Dr. Paul Anderson explains ME/CFS as a multi-system illness, not a psychiatric disorder. He uses a "bucket-with-holes" model to show why diagnosis requires checking endocrine, immune, infectious, gut, toxin, and mitochondrial health simultaneously. Patients who address all these areas often improve significantly.
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All right, good day. Welcome everyone, uh, back to the show. And today is chronic fatigue syndrome question and answer. We've got some, uh, great questions, have some information about it, uh, have some questions about potential new treatments, uh, also what's good and bad about the way that we decide somebody has chronic fatigue syndrome. What can the way we decide and the way we diagnose it, uh, help us with the treatment and investigations into what's wrong and more. So let's just jump right in. Want to talk about chronic fatigue syndrome. Now, as usual, I've got, you know, a lot of background material. I just went through and looked, you know, at recent publications, but also some recent medical reporting. So as you know, most of the time when I post things or I post links, I try to make them either primary sources from medical literature or If there's something I feel that was really well done in medical reporting. So it's not really peer-reviewed, but usually there's a medical reviewer and then a professional writer, a science writer. So I've got those things. And as you might remember, the links and the show notes we put up when we move this over tonight or tomorrow to the YouTube channel. And so if you're watching live on CTR Radio, thank you. And you can follow us there. You can also probably be watching live on Facebook Live. It'll be on there right now. And then, as I said, later we're going to put up on all the pod burners. So pretty much any pod burner that you have, whether it's Google or Apple or iHeartRadio, etc., look for Medicine and Health with Dr. Paul Anderson. And then like and share there. But the YouTube channel is where we put the video up. And under there we put up any links that I have. So this one will have, I don't know, 4, 5, 6 links that go to things in case you want to do some background digging, and that's why I put them in there. Now, if you're not familiar with YouTube, what we do there is if it's on your phone or a small device, below the video on the right side there's a little arrow down or a chevron. Click on that and it opens up the description box. That's where the links are. If you're on your laptop or a bigger computer screen, it's usually under the, under the video picture on the left side, and it says show more. And that doesn't really look like a link to me, but you just click on show more, it'll open up the description box where the links are. So that's where I put them, and you can do that there. So thank you so much. We got a lot of new subscribers. Please like, share, subscribe, hit the notification bell on YouTube. And it's kind of nice because from CTR Radio, where we produce the program and the podcast and the video, we can move that over to YouTube and keep it there on my YouTube channel for posterity and sharing, etc. So as we get into this, I want to just kind of jump right in. Most people have heard of chronic fatigue syndrome. It was first described in the 1930s, actually, so it's not like a new problem, but it's one of those frustrating chronic illnesses, at least in my experience. So although I certainly, you know, have done a lot of background work and kind of updating— is there anything new in the research and new in what people are thinking clinically? Many people know me from my work in oncology and cancer, and our practice was always split between oncology and then chronic illness. And a large portion of the chronic illness population that we serve were chronic fatigue fibromyalgia patients. And those are 2 different medical diagnoses, but they have a lot of crossovers we'll talk about. So I have a great deal of experience and a long amount of experience in the chronic illness population, especially chronic fatigue fibromyalgia. And for a period of about 5 or 6 years, I actually took over a very large chronic fatigue fibromyalgia clinic's patients. The clinic had to move, or I guess the clinicians had to move and the patients didn't. And so we added them to our patient population. So certainly a lot of experience there. So I'm going to talk about some of the research, some of the new treatment that people are talking about and what's good and bad about that, with some of the frustrations that patients run into. But then also I'm going to try and inform it with a lot of you know, rubber meets the road treatment that I have been involved in and even some research over the years. So when we look at this, chronic fatigue syndrome is also known as myalgic encephalomyelitis, which sounds horrible. And ME/CFS is the way that they usually do the shorthand for it. And if you look at chronic fatigue syndrome, what you have— hence the name, at least the common name chronic fatigue syndrome, and there's some updated names too, but most people know chronic fatigue, so I'm just going to stick with that. If you look at that, what you're really looking at is a syndrome where there's not another medical reason for fairly profound fatigue and exercise or exertional Intolerance. Now, this gets into not just splitting hairs, but some problems that there are, which creates a lot of frustration with the diagnosis, or at least carrying the diagnosis of chronic fatigue syndrome, or whatever else you want to call it. And that is that part about the criteria that says there has to be no other medical diagnosis that would account for these symptoms. Now, that makes total sense, because what are other things that might cause chronic fatigue, exertional intolerance, some of the other things that we're going to talk about symptom-wise. Well, you could have cancer and have that, so you certainly wouldn't want to call it chronic fatigue and have it be cancer. You could have any number of autoimmune diseases that give you the same symptoms. You wouldn't want to not treat your cancer, your autoimmune disease, and, you know, have it be from those symptoms. So that makes a lot of sense. You know, you wouldn't want to have it be undiagnosed diabetes, which can do that. You wouldn't want to have it be undiagnosed