Chronic Fatigue Syndrome: The Disease No Doctor Wants to See with Dr. Jacob Teitelbaum
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On The Smartest Doctor in the Room podcast, Dr. Dean Mitchell speaks with chronic fatigue syndrome expert and author of From Fatigued to Fantastic, Dr. Jacob Teitelbaum who shares his insights on how to overcome this complicated disease.
Dr. Teitelbaum has spent at least 40 years, maybe more of his career, helping patients with chronic fatigue syndrome and advancing the latest information on that. He is the author of the bestselling book From Fatigued to Fantastic! This is the third edition and we’re really quite excited in another week or so the fourth edition is coming out.
LISTEN TO THE PODCAST ON SPOTIFY
Podcast main points & discussion.
Dr. Mitchell: In February 2015, I found an article in The New York Times by science writer Julie Rehmeyer titled A Disease that Doctors Refuse to See. Mrs. Rehmeyer wrote about her own battle with chronic fatigue syndrome and how she felt so many doctors she saw dismissed her diagnosis or seemed uninterested in finding out more to help her. My guest today, Dr. Jacob Teitelbaum is quite the opposite of that type of doctor.
I can’t tell you how many patients I see in NYC who come in with the book From Fatigued to Fantastic marked up, dog-eared, and asking me the most excellent questions on how they can overcome chronic fatigue. I’ve been fortunate to know Dr. Teitelbaum for about 10 years and my wife, Dr. Ricki Mitchell, and I were involved in the fibro and fatigue centers that were established back in 2010 where Dr. Teitelbaum was the medical director and helped to oversee so many of the protocols such as the S.H.I.N.E.® Protocol which are being used in various centers around the country.
Dr. Mitchell: Patients with chronic fatigue syndrome have heart-wrenching stories. They are too ill to work. Sometimes they’re too ill to care for themselves. Sometimes their whole life and their family life falls apart.
Dr. Teitelbaum I want to ask you because in your book, you do you open up with your own story of chronic fatigue syndrome. Could you please share with us a little bit, I mean, you mentioned how, I think you had a pediatric lecture and all of a sudden you were this healthy, vibrant guy going to medical school, and then it cascaded into you leaving medical school. I think you mentioned you were homeless for a while. Can you tell us your story, that what you remember, if it’s still pretty vivid in your mind?
Dr. Teitelbaum: It seemed to me the biggest curse that ever happened, and it turned into the biggest blessing. It’s funny. I was paying my own way through medical school and college. My dad was to finish college basically about two and a half years because you’re paid by the year. I was doing 60 credits a semester and it was just kind of rolling through things and medical school and my work was the easiest part of my life. I’m like I came from a family, that was basically a concentration camp community and a survivor community and the rest, and they all went to meltdown and I ended up putting myself in the middle. Fool that I was trying to be the peacemaker. It was funny. I mean, my uncles literally came to my apartment. I’m in medical school and had a heart attack in my living room. It was like one of those TV sitcoms. Like they’re all trying to manipulate me in different ways.
Basically that put me my energy on the edge with everything I was doing. Came down with the nasty viral, what I call the drop dead flu. The blood tests showed this high atypical lymphocytes. They couldn’t identify the virus, but six weeks later I was still nonfunctioning. All the professors were trying to figure it out. Then they figured, well, it must be what they call med student depression, all the rest. But eventually I just nonfunctional. I had to drop out of medical school. Since I couldn’t work, I found myself homeless, sleeping in parks. It was as if the universe hung a holistic, homeless medical school sign on my park bench. This was in 1975.
That’s now 45 years. They all taught bits and pieces herbalists, naturopaths, energy workers, physicians would come and find me sitting on my park bench and if they had some pizza with them I would actually eat that day. I was able to go back to medical school. It’s funny when you’ve been on the other side of the white coat, cause somewhat if you have the experience. If you go to the doctor and the doctor says, I don’t know what’s wrong with you. You’re crazy. Which by the way is abusive and totally unacceptable.
We’ve treated successfully thousands and thousands of people of this illness. We have five studies that are published or submitted so far for publication out of factor treatment, a number of other studies as well. This is a very, very, very treatable illness. Unless you rely on most doctors to treat you.
Immune Signature
Dr. Mitchell: In 2017, Mark Davis and Jose Montoya out of Stanford, they put out a nice paper. It was pretty interesting showing and they’re both immunologists and they wrote a paper what they called about immune signature. I think my list is going to find this very fascinating cause it relates to COVID now that they found in chronic fatigue patients versus healthy patients, and I believe even rheumatoid arthritis patients, that there was a difference in what’s called cytokine profile that certain inflammatory markers were clearly elevated in these patients compared to healthy control patients and even I think to rheumatoid autoimmune arthritis patients. I wanted to just ask you if you have anything to offer and we’re going to get into a lot of other things that you do in evaluated patients, but just on this basic level anything that you find striking from those papers or anything? I mean, do you look at cytokine levels in patients with chronic fatigue?
