Michael E. Rosenbaum, M.D., is a pioneer in Nutritional Medicine with 25 years experience in alternative healthcare, specializing in the treatment of Chronic Fatigue Syndrome, fibromyalgia, Myofascial Pain, endocrine and metabolic disorders, and allergies. He is currently in private medical practice in Corte Madera, California.
Early in my career, about thirty years ago, I underwent a period of extreme stress and exhaustion. Even in those days, I had an intuitive leaning toward natural healing and turned to diet and nutrients for rejuvenation. I had been fascinated by nutritional therapeutics way back in the early seventies when there was a relative scarcity of available nutritional supplements. I was influenced by the works of leading naturopathic doctors of the time, especially Paavo Airola who wrote seminal books including “Are You Confused” and “How to Get Well”.
I was introduced to nutritional medicine by joining the Orthomolecular Medical Society (OMS), one of whose founders and the President Emeritus was Linus Pauling. It was an exciting time for this burgeoning young field. I recall the almost palpable electricity in the air at nutritional medical meetings as new findings concerning nutritional therapeutics were reported. We were all so hungry for this information. We felt that we were participants in a fundamental health revolution that emphasized healing over symptom suppression. Eventually, I became President of the OMS and was privileged to be able to contribute to the evolution of orthomolecular medicine.
Healthwatch (HW): You are a pioneer in nutritional medicine with over 25 years of experience in alternative healthcare. How did you come to value nutritional and alternative approaches as being effective in treating your patients with Chronic Fatigue Syndrome (CFS)?
Dr. Rosenbaum: I became interested in CFS soon after the article in the Annals of Internal Medicine describing the Incline Village epidemic was published by Cheney and Peterson in January, 1985. Subsequently, I began to see more and more patients with CFS and what is now called fibromyalgia. The diagnosis, management and disability insurance support of patients with these very real fatigue disorders now constitute about 75% of my medical practice. In 1992, I crystallized my long experience with CFS in a book that I co-authored with Murray Susser, M.D., entitled Solving the Puzzle of Chronic Fatigue Syndrome (Life Sciences Press). We advanced the concept that CFS is a multifactorial condition with the possibility of multiple coexisting infections and endocrine imbalances.
HW: About how many CFS and fibromyalgia (FM) patients have you treated? Do you have a standardized treatment protocol for your CFS and FM patients?
Dr. Rosenbaum: Because of its inherent variability, it is unrealistic to create a rigid standardized treatment protocol for CFS. Although symptoms frequently overlap among CFS patients, each CFS patient is different and manifests a unique symptom blueprint. In the treatment chapter of my book, four steps were proposed as part of a general treatment approach:
Step 1: Treat mixed infections especially those that are readily apparent and treatable as bacterial and/or fungal sinusitis or enteritis.
Step 2: Treat allied mixed conditions which often occur in CFS patients. These include food and inhalant allergies and sensitivities, mold exposure, heavy metal toxicity; adrenal, thyroid and sex hormone endocrinopathies.
Step 3: A) Inactivate the core intracellular microbes that may cause the disease including herpes family viruses, enteroviruses, mycoplasma species and Chlamydia pneumonia.
B) Normalize the immune dysregulation that appears to characterize CFS, including abnormally high T-cell activation and a shift in the predominant immune response from T helper-2 which emphasizes antibody responses to allergens and autoimmune reactions to a T helper-1 mode, which emphasizes the eradication of intracellular viruses and bacteria.
Step 4: Heal nervous system problems involving mental alertness, cognition and mood disorders.
HW: What are your treatment recommendations regarding improving sleep, low energy, pain, and depression among your CFS and FM patients?
Dr. Rosenbaum: A menu of medications, nutrients and herbs help the treatment in each step described above. The following nutrients and alternative approaches have worked best in my practice:
Energy: B Complex vitamins, especially vitamins B1 and B12; NADH – a stabilized form of vitamin B3, Coenzyme Q10. The above vitamins all participate in the formation of ATP energy packets. For muscle energy, creatine, carnitine and branched chain amino acids are often very useful.
Cognition: Raising brain acetyl choline with tyrosine, N-acetyl carnitine and DMAE; supporting brain cell membrane functions with phosphatidyl serine.
Anxiety: Magnesium, relaxant herbs.
Poor mood: amino acid neurotransmitter precursors phenylalanine, tyrosine and tryptophan or 5 HTP; also, SAM-e.
Sleep: It is important to preserve stage 4 deep or ‘slow wave sleep’. Stage 4 sleep is interrupted by benzodiazepines like lorazepam that are frequently used by CFS patients. Tricyclic antidepressants like elavil and sinequan are also excellent sleep inducers and enhance stage 4 sleep but can impair dreaming during REM sleep and cause weight gain.