profound anemia or any number of other problems. So it makes sense that you would say in your diagnostic criteria, well, there has to be no other medical explanation. Here's the problem that that's led us to, and that is in the world of medicine, there is still a large number of— not all doctors, but there's a large number of doctors who still look at chronic fatigue, you know, CFS/ME as a neuropsychiatric problem, and it's really not. I mean, anyone who's worked with a lot of chronic fatigue patients knows it's not. But there's a lot of doctors, and we'll talk about this, who just, you know, don't want to sort of move away from the neuropsychiatric basis of chronic fatigue syndrome. So they will say, well, if we're calling it a diagnosis of exclusion and there's no other medical reason for the chronic fatigue, then Why is it not, you know, a psychiatric diagnosis? Well, that not only, you know, upsets, uh, obviously the patients and often their families, but other clinicians like myself who try and treat chronic fatigue fibromyalgia, uh, through an integrative multi-system treatment protocol, treatment rubric. So just to read a couple of quotes here, um, you know, distinguished from medical and psychiatric, uh, conditions by fatigue that is debilitating for more than 6 months. So again, if it's just a couple of weeks, you could have the flu or COVID or something like that, obviously, um, including combinations of cognitive dysfunction, brain fog, and other things are very common, total body pain, unrefreshing sleep that does not restore normal function. So another thing, and I just, this want to talk about this quickly is this statement of unrefreshing sleep that does not restore normal function. So most people, you get worn out and you sleep and you have good sleep and you feel much better the next day. Your fatigue is kind of gone. Or maybe you really get worn down, or, you know, students, we see this a lot where they overdo during finals and they get a lot of rest for a few days afterwards. They kind of perk back up, right? That's sort of the normal human pattern. So unrefreshing sleep that does not restore normal function would indicate that there's some sort of problem. If your sleep really is happening and then you are not restoring your exertional tolerance and your energy and all, and your cognitive function, all this stuff, there's got to be a problem. Well, the reason I stopped there is in current and older diagnostic textbooks, there is this misnomer that a lack of return of energy after sleep is a psychiatric problem. And so this becomes another one of the problematic portions of people's lives and diagnosis, especially if your clinician wants to put this all— it's all in your head, quote unquote— is they'll say, well, you know, normally people, you know, who have fatigue but are sleeping well, um, you know, and don't have a medical reason like cancer, anemia, diabetes, etc. Uh, if that's happening, you know, it's usually a mental, emotional, psychiatric problem. Well, it can be, but that doesn't mean that's the only reason for it. This becomes very frustrating also if you're trying to treat these patients because their other doctors may be looking at them as, you need psychiatric care, you don't need medical care. Uh, so other things, uh, post-exertional malaise, uh, And stress exacerbation, so exertional or physical or mental-emotional stressors will exacerbate all of your symptoms. Now, the World Health Organization, which we've heard a lot about in the days of COVID in case you didn't know who they were, classifies ME/CFS as a neurological illness, which is, you know, at least in the ballpark Um, and the big problem, as they say here, is there are no objective diagnostic tests, verified biomarkers, curative medications, or really curative treatments for ME/CFS. And so the goal is usually to manage symptoms and improve functional capacity. Now I'm going to put in links to both the British Medical Journal and the National Library of Medicine here in the U.S., and they have some really actually very good things you can read in there if you want to take a deep dive in. Maybe you or a family member has been diagnosed with this. And often what you'll find, and the reason I put those up at the top, is, um, you'll find if you read the actual, you know, diagnostic criteria and all that in British Medical Journal or the National Library of Medicine diagnostic criteria here in the U.S., there is a lot more to it than most of your clinicians are probably telling you or working with or doing. So I will put those in when we get over on YouTube. Again, thanks for all the new subscribers. Please continue to subscribe, like, and share. We try and get good information out here. Now, one of the things that, um, is a frustration is if we say chronic fatigue syndrome is profound fatigue, post-exertional intolerance, etc., that lasts for 6 months or longer and does does not have a medical diagnosis that is causing the symptoms. So whether it's the exertional intolerance, the whole body fatigue, can be sleep disorder, cognitive disorder, all that stuff. No medical diagnosis. Well, that's a little bit of a misnomer. So I said earlier that what that means is that we've ruled out the big things. We know you don't have cancer, or we know as much as we can know that. We know that, you know, you don't have an autoimmune disease. We know that you don't have, uh, you know, a, uh, a primary metabolic problem like hypothyroidism or diabetes that's undiagnosed, or profound anemia, etc., etc. So we, we've looked at all those things. So that's good. We don't want you running around with an undiagnosed disease and calling it chronic fatigue syndrome because there's stuff you can do about those other things. But here's what we often saw, and this is with literally thousands of patients. Okay, this is, this is my own personal experience as a clinician. When you look at chronic fatigue syndrome patients, what we would normally do is not just screening for those other problems, and certainly we did all of that, but we would look in a number of different core functional areas in the body because often, while there might be a little blip here and there. So somebody may discover they have type 2 diabetes, but they get that corrected and their fatigue doesn't go away. They might discover they're hypothyroid and they get