CHAPTER TEN
An anti-fatigue management programme
Principles to remember
In the approach to any health problem three important principles must always be applied:
1. An accurate diagnosis.
2. The removal of the causes, aggravating factors and symptomatic treatment.
3. The optimisation of the health status and environment of the individual.
These factors are discussed in depth in this book. With most medical conditions, orthodox medicine performs extremely well on principle No. 1, moderately well on principle No. 2 but, to- date, has been unable to come to grips with the holistic methods required for the induction of health optimisation and environmental medicine.
Inherited weaknesses in immune function are well known and a number of diseases of the immune system are genetically acquired. For example, a disease called primary immunodeficiency or ataxia telangiectasia is determined by genetic factors. However, it is highly likely but not yet defined that other factors inherited by an individual in their genes may adversely affect expression of these genes in immune functioning.
To take a simple example of this, many people in the community can escape the common cold and influenza epidemics year after year and yet others are extremely susceptible to them and may contract more than one virus every winter. We may argue that those people who suffer from these infections more often than not are under more stress, don’t eat well and perhaps abuse themselves with tobacco, alcohol and other drugs. However, this is not necessarily the case for in careful history taking it is often revealed that these individuals suffered from more frequent respiratory infections as infants and children. The pointer here is to a genetic weakness and perhaps other system malfunctioning. Although peri-conceptual nutritional factors may play a role in immune functioning in the offspring, it is beyond the scope of this book to discuss the importance of nutrition in the parents and even grandparents prior to conception. We know from scientific studies that if rats are deprived of zinc during pregnancy the offspring will show weaknesses in their immune system due to their mother’s zinc deficiency state during pregnancy. These offspring will pass on this weakness to their offspring for another three or four generations down the line. This is despite adequate zinc nourishment of all those subsequent generations of rats. Whether this occurs in humans or not is debatable and very little evidence exists to support this concept. However, we know from clinical experience that some families are more susceptible to immune and infectious type disorders, including allergic diseases, than others. In clinical practice, it is also observed in these families that if diet is improved and simple nutrient supporting supplements like vitamin C, B-complex and zinc are provided, then the atopic or allergic state improves and may even disappear over a period of time.
Intertwining themselves within these basic principles of care are the holistic facets of health optimisation. These include a concentrated patient-centred approach to management which is comprehensive in extent and multifactorial in nature, encompassing orthodox and alternative complementary and natural healing methodologies. Holistic care does not exist in a stressful environment and emphasises non-toxic (but not exclusively) drug-free care. Psychological and spiritual factors may play a minor to major part in holism, depending upon the particular and individual circumstances.
Summary of treatment of fatigue
Most importantly, the patient and the doctor must recognise the syndrome and then eliminate the medical and psychiatric causes of fatigue e.g. anaemia, heart disease, depression, diabetes, cancer etc.
Investigate and treat food sensitivity and allergy.
Investigate and treat chemical sensitivity, or overload.
Investigate and treat environmental factors including
inhalant allergies, electro-magnetic radiation factors and the ‘sick building’ syndrome.
5. Correct vitamin and mineral balances and deficiencies.
6. Correct any other nutrient imbalances or deficiencies including essential fatty acids, trace elements and amino acid therapy.
7. Diet with nutrient dense foods and food rotation.
8. Stimulate immune function, non-specific and specific immune stimulating agents, e.g. the herbs echinacea, glycyrrhiza, galium, and zinc and antioxidants.
9. Address any problems with infestations of parasites and Candida, especially in the bowel.
10. Protect cells and tissues with antioxidant nutrients and compounds.
11. Utilise detoxification methods especially for the large bowel and liver.
12. Improve circulation of the blood and lymphatics.
13. Evaluate for mercury toxicity and sensitivity (include other heavy metals also).
14. Institute specific herbal therapies for symptomatic relief and specific organ nourishment.
15. Encourage appropriate physical exercise.
16. Provide oxygen therapies when indicated.
17. Insist on some form of positive thinking, mind control or meditation with affirmations.
18. Evaluate the worthiness of homeopathic remedies and acupuncture if appropriate.
19. Encourage as much social interaction as possible.
20. Do not use prescription drugs unless they are absolutely necessary eg. pain killers, tranquillisers or anti-depressants.
Stress
As stress, poor diet and chemicals are the main ingredients in the production of ill health, their correction is vital for a full recovery. Factors in correcting them, in order of importance are:
Strict adherence to diet
A reduction in the level of stress, plus adequate rest and relaxation
Appropriately prescribed nutritional supplements
Adequate gentle exercise such as yoga
The diet entails the strict avoidance of:
■ Sugar rich foods such as confectionery, soft drinks, glucose,
honey, malt, cane sugar containing foods, sweet biscuits, cakes, deserts, golden syrup, molasses, dried fruits, sweet dried fruits, raisins, dates, figs, sultanas etc. Fruit juices should be diluted 50% with mineral water or preferably purified water with a maximum of two glasses of diluted juice per day. ■ White flour products and refined starchy foods such as white bread, biscuits, pasta, pastries, pies, sauces, gravies and canned and bottled foods which may contain white flour as a filling or bulking agent.
