Oxidation for Chronic Fatigue Syndrome and Fibromyalgia
It would not be an underestimation to say that the great majority of my naturopathic patients present with some form of fatigue and fibromyalgia type pain, in which they would like help from. It is a very common complaint even in cities such as Vancouver and Richmond, which have a relatively health conscious population. In many cases, the fatigue is a symptom of a coexisting disease. For example, fatigue is one of the many symptoms of diseases such as rheumatoid arthritis, anemia, hypothyroidism, congestive heart failure, and so forth. In fact, fatigue can be a symptom of almost every disease process. This is why a conventional workup, including history, examination, and when necessary, laboratory investigation, is necessary to rule out reasonably likely disease processes that may cause fatigue. In these cases, the fatigue is secondary, and will resolve when treatment for the primary condition has been successful.
But how about the patient, and there are many of them, where fatigue persists and no conventional cause or diagnosis can be found? The numbers are actually quite staggering, as the CDC states that up to 4 million Americans suffer from the disease that has been labelled chronic fatigue syndrome. When specific types of pain and sensitivity are present, then the diagnosis is chronic fatigue syndrome and fibromyalgia. Diagnosis is a challenge for a conventional internal medicine approach because there are no consistent lab biomarkers that are specific for CFS, patient's do not “look sick,” as mentioned above, fatigue is common to many other illnesses, and finally, chronic fatigue syndrome and fibromyalgia can tend to relapse and remit. Can 4 million American's, (and many Vancouver and Richmond patients of course!) and many more world wide, all have chronic fatigue and fibromyalgia, and yet be correctly told that there is “nothing wrong with them?”
The CDC in the US has given the following two criteria for a diagnosis of chronic fatigue syndrome:
1. Unexplained, persistent fatigue that's not due to ongoing exertion, isn't substantially relieved by rest, is of new onset (not lifelong) and results in a significant reduction in previous levels of activity.
2. Four or more of the following symptoms are present for six months or more:
• Impaired memory or concentration
Postexertional malaise (extreme, prolonged exhaustion and sickness following physical or mental
• Unrefreshing sleep
• Muscle pain
• Multijoint pain without swelling or redness
• Headaches of a new type or severity
• Sore throat that's frequent or recurring
• Tender cervical or axillary lymph nodes
That is a reasonable list that covers most of my patients who have chronic fatigue and have had other, reasonably likely, diseases ruled out.
Additional Naturopathic Work Up for chronic fatigue syndrome and fibromyalgia
Naturopathic medicine views a patient from a wholistic perspective. It is not simply about using natural substitutes for drug products or surgery. Conventional medicine is largely pathology based, meaning that the search to help a patient begins in a very linear fashion, with the premise that naming, blaming, and taming a disease will cure the patient. For example, in a patient who has a low mood and meets the criteria for depression, the process might involve naming depressing, blaming serotonin deficiency, and then taming depression with serotonin reuptake inhibitor drugs.
A naturopathic approach in depression might involve, depending on the detailed history, looking at subtle thyroid or adrenal hormone imbalances, toxicities that affect neurological function and communication, deficiencies or dependencies on nutrients that affect mood, or sometimes even infection or inflammatory disorders. It would not simply involve giving a natural substitue for the serotonin reuptake inhibito drugs, although that could be a part of the whole plan.
In a naturopathic work up for chronic fatigue syndrome and fibromyalgia, the naturopath or naturopathic doctor could find that the following tests can be useful:
– thyroid panel with TSH, free T3, free T4, reverse T3, TPO
– 4 point salivary cortisol levels in 24 hours
– mold allergy IgG and IgE panel, including Stachybotrys, Candida
– Western Blot IgG for Lyme (Borrelia)
– metabolic panel
– blood mercury level and provoked urinary metals
Some of these tests, such as the western blot for Lyme, ferritin, and the thyroid panel, are still looking for conventional diseases, but are often overlooked by conventional medicine. The rest are often positive in chronic fatigue syndrome and fibromyalgia patients, but are not specific for that disease only. In other words, they can be positive in other diseases as well. However, they can often help to guide the frequency and intensity of treatment, as well as provide objective markers for improvement in health to correlate with subjective improvement in fatigue.
Is there a naturopathic treatment approach that works for chronic fatigue syndrome?
Yes. It is highly unlikely that patients who fit the above 2 criteria from the CDC, and have had reasonably likely diseases ruled out, all have distinct, undiagnosed illnesses. (By diagnosis, I exclude chronic fatigue syndrome as a formal diagnosis as it was born out of necessity originally as a diagnosis of exclusion – ie no one could find anything else.) Many physicians and naturopathic doctors have firmly held the belief that chronic fatigue syndrome and fibromyalgia is the result of multiple, silent, persistent infections.
Multiple because it would be extremely rare for a single infection to cause such profound and long-lasting weakness. This is even the case in cases where Lyme disease is involved. The Borrelia organism that causes lyme disease creates a distinct subset of disease. However, in patients who have reacted with the full chronic disease syndrome manifestations, Borrelia may be primary but coinfections with other organisms is likely the cause for the longstanding persistence and debilitating nature of the disease.
Silent because it is rare to have the typical manifestations of infections. Thus it is rare to see a patient with a fever, an elevated white blood cell count, or very high CRP or ESR levels. Silent also because the immune system is unable or unmotivated to mount an effective response to the infection.