that corrected and that fatigue doesn't go away. Um, what we found was with chronic fatigue syndrome, looking at the whole person and all of the ways the human body can start to break down that would create fatigue or a fatiguing, painful illness We did better to look at, diagnose, and treat underlying issues sort of in a 360-degree circle around the the person, as opposed to trying to focus on one thing. Now this is frustrating a lot of times for other doctors and patients. For other doctors, it's because they're really not trained a lot of the times to do this. They're not trained in sort of this integrative holistic look at the body. They're trained to find one thing and hopefully treat that, make the problem go away. Most our Patients would come in having had one thing found. It could be a diagnosis of Epstein-Barr virus, and that was being treated, or a diagnosis of hypothyroid, or a diagnosis of some GI problems, or a diagnosis of whatever. And the problem that would occur is they would get better, and then they would crash again. Well, why would that happen? It's you think of it like you have a bucket holding your vitality. That's you know what makes us healthy and feel good and all that. And then you start poking holes, little holes in it all over. Well, if you find one hole and plug it up, what's going to happen? The other holes are still going to leak, right? Well, it's the same thing with illness. And what I would tell patients, the way to think about it is you could have a stack of, you know, 20 quarters sitting here, and that could illustrate, you know, one disease. And one big disease, sometimes if you take care of that, makes the other things feel better. But what would happen if you had 5 quarters stacked up with that disease, and then 5 with another, and then 5 with another and 5 with another. So your 20 quarters were spread out over a number of different, uh, functional disease areas in your body. What that's going to do is that's going to give you a lot of targets where maybe you don't need a big gun or you don't need a whole bunch of treatment on one, but you need a lot of treatment on everybody. Or if you go back to the bucket analogy, what you want to do is you want to plug as many holes in the bucket as you can. And with true chronic fatigue syndrome, and again, I'm using that as the one term, there are other terms, but I'm just going to use that to make it easy. Our experience with, you know, well over 1,000 patients, definitely 4 figures worth of patients over time, was in true CFS, if you did not look for all of these things and treat all these things on a consistent ongoing basis, nothing else worked. And that leads us to a lot of the discussion, some of which I do want to talk about briefly. Uh, with regard to the, um, common statement in medicine that there is no curative treatment and there's no, uh, you know, long-term therapies that work, etc. And that is a true statement and a false statement at the same time. So the true part about it is we don't have a magic bullet that is the chronic fatigue syndrome treatment that we put in and it makes you better. Okay, so if you have certain infections, we can give you an antibiotic for a bacterial infection, and it usually will kill the infection, and then the infection is gone, right? That's the medical model of, you know, one shot, one kill. So that's the normal acute model. Well, there's nothing about chronic fatigue syndrome that matches the acute care model. You're way beyond acute care at that point. And this is why I say, yes, it's true that there is no, uh, there is no curative treatment, there's no long-term therapies that eradicate the disease, etc. But that's because they're looking at it as requiring one therapy to clear out everything else. It's not going to work. Okay, trust me. If you find one treatment that cures your fibromyalgia, you probably— or your chronic fatigue syndrome, excuse me. then you probably didn't have actual CFS/ME because there's not one treatment that'll do it. Then you say, well, that's a bummer. Do you have any good news for us? Well, yeah, I do. What I want to talk about are ways to get into and ways to access into this collage of problems. Now, here's another thing just to keep in mind because I keep saying, well, it's multifactorial, You got to treat all the holes in the bucket and all that. Is— and this is something that drives researchers crazy for hopefully obvious reasons— is there a common group of things? So you're saying back up and treat the holes in the bucket. Is it always the same holes in everybody's bucket that creates chronic fatigue? And the answer is no. There are some commonalities, there's some things that are more common. But here's the problem as the clinician, and I've been treating people with this for 3 decades, I've been training other doctors how to do it, and the biggest problem that clinicians run into after they get over the fact that it's not one problem that they can just find one problem and treat it, the next step is they can't just check 3 things repeatedly and have that fix all of the people. Because fatigue is a constitutional system, that means it's a whole body-wide problem. And so your body operates on a lot of different levels and with a lot of different physiologic inputs that go on. And so if that's going on, then it would stand to reason that you could create a constitutional symptom like fatigue through a large number of possible combinations of problems. And so then not only does that frustrate patients, but then the other clinicians are like, so you, you mean I really have to back up and I have to check a lot of things in each area on these patients? And the short answer is yes, you do, and here's why. If you don't, then you're going to wind up going down the pathway of diminishing returns. And so, for example, in the hormone, the endocrine system, an area we check a lot of things in, you check one thing and you find that, like low thyroid or something like that, you treat that, the person gets better, and then they crash again. It doesn't work. It doesn't work. Why? It's because there's other things wrong. You can't just check one organ system within your physiologic system. So you can't just check the thyroid when you're looking into the hormonal system. Now, there may be trouble there, so you need to check it, but there's a lot of other