Dr. Teitelbaum: I don’t personally do it because it does not affect my treatment approach. What you will find for those of you who are wondering, is this a real disease? Absolutely. There are dozens of abnormalities on the lab tests that are commonly seen. The thing is that there’s no single one test that is only abnormal in this disease and not in anything else. For example, somebody has a very high blood sugar they’re diabetic period. Somebody has for high blood pressure, they’re hypertensive.
Where chronic fatigue syndrome is a much more complex multisystem disease. There are less severe, but devastating permutations from literally dozens of different tests. But it’s not only seen in this disease. You can see this permutation and eight other diseases as permutation others.
The bottom line for diagnosis, there’s very, very simple test that works very, very well. I asked the person, are you exhausted? Yes. Do you have trouble sleeping? Yes. You can’t sleep even though you’re exhausted and you don’t have anything else overt. It doesn’t go away. The vacation. You have the process. That paradox of can’t sleep despite exhaustion. Tells you that there’s hypothalamic dysfunction in play. You basically tripped a circuit breaker. Really that’s all you need because even if it’s being triggered by other diseases like lupus or rheumatoid arthritis that can’t sleep, even though exhausted paradox, it tells you this fibromyalgia process for CFS processes is going on.
S.H.I.N.E.® Protocol
So my question is, “What insight can you give to patients and the doctors if they feel it’s an infectious etiology?” A lot of patients come with Epstein-Barr, which we have to sort through, because I always feel like Epstein-Barr’s a maker, not necessarily the actual cause in these chronic patients. So I was just curious. I’m interested to know because, as you know, there’s just so many factors involved in chronic fatigue. But when you have one that you think it’s a clear cut infectious, like if a patient traveled to Africa, came back, and they’ve ruled out everything, but they’re really sick, or a patient had severe Epstein-Barr infectious mononucleosis. Do you treat that differently? We’ll talk about some things that you trained Ricki and I to do. But I was just curious, again, if you look at the patient a little differently than you would, if somebody had obviously, some type of traumatic life thing where they went through a divorce and it was all stress, which causes illness in its own way.
Dr. Teitelbaum: Well, it’s not rocket science. If somebody comes in saying, “I had a nasty flu-like symptom or flu-like illness and it never went away, and I’m constantly feeling like I have the flu,” ain’t rocket science.
The reason that they’re getting a persistent disease is because of the virus. These are not horrible mutant viruses. These are just run-of-the-mill viruses, like Epstein-Barr, CMB, FHHV-6 that over 90% of the population has had.
So you really need to tune up their entire body, especially getting the sleep and nutritional support, getting adrenal support. These are the critical things for immunity to act properly. And then I will go with Famvir and Celebrex, a combination, and I usually tend to start with that. If that doesn’t work on the FHHV-6 or CMB, very, very high titers, I go with the Valcyte Equilibrant from suspecting enterovirus, and this is all in the book. How do you tell? Okay, what makes you think one? What makes you think the other? How do you dose it? It’s all there. On the other hand, if I have somebody who’s having more chronic lung congestion, scalp scabs… There are a number of things that make me think more antibiotic sensitive, and I’m going to go and head down and consider a trial of Doxycycline, or Erythromycin, or Cipro, although Cipro, you need to be a little more careful with than the others, and we’ll go with these different things. The testing is not very helpful for the infection. More matter of history and see what works.
Dr. Mitchell: Yeah, I found Flexeril to be very good for fibromyalgia patients cause in some cases it’s been remarkable. But what battles are just for these chronic fatigue patients have no energy. I mean, do you, will you use the Adderall? I’ve seen like the Adderall on some patients.
Dr. Teitelbaum: I think the Adderall is overused in hyperactive kids and underused in CFS and fibromyalgia. It optimizes dopamine. It helps the orthostatic intolerance or pop. It basically can be very, very helpful. And as long as people are keeping up to 20 milligrams a day or less, I’ve never seen anybody get addictive issues at 20 milligrams a day or less. I think that is underused and can be very, very helpful.
Dr. Mitchell: What else I find underused, which again, I learn from you and I have used with patients with success is the floor nap. And I just want the listeners to understand what that’s for. That’s an adrenal, essentially adrenal type of hormone. And what’s very interesting in chronic fatigue is that you have patients that tend to run very low blood pressures. I think it puts them at risk that women can in general tend to have a little bit lower blood pressure than men. But when I see even a woman that comes in with a blood pressure of 90, over 60, that’s just her normal blood pressure. I sometimes say to them, and they’re having all this severe chronic fatigue and other things are going on. I said, you know what? Your blood pressure dips 5 or 10 points in a day, for whatever reason, how something in the atmosphere or just whatever’s going on in your body.