■ Coffee and conventional tea. These are unnecessary stimulants which have been shown to increase levels of anxiety thus interfering with any attempts to reduce stress in the unwell person. Coffee has also been proven to raise the levels of cholesterol in the blood. Both are associated with high rates of certain cancers. Preferably drink ‘purified’ tap water and herbal teas. For information concerning effective water purifiers (not filters), contact the Allergy Aid Centre in your capital city. ■ All alcoholic beverages ■ All tobacco products, cigarette smoke, drugs (unless medically prescribed), environmental pollutants including chemicals used at work and in the home and food additives. ■ The strict avoidance of all foods and chemicals that are causing sensitivity reactions shown by blood tests, skin tests, sublingual challenges or food provocations.
Protein rich snacks
Frequent snacks of protein-rich foods in between meals are often helpful in times of stress and provided the snacks are kept small, weight should remain stable. This is a form of ‘grazing’ and it is particularly helpful in people who have problems with digestion and symptoms in the abdomen. Instead of consuming three large meals a day, 6 to 8 small snacks are eaten. These snacks should consist of as many different foods as possible, to avoid repetition and to supply a wide range of nutrients.
Protein rich snacks could include the following (vegetarians select only the non-animal protein sources):
• Unsalted nuts e.g. hazel, almonds, cashews
• Seeds e.g. sunflower, pumpkin — both are more easily digested if they are softened by soaking in water for a couple of hours before eating.
• Legumes and pulses including peas, beans, unsalted peanut butter, lentils etc.
• Thick pea soup
• Hard-boiled free-range eggs
• Thick lentil soup
• Fish
• Veal
• Steak
• Poultry
• Lamb’s fry
• Bean curd (tofu), chick pea dip (hummus)
Meals generally
Meals should generally contain a substantial protein component until the symptoms of stress have eased. Lean meat, grilled fish and lamb’s fry are all beneficial. Alternatively, dishes made from vegetable proteins such as beans, bean curd, lentils, chick-peas, sesame and sunflower seeds and pumpkin seeds are ideal.
Free-range eggs and yoghurt are also good sources of protein but it must be stressed that if allergies are suspected, then avoidance of these foods may be necessary.
Plenty of fresh organically grown fruits and vegetables should be included and at least one third of the vegetables should be eaten raw. Lightly steam or quickly stir fry the remaining vegetables. Always avoid hidden sugars in meals and especially desserts and processed foods e.g. canned fruits, baked beans, breakfast cereals.
Dietary considerations
Although a significant proportion of people with CFS appear to benefit from the manipulation of their diet and the removal of foods to which they are sensitive, the nutritional approach is grossly incomplete if the elimination of a number of foods is the only management. It is simplistic and most unscientific.
Probably more important in this group of patients, many of whom have been shown to be suffering from multiple nutritional deficiencies, is the assessment of macro- and micro nutrient balance. Deficiencies of zinc for example in this population group are extremely frequent. The assessment of zinc status must be correctly performed. To simply rely on a better diet to correct these zinc deficiencies is absolutely futile. In fact, by simply placing a patient on an elimination diet with or without rotation of foods is tantamount to negligence with regard to their specific nutritional needs. Aggravation of these deficiencies is highly possible on elimination diets. Arguably, the removal of foods causing sensitivities results in the enhanced absorbtion rate of nutrients from the small intestine. However, this does not ensure the satisfactory correction of nutrient deficiencies or imbalances.
Some medical researchers still believe that patients may recover from CFS spontaneously without any active treatment at all. However, it has been the experience of the practitioners in the nutritional and environmental medicine movement that most patients who have been documented by medical researchers as having a spontaneous recovery have in actual fact recovered as a consequence of so-called alternative or complementary medicine approaches. Indeed, it is unfortunate that medical researchers actually ignore the benefits obtained by CFS patients from modalities of treatment with which they are not familiar.
Common myths about nutrition
A well-balanced diet supplies ail of the nutrients in sufficient quantities that we need for optimal health.
Processed foods contain nutrients sufficient for optimal health and disease prevention.
Our food supply contains safe levels of agricultural chemicals e.g. herbicide and pesticide residues.
If we suspect a nutritional deficiency then all we have to do is increase the quantity of food we eat to correct it.
Organic fruits and vegetables are safe to eat.
Chlorine and fluoride in the water are harmless in the dosesthat are added.
Vegetarianism is best for everybody.
Sugar is a natural part of a balanced diet.
Processing of food does very little harm, e.g. storing, packaging, freezing, colouring, processing, flavouring, gassing and irradiating it.
The selection of a variety of foods from the five major food groups is good nutrition for everyone. (This ignores the fact that over 10% of the Australian population have food sensitivities.)
Food allergies and food sensitivities are rare and affect less than 5% of the population.
12. Nutritional deficiencies are uncommon in modern western societies.
13. Fast take-away foods are an acceptable part of a balanced nutritional programme.
14. Alcohol is safe if consumed in small quantities.
15. Biological individuality is not important if a wide variety of foods are consumed.
16. The human body has evolved mechanisms that will allow it to detoxify the 60,000 chemicals it is exposed to in the environment.
