|
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
>>>
ORDER
The Canary and Chronic Fatigue
|
