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New Understanding of Chronic Fatigue Can Pave Way to Better Treatment

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
Ugggh guys. Bit of a rant ahead, sorry!

So it starts off okay: the lead-in by the author, Conan Milner, shows he Did His Homework. The article actually appears to be describing ME, or CFS based on some of the more stringent criteria, at the very least:

Imagine feeling dead tired—drained of every drop of energy. On top of this, you feel as if you’ve come down with an infection. Your throat is sore, your body aches, and your memory and ability to concentrate are shot.

For the 1 million to 2.5 million Americans who suffer with chronic fatigue syndrome, this is daily life. People with this condition find exercise nearly impossible, even a minor stress can be devastating, and they may sleep for more than 12 hours a night yet still never overcome the overwhelming sense of exhaustion.

So far, so good. Then we get to the actual interview, with

Dr. Chad Larson is a naturopath, chiropractor, nutritionist, and strength and conditioning specialist

Uh oh.

Chad: People with this condition can exert themselves in ways that may seem trivial to healthy individuals, but they get incapacitating fatigue. This is fatigue to the level where they’re not just tired and unmotivated, but they can’t move. They’re stuck on the couch or bed. It’s very debilitating.

...oh. Well. More power to you, Chad, for actually knowing what the illness is.

Then he goes on to wax rather eloquent about past studies with EBV, the new stuff on the microbiome and leaky gut, etc. Lulling the reader into a false sense of security. ;)

Epoch Times: When doctors talk about fatigue, they often refer to the adrenal glands. How do the adrenals fit into the chronic fatigue equation?

Dr. Larson: The adrenal glands respond to different types of stress: mental or emotional stress (when people say: “I feel stressed out!”), biochemical stress (food allergies and sensitivities, and blood sugar imbalances), and there’s also physical stress (unresolved injuries, chronic headache or neck pain.)

These could all trigger an adrenal response, which typically generates a release of cortisol, which is like a natural anti-inflammatory. When cortisol goes up, our pain usually goes down. It also helps with blood sugar balance.

But when adrenals respond to a chronic stress situation, cortisol can go too high. This can affect the hippocampus, which can lead to mental and emotional issues...

It appears we are heading to an 'emotional exhaustion' / 'adrenal burnout' narrative. Not CFS, sorry.

Epoch Times: Talk about treatment. What is the conventional treatment for chronic fatigue, and what do you recommend?

Dr. Larson: It depends on the chief symptoms the patient has. Oftentimes, depression is a key thing that threads throughout people with chronic fatigue, so they’re often treated with anti-depressants. In some cases, these can be very helpful, but I always want to dig to the next level down and figure out a way to influence their system so that their neurotransmitters are balanced and they don’t have depression.

Wait, what?

Dr. Larson, it's very nice of you to try and put it some more palatable way, but if it screws with your neurotransmitters to improve your mood, it's doing the job of an antidepressant and should likely be called one. And then there's the oft-repeated homily that we're more depressed, as a rule. Good to see it's alive and well (and in print... again). o_O

First, we have to see if they’re anemic. If someone has low iron, B12, or folic acid, the number one symptom is going to be fatigue. And fixing it can be as easy as giving somebody iron or B12. Anemia really means that oxygen is not getting to the brain. If oxygen can’t get to the brain, they’re going to be fatigued.

There are other lifestyle factors that need to be considered like caffeine and alcohol. We want to dramatically reduce or eliminate these because they can influence a person’s energy.

We also have to practice good sleep habits.

....aaaand we've gone from talking about clear ME/CFS utilizing the IOM report (the author of the article does!), to talking about burnout / adrenal exhaustion, to talking about anything that can cause the symptom 'fatigue' being CFS.

Anemic? You have CFS. Pernicious anemia? That's CFS, too. If you drink too much coffee in the morning, this can cause you to have CFS later in the day.

...I mean fatigue.

Hypothyroidism and hypoglycemia also apparently give you CFS.

We also have to get them moving. Difficult as it is for a person with chronic fatigue, a sedentary lifestyle is just going to seed this deeper and deeper. So we have to get them moving. It might just be a short 15-20 minute walk daily. But as we work on these other factors—thyroid, adrenals, glucose, anemia, diet, sleep—once all that stuff is improving, then we can help to increase their exercise even more.

There is a lot of information that shows that HIIT (high intensity interval training) is very good to help people with chronic fatigue. HIIT increases a person’s mitochondria.