17. Foods do not influence behaviour, learning or the emotions.
18. Dietary manipulation and therapeutic nutrition do not influence diseases that have a genetic component, e.g cancer, diabetes, arthritis, cardiovascular disease.
19. Everybody’s metabolism is basically the same and the concept of ‘metabolic types’ is a fallacy.
20. Fasting and juice diets are harmful.
21. Doctors and dieticians know enough about nutrition to provide the best advice.
22. The government has good control on the quality of our food supply.
23. Ice-cream and soft-drinks are good foods (according to some Australian dieticians).
Increasing vitamin intake does not improve health and generally increases the risk of harmful side effects. Note— vitamins are far safer than drugs — 20% of hospital beds are occupied by patients suffering from the side effects of medically prescribed drugs. There has only been rare instances of patients hospitalised from an overdose of a vitamin and the effects are reversible.
25. Australians do not consume an excessive quantity of junk food.
26. Foods do not have therapeutic properties e.g. they don’t improve diseases such as the chronic fatigue syndrome, arthritis, heart disease, cancer, diabetes.
27. The mainline print and electronic media give unbiased information on diet and nutrition.
28. The only benefits derived from nutritional supplementation are due to the placebo effect and are based on anecdotal reports without hard scientific data.
Timing of meals
Body rhythms are becoming an important part of the study of biology and disease. There is good evidence to show that the normal body rhythms of people with the chronic fatigue syndrome are disturbed.
Daily, monthly and seasonal rhythms have been discovered. Biochemical changes occurring during the daily rhythms are a direct result of the interaction between inherent biotimes and biorhythms, the time of feeding and probably the type of foods eaten. Meal timing can affect body weight, hormone levels, blood pressure, mental alertness, body temperature, cell division and many other bodily functions.
Modern science is only just coming to terms with these cycles that ancient Chinese and Indian healers used in clinical practice for centuries. Our eating patterns are dictated by food supply, satiety, hunger, social habits, work pressures and convenience.
The consideration of meal timing has important implications concerning the body’s ability to obtain optimum energy from the food consumed. For example, fats are utilised preferentially in the evening. The timing of the intake of foods that contain the precursors to stimulate neurotransmitter production, for example glycine, tryptophan and tyrosine, is particularly important in patients suffering from neuropsychiatric problems and depression. Neurotransmitter functions exhibit a spectrum of rhythms and these are reflected in hormonal changes. Alterations in the rhythms of the production of the hormones cortisol, melatonin and some hormones from the pituitary gland may be the harbingers for the risk of the development of depression, high blood pressure and even cancer.
Intervention by dietary means to correct these disturbances may turn out to be one or the most effective methods of preventing and treating these diseases.
In more than 90% of patients studied with the chronic fatigue syndrome, disturbances in both sleeping and eating patterns have been found. The two most common findings in these patients have been the missing of meals, especially breakfast, and the bingeing on or craving for refined carbohydrates, especially sugar.
From the perspective of what to eat and when, the most effective single piece of advice is to eat breakfast every day and this most important meal should contain good quality protein. A small piece of grilled, de-fatted red meat is ideal in the short term. Other protein rich foods are listed in this chapter.
Nutritional supplements — vitamins, minerals and antioxidants
The use of nutritional supplements is the single most effective treatment in the management of the chronic fatigue syndrome and its future prevention.
The following protocol is essential for all patients with CFS:
1. Vitamin C with bioflavonoids & quercetin — lOOOmg three
times a day.
2. High potency B-complex containing the exact concentrations of the following;
Vitamin B1 - 50mg.
Nicotinic acid - l0mg.
Vitamin B2 — 20mg.
Vitamin B3 - 200mg.
Vitamin B5-100mg.
Vitamin B6 -100mg.
Vitamin B12-100mcg.
Beta carotene-3mg.
Vitamin E -20mg.
Biotin-20mcg.
Folic acid-150mcg.
Lithium-140mcg.
Skullcap-100mg.
Valerian-100mg.
Glutamine-50mg.
Lysine-10mg.
Choline-50mg.
Inositol-20mg.
Betaine hydrochloride-10mg.
3. Antioxidant formula with selenium (50mcg. selenium per tab.) 1 tablet three times a day.
4. Water soluble ‘natural’ vitamin E 250 (mixed tocopherols) units per capsule - 1 capsule three times a day.
5. Halibut or cod liver oil capsules for vitaminsA and D
2 capsules daily.
6. High potency GLA evening primrose oil capsules
2 capsules three times a day.
7. Multi-minerals containing calcium, magnesium, chromium, copper, iodine, iron, manganese, molybdenum, potassium
1 tablet three times a day.
8. Lactobacillus and bifidobacteria powder (mixed) 1 teaspoon in water three times a day before meals for one week, then once a day.
