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Understanding and Treating Chronic Fatigue Syndrome:
An Interview with
Dr. Jacob Teitelbaum

Jacob Teitelbaum, M.D., is a board-certified internist and a leading researcher in the field of Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM). He has a specialized practice for CFS/FM and pain patients in Annapolis, Maryland, and is director of the Annapolis Research Center for Effective CFS/FM Therapies. Dr. Teitelbaum is also the author of several books, including From Fatigued to Fantastic, Pain Free 1-2-3!: A Proven Program to Get You Pain Free Now!, and Three Steps to Happiness: Healing Through Joy.

Dr. Teitelbaum received his medical degree from the Medical School at Ohio State University and, in 1980, he became Board Certified in Internal Medicine. For over two decades he has worked with CFS/FM patients. His motivation to specialize in this area of medicine began with personal experience. In 1975, Dr. Teitelbaum had to drop out of medical school when he himself contracted CFS/FM, and this had a profound influence on the course of his medical career. Although he recovered enough to resume his medical school training a year later, CFS/FM symptoms persisted for many years, and this motivated him to become an avid reader of scientific and medical literature where he came across many studies that he had not learned about in medical school.

Dr. Jacob Teitelbaum

Applying this research, Dr. Teitelbaum began to treat his patients with nutritional and herbal therapies, hormonal supplements, anti-infectious treatments, physical therapy measures, and sleep support. Much to his surprise, these previously untreatable patients started to improve dramatically. Dr. Teitelbaum was amazed as his general internal medicine practice began to fill with patients who were flying in from around the country. He has now effectively treated approximately 2,000 patients with CFS/FM related disorders.

In addition to having written several books, Dr. Teitelbaum has written numerous articles on CFS/FM, including the recent landmark paper “Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia—A Randomized, Double-Blind Placebo-Controlled, Intent to Treat Study,” published in the Journal of Chronic Fatigue Syndrome. Dr. Teitelbaum has also designed a line of nutritional supplement and support formulas, and all of his royalties from the sale of these products goes to charity. To find ot more about Dr. Teitelbaum’s work visit his Web site: www.endfatigue.com

Dr. Teitelbaum is open-minded, curious, and very enthusiastic about alternative medicine. He has a very upbeat perspective on life in general, and he laughs a lot. We spoke about the etiology of Chronic Fatigue Syndrome, the relationship between CFS and FM, how to sleep better and increase mental clarity, and other effective treatments for CFS/FM.

Q: Can you talk a little about what you’ve learned about the etiology of Chronic Fatigue Syndrome?

Dr. Teitelbaum: Yes, Chronic Fatigue Syndrome is basically like blowing a fuse.

It’s like the circuit-breakers you have in your home. If you plug in too many heaters, for example, or blow-dryers—boom!—off go the lights because you’ve blown a circuit or a fuse. The fuse that you blow in Chronic Fatigue Syndrome is called the hypothalamus, and that’s a key control center in the brain. It controls temperature regulation, sleep, hormonal function, and the autonomic nervous system, which regulates blood flow, blood pressure, and pulse. Because the hypothalamus is blown, those four systems are off-line in Chronic Fatigue Syndrome.

Now the way that that acts as a circuit breaker is like this: You can view Chronic Fatigue Syndrome, and its painful cousin Fibromyalgia, as an energy crisis where you’re calling on your body to supply more energy than it’s able to supply—and you can only overdraw your bank account for so long before things start bouncing, so to speak. So, since the hypothalamus is so energy-dependent, because it’s doing so many things in a small area, when you are outstripping your energy supplies, that’s the place that goes first, and that’s why it acts as a circuit-breaker.

Q: How does Chronic Fatigue Syndrome lead to immune system dysfunction?

