multiple

People who have several different problems that all add up to a CFS illness.

Some sufferers of CFS illness possably have a few different disorders that all add up to producing a CFS picture. Some of these disorders are not yet well recognised in the orthodox medical world. What different disorders do I mean?

CFS/FMS checklist.
If you want to go back and forth from this table it is easier to use the one found by scrolling right to the end of this web page. Note: It is possible to have more than one of these problems at the same time.

Are the good types of bacteria in my bowels out of balance?

Do I have type II nutritional deficiency?

Do I have abnormally large amounts of cupped or flat red blood cells?

Do I have chronic candidiasis?

Am I suffering from food sensitivity?

Are my sex hormones out of balance?

Do I have "adrenal exhaustion"?

Am I suffering from heavy metal poisoning?

Do I have multiple chemical sensitivity or a history of heavy exposure to pesticides, herbicides or industrial chemicals?

Do I have problems with low blood sugar?

Introductory comments: It appears to me that Intestinal dysbiosis is being increasingly recognised as an important factor in CFS illness. However, I believe that not all CFS sufferers have dysbiosis.

Predisposing factors: Antibiotic use (especially long or repeated courses). For example the use of tetracycline in acne and repeated courses of antibiotics for bladder or ear infections. Oral contraceptive pill. Prolonged stress. Probably also certain diets especially the high sugar and refined carbohydrate diet or the "junk food" diet. Possibly also certain "food poisoning" bugs.

Possible signs or symptoms: Irritable bowel syndrome. Problems with constipation and/or diarrhoea. Bloating. Food intolerance.

Relevant tests. Comprehensive digestive stool analysis (CDSA) - Analytical Reference Laboratory (ARL - PO BOX 279, North Melbourne, Victoria, Australia , www.arlaus.com.au ), Great Smokies Laboratory (GSL - www.gsdl.com ).

Treatment considerations. Probiotics (friendly bowel bacteria): E.g. Symbiotique^â and prodofilus^â, from www.fit.net.au. Progastrin is another very good one. Yoghurt cultures.

Nutrients that promote friendly bowel bacteria: FOS (fructo-oligo-saccharides. I recommend buying it as loose powder rather than in capsules). FOS occurs naturally in foods such as bananas but for therapeutic purposes the concentrated powder is really needed.

Introductory comments: Basically, there are two types of nutritional deficiency: type I and type II. In type I deficiency single nutrients can be considered separately and treated separately. For example in iron deficiency you can just give iron to correct the problem. In type II deficiency you have to treat a group of nutrients together. These nutrients are magnesium, zinc, protein, essential amino acids and phosphorus. If one of these nutrients is deficient then the rest tend be low as well. And to treat them you need to supplement all of them together.

Predisposing factors: Fad diets. Anorexia nervosa and other eating disorders. The use of appetite suppressants especially smoking. Alcohol abuse. Prolonged exclusion diets. Operations and severe accidents. Stress. I think that vegans are also at risk of suffering from this illness.

Possible signs or symptoms: CFS. Muscles pain probably quite frequent. Recurrent infectious illness. Reduced energy. Muscle wasting. Loss of skin elasticity. Loss of condition at the finger pulps (they are easily indented and take some time to recover).

Relevant tests. Red blood cell zinc and magnesium (ARL www.arlaua.com.au ). Possibly: serum amino acid analysis (ARL). 24-hour urinary magnesium collection (many local labs).

Treatment considerations. The diet needs to be assessed and inadequacies corrected. Tobacco, alcohol and caffeine should be strictly avoided. Supplementation of protein, zinc and magnesium orally. Amino acid chelates of the minerals should be used (avoid magnesium or zinc oxide - it is not as well absorbed) and the zinc should be taken last thing at night as well as at meals. Magnesium injections (and in severe cases zinc injections). Digestive supplements especially Betaine and protein digesting enzymes taken with meals). Treatment with the amino acid L-Serine (about 2g per day usually taken in the morning) may be worth considering as apparently it is commonly low in CFS/FMS sufferers. For protein, the use of one to two eggs per day from healthy, free-range hens may be very helpful.

Introductory comments: The pioneer in this approach appears to be Dr Simpson from Otago, New Zealand. Doctor Simpson has been using an electron microscope to study red blood cells (RBC's) in CFS patients for some time now. He has noticed that CFS patients often exhibit unusually large numbers of flat or cupped RBC's. The hypothesis is that having too many cupped or flat RBC's reduces oxygen transport to tissues because these shapes are not as good at negotiating small capillaries (due to reduced flexibility) as are normal doughnut-shaped RBC's.

