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Considerations When Undergoing Treatment For Gulf War Illness, Chronic Fatigue Syndrome, Fibromyalgia, and Rheumatoid Arthritis

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Antibiotic Therapy for Chronic Infections and Inhibiting Drugs

Subsets of GWI (~40%), FMS (~70%), CFS (~60%) or RA (~45%) patients have chronic mycoplasmal infections, and probably other infections as well. Several months of doxycycline, ciprofloxacin, azithromycin, minocycline, clarithromycin or other antibiotics with cycles of Augmentin in between or concurrently, if needed, work best. Oral antibiotics must be taken with a full glass of water, crackers or bread to avoid esophageal irritation. During the first 6 months the cycles are usually run together without a break.

To overcome Herxheimer reactions or die-off (chills, fever, night sweats, muscle aches, joint pain, short term memory loss and fatigue) or adverse responses i.v. antibiotics have been used for a few weeks, and oral Benadryl (diphenhydramine HCl) 50 mg as needed and lemon/olive drink are useful (1 blended whole lemon, 1 cup fruit juice, 1 tablespoon olive oil–strain and drink liquid). This period usually passes within 1-2+ weeks. Some add the antiviral Famvir (500 mg 3X/day) or other anti-virals for the first 2 weeks in a 6-week antibiotic cycle. Mycoplasmas have some characteristics of viruses, so this can be useful, and viral infections are also important in these illnesses.

Antibiotic uptake and immune responses may be inhibited by some drugs, and anti-depressants (sertaline or Zoloft, fluoxetine or Prozac, amitriptyline or Elavil, maprotiline or Ludiomil, desipramine or Norpramin, clomipramine or Anafranil, nortriptyline or Pamelor, bupropion or Wellbutrin), muscle relaxants (cyclobenzaprine or Flexeril), opiate agonists, anti-convulsives or analgesics (oxycodone or Percodan, carbamazepine or Tegretol, acetaminophen/hydrocodone or Vicodin), narcotics (codeine w/ Penergan, propoxyphene or Darvon, morphine), antacids, antidiarrheas, metal salts, and others should not be taken, if possible, during therapy. Some (certain antibiotics, antidepressants, analgesics, narcotics, etc.) may inhibit immune responses.

Oxidative Therapy for Chronic Infections

Oxidative therapy appears to be useful in suppressing anaerobic infections: Hyperbaric Oxygen, American Biologics Dioxychlor are useful, or peroxide baths using 2 cups of Epsom salt in 20 inches of hot bath or Jacuzzi. After 5 minutes add 2-4 bottles 16 oz. of 3% hydrogen peroxide. Repeat 2-3 times a week; no vitamins eight hours before the bath. The hydrogen peroxide is added after your pores open. Hydrogen peroxide can also be directly applied to skin after a workout or hot shower/tub. One approach is to apply Swedish Beauty Type A tanning accelerator for 5 minutes before peroxide. Leave hydrogen peroxide on for 5 minutes and then wash off. For oral irrigation, mix 1 part 30% hydrogen peroxide with 2 parts water and use like a mouth wash, 3 times per day. Most chronic illness patients have dental problems, and infections are common.

General Nutritional Considerations

GWI/CFS/FMS/RA patients are often immuno-suppressed and susceptible to opportunistic infections, so proper nutrition is imperative. You should not smoke or drink alcohol or caffeinated products. Drink as much fresh fluids as you can, lots of fruit juices or pure water are best. Try to avoid high sugar and fat foods, and acid-forming, allergen-prone and system stressing foods or high sugar/fat junk foods. Increase intake of fresh vegetables, fruits and grains, and decrease intake of fats and simple or refined sugars that can suppress your immune system. To build your immune system, cruciferous vegetables and soluble fiber foods, such as prunes, bran, wheat germ, yogurt, fish and whole grains are useful. In some patients exclusive use of ‘organic’ foods has been beneficial.

Vitamins and Minerals

Chronic illness patients are often depleted in vitamins (especially B complex, C, E) and certain minerals. These illnesses often result in poor absorption. Therefore, high doses of some vitamins are useful; others, such as vitamin B complex, cannot be easily absorbed by the gut (oral). Sublingual (under the tongue) natural B-complex vitamins in capsules or liquids should be used instead of swallowed capsules.

General vitamins plus extra C, E, CoQ-10, beta-carotene, folic acid, bioflavonoids and biotin are best. L-cysteine, L-tyrosine, L-carnitine, malic acid and especially flaxseed or fish oils are reported to be useful. Certain minerals are depleted in chronic illness patients, such as zinc, magnesium, chromium and selenium. Some recommend up to 300 mcg/day sodium selenite, followed by lower doses. Minerals should not be taken at the same time of day as antibiotics because the minerals can affect the absorption of antibiotics.

Replacement of Natural Gut Flora with Lactobacillus

Patients undergoing treatment with antibiotics and other substances risk destruction of normal gut flora. Antibiotic use that depletes normal gut bacteria and can result in over-growth of less desirable bacteria. To supplement bacteria in the gastrointestinal system, yogurt and especially Lactobacillus acidophillus tablets are recommended. Mixtures of Lactobacillus acidophillus, L. bifidus, B. bifidum, L. bulgaricus and FOS (fructoologosaccharides) to promote growth of these “friendly” bacteria in the gut should be taken 3 times daily.

Natural Immunoenhancers or Immunomodulators

A number of natural remedies, such as ginseng root, herbal teas, lemon/olive drink, olive leaf extract and antioxidants are useful, especially during or after antibiotic therapy. Examples are Immunocal, Echinacea and vitamin C, olive leaf extract, and Tahitian Noni. These have been used to boost immune systems. Although these products appear to help many patients, their clinical effectiveness in chronic illness patients has not been evaluated. They appear to be useful during therapy or after to boost the immune system or after antibiotic therapy in a maintenance program to prevent relapse of illness.

Yeast/Fungal or Bacterial Overgrowth

Yeast overgrowth can occur, especially in females (vaginal infections). Gynecologists recommend Nizoral, Diflucan, Mycelex, or anti-yeast creams. Metronidazole (Flagyl, Prostat) has been used to prevent fungal or parasite overgrowth or other antifungals (Nystatin, Amphotericin B, Fluconazole, Diflucan) have been administered for fungal infections occurring while on antibiotics. As above, L. acidophillus mixtures are used to restore gut flora. Bacterial overgrowth can also occur, for example, in between cycles of antibiotics or after antibiotics have been stopped. This can be controlled with two week courses of Augmentin (3 X 500 mg/day) in between cycles or concurrent with other antibiotics.

Flying, Exercise and Saunas

Flying, excessive exercise and lack of sleep can make signs/symptoms worse. Flying exposes you to lower oxygen tension, and can stimulate borderline anaerobes that grow better at low oxygen (see above). Some exercise is essential, but avoid relapses due to overexertion. Dry saunas help rid the system of chemicals, and saunas should be taken at least 3X per week–moderate exercise, followed by 15-20 min of dry sauna and tepid shower.

Repeat saunas no more than 2X per day. Work up a good sweat, eliminating chemicals without placing too much stress on your system, and replace body fluids after each session. During exercise, patients should always avoid pollutant and allergen exposures. For recovery after exercise and to decrease muscle soreness, some use a Jacuzzi or hot tub, but only after a sufficient cool-down period. Don’t get overheated in the process. Don’t over do it!

Source: Intern. J. Medicine 1998; 1: 115-117, 123-128. Reprinted with permission from the author, Prof. Garth L. Nicolson.

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