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1670 ROUTE 34 N. 3R FLOOR SUITE 3C WALL • NJ 07727

Chronic Fatigue Syndrome (CFS)

A Metabolically Directed Approach to Chronic Fatigue

Conventional Medicine Approach to Fatigue

  • Stimulants
  • Anti-Depressant Drugs
  • Other drugs

Metabolically Directed Approach to Chronic Fatigue

  • Fix what is wrong
  • Frequently a sex hormone or adrenal hormone problem
  • Frequently an unrecognized environmental issue
  • Frequently metabolic imbalances
  • Frequently a dietary problem
  • Frequently an unrecognized or poorly treated thyroid problem
  • Frequently a “stealth organism”

Health and Vitality is Achieved Toward the Middle of the Curve

Hormonal Imbalance can Contribute to Fatigue

All of your Sex and Adrenal Cortex Hormones are Made from Cholesterol

Breast Milk

55% of the calories from breast milk come from Saturated Fats

Also high in Cholesterol

Saturated Fats, Won’t They Hurt Me?

  • This is not true
  • The notion that saturated fat is bad was created by the food industry to sell margarine, vegetable and seed oils

Saturated Fats Have no Double Bonds, They are very Stable and Tend to Increase Energy Production

Unsaturated Fats Have Double Bonds – They are Unstable and Tend to Decrease Energy Production

Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease

  • Patty W Siri-Tarino, Qi Sun, Frank B Hu and Ronald M Krauss 1 From the Children’s Hospital Oakland Research Institute Oakland CA   Harvard School of Public Health Boston MA.   .
  • ABSTRACT 
  • Background: A reduction in dietary saturated fat has generally been thought to improve cardiovascular health. 
  • Objective: The objective of this meta-analysis was to summarize the evidence related to the association of dietary saturated fat with risk of coronary heart disease (CHD), stroke, and cardiovascular disease (CVD; CHD inclusive of stroke) in prospective epidemiologic studies. 
  • Design: Twenty-one studies identified by searching MEDLINE and EMBASE databases and secondary referencing qualified for inclusion in this study. A random-effects model was used to derive composite relative risk estimates for CHD, stroke, and CVD. 
  • Results: During 5–23 y of follow-up of 347,747 subjects, 11,006 developed CHD or stroke. Intake of saturated fat was not associated with an increased risk of CHD, stroke, or CVD. The pooled relative risk estimates that compared extreme quantiles of saturated fat intake were 1.07 (95% CI: 0.96, 1.19; P = 0.22) for CHD, 0.81 (95% CI: 0.62, 1.05; P = 0.11) for stroke, and 1.00 (95% CI: 0.89, 1.11; P = 0.95) for CVD. Consideration of age, sex, and study quality did not change the results.
  • Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.
  •  

Harvard Medical School Published in the American Journal of Clinical Nutrition January 2010

Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD

Low Intake of Saturated Fat

Lowers levels of HDL (“good cholesterol”)

Effect of low-fat diets on plasma high-density lipoprotein concentrations.

  • Katan MB.
  • Department of Human Nutrition, Wageningen Agricultural University, The Netherlands.
  • Low concentrations of HDLs in plasma are a strong predictor of risk for coronary as well as other cardiovascular diseases. There is increasing evidence that this relation is causal and that interventions that change HDL concentrations also change risk. One such intervention is exchanging fat and carbohydrate. In controlled trials, low-fat, high-carbohydrate diets decrease HDL concentrations. The effect is strongest when carbohydrates replace saturated fatty acids, but is also seen when carbohydrates replace mono- and polyunsaturated fatty acids carbohydrates. The effect is seen in both short- and long-term trials and therefore appears to be permanent. This finding is supported by epidemiologic studies in which populations eating low-fat, high-carbohydrate diets were shown to have low HDL concentrations. Weight losses with consumption of low-fat diets could theoretically counter effects on HDL, but in published trials weight losses have been modest and insufficient to offset the decrease in HDL concentrations induced by carbohydrates. Thus, replacement of saturated fat by carbohydrates adversely affects plasma HDL concentrations; replacement of saturated fat by unsaturated fatty acids deserves consideration as an alternative.
  • PMID: 9497172 [PubMed – indexed for MEDLINE]

Manifestations of Low Saturated Fat Diet

  • Lowers HDL (“good” cholesterol)
  • Lowers sex hormone levels
  • Contributes to metabolic syndrome (weight gain, high blood pressure, diabetes, heart disease)
  • Instead of burning food energy, food is stored as fat – which can contribute to chronic fatigue

Undiagnosed or Poorly Treated Thyroid Problem as a Cause of Chronic Fatigue

  • An extremely common cause of chronic fatigue
  • Myth – “All my thyroid labs are within normal limits” means “there is nothing wrong with my thyroid”
  • Fact – The ranges for thyroid hormones (and many other ranges) by definition are based on a statistical analysis such that 95% of all patients will always be within the “normal” range.