9. Zinc with manganese, cone flower and sarsaparilla (with 30mgm of elemental zinc) 1 tablet three times a day.
10. Injections:
a) Daily injections of intravenous vitamin C, 15-30
grams or more depending on the clinical response for two weeks, reducing to twice weekly injections for one month and then weekly to fortnightly injections.
b) Weekly or twice weekly injections of high potency B vitamins containing the following vitamins in exact
proportions:
Vitamin B1 — 250mgm. Vitamin B6 — lOOmgm. Vitamin B12 — lOOOmcg. Folic acid — 15mgm.
The following may be added to the above when indicated:
Liver nutrients for people with symptoms pertaining to the liver and gastrointestinal tract such as nausea, abdominal discomfort, flatulence, constipation etc. (dandelion, barberry, slippery elm, golden seal, greater celandine, boldo, choline, inositol, methionine, peppermint oil — these can be obtained in a single tablet.)
Bowel cleansing nutrients for severe constipation and toxic problems (psyllium, rhubarb, gentian, cascara).
Shitake and reishi mushrooms in powder form 1 teaspoon per day are especially useful in people who have been shown to have immune suppression or who suffer from recurrent infections. They are used extensively in the east and in Japanese medicine.
Herbal remedies for the nervous and immune systems include lomatium, astragalus, liquorice, phytolacca, baptisia, echinacea, panax ginseng, Siberian ginseng and mistletoe which is often given also by injection.
Biotin 300mcg per day will assist those with confirmed Candida sensitivity as will the drugs Nystatin (500,000i.u, 4 times a day) or Ketoconazole 200 to 400mg. per day under medical supervision.
Garlic extracts are useful in heavy metal and bowel toxicities.
Selenium in medically monitored doses of 200 to lOOOmcg per day are of benefit to patients with proven chemical sensitivities and mercury sensitivity/toxicity syndrome.
Total dental amalgam clearance in the resistant patient with high levels of toxic heavy metals in the hair analysis or mercury sensitivity. These people may also require intravenous chelation therapy to remove a substantial burden of heavy metals in their tissues.
Oxygen therapies including the use of intravenous and oral hydrogen peroxide and ozone have been reported to be of benefit in some patients, but these are not generally recommended unless under strict medical supervision including the monitoring of the patient’s antioxidant status which may be compromised by oxidation processes.
10.Specific homeopathic remedies carefully prescribed by an experienced homoeopath may bring about dramatic benefit,
but the above mentioned nutritional protocol improves the chances of successful homeopathic treatments.
11. Glutamine 400 to 500mg. three times a day before meals has been of benefit to people with symptoms of severe ‘brain fag’. It is an important chemical for brain functioning and, being an amino acid found in foods, can be regarded as safe to take. However, it is recommended that glutamine be taken with vitamin C and the high potency B-complex mentioned above for best results.
Avoidance of chemicals
Although it is virtually impossible to avoid the multitude of chemical pollutants present in the air we breathe, the water we drink and the foods we eat, it is possible to reduce the ‘total chemical load’ on our bodies. The avoidance of deliberate and direct contact with garden and household chemicals is relatively simple. Cosmetics and perfumes are also major sources of chemical contamination. Highly polluted air in cities and industrial areas cause ear, nose, throat and lung problems for many. In farming areas, pesticide sprays can cause severe physical and psychological illnesses. In fact, virtually any symptom or disease can be caused or aggravated by synthetic or naturally occurring chemicals. Dr Richard Mackarness’ excellent book Chemical Victims has an appendix showing how to avoid excess chemical exposure.
Important affirmations
As a psychological aid and effective behavioural tool, the following series of affirmations should be repeated as many times as necessary during the day and last thing at night to achieve a more positive attitude of mind:
Every day in every way I’m getting better and better and better.
Negative thoughts do not influence me — I am always positive.
I am always relaxed and happy.
My energy levels are increasing.
I am totally confident in all situations.
• I am under my own control — I am in control.
The principles of natural good health
Health is the normal condition of the body and under natural conditions it should continue from birth to death.
Health is that condition of the body when all of its functions perform harmoniously and it is maintained by living in accordance with nature.
The health of an organism is governed by eating habits, proper exercise, abundant sunshine, fresh air, pure water, rest, a positive mental attitude and the avoidance of all habits which devitalise the system and disturb the balance of bodily functions.
Disease is basically the reaction of the body to a departure from some of the conditions necessary for good health.
Health can be regained and maintained by living in harmony with nature and allowing the natural healing powers of the body to restore health.
Drugs, radiation and other similar treatments interfere with the body’s restorative power and so, while suppressing symptoms, retard the restoration of health. They are necessary for intervention for acute severe and life- threatening illnesses when there are no alternatives.
The same factors which are necessary to maintain health are also the basis for the control of disease conditions if they arise.
Incorrect eating habits, stress and chemical pollution are the principal causative factors in most of the health problems of civilised life.
The natural and most beneficial way to alleviate acute disease is through fasting — that is, complete abstention from both solid and liquid foods, consuming only pure water. Alternatively, diluted vegetable juices may be consumed, for example carrot or celery.
Chronic disease is the intensification of acute disease. It becomes manifest when the self-healing powers of the body are overtaxed.
