CHRONIC FATIGUE - ME/CFS What to do...

Good day and welcome to Medicine Health with Dr. Paul Anderson. That's me, I'm Dr. Paul. And today our topic is, uh, some patient stories and some helpful hints with chronic fatigue syndrome. So we had, uh, we had a show— the last show was about chronic fatigue syndrome. We got a lot of questions about that, which is great. And so I thought, well, we'd pick up on that and do some, uh, uh, some practical tips, uh, give some, uh, patient stories so you kind of get a background and a flavor for what's going on. And, uh, then we can move on from there. I love the comments, um, that we get. That really helps because, you know, uh, we all only know what we know inside. And, uh, and when you make comments, it shows me, you know, where people have questions or Sometimes the comments are around, you know, therapeutic things and maybe is this good or bad and all of that. So chronic fatigue syndrome, certainly not a small number of people, millions of people diagnosed with CFS/ME in the United States and certainly all around the world. So that's what we do. Now we're doing this live right now on Contact Talk Radio. That's my home. So CTR Radio Network, and they do all of my background production. So they will take, and they'll take the video version of this. If you happen to listen on the radio, you're getting the audio. They'll take the video version and move it over to YouTube and my YouTube channel. You can get there fairly easy. Just search DRA Online, Dr. A Online. You can also go to my hub website, which is dranow.com, and there's links to all of my media, including and the YouTube channel. Now today we're not gonna have a whole lot of show notes, but a lot of times, especially if we're doing some of the, you know, deeper things or if there's new studies we're looking at or whatever, I'm gonna put those studies up in the show notes and that's gonna be on the YouTube channel. And so take a look in there. Also, please, whatever platform you're on, whether you're on one of the pod burners, you know, iHeartRadio or Apple iTunes, et cetera, et cetera, et cetera, Google, please like, share, subscribe, click on notifications. If you're on YouTube, uh, we're, we're heading now, you know, towards a couple thousand, uh, subscribers. Really like to get over the 2,000 mark. Really appreciate all of that. So, uh, please let people know, like, share, subscribe, and go back through, uh, on the YouTube channel. I've got these long-form podcasts that I do every week live on the radio, and then I've got shorter forms, uh, and it's all aimed to you know, make you an empowered patient, give you information, etc. So as we move forward here, uh, there's a big question that came up. So I want to kind of do this in, uh, in 3 parts, and the last part will be a lot longer and deeper. But the first part really is answering a big question because I had said, uh, I think both in one of my shorts that I did on YouTube and TikTok and stuff about chronic fatigue, that Uh, part of the diagnostic criteria is that you don't have any other medical explanation for the problem. And this becomes sort of an issue for people because they'll say, well, um, does that mean, you know, it's not a medical problem like chronic fatigue syndrome? No. Um, what they're getting at there with the diagnostic criteria really is, um, You want to make sure that you do not have a fatiguing disease that you don't diagnose other than chronic fatigue syndrome. So, for example, you could be profoundly anemic and have chronic fatigue, pain, other things. Well, you need to correct the anemia, and if that makes it all go away, then you fit into the anemia diagnostic bucket. You could have a severe or significant thyroid problem. You could have diabetes. You could have an autoimmune disease. You want to make sure you don't have one of those other diseases or cancer or something like that. So that's all that means. But what you need to remember is no other medical diagnosis. And for those not seeing the video, I'm doing air quotes under no other medical diagnosis. Doesn't mean that you don't have a medical problem. And I'm going to talk about that coming up in the, in the second section and with some of the patient stories. But that's the big deal is you do have a medical problem. It's just we've ruled out other stuff. So we're not seeing autoimmunity. We're not seeing metabolic things, at least that are causing all of it. Now, could you have all of those things and still have chronic fatigue? Yes. Because, you know, what if— and this happens all the time— what if you get diagnosed with something? Okay, maybe hypothyroidism, and your doctor says, well, that's probably causing your fatigue. So they fix your hypothyroid state and you're still fatigued. Okay, maybe you feel a little bit better, but you still have your chronic fatigue. Well, you can have 2 things going on at the same time. And in our practice, where we, uh, took over a very large chronic fatigue specialty clinic a number of years ago, We had all sorts of patients who would get their diabetes treated appropriately. They would get their hypothyroid treated appropriately. They'd be diagnosed with, you know, an autoimmune disease and that'd be being treated appropriately, but they still had chronic fatigue syndrome on top of it. Okay, so there are criteria for that. Now, with previous video, you can go through and take a look at that, but that's all that that means when we say No other medical diagnosis. Now the next thing that I got questions about was, well, what— can you put some flesh on this with respect to, you know, some patient stories or case histories, stuff like that? And the answer is yes. I want to do that here in Section 2. And so I want to kind of focus on a couple of examples that came into the Chronic Fatigue Center. And so one was— I'm going to kind of do 2 ends of the spectrum of what we see clinically. One was quote unquote easier, uh, in that the patient had less underlying problems and we were able to sort them out and we were able to treat them And in a relatively short