There are a Few Forms of Thyroid Hormones

  • T4 = levothyroxine, four iodine molecules, also known as Synthroid, most commonly prescribed thyroid hormone. NOT the active form of thyroid hormone 
  • T3 = liiothyronine, 3 iodine molecules, also known as Cytomel, rarely prescribed by primary care doctors and endocrinologists. THE active form of thyroid hormone
  • RT3 = Reverse T3, a mirror image of T3. BLOCKS T3 effectively putting the brakes on the active hormone by blocking the T3 receptor. Rarely measured by primary care doctors and endocrinologists
  • Natural forms of thyroid hormone (dessicated porcine hormone)
  • Gluten free T4 = Tirosint 
  • Gluten free T3 – not commercially available – needs to be compounded 
  • Gluten free dessicated procine thyroid hormone – available commercially as NP thryoid or can be compounded

Significant Percentages of Thyroid Patients are Inadequately Treated with Inappropriate Medications

  • T4 only Thyroid Hormones are inactive and must first be activated by your liver and peripheral tissues to be biotransformed to T3 (active)
  •  Many people, do not properly biotransform T4 to T3 and make significant amounts of Reverse T3 (blocks active T3)
  • Many factors can contribute to Reverse T3 syndrome – excessive estrogen, excessive insulin, excessive cortisol,

Several Factors can Contribute to Reverse T3 Syndrome

Circadian Dysfunction Contributing to Chronic Fatigue

  • Fact – lack of sleep, poor quality sleep, poorly synchronized sleep-wake cycles (like night shifts or staying awake too long and and sleeping too late, daytime napping) contribute to insulin resistance, hormonal imbalances, metabolic imbalances, weight gain and chronic fatigue
  • Solution – Good sleep hygiene. Sunlight during day (especially in the morning) avoidance of excessive artificial light after sunset. Sleeping in pitch black. Minimizing stimulating activities and food intake after sundown can help restore normal circadian rhythm and improve energy levels

Unfiltered Sunlight is Vital to Your Health, Sunlight has a Powerful Effect on Your Hypothalamic/Pituitary/Adrenal Axis

Chronic Stress can Lead to Chronic Fatigue

  • Fact – excessive cortisol impairs thyroid function, increases blood sugar, contributes to insulin resistance, reduces production of sex hormones and can lead to significant weight gain and fatigue
  • Myth – taking supplements that purport to control or reduce cortisol are helpful 
  • Solution – identify and reduce stressors like poor quality diet (edibolic stress), environmental stress, immune system stress, situational and emotional stress, circadian stress

Chronic Stress Can Increase ACTH and Cortisol Levels

Many Menstruating Women Suffer from Fatigue During Parts of Their Menstrual Cycle

  • Fatigue early in cycle can indicate hormonal deficiency 

  • Fatigue mid-cycle (ovulation) can indicate excess estrogen

  • Fatigue in mid-luteal phase can indicate hormone excess

Chronic Inflammation Contributing to Chronic Fatigue

  • Fact – Chronic inflammation as a result of various stressors increases your cortisol, contributes to insulin and leptin resistance leading to fatigue
  • Solution – Fix what is wrong! Unhealthy foods, unhealthy air quality, stealth organisms, food sensitivities, unhealthy relationships, negative thoughts, metabolic imbalances need to be rectified
  • A very common cause of chronic inflammation is environmental illness
  • There are usually other symptoms like pain, brain fog, headaches, sinus issues
  •  

Biotoxin Illness

  • Chronic Inflammatory Response Syndrome (CIRS)

  • Extremely Common, often Overlooked Cause of Chronic Fatigue

Environmental Illness Contributing to Chronic Fatigue

  • About 24% of the general population react to biotoxin exposure with production of inflammatory cytokines
  • The gene known as HLA –DR is carried on your sixth chromosome and helps your immune system differentiate “friend from foe”
  • These cytokines create a huge burden on your body and can contribute to chronic fatigue

HLA DR Susceptible Genetic Patterns

  • 4-3-53
  • 11-3-52B
  • 12-3-52B
  • 14-5-52B
  • 7-2-53
  • 7-3-53
  • 13-6-52A,52B,52C
  • 17-2-52A
  • 15-6-51
  • 16-5-51
  •  

Stealth Organisms

Hidden or “stealth organisms” – viruses, bacteria, parasites can contribute to chronic inflammation of chronic fatigue

Test and Treat for Tick Borne Diseases

  • Lyme Disease

  • Erlichiosis

  • Babesiosis

  • Bartonella

  • Rocky Mountain

  • Spotted Fever (RMSF)

  • Anaplasmosis

  • Tickborne Relapsing

  • Fever (TBRF)

  • Rickettsia

  • Tularemia

  • Powassan Disease

  • Borrelia mayonii

  • Borellia miyamotol 

Consider other Sources of Toxicity

  • Chronic Mold Exposure leads to immune dysfunction which can contribute to downstream distortions in your microbiome, paving the way for:
  •  Fungal overgrowth – Candida, yeast, small intestinal fungal overgrowth (SIFO)
  • Dysbiosis – small intestinal bowel overgrowth (SIBO), imbalance in bowel flora, H Pylori
  • Parasites 
  • Heavy Metals

Metabolic Imbalance Contributing to Chronic Fatigue

  Anabolic-Catabolic Imbalance

The Work of Emanuel Revici MD

Fatty Acid vs Sterol Levels Leading to Metabolic Imbalance

Too Many Fatty Acids, Not Enough Sterols

A Balance Between Fatty Acids and Sterols

Too Many Sterols

Autonomic Nervous System Imbalances

Contributing to Chronic Fatigue

Energy Production Imbalance as a Cause of Chronic Fatigue

The Work of George Watson PHD

Metabolically Directed Approach to Chronic Fatigue

  • Fix what is wrong
  • Frequently a sex hormone or adrenal hormone problem
  • Frequently an unrecognized environmental issue
  • Frequently an oxido-reductive imbalance 
  • Frequently an autonomic nervous system problem
  • Frequently a lipo-oxidative problem
  • Frequently a dietary problem
  • Frequently a “stealth organism”
  • Frequently a dysbiosis
  • Frequently an unrecognized or poorly treated thyroid problem
To learn more about Michael Rothman MD contact us today by giving us a call at (732) 268-7663, emailing us at [email protected] or by requesting an appointment online.
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