Heat therapies
The history of heat therapies dates back to the ancient Chinese physicians who believed that certain body types responded to either heat or cold depending on the illness. The great classical Greek physician Parmenides told his followers two thousand years ago — ‘Give me a chance to create a fever and I will cure any disease’. Fever, that is a raised temperature due to an increase in body heat, is one of the greatest defence mechanisms. It creates an increase in the metabolic rate as a consequence of infection. The result of this high temperature actually inhibits the growth of infecting viruses, bacteria and fungi. In fact, before the advent of penicillin and other wonder antibiotics, one of the treatments for syphilis and other infectious diseases, was the production of fever. The use of heat treatments, saunas and fever therapy in the health clinics of Europe is not restricted to the treatment of infectious diseases. It is also used in the management of other serious degenerative disorders including arthritis, diabetes, leukaemia and cancer. The Arapaho Indians of Arizona use a form of herbal sauna for the treatment of a variety of diseases including chronic viral infections. Some improvement in the well- being of patients with these chronic viral infections is invariably gained. The various methods of inducing a fever may vary from drugs, vaccines (e.g. BCG vaccine for tuberculosis), exercise, hot packs, steam, hot air, saunas, showers and baths.
The most efficient way of inducing fever is by using either a sauna or a Schlenz bath. In patients with the chronic fatigue syndrome, the application of heat therapies must be approached with caution. The use of drugs and vaccines is definitely forbidden. Expectations from an exercise programme are usually beyond the ability of the sufferer to fulfil them.
The sauna is a steam bath, developed in the Scandinavian countries, that induces a fever resulting in profuse sweating. It is the profuse sweating which is probably of greatest benefit to the CFS sufferer because the sweating process eliminates wastes and toxins from the body. The skin, being the largest organ in the body and having a very large surface area, can act as an efficient eliminating organ. It may even reduce the burden on the kidneys and intestines. It also results in loss of water and electrolytes and these must be replaced in the diet. On the day of the sauna, a patient should consume between three and four litres of water to aid the flushing-out process. Owing to our modern lifestyle, the wearing of clothes and the distinct lack of physical exercise especially in the patient with CFS, the skin’s role as a cleansing organ is minimal.
The Schlenz bath is not a recommended detoxification method because it is basically a heating therapy without the production of sweat. Schlenz baths involve the total immersion of the body in a bath of hot water. It is useful though at times of acute viral infections. The Schlenz bath should be hot enough for the patient to bear comfortably without risk of being scalded. The bath should be started at a warm temperature and then hot water added every five to ten minutes to slowly increase the temperature from an initial 95 degrees fahrenheit to 103 degrees fahrenheit. The temperature of both the patient and the water should be monitored and the pulse rate of the patient should not be allowed to rise above 140 beats per minute. If there is any discomfort the patient should be removed from the bath immediately. If possible, bathtime should be approximately one to one and a half hours and it may be performed once or twice a day.
This form of heat therapy can be performed simply and cheaply at home and is indicated as mentioned before only in the CFS patient with an acute viral illness and not in a patient suffering from the chronic fatigue syndrome.
Approximately one third of patients with the chronic fatigue syndrome cannot tolerate any form of heat therapy, including saunas, at all. The reason for this unknown but it is postulated that the heat therapy may itself may stimulate the production of lymphokines (chemicals secreted by the immune system that can cause fatigue) or the heating therapy may actually mobilise stored toxic (xenobiotic chemicals) which pass into the blood stream and affect the nervous system. It is proven scientifically that exercise can mobilise chemicals in this way. If saunas and heat therapy result in an aggravation of the condition, they should be ceased immediately.
It is advisable to use heat therapies at times when the patient can rest immediately afterwards. Heat therapy should be performed on an empty stomach and fresh filtered water or mineral water should be consumed before treatment. The water should be at room temperature and not cold.
Benefits of heat therapies and saunas.
Stimulate sweating
Stimulate waste and toxin removal
Increase metabolic processes
Increase nervous excitation
Relax muscle tension
Reduce the motility and secretions of the stomach and intestines
Lower the blood pressure
May stimulate some hormonal functions
Inhibit the growth of viruses
Relieve joint pains
Note —as with anything in life, approach the use of saunas and heat therapy with caution and moderation; seek medical advice if you suffer from lung, heart or brain disease.
Exercise
The cardinal symptom in the patient with the chronic fatigue syndrome is muscular tiredness and fatigue after only very slight exertion. Although exercise is the last thing a patient with CFS wants to do, it is an extremely important part of their quest for better health. The motivation to get well, combined with self discipline and some external source of motivation, is essential. An exercise programme may seem daunting to the CFS patient initially but it can be done and done very effectively. The best exercise to commence with is yoga. Yoga is an extremely gentle and non-stressful form of exercise. Even if some yoga postures are tiring, this unwanted side effect is short lived. Yoga breathing exercises contribute to an increase in energy in over two thirds of the CFS patients who have adopted them.