things that make up the hormonal milieu, and either the hormones kick into, you know, positive health or negative health. So I want to go through the areas that we normally look at, but I wanted to clear up a couple of things. I got some really great questions, uh, and I just want to talk about them, and I'll put— actually, there's some Nice articles that I found that will help if you were one of the people had this question or asked it in the chat or in the comment boxes or wherever, you know, with social media. I get feedback on TikTok and Instagram and YouTube and Facebook and, you know, all of the other places I am. And so I never remember exactly where all the questions come from. But another question that comes up is, and I even misspoke earlier, so hopefully I didn't confuse anyone, is, well, there's fibromyalgia, which is another diagnosis of exclusion, and chronic fatigue syndrome. And so I put an article in by a medical writer who happens to have chronic fatigue syndrome, and then a medical reviewer, Dr. Marcelin, a medical doctor who reviewed the paper. And the paper has been around for a little while. But it's an article about— basically it says half the people diagnosed with fibromyalgia fit the bill for chronic fatigue syndrome too. Are they really just the same disease? And we— this came up a lot because we had— when we picked up the patients from this chronic fatigue syndrome clinic, which was very specialized, it was chronic fatigue and fibromyalgia patients. Now, there are a lot of similarities, but also there are differences. So this was probably the most common question I got that triggered this particular podcast, and that is, are they just the same thing? Well, they have a lot of similarities, but they have differences too that are important to remember. Now, what I'm going to say, and I will probably do a separate podcast on fibromyalgia, but to shortcut that, if you happen to be listening and you feel like you have more fibromyalgia and less chronic fatigue syndrome, the idea of taking a 360-degree look at you as a patient and checking as many organ systems and places the body breaks down as possible. That still applies. There may be different problems, but it still applies. So, um, statistically fibromyalgia occurs in more people, at least the way the CDC keeps track of these things— about 5 million with fibromyalgia and 1 to 2 million with chronic fatigue syndrome. If you look at fibromyalgia, about half to 2/3 of the people fit the criteria for chronic fatigue as well. So there's a lot of crossover. And so in many people, up to half of fibromyalgia patients, you could probably have a diagnosis that went either way. Now, if you are looking for a curative treatment that's one treatment, then that might be frustrating. But if you remember that with chronic fatigue or fibromyalgia, You have to look at all the holes in the bucket, you have to treat all the holes in the bucket, it makes it a little easier to feel like the label is less of an issue. We would literally have people come in and they would get angry if we didn't label them correctly because they needed to have a particular name for their disease in order for it to make sense to them, which is fine. We tell them, well, you fit the criteria for this versus that. Um, but really what we tried to move people towards for their own consciousness was a diagnosis of a complex chronic illness, because yes, it might be labeled chronic fatigue syndrome, for example, but complex chronic illness is a little bit more descriptive of why your body broke down and what's wrong with it, right? So what else they say in this thing? Well, the links between chronic fatigue and fibromyalgia include Um, a, a number of the symptoms, obviously. Now, when you see research, one of the things to keep in mind is that fibromyalgia research, at least for the beginning decades, was done mostly in the rheumatology world. The rheumatologists are people who treat your, you know, a lot of your autoimmune issues, rheumatic diseases, joint problems, inflammatory problems, etc. And chronic fatigue syndrome researchers were mostly in immune system people, immunologists, virologists, etc. Because initially there was a thought, and it's, it's still actually true, it's just not the only thing, that there was a viral trigger for chronic fatigue. Well, there are often viral triggers, but they're not the only trigger. Again, you can't have one trigger to a complex illness that affects you all over. Um, so chronic pain and fatigue are common to both fibro and chronic fatigue. The difference is usually that in fibromyalgia there's more pain and less fatigue focus, whereas in chronic fatigue there's pain but the fatigue is the main focus. Now, if, if you've never experienced chronic— and this is another thing that comes up in the sort of psychosocial world of the patient— is if you've never experienced chronic fatigue that is profound, you don't know what it feels like. to wake up having even slept well, maybe for days and weeks, and still feel drained of all of your energy. And that's literally what it feels like in chronic fatigue. Now, with fibromyalgia, the people will have a component of that, but it will be almost overwhelmed by pain, which is why the fibromyalgia diagnosis originally was pushed over to the rheumatology world. Because there's other rheumatologic diseases that looked like it, and the rheumatology world basically pushed fibromyalgia back and said somebody else deal with this. Now there's great rheumatologists who deal with these things, but by and large that's what happened. Um, now something that I would say, and this is from research, so this means they're making declarative statements Um, chronic fatigue syndrome, it's very common to see fever, swollen glands, other signs of inflammation. This kind of goes with the chronic fatigue people having probably some viral and other infectious etiologies that they're dealing with. So very true. Okay. And in fibromyalgia, they don't see an inflammatory response. Now what I would say is, having treated, you know, hundreds and hundreds, if not thousands, of both of these, um, over the last 3 decades. You can't really make declarative statements like that. I've seen plenty of fibro people with inflammatory responses. Both of them have disruptions in REM sleep, so the deep type of REM sleep. But there's certainly