amount of time for chronic fatigue syndrome, being about a couple of years, we were able to get her through the whole arc of her treatment. And she essentially lost the diagnosis of chronic fatigue because she went back to being pretty normal. So this was a young woman, about 48 years old, and, uh, they had been very healthy up until kind of a slow slide into chronic fatigue, let's say about 5 years prior. So from about 43 to 48, they just got progressively less vital. They didn't feel as strong, all of that business. And so by the time they hit 48, uh, the last year they had just been really kind of flat there. They had, you know, post-exertional fatigue and pain. They had unrefreshing sleep. They had all of these things going on, and so they fit the criteria. Their primary care doctor had checked them for big things, and certainly, you know, there were no big things, quote unquote. Now, when they came to us, it was sort of one of those things where I looked at the labs the primary care doctor had done, And I took their history and I looked at what was going on. And one of the things that you see with people is when they are really healthy. So if this person was an athlete, they were very healthy for over 40 years of their life, and then they kind of went into this long, slow slide. With those folks, often you can ask some questions around, you know, what was going on when you started to slide into not feeling well and what happened in that time period between 43 and 47 or 48 when you got real bad, what was your health like? Obviously it wasn't good, but was it, you know, a slow degeneration? Was there one big thing and then you kind of fell off a cliff? What was, what's happening there? So in her case, um, it was kind of a slow slide. She kept getting, you know, sicker and sicker every winter with colds, and then they would last longer and longer and longer. And then she developed this just persistent fatiguing illness. So what we did then is we went from— now remember I said with this no other medical diagnosis, there are different levels of investigation. So what we did with her was we kicked it up to the next level of medical investigation and said, well, we should look at your immune system. Now I'm going to talk to you in the, in the last part about, you know, what we do and all that. But in her case, because She had essentially been very healthy for most of her life. I didn't think that she had a, like, a primary immunodeficiency, which we find in people, or some of these other things. But what I did see is she had this time period where she got sick, and then she got sicker more frequently, and that does kind of scream out at some immunologic problem. The most common immunologic problems are where you get 1 or 2 chronic either viral or bacterial other infections, and then they all pile on each other. Okay, so what happened was we decided to check some of the common chronic infectious agents. So we did that. We looked at her hormonal testing that she had done with her other doctor, and it was very basic. So they had ruled out a primary hypothyroidism. hypothyroid state. They'd ruled out diabetes, you know, the big things. So what we did there is we looked and looked a little deeper at thyroid resistance, looked at her reproductive hormones, um, and some other things like that. Then we looked at some biological, uh, markers of, you know, inflammation and some other blood sugar things and, you know, just a lot of other biochemistry around her. And the way we look at it was, well, let's start with what seems reasonable, and if we're not getting answers, we can always do more. Okay, now that usually works out, but sometimes people's cases will fool you and you'll need to look at a lot more. Well, in her case, we get all this data back from her laboratory testing, and it turns out that there's sort of 2 groups of things that we had to work on. One were What you'd call, you know, hygienic lifestyle sorts of things. So she had sleep issues, so she wasn't getting enough sleep that wasn't restorative. Her diet and intake of food and drink had gotten kind of off the rails, and she was a very healthy person prior. There were a number of other things. She was— she had stopped exercising, all that stuff. Now, when you have chronic fatigue syndrome, CFS/ME, exercise can be a problem because it can create more pain, more fatigue, etc. So you can't just suddenly just boom, do more exercise and then you're, you know, better. But it has to be in the mix. It's sort of like diet. You got to get into the diet, do some things, but, you know, sometimes you can't change it all at once. But then the other bucket that we had— so we had the lifestyle and diet and all that stuff, then we had the biochemical problems. Okay, so what we found in all those labs that we did was a number of chronic infections that were active. Now, she didn't have an immune deficiency, she just happened to have a beat-up immune system, which over those 5 years had progressively picked up more of these chronic infections. And then they become very suppressed in your system, and your system basically comes to an agreement with them, and they take a lot of the energy from you. So the only symptom you really have is fatigue. Okay, so that's a problem there. Then in the hormonal system, she had developed some thyroid resistance, which is different than a low thyroid or hypothyroidism. She needed a very specific type of thyroid treatment to sort of get the resistance to go away. And when you develop thyroid resistance, it's usually because you've wound up having, uh, fatigue or other chronic problems long enough that your body turns your thyroid down to keep you from having a whole lot of energy because it knows that you're already fatigued and sick. So it's a compensatory mechanism. So just like you don't want to come in with guns blazing, make someone with CFS/ME, you know, do a whole bunch of exercise because it'll hurt them, you also don't turn up the thyroid really quickly either. But we had to be attentive to it. All the other blood sugar stuff looked pretty good. But