Monday, April 11, 2011

SHINE program

By Jacob E Teitelbaum MD
Jacob E Teitelbaum MD

The “perfect storm” for Fibromyalgia, CFS/ME, and fatigue in general is preparing to hit.

A combination of poor nutrition, decreasing sleep, increasing stress and environmental toxins has created a human energy crisis of unprecedented proportions. Over the past 10 years, the incidence of Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FMS) has exploded by 400 to 1000 percent, as documented in five separate studies.

The numbers for those with CFS in the U.S., previously estimated at 500,000, are now being re-tallied at closer to 1- 2.5 million. Previous estimates placed the number of Americans with FMS at 6 million. Studies worldwide suggest this has likely gone up in the last decade to ~ 12-24 million Americans! Meanwhile, ¼ of Americans suffer with chronic pain and most are fatigued.

So what does the research show? 

The lead article published in an issue of the Journal of Chronic Fatigue Syndrome is titled "Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia -- the Results of a Randomized, Double-Blind, Placebo-Controlled Study"! After decades of hard work by hundreds of researchers in the field, we have progressed to the point where effective treatment is now available for these illnesses! In our study, 91 percent of patients improved with treatment.

In the average patient, after two years of treatment, the average improvement in quality of life was 90 percent. Pain decreased by over 50 percent on average. Many patients no longer even qualified for the diagnosis of CFS or fibromyalgia after treatment! Interestingly, many of the same principles for treating fibromyalgia also apply to myofascial pain syndrome

That the vast majority of patients improved significantly in the active group while there was minimal improvement in the placebo group proves two very important things. The first is that these are very treatable diseases. The second is that anyone who now says that these illnesses are not real or are all in your head are clearly both wrong and unscientific.

A new day is dawning in how CFS/fibromyalgia/MPS will be treated. In support of our work, an editorial in the April, 2002 journal of a major multidisciplinary medical society for pain management in United States noted " the comprehensive and aggressive metabolic approach to treatment detailed in the Teitelbaum study are all highly successful approaches and make fibromyalgia a very treatment responsive disorder. The study by Dr. Teitelbaum et al. and years of clinical experience make this approach an excellent and powerfully effective part of the standard of practice for treatment of people who suffer from fibromyalgia and myofascial pain syndrome”.

It is important to recognize that these syndromes can be caused and aggravated by a large number of different triggers. When all these different contributing factors are looked for, and treated effectively, patients improved significantly and often get well!

What is causing these illnesses?

As we noted above, CFS/FMS/MPS is not a single illness. Our study has shown that it is a mix of many different processes that can be triggered by many causes. Some of you had your illness caused by any of a number of infections. In this situation, you can often give the time that your illness began almost to the day.

This is also the case in those of you who had an injury (sometimes very mild) that was enough to disrupt your sleep and trigger this process. In others the illness had a more gradual onset. This may have been associated with hormonal deficiencies (e.g. low thyroid, estrogen, testosterone, cortisone, etc.) despite normal blood tests. In others, it may be associated with chronic stress, antibiotic use with secondary yeast overgrowth, and/or nutritional deficiencies. Indeed, we have found well over 100 common causes of, and factors that contribute to, these syndromes.

What these processes have in common is that most of them can suppress a major control center in your brain called the hypothalamus. This center controls sleep, your hormonal system, temperature, and blood flow / blood pressure. When you don't sleep deeply, your immune system also stops working properly and you'll be in pain. When we realized this, the myriad symptoms seen in CFS/fibromyalgia suddenly made sense. It also gave us a way to effectively treat you!

The “SHINE Protocol”- Five main categories of problems need to be treated.

A half-century of work by Dr. Janet Travell, the White House physician for Presidents Kennedy and Johnson and author of the Trigger Point Manual showed that the same problems caused by hypothalamic suppression resulted in muscles getting stuck in the shortened position. Chronic muscle shortening then causes myofascial and fibromyalgia pain, with chronic pain then being amplified in the brain (called Central Sensitization). As she laid the groundwork for effective treatments these processes, our research team dedicated our published study to her memory. These are the five key areas that need to be treated for Chronic Fatigue syndrome, fibromyalgia and muscle pain to resolve:

1- Sleep. Most patients with these illnesses find that they are unable to get 7-8 hours of deep sleep a night without taking medications. In part, this occurs because hypothalamic function is critical to deep sleep. Unfortunately, many of the most common sleep medications actually aggravate the sleep problems by decreasing the amount of time spent in deep sleep. For patients to get well, it is critical that they take enough of the correct sleep medications to get 8 to 9 hours sleep at night! These medications include Ambien, Desyrel, Neurontin, Klonopin, and, if you don't have Restless Leg Syndrome, Flexeril and/or Elavil. In addition, natural remedies can help sleep. An excellent one (which I developed –the Revitalizing Sleep Formula by Enzymatic Therapy -- 100 percent of my royalty for all products I develop is donated to charity) includes theanine, Jamaican Dogwood, wild lettuce, valerian, passionflower, and hops. Other natural sleep aids include magnesium (250-500 mg of the Jigsaw Health sustained release magnesium would be an excellent choice), and melatonin (3/10-1mg). In the first six months of treatment, it is not uncommon to sometimes need to take even six to eight different products simultaneously to get 8 hours of sleep at night. After 6-18 months of feeling well, most people can come off of most sleep (and other) medications. I'm starting to believe that, to offer a margin for safety during periods of stress, it may be wise to stay on 1/2 to 1 tablet of a sleep medication for the rest of your life.

2--Hormonal deficiencies. The hypothalamus is the main control center for most of the glands in your body. Most of the normal ranges for our blood tests were not developed in the context of hypothalamic suppression or these syndromes. Because of this (and for a number of other reasons) it is usually necessary, albeit controversial, to treat with thyroid, adrenal (very low dose cortef; DHEA), and ovarian and testicular hormones -- despite normal blood tests! These hormones have been found to be reasonably safe when used in low doses.

3--Infections. Many studies have shown immune system dysfunction in FMS/CFS. Although there are many causes of this, I suspect that poor sleep is a major contributor. The immune dysfunction can result in many unusual infections. These include viral infections (e.g. –XMRV, HHV-6, CMV, and EBV), parasites and other bowel infections, infections sensitive to long-term treatment with the antibiotics Cipro and Doxycycline (e.g. mycoplasma, chlamydia, Lyme’s, etc) and fungal infections. Avoiding sweets (stevia is OK) and taking Acidophilus Pearls (healthy milk bacteria –2 pearls twice a day for 5 months) can be very helpful. We often also add prescription antifungals as well.

4--Nutritional supplementation. Because the western diet has been highly processed, nutritional deficiencies are a common problem. In addition, bowel infections can cause poor absorption, and the illness itself can cause increased nutritional needs. The most important nutrients include: a) vitamins -- especially the B vitamins (most at 25-50 mg/day), vitamin B12 (50-3000mcg/day), antioxidants (e.g. -- vitamin C and E). b) Minerals -- especially magnesium, zinc, and selenium and c) amino acids (proteins).

In addition, a new nutrient discovery called Ribose (Corvalen by Bioenergy) is looking like the most exciting discovery of the decade in energy research. Two studies using it in ~ 300 CFS/FMS patients at 53 medical centers have shown it increased energy an average of ~60% after only 3 weeks! Take 5 grams (1 scoop) 3 x day for 3 weeks, then twice a day. For “day to day” fatigue, even lower doses are helpful (I take 1 scoop each morning mixed in with the vitamin powder).

5- Exercise as tolerated. In the beginning, walk as much as you can so that you feel “good tired” after and better the next day. Because you do not yet have the energy to condition, do not push beyond what is comfortable. Otherwise, you’re likely to crash. After 10 weeks on the program, your energy production will increase, and then you’ll be able to condition by increasing your walking by one minute a day as able. When you get to 1 hour a day, you can increase the intensity of your exercise.

There are many other treatments available as well. Although space does not allow for a full discussion of these in this article, I discuss them at length in my book “From Fatigued to Fantastic! “ and at my website. Our free short online “ symptom analysis program” on my web site can simplify this process markedly. It can analyze your symptoms and labs to tell you what the likely causes are of your Chronic Fatigue or Fibromyalgia, and even of day to day fatigue, and tailor a treatment protocol to your specific case!

Effective treatment is now available. It’s time for people to get well!

Dr. Teitelbaum is a board certified internist and Medical Director of the ”Fibromyalgia and Fatigue Centers” nationally. Having suffered with and overcome Chronic Fatigue Syndrome (CFS ) and Fibromyalgia in 1975, he spent the next 30 years creating, researching, and teaching about effective therapies for fatigue and pain. He is the senior author of the landmark studies "Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia -- a Placebo-controlled Study" & “Effective Treatment of CFS & Fibromyalgia with D-Ribose”. He lectures internationally. He is also the author of the best-selling book” From Fatigued to Fantastic!” (3rd ed-Penguin/Avery Oct 2007), “Pain Free 1-2-3- A Proven Program to Get YOU Pain Free! “ “Beat Sugar Addiction NOW”, and the free iPhone and Android application “Cures A-Z”. His web site can be found at:

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