Arizona Advanced Medicine Clinic

Chronic Fatigue

Dr. Murray “Buz” Susser was among the first medical experts who proposed that people could have more than one infection at a time. Conventional medicine used to say that only when you are to the point of dying could you have multiple, opportunistic infections. Dr. Susser’s early recognition of the more common presence of multiple infections is now widely accepted.

Dr. Susser co-authored one of the first books on the subject, entitled “Solving the Puzzle of Chronic Fatigue Syndrome.”

As the book explained, chronic fatigue syndrome is the product of a dysfunctional immune system. How so? Probably because it got overloaded with multiple infections from viruses, bacteria, fungi and/or protozoa may parasites. Let’s toss in some contributing factors too - hormone imbalance, food and chemical sensitivities, and especially heavy metal toxicities.

The following interview with Dr. Susser covers new ground since the book was written in 1991.

Q - What do you call Chronic Fatigue Syndrome today?

A - By definition, it is intense fatigue that is not improved by bed rest that has lasted for six months or longer, and has greater than 50 percent debility (weakness) with no known cause. That is chronic fatigue syndrome, CFS.

Chronic fatigue, CF, is different. It is chronic fatigue from a known cause like low thyroid or low adrenal function which can make you feel like you can barely get up in the morning.

The problem with the CFS diagnosis is that it is unclear. We know what six months means, but what exactly does 50 percent fatigued mean? I consider CFS a disease of exclusion. If I can exclude everything else, then it is CFS.

Q - What causes CFS?

A - I believe it can be caused by many things. One of the most common and treatable is a poly-microbial infection. In other words, more than one infection. All infections are opportunistic. When the day comes that we can identify and get rid of all infections, we won’t have CFS anymore. But there are other insults to the immune system that can cause fatigue too.

A lot of people used to get CFS after they left the hospital following surgery. The anesthesia drugs can give lasting liver, kidney, or brain damage. It used to happen a lot that people would wake up almost as if they had had a little stroke, but you couldn’t prove it. The newer anesthetics are better.

Other causes of chronic fatigue are:

When I first started treating CFS, we didn’t know much about Lyme. That was the 1980s, the early days of Lyme and the early days of CFS. I can tell you this, it was a lot easier to get rid of Lyme with antibiotics then. I think the organism has morphed since those early years. It has become more stubborn, more resistant to treatment. It is a clever, insidious bug.

I think a lot of the brain dysfunction so common now is Lyme or heavy metal poisoning. There is evidence that Lyme is fueling the epidemic of Alzheimer’s disease specifically. Pathologist Alan MacDonald acquired sections of 10 different brains from Harvard Medical School - all the people had died of Alzheimer’s. MacDonald looked in the microscope and found that Lyme, syphilis, and Alzheimer’s brains look identical. He also did PCR (DNA testing) which showed Lyme in seven of the ten brains. It would be wrong to extrapolate that 7 out of 10 Alzheimer’s cases are actually Lyme disease, but it certainly suggests there is a connection.

Q - When CFS is not Lyme, how treatable is it?

A - Sometimes it’s incredibly simple. I remember one woman who had been to 64 doctors for fatigue, pain, and brain fog. No one would believe her. She stopped telling doctors how many she had been to because they didn’t want to see her. So at first she didn’t want to tell me either. I did my routine physical and I asked about soreness in her mouth. I put a glove on and felt around her molars. She was tender so I got an X-ray and saw an abscess. She had already been to a dentist who had ignored her. So we got the abscess drained and that was it. She was cured.

Treatment depends upon using the best possible diagnostic technologies and seeing if you can find a clue as to what the cause is. Infection is the most common thing we find. So you treat it and you boost the immune system with things like intravenous vitamin C and glutathione, large amounts of oral vitamins, the best possible diet, and often heavy metal detoxification.

Hidden yeast infection is a common part of the equation. Something that seems as innocent as acne treatment with antibiotics can lead to an occult overgrowth of yeast in the gut. This can cause varying degrees of digestive problems, and can - in an of itself - cause chronic fatigue and require intense treatment.

Candida plays a major role in CFS. Being “so tired” and “sick all over” is a common link between sufferers of CFS, fibromyalgia and yeast overgrowth. Candida is a fungus, and it has several forms. The yeast form is the young form of fungus before it “sprouts arms” and it can do a lot of damage. Candida is common in gut and vaginal infections. Yeast by itself has been a common cause of CFS. Candida can be tested for and if positive, it needs aggressive treatment. I use Nystatin or Diflucan, but we are seeing some resistance now to Diflucan. You see a quick, sometimes dramatic response to these drugs within a couple of days - that way you know it is not Lyme.

Chelation is really wonderful in many ways. It cleans out the toxic elements and heavy metals that suppress the immune system in your body. I’ve seen numerous cases of CFS cleared up with a course of chelation One of the most helpful treatments for CFS and Lyme is gamma globulin injections, although the intravenous form and the injectable form have gotten very pricey. Gamma globulin is the human protein from which antibodies are made. Gamma globulin is a product of blood - without the problems that can come with blood transfusions. When you get gamma globulin, you are receiving antibodies from ten thousand other human beings who may have been better at making antibodies against various things than you are. Antibodies are specific for a specific invader. Antibodies against measles, for example, do nothing against Lyme and vice versus. Antibodies can destroy pathogens. I’ve seen a number of cases of chronic fatigue from sinus infections that go away when people take a monthly gamma globulin shot.