her reproductive hormones were just all over the map. So one thing that she had developed was something that kind of, you know, colloquially call estrogen dominance, where she had plenty of estrogen, but not very much progesterone and testosterone. That can be a problem because a lack of progesterone feeds into the sleep disorders, et cetera. And so that was a big problem and also pain and other things. And then she also had zero detectable testosterone. Now, women don't have large amounts of testosterone, but she had none. Okay. And that's very common in men or women who are chronically ill, that their androgen levels, the testosterone family, go down and down and down. So in a man, you'll see that happen. But in women, there's, there's shorter drop. And the problem is you cannot heal very effectively if your testosterone levels is zero or very low, man or woman, doesn't matter. So she had all that going on there. Well, now we could have done a bunch of other tests, but in her case, I felt like healthy up until her early 40s, middle 40s, things go all off the rails, and then later 40s, she's got persistent chronic fatigue syndrome. So let's undo the things we found. Now, here's the general rule. If we do that and they're getting better, great. If we do that, they get a little better or they have a recurrence, uh, it's time to open the books up and take a look, take a deeper look. Well, basically over the following year, we worked very diligently with her on lowering the amount of activity of the chronic infections, getting her immune system kind of tuned up, getting some nutrients into her, uh, that would get some energy percolating back. We corrected the hormonal issues, uh, by putting her on some natural progesterone at nighttime to help her with the sleep cycle part of progesterone and the pain improvement. And then we put her on some testosterone as well because she had none. Now, the goal with the hormones was not so much to leave her on them forever. This is different than hormone replacement therapy. This is a therapeutic use of hormones to kind of turn things back on. So the thyroid we gave her was a very specific kind to undo the thyroid resistance. And the bioidentical testosterone and progesterone, same thing. They weren't really to replace what was going on because her ovaries still worked. They were just working dysfunctionally. So we did this and kind of put all this in, and then as she started to feel better, we worked on the, the other bucket of things, the, the hygienic things, diet and lifestyle. And so she was starting to get better sleep. So then we started to do just little baby steps with her exercise. And we've talked on the program before, I got a lot of TikToks on this too, about, you know, graded exercise tolerance. So we did a little baby step exercise, did that for a long time, then took a step up, then took a step up. So it's, you're not overwhelming the system. She already was feeling a little better, motivated to go back to her better, you know, diet, more hydrated, eating the right food and all that stuff. So over the course of a year, she had a huge change. She was really back to herself. We took the second year and kind of tapered down on some of the hormonal treatments, went to kind of maintenance on those, did a lot of nutritional support to get her body built back up. She was then at, you know, in the second year, she was back to exercising and sleeping okay and all that stuff. And really by Throughout the second year, she persisted with good health. And so what it shows you is if you can find the underlying problems and work through that, you can actually work your way out all the way or part of the way of the chronic fatigue syndrome. Now, the longer you have the problem, the more of a challenge that is. Hers was a little more finite. So the other clinical story I wanted to tell was really around the other end of the spectrum. And these are people that I have seen over time, and you see them and you kind of have to treat them in stages, and they have kind of instead of a linear, you know, progression to feeling better. They kind of have like roller coaster where it's up and down a bit and up and down a bit. And sometimes it's up, up, up, and then the crash, and then you got to rebuild. So the second person was a little bit more like that. They couldn't remember the last time they felt well. They were again somewhere in their middle 40s, but they really had felt horrible and qualified diagnostically as having chronic fatigue for, you know, as long as they could remember. So, you know, going on half of their life. So in that case, then you've got a lot more things to consider. So in their case, we of course did make sure there wasn't latent autoimmune disease or cancer or, you know, severe anemia or something like that. But what we found was there was a, you know, sort of one of everything that was wrong. So there were certainly a lot of infectious things and there were certainly a lot of nutritional deficits. There was certainly profound sleep disturbance, which is common. Diet was okay, but you know basically no exercise. But then also they had you know a lot of other things. So the chronic infectious piece was there. A lot of hormonal dysregulation was present. So that's never any good. A lot of Toxic influences that go on, you know, chemical and metal toxins when we tested for those, uh, exposure in the past to mold, which kind of sidelines your immune system. Their digestive system was not working very well at all, so they had malabsorption and other things, and just a host of things. So this person, obviously we started with the same idea to treat these things, but you have to do a little bit of prioritization. And it may be, for example, the diet and lifestyle things you might work on, but they may be in baby steps. So we started working on the toxicity and the infectious things and certainly the hormonal things. And then we tried to get the person, you know, kind of stabilized. And then you get to the next step and then you see what you can add on or change or do. Well, now