? Could it be a circulatory disorder? There are so many tantalizing findings in ME/CFS right now, but the blood vessel / blood flow issue must be near the top of the list.

David Systrom believes that n theblood loss issue may be occurring between the arterial and venous systems. (Blood has also been found to collect in the abdomen and lower body in POTS patients.) Wirth and Scheibenbogen propose that clamped down blood vessels, plus a rather nasty compensatory response involving vasodilators play a role.  Barnden has documented problems in the brainstem which it appears could affect blood vessel functioning, breathing, heart rate, etc.. Other studies suggest reduced blood flows to the muscles are occurring as well.

At the end of the paper, the authors asked whether the orthostatic intolerance found in ME/CFS is similar to the circulatory dysfunction found in autonomic neuropathy. Autonomic neuropathy signifies damage to the nerves of the autonomic nervous system. Systrom, Oaklander and Scheibenbogen have all speculated that an autoimmune process may have damaged the small nerve fibers that carry sensory and autonomic nervous system signals; i.e. that ME/CFS could be an autoimmune-induced autonomic neuropathy.

Other possibilities, of course, are present, but it does feel like we’re getting closer.


Containing over 400 people, this is also surely the largest orthostatic intolerance study done in ME/CFS. This study used an unusual technique (extracranial doppler) to clear up a mystery, introduce a new diagnostic category and possibly identify a fundamental issue in ME/CFS (low blood CO2 levels upon being tilted).

The study explained why so many people with ME/CFS with symptoms of orthostatic intolerance (OI) have not tested positive for it, and suggested that virtually everyone with ME/CFS has a form of orthostatic intolerance. That may come as a shock to some doctors, but will probably not come as a surprise to most of us. We’ve just been waiting for the right technology to uncover what’s going on.

The study found that virtually everyone with ME/CFS had a form of orthostatic intolerance characterized by low blood CO2 levels and low blood flows to the brain. While the study was not able to show that low CO2 levels are contributing to the low blood flows, low CO2 levels can produce a narrowing of the arteries that reduces blood flows to the brain.

At the end of the 10-minute tilt table test, blood flows to the brain were on average reduced by 27% in ME/CFS and 7% in the healthy controls.

The fact that people with the lowest blood flows to their brains were the most symptomatic suggested that low blood flow to the brain is the key factor in OI. Even some people with ME/CFS without symptoms associated with orthostatic intolerance still had reduced blood flows to the brain.

ME/CFS patients with a diagnosis of POTS or orthostatic hypotension also have low blood CO2 levels. In fact, POTS patients had the lowest CO2 levels of all.

ME/CFS patients without a diagnosis of POTS or orthostatic hypotension should, if possible, have a tilt table test done using extracranial doppler to measure their blood flows to the brain. That is the only way that most people with ME/CFS will get diagnosed with OI.

The cause of the reduced CO2 levels is unclear but could be due to a number of factors (baroreceptor problems, problems with signaling, metabolic acidosis, a result of low blood flows to the brain, etc.).

The success phenylephrine had in removing all symptoms of orthostatic intolerance during a tilt table test is a bit hard to understand given that the drug is a vasoconstrictor, but the drug may have helped with baroreceptor activation or with blood vessel problems in the body.

About the Author: ProHealth is pleased to share information from Cort Johnson.  Cort has had myalgic encephalomyelitis /chronic fatigue syndrome for over 30 years. The founder of Phoenix Rising and Health Rising, he has contributed hundreds of blogs on chronic fatigue syndrome, fibromyalgia and their allied disorders over the past 10 years. Find more of Cort’s and other bloggers’ work at Health Rising.

Chronic Illness and The Pain of Being Medically Marginalized

The medical community has theoretically embraced the importance of the patient-centered experience. Almost every hospital describes their care as compassionate and focused on the needs and expectations of the patient. Part of this shift in thinking (from doctor or hospital-centered to patient-centered) may be the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).  HCAHPS is a patient survey that is randomly sent out to individuals who have been recently hospitalized at a facility.  The government (CMS) then uses HCAHPS scores when they are contracting with hospitals to establish their Medicare reimbursement rate.

