Richard Podell, MD, on Reversing Eight Vicious Cycles that Block Fibromyalgia and Chronic Fatigue Syndrome Healing

Richard Podell, MD, is a clinical professor at New Jersey’s Robert Wood Johnson Medical School. He has special interests in chronic fatigue syndrome, fibromyalgia, stress-related disorders, and clinical nutrition. Dr. Podell has offices in Springfield and Somerset, New Jersey. For more information, see

People with any chronic illness tend to develop a set of self-defeating vicious cycles, which conventional medical approaches too often overlook. My practice places high priority on reversing these self-defeating cycles, as they are major obstacles to healing.

Vicious Cycle #1: Non-restorative Sleep 

Both Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome (CFS) disrupt sleep quality. Poor sleep, in turn, worsens physical and mental stamina. Poor sleep also increases sensitivity to pain. These, of course, further disrupt sleep. [See Dr. Podell’s lecture on “Improving Sleep Quality Despite Fibromyalgia or Chronic Fatigue Syndrome” – which includes a discussion of 13 principles that should be considered in approaching sleep problems for people with FM and CFS.]

Vicious Cycle #2: Disordered Breathing Rhythms

More than half of our patients with FMS or CFS develop a disordered pattern of breathing. They take very small rapid breaths using the small muscles of their chest instead of slow, deep breathing with the large muscles of the abdomen. These changes are subtle and most people who “hyperventilate” in this manner don’t realize that their breathing pattern is out-of-synch.

Shallow chest breathing makes people feel tense. Slow, deep abdominal breathing creates feelings of calmness. Disordered breathing can also cause a broad array of frightening symptoms including mental fog, dizziness, irritability, chest pain, feeling numb and more. Worsening symptoms then disrupt breathing further.

Vicious Cycle #3: Inactivity Leads to Progressive Loss of Physical Fitness (De-conditioning)

People with FMS and CFS often feel too ill to exercise, and if they push themselves, they get worse. However, not exercising at all is also a mistake. With inactivity, fitness fades. This increases a patient’s vulnerability (i.e., it takes less and less exertion before you’re pushed beyond your limits). This leads to less activity, which, in turn, leads to lower blood pressure and blood volume. Blood sugar becomes unstable. Disruptive stress hormones increase (e.g., adrenalin and cortisone). People feel worse, so they can do even less. And the cycle repeats itself.

Vicious Cycle #4: Magnesium Loss in the Urine

Both physical pain and mental distress cause magnesium loss through the urine. Low magnesium, in turn, turns up pain volume and also heightens vulnerability to stress. This brings about further magnesium loss.

Vicious Cycle #5: Hormonal Imbalances

Both physical and mental distress trigger the release of hormones such as cortisol that promote tissue breakdown. At the same time, distress depresses the output of hormones that promote growth (e.g., DHEA growth hormone). Thyroid and sex-hormones may also be affected. These hormonal disturbances undermine healing, which then leads to further hormone disruption.

Vicious Cycle #6: Blood Sugar Instability

The five vicious cycles just discussed all have adverse effects on the body’s blood sugar and insulin system. Blood sugar tends to rise higher after eating carbohydrates, and then falls rapidly lower, which is the “hypoglycemic” reaction. Actually, low blood sugar per se is not the direct cause of symptoms. Rather, falling blood sugar causes “stress hormones” to surge, including adrenalin and cortisol. These disruptive hormones are actually the cause of most “hypoglycemia” symptoms. These symptoms include: mood instability, depression, light-headedness, foggy brain, fluid retention and fatigue.

[See also Dr. Podell’s discussion of “Hypoglycemia Symptoms and Alternative Hypoglycemia Treatments”.]

Vicious Cycle #7: Mind/Body Tension

Feeling bad for so long makes people “tighten up,” both literally in their muscles and figuratively in their mind. Muscle tension increases pain and stiffness. Mental tension creates feelings of anxiety, and a sense of not being in control. This causes more physical and mental tension, reinforcing the illness.

Vicious Cycle #8: Losing Perspective, Losing Hope

People who are chronically ill tend to lose optimism and also their sense of perspective and proportion. Small set backs feel like catastrophes. Dips feel like they are taking forever. Anger suppresses immune function. A patient experiencing these lows may lose hope and stop trying. This heavy burden adds to the illness.

What tools do we have to reverse these vicious cycles?

• For sleep quality, we have many options including behavioral training, nutritional supplements, herbs and medicines.

• For disordered breathing, we teach how to restore rhythmic breathing. This can be mastered in just two or three training sessions.

• To improve physical fitness, the Goldilocks Principle applies – not too much exercise and not too little, but just the right amount. Within a few months this usually improves fitness, function and symptoms.

• For low magnesium, we offer a specialized test of magnesium status, and aggressively replace deficiencies.

• For hormone imbalances, we measure relevant hormones and consider the pros and cons of hormonal supplements.

• We treat blood sugar instability with the traditional anti-hypoglycemia diet plus several important new wrinkles.

• To reduce physical and mental tension, we teach a broad set of practical relaxation skills.

• There are also techniques for regaining perspective and realistic hope without long-term psychotherapy. Cognitive Behavioral Therapy (CBT) is a brief educational technique that teaches you how to “reframe” practical problems so that you deal with them more effectively.

Our strategy is to first reverse one vicious cycle, then the next and the next. This removes obstacles that perpetuate illness, thereby strengthening the body’s natural abilities to heal.

Richard Podell, MD
The Podell and King Medical Practice
105 Morris Avenue, Suite 200
Springfield, NJ 07081
Tel: 973-218-9191
Somerset, NJ office: 732-565-9224

Note: This information has not been evaluated by the FDA. It is for general information purposes only and is not meant to prevent, diagnose, treat, or cure any condition, illness, condition, or disease. It is very important that you make no change in your healthcare plan or regimen without researching and discussing it with your professional healthcare team.

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