what often happens with people that have a longer history and more comorbidity, more reasons for their illness, is that they may actually improve pretty well to the first step. And then on the exact same therapies they've been on, they kind of crash again and they say, well, why the hell did that happen? Well, that's because what happens is your body has been so suppressed and weak that by the time you put all this good stuff back in and you start to kind of try and take away some of the chronic infectious stuff and detoxify and get the hormones online, the body kind of builds up and says, wow, I've got enough energy now to go attack the next thing. So your body, when you're really sick and fatigued, often prioritizes and says, I've only got enough energy to deal with these things. And that's the first things that you work on. But then you get built up and you've You help those things a bit, and then the body says, wow, I'm feeling better. My immune system now is going to go attack some stuff we didn't know we had going wrong, or we haven't had time to treat yet. So it's really common to have this happen where you plateau and then maybe even crash, or like I would tell people, sort of an upward trending roller coaster where you have up and down, but it sort of trends upward over time. Now the thing in that case to work on is not so much, oh no, you know, it stopped working or whatever. No, it didn't stop working. It's your body telling us that we have to go to phase 2 and we have to do the next thing, which is then to take a step back and say, okay, we've made some gains, we're winning in some of these areas, but do we need to increase intensity in an area? Do we need to back off a little bit? a little of both, and what's on the short list of things we haven't been able to get to yet. Okay, that might be a little more intense look at the detoxification part, might be checking and making sure they're not currently, you know, urinating out a bunch of mycotoxins, biotoxins from mold, which are very immune dysregulatory, inflammatory, etc. It might be looking at a little deeper at the hormones, because one of the things you see with chronic illness is You start with hormones one way, and 3 to 6 months into treatment, you've got a whole different hormone picture, so you might have to reshuffle that around. Then there may be other things like we've, you know, not put a lot of effort into the digestive problems, or it's now time to put more effort into digestive problems, or maybe there's some metabolic things that the person couldn't handle early on. I've seen this where you do what you can with, say, a blood sugar issue or low iron or, uh, you know, some other problems that are non-hormonal but metabolic. And you can only do a little bit in phase 1, and now it's time to kind of back up and say we need some more effort and intensity here. So in the— in that case, and that's what we did, we took this pause and kind of crashed to say, you know, nothing's wrong with what we're doing. We have to back up and say What can we back off on because it's doing better? What do we need to kick the intensity up on? But then also, what are the other things, like I say, on the shortlist that we need to bring back in and we need to do more with? A lot of times those patients would be on this pattern and they may go through that cycle 3, 4, 5, 6 times, maybe the whole first year. Maybe the whole first 2 years they're doing that. So one of the problems comes in that if, if the doctor is easily confused by that or thrown off, then the doctor may start to doubt what they're doing, or they may not look back into the shortlist, or they may not know the shortlist exists or whatever. And so then the patient and the doctor are kind of stuck at a point, right? Because doctors, you need to You know, remember, we're not trained largely to treat chronic illness. We're trained to treat acute illness really well. Chronic illness uses a whole different set of skills, a whole different set of thought processes in the brain. So the other thing, though, is that patients get really discouraged, and it is discouraging. You know, you're not— you know, you're better, but you're not better, right? And so you have to be able to, number one, kind of keep the faith and keep your focus and keep moving forward. But you also have to understand that this is part of the process. And I have had patients that were really, really significantly chronically ill, especially with CFS/ME, that have been sick a long time. Where it wasn't like the first patient where there's sort of this trajectory over 2 years to kind of being mostly better, but it was this up and down and up and down and readjusting. And, you know, that went on for 5 years, 10 years sometimes before they were stable. doctor, but it's because the body is so out of balance that it takes that level of intensity and effort. And so if patients would stick with it and they knew that, you know, at these checkpoints when we have a plateau or we get to a high point, we crash and plateau a little lower or whatever, that, that is our body telling us, okay, it's time to regroup and start looking at stuff. And sometimes, you know, these people, what took 2, 3, 4 years or 5 years or 10 years or whatever is because their body can only handle so much at a time. Very, very important. But that can happen, and it does happen, and you can move through it. The big things about that are acknowledging the discouragement of it, acknowledging how frustrating it is, but also acknowledging the reality of the situation is there's no magic wand to make this better. You just have to keep pounding away at the underlying causes, get the body stronger, and then pound away again, and then get the body stronger and pound away again. That's how this works. So the sicker that the person has been, the longer they've been ill, the more of that that goes on. And I've had people where we, we said, you know, you're, you're kind of at a plateau that's better. You're not where you want to be, but you're not where we started. But, you know, you've had a lot