Dr. Teitelbaum: It does this in several ways. Chronic Fatigue Syndrome is integrally tied in with the hormonal functions of the hypothalamus, which control the immune system, and poor sleep also causes immune dysfunction. There’s also the problem of not making enough energy in your muscles, so the muscles get stuck in a shortened position, just like with rigor mortis when somebody dies. The muscles don’t have enough energy, so they don’t go loose. The muscles become rigid and they hurt. So there are a number of ways that it causes direct immune dysfunction, as well as ways that are not quite as direct; they’re basically one step removed from that. Then, because the immune system is not able to have the energy it needs to fight infections, you get these infections which puts more demand on the immune system when it’s already on its knees. Then it basically just starts firing off wildly, trying to fight all these infections, and then it exhausts itself. That’s why the change is biphasic. We have an overactive immune system followed by an exhausted immune system.

Q: Can you talk a little bit more about the relationship that you see between Chronic Fatigue Syndrome and Fibromyalgia?

Dr. Teitelbaum: They’re the same thing in most people. The body doesn’t care what name we call things. What’s going on is what’s going on. You can call it Fibromyalgia, Fibrositis, Chronic Fatigue Syndrome. If the person, in addition to fatigue, insomnia, and brain fog, also has widespread muscle pain, which most of them do, then they have Fibromyalgia.

Q: What role do you think vitamin deficiencies and diet play in Chronic Fatigue Syndrome and Fibromyalgia, and how might taking nutritional supplements and improving one’s diet help improve symptoms?

Dr. Teitelbaum: Oh, it’s a major role. Remember we talked about blowing a fuse because you can’t make enough energy? So the question then is how do you make enough energy so that you can turn that fuse back on? I use the acronym T.H.I.N.S. to help people understand how to do this. The initial T is for toxins, which you want to eliminate. H is for hormonal support. I is for infections, which need to be treated. N is for nutritional support. And S is for sleep support. Those are the things that make energy, keep energy, and eliminate the energy drain. So people who have this disease need proper nutritional support. Actually, the American public in general is horribly nutritionally deficient—and it’s not that they’re deficient in one nutrient. They’re deficient across the board, and the reasons are multiple:

One reason is that we get an average of a hundred fifty pounds of sugar per person added to our diet every year. Soda has almost one teaspoon of sugar per ounce. So if somebody goes to the 7-11® store and gets one of these 64 oz Big Gulps, that’s 64 spoons of sugar and sugar supplies 18% of our calories. Another 18% of our calories come from white flour. So 36% of our diet is nutritionally wiped out before you ever get out of the starting box. Then you have food processing, and you have all the different bowel infections that people get that decrease absorption and increased nutritional needs. So most Americans are nutritionally deficient, and it’s not just with a single nutrient. In Chronic Fatigue Syndrome and Fibromyalgia it gets even much worse because you have both increased needs and decreased absorption. So the question is what do you do?

Q: You said that the cause of Chronic Fatigue Syndrome and Fibromyalgia is the hypothalamus being blown out. Would you recommend any type of hormonal treatment then to help correct the situation?

Dr. Teitelbaum: Absolutely. Remember the acronym T.H.I.N.S. H is for hormonal support.

Nutritional support is easy. Avoid sugar and increase water because the hormone that holds on to water is low. Most people find a high-protein diet feels better than a high-carb diet, but everybody is different with that. Except for sugar, it’s most important that people eat what makes them feel good, because there’s no one diet that’s right for everybody.

Then with hormonal support it’s important to be clear that blood tests are hopelessly unreliable, and they miss the majority of people who benefit from and need hormonal support. So thyroid is usually low if people are tired and achy, cold-intolerant, and suffer from weight gain. If they have two or three of those, they deserve a trial of thyroid hormone, period, regardless of what the blood tests show. Tens of thousands of adults are dying a year, in addition to tens of thousands more neonatal deaths and miscarriages, because people are not being treated for their low thyroid. Generally, it’s better to use the natural hormones than the synthetic ones because they’re the same thing that the body makes. So Armour thyroid is excellent and very helpful.

