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Q & A with Jacob Teitelbaum, M.D.: Treating the Pain and Fatigue of FM and CFS Comprehensively

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Dr. Teitelbaum is a board certified internist and director of the Annapolis Center for Effective CFS/Fibromyalgia Therapies. Having suffered with and overcome these illnesses in 1975, he spent the next 30 years creating, researching, and teaching about effective therapies. He sees patients in Kona, Hawaii and Annapolis, Maryland (410-266-6958). He is the senior author of the landmark study “Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia — a Placebo-controlled Study”. He lectures internationally. He is also the author of the best-selling book” From Fatigued to Fantastic!”, “Three Steps to Happiness! Healing through Joy”, and the recently released “Pain Free 1-2-3- A Proven Program to Get YOU Pain Free! “ His web site can be found at: www.Vitality101.com.

“Dr. Teitelbaum believes one not-so-obvious factor of painful conditions, like fibromyalgia, may be an energy crisis in the body’s cells. That’s where the sugar ribose comes in. Ribose is used by the cell’s power-generators, mitochondria, to make energy molecules for the body. Ribose is actually one component of DNA (deoxyribonucleic acid). The body creates some of this special type of sugar, however, some people are not able to create enough of their own ribose — leading to less energy and more pain.” (source: Ivanhoe Newswire, reported by Vivian Richardson, online at www.ivanhoe.com)

ImmuneSupport.com: Dr. Teitelbaum, I read the preceding piece of intriguing information in a recent Ivanhoe Broadcast News interview, and I’m sure our readers would like to know more. Could you please explain in more detail why cells become vulnerable to an “energy crisis,” how ribose can help fibromyalgia (FM) patients, and how you incorporate it into an overall treatment program? Please include the highlights from your recent research study.

Dr. Teitelbaum: I do not view CFS and Fibromyalgia as the enemy. Rather, I see them as attempts on the body’s part to protect itself from further harm and damage in the face of any of a number of overwhelming stresses. Research has implicated mitochondrial and hypothalamic dysfunction as common denominators in these syndromes. Dysfunction of hormonal, sleep and autonomic control (all centered in the hypothalamus) and energy production centers can explain the large number of symptoms and why most patients have a similar set of complaints.

To make it easier to understand, we use the model of a circuit breaker in a house:

“If the energy demands on your body are more than it can meet, your body “blows a fuse”. The ensuing fatigue forces the person to use less energy, protecting them from harm. On the other hand, although a circuit breaker may protect the circuitry in the home, it does little good if you do not know how to turn it back on or that it even exists.”

This analogy actually reflects what occurs. Research in genetic mitochondrial diseases show not simply myopathic (muscle) changes, but also marked hypothalamic disruption. As energy stores are depleted, hypothalamic dysfunction occurs early on (because this is the most energy dependent area in your body), resulting in the disordered sleep, autonomic dysfunction, low body temperatures, and hormonal dysfunctions (despite normal blood tests) commonly seen in these syndromes.

In addition, inadequate energy stores in a muscle results in muscle shortening (think of rigor mortis) and pain which are further accentuated by the loss of deep sleep.

Therefore, restoring adequate energy production and eliminating the stresses that over-utilize energy (e.g.-infections, situational stresses, etc) restores function in the hypothalamic “circuit breaker” and also allows muscles to release-allowing pain to resolve. Our placebo controlled study showed that when this is done, 91% of patients improve, with an average 90% improvement in quality of life, and the majority of patients no longer qualified as having FMS by the end of three months.

An editorial in the Journal of the American Academy of Pain Management noted that “Teitelbaum’s study and years of clinical experience show that his protocol is an excellent and highly effective part of the standard of practice for treating Fibromyalgia and MPS” (see the full study text at http://www.immunesupport.com/library/showarticle.cfm/ID/3599/T/CFIDS_FM/searchtext/teitelbaum). CFS and FMS are now very treatable!

Your body can become susceptible to an energy crisis for many reasons. For example, a number of infections have been shown to directly inhibit energy production and your mitochondrial “energy furnaces.” Others may have a genetic problem that results in your body going into “immune overdrive and exhaustion” in the face of certain infections.

Some people simply get overwhelmed by a massive amount of life stresses (often because we are “people pleasers”), are more sensitive to the increased chemical exposures seen in modern life, or have inadequate sleep after an injury or having a baby. There are literally thousands of ways to overdraw your body’s energy resources and trigger CFS/fibromyalgia.