:cry::cry::cry::cry::cry::cry:

WTH, sir, you started off so strong.

This is where the exercise physiologist aspect of the man pokes his head up. And he doesn't stop there.

From a dietary standpoint, we have to get things like sugary foods, sodas, and energy drinks out because of their effect on the adrenals. Hydration is very important too. Just a minimal amount of dehydration could cause fatigue and muscle achiness, which are some of the symptoms people with this condition suffer from. Most people don’t drink enough water. They think they do, but they don’t.

Yes, people with CFS are mostly just dehydrated.

Look, nothing he's saying is wrong in this paragraph, but that's what makes it so awful. You can just feel the public out there, nodding to themselves wisely: exercise is good; added sugars are unhealthy; we should all drink more water.

It's the "if we did, we would be cured!" that's so horrifying.

We have to make sure they have a healthy diet. Protein should be the centerpiece of an anti-fatigue diet.

Well, alright. Can't disagree...

I always check people with chronic fatigue for food sensitivities and often times we find gluten and/or dairy is causing a problem...

Sure, okay...

We also make sure they eat more vegetables.

"They didn't know they should eat vegetables or drink water or ramp up exercise slowly before they met me," the doctor said. "They'd never thought to try those things before." :cautious:

Note: that line above is complete farce, but I feel it would have fit well into this article. In fact, I could probably have replaced that with this honest-to-goodness line in the actual article:

A lot of this is just back to basics. Sometimes it’s the basics that people are missing.

Same vibe, yeah?

Epoch Times: Talk about obstacles to recovery. I’ve read that oftentimes when people make progress with their condition, they can have a dramatic setback, and climbing back up again can be really frustrating.

Dr. Larson: It is difficult to stick to a protocol like this. In my opinion, the complexity of the condition needs to be matched by the complexity of the treatment protocol. This is a complex condition that needs a complex and comprehensive treatment.

Frankly, it’s difficult for a lot of people to stick to. We can create the perfect treatment plan, but if it’s not followed, then we’re only going to see a certain percentage of improvement.

IMO, this is actually the worst part. By conflating CFS with all illnesses in which fatigue is even a symptom, Larson probably gets a lot of people exercising more and they show improvement. Actual PWME would not be able to carry this out.

Here he is, blaming them for their illness: I had this perfect plan that would have made you well; but because it's tough, the weak of will just can't stick to it. It is blaming patients for their illness, when what they were actually doing was sensibly avoiding PEM.

Please add thoughtful comments on this article. Note again that it's the interviewed party getting everything wrong; the author appears to have done quite a good job of representing ME at the start of the article, before he starts asking the supposed expert any questions.

-J
 

Groggy Doggy

Guest
Messages
1,130
I know some of these articles can be disappointing. I have not read one study or article that I feel is even remotely close to understanding the complexities of diagnosing and treating ME. But I do agree that if we could somehow get to the point of wellness where we could exercise consistently (without PEM, which is the biggest hurdle in my opinion) that some of our other secondary symptoms would improve. So I think he is oversimplifying what diagnostics and interventions are needed to get well enough to the point of being able to exercise consistently. This is where his expertise is lacking.
 
Messages
3,263
Oh, @JaimeS, I thouroughly enjoyed your commentary on this article. What an absolute hoot that was!

Actually, I could see the bad moon rising on "adrenal glands", the classic opening for a superficially plausible but essentially psychosomatic stress-based account of CFS.

Then when he mentioned the hippocampus, he was done for. The idea he's hinting at there is that somehow the stress has distorted our memories and emotions so we are psychologically messed up (he got that hippocampus idea from studies where rats were repeatedly tortured and then their brains examined). Its pretty much in the same league as saying we have demons in our brains, IMO. Only maybe more dangerous because it "sounds" plausible.

Some nice categories I just made up for the psuedoscienfictic BS here:

Adrenal/cortisol BS: Any BS that sounds superficially plausible - especially containing the words adrenal or cortisol of the phrase HPA axis - but is essentially saying that psychological factors such as stress caused us to get sick and/or are maintaining our illness.

Nutritional BS: Any BS that makes it sound like tweaking with diet, vitamins, fluids, coffee or alcohol intake will make us better. We've all fallen for it in the past, but let's face it, none of this stuff fixes serious chronic illnesses like our own. Just as it doesn't fix MS or cancer.

Covering your bases BS: Any BS that defends itself by saying that factor X is "only one factor at play" and that there are many others. Any BS that avoids any responsibility for not fitting the evidence by using these tactics.

