Treatment
The treatment of chronic fatigue syndrome can be divided into six major parts as follows:
- Symptomatic approaches
- Treat abnormal or non-ideal lab tests
- Primary therapy which assumes a known etiology
- Biological terrain adjustment
- Treatment of complications
- Supportive measures
Dr. Cheney believes there can be a measure of success in doing all of the above, and many good physicians do all or most of that listed above. Success or failure depends on the patient as well as the strengths of the practitioner.
Symptomatic Therapy
The most important therapy in the area of symptomatic relief is to address the often severe sleep disturbance of CFS. I use a long-acting benzodiazepine and a centrally acting antihistamine plus a GABA agonist along with magnesium injections or magnesium transdermal paste at night. We also use low-dose transdermal pregnenolone.
The important thing is to not depend on one thing, and to use low doses of many things given together.
Abnormal Test Results
Abnormal test results can be very tempting to treat, but we have increasingly moved away from this approach though it can be important depending on what is abnormal. The single most common area treated here in CFS is hormone therapy, especially thyroid hormone.
It is our view that hormone therapy, while occasionally dramatic in its effect clinically, is often a false hope. All too often there is a reason for the body’s internal hormone adjustments that reflects deeper problems, and hormone therapy interferes with this adjustment more than it is helpful in the larger context.
Primary therapy which assumes a known etiology
The problem here is that there is no known etiology for CFS, and aggressive therapy here cannot be long defended. The most common therapies include antimicrobial therapies, detoxification and/or remediation.
While sometimes helpful, we know of no study of any putative primary therapy which has been uniformly helpful when used broadly to help or cure CFS. In large, well controlled studies, such therapies are no better than placebo.
Biological terrain adjustment
From all the way back to medical school, Dr. Cheney has been intrigued by the power of adjusting biological terrain. An experiment in pH adjustment will convince anyone of the power of optimizing enzyme function by even a small pH shift.
It is intriguing when you realize that pH and redox set points are the opposite sides of the same coin, and that redox set points control cellular energetics. That said, anything that can control pH or redox can control cellular energetics and the reverse is also true.
We have been increasingly intrigued with the therapeutic power inherent in shifting the biological terrain. We use several powerful redox shifters, and perhaps the most powerful terrain shift approach of all is to directly alter the genetic phenotype.
This can be done with low-molecular-weight peptides derived from mammalian tissue extracts called cell-signaling factors, or CSFs. We are presently investigating CSFs and other approaches to gene expression shifts in an attempt to alter the biological terrain.
We feel that, along with stem cells which shift the genotype itself, this is one of the most powerful approaches in medicine today. It is proving more and more effective in CFS even though we are still early in our understanding of this mode of therapy.
Treatment of complications
Most CFS patients suffer any number of complications related to CFS. Probably the most common and the one most in need of addressing is the complication of gut dysbiosis.
Gut dysbiosis is a term that signifies an altered gut microbial ecology associated with features of gut motility disturbance, digestive malfunction, gut immune disruption and food intolerances. It is universal in CFS and must be aggressively treated though it is not primary. In our opinion the primary problem is reduced cellular energy and its ubiquitous effects on autonomic balance, pH balance and redox issues.
Despite its secondary role, dysbiosis may account for most of the symptom misery of CFS. We employ a relatively old therapeutic approach from the mid-1990s called the 3-R approach, with a few new twists.
The first R stands for Remove, and we use a broad-spectrum gut antimicrobial agent for a short period of time.
The second R stands for Repair, and we primarily use colostrum and a pre-biotic protein mixture.
The final R stands for Replace, and we use a variety of pre-biotics plus a German derived commensal known as 1917 Nissle strain E. Coli.
We also recommend a modified elimination diet and digestive enzymes.
Supportive measures
Patients are often their worst enemy and fail to remove the stressors that surround their lives and all too often contribute to their own stress.
We have seen no one improve their CFS in the face of significant stress, whether exogenous or endogenously applied. Patients are encouraged to get to a place of peace and tranquility and acceptance of their condition, or they will find a rough road ahead.
Somehow finding that peace and graciously accepting their fate seems to trigger the very improvement they turn away from, and the road to recovery becomes less steep.
Reduction of stress, proper diet and a less toxic environment are the keys to supportive care.