Predisposing factors: I'm not sure, but abnormalities of red blood cell populations may run in families. Possibly essential fatty acid deficiency or vitamin B12 deficiency.

Possible signs or symptoms: The usual huge range of possibilities found with CFS and FMS patients. Fatigue. Reduced concentration.

Relevant tests. Latest information, Oct 2005. Unfortunately this test is nolonger done as Dr. Simpson could not get funding any more.

Treatment considerations. If there are increased numbers of cupped cells: "Efamol" evening primrose oil (available from chemists in Australia. You may also be able to get it cheaper through a local CFS support group). Personally, I do not advise using other brands as there appears to be some differences between brands and, as far as I can tell, Efamol is the product on which most studies have been based. Gingko biloba for the symptoms of "brain fog" (standard dose). You may need to wait three to six months for improvement.

If there are increased numbers of flat cells: vitamin B12 injections (1 mg) twice a week initially. Again, you may need to wait several months for improvement. You should know that there are different types of vitamin B 12. The usual form is cyanocobalamin. Apparently methylcobalamin is more effective (available in Australia from Biological Therapies, Melbourne). There is some debate as to whether B12 should be used in people who have mercury (amalgam) issues as it can possibly bind to mercury to produce a more toxic product called methyl-mercury. The "jury is not out" on this issue in my opinion.

Other supplements that may help in either case are: vitamin C (3-5 grams per day); vitamin B6 (100 to 500 mg per day. If you take this dose for more than a few weeks you should take a good vitamin B complex with it); the herb Feverfew; vitamin E, 1-2 grams per day. I advise a water-miscible form. The product made by Golden Neolife Diamite - GNLD (Box 419, Beenleigh, Qld., 4207) is the best I know of at the moment.

Predisposing factors: Antibiotic and oral contraceptive use (especially prolonged). Broad spectrum antibiotics (for example tetracycline or amoxicillin) are the worst at promoting candidiasis. The use of a high sugar and refined carbohydrate diet. Prolonged stress. Reduced immune function. Reduced stomach acid (hypochlorhydria).

Possible signs or symptoms: CFS/FMS. Recurrent vaginal and/or oral thrush. Make sure a swab confirms it. A persistently itchy anal area (in general the most common causes of this are excessive moisture and too much rubbing with toilet paper -- try cleaning the area by patting with wet then dry toilet paper and also take measures to reduce moisture). There is a huge list of possible other symptoms. Usually gastro-intestinal symptoms are present such as bloating, indigestion, diarrhoea or constipation. There may be food-sensitivity and mood problems. Also muscle aching is common.

Relevant tests. It is most important to seek to confirm the diagnosis of candidiasis as it is quite possible to think you have this problem when actually you don't. I would recommend the Comprehensive Digestive Stool Analysis (ARL www.arlaus.com.au GSL www.gsdl.com). Normal stool microscopy, rectal swabs, oral swabs, and vaginal swabs can all be useful. Also, I understand there is a serological blood test for antibody against Candida. I have not used this test.

Treatment considerations. Treatment can be complex. I definitely recommend having the help of a sympathetic practitioner. Common sense is required regarding avoidance of certain foods especially in people with tendencies towards obsessional or hypochondriac behaviour. I would recommend getting a good book on the subject such as "The Yeast Connection" (Crook W, Professional Books, Jackson, USA, 1983). The basics of treatment include the strict avoidance of sugar and refined carbohydrates (I advise avoidance of sugar substitutes also as aspartame at least has been implicated in serious side effects). Probably the herb Stevia is a safe alternative sweetener. Also included in basic treatment is the use of anti-yeast agents such as nystatin. The use of probiotics is also basic as well as probiotic enhancers such as FOS. When treatment is started for candidiasis you must be aware of the so-called Herxheimer reaction. This is a feeling of getting worse which occurs for a few days due to the release of toxins from the death of yeast cells in the body. The more yeast is in the body the worst the reaction can be.

Introductory comments: Food sensitivity is not the same as the classical allergic reactions to food characterised by skin rashes and itching. A different part of the immune system seems to be involved with these sensitivities. Like candidiasis a multitude of symptoms are possible including fatigue and muscle aching as well as gastro-intestinal problems. It is essential for you to work with a practitioner who has had some experience in this area -- and preferably a practitioner who has experienced food sensitivity problems themselves! This is because it is easy to just hand out dietary advice without realising how difficult it can be to put it into practice. I would also recommend a good book on the subject. A book that is getting a little old now but which I believe is still very good is Davies S, Stuart A., Nutritional Medicine, London, Pan Books Ltd, 1987. This book gives a good summary of the situation including causes, symptoms, diagnosis and treatment. It warns about withdrawal symptoms and gives practical suggestions including dietary regimes. Also, because it is not long-winded it avoids causing the confusion that can come with too much information.