of intensity of stuff going on. You want to take a few months off and, you know, obviously take what you need to keep you plateaued, but just give it a rest, you know, and get out of the medical system for a few months and, you know, and just, you know, live and do your stuff and know that there's more steps to go. But you certainly don't— they don't have to do them tomorrow, you know, and sometimes that's very good for your mental space to do that as well. So there's no right answer to it. So that's kind of the first half. I want to answer that question, the big question about what does it mean, no other medical diagnosis. Also want to kind of tell the, you know, the, the easier and the harder end of the spectrum with patient stories. And then the second half of the podcast, what I really want to focus on is You know, what are these areas that we look at? What ones can you as the patient or the family member focus on? What are things that you could maybe ask your doctor to look into? Or if you're interviewing doctors or healthcare providers who work with chronic illness, you know, find out kind of how holistically they're doing it. All right, so for this next section on chronic fatigue, Uh, CFS/ME, what I want to talk about is the areas that we like to, you know, look at and areas that we like to focus on. So now I said that there's the hygienic kind of the lifestyle things that we look at, but that has to be tempered with the idea that the person has to be at least strong enough and recovered enough to participate in those things. So For example, if you go in and you have someone who's, you know, chronically fatigued, and then you, uh, you know, force them into an exercise program, they're just going to hurt and be more tired. Now, does that mean that they can't do it? No. But it means you have to be judicious about when you bring that in. It's part of the healing process. But you can't come in guns blazing and force a whole lot of physical activity till they're ready for it. So when we're looking at that, the areas we look at are sleep quality. And one of the things, especially if you've had a lot of chronic illness, whether it's CFS/ME or other things, is if you haven't had a sleep study where they actually, you know, look at you and hook you up to things while you're sleeping and see what your quality of sleep and timing is, you probably should do that. Now, if you have one of these bio trackers, you know, like an Oura Ring or a Fitbit or the watches or whatever you're doing there, you can get some pretty good data out of those things, especially about your sleep quality. And if it doesn't look good persistently, maybe watch that. But sleep is probably the first place we gotta look. And like I say, if you've been sick fairly long time, a sleep study can be invaluable because a lot of people, you know, maybe not that that's the reason they have chronic fatigue, but it's a reason it's not helping them. Unrestorative sleep is huge. You can see it's an epidemic in modern times. And one of the other things, just, just as a little footnote here on unrestorative sleep, a lot of the drugs that people prescribe and take to help them go to sleep will make you asleep and unconscious but not give you restorative sleep because you're not going into REM cycles and stuff like that. So there's a lot of drugs, for example, I could prescribe to you that definitely will make you asleep at night, and in some people that's good, but in other people they're just unconscious but they're not really sleeping better. So there's a lot to this whole sleep part. So sleep is huge. Diet, and that has to go in stages, but the diet can become— especially when you feel horrible, your diet can become horrible. The focus of the diet changes. While there's a lot of specificity to this, the focus of the diet changes needs to be around, you know, regular eating, but also good quality protein, good quality fat, and then a low glycemic approach to your carbohydrates. So you A lot of vegetables, a lot of color, but a low amount of high sugary things. Okay. So diet kind of has to be worked into often. But what you want to do is you want to keep your blood sugar and your insulin fluctuating through the day at a low amplitude. You don't want to be, you know, low blood sugar, insulin crashing, and then you eat and then your insulin goes way up and Your blood sugar goes way up and then it crashes again. And I've literally done this with people where we do a glucose insulin tolerance test and you just see it is bouncing, you know, up and down like a, like a ping pong ball. That is not commensurate with good health or feeling good or even good energy. So the diet has to be worked towards that, or you might even need some medical help there. Hydration, being maximally hydrated is huge. And it'll trigger me to drink some more water. But that's huge. Most people are dehydrated even when they're trying. So you really have to work at that. Movement, body movement. And again, I talk about this a lot, especially on the TikTok channel, but moving the skeletal muscles, the muscles that move your skeleton around. that is associated with better health, longer life, all sorts of good things. Well, part of the reason for it is that moving those muscles pushes your metabolism towards better blood sugar and insulin control, but also a lower amount of inflammation. Now, what do we say the catch-22 with chronic fatigue is? People who have chronic fatigue, so CFS/ME, if they do too much muscular activity, they will become more fatigued, more pain, et cetera. So what we do is we do baby step movement where once we kind of get your case, you know, we got a base for it. Part of what we work on then is how are we going to get better hydration? How are we going to get better sleep? How are we going to get better diet going in you? And also, what level of physical activity do you do right now? Most people with CFS/ME are not you know, out running marathons or, you know, playing tennis every day or doing other stuff. So we start with that. For some people, it's like the, the only exercise