CHRONIC FATIGUE STATES: A SPREADING EPIDEMIC

A state of undue tiredness is not a new discovery. A diminished level of general energy — and the sense of decreased vigor that accompanies it — has been known to health practitioners and lay people throughout history. Modern notions of fatigue are often traced to descriptions of George Beard — a New York City neurologist — who in the 1960s called it neurasthenia. Since then, Beard's neurasthenia has largely been regarded pejoratively — not unexpected in view of the "nervous weakness" implicit in the term. The terms "shirker's syndrome" and "yuppie plague" attempt to cloak this bias in contemporary vernacular. In the decades that followed Beard's description, the search for the cause of chronic fatigue often focused on infection with a host of organisms such as Brucella species, Epstein-Barr virus and, more recently, retroviruses. In 1985, a group of investigators at the Centers for Disease Control (CDC) formulated a set of criteria for the diagnosis of chronic fatigue syndrome. These criteria, as I show later, have done nothing to elucidate the true nature of this problem; rather, they have served as a diagnostic label to test the efficacy of drug therapies for chronic fatigue prescribed by practitioners of N2D2 medicine. Chronic fatigue — I repeat for emphasis — will be the dominant chronic health disorder of the next century. How prevalent is it at present? Twenty one percent of 500 patients visiting a primary care clinic in Boston and 24% of 1,159 patients presenting at two adult care clinics in Texas complained of chronic fatigue. As comic relief, I cite a recent CDC estimate of the incidence of the chronic fatigue syndrome (reported by Science 254:1726;1991) which puts the number of total cases in the United States at 100,000. The wisdom of government experts often escapes me, and this is a good example. New York City alone has several times that number of people whose lives are severely limited by chronic fatigue states. Almost 90% of patients who consult me these days suffer from chronic fatigue. I wonder what could possibly be the motive behind such a ludicrous estimate by the folks at the CDC.

WHEN I WENT TO MEDICAL SCHOOL IN THE LATE 1950s, CHRONIC FATIGUE SYNDROME DID NOT EXIST IN MEDICAL TEXTS

When I went to medical school in the late 1950s, chronic fatigue as a disorder didn't exist in medical texts. Indeed, it still does not exist in most medical texts. There were a few reports in the literature of chronic fatigue that followed some viral and bacterial infections such as chronic brucellosis, coxsackie and CMV viral infections and a host of other bacterial infections. It was not a subject worthy of serious study. Now, hardly a day goes by that I do not see patients with disabling chronic fatigue. Where did this epidemic of chronic fatigue come from? What makes previously healthy people severely fatigued? Most important, why are our children suffering from chronic fatigue states in such frightening numbers?

CHRONIC FATIGUE STATES CANNOT BE UNDERSTOOD THROUGH SIMPLISTIC ONE- DISEASE-ONE-DRUG THINKING

States of chronic fatigue cannot be understood through the prevailing reductionistic medical thinking that regards diseases as drug-deficiency syndromes, to be cured by supplying the missing drugs. Nor can chronic fatigue states be successfully managed with narrow-focused drug "cures." What is required is a "systems study" of man and his environment — a holistic view of the impact upon a person's genes of environmental factors, nutritional status, microbes, stress and lack of physical fitness. Instead, millions of dollars are being spent on fragmentary studies of single issues. Isolated studies of epidemiology, immunology and virology, and clinical response to drugs have not — and I am certain will not — lead to effective therapies for restoring normal energy enzyme pathways in chronic fatigue states. What we need are integrated programs of fundamental research into human enzymatic energy mechanisms that are impaired by incremental molecular oxidant stress. Recognition and elimination of specific causes of increased oxidant stress, whenever possible, remain the true answers. Environmental, nutritional, self-regulatory and fitness approaches to reducing excessive oxidant stress are the keys to solving this global problem.

HOW DO WE CAPTURE LOST ENERGY?