These are very useful medications in spite of their adverse effects upon sleep architecture. Sonata does not disrupt any of the sleep stages and is particularly useful with middle of the night awakening due to its rapid disappearance from the blood stream.
I have found that a cocktail of calcium 600 to 800 mg and magnesium 300 to 500 mg taken before bedtime has a relaxant effect that is very useful for sound sleep and to prevent restless legs. Melatonin and serotonin inducers like tryptophan and 5 HTP are also very useful. Too much tryptophan can cause bizarre and unpleasant dreams. GABA which occupies GABA receptors helps allay anxiety and induces sleep. Usual dose are 500 to 1500 mg.
–Nutrients: MSM at high doses of 8 to 12 grams a day. DLPA at doses of one to three grams a day increases endorphins.
–Drugs: Ultram (generic- tramadol) is my favorite. It has very low addiction potential and seems to work well. It is energizing and can cause insomnia if taken too late in the day.
–Nutrients: all antioxidants which are anti-inflammatory. Fish oil supplements – especially those with a high EPA content, promote a healthy inflammatory response.
–Drugs: NSAIDs if tolerated. These need to be carefully monitored and can cause a wide variety of adverse effects.
HW: What do you believe are the most common factors for these illnesses – why do you think so many CFS patients also have FM, and vice-versa?
Dr. Rosenbaum: About 80-90% of CFS patients have FMS (fibromyalgia syndrome). I believe that FMS has multiple causes including chronic infections, physical and emotional trauma and connective tissue inflammatory diseases. CFS is just one potential cause of FMS.
There are similarities in both conditions including low brain serotonin and low vitamin B12 levels in cerebrospinal fluid. Both conditions exhibit abnormalities in immune cytokines with an elevation of proinflammatory cytokines and a decrease in exercise and a frequent profound deficit in slow wave sleep.
HW: You participated in a 2001 clinical research study “Improved Immune Activation Markers in Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Patients Treated with Thymic Protein A.” Would you talk a little bit about this study?
Dr. Rosenbaum: I believe Thymic protein A is a potent T helper-1 stimulant. I have focused much of my attention in recent years on the effects of diet, individual nutrients and herbs upon immunity in general and upon the aberrant immune response in CFS patients. The literature on the immune response in CFS patients indicates a trend toward a decline in the response of Natural Killer (NK) and T helper-1 cells to customary immune stimuli. Many of us in the field have been searching for ways to restore T helper immune balance.
Thymic protein A (TPA) appears to be such an immune modulator. It is a native thymus peptide which is necessary for the activation of T helper-1 cells. THP is grown in cell culture from a single bovine cell obtained about ten years ago. I participated in a study on CFS patients who had been ill for at least one year and whose symptoms and treatment program had plateaued. These patients were treated with one packet of TPA containing 4 mcg of TPA administered sublingually three times a day for three consecutive months and were examined at baseline, six weeks and three months. Blood tests for CFS biomarkers included T cell numbers and activation markers, RNAase, 2,5A synthetase and NK cell activity. Quality of life questionnaires were filled out weekly.
The results were encouraging. T-Cell activation markers were reduced in about 2/3 of the patients. There was an overall trend toward a reduction in the RNAase anti-viral enzyme system. Substantial improvements were noted in ‘Quality of Life’ symptom scores especially with regard to anxiety, mood, short-term memory and non-restorative sleep. There was an improvement in the incidence of canker sores in nearly 100% of the participants who had canker sores before trying TPA. I suspect that the improvements in blood tests and symptom scores would have been even more significant if the trial were to have been extended longer than three months.
HW: What do you think the future looks like for CFS and FM patients? Are we moving forward in dealing with these diseases – as patients, practitioners, and as a society?
Dr. Rosenbaum: CFS is a multidimensional disorder. There is, as yet, no simple and definitive diagnostic test or magic bullet cure. In spite of this complexity, I do believe that the future for the identification and control of CFS appears brighter. Laboratory tests are slowly honing in the identification of subtle infections and T Cell immune dysregulation. Immune-modulating agents are available including concentrated mushroom and thymic extracts that were not sold in stores just a few years ago.
Two other dimensions of CFS are receiving increasing attention:
1)The role of dysautonomias manifested by abnormal regulation of pulse, blood pressure and body temperature and, 2)The role of hypercoagulopathy – an increased tendency of the blood in CFS patients to impede blood flow to the brain and muscles and to sequester potentially harmful microorganisms and shield them from immune surveillance and destruction.
The puzzle pieces of Chronic Fatigue Syndrome are gradually forming patterns that will allow for more ready diagnosis and treatment in coming years. HW