I get, uh, is, uh, you know, I walk around the block once a day, or the only exercise I get is getting up off the couch and walking to the kitchen. We literally start with whatever that is. So if it's walking to the kitchen, we have you do just a couple more laps to the kitchen every day. It seems just stupid and People feel like it's not even worth it and all this. Here's what you're doing. If you do this baby step approach to exercise instead of, you know, what you might have done when, say, you're in high school and you're in athletics and, you know, you really work out hard the first week, it sucks, and then you start to get used to it, and then you're trained and you're working out all the time. Well, when you have a fatiguing problem like CFS/ME, Uh, you can't push that because the mitochondria get behind, the energy-producing parts of your cell. So what you have to do is wake them up real slow. So while you're working on all the other stuff and you're working on the hygienic things, diet and hydration and sleep and all that, you just do a little bit. And maybe for 4 weeks or 6 weeks, that's all you do is a couple more laps around your living room. And I know it seems dumb and all that, but then pretty soon it's like, well, that doesn't fatigue me. And then that person who's just doing a few laps around the living room might go out and walk around the house once or twice a day. And then after 3, 4, 5, 6 weeks, they might walk around the block. And it literally can build in that way. That's how important it is. But it's also important that you don't overdo and crash your system because, you know, if you go from walking around the block once to suddenly wanting to run a mile or 2 miles, That's too much all at one time. So it has to be baby steps, but you got to be progressive with it. The other thing is supplementation. Now there's basic things that, you know, this is not medical advice, it's just what people have done in the past. You do what your doctor tells you to do. But basic things to add on to your diet that are usually helpful helpful. Basic nutrients, multivitamin, a B complex, some of the energy-helping things like coenzyme Q10 and alpha-lipoic acid. Those are very commonly used in fatiguing situations. There's some amino acid or amino substances like carnitine, which helps with the energy production, and a number of other things. So there's a lot of supplements that can be used. The thing you want to keep in mind is supplements should be just what they're called, supplements. They should be supplementing what you're doing with your diet and lifestyle and the other approaches, the health approaches you're taking. So you generally cannot supplement your way out of chronic fatigue syndrome, for example, but it can be an extremely important part of the care. And then you have to look at the other bucket, which is the metabolic medical side of things. And so this gets into the big categories of things, and these don't go in any particular order, but things such as hormones we talked a lot about. So you want to be attentive to your blood sugar control because that has a lot of feedback towards your adrenal glands, and they have feedback towards your sleep-wake cycle and inflammation and other stuff. So we would often check people's blood sugar control hormones. We would check their adrenal hormones, so the corticoids, cortisol family, very important there. Then, as I mentioned, we check both thyroid and thyroid resistance, thyroid autoimmunity, the 3 big areas of thyroid dysfunction. We would check the reproductive hormones, men or women. Estrogens, progesterone, and testosterone, all super, super important. And then any other hormones that we felt were necessary to check into. The next, which you heard me talk about in both of the cases, would be the immune chronic infection area. So chronic infections, we check for things that are stealthy. They like to hide out in your body and be a problem. The HHV family of viruses for humans is always problematic. So we see things like Epstein-Barr and cytomegalovirus commonly, and sometimes the other HHVs. We see non-HHV like parvo B19. Parvo is not just for dogs. There's a human version that can cause a lot of inflammation and other things of that nature. And there's some other viruses we might look at too. There's some chronic persistent bacteria, the pneumoniae family, so Mycoplasma pneumoniae, which is a whole bunch of different strains, uh, Chlamydia pneumoniae. Then there's the persistent streptococcal organisms that some people get. So we do a screening, uh, for chronic strep, etc., like that. Um, we look at sometimes the chronic fungal problems. So there's, you know, some people know about Candida. There's also aspergillosis and other things that go on, different tests you can look at there. So all of these chronic infectious things, and then the digestive tract is a huge ground zero for dysfunction in your body. And the digestive tract can be looked at through various testing means. And if you really feel like there's an immunologic problem and you're not getting at it or finding a lot with the, you know, the blood tests. You might want to look at a digestive system infectious panel. Mentioned a lot of metabolic things. So one thing some commenter on one of the platforms said, and I never remember who or where because I'm on most of the platforms, they were talking about iron and low ferritin and symptoms. It is very, very common in chronically ill people that their storage iron, the ferritin, is low and they have symptoms. And I've seen some people where they had almost no ferritin, no stored iron. And so we would, you know, it's not a cure-all, but you have to get the iron levels up because here's the thing, you talk about the mitochondria in your cells which make the cell energy and give you your energy. Yeah. They have 2 places in the respiratory chain that use iron to move electrons around. And the more iron deficient you are, the more deficient you're gonna be in moving electricity and moving energy around. Now, there are people who are very against iron. They