Using this model, you can treat the illness by avoiding excessive energy losses (e.g., infections, toxic jobs or relationships, etc.) or by increasing energy production. As discussed above, our research and clinical experience has shown that by treating “SHIN” (sleep, hormonal deficiencies despite normal blood tests, infections, and nutritional deficiencies), 91% of CFS/fibromyalgia patients improved with an average 90% improvement in quality of life. Nutritional support is an especially important and a powerful part of getting well.

In addition to its role in making DNA and RNA, those of you familiar with biochemistry remember ribose as the key building block for making energy. In fact, the main energy molecules (like “energy dollars”) in your body (ATP, FADH, etc.) are made of ribose plus B vitamins/phosphate. That makes these energy molecules similar to the paper that money is printed on — kind of like being able to print your own “energy currency.”

ImmuneSupport.com: You specialize in the comprehensive, whole-person treatment of the spectrum of symptoms and issues that FM and CFS patients face. How does your approach differ from the limited care many patients receive, and what advice can you give our readers about seeking out more comprehensive care?

Dr. Teitelbaum: These illnesses do not have a single cause, and trigger a cascade of problems that need to be treated. Our research has shown that when you treat all of the underlying problems simultaneously, people get well!

The other difference is that the FDA will generally only approve individual treatments, and therefore research dollars are spent looking for a “magic bullet.” When you use only a single treatment you may improve one system in your body, but you then stress other systems which often later crash. This is why patients often feel better for a while on single treatments, only to have them stop working. Our study showed that by using a comprehensive medicine approach, at the two-year follow-up patients were continuing to feel better and better, while having been able to come off of most of the treatments as their bodies healed.

ImmuneSupport.com: Your new book, Pain Free 1-2-3! (McGraw Hill), will be available this February. Could you give us a sneak peek at some of the main topics this book will cover that concerns FM and CFS patients?

Dr. Teitelbaum: The table of contents below (from the first edition now available at www.Vitality101.com) gives an idea of the scope of the book. Except for cancer pain, most of these issues are common in and relevant to CFS/FMS.

Table of Contents

Introduction—From Pain to Pain Free!

Section 1 General Principles of Pain Relief—Giving Your Body What It Needs to Heal and Eliminate Pain

Chapter 1 Getting Started—Why We Have Pain

Chapter 2 Optimizing Nutritional Support Easily

Chapter 3 Getting 8 hours of Sleep a Night—The Foundation of Pain Relief

Chapter 4 Treating Hormonal Deficiencies

Section 2 Eliminating the Underlying Causes/Triggers of Your Pain

Chapter 5 Infections

Chapter 6 Body Work, Structural Issues and Trauma, By Bren Jacobson

Section 3 Types of Pain

Chapter 7 The Biochemistry of Pain

Chapter 8 Neuropathic (Nerve) Pain and Reflex Sympathetic Dystrophy (RSD)
Chapter 9 Myofascial (Muscles/Ligament/Tendon) and Fibromyalgia Pain

Chapter 10 Arthritis Pain

Chapter 11 Inflammatory Pain

Chapter 12 Other Pains—Osteoporosis and Cancer Pain

Section 4 Evaluating and Treating Common Pains Based on Their Locations

Chapter 13 Headaches and Facial Pain

Chapter 14 Back Pain

Chapter 15 Indigestion, Ulcers, Acid Reflux, and Gastritis—Getting off Acid Blockers Naturally

Chapter 16 Spastic Colon

Chapter 17 Noncardiac Chest Pain

Chapter 18 Pelvic Pain Syndromes—Menstrual Cramps, Vulvadynia, Interstitial Cystitis, Endometriosis and Prostadynia

Chapter 19 Wrist, Hand, Shoulder, Leg, and Foot Pains

Section 5 A Review of Effective Therapies

Chapter 20 Natural Remedies

Chapter 21 Structural Therapies—Chiropractic and Osteopathic Medicine

Chapter 22 Prescription Therapies—We’re Way Past Aspirin!

Chapter 23 Prolotherapy

Chapter 24 Traditional Chinese Medicine: Acupuncture for Coordinated Wellness-Care

Chapter 25 Sexual Dysfunction, Depression, and Mind-Body Aspects of Pain

Chapter 26 Eliminating Weight Gain

Appendix A: Summary (like “Cliff Notes”) and Flowcharts for Quickly Evaluating Your Pain and Determining How to Treat It

Appendix B: Treatment Protocol

Appendix C: Resources

Appendix D: Study Abstract—Effective Treatment of Fibromyalgia and CFS; Editorial published in Journal of the American Academy of Pain Management

Appendix E: Why Physicians Do Not Focus on Pain Medicine

Appendix F: Myers’ Cocktails

Appendix G: Footnotes/references

ImmuneSupport.com: After pain, fatigue is a primary problem for FM and of course CFS patients. Do you have any new strategies for defeating the debilitating fatigue that CFS and FM patients struggle with?