You’re now in a state of where your body doesn’t want to be fully erect. And I will check their baseline cortisol levels before I started now dostrom levels. And in some of the cases, I’ll check. As you mentioned, like in adrenal fatigue, they’re like the saliva test just to see the levels throughout the day. So I was curious if that’s, again, something that you tend to see a lot with the chronic T patients basically borderline hypotension, low blood pressure.
Dr. Teitelbaum: Well, if you look at Sean, we talked about S-H-H we talked about hormones, but it also is hypotension, which is basically orthostatic intolerance. We are set up. If you think about we’re a big bag of water, we stand up, what’s gravity going to do to our blood. It all goes down to the legs to become an upright species.
We had to develop the ability to go ahead and send up blood back up to our brain and muscles. That’s called the autonomic nervous system. We talked about people tripping, a circuit breaker called the hypothalamus small almond-sized area in the brain that controls sleep hormones and automatic function. So all those are circuit breakers gone off. So when people stand up, the blood goes to the legs and stays there. And after a while, the brain starts to get fuzzy and theypain and the whole thing. So there’s a simple quiz that people can do in one minute. It screens for the orthostatic intolerance. Also, there’s a 10-minute pulse test where if you check your pulse and you’ve been sitting quietly for a while, then you go ahead and you stand up. And every minute for 10 minutes, you check your pulse. And if it goes up more than technically more than 30 beats a minute, any time relative to sitting that document’s orthostatic intolerance, and that’s called pots or MMH.
So for those who would like they can email me. My personal email is fatiguedoc@gmail.com. And you can ask for the orthostatic intolerance information sheet, it will have the quiz on it. It’ll tell you how to do the pulse test then will talk about Midodrine, which is very, very helpful for enough DDA VP and a host of other treatments, increasing salt, water intake, compression stockings. These can dramatically improve people’s stamina and can help brain fog. So yes, the far enough, I find it works better in younger populations, the rest tend to work better for those over 20.
Dr. Mitchell:
Which kind of patients do you think need that tilt table test, which obviously nobody really would enjoy going through.
Dr. Teitelbaum: Well, there’s a very select group of people that I do tilt table testing on, it’s really nobody.
Dr. Mitchell: You get the practical information. It’s interesting that Julie Rymeyer and the article that I read right at the end after she was obviously so discouraged by spillover positions, eventually one doctor gave her rituximab, which is actually used, I believe for lymphoma. And there are other autoimmune drugs. Do you find those ever really have any no, you shake your head. So I know the listeners will not see it, but in the video they’ll see it. I just wanted to throw that out because I think we’ve kind of covered the medications cause people to ask, okay. I want to ask you, it’s funny. I did a whole is very interested in a podcast.
Also early with Paul Merrick who was a very interesting guy. He’s actually, he took a lot of heat, but he had shown several years ago in a study that he published showing IB, vitamin C, along with cortisone, help people prevent from going on ventilators with, with sepsis and stuff like that too. And then he started doing this with COVID and again, I’ve got a lot of flack. I interviewed him. I think he’s a really bright guy and sounds very practical. So what I want to ask you is this, you get a call maybe a month from now, especially after your book comes out and a person who calls you up says, Dr. Teitelbaum, I had COVID-19. I was diagnosed legitimately with nasal swab and you know, it was a pretty bad couple of weeks, but now I am just still, I’m just exhausted. I’m just dragging myself, Chris Cuomo.
Who’s like a big CNN anchor is saying he’s battling. And he just doesn’t feel right. He’s got brain fog. You know, the things that doctors used to never liked to hear and say just doesn’t feel right. He doesn’t have the energy that it used to. What would you, again, I know this is kind of in this preliminary stage now, but again, with your kind of expertise, what would you tell somebody like Chris Cuomo, if he calls you up and said, I have no energy, I have to do my CNN things. I usually travel do stuff. What would you recommend? You take all this?
Dr. Teitelbaum: I tell them this is really treatable. I mean, we have seen for dozens of viruses when the SARS virus research shows that about 30 to 40% of people who had those cousins COVID had postmers persistent fatigue and other symptoms, basically even Dr. Fauci noted that long collage syndrome is suggestive of post-viral chronic fatigue syndrome.
And we know, I know from having encountered myself and treated thousands of people, a post-viral chronic fatigue syndrome, that this was very, very, very, very treatable. So using the Shang protocol, there’s no reason why COVID-19 would not be just one more virus during this and all plenty of evidence that it is. It’s just one more virus, a trips out hypothalamic circuit breaker on the brain. If you turn it back on with the S.H.I.N.E protocol, people get their life back. They feel healthy.
Dr. Mitchell: What about also against something I learned from you was the IV vitamins, which we’ve been doing now in our office, essentially, Ricky and I have been doing for women practice 30 years. We did it pretty early on. She had learned from somebody else, but then we really refined it. When we learned your protocols, what do you think that their place has got?
I mean, I hear doctors running around, giving themselves weekly IV vitamin drips. Do you think it has a place in these posts COVID patients or in preventing?
Dr. Teitelbaum: Not so much for prevention, but an early treatment. I think giving the IV vitamin C and if you have Glycyrrhizin, I would absolutely throw the Glycyrrhizin. It’s an antiviral activity against COVID, its licorice.
Dr. Mitchell: Vitamin C, that’s something actually, that was so fascinating. It was something that Dr. Merrick brought up when we were talking about why he felt vitamin C was so helpful because he felt it was huge adrenal support because I think, cause he was explaining that every other mammal except us makes vitamin C inherently in their body, right? We don’t, we have to take it in. And that essence, the high doses is what stimulates the adrenal glands.
These are helpful to jumpstart recovery, but they’re not critical to recovery. So if people can’t get the IVs, it’s not a big deal. There’s so much that people can do on their own to recover while there’s from the post COVID or not. Now a couple things specific to the post-COVID CFS. Cause there are differences. Each virus has its own unique flair. So you have the overview is the same, but some people will have some pulmonary scarring or pulmonary changes from the shock lung, a very reasonable diagnostic devices to get a pulse oximeter.
$50 clip you put on your finger, it’ll read your oxygen levels. And if you’re finding that when you’re walking around your oxygen is going up and you’re having shortness of breath, that is not from damage to the lungs.
That’s from anxiety. If on the other hand you held the pulse oximeter, then you’re running 94, 95% walk around, you’re dropping to 92. Then you are having a lung injury. That’s contributing to the shortness of breath. A very simple thing for that would be to do things like the antioxidants glutosiome things along those lines to help improve the lung function, to help it recover for those with persistent palpitations, the things we talked about, rivals, B vitamins, magnesium, coenzyme, Q 10, these simple things can really help the heart muscle energy to improve and can help that piece of it in case there is that injury during the COVID. You give it the overall shock protocol, you tailor it to the individual for the COVID. And I think we’re going to find that this is easy to treat as long as people know how to treat it.
Dr. Mitchell: Yeah, that’s great. That’s really good to know. What were the other one or two areas you said you wanted to get to on the S.H.I.N.E protocols?
Dr. Teitelbaum: The other thing is we’ve talked about shine and the biochemistry, but how about resetting those circuit breakers in the brain, the limbic system, the hypothalamus sediment off. And releasing the emotional, almost spiritual muscle trauma, all these different things. The mind-body-spirit component is essential. There’s a program called the Dynamic Neural Retraining System by Annie Hopper, do a search online and it’ll pop up.
Well, the mind, the unconscious mind really directs you. The immune system is one of the things I learned. I was paying my way through medical school. I was working as a nurse at a children’s hospital. That’s how I paid my way through. And I was being rotated to the burn unit. So I asked my psych professor to train me in hypnosis. I could do the dressing, changes more comfortably on the burnt children. And what I learned was that if you get an acute burn and you could go into a quick hypnotic state and go heal quickly, no injury, that’s it. Let your psyche know that there was no real harm. You won’t blister. And that blew my mind. I thought that’s a good reason. I’m not a surgeon. I’m a Butterfingers. I would burn myself along to get these big claiming blisters. Once I did that, I’d never blizzard it.
Just the skin might turn white and hard and fall off. So the blister is the psyches perceiving an injury and sending the immune system there to fight what a perceived system. But if you let your immune system, no, no, it’s fine. It’ll stand down. And we are living in a time when we feel like this, amorphous sphere that it’s a tap from everything we don’t know, walk on. The immune system goes wild, trying to defend against the environment, also in the rest and it exhausts itself. And part of helping the immune system to heal is to get to a place of feeling safe. So your immune system can finally stand down and dressed. There’s wonderful work by Stephen Porges on the Polyvagal theory, that looks into it.
Dr. Mitchell: I think this is huge. I did a podcast, one of my initial ones with Dr. Kevin Tracy here in New York, I think he’s going to win the Nobel prize. I hope he does. And his work was all on the neuroimmune reflex. He was a neurosurgeon who ended up going into research and fascinating, found that by blocking the Vegas nerve, that autoimmune disease went away. I think it was called the Sherrington reflux or something. I believe that’s, what’s called that. It was a, it was this whole neuroinflammation pathway that