say iron makes you oxidize and die. Certainly if you have too much of it, but you can also have too little. Okay. Same with any nutrient in your body. You can have too little vitamin D or too much. You can have too little magnesium or too much. You— it has to be in the right place. But most chronic fatigue patients, that's at least got to be screened. And certainly if it's low, you need to build the level up. Now, it doesn't cure everything, but it's sort of like if you have a thyroid problem, you don't treat that, you're not going to get your fatigue under control either. We talked about other metabolic things like blood sugar control. Also, you know, vitamin D. Vitamin D and K work together. Very important that they're in the mix. All of your other nutrient type things. The other thing that we started to add on once we could test it was genomics and nutrigenomics. What's important there is in a lot of our patients that I actually posted on an earlier, uh, podcast about this. We actually did a study with some genomic dysfunctions, and one of the genomic dysfunctions that's not only associated with low cell energy but also poor neurotransmitter production in the brain was more common in people that had chronic fatiguing diseases. And so if you're not getting anywhere and you've checked these other areas doing one of these nutrigenomic profiles can be very, very useful because you could find out, for example, that you have very slow detoxification pathways, or you could find out in your neurotransmitter balance that, you know, maybe you're just not very good at making some of the ones that produce energy, or you're eliminating them too fast, or maybe your cell energy production is just not appropriate for genetic reasons. Now you say, well, if it's genetics, I can't help it. Well, no, you can epigenetically. So genetics are the code, but epigenetics are what turn on and off the code. You can epigenetically help these genetic problems that you were born with, with proper targeted nutrients, sometimes some herbs, sometimes other things that would do it. Very important. The next thing that we see a lot was dysfunctions in the immune system. So one of the immunologic dysfunctions that we see was in the area of allergic response. Now, if you already have, say, you know, you have seasonal allergies, you get hay fever, you know, when the trees bloom, you cough and wheeze, that's one thing certainly. And, you know, you usually know about that. But if you don't, but you have that pattern of, you know, every early or late spring I get these symptoms, it's probably good to find out what you're allergic to. So those can be done. A lot of people, you know, are familiar with like, you know, the scratch testing on your back from the allergist. It's one way to do that. You also can do blood tests to check for environmental allergens. And in those, I usually do your local, you know, trees and plants and pollens and other stuff. But we also do— normally we add on allergy to different mold spores and other stuff like that. We'll get into mold a little bit more coming up, but that all becomes very important. But also allergies and sensitivities to food. Now, we don't have time to get into the deep dark secrets of food sensitivity versus allergy, but one of the things that gets misunderstood is that you can have a true, what we call a type 1 IgE, like Edward, mediated food allergy. Usually you know about those because you're deathly allergic to the food. May not be, but usually you are. And you might be wearing a bracelet that says, you know, I'm allergic to whatever. But there's also a non-type 1 reaction that goes on that's an immunologic reaction that's a sensitivity. Now, this is a chicken or egg thing. It can come from the fact that your GI tract is dysfunctional, and so you become sensitized to foods you eat all the time just because your GI tract doesn't work. But it also can be that you have non-IgE-mediated immune responses to foods that don't kill you, but they're not good for you. They make you inflamed, etc. So you want to think about that as well, and that can be tested through other testing means. So in a lot of people where, let's say, you know, we've been chunking along, things are going pretty well, they've made some steps forward, had some reversals, made some steps forward, and we got the big things like, you know, the hormonal issues and the metabolic issues covered, uh, and we're working on their chronic infections and working on their gut, you know, but we're still kind of running up against the wall. We're going to look at the hygienic things, make sure that the baby steps, sort of new exercises going on, make sure the diet's turning the right direction, make sure they're hydrated, make sure their sleep is working okay. But then we're going to take a step back and say maybe some of these other things, the genomic things, maybe we need to do a nutrigenomic profile to take a look at that. Maybe we need to do some searching for food sensitivities or other allergies, etc. And those are all very legit things to do when you're running up against things. Now, the other immunologic things that you want to take a look at is— remember I said early with that first case, because it was a fairly short, just a few years in a 48-year-old woman, of fatigue, I didn't think they probably had a primary immune deficiency. But if we get somebody and they've been sick for years, or they don't remember when they were healthy, or they have the childhood history of illness. Now you can screen people for primary immune deficiencies. The, the 2 that are the easiest to locate are the B cell types, and those are usually IgA like Apple or IgG like George. And there's ways to test for those with blood testing and things that look at the genomics or look at the output of the B cells, stuff like that. But I've also had some of my chronic fatigue patients turn out to have a cell-mediated or a T-cell problem. Those are a little more elaborate tests, and there's a lot of T-cell immune dysfunction that don't have names. So, um, you know, the most