In part 1 of this series, I focused on the importance of rechecking the basics, and I described the first 10 of my top 30 tips for treatment.

In part 2, I discuss advanced approaches for optimizing hormonal and nutritional support - while also making sure the basics are covered - and I give you my next 10 top tips for treatment!

Part 2: Recheck the Basics - and then Add Advanced Therapies

As in last week's installment, I've put an asterisk (*) next to treatments that are self-care/non-prescription. The other treatments require that you work with your doctor. Also, as I did in Part 1, I've listed treatments that require a blood test at the end of the article (a convenient summary in case you want to do all those tests at one time).

Hormonal Support

(Continuing the "30 top tips" numbering at 11, as numbers 1-10 are in Part 1...)

11. Consider a trial of high-dose T3 thyroid hormone.

If it hasn't been tried, consider a trial of high-dose T3 thyroid hormone. Many people with fibromyalgia are resistant to thyroid hormone - it's as if their body is "deaf" and has trouble "hearing" the hormone - and they need high levels to achieve normal function.

*12. Optimize your adrenal, Cortef, DHEA-S.

Is your adrenal functioning optimized? Probably not, if you have one or more symptoms of suboptimal adrenal functioning, which include low blood pressure, post-exertional fatigue, or becoming very irritable when hungry. You can optimize adrenal function with an adrenal herbal mix, the adrenal hormone Cortef (5 to 15 mg daily by prescription), and DHEA (if DHEA-S is suboptimal). You should also drink more water and consumer more salt (unless you have high blood pressure or heart failure).

*13. Stimulate hormone production with Pregnenolone.

Pregnenolone is the "mother hormone" - the main raw material your body uses to make other hormones, like cortisol, DHEA, estrogen, progesterone and testosterone. We have found that pregnenolone is often low in CFS and fibromyalgia. Have your level checked - and treat if you find it's suboptimal.

14. Consider growth hormone injections.

IgF is a biochemical marker for growth hormone (GH) - and we see GH deficiency over and over again in fibromyalgia. If your IgF levels are suboptimal, consider GH injections. (These are expensive, so this isn't an early choice for treatment.) In a recent study, the dose was .006 mg/kg/d of GH, adjusted based on IgF levels. Good news: exercise, sex, and sleep also raise GH. (For more information on fibromyalgia and growth hormone, see Growth Hormone Treatment Helpful in Fibromyalgia.)

15. Oxytocin can produce quick benefits in some cases.

Oxytocin is an important hypothalamic neurotransmitter, which is shown to be low in FMS. I suspect a deficiency is present in those with pallor and cold extremities. The typical dose (administered via intramuscular injection) is 10 units (add 0.2 cc lidocaine without epinephrine to minimize stinging). If it's going to help, the benefits will begin in 45 to 60 minutes and are clear cut. If the injection works, you can try a sublingual (under the tongue) or nasal spray, made by a compounding pharmacy, to see if there's a similar benefit - but these forms are less effective and more expensive than the injections. The injections can be used daily, or daily as needed.

16. In women, look for PCOS (Polycystic Ovary Syndrome).

Ten percent of American women have PCOS - a condition characterized by high blood levels of testosterone and DHEA associated with insulin resistance (blood sugar problems). The symptoms can include acne, increased facial hair, irregular periods and infertility.  If those symptoms are present along with an elevated testosterone and DHEA level, and a fasting insulin blood level over 10, you might have PCOS triggering your CFS/FMS. Treatment consists of:

  • The prescription anti-diabetes drug metformin, at 500 mg, 1 to 2 times daily. (Metformin can cause vitamin B12 deficiency, so be sure to take a good multivitamin or vitamin powder with it. Beyond that, it is an excellent and very safe medication.)
  • Cortef, at 10 to 20 mg a day, can also improve PCOS.
  • Cut sweets out of your diet - sugar flares PCOS.
  • Some birth control pills can help regularize the menstrual cycle.

*Nutritional Therapies

Make sure your foundations are covered by taking a good multivitamin powder - I recommend the Energy Revitalization System from Enzymatic Therapy - (1/2-1 scoop a day) plus ribose 5 gm 2-3x day. I  also recommend zinc (sulfate or picolinate) 25 mg a day for 3-6 months for everyone with CFS/FMS. After 3-6 months, the zinc from a good vitamin powder should be enough to maintain zinc levels.

*17. Take these additional supplements for first 3-6 months.

For 3 to 6 months, add:

  • Coenzyme Q10, 200 mg a day.
  • Acetyl L-carnitine, 1500 mg a day.
  • Iodine, 6.25 mg a day.
  • Fish oil (I recommend a special brand of fish oil called Vectomega by EuroPharma; take 1 to 2 capsules a day).
  • Zinc, 25 mg a day (zinc deficiency is incredibly common in CFS and FM).

*18. Check for food allergies.

Food allergies can severely aggravate CFS/FMS. To see if food allergies are playing a role, go on a Multiple Food Elimination Diet. A wonderful technique to treat food allergies is a specially modified form of acupressure, called NAET. In addition, many food allergies settle down after you provide adrenal support and treat Candida.

19. Take high-potency nutritional IVs.

These are called Standard IVs at the Fibromyalgia and Fatigue Centers (which use a special advanced formula) and Myers Cocktails in holistic practice. I recommend taking a set of 6. You can find the recipe for Myers Cocktails at IV (Intravenous) Nutritional Support Gets More Support.

20. Take iron.

Iron is critical for thyroid function, helping to convert T4 to active T3. It also helps produce dopamine, a key neurotransmitter. And it helps settle down Restless Legs Syndrome. So be sure your iron stores are optimized. Have your blood ferritin (a biomarker of stored iron) level checked. If the level is under 60, you should take 29 mg a day of iron, plus 100 mg vitamin C (which aids absorption). Important: the so-called "normal" range for "adequate" ferritin is anything over 12, which is frankly insane.

Summary of Blood Tests

There are a number of blood tests used in the treatments discussed in this three-part series. They are summarized below for your convenience:

  • Ferritin (treatment no. 3)
  • Anti-transglutaminase IgA and IgG antibody (treatment no. 7)
  • Serum ammonia level (treatment no. 8)
  • Fasting morning cortisol; DHEA-S (treatment no. 12)
  • Pregnenolone (treatment no. 13)
  • IGF-1 (treatment no. 14)
  • Free and total testosterone (treatment no. 16)

About the Author

Jacob Teitelbaum

Jacob Teitelbaum, M.D., internist and author of From Fatigued to Fantastic!, researches treatments for Chronic Fatigue Syndrome and fibromyalgia.

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