Persistent for obvious reasons. Most of the patients who have had chronic fatigue syndrome and fibromyalgia have tried multiple approaches, and multiple natural alternatives to drugs.
Thus, the naturopathic treatment for chronic fatigue syndrome and fibromyalgia that I prefer is oxidation and nutrient replention. Nutrient replention and alkalinization is achieved with vitamin and mineral infusions, oxidation is achieved by ozone therapy.
Alkalinization reverses a fundamental biochemical problem in chronic fatigue syndrome and fibromyalgia. When the cells are chronically under stress, and become toxic, the extracellular matrix increases in protons and becomes more acidic. This also occurs with each acute exposure, in that when a cell is exposed to what it perceives to be a toxin (allergen, toxin from infection, waste products), it becomes temporarily more acidic. However, in the case of chronic fatigue syndrome, the silent nature of the multiple infections causes a chronic acidity of the fluid surrounding the cells. In such acidic conditions, proper nutrient delivery, waste removal, and immune function cannot occur efficiently. Environmental toxicity from busy cities like Richmond and Vancouver can also contribute. Intravenous nutrient infusions directly buffer this toxicity, corrects the pH in the extracellular fluid, and makes the cells more receptive to the immune stimulation by ozone.
The second step of the naturopathic treatment for chronic fatigue syndrome and fibromyalgia is either ozone or ultraviolet blood irradiation. This is an older therapy which was used in American hospitals before interest was lost with the advent of the “cure” of infections with penicillin. Ultraviolet blood irradiation, with the addition of ozone, strongly stimulates the immune system to clear both acute, and in the case of chronic fatigue syndrome, multiple silent chronic infections. The mechanism involves oxidation, stimulation of cytokines that regulate the immune system, and vitamin D (which is often lacking from the limited sun in Richmond and Vancouver). I often find that ozone therapy alone gives the same results as ozone combined with ultraviolet blood irradiation.
Robert Rowen, MD, author of Second Opinion Newsletter, has written a very comprehensive article about the use of ultraviolet blood irradiation in American hospitals for serious acute infections. The article is called the “Cure that time forgot,” and is available online.
There are a few theorized mechanisms of how such a naturopathic treatment may help addressing multiple, silent, persistent chronic infections. What we do know is that although the small amount of blood treated (100-250 mls) is disinfected of infections by the treatment, the mechanism does not involve a simple direct killing of infections in the blood because it is only a small portion of the total blood supply that is treated.
One very plausible and likely mechanism is that the ozone or ultraviolet blood irradiation acts as a “auto vaccine,” in that the infections or toxins produced by the infection are present in the blood stream already. The combination of UV exposure and ozone acts to break down the germ or toxin, exposing new areas to the immune system when the blood is reinfused. The immune system then becomes activated, and over a few stimulations, these infections are no longer “silent” and they stimulate an appropriate response from the white blood cells. This is the same mechanism where a vaccine stimulates an immune response that confers protection from a specific infection.
Ultraviolet blood irradiation, with ozone, works as a naturopathic treatment for the multiple, silent, persistent infections that cause chronic fatigue syndrome because these infections are always present in the blood as well. IV nutrient therapy helps to support the body as well.
A more recent mechanism that has been elucidated involves the stimulation of cytokine release by the white blood cells. When UV energy or ozone reacts with the white blood cells in the blood, the chemical messengers that stimulate activation of the immune system are released. These cytokines are then reinfused into the body as the blood is returned to the patient. Cytokines are really the messengers of the immune system, and with a proper coordinated release of cytokines, the immune system becomes much more adept at clearing chronic persistent infections.
There is also the mechanism of increasing circulation, oxygen delivery, and energy generation that I have described in an article on oxidative medicine in general. This involves the effect of peroxides that are created by ozone and UV when reacted with blood. The short chain fatty peroxides oxidize cofactors in the energy generating systems of the cell, called the Kreb's cycle and oxidative phosphorylation in the mitochondria. Chemicals like 2,3 diphosphoglycerate increase (helping red cells to deliver oxygen,) intracellular antioxidants such as catalase and glutathione increase, and blood viscosity decreases. While these effects definitely contribute to good energy, I believe they are secondary in chronic fatigue syndrome, as clearing of chronic infections and activating the immune system are most likely primary.
Is alkalinization and ultraviolet blood irradiation superior to antibiotic therapy for chronic fatigue syndrome and fibromyalgia?
It depends. Unless lyme disease, or a similar intracellular pathogen (germ) is confirmed to be positive, it is very difficult to find a drug that is active against the multiple infections present. Further, it is better to actively involve and stimulate the immune system to clear the infection, so this ability to clear the infection lessons chances of recurrence. If just antibiotics are used, or antivirals, then on stopping the medicine, there is a chance of recurrence if exposure reoccurs, or if latent infection becomes more active. Finally, drug therapy does not address the hyperacidity of the tissues.
Ideally, a combination of longer term antibiotics with ozone and IV nutrient therapy would be ideal.
What does a course of therapy entail?
In most cases of chronic fatigue syndrome, the short course of IV nutrient and ozone treatments involves two to three treatments a week for 4-5 weeks. Follow up lab panel and treatment is given in 4 weeks.