Dr. Teitelbaum: In our recent study, ribose was shown to help in treating fatigue with the average CFS/FMS patient, with up to a 45% improvement in energy.

The entire “SHIN Protocol” helps with increasing energy – often dramatically as well. Prescription medications that can help directly are Provigil, which I find modestly helpful. But please note, we have no idea what the long term risks of this medication are. Much more effective, and I feel safer, is the use of Dexedrine.

Although in the Amphetamine family (like Ritalin), it can be very helpful in CFS as it can normalize low Dopamine levels, treat the NMH, decrease the average 32 pound weight gain seen in this disease(which can then also decrease both pain and sleep apnea), and help energy directly. As long as the rest of the body is supported with the “SHIN Protocol” we have found it to be very safe and effective, despite theoretical concerns that have been raised, and we know its long term effects.

ImmuneSupport.com: Of the new prescription drugs available, do you like any of them for helping with FMS and CFS issues? A new study of Milnacipran was completed recently, and I just read that Ampligen could soon be available due to a new manufacturing agreement.

Dr. Teitelbaum: My two new favorites are Lyrica (Pregabalin) for pain and Xyrem (GHB) for sleep and pain. I have concerns with Ampligen, as it is a new category of medication (like Provigil) so we have no idea what the long term risks might be. In addition, if it continues to cost about $30,000+ per course of treatment, you can expect your insurance company to make your life miserable trying to get it. The SHIN protocol is much safer with no dangerous side effects in over 3000 patients, much more effective, much less expensive, and gives the body what it needs to restore health and balance-using largely natural therapies. I’ve only needed to recommend Ampligen in three of the over 3,000 CFS/FMS patients I’ve treated.

ImmuneSupport.com: Of the newer alternative therapies available, do you like any of them for helping with FM and CFS issues? Lately I’ve been reading about neurocognitive feedback, acupuncture, and even hypnosis (to help with IBS).

Dr. Teitelbaum: As we’ve noted for many years, the IBS (and chronic sinusitis) routinely goes away when you treat the yeast/Candida issues. For IBS, make sure parasites and other bowel infections are also treated. Prolotherapy and acupuncture can help many types of pain, but are usually not powerful enough by themselves in treating FMS. A neurofeedback treatment called Flexyx (see www.flexyx.com ) can be more helpful for FMS pain. For those of you with severe sensitivities/allergies, treating food and other sensitivities using a special acupressure technique called NAET can be helpful in treating CFS/FMS.

ImmuneSupport.com: Is there something simple that our readers can try right now to help with their pain and fatigue, without going to much trouble or expense?

Dr. Teitelbaum: I strongly recommend that you add a few key things as you start applying “SHIN”:

A-Sleep-My treatment protocol [see http://www.immunesupport.com/library/showarticle.cfm/ID/3346/T/CFIDS_FM/searchtext/teitelbaum] gives a list of natural and prescription sleep aids that are healthy and effective in CFS/FMS. It may be hard to believe, but you can get 8-9 hours of restorative sleep a night.

B-Hormones– Get a trial of Armour Thyroid from your doctor-even if your blood tests are normal.

C-Infections-Presume that Yeast/Candida overgrowth is present and treat it with Acidophilus plus Diflucan 200 mg /day for 6 weeks.
D-Nutritional support- Use a vitamin powder. Increase salt and water intake and eliminate sweets (stevia is OK).

ImmuneSupport.com: Are you involved in any exciting new CFS or FM research?

Dr. Teitelbaum: The next study we hope to do will be a “Gold standard” placebo controlled study on Ribose/Corvalen in CFS/FMS to follow up our initial pilot study. If you would like to be part of the study (it’s easy – we’ll mail it to you), e-mail us at office@endfatigue.com so we can let you know when it’s starting. After that, we’re planning a study on highly effective natural treatments for infertility (also common in CFS) followed perhaps on a study exploring the effectiveness of detoxification.

ImmuneSupport.com: Thank you for your time! Any parting advice or comments for our readers? It is so easy to lose hope from time to time, and feel discouraged and frustrated when you are struggling with these debilitating illnesses.

Dr. Teitelbaum: I had CFS and Fibromyalgia and have treated thousands of people successfully. Don’t spend 20 years trying to train your doctor! My web site has a list of practitioners who know how to help you NOW, or you can even come to our clinic (410-266-6958). Despite the confusion and politics surrounding CFE/FMS, these are very treatable illnesses.

Best wishes,
Jacob Teitelbaum, M.D.

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