with Jacob Teitelbaum, M.D.
I have had CFS since 2007 and in the past month a PCR test revealed I have mycoplasma (not M. fermentan) and chlamydia (routine blood test did not show antibodies for either of these). My doctor is well known for his experience in treating CFS and RA patients infected with these pathogens and he has suggested low dose antibiotic treatment with minomycin. Because I have had so many gut problems including chronic and systemic candidaisis, I am trying to research alternative treatments first and foremost. As there seems to be very little information about on the effectiveness of herbs to eradicate these pathogens, I was hoping to get your expert advise on the subject. I am already taking a nice antibacterial/anti fungal herbal mix (goldenseal, cat’s claw, pau d’arco, grape fruit seed extract, oregano oil, plus a few others) but I am keen to find out if these herbs or others like it, would have an effect on mycoplasma or chlamydia. Many thanks for your time.
Dr. Teitelbaum’s response:
Although there are a number of natural antifungals that can be helpful in preventing candida (I like a mix that is present in the product called Anti-Yeast — we carry it at vitality101.com), unfortunately, I don’t think the natural remedies are likely to be especially helpful in clearing mycoplasma and chlamydia. On the other hand, with negative antibody levels (if your physician checked IgG antibody levels– the IgM antibodies will normally be negative in chronic infections) it leaves me concerned that the PCR test may not have been accurate (what is called a false positive result, which can happen from test tube contamination).
In general, I think testing for this many infections in CFS tends to be unreliable. On the other hand, a trial of antibiotics and antivirals can be helpful in some with CFS, regardless of the test results. I usually will decide when and how to prescribe antibiotics based more on symptoms.
Treating infections is the most complex part of the “SHINE protocol”, and an area where even top experts disagree, so what I will offer is simply my recommendations and approach.
I would begin by noting that the available testing for the chronic infections seen in CFS/FMS is clearly not reliable, and do NOT tell us with good specificity and sensitivity what infections a given patient is likely to have. What they can do, if very high or low, is to help us tune our clinical “index of suspicion” as we assess the patient. Using all the information at hand, we offer clinical trials of treatment, and then assess based how the person responds.
So how does this work in real life?
- I recommend that ALL CFS/FMS patients be treated for candida, as clinically most have the symptoms and improve with treatment, and this is a very hard infection for the immune system to clear on its own. I do not consider the blood testing for candida antibodies in this decision, but might consider them in deciding to switch to a different antifungal if they fail treatment with the first. For example, start with Diflucan 200 mg a day for 6+ weeks (available in generic for $40). If not helping candida symptoms such as sinusitis and spastic colon, I may switch to Sporanox (expensive but soon to be available in generic) and in rare case to VFend (good, but ridiculously expensive) if the symptoms and/or candida antibodies are very suggestive, where otherwise I would consider the 6 week Diflucan trial adequate and focus on other SHINE Protocol treatments. I would treat ALL patients with the Anti Yeast herbal mix and probiotics for 3-5 months along with the prescription antifungals.
- Check a stool test at Genova Labs to look for parasites and also a bacterial culture and sensitivity. The yeast stool culture adds little but costs little, and if negative means nothing, but if positive will give antifungal sensitivities–so if resistant to Diflucan, I would use a different antifungal. I treat ALL parasites, whether or not considered “pathogenic” as “nonpathogenic” parasites can still be problematic in immune suppressed patients.
