You may have heard about chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS)—two syndromes with overlapping symptoms. Both conditions have contributed to significant mental and physical frustration in our communities. CFS has been a subject of controversy for many years, but now it is officially recognized by the Centers for Disease Control and Prevention (CDC). CFS affects 3 out of every 1,000 Americans. Most patients are Caucasian women between the ages of 20 and 50. FMS affects more than 3 to 6 million people in the United States, and it is responsible for more disability than rheumatoid arthritis (RA).

Although they can present alone, CFS and FMS can be triggered as a result of an infection or stressful event, underlying autoimmune diseases, chronic inflammation, or hormonal imbalances. They are quite challenging, but surely an astute physician will investigate to discover the underlying causes. FMS is characterized by widespread pain, tenderness on light touch, nonrestoring sleep, brain fog, poor metabolism from hormonal imbalances, and depressed mood. CFS is a state of energy crisis characterized by low energy production such that it cannot match body demands. Patients suffer from persistent fatigue, even after rest or vacation, and notice extreme

exhaustion after workouts. Irritable bowel syndrome and recurrent sinus infections are also common. To make it easier to understand, think of your body as a house. Having a chronic autoimmune disease or inflammation is like having your house on fire. If ignored, the fire will set off fire alarms, which is like developing FMS. If the alarms remain unattended, the house will eventually collapse. This is like having CFS settling in your body. Most of my patients appear depressed and are frustrated due to a lack of energy. However, even though they are depressed, depression is not the cause but one of the complications.

Several research studies have pointed out that a specific area of the brain known as the hypothalamus is affected, creating an energy crisis of your body’s control center. The hypothalamus regulates sleep, hormonal balance, body temperature, and low blood pressure. As a result, patients suffer for months, if not years, with disordered sleep, poorly regulated body temperature and low blood pressure, irritability, and exhaustion.

Unfortunately, modern medicine and pharmacologic prescriptions have come up short in solving the challenges seen in these complex chronic disorders.

Currently, there is no FDA-approved treatment for CFS, but FDA-approved therapies for FMS include Cymbalta, Savella, and Lyrica. It’s about time we think outside the box. Fortunately, over the last decade, integrative and functional medicine research has led thought leaders to design treatment protocols for FMS and CFS. One of the integrative physicians, Dr. Teitelbaum, has developed the S.H.I.N.E. approach, which has been successful in the majority of patients. S.H.I.N.E. focuses on five key areas related

to the body that, when addressed in combination, can provide a road map for optimal energy production.

I have modified to meet the unique needs of my patients with autoimmunity and inflammation. Our approach is called RISE and SHINE, which has a functional medicine basis. RISE is to Reduce Inflammation, Stress and Exhaustion. SHINE address issues of Sleep, H for hormonal balance, I for immunity and infections, N for nutritional deficiency, and E for exercise (as able) and energy.

Relaxed and uninterrupted sleep can be achieved by educating patients about maintaining sleep hygiene and, if needed, using nonaddictive natural therapies. A customizable combination of valerian root, passionflower, lavender oil, 5HTP, and melatonin can help meet individual needs. Magnesium at night can help relax muscles and reduce spasms. Early recognition of poor function of the thyroid and adrenal gland is crucial, and, when indicated, natural

supplements to support hormones help significantly. The literature supports use of licorice extract, vitamin B6, vitamin C, and DHEA for adrenal support.

To address inflammation and misdirected immunity seen in patients with rheumatologic diseases and chronic infections, I pay very close attention to an anti-inflammatory diet rich in omega fatty acids such as fatty fish (salmon, mackerel, sardines), avocados, raw nuts, seeds (walnuts, flax seeds), and extra virgin olive oil. Increasing use of dietary fibers from whole fruits and vegetables along with seasoning with garlic, ginger, and turmeric add anti-inflammatory properties to the diet. Probiotics help intestinal inflammation. Elimination of trans fats and animal fat and protein can reduce inflammatory chemicals.

To boost immunity, antioxidants like B-complex, vitamin C, eleuthero, coenzyme Q10, and raw garlic are helpful. Daily vitamin D is essential for

stabilizing immune cells. Supplements like carnitine and D-ribose with exercise help mitochondrial function and promote energy production. I assure patients that, just as it took them several months and years to develop CFS and FMS, it may take months to get better. For realistic recovery, expect 10% improvement every month. Eventually, they will be ready to embrace life and SHINE like a star.

About the author: Dr. Farhan Tahir, MD is board certified with the American Board of Internal Medicine, Rheumatology and Integrative Holistic Medicine. He is a member of the American College of Rheumatology and founder of Pennsylvania’s first and only integrative rheumatology practice. He lives in Bucks County with his wife and three young boys. For a personal integrative consultation, call 267-685-6070 or email:info@rheumpa.com. Visit www.RheumPA. Follow Facebook www.facebook.com/ftahirmd Twitter https://www.twitter.com/iRheum.

By: Farhan Tahir MD, FACR, ABIHM

Fibro, Fog and Fatigue? Let’s help you SHINE

Disclaimer* These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. Do not start any supplements without advice of a healthcare provider.

Health&Medicine BCWJ ~ Page xx August/September 2014

Farhan Tahir MD, FACR, ABIHM

We offer integrative rheumatology care to patients with joint, muslce pain or inflammation. We offer solutions using conventional and natural treatment modalities.

Patients with any kind of autoimmune disease can benefit from a more thorough and open minded approach for the whole body. Reducing inflammation with this approach also helps

slowdown aging and improves quality of life