Yoga breathing may be sufficient to start with in an exercise programme, gradually building up to the full yoga exercises and postures. After this has been achieved, brisk walking, light jogging, cycling, swimming and low impact aerobic type exercises may be adopted. The basic rules for the chronic fatigue syndrome patient and exercise is be careful and be moderate. Don’t exercise
to the point of fatigue. Exercise is meant to improve well-being. A feeling of mild euphoria immediately after exercise sessions should be aimed for.
Two of the most effective yoga postures for the chronic fatigue syndrome sufferer are described here. The first is a posture which is classical — touching the toes. The yogic description of this exercise is that it revitalises the nervous system, stretches the major muscle groups of the back and legs from the head to the feet and massages the contents of the abdomen to reduce constipation, flatulence and acidity. The exercise is simply described as follows:
• Standing as straight and erect as possible, with feet slightly apart, take a deep breath and raise arms high above the head. Bend slowly at the waist bringing the arms down to touch the knees breathing out as you do so. Attempt to stretch down as far as possible with the hands reaching the ankles or feet. Continue breathing out while doing so. Perform the exercise very slowly. Hold the posture for a few seconds and then slowly return to the upright position while inhaling slowly. Repeat this exercise as many times as possible to a total of ten maximum. The slower and more deliberate this exercise is performed, the better are the results. The breathing is extremely important and must be perform ed slowly and gently.
The second most effective yoga exercise for the chronic fatigue syndrome is the gas-relieving posture, as it is called. This posture again helps in relieving flatulence and stimulates the proper and complete evacuation of the bowels. The exercise is described as follows:
• Lie on the floor on your back with hands straight down beside the hips. Slowly breathing out, bend the legs at the hips raising them to a right angle with the body. Then bend the knees until they come close to or touch the chest and wrap your hands around the legs pulling them in tight against the stomach. Hold the posture for a few seconds and then slowly return to the starting position breathing in very slowly and deliberately as you go.
There are many other postures and yoga exercises that will help individual symptoms but these are best learnt from a trained yoga expert.
Yoga — like meditation, exercise and diet — requires self-discipline and deliberation. But it helps even more if there is a genuine desire to get better.
Enjoyable exercise is the key to stress reduction
Once the symptoms of the fatigue syndrome have improved, more vigorous exercise can be commenced cautiously.
Exercise seems to be a particularly desirable method of treatment for stress as it requires very little equipment, is inexpensive and can be done at home. Exercise definitely has no undesirable side effects if performed sensibly and in moderation. Exercise reduces physical stress as well as emotional and mental stresses. It lowers the pulse rate and blood pressure, it improves strength and endurance and it improves the overall fitness of the heart and lungs. Exercise also increases the high density lipoproteins, which are the fats in the blood which help to prevent heart attacks. These substances are also known as HDL- cholesterol, and this is the good form of cholesterol.
A wide range of psychological and emotional benefits result from exercise. These include a reduction in fatigue, greater stamina and vigour, a reduction in depression and anxiety, relaxation of muscular tension and interestingly, a decrease in anger scores. This last benefit is an important reminder to a society of sedentary individuals in which anger manifests itself in violence — perceived to be a growing problem. Furthermore, it has been scientifically shown that there is an increase in clarity of thought and improved concentration as a result of healthy exercise. Aerobic exercise also improves perceptual functioning such as problem-solving ability, short-term memory and ‘psychological’ speed and reaction time performance.
Proven psychological benefits of exercise
Reduces depression
Decreases anxiety
Improves concentration and clarity of thought
Increases vigour
Decreases fatigue
Relaxes muscular tension
Decreases anger
Positive changes in eating habits, smoking and sexual functioning
The important thing to remember is that exercise must be regular and enjoyable in order to experience its benefits. Unless the exercise is enjoyable, pleasant and regular it may add to your stress. Exercising vigorously and at high intensity is probably more taxing and stressful to most people than longer duration and low intensity exercise, such as walking and yoga. If the high intensity exercise is stressful it is quite likely that there will be little or no improvements in mood, anxiety and depression despite positive gains with regard to weight loss and improved cardiovascular fitness.
We generally see improvement in moods and emotions in people who exercise moderately 20 minutes twice a week for twelve weeks, providing the exercise is enjoyable. No improvements occur if, for example, one jogs in cold wet weather or swims in an excessively hot water swimming pool. Thus exercising in extreme weather conditions, for example hot, cold, wet or humid conditions and so on, may neutralise the effects of exercising and result only in minor mood changes or no improvement at all. Therefore, although jogging and walking are conducive to psychological well-being, cycling at noon on a hot summer’s day may result in some cardiovascular benefits but reduce the psychological benefits.
Another very important aspect of exercise is that it should be non-competitive. Competitive sports are important socially and psychologically for other reasons. However, it has been found that competition and competitive activities increase stress. There are always losers and always winners in competitive sports. The winners may feel less stressed, but those who don’t win are at greater risk of suffering stress. An effective exercise prescription for stress reduction excludes competition and sports such as football, tennis, basketball and other team sports. Golf, despite player’s enthusiasm for it’s outdoor and seemingly non- competitive nature, has stressful components to it.