similarities— more women than men, uh, tends to be people in their 40s or 50s, although in especially the last decade I've seen many younger younger people with either fatigue, fibromyalgia, or chronic fatigue. So disrupted sleep. And then there are different treatments, but they're basically all done in the world of symptom control. Okay. So what I want to do here is to now kind of get into the specifics of what are the areas where we look for the holes in the Okay, where are the energy leaks, the physiologic problems, the places where things go wrong? So now we'll transition over and get into the areas that we like to look at. So one of the areas I already mentioned was hormonal, the endocrine system. So it's very common that a chronic fatigue fibromyalgia patient will come in and they'll already be diagnosed as hypothyroid, low thyroid. Now they might be diagnosed something else but low thyroid. But certainly if that hasn't been looked at, it needs to be looked at. But what we would do with a true chronic fatigue patient in our workup is take a step back. And what I would always tell them is if their lab tests were more than a month or 2 old, they really didn't help us because number one, The lab tests done usually in primary care were too limited. And number 2, if they were sicker over those months, their labs may be very different as well. So in the hormonal arena, we would look at big picture areas and then do specific testing to parse out problems. So in the world of the hormones, the adrenal hormones, we would look at the cortisol levels. If they were having circadian sleep problems, we might do cortisol output throughout the day. So cortisol and the adrenal output became very important. With the thyroid, we looked not only at just pure simple hypothyroid, but we would look at a number of critical factors. We would look at the TSH, which is a global marker. We would look at the free T3 and free T4, which are the actual gland making the inactive T4 and the active T3. And we would look at the A lot of people had low T3 output, which is not great. It triggers fatigue and stuff. We'd also look at something called reverse T3. Now, I've talked about this before. Reverse T3 is not a great marker in healthy people, but in sick people, it's actually quite predictive for resistance, thyroid resistance. So reverse T3, we would do that. So free T4 and T3, the output, reverse T3, which is immunologically created to block your thyroid, And then other thyroid blockers would be the antibodies. So a lot of people have Hashimoto's thyroiditis, which is the most common reason for low thyroid, and it's actually an autoimmune disease. So again, we get into the splitting hairs with, well, there's not another medical reason. Well, it's not the only reason, but it's a part reason. So certainly if you have Hashimoto's thyroiditis, you not only need support for your thyroid, but you need support for the autoimmune process. Okay. The next thing that we would look at— so we've got the corticoids, the adrenal output, the thyroid and thyroid resistance and antibodies and all that. We would also look at the reproductive hormones. So you look at the— and this is men or women— estrogen and testosterone and progesterone. You look at the balance between them. Now, if you have a cycling woman, you need to know what, you know, where in the cycle it was. But here's a couple of things. There is a balance or an imbalance that occurs in very chronically ill people where their estrogen keeps rising, men or women. And as estrogen rises, androgens like testosterone decrease in their ability to work. And in women or men, a small amount of decrease in testosterone binding can lead to a lot of chronic illness problems. So we don't want to have that happen. So we look at the reproductive reproductive hormones, and we follow those and treat them as needed. We also look kind of critically at blood sugar because that's an endocrine issue. Now, certainly if someone knows that they're a type 1 diabetic and they're on insulin, all that, that's got to be managed. But we found a lot of people who were early or even full-blown type 2 diabetics that tend to be diagnosed a little bit later in life, and that was a piece of their fatigue. It wasn't the only reason, piece their fatigue. So we would look at the hemoglobin A1c, something called a C-peptide, fasting blood sugar, and then there are more tests that you can do there if needed. But why such a focus on silent diabetes, etc., other than diabetes causes a lot of problems for you if it's undiagnosed? The other reasons for that is if you have blood sugar control problems, blood sugar control problems lead to a couple of major things that create chronic fatiguing, debilitating problems. One of them being an inflammatory response that then can feed forward onto the other hormonal systems and inflame you, mess up your other hormones. But then the other thing is, is that chronic higher levels of uncontrolled blood sugar lead to fatigue because sugar that's in your blood is not getting in your cells where it's supposed to be creating energy. energy. So one of the things that you see with people who have diabetes is increasing amount of fatigue for many, many reasons, but that— those are just 2 of those reasons. So blood sugar became very, very important as well. Then we would look at rheumatologic things. Now, I said that the rheumatologists, uh, kind of got, uh, given the fibromyalgia patients, and chronic fatigue were sent to whoever would take them. Uh, we still want to make sure there's not rheumatologic disorders, and so that would include things like antinuclear antibody testing, We'd work people up for the common autoimmune diseases. There are panels that can do that, and what we would find is there were a fair number of people who had—we might catch a full-blown autoimmune disease, and that wasn't the only cause. So they had other problems, other holes in the buck to fill. But again, it's sort of like silent diabetes. We would catch these people, and at least we'd be able to get get them you know get treatment for the autoimmunity as well. Now, treating the autoimmunity would help, but it wouldn't make the chronic fatigue syndrome go away. So it's part and parcel of the whole thing. Then the other side of immunology— so there's the rheumatologic side where we're looking at, you