Chronic Fatigue Syndrome (CFS, Chronic Fatigue and Immuno-Deficiency Syndrome, CFIDS) and Fibromyalgia (FM, formerly called fibrositis) may manifest as hypothalamic, pituitary, and immune dysfunction. A study in the Annals of Allergy, Asthma and Immunology [2000 Jun;84(6):639-40] demonstrated that supplementation with NADH for one month resulted in significant improvement, and other studies have shown some minimal improvement with magnesium. Ann Allergy Asthma Immunol. 1999 Feb;82(2):185-91 Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome.
Click here to access the PubMed abstract of this article. The combination of pituitary dysfunction, high reverse T3, and thyroid resistance, leads to inadequate thyroid effect in most, if not all, CFIDS/FM patients. T4 (levothyroxine) preparations are often ineffective for CFIDS/FM patients. A T4/T3 combination preparation or straight T3 (triiodothyronine) may be preferable. T3 works the best for many of these patients, but Cytomel, a very short acting T3 available at retail pharmacies, is also a poor choice because the varying blood levels cause problems such as heart palpitations.
Compounded, sustained-release T3 may be the best treatment. However, standard blood tests may lead one to dose incorrectly and not obtain significant benefits. Ultimately, it is the expertise and dosing of the T3 or T4/T3 combinations and the makeup of the medications that determines the success of treatment. Natural Therapies for CFIDS/FM: Proper nutritional supplements, proteins, and hormones can protect and enhance the immune system.
Antioxidants may also be beneficial because free radicals play a role in causing damage to the immune system. Vitamin B-12 levels are often low in patients with CFIDS/FM. A malfunctioning thyroid or adrenal gland can decrease the ability of the body to absorb and utilize vitamin B-12. Vitamin B-12 is necessary for a healthy nervous system; it has been known for many years that depression and fatigue can be caused by low B-12 levels.
D-ribose significantly reduced clinical symptoms in patients suffering from fibromyalgia and chronic fatigue syndrome, with an average increase in energy on the VAS of 45% and an average improvement in overall well-being of 30%. J Altern Complement Med. 2006 Nov;12(9):857-62 The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study.
Click here to access the PubMed abstract of this article.
Treatment for Infection and Enhancement of Immune Function is Key
Komaroff et al. of Brigham and Women's Hospital, Harvard Medical School, have concluded that CFIDS “is an illness characterized by activation of the immune system, various abnormalities of several hypothalamic-pituitary axes, and reactivation of certain infectious agents.” Multiple infections either may cause or contribute to CFIDS/FM. Immunological defects may underlie CFIDS/FM, and if a poor immune system is not addressed, successful eradication of the organisms is not likely. Also, if an infective organism produces neurotoxins, these substances can remain in the body and continue to cause symptoms long after the infection is gone.
Hormone Balance is Essential
Hormone balance is essential for optimal therapeutic outcomes. Therapy should be individualized with multiple hormonal deficiencies addressed concurrently to assure successful treatment. Studies have reported that there is an altered hypothalamic-pituitary-adrenal axis (HPA axis) in CFIDS/FM, leading to altered function that is often overlooked when interpreting standard blood tests.
Adrenal insufficiency is very common in patients with CFIDS/FM, and is often the cause of serious fatigue. Sophisticated tests are required for an accurate diagnosis. Proper supplementation can often have profound effects. However, if only the adrenal deficiency is treated without addressing deficiencies of other hormones, results will be disappointing. And, if poor adrenal function is missed, it can mean the difference between treatment success and failure.
Thyroid Problems / Pituitary Dysfunction
Thyroid Problems/Pituitary Dysfunction often requires treatment with several hormones. Normally, Thyroid Stimulating Hormone (TSH) is secreted by the pituitary in the brain, telling the thyroid to secrete T4, which must then be converted in the body to the active thyroid hormone T3. When T4 and T3 levels drop, TSH should increase indicating hypothyroidism. This is the standard way to diagnose hypothyroidism. There are, however, many things that result in hypothyroidism but are not diagnosed using the standard TSH and T4 and T3 testing. Standard methods and interpretation often miss thyroid problems with CFIDS/FM patients. Pituitary dysfunction in CFIDS/FM may have a variety of causes, including viruses, bacteria, stress, yeast, inflammation, toxins, pesticides, plastics and mitochondria dysfunction. These problems result in low normal TSH levels along with low normal T4 and T3 levels. Low normal values are significant, and can cause fatigue, depression and difficulty losing weight and also increase the risk of heart disease.
In addition, most CFIDS/FM patients do not adequately convert T4 to the active T3, resulting in low levels of active thyroid hormone; therefore, they suffer from low thyroid despite having a normal TSH. Another problem is that T4 is converted to reverse T3, which is inactive and blocks the thyroid receptor. The conversion of T4 to reverse T3 is increased in times of stress and illness. Reverse T3 causes fatigue, difficulty losing weight, brain fog, muscle aches and all the other symptoms of hypothyroidism. Reverse T3 can be increased by chronic illnesses such as CFIDS/FM, yo-yo dieting (often responsible for the quick weight gain after losing weight), stress, heavy metals and infections commonly present in CFIDS/FM. There are only a few labs that can accurately measure reverse T3, and interpretation of results can be difficult.
Thyroid resistance is present in many CFIDS/FM patients, so endogenous thyroid hormone does not appropriately stimulate thyroid receptors. A study published in Clinical Rheumatology in May, 2007 showed that although basal thyroid hormone levels of FM patients were in the normal range, 41% of the patients had at least one thyroid antibody. Treatment for thyroid resistance can include eliminating the cause, such as an infection or toxin, or overcoming thyroid resistance by giving higher doses of thyroid while monitoring the effect.
The combination of pituitary dysfunction, high reverse T3, and thyroid resistance, leads to inadequate thyroid effect in most, if not all, CFIDS/FM patients. T4 (levothyroxine) preparations are often ineffective for CFIDS/FM patients. A T4/T3 combination preparation or straight T3 (triiodothyronine) may be preferable. T3 works the best for many of these patients, but Cytomel®, a very short acting T3 available at retail pharmacies, is also a poor choice because the varying blood levels cause problems such as heart palpitations. Compounded, sustained-release T3 may be the best treatment. However, standard blood tests may lead one to dose incorrectly and not obtain significant benefits. Ultimately, it is the expertise and dosing of the T3 or T4/T3 combinations and the makeup of the medications that determines the success of treatment.
Chronic Fatigue Syndrome and Fibromyalgia