An additional and important requirement in exercise activity is that it is practised regularly and in familiar surroundings. This can be achieved with yoga, simple gymnastics, walking, swimming and jogging. These forms allow you to immediately switch off, tune-out or withdraw from the outside world into your own mental world of imagery. In a way, this is a form of meditation. These activities allow your mind the freedom to wander and reduce attention to the real world. This freedom of the mind seems to be helpful in enhancing the mood and freeing up the emotions. Exercise which is repetitive and rhythmical, such as cycling, jogging, walking, swimming and yoga, seem to be more conducive to producing psychological benefit. Experienced meditators know that repetitive and rhythmical movements, mantras, sounds and breathing are the easy pathways to the meditative state.
Exercise frequency is very important. Exercise should be regular and fit in to your weekly schedule. It should start at a low level and be gentle. Exercising vigorously to begin with is not pleasant and will not give the expected benefits. Tkxing, difficult exercises will be neither enjoyable nor stress reducing. Regular training is essential before mood benefits are felt and sedentary people who exercise vigorously without training and building up to a satisfactory exercise level do not achieve psychological benefits.
So, to start with, a ten minute walk in the morning and a ten minute walk in the evening is better than a vigorous twenty minute jog.
You must exercise daily or every second day to reinforce the levels of psychological and physical well-being which you have achieved. It has been shown scientifically that the improved feeling of well-being, relaxation and reduced depression lasts from two to six hours after the exercise.
Inactivity, physical fitness and over-training
Clinically, the vast majority of people who develop the chronic fatigue syndrome have been physically unfit and malnourished at the time of the initial assault by the infection, chemical or drug. Over 80% of patients questioned did not exercise regularly. Less than 30 minutes of low impact type aerobic exercise four times a week puts one in the unfit risk category for not only the chronic fatigue syndrome but other diseases, including cardiovascular disorders, as well. In fact, from the historical evidence available, over 85% of patients in a study of more than 200 people with CFS fell into the ‘unfit’ category. (Brighthope I.E., 1989.)
A small percentage of CFS sufferers, less than 5*Vo, actually belonged to an over-trained group. These people were either professional athletes or over-trained for such events as marathons, triathlons and other endurance activities. One of the most difficult aspects in the management of this small group of obsessive individuals is reducing their levels of physical over-activity after they have partially recovered. In the early stages of recovery, when energy levels start to return, athletes in this group start to over- train again and burn themselves out. The message is everything in moderation.
Sunlighty, depression and energy levels
Sunlight has been shown to have an effect on the ‘master gland’ in the middle of the brain called the pineal gland. This gland secretes a hormone called melatonin that influences the hypothalamus and pituitary gland and their hormone secretions from the brain. As a consequence of the changes of the amount of sunlight exposure between different seasons, a condition termed seasonal affective disorder has been coined (SAD). This disorder is associated with winter depression and summer hypomania (over-activity without mania). Patients suffering from SAD are depressed, have low physical and mental energy, over-sleep and feel better on holiday when there is more outdoor activity and presumably more sunlight. Scientific studies have shown that patients with depression and SAD respond to the anti-depressant effects of full-spectrum natural light. The anti-depressant effect is probably caused by the change the circadian (daily) rhythms of melatonin and other hormone synthesis mentioned earlier in the discussion on the timing of meals. Melatonin actually inhibits the secretion of two of the body’s stress hormones — ACTH and cortisol. High levels of cortisol are often found in the blood of depressed patients.
It is recommended that exposure to full spectrum light be increased for patients with the CFS to assist with the element of depression. Improved energy levels are achieved in some patients. The exposure must be daily and for those confined indoors the use of proper full-spectrum fluorescent light is advocated. Developing the habit of looking at the light for a few minutes every hour should be encouraged.
Chelation therapy
The word chelate is derived from the Greek word chele which refers to the claw of the crab. The word itself implies a firm pincher like action or binding effect. In biological terms therefore, chelation is the binding of a metal to an organic or inorganic molecule. In chelation therapy we talk about the binding of a chelating substance to heavy metals for example lead, zinc, mercury, cadmium etc. Chelation therapy involves the administration of a chelating substance, called EDTA or Ethylenediaminetetraacetiacid, usually by an intravenous infusion. It is not routinely used in orthodox medicine except for patients with heavy metal poisonings. In the chronic fatigue syndrome it can be demonstrated by full hair analysis that as many as 30% of patients have high levels of heavy metals in their system.
The hair analysis is the most accurate method of measuring these heavy metals and an assessment of the total toxic load of heavy metals can be obtained from this test. If the levels are high, and there has been no response to any other form of therapy, chelation should be seriously considered in the recalcitrant patient. In the right hands, the use of intravenous EDTA, 2 to 3 grams in SOOmIs of intravenous fluid daily, is extremely safe. Providing the patient has good kidney function, and kidney function is monitored closely, the removal of heavy metals by this method can be extremely rewarding. Vitamins C, B-complex and minerals are given simultaneously. Between three and twenty chelation treatments administered on a daily basis are generally recom- mended. Some patients may feel an improvement after only three or four chelations. In this group of patients it is recommended that a total of between six and ten treatments are given. It is pointless giving chelation therapy if the source of heavy metal toxification persists. Nothing can be done about the leaching out of lead from the bones into the bloodstream during chelation therapy. However, something can be done about other sources of lead especially if patients live near busy highways where the air is polluted from motor car exhausts. That is, moving to a cleaner environment to reduce the body’s burden of lead. Similarly, the patient with high levels of mercury will only benefit temporarily from chelation therapy if nothing is done about their mercury-silver amalgam dental fillings.