famous, uh, you know, T-cell dysfunctional immune deficiency is HIV disease and AIDS. But there's a lot of them that don't have to do with that virus that you're just born with. You have dysfunctional T cells. So again, if you're not getting, you know, answers, or you're treating all these infections, they never go away, you got to start looking at what's the immune system doing. So that is often something, if the history is there, we do that up front. But if the history is not there, but we keep running into a thing, or we're constantly having positive immune challenges from these bugs and chronic infections, you want to start looking at the immune system. The next thing are what might slow down my immune system. We've got a couple of minutes here and we're almost to the end. So mycotoxins, the mold toxins. So I talked about looking at mold allergy. That's one thing. But the other thing is we can now do, say, a urine test for a screening that will look at the mold toxins coming out of your body. And a lot of people either live or work in settings where they have mold and mycotoxins. And the problem with a lot of mycotoxins is they are 2 big things that make chronic fatiguing illnesses bad. One is they're an immune suppressant. So literally there are mycotoxins that are used in, uh, like oncology to suppress parts of the immune system. Well, imagine if you have those mycotoxins and you don't need your immune system suppressed, you're going to collect infections. Very, very common. People with chronic recurrent Candida or Epstein-Barr, some of these things you hear about, a lot of times there's, um, uh, you know, there's mold in the background. And so you gotta, you know, figure that out. Sometimes that's, uh, you gotta get something cleaned up. I've seen it where People had a, you know, a mattress, and under the mattress was full of mold, and they're sort of breathing in all night. I've seen it where, you know, it's in the house or the carpet or whatever. And, you know, so you've got to be careful. You got to remediate that, get rid of it. But then also there are detoxifying things that you can do. There's other things that can slow your immune system down, such as chemical toxins or metal toxins, and those can be screened for fairly easily. And again, if that hasn't been done, we want to take a look at that. Then there are medications that slow your immune system down, and this can be very tricky because if you need the medication to keep you alive, like in certain cases with autoimmunity or cancer or something like that, you have to know that the good of the, the medication keeping you alive comes with the negative of your immune system being suppressed. And so in cases like that, what we've had to do is we have to more chronically treat the infections that come along with the immune suppression from your drugs that are keeping you alive. Now, sometimes you get to the point where you don't need those drugs anymore, but sometimes you can't. And so then it's like you have to just accept that If you are going to need to take that immune suppressive medication for your other health problems, which in some cases are life and death matters, you don't want to stop those drugs sometimes. You also are going to have to do a lot of immune support and, you know, killing of opportunistic infections that come along, or you're never going to regain your energy. So sometimes that's one of those things where that's more of a lifelong You know, sort of pattern. And then the other thing which I want to end on, because I think it's one of the more important things long term— we talked about, you know, if you're one of those people that doesn't have the arc where you're, you know, getting better in a year or two and then you're pretty stable, but you're more like, I've been sick for so long, can't remember when I was feeling good, and you have the up-down, up-down plateau, get a few clicks up. Right. crash, a few clicks up, you know, up and down. That's hard on your brain, you know, it's hard on your doctor's brain, it's hard on you, it's hard on you emotionally. The mental-emotional part of chronic illness is, is not only very real, it is very impactful to you, uh, as a human. And so while certainly chronic fatigue, CFS/ME, is not in your head, It is a real medical problem. There is a— there's an overlay of the mental-emotional. It just goes along with being chronically ill. And so we want to make sure that that is also being taken care of. You need someone who you can vent to about how slow your care is going, maybe, or you need someone you can talk through, like, should I, you know, should I go back and kind of press on my doctor a little bit more? Should I, you know, do this? Or, you know, what can I do with maybe some, you know, some other types of therapy just to help that axis. So it's not that mental-emotional is the end-all be-all, just like hormone problems are not the end-all be-all, or other problems aren't. It's that it's all part of this holistic look. And the one thing I want to leave you with, as we run out of time, is if you have chronic fatigue, CFS/ME, and you're not having this sort of holistic approach to it it will never start on the road to recovery, whether that's a complete recovery or a cyclic recovery or progressive type of recovery. Whatever it is is appropriate for you. You can't do it with CFS/ME without looking at all of these areas. Well, I've burned up all of the time for today, as I always do. I'm Dr. Anderson. Uh, please like, share, and subscribe on whatever platform you're on. If you're not on our YouTube channel, please go I'd love for you to subscribe, put your questions in there, etc. And I do, I do a lot of these programs and a lot of the YouTube Shorts or the TikToks based on your questions and comments. So thank you very much. Thank you to CTR Radio, who's the host. And if you're on a PodBurner, please like, share, and subscribe there. Go over, check out the YouTube channel. Check me out on dranow.com. That's got links to everything there. Thank you very much, and I'll see you all on the radio next week.