know, autoimmunity, etc., etc. But the other side are chronic infections. And this is one that was hard for a lot of my colleagues to get to wrap their heads around. But we would look at the most common chronic infectious illnesses that would be— we call them stealth illnesses because they would step back. Person's chronically fatigued, but they don't have classic symptoms of one of the viruses or chronic bacteria or parasites or other stuff. So sort of 2 targets we would look for illness in of the infectious nature. One was systemic illness, and that's the big ones that we would find there are the human herpes virus family, especially Epstein-Barr, cytomegalovirus, etc. We screen for those in blood tests. There's a type of parvovirus, parvo B19, that humans get that create problems that are chronic illness problems. There's a few other viruses we would screen for. There's some chronic respiratory infections, the Mycoplasma pneumoniae, chlamydia pneumoniae, and some other ones there. that people often carry around and are very draining. We would look at chronic streptococcal illness. So there's blood tests for that that can certainly create a lot of problems. So, you know, you think of like strep and you think strep throat. Well, there's a lot of people that go chronic and it becomes just a part of their immune dysregulation. And so there's a lot of systemic things we'd look for. Also chronic fungal problems like Candida and other fungi and on and on. And people would say, well, I thought it was dysbiosis. prove that there was an infectious cause for chronic fatigue. And the problem is, well, again, if you're looking at one problem causing, you know, all of your chronic fatigue, yeah, sure, there's not one cause. Uh, but is it extremely common in chronic fatigue syndrome people to have, you know, 1, 2, 3, 4, 5, 7 infections? Yeah, it's very common actually. Longer you've been sick, the more of them you pick up. The other target we would look at for infectious and immune problems is the GI tract. So GI tract's super important just because it's got to digest your food and get the nutrients in. Most chronically ill people have messed up GI tracts, so that's one thing. But also the GI tract can harbor not only a lot of biofilms, but it can harbor a lot of other chronic infectious agents that you may have no digestive symptoms at all. And we do GI tract testing and we find that you've got some really nasty chronic infectious material there or inflammatory stuff. And just like the systemic part of your body, you've got to deal with the infections, the inflammatory stuff, or you're not going to get very far with your chronic fatigue. Then we would look at resistance factors. One of them is one that I mentioned, biofilms, biofilms and other reasons why the immune system is isn't functioning like it should. Beyond biofilms, other resistance factors would be we would check your B-cell, your part of the B-cell, part of your immunity output. If you're really having a lot of infections, we also would do specialized tests for T-cell function. But most screening, we would start with B-cells and work our way towards T-cells. Interestingly, found a lot of B-cell dysfunction in people with chronic fatigue syndrome. And every now and then we would uncover a T-cell dysfunction, which is more— you could think of it like a hardwired cell-mediated immunity problem that we would find. So if we weren't getting answers or if there was a ton of infections, you look for immune dysregulation or immune deficiencies. That's why people get these things a lot. And you don't want to be treating someone forever and ever and then not realize they were born with a primary immune deficiency or something that just didn't get diagnosed yet, which which is more common than it seems. The next area we'd look at would be things that interfere with normal function. So toxicity is a big one. And we would do screening and then go to deeper testing if we found something in the screening. So the screening would include usually urine tests. You can do a screening test for heavy metals, you can do a screening test for toxic chemicals, and then you do a screening test for biotoxins like mold toxins and things like that. Very, very common that one or all 3 of those toxic areas are afoot. And you think about it like the toxicity could be around us all the time. We could live in a toxic environment, work in a toxic environment. We could have gotten exposed to all kinds of things. And toxins basically sideline your immune system from working well. And so, um, if you, if you're treating, treating, treating, it's just like treating somebody for a bunch of infections. You don't realize they have an immunodeficiency. It's the same problem. You treat people and treat them and treat them, and they get better and worse, better and worse. You don't realize they've got some toxic influence that's taken their immune system down, you know, 5 notches. Uh, you got to treat the underlying immune deficiency, whether it's, you know, primary functional or, you know, due to something like toxins. Another area, um, that we would look at a lot— so we've talked about digestive, we've talked about the hormonal, we've talked about immune. and resistance factors, toxins. Another area is the physical and structural parts of the body. So, and, and not, you know, not every doctor maybe does all these things, but you certainly can refer to people. One thing would be screening people for musculoskeletal problems, structural problems, and, and those are in the purview of a lot of very good, say, chiropractic physicians. There are certain physical therapists who do a lot with chronic fatigue syndrome, other type of bodywork people, and sometimes it was a whole team. But you can't— excuse me— leave the physical body out because that's where we live. And so that's another area that has to be looked at. And a lot of times it's like people say, well, you know, I've done work with a PT or with a chiropractor or whoever and it helps, it doesn't, you know, cure it or whatever. Well, it's sort of like you can also say the same thing about infections or hormonal problems or your gut or whatever. You got to work on all of them. Remember, it's a bucket with a lot of holes in it. So the physical stuff has to be worked on, but has to be worked on alongside all the other internal medicine things that are going