Careful removal of dental amalgam fillings by a properly trained dentist using special dams and replacement with modern resins is recommended if mercury levels are high or mercury sensitivity can be demonstrated. Other less significant heavy metals in respect to the chronic fatigue syndrome are cadmium, arsenic and aluminium. However, the presence of these toxic metals even in small amounts can add significant value to the total toxic heavy metal load.
Orthodox immunotherapy
The chronic fatigue syndrome has remained an enigma for orthodox medicine. The exact cause or causes and its pathology have not as yet been accurately defined. Equally, effective treatment by orthodox methods has been a virtual failure. As a consequence, patients have been referred from one medical practitioner to another and to some of the best specialists in the country to no avail. In fact, many have ended up on a psychiatrist’s couch with various diagnoses ranging from chronic anxiety, depression, worker’s compensation neurosis, various phobias and so on.
This has resulted in frustrated patients — not only with their medical carers, but of the entire health care delivery system. Naturopaths, chiropractors, psychologists and some ‘complementary alternative’ doctors have, to a large degree, filled this therapeutic gap. By giving appropriate advice regarding changes to lifestyle and, more importantly, advising on the use of nutrient-dense diets, vitamin, mineral and other nutritional supplements and the avoidance of food and chemical sensitivities, the opportunity for greater self-control and management has been provided for many an unfortunate CFS victim. Orthodox medical and psychiatric management are important in the overall care of patients with CFS, but lifestyle changes and natural medicines are the mainstay of treatment.
There are some promising approaches on the medical horizon for the treatment of CFS. One of these is the use of intravenous gamma-globulin. A number of clinical trials have been performed supporting the use of gamma-globulin. This is an antibody protein fraction extracted from the plasma or fluid component of human blood. Both physical and psychological benefits from this treatment have been shown and some patients treated with gamma-globulin have shown improvement in their immune system.
High doses of intravenous gamma-globulin are proven to be of benefit and may be even curative in some cases of idiopathic thrombocytopaenia, myasthenia gravis, pemphigus, haemolytic anaemia and other auto-immune diseases. These are all conditions in which the immune system’s control mechanisms are disturbed in some way and the immune system produces antibodies to the person’s own tissues (i.e. self-antibodies) — biological treason. The use of gamma-globulin may act as a regulator of the immune system and it probably affects the function of suppressor cells.
Another substance that is being used in CFS is transfer factor by intramuscular injection. Transfer factor is protein made from the white cells of healthy people. It has been shown to transfer cell-mediated immunity to patients who have a cell-mediated immune deficiency. The use of transfer factor therefore makes the patient’s white blood cells function more effectively reducing infections, infestations, allergies and perhaps even cancer. More work is yet to be done on the importance of transfer factor in CFS.
Another drug that has been tried in CFS is the anti-viral drug, Acyclovir. Anti-viral drugs have not been shown to have any significant benefit in chronic fatigue syndrome. In fact, many drugs which have been trialled in chronic fatigue syndrome have been found to be worthless. Anti-depressants, for example, have actually been shown to exacerbate rather than relieve the symptoms of depression that are associated with the syndrome. This in itself should suggest to the astute clinician that synthetic or xenobiotic chemicals may actually produce hypersensitivity reactions in this group of patients.
In fact any patient — whether they have chronic fatigue syndrome or not — who suffers from mild, moderate or severe side-effects from using synthetic medication should be examined for food and chemical sensitivities. Their vitamin, mineral, trace element and anti-oxidant status should be carefully assessed. There is good scientific evidence now to suggest that this group of sensitive patients are at greater risk of developing severe disease such as heart disease, hypertension, diabetes, arthritis, stroke, asthma, emphysema and perhaps even some forms of cancer. Dietary supplements invariably help them.
Included in this section on orthodox immunotherapy is a brief mention of the use of intravenous vitamin C therapy. This is discussed at greater length elsewhere in this book. However, it is mentioned here because there is a growing number of medical practitioners and specialists in this country who are using megadose intravenous vitamin C therapy very effectively in the management of CFS. It must be emphasised here that the earlier the treatment with intravenous vitamin C the better the result. Even with long-standing CFS cases the results are very good, but it may take longer for them to be achieved.
This is the final chapter of the book which was published in 1990.
I have found the management of most patients suffering fatigue from any cause can be adapted from the principles outlined in this book. The book is intended for educational purposes only and a guide for those individuals who take responsibility for their own health. However, I insist that readers always attend an appropriately qualified and experienced health-care practitioner to help manage their health problems, including diagnosis and treatment. The contents of this book should be familiar, or made known, to your practitioner.
I will be providing an update to the book in due course with all the references.
Yours in good health.
Ian Brighthope
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