Chronic Illness and The Pain of Being Medically Marginalized

The IOM (Institute of Medicine) defines patient-centered care as “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”

Allowing patients to be fully engaged in their healthcare decisions is a good step. Yet, my previous in-patient stay at a hospital owned by a large for-profit corporation makes me question whether this new mindset is no more than just words on a website.

Many people live with pain inflicted not only by a chronic illness, but also by the healthcare delivery system that ultimately holds the collective wisdom that, when applied, can improve their quality of life.  Systemic failures of hospital systems to live up to those lofty, yet attainable, goals create patients who feel overwhelmingly victimized and fearful that no one will listen to them. There is a good reason for that. They are. Those patients can include people with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), fibromyalgia, Lyme disease, among others.

A pior hospitalization allowed me to experience this first hand, and I remain stunned by the realization that this is how so many people go through the healthcare delivery system and emerge physically and emotionally scarred. I have heard personal stories from those individuals. I have had conversations with them, sat with them in PAINS-KC meetings, and I thought I understood the pain of being medically marginalized.  I worked with many individuals in hospice care for almost two decades who were desperate to be heard, yet their voices were an inaudible whisper, drowned out by the superiority of a health system that didn’t care to listen.

I went into the hospital through the emergency room on a Sunday evening and came out four days later as an individual acutely aware of the top-down corporate failure to create a patient-centered environment of care. I have no illusions that it was just an experience limited to this one hospital or just one physician group. It is easy to preen about the outstanding patient experience, but far more difficult to be the patient who is experiencing the experience.

I was in the hospital for almost a day with no treatment. The ER failed to notify my primary care physician that I was there. The staff could not tell me why I had no orders other than the customary IV.  A phone conversation requesting orders from my physician could have answered that. In desperation, I finally called my physician’s office to be told they didn’t know I was there. They did send a doctor over quickly, and he did discuss his treatment plan. I had never seen him before. He had no way to understand how a simple medical event could seriously impact my well-being. Yet, here he was, tasked with making recommendations that would make me better. It made me wonder about the push to have a primary care provider who knows you and understands your medical history if that history becomes irrelevant during hospitalization. However, I had asked that a specialist who had treated me for ten years and who knew my complicated medical history be consulted in all treatment decisions. My specialist is on staff at that hospital, yet no one contacted him during my stay.

I went to the OR on Wednesday still wearing the gown that was put on me in the ER three days earlier. I had asked for a gown, but it never materialized. I didn’t even have a towel until Tuesday when I asked housekeeping if they could bring one to me. I also asked the OR if they could change my sheets as those had never been changed.  Even though I had a fully anesthetized surgery procedure, no blood work was ever ordered. I was fortunate to be fully ambulatory, so I could get to the bathroom to wash my hands and dry them on my gown. Others are not as fortunate. The remainder of my stay was equally dysfunctional. It was not defined by one flagrant mistake, but by a culmination of individual instances that seem insignificant alone, outside of the context of the entire hospital stay.

I generally make it a policy to not speak negatively about physicians. They are human. Medical care is complicated. I’m not a person who leaves ugly one-star reviews. However, I am a person who believes it is the right and responsibility of every person to advocate for change in systems that marginalize the very people who need its help the most.

I have the tools I need to advocate for myself. I have college degrees and social support. I am financially stable.  I can challenge those who attempt to marginalize me. I can change doctors if I feel that I need a new one. I can afford excellent health insurance. I am a good health historian. Yet, I still shudder at the feelings of worthlessness I experienced at this hospital on this one visit. I realized that every individual can encounter these systemic deficiencies. We can be vulnerable because we are the wrong age, the wrong color, the wrong sex, have the wrong diagnosis, take the wrong medications, or speak the wrong language, come from the wrong socioeconomic background, have too many tattoos, dirty hair, or not enough education.

It is important to acknowledge that these vulnerabilities exist and to advocate for yourself and others so that your story is heard, believed, and respected.

This article was first published on ProHealth.com on April 12, 2018 and was updated on September 30, 2020.

Lesli A. Hill, MS, is the co-founder and CEO of Pain University. In 2014, Lesli had suffered six years of catastrophic complications from a routine surgery, with intense pain being the most frightening part of the overwhelming complications.  Although she kept hoping it would go away, she sensed that this type of pain would stay with her perhaps for the rest of her life, which seemed impossible to imagine. Pain University is her answer.