Complex Illness BS: Any mention of CFS as a "complex illness" (as opposed to "simple" illness like cancer and MS). Used to pave the way for a "Many factors - including psychological" type account.

Exercise BS: I don't need to elaborate on this one.

Willpower BS: Any mention of any protocol that's "hard to stick to" or "takes willpower". What a get out of jail free card for any failures!

Positive thinking/mood BS: I don't need to elaborate on this one, either. Fortunately, not too much of this in interview.

"I can fix it" BS: Any attempt to use CFS as a tool to increase the apparent scope of one's professional reach and/or the market for one's services. Includes faith healers, nutritionists, osteopaths, psychologists, psychiatrists, physiotherapists, anyone who capitalises on the uncertainty surrounding our illness to advance their cause. Not saying these domains don't have something to offer, just please don't use us to advance your interests!
 
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sarah darwins

Senior Member
Messages
2,508
Location
Cornwall, UK
So for the past 5 years it's just the basics I've been missing.

:bang-head:

Hey, come on, AndyPandy. You've just got to HIIT it! Me, I started on the HIIT this morning, inspired by the picture on that link Jamie gave us ....

shutterstock_213255250-676x450.jpg


... and I've got to say it's working great. Of course, I'm still currently face down on the floor and typing this on an iPad with my nose, but I'm pretty confident I'll be able to get up some time this evening. Or tomorrow, at the latest.
 

Gijs

Senior Member
Messages
690
I don't believe that 1 million to 2.5 million Americans suffer from chronic fatigue syndrome, maybe fatique but not ME. It is much less. I think 'only' up to 100.000.
 

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
I don't believe that 1 million to 2.5 million Americans suffer from chronic fatigue syndrome, maybe fatique but not ME. It is much less. I think 'only' up to 100.000.

There is data on this, however; it's not pulled from thin air. The "1 million to 2.5 million" is directly quoted in a long, meandering line, back to mostly Jason's epidemiology, and since frequently quoted in #MillionsMissing-related documents, and from there out to a wide variety of journalists. There are actually multiple quotations, some much higher, but after much debate and reading of epidemiological stuff (which does exist in the form of 90% Leonard Jason) these were the figures we quoted.

Every time I see one of the phrases we painstakingly researched quoted again, I do a little fist-pump in the air.
 

Gijs

Senior Member
Messages
690
There is data on this, however; it's not pulled from thin air. The "1 million to 2.5 million" is directly quoted in a long, meandering line, back to mostly Jason's epidemiology, and since frequently quoted in #MillionsMissing-related documents, and from there out to a wide variety of journalists. There are actually multiple quotations, some much higher, but after much debate and reading of epidemiological stuff (which does exist in the form of 90% Leonard Jason) these were the figures we quoted.

Every time I see one of the phrases we painstakingly researched quoted again, I do a little fist-pump in the air.

There is no hard data. It is about fatique in general not ME. 'Real' ME patiënts are rare. This make big ME studies even more complicated. Real ME is one disease not heterogenic at all. If their are really millions of ME patiënts this disease would be much more regonised by ordinary people because many people would know some patiënts, that is not the case. Millions is bullshit, sorry.
 

Snowdrop

Rebel without a biscuit
Messages
2,933
@JaimeS
Thanks. Enjoyed the forensic analysis of the lame article. Agree this type of article that provides correct info then combines it with pseudo science is the most insidious--and it touches all the right notes for pulling people in in terms of the current health 'zeitgeist'. Everyone knows these things to be true (whether they are or not) it's all so plausible. Here we need a new word; plausation does not equal causation.

Its pretty much in the same league as saying we have demons in our brains, IMO. Only maybe more dangerous because it "sounds" plausible.

Yes. Instead of religious dogma for explaining the not fully understood we now have pseudo science as the authority cobbling together tidbits of not very clear but dearly held science belief into one big theory which is not ascribed theory status but de facto knowledge.

And every time it's always about what the person with illness must do--better--different--more etc. :rolleyes: :rolleyes: :rolleyes:
 
There is no hard data. It is about fatique in general not ME. 'Real' ME patiënts are rare. This make big ME studies even more complicated. Real ME is one disease not heterogenic at all. If their are really millions of ME patiënts this disease would be much more regonised by ordinary people because many people would know some patiënts, that is not the case. Millions is bullshit, sorry.
So what is the definition of 'real' ME then?