This question has preoccupied me for some years now. During this time, my theory that accelerated oxidative molecular injury is the true nature of chronic fatigue states gradually took form in my mind. Also during this time, I formulated — and validated with clinical outcome studies — my nondrug strategies for restoring normal energy enzyme pathways. As my clinical and research interests became sharply focused on chronic fatigue states, I started writing this book, and began to search for a suitable term for my work — some word that would fully express my notions of the true nature and optimal management of these states. I considered and rejected several different words for this purpose. Recently, between seeing patients in my office, my eyes fell on a draft of this chapter and I saw the question that appears in the heading of this paragraph. My eyes remained fixed first on the word "capture" and then on "energy." In a flash, I saw how the letters in the two words could express my total conceptual clinical approach.

The three letters in the word "cap" stood out for the three essentials of my core philosophy of caring for chronic fatiguers and the six letters in "energy" for the core elements in my clinical strategy. Thus:

Catch in early stages Avoid drugs Prevent relapses.

In the same flash image, the word "energy" stood for:

Environment Nutrition Exercise Restoration (of energy enzyme pathways) God You

Catching chronic fatigue states early is the first of the three core elements of my philosophy of caring for chronic fatiguers. From extensive clinical experience, I know that chronic fatigue states are easy to reverse if caught early. I also know that chronic fatigue states can be prevented. There are two essential requirements for this.

First,

we must dispense with silly notions of searching for the cause of chronic fatigue in frivolous diagnostic labels.

Second,

we must diligently address all factors that increase oxidant stress on human biology.

Avoiding drugs for chronic fatigue is the second core element. Nearly every working day I see the tragedy wrought by misuse of drugs for chronic fatigue states. Nearly every working day I see patients suffering from unrecognized and unmanaged functional nutritional disorders, sugar-insulin-adrenalin roller coasters, allergy and chemical sensitivity, temperature dysregulation and Fourth of July chemistry under the skin. None of these issues can be truly addressed with drugs, though drugs may be necessary for temporary symptom suppression. I address this subject at length in the chapters Lamppost Labels for Chronic Fatigue, What Is Chronic Fatigue? and Where Does It All Begin?

Preventing recurrence of chronic fatigue after initial success is the third core element. Not uncommonly I see chronic fatiguers who make slow and sustained recovery only to be plunged back into physically and emotionally exhausting states of fatigue by mindless use of drugs for sheer symptom suppression. Chronic fatiguers need to understand this. They must find physicians who have a global view of how our environment affects our genes and injure our energy and detoxification enzymes.

ENERGY: THE ESSENTIAL CLINICAL STRATEGY

Environment sustains life. Chronic fatigue is a state of accelerated oxidative molecular injury. The increasing oxidizing capacity of planet Earth, in my view, is the principal threat to mankind and the other living creatures that share this planet with us. I return to this subject several times because it is the essence of this subject. I suggest that the professional reader consider my article "Hypothesis: Chronic Fatigue is a State of Accelerated Oxidative Molecular Injury" published in the Journal of Advancement in Medicine (6:83-96; 1993) and reproduced with the kind permission of Human Sciences Press, Inc., at the end of this volume. For the general reader, I devote the chapters What Is Chronic Fatigue? and Where Does It All Begin? to this subject. I discuss some other aspects of this subject in the companion volume RDA: Rats, Drugs and Assumptions.

Here I briefly state that the environment — as it relates to matters of human health and disease and states of chronic fatigue — includes not only the bedroom environment, the workplace environment, air pollution etc., but also the internal environment of our body organs such as the bowel ecosystem, the lung ecosystem, the cell ecosystem and, indeed, the ecosystem of the microcosms of life that exist within single cells and individual cell organelles such as mitochondria — the tiniest powerhouses where energy enzymes are arranged on submicroscopic shelves.

Specifically, I include in environmental concerns the issues of mold and other types of inhalant allergy, chemical sensitivity and toxicity and toxic metal overload.

Nutrition is what makes up our internal ecosystems. Few things sadden me more than the disdain of my colleagues in drug medicine for the essential role nutrition plays not only in preserving health but in restoring health by reversing chronic diseases. There are three essentials in this area: 1) optimal food choices in the kitchen; 2) oral nutrient protocols; and 3) intravenous nutrient protocols. I devote The Butterfly and Life Span Nutrition to the first subject and strongly recommend that volume to fatigue sufferers. I address the latter two subjects later in this volume.