Predisposing factors: Bottle-fed as an infant. The early introduction (as an infant) to cows milk, wheat, peanuts and probably other items such as chocolate, caffeine, confectionery and alcohol. Family history of allergy related disorders including migraine, eczema, asthma and hay fever. Extensive exposure to antibiotics. Recurrent infections.

Possible signs or symptoms: CFS/FMS. As an infant and child: colic, persistent runny nose, recurrent tonsillitis (dairy products) and ear infections, and diarrhoea. Constipation, bloating, wind. Migraine is considered to be a strong indicator.

Relevant tests. Going on an exclusion diet of one type or another. If you are desperate and want to get on with things you could try excluding completely dairy and wheat products. In my experience these are the two most common culprits. It can be finicky going off these completely, especially wheat, as they are contained in many commercial products. You definitely need to use the help of a book and, if possible, a sympathetic practitioner. Most foods you may be sensitive to can usually be tolerated in small amounts eventually. Blood tests can be useful especially to check for coeliac disease (gastroscopy is needed to confirm this diagnosis). Also stool tests, especially when diarrhoea is present, to check for such things as lactose intolerance can be useful. I have not found skin prick and blood "RAST" type blood tests very helpful so far.

Treatment considerations. Exclusion diets, and rotating diets (see a good book on the subject such as Davies mentioned above). It is important to treat any underlying nutritional deficiency. Be particularly aware of possible magnesium, zinc or vitamin B deficiencies. Treatment of other problems such as nutrient deficiency and persistent infection should go a long way to reducing problems with food sensitivity.

A food sensitivity is not necessarily something you will have for life. If the immune system improves and the gastro-intestinal tract improves you may find that a previous sensitivity has gone. Also it appears that when some pathogens are eliminated from the system a food sensitivity may improve or go.

Introductory comments: The hormones I refer to here are mainly oestrogen, progesterone, testosterone and DHEA

Predisposing factors: Prolonged stress, malnutrition, weight fluctuations, tubal ligation and probably use of the oral contraceptive pill.

Possible signs or symptoms: CFS/FMS. PMT, abnormal periods, menopausal type symptoms, reduced sex drive (libido). Fatigue common.

Relevant tests. Salivary hormonal assays (ARL www.arlaus.com.au GSL www.gsdl.com ). Blood tests. A therapeutic trial of hormonal therapy.

Treatment considerations. For persons with mainly chronic fatigue I would recommend DHEA capsules 50 mg per day for men and 25 mg per day for women. Or alternatively DHEA cream 50 mg per day for men and 40 mg per day for women. I recommend natural progesterone cream for menopausal symptoms and at least initially for PMT. Combination creams may be necessary. For difficult cases salivary hormonal tests are essential as they give you a good guide as to what the imbalance is and enable treatment regimes to be tailor made. Some pharmacists specialise in preparing natural hormonal creams.

Introductory comments: Another hormonal problem that may be associated with CFS is what is known as "adrenal exhaustion". I'm not talking here about full-blown Addison's disease.

Possible signs or symptoms: CFS/FMS. Lack of energy common. Possibly low blood pressure with feelings of giddiness getting up.

Relevant tests. Salivary adrenal hormonal assays. It would be prudent to have some orthodox blood tests to help exclude the rare possibility of proper Addison's disease.

DHEA capsules 50 mg per day for men and 25 mg per day for women. Or alternatively DHEA cream 50 mg per day for men and 40 mg per day for women. Treatment of nutritional deficiencies. Attention to alleviating long-term stresses. Possibly low dose cortisol. Licorice root (not confectionary licorice).

Introductory comments: The main culprits are probably mercury, lead, copper, cadmium and aluminium. Mercury from amalgam is a major cause of CFS in my opinion (as are cavitations and root canal teeth). An experience doctor and dentist who understand the issues are needed to help make this judgment. For more information see www.mercola.com and www.drshankland.com.

Predisposing factors: Dental amalgam. Copper piping in drinking water systems. Contaminated groundwater. Aluminium cooking utensils. Exposure to lead paint or leaded petrol. Industrial exposure. Possibly the mercury based preservative thimerosal in vaccinations (in susceptible individuals).

Possible signs or symptoms: CFS/FMS. Many and varied. Usually insidious in onset. Behavioural problems in children. Reduced learning or memory ability. Reduced concentration. Muscle ache. Headache.