on. Now, another area that's incredibly important, uh, is the psychosocial area. And a lot of people get really either upset or kind of skittish about bringing up psychosocial because they thought we were going to be just like all the other doctors who were going to tell them, well, this is all in your head. And that's not what we meant by, by that. There is a huge toll on you as a human when you have any chronic illness. This book over my shoulder I wrote is, is about that phenomenon in cancer patients. And a lot of cancer patients now, we essentially treat them as a chronically ill person who has cancer. And, and so they have a, you know, disease that is there, it's not going to go away. There's a lot of mental, emotional, you know, things that go on with that. Well, same thing if you've been gaslit by the medical profession and been told this is all in your head and you don't feel as bad as you do, or you're drug-seeking or whatever. Um, that's not very good for your psyche, right? So you need to have things going on that work on the mind-body connection. And again, it's that one thing will not cure everything else. But just like your physical body, if you leave your mental-emotional self out of it, it's not going to work really well. So that becomes very important as well. And then the other area, which is very broad, and I want to talk about last, just because it's probably the most global thing, is what I refer to when I'm teaching it just as cell function. That's, that's a disturbingly simple term. Well, that means everything about yourself. You're made up of cells, so there's no part of you that cell function doesn't, uh, doesn't interact with. Your cells are affected by all these other things. So that's the first off. They're affected by toxins, by your hormones, uh, they're affected by your gut and your absorption of nutrients in your gut. They're affected by chronic infections. They're affected literally by mind-body psychosocial things through the epigenetic triggers that those trigger, on and on and on. Your cells are part and parcel of all this. But what else specifically with your cells? Well, you can kind of break cell function down into a couple of, or a few very important things. One is cellular nutrition. Okay, the other, it goes hand in hand with that because it can't work without each other is cell health. So if your cells are healthy, the membranes around your cells, which hold all of the communication devices and the little channels that let nutrients in and out and let, you know, build stuff on the inside to let toxins out, all of that stuff has to work. And as you're chronically ill, your cells get sicker. And so the cell membranes and the organelles in your cells can become very inflamed and oxidized. And you don't die, they don't stop working, thankfully, but they don't work very well. And that doesn't work so hot. Okay? So if you have nutrition but you have a sick cell, the nutrition and the cell don't work together very well. If you have a really spunky cell that's working great but you don't have very good nutrition, reverse problem goes on. So So nutrients going in, which is largely is, is your diet and your gut working, and then, you know, supplements after that. And then cell function and health. How long you've been sick? And people say, well, are they good tests for this? Not really without biopsies and stuff like that. But the bottom line is you can look at people and historically, if you've been sick for 2 to 5 years, your cells are not healthy. Okay. You've been sick for 5 to 10 years or 10 to 30 years, as we've had some people, your cells are really unhealthy. And there's going to be some biological markers we look at in your lab tests. There's other labs than what we mentioned earlier, and there are specialized tests that can be done looking at nutrient levels. And we certainly look a lot at iron levels and vitamin D and those guys, but, but also other nutrients become very important. So cell function and cell health get into let's clean up the cell, let's allow it to work better. And that has a lot to do with the movement of oxygen and carbon dioxide out, the movement of nutrients in and toxins out. But also sometimes there are specific things that need to be done to kind of rebuild the cells. Now, if you have toxins and chronic infections and bad hormones, uh, and some of these other things we talked about, the better they get, the healthier your cells get, and the more that the nutrients going in will do for yourself. So it's very synergistic. As you— as the ship goes down, all these areas get worse. But as you start to clinically work on all these areas, all these holes in the bucket, the cells naturally will improve in their function. And here's the thing: when the cells improve their function and when the cells have more energy, you have more energy. Okay, what makes the energy that you feel? It's the sum total Total of the energy-producing parts of your cell, which starts with your mitochondria and your nucleus in your cell and works its way out, all of the cells in your body. Now, a lot of people say, well, that's a brain thing. Well, yes, your brain energy gets involved as well, but it's more than that. It's really all of the cells in your body. When they're turned down and they're not working appropriately, you don't feel good. You don't feel energy in your body. Yeah. The other thing with cell function, and we've got a few minutes so I can describe this, and this is actually some research that we did, and I'm going to right now with this pen here remind myself to post the link. Now this link I'm going to post, I'm going to add it on there. I just thought of it just now, some research that I headed up in, I think it was 2011, about 10, 11 years ago. And it was when we were doing these hundreds of chronic fatigue and fibro patients. And what we did was we took people who were doing this 360-degree integrative medicine, fill all the holes in the bucket that you can treatment. And we took those people and many of them just by doing this holistic kind of fill all the holes in the bucket 360 treatment, they would progressively get better. But we took the people who were kind of plateaued, like they got better but they were kind of stuck, and started to look at what would be other things. This relates back to cell function, so that's why I'm looking