Then there’s adrenal support. The adrenal is our stress handler, whereas the thyroid is like our gas pedal—it’s like the thermostat that says how much energy you’re making. The adrenal gland is what helps you handle stress, and in our modern society we put so much stress on our bodies, because of the environment, because the fast pace of things, things like that. We exhaust the adrenal glands, and you can tell that that’s going on because you get these hypoglycemic symptoms. This is basically when you get very irritable, when you’re hungry, when your blood sugar drops, people around you recognize that if they don't feed you NOW, you get so irritable that they feel like you’re going to kill them. Fortunately, natural adrenal hormones and glandulars (e.g. Adrenal Stress End) can be given in low dose very safely and can be dramatically beneficial.

You can use natural hormones safely. Testosterone deficiency needs to be treated in women as well as men. Treating low testosterone in men using natural hormones decreases the risk of angina, improves diabetic control, and decreases cholesterol. Now you don’t want to go to super-high levels like the body builders; that’s dangerous. You don’t need to do that with hormones generally. So the hormonal support is critical and the blood tests are horribly unreliable.

Q: You spoke about the role that sleep deprivation plays in Chronic Fatigue Syndrome and Fibromyalgia. What suggestions would you make to help improve someone’s sleep patterns?

Dr. Teitelbaum: The hypothalamus is the sleep center, so it’s not a matter of poor sleep hygiene. It’s a matter of the sleep center is not working.

So, first of all, I like to start with natural remedies.

5-HTP is good, but is expensive and takes six weeks to work. It also causes weight loss, and because the average weight gain in this disease is 32 pounds, that’s helpful for people. It also decreases pain. Taking calcium and magnesium at bedtime also helps.

Melatonin helps too, but only one half milligram. A half milligram is all it takes to totally bring a low melatonin level up to normal, and the studies show that for most people that low dose is every bit as effective as a higher dose for sleep. I have concerns when someone starts taking a massive dosage of hormones. Even if they’re natural, I don’t think one should take a dose that brings us above what the body normally would have.

Q: Are there any other herbal remedies that you would recommend for treating chronic fatigue syndrome in general?

Dr. Teitelbaum: Oh, there’s a whole host of things. If you go on my web site at vitality101.com, and click on “treatment protocol”. It’s the bottom link on the left. And if you go through it section-by-section—for sleep, for treating yeast, for treating pain—you’ll see dozens of different herbals that are recommended, and how to use them.

Q: What are your thoughts about human longevity, and what do you think are the best ways to slow down the human aging process?

So a couple of things if you want to stay young and live very long—or as I put it, if you want to die very young very late in life. Number one is sleep, because studies show that things that raise growth hormone can slow aging. For example, if you have sex three times a week you look ten years younger. This is from a study out of Scotland, and it was postulated that that’s because of the growth hormone release. So if you want to increase your growth hormone, get deep sleep, get exercise, and have sex. That’s how you raise growth hormone naturally. I don’t like growth hormone shots because I’m not convinced of the safety. They’re also expensive, and they’re a pain. So raise it naturally by following the “rough” prescription that I just gave you. Two, get good nutritional support. The antioxidants are critical. Get solid nutrition. Then the T in T.H.I.N.S. is toxins, so detox. It doesn’t mean that you need to avoid every toxin. You can’t do that in the American environment—it’s pretty much impossible. But don’t spray a can of bug spray in your house for God’s sake. That’s poison. That’s why it kills bugs. There are safer ways to control pests, like by using boric acid.

We had this big line of ants coming into my house recently because they found the cat food bowl. So we could have sprayed the hell out of them, which would have kept them away for about two days, and then killed us more than them. But we just put the cat bowl in a bigger dish that had water in it, so the ants couldn’t get to it because there’s a little moat around it. So you can poison yourself, or you can just use common sense.

I often gave lectures in the schools to the third graders on nutrition. When I was first starting this practice, I would say that there’s a very simple rule of thumb—if you can’t read what’s in the ingredients because the words are so complicated, don’t eat it. If the ingredient list says that it contains chemicals with names that start with something like tiulated, futalated, hydroxy, or whatever it is, then avoid it. Also avoid sugar. But words like flour and milk—you can read that. But these big long chemical names, that’s probably not very good for you. So just use common sense with it, but don’t make yourself nuts.

So avoid heavy toxins, get the hormonal support that really prolongs life, add nutritional support and sleep, and those are the key things basically. There’s a concept that I call Vitality 101, which says, feed your body—get proper nutrition, avoid sugar, and get plenty of water.