Relevant tests. The "open your mouth" test. If you can see amalgam then mercury is being absorbed in my opinion. The APO E genotype blood test is very useful for estimating the susceptibility to heavey metal bio-concentration. DMPA/DMSA challenge (urine testing, ARL www.arlaus.com.au ). Hair mineral analysis (ARL). Blood tests.

Sauna, especially the far-infrared. Chelation treatment with DMSA or DMPS. Specific nutrient supplementation for specific metals. In my opinion it is important not to launch into the removal of dental amalgam without first carefully considering the situation and checking to see if there are other possible causes. If it is not the cause of one's problems then removal of dental amalgam can be a very expensive and needless procedure. Dental amalgam may be either the primary cause of one's problems or just one of many long-term immune suppressants that is adding to the overall problem. In the former case it is more of a priority to consider removal. In the latter case it may be possible to overcome the overall ill-health without resorting to the expense of mercury removal -- at least until the person is in better overall health or has enough money to do it. It is most important to get a dentist who specialises in removal of Mercury amalgam to do the procedure (please refer to ASOMAT, www.asomat.com )

Introductory comments: By "multiple chemical sensitivity" I refer to people who react badly to such things as perfumes and other personal care products, petrochemicals and "out-gassing" from books and similar items. I include here also exposure to pesticides etc. because, in my opinion there are many similarities between the two conditions.

Predisposing factors: There is often (but not always) a history of some long-term or sudden major exposure to some chemical. Examples include agricultural chemicals, top-dressing, inhaled chemicals during fires, sprays on vegetables and fruit. Cigarette and other smoking, the use of alcohol and caffeine aggravate the problem.

Possible signs or symptoms: CFS/FMS. Similar to heavy metal poisoning with the addition of the reactions when exposed to various chemicals.

Treatment considerations. Sauna, especiall far infra-red. It is most important, as usual, to carefully follow "The Basics" (see previous web page). Smoking, alcohol and caffeine must be strictly avoided. It would also be most advisable to avoid using the oral contraceptive pill (use alternative contraception or abstinence if you do not want to get pregnant) and any unnecessary analgesic medication such as paracetamol. Supportive measures for the liver are often necessary. This involves the use of specific foods, herbs and nutrients. These may include brussel sprouts, globe artichoke, garlic, onion, dandelion, vitamin E, glutathione, glutamine, glycine, cysteine, lipoic acid and silymarin. I also advise the use of a powerful antioxidant such as Revenol by Neways www.neways.com.au or at least another one with OPC's as found in grape seed extract or pine bark extract. Use the antioxidant in large quantities (get professional advice on dosage) when major exposure to a problem chemical has occurred. Avoid offending chemicals as much as possible -- without going mad from being too obsessive! Try to use personal care products that contain genuinely "healthy" non-irritant ingredients. Sunlight is helpful for optimal liver function.

Introductory comments: This is called hypoglycaemia syndrome and is characterised by low blood sugar -- especially before meals.

Predisposing factors: The use of sugar and refined carbohydrates in large quantities. Nutritional deficiency.

Possible signs or symptoms: CFS/FMS. The low blood sugar may be associated with a variety of symptoms including fatigue, feelings of faintness, headache, irritability, loss of concentration and sugar craving.

Relevant tests. Blood testing before meals. Some people do a prolonged glucose tolerance test (for example six hours). I have not used this test but normally go on history and blood tests before meals.

Treatment considerations. The use of foods that promote the slow release of sugar into the system. These include legumes (very good), rolled oats, brown rice, millet, root vegetables and other whole grains. These items should be prepared as whole as possible. It is especially important to include keeping the "skin" on. Meal-times should be as regular as possible. The ideal regime includes breakfast as the biggest meal, lunch slightly smaller, and the evening meal the smallest. I do not normally recommend snacking between meals. Sugar and all refined carbohydrates including confectionery, chocolate, soft drinks, cakes, crisps, ice-cream, and the like should be strictly avoided. All beverages containing caffeine and alcohol should be strictly avoided. Smoking should be completely avoided. Careful attention should be made to correcting nutritional deficiencies especially magnesium and vitamin B complex. Sugar cravings should be dealt with by having a very large drink of water with lemon juice. If this does not work I would advise a banana or apple.

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Disclaimer: These notes are not intended to provide personal medical advice. Such advice should be obtained personally from a qualified health professional. If you have fibromyalgia or CFS I do not advise following any of the suggestions contained herein without first consulting a suitably qualified health professional.