there. So we're already treating their hormonal issues, we're already treating toxicity, we're already treating the gut, we're already treating chronic infections, we're already working on the psychosocial and the physical and All of that. Why are they plateauing? Well, not the only reason, but another reason that affects the energy in the body and cell turnover and repair of your immune system and your skin, your connective tissue, really all parts of your body, is the ability to undergo a process called methylation. And so over the years since the ability, sort of the easy ability to do genomic SNP testing, single nucleotide polymorphism testing. Back in those days, we were sort of early on. You look at 2009 and 2011 when we were collecting most of this data. We took the resistant people who got better, but they were stuck, and we tested them for a particular single nucleotide polymorphism called MTHFR. And that codes for methylene tetrahydrofolate reductase, a particular enzyme that helps to convert folic acid to its active form. And without the active form of folic acid, you can't do a lot of methyl transfers, which messes with your brain chemistry, messes with your bone marrow function, messes with your GI turnover function, messes with everything, but especially brain chemistry. and the energy-producing parts and regenerative parts of your body. And what we found out indeed was— and you can look at the data in there— the first thing we did was just an incidence study where we looked at their labs. Now, nowadays— so remember, this is 12, 13 years ago— nowadays we'd look at a whole SNP array and we'd look at all their SNPs, but we didn't have that availability back then. So we looked at the big one, MTHFR, and what we found is that disproportionately and statistically— you can look at the charts I did— but MTHFR, the bad variants of it which really screw up your methylation, were like statistically not very common in the whole population matched to gender and inheritability and stuff, but were very common in these people who were plateaued. So that was the first thing— there's a problem. Well, the next question you have to ask in research is, if there's a problem, if we treat the problem, does it help? Okay, so we did symptom surveys with these people to say, you're stuck here, here's all your symptoms, and you get a score, etc. And then we did an intervention, which is basically we gave the nutrients that would, uh, you can kind of think of these enzymes when they're blocked, you don't— they don't make, you know, Part B, okay? And Part B affects, you know, Part C, D, and E. So we gave them nutrients that would support what wasn't being made downstream and would make, you know, Part B and C, D, and E and support it all and all this business. So we put them on that, and in large numbers, I mean you know, numbers like 50 to 70%, it improves once we fix these problems. Now, other people have looked at this from the other point of view and said it's a magic bullet. So they take their chronic fatigue patients, they put them on methylation support, and some of them it helps, some it doesn't, and some of it's diminishing return. Well, that's not how it works. That is the same as finding a thyroid problem in a chronic fatigue patient, treat the thyroid, and and then it quits helping. Well, it's not really quitting helping, it's just that you're only plugging one hole. What's the difference? Our patients already had many of the other holes plugged, and then we found the metabolic enzymatic deficiency from their genetics, and then we fixed it, quote unquote, by going around and supplementing the nutrients that were supposed to be being made. And we got these big gains in these people. That was only after we fixed all other stuff and plugged all of the other holes. So that'll be the last link I'll put up in the links. And again, when I talk about the links, so we're, we're live on CTR Radio right now, we're live on Facebook, uh, but we're going to take this video and we're going to move it over, uh, to YouTube on the YouTube channel, my YouTube channel. And if you can't find me, just go to dranow.com, and it's got links to everything I Also remember, if you like, uh, you don't want to see my face and you want to listen— a lot of people just prefer to listen to the audio— uh, pretty much every pod burner we're over on. So whether it's Apple or Google or iTunes, whoever, uh, Medicine Health with Dr. Paul Anderson. So this will be up there too. But the links in the show notes, if I have any links we'll have for this one, those are going to be on YouTube in the description box. Okay. On your phone, lower right corner, little down arrow. Click on that, opens it up. Links will be there on your laptop or your desktop computer. Lower left corner, show more. Click on show more, and you'll find all of these links. So I'll put the link into that research now. Interestingly, at the same time as we presented that at a scientific meeting, a research group out of Harvard University published a real similar. Thing, only theirs was on treatment-resistant depression. And they found that if they did this same supplemental thing to go around the methylation problems, they could treat drug-resistant depression. And I communicated with the author at Harvard, and I said, this is what we found. I sent in my data, and I said, this is what we found with chronic fatigue patients. And he just wrote back and he said, yes, we're seeing exactly the same thing. We weren't studying chronic fatigue, but incidentally, Incidentally, that's what we're finding too. So again, it's not a silver bullet. That's not the only problem people have, but it was a really big addition when we got there. So again, we're out of time. Want to remember that chronic fatigue syndrome is a unique diagnosis. It's not all in your head, but you have to treat as many holes in the bucket as possible. And in this program, we got into those things, got in those holes, and you can certainly Uh, like, share, and subscribe, uh, and do the notifications. This is a great one to go back. You can rewind, one of the great things about electronics now, and you can go back through some of the information that I shared. But I'm Dr. Paul Anderson from Medicine Health, and I'll be back on my podcast next week to share more with you. Otherwise, we'll see you all on the radio. Thanks.
