Chronic Fatigue^® Information

Edward Lichten, M.D.,PC
180 East Brown Street
Birmingham, MI 48009 
248.593.9999

OVERVIEW:
Chronic fatigue is a mystery illness to most physicians because they cannot find a specific 'cause' of this disabling condition. They have looked for a virus and found Epstein-Barr, cytomegalovirus (CMV), herpes simplex I and II, and even a Herpes VI. But treating these viruses with anti-viral medications such as Zovirax®, and even Ampligen® does not eradicate Chronic Fatigue Syndrome/ Chronic Fatigue Immune Dysfunction Syndrome (CFS/CFIDS).

The reason that CFS/CFIDS is so mysterious is that physicians are taught that there must be an external cause for illness within the body. This tunnel-vision prevents them from seeing CFS/CFIDS as a deficiency of the immune system of the human body. The immune system fails to keep routine viruses like Epstein-Barr suppressed because the human body is unable to generate enough energy for the body to keep healthy. The terms we use are ANABOLIC (makes energy to repair) and CATABOLIC (breakdown from lack of energy).

Anabolic is the ability to grow and repair tissue. To define anabolic look at the transition from pre-teen to young adult. Anabolic processes promote growth in height, development of muscle, unlimited energy and improved reproductive function. All these processes take energy. Compare these teenagers to individuals in a nursing home. They are unable to repair their thin skin, unable to make muscle to get out of a chair, unable to fight off the simplest virus or bacteria. They are catabolic. Catabolic refers to a state of breakdown and disrepair.

Causes of Catabolic States:
There are a number of causes for development of a catabolic state. Examples are overwhelming infections, major trauma with crush tissue injuries, major surgery and of course, getting old. If the body cannot generate enough energy to repair the damage, then we die. If our body can generate enough energy to repair the tissue, then we proceed with anabolic repair and we live. It all depends on how much energy are system can produce. And if our system has a problem with its ability to produce energy, we remain catabolic. Doctors now call this state, CHRONIC FATIGUE!

Making the Diagnosis:
CDC Criteria include the following:

• Severe unexplained fatigue for 6 months or longer

• Not caused by exertion or relieved by rest

• Has an identifiable onset (not entire life)

• Results in substantial reduction in previous levels of occupational, educational, social or personal activities.

• No active medical diagnosis including depression, eating disorders, psychosis, alcohol/substance abuse and severe obesity.

Four or more of the following symptoms must have persisted or recurred during 6 or more months of consecutive illness and must have predated the fatigue:

• Short-term memory or concentration problems

• Sore throat

• Multiple joint pain without joint swelling or redness

• Myalgia (muscle pain)

• Headache or a new type, pattern or severity

• Non-refreshing sleep

• Post-exertional malaise lasting more than 24 hours

Understanding How the Body Makes Energy:
THE KREBS CYCLE

We convert the food we eat into energy. As Edward J. Conley, D.O. noted in his book America Exhausted: Breakthrough Treatment of Fatigue and Fibromyalgia, 80% of the energy is converted into heat. If an individual is 5 or 10% less efficient in generating energy, then he is 25% lower in energy production for the necessary anabolic processes. The problem is that eating more food generates more fat stores, not more energy!

Consider energy production that occurs at the industrial plant. In the furnace at the plant, a substance is burned to create energy. In the cells of the body, this furnace is located in the structures called mitochondria. The energy the mitochondria produce from burning food is called ATP for adenosine triphophate. ATP is the body's fuel. It is the energy that generates our heat, lights our imagination and repairs our body's equipment. Without ATP there is no energy, no heat, no light, no action.

Just like any industrial plant, the mitochondria need a whole list of substances to make energy. Some are vitamins, some are minerals, and the building blocks are proteins. The list appears below:

But the key is first that these substances must be absorbed from the gastro-intestinal track and secondly, that the enzymes that work to produce energy are not poisoned so that they are prevented from making ATP!

Treatments:
Non-Hormonal Treatments are Secondary in Importance. Conley's protocol is included for historical purposes only. We do not use Kutapressin but rely on nutrition and hormonal therapy entirely.

1. Add B12 and pancreatic enzymes. One of the problems with a 'leaky gut' is the failure to absorb the necessary vitamins and nutrients while allowing large molecules to 'leak in.' These larger molecules cause an inflammatory and allergic reaction and make the individual sicker. The body becomes too busy fighting these allergens to produce the necessary enzymes to digest food, thereby increased indigestion. By adding pancreatic enzymes and B12, the body gets the proper enzymes to start the healing process by absorbing appropriate nutrient.

2. Add liver sparing glutathione. Because the liver must handle the toxins produced by yeast, it needs the most help. We use 2000 mg of IV glutathione twice weekly with 25 grams of Ascorbic Acid (vitamin C) and 5 grams of magnesium to support the liver.