Exercise for chronic fatiguers must be slow, sustained and non goal-oriented. This is a point of considerable importance. Several of my patients who suffered from chronic, disabling fatigue are competition athletes, dancers and fitness trainers. Oxidative injury to energy enzymes does not seem to show any respect for people no matter their status in society. Time and again, I see the tragedy of a chronic fatiguer making herculean efforts to pull himself out of chronic fatigue with sheer willpower. It does not work. I have seen people who worked with one of the popular exercise videos only to collapse for days after strenuous activity. Oxidant injury to energy enzymes, I might add, is equally ignorant of the teachings of mind-over-body gurus. This is also an essential subject to which I devote the companion volume The Ghoraa and Limbic Exercise.

Restoration of energy and detoxification enzyme pathways calls for strategies that are based on a deeper understanding of how human biology succumbs to the onslaught of oxidant injury.

Specifically, the fundamental issues in this area are:

1. Restoration to normal states of bowel ecology. 2. Restoration of even, steady-state molecular dynamics of health (eliminating sugar, insulin, adrenaline and neurotransmitter roller coasters). 3. Restoration of normal body temperature (through self-regulation and normalization of thyroid gland function). 4. Restoration of cell membrane structure and function (through food choices in the kitchen, oral and,when necessary, intravenous nutrient protocols). 5. Restoration of normal energy dynamics by reducing, and eventually eliminating, stress-related molecular events. 6. Restoration of energy systems that have been blocked or impaired by toxic metal overload such as aluminum, mercury, lead and others.

I devote the companion volume Battered Bowel Ecology — Waving Away A Wandering Wolf to issues of altered bowel ecology states. For the professional reader, I suggest my monographs Intravenous Nutrient Protocols in Molecular Medicine and Allergy: Diagnosis and Management.

God and You are taboo subjects in medicine. I know these words will invite derision from my colleagues in "scientific" medicine. Practitioners of N2D2 medicine, I know, have no respect for "religion" in medicine. That is why they are so fond of dismissing all dimensions of the healing process that are outside the domain of their drugs and scalpels. I make no apology to them. But I know that those who care for persons paralyzed with persistent, debilitating, chronic fatigue will immediately see why I choose to give so much importance to this subject in this volume. The way out of unrelenting suffering cannot be found without redefining — at least in some measure — the link that binds us to the gentle guiding energy of that presence that always surrounds us. On a mundane level, the goal of reducing total oxidant stress on an individual requires making many changes in choices he makes in his everyday life — and mere martyrdom doesn't work. He cannot reach the stage at which he wants to do the things that he needs to do without some profound visceral-spiritual changes. Indeed, in my view, some spiritual dimensions are essential for coping with all serious types of illness. Persistent, disabling chronic fatigue states certainly qualify as serious illnesses. I make no apologies to the "scientist" in drug medicine for this statement.

I consider training in effective methods for self-regulation essential for all my patients who suffer from chronic fatigue. Beyond the issue of understanding energy dynamics in health and disease through self-regulation, there is the matter of opportunity for doing some spiritual work — opening some new spiritual dimensions in one's life. Enlightenment, in both physical and spiritual senses, usually comes to the seriously ill in three phases: awareness, higher states of consciousness and spirituality.

When caring for seriously ill patients, physicians, in general, are deeply troubled by subjects of states of consciousness, enlightenment and spirituality. It is ironic because the sick almost always welcome any opportunity for instruction and training in these areas. Suffering brings new insight into matters of the human condition, states of consciousness and domains of spirituality. It is really that simple. We do not need to invoke esoteric brands of mysticism for such work. Gurus are really not necessary. Good teachers will do. I return to this essential subject in the chapter On Hope, Spirituality and Chronic Fatigue.

CONTINUE CHAPTER 1 THE CANARY AND CHRONIC FATIGUE >>>