Editor’s note: Though it’s been two decades since Dr. Paul Cheney first wrote this article on ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) treatments for ProHealth, we were struck by how relevant and useful it is today. We’ve updated it to fit the present language and current terminology for people living with ME/CFS and for reader clarity. We hope this article will continue to be of benefit to those working towards ME/CFS recovery, just at it has been for the last 20 years. If you have any questions about the information containted in this piece, please consult with your healthcare provider for current recommendations regarding treatment.
Below is a treatment pyramid. The bottom of the pyramid contains the most important strategy for improving your ME/CFS symptoms: Limit setting. Often, ME/CFS patients are very susceptible to push-crash phenomena, and they need to learn to stay within certain boundaries. To the extent they do that, they tend to do better. To the extent they don’t do that, they may not do well.
Potential ME/CFS Treatments
1. Elimination diet. The more I get into the issue of diet and food sensitivities, it’s obvious to me that the single most common antigen to which we are exposed is food proteins. Elimination diets, and improving digestion, and gut epithelial function can pay huge dividends. I’ve seen people in 30 days have huge clinical responses simply by this very simplest of moves.
2. Rebound exercise. We know that exercise can lead to post-exertional malaise (PEM) and a worsening of symptoms in many people with ME/CFS. Progressive aerobic exercise, in particular, especially in Phase 1 disease, is counter-productive. But during some point in the recovery process, you may find that you’re stable enough to engage in exercise, and rebounding is one option to consider. It’s very easy, it’s non-weight bearing, it does a very important job, I think, in autonomic tone in a population that has difficulty with exercise. But the most important thing is not to do aerobic exercise.
3. Stress management. Many patients have a defect in the HPA axis in response to stress, so they have to be stress limited. The need to learn how to handle stress better, and there’s all kinds of ways to do that. Ways like meditation, journaling, or restorative could be great places to begin.
4. Belief systems. A change in orientation from “doing” as a definition of yourself to “being” as the definition of yourself, and and to orient from recovery to healing. As soon as you orient toward “being” and healing, interestingly, ME/CFS patients are far better able to “do,” and I think far better able to heal — and recover.
5. Integration of supplements. Some of my preferences include:
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- Magnesium: Magnesium is an important element. Many are magnesium depleted.
- Taurine: Taurine is very important in brain protection.
- Mitochondrial DNA protection: We use a mix of things, such as a multi-vitamin chelated-mineral complex.
- Plant bioflavonoids: Plant bioflavonoids are very important. Examples of plant bioflavonoids are proanthocyanadins, French maritime pine bark, silymarin, quercetin, and there are many others.
- CoQ10: CoQ10 is a critical item in the protection of the DNA. I think the more the better, but realistically 200 mg. We tend to use it crunched under the tongue since it’s not very well absorbed, although there are other absorbable forms that can be swallowed.
- Alpha lipoic acid: Alpha lipoic acid may be one of the most important of all of these, in high doses, particularly for the central nervous system.
- Vitamin E: Extra vitamin E, an antioxidant, because it becomes depleted.
- Melatonin: Melatonin may be helpful also. It’s a potent antioxidant in the brain, particularly.
6. Medication options.
- Klonopin: For me, Klonopin is my most effective drug over the years. We use very low doses in the daytime. And at night we use higher doses.
- Doxepin elixir: An antidepressant with potent antihistamine properties. I suspect that this is the most powerful antihistamine known to man, and it gets into the central nervous system. We use very small amounts of this, and small doses at night.
- Neurontin: We’ve been using Neurontin sparingly. Neurontin could be a very potent weapon in resistant cases, but I’m a little bit concerned about the extremely high doses that are being used in some patients.
7. Detoxification. In ME/CFS patients, two thirds of them have no detectable B-12 in their brains, even though their blood levels are normal. We use high doses. We prefer hydroxycobalamin, and perhaps methylcobalamin.
8. Root canals. Root canal extraction, and particularly careful regarding bone excavation. This could be a big issue in some people, and heavy metal issues could be very prominent in some people.
9. Chemical detoxification. Some people are loaded with all kinds of pesticides and things, and they may need to be detoxified ultimately to see success.
10. Gut health. Implement the “3-R” program to bring back gut ecology. Remove the bad guys; support and repair the epithelial integrity, and then replace with friendlies.
11. Liver-gut resuscitation. The undenatured whey protein concentrate, I think, is the most important element in resuscitation of the liver and gut. Add silymarin to recycle glutathione between it’s reduced and oxidized states.
This pyramid is an integrated program. No one element suffices —it’s everything working together. It’s a stepwise program, meaning you move up the scale every one or two weeks. You don’t start it all at once. Patience is required for ME/CFS recovery.
The article was first published on Prohealth.com on March 10, 2000 and was updated on March 17, 2020.