Use your body—get exercise and have sex, things like that. And rest your body—get eight to nine hours sleep a night. And if you do that, you can die very young very late in life. These things are not hard to do. There’s a policy that I have—you never take away something that’s giving a person pleasure without substituting something equally pleasurable. So, for example, I’m going to say avoid sugar, but I’m going to add the three magic words—except for chocolate. I think chocolate is a healthy food, and so are other things that give you joy.

I’ll tell you the fourth thing for Vitality 101, which is the most important for staying young and alive late in life—follow your bliss. This means do what feels good.

Q: What advice would you give to someone who is looking to improve their mental performance?

Dr. Teitelbaum: Again, nutritional support and sleep are critical. Then, if they have low thyroid the brain is not going to work very well. If they’re tired, achy, gaining weight, and cold-intolerant, they probably have low thyroid. Get eight to nine hours sleep a night. A hundred years ago the average American got nine hours of sleep a night—as many people got ten hours as got eight.

We’re sleep deprived, and because of this our brains are not going to work too well.

So first of all, make the time for sleep. Then second, take what you need to get solid sleep. There are many natural remedies like we discussed. You do those two simple things and you’re going to improve function markedly. Then make sure your hormonal levels are okay. Make sure your testosterone and your thyroid levels are not too low. But let me give you a quick primer on blood testing. For most blood tests, the normal range is based on what’s called two standard deviations. This is just a statistical norm. What that means is that they take a hundred people and measure the blood test. The highest and lowest two and a half out of a hundred are considered abnormal, and the other ninety-five percent in the middle are defined as normal. That’s all the normal range means for most tests.

So say you wanted to define a normal shoe size. We take a hundred people in the mall, look at their shoe size, and you get a normal range of maybe four to thirteen. That would get ninety-five percent of people. So say you had a shoe problem, and I measured your shoe size, and you were wearing a size five. I’d say, “no it’s normal. There’s no problem. It’s in the normal range.” I see you lost your shoes, so I’ll just take one out of the pile, and as long as it’s in that range, it’s ok. You would put it on and say, “I can’t get into this thing.” Then I’d measure it again, and I’d say, “no the test says it’s normal. It’s just fine.”

The analogy I just gave you is almost exact, and that presuming that if the test is normal the shoe fits doesn’t work. You have to look at the symptoms. Are you tired? Are you achy? Are you cold intolerant? Do you have weight gain? Then you have low thyroid, and you deserve a trial of natural thyroid hormone. So consider thyroid, testosterone, and adrenal support. If any of those three are low your brain is not going to work very well. So taking the treatments to bring these up to normal, if they’re low, could make a big difference. So start with getting nutritional support, get your eight to nine hours sleep, treat your hormonal system, and treat any infections or toxin exposures. But that’s kind of Vitality 102 at that point. I’d start with 101 for most people.

Q: Is there anything that we haven’t discussed that you would like to add?

Dr. Teitelbaum: If I could just say one thing, if there’s one message I could get out for people; it’s follow your bliss. It’s do what feels good, because that’s authentic to you. There’s no one thing that’s good for everybody to do—to eat this or do that. I can only give you general principles. It’s by following what feels good to you that you check in with your own intuition, your own inner wisdom, and that’s how you know what’s good for you. So that’s what it boils down to.

David Jay Brown is the author of four volumes of interviews with leading-edge thinkers, Mavericks of the Mind, Voices from the Edge, Conversations on the Edge of the Apocalypse, and Mavericks of Medicine. (Mavericks of Medicine will be published by Smart Publications as a book in late 2006.) He is also the author of two science fiction novels, Brainchild and Virus. David holds a master’s degree in psychobiology from New York University, and was responsible for the California-based research in two of British biologist Rupert Sheldrake’s bestselling books on unexplained phenomena in science: Dogs That Know When Their Owners Are Coming Home and The Sense of Being Stared At. To find out more about David’s work visit his award-winning web site: www.mavericksofthemind.com.