Adding Hormonal Therapy

• Pituitary

  1. Human Growth Hormone. No substance has a more pronounced improvement on Chronic Fatigue or Fibromyalgia than hGH, human growth hormone. The longer the CFS/CFIDs exists, the lower the levels of Somatomedin-C, IGF-1 from the liver. This is the active form of tissue growth factor. Without it, repair does not occur. The measured level of IGF-1 should be greater than 200 mg/ml but levels over 300 are optimal. HGH is replaced with 4 to 16 IU per week in daily subcutaneous injections. Some individuals inject 1/2 in the morning and 1/2 before bedtime. RM Bennett, MD, professor and chairman of Arthritis and Lupus at the University of Oregon made this discovery more than 10 years ago and has confirmed that hGH makes a tremendous difference in those with low levels of IGF-1.

  2. Calciferol (Vitamin D3). CFS/CFIDs have sleep disturbances. We use the oral Vitamin D3 4000 IU drops per night to assist in sleep. For without sleep, there can be no repair and release of IGF-1. If further sleeping aids are needed, we will use Gabapentin 500mg at bedtime because it helps most with the muscle aches. On other occasions, Atarx® 25-50m may be prescribed. Rarely do we allow short term Xanax® .5mg.

  3. Serotonin. Serotonin is necessary to control mood and thought. Most of these CFS/CFIDs individuals are low in Serotonin. The precursor to Serotonin is tryptophan. Tryptophan is found in turkey, for example, and protein drinks. However, we find the intermediary, 5-hydroxytryptophan to be most convenient. This is available in 50mg capsules from a compounding pharmacist. We start with 200mg at bedtime and 100mg three times daily. More can be taken at bedtime. 5-HTP helps in the treatment of both PMS and depression.

• Adrenal Hormone Replacement. There are a number of adrenal support products made from ground up adrenal glands. These are sold over-the-counter. We use the ones from Biotics Research. However, this adds the building blocks for the creation of the following powerful hormones.

  1. DHEA. Dihydro-epiandrosterone is the key to energy production in the cell. DHEA is a key to Anti-aging therapy as well. This hormone is necessary for the conversion and use of sex hormones and probably many other intracellular functions. Normal levels in the teens are 300-600ng/ml. I have seen levels less than 20 in those with CFS/CFIDs. Replacement is with 10-50 mg in the morning and afternoon. Some can take it at bedtime, but many report it keeps them awake.

  2. Cortisol. Although the problem with CFS/CFIDs sleep pattern is too much cortisol release late in the evening, for some, cortisol replacement actually turns down the cortisol response. WE add 2.5-10 mg of Cortisol in the morning and then 2.5-10 mg at 1 PM. Some need 5 mg at 4-5 PM. Thereafter, the cortisol levels drop before bedtime improving sleep. Many individuals report that the afternoon cortisol dose makes them inclined to take a short nap. I assure them this is normal and helpful to replenishing their sleep deprivation.

• Thyroid. The thyroid is taxed because of the lack of sleep and disturbance in enzyme production. There is a decrease in the conversion of T4 to T3. This is usually not apparent on laboratory tests but the basal body temperature before arising is less than 98*F. Therapy with Armour thyroid and sustained T3 is necessary to increase body temperature and activity level.

• Testosterone. Not enough can be said about the positive effects of testosterone in both men and women. This is the strongest natural anabolic hormone. Both men and women report that testosterone improves their lives more than any other compound.  See testosterone link for dosing.

• Estrogen. All women in the menopause, except those with estrogen receptor positive breast cancer and deep vein thrombophlebitis should be on natural estrogen replacement. We prefer the estradiol pellets and testosterone pellets for ease of use and the avoidance of the allergic reactions to transdermal patches. Oral estrogens worsen the load on the liver.

• Progesterone. Much has been written about the use of low dose progesterone for these conditions. It surely will not hurt either a man or a woman. We suggest progesterone gel applications to the skin twice daily in women. Compounding pharmacists will make up a 3 - 6% solution. Over-the-counter preparations are usually less than this or none at all. We doubt that there is a benefit to men. For both we prescribe pregnenolone for memory with the conversion of some pregnenolone to progesterone.

CONCLUSIONS: Chronic Fatigue is a Catabolic disease. Many systems are breaking down which continue the illness. Only by addressing each one of the 'broken-down' systems will there be a chance for improvement. Stop the sugar, the toxins, the antibiotics and try to repair the gut with the appropriate vitamins, enzymes, and quality food. Kill the yeast with Diflucan® or Nystatin® then add lactobacillus. And add back anabolic hormones to improve the body's ability to heal and make repairs (Anabolic processes). IV vitamin therapy (Majid Ali, MD  protocol) with glutathione twice weekly complements the added DHEA, calciferol (Vitamin D3), hGH, testosterone and estrogen/progesterone.

There is new hope for chronic fatigue. Let us hope we stop the disease by fixing our environment before CFS/CFIDs affects every last one of us!

The information in this newsletter does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice.

For Additional Information:

• See Fibromyalgia.
• See DHEA for energy
• See Growth Hormone-overview

The materials within this website are copyrighted under the statutes of the State of Michigan. For additional copies contact:
 

 Laura's
Fatigue Story

Reference Materials