Some people like to use transfer factor, but it takes a good ten months to work and in ten months so many things change, you don’t know how helpful the transfer factor was. But mostly it just takes too long to work.

I love hydrogen peroxide. Twenty percent of the oxygen we breathe becomes hydrogen peroxide in the body. It is a natural and potent bug killer. The amount we give intravenously can kill organisms and do no damage to us. Hydrogen peroxide is like a little internal flame thrower. You don’t want to drink it, however, because it will kill off good as well as bad guys in the colon. But anything in the bloodstream XXX doesn’t belong there AND can be killed by hydrogen peroxide.

Many cases of fatigue and emotional instability are cleared up quickly when the hormones got balanced using bio-identical hormones. Synthetic hormones had some hormonal action, but they caused huge imbalances in a person’s physiology. Synthetic hormones were dangerous and could cause depression and weight gain. When you have the right balance of natural progesterone, estrogen, and testosterone, then you have good energy. Pills are my least favorite form. Cream is good. I like sublingual drops the best. I start with one hormone at a time, and then watch for symptoms that tell us how to adjust the three hormones. If you get weight gain with bio-identical hormones, you need to cut down the dose. The “side-effects” from bio-identical hormones come from overdosing. So you just lower the dose. When you get the combination right, fatigue and depression go away. Balance is the key.

Q - What about the connection to fibromyalgia?

CFS by definition must include fatigue. But it often causes pain. So fibromyalgia, a chronic muscle pain of unknown origin, often comes with CFS. The two are often intertwined.

Fibromyalgia is myalgia - muscle pain. If you don’t know the cause, then you call it fibromyalgia. The accepted criteria say that if 11 out of 18 specified trigger points are tender, that’s fibromyalgia. But what if there are 9 or 10 spots? What if there are 18? It is a nonsensical criterion. But conventional medicine decided to label it and assign diagnostic codes. Think about this - how hard do I press on the 18 points? How much pain tolerance do you have? There is a lot of nonsense in medicine and you have to see through it or you get stuck in it.

Trying to treat fibromyalgia with pain pills is frustrating because they usually don’t work well. Fibromyalgia doesn’t respond well if at all to anti-inflammatories and analgesics or muscle relaxants because they are addressing the wrong problem. The problem is hidden toxins. The toxins that are causing the fatigue are also causing the pain. All anti-oxidant nutrients play a role in pain reduction including vitamins C and E.

Q - Did we ever solve the puzzle of why Incline Village, Nevada, was ground zero for the modern era of CFS starting about 1985? That’s when two physicians in a small medical practice there claimed that the symptoms of fatigue and poor mental functioning had affected the town in unusual numbers. There had been a flu-like epidemic and some of the people remained sick.

A - No. There was a new test out at the time, the one for Epstein Barr virus (EBV), and when they tested, everyone who tested positive for EBV also had the fatigue. Turned out that almost everyone has been exposed to the EBV so it was an almost worthless test.

EBV has an incubation period of about 40 days, so it is not a good candidate for a rapidly spreading viral epidemic. But the level of EBV antibodies probably goes up because of what is causing the chronic fatigue. So it is still kind of a mystery.

Doctors didn’t know what to do WITH EBV so they would prescribe the anti-herpes drugs for it, Valtrex and Acyclovir. EBV is Human Herpes Virus 4 (HHV-4). But the drugs almost never did anything.

What did help was good anti-viral alternatives like large doses of vitamin C or a good solid course of hydrogen peroxide therapy - non-pharmaceutical agents that knocked down the body’s viral load overall.

In October 2009, the National Institutes of Health announced that a retrovirus named XMRV is frequently present in the blood of patients with CFS. Researchers found XMRV in 67 percent of samples from patients with chronic fatigue syndrome out of 101 samples analyzed, compared to approximately 4 percent of 218 control samples. That suggests there is an association between XMRV and CFS, but that does not prove that XMRV causes CFS. XMRV belongs to a family of viruses that cause neurological disease.

I wonder if this is going to turn out to be just another fancy EBV situation. Maybe, like with EBV, the XMRV emerges when your immune system is overwhelmed with something else like Lyme.

Q - When you peel off all the layers of the onion, what is the fundamental cause of fatigue?

A - Mitochondrial dysfunction. Mitochondria are inside each cell of our body and they act like a digestive system that takes in nutrients, breaks them down. This is where the body turns glucose into energy, creating energy for each cell. We have 60 trillion or so cells and there are a thousand or more mitochondria generating energy inside every cell. Just as a coal-fired power plant requires a lot of raw material, the mitochondria require a lot of nutrients to create energy. I don’t think we know enough yet to really understand how substandard mitochondrial action creates CFS - but we know the mitochondrial action isn’t creating enough energy. That makes us tired.