The above is a starting point. Having done these, I then usually focus on the Sleep, Hormonal, and Nutrition (and mild exercise/walking as is comfortable for the patient) components of treatment. I add in other infection treatments early on if they have a history suggestive of infections. As testing is unreliable, what I am looking for is evidence suggesting they have either:
- An antibiotic sensitive infection–this can include Lyme and many others;
- An antiviral sensitive infection
Suggestive symptoms for an antibiotic sensitive infection:
- a chronic/recurrent fever over 98.6°F—even 99°F—and/or
- chronic lung congestion;
- recurrent scalp sores which scab;
- history of bad reactions to several different antibiotics (people misinterpret the die-off reaction as being an allergic reaction);
- history of the CFS/FMS symptoms even transiently improving in the past when given an antibiotic;
- severe vertigo—this is when you feel like you or the room is spinning in a circle and is not to be confused with the dysequilibrium experienced by most of us with CFS;
- severe night sweats which persist after treating the candida and hormonal deficiencies;
- when the 1.25 to 25 vit D level ratio is over 2 it raises the question of antibiotic sensitive infections
If any of these are present, I consider an empiric trial of the antibiotics Zithromax 500 mg a day or Minocycline (or doxycycline) 100 mg 2 x day for 3-6 months.
For more information, see endfatigue.com/health_articles_f-n_2/Infections-treating_hidden_antibiotic_cfs_fm.html
Suggestive symptoms for an antiviral sensitive infection:
- pure CFS with minimal pain;
- sudden onset of illness with a severe flu like infection;
- chronic flu like symptoms;
- marked autonomic symptoms (low blood pressure, poor bowel motility);
Antiviral treatment includes a number of options. We often forget Amantadine (symmetrel) 100 mg twice a day, but this is a very good and low cost antiviral (60 caps is under $40 at Costco). It has the added benefit of raising dopamine. Isoprinosine is also helpful in CFS and relatively low cost. I have found Valtrex rarely helps (Famvir a little bit more often), though I historically do not go beyond a 3 month trial, and in the Lerner study below they note an average 2.7 years of antiviral treatment. If the HHV6 IgG is 1:640 or over I consider Valcyte, which has been more helpful clinically, though the double blind study by Montoya was disappointing.
IF problematic symptoms still persist after treating with the rest of the SHINE protocol and the above, then I consider empiric treatment with antibiotics (zithromax 500 mg a day generic, or doxycycline 100 mg twice a day) or antivirals (Amantadine 100 mg 2 x day and/or the Isoprinosine protocol are both low cost and well tolerated and good places to begin). I also will give gamma globulin injections IM (often as effective as IV as much more affordable for patients) giving 2 cc IM weekly for 6 doses (or 4 cc IM every other week for 3-6 doses).
I don’t know that the tests add much along the way. A Lyme Western Blot should be checked at a standard lab, but will likely be negative in most with Lyme. If positive, I treat for Lyme. It is also horribly unreliable to rule out Lyme. Some labs do testing which I suspect is equally problematic in the other direction, seemingly saying everyone has Lyme.
So though the testing may point us in a direction, I recommend tailoring treatment based more on symptoms and clinical response to treatment than the labs, giving more weight to symptoms than labs, but using both. The free symptom analysis program at vitality101.com can analyze both the patient’s labs and symptoms to determine the likely causes of their CFS or fibromylagia, and tailor a treatment protocol to each case.
SHINE represents four areas of health issues that need to be addressed when creating a treatment program. These health issues and their roles in treating CFS/FM are as follows:
S = SLEEP: Get adequate sleep, preferably eight to nine hours a night. Sleep replenishes the body's energy and heals its muscles. Inadequate sleep will leave you exhausted and in pain.
H = HORMONES: Get tested for hormone deficiency and treated if needed. Hormone deficiencies can contribute to fibromyalgia and chronic fatigue syndrome.
I = INFECTIONS: Get treatment when symptoms of infections occur. The lack of restorative sleep in CFS/FM leads to dysfunctional immune systems. Underlying viral, bacterial, bowel, sinus and yeast infections are common and can be a contributing cause or result of CFS/FM.
N = NUTRITIONAL SUPPLEMENTS: Optimal nutritional supplementation is essential. Many nutrients can be depleted as a result of CFS/FM. B-12, magnesium, Acetyl L Carnitine and glutathione, as well as your basic A, B, C and D vitamins need to be supplemented at a level that your average over the counter multivitamin cannot provide.
E = EXERCISE: Exercise as able. After 10 weeks on the 4 steps above, you will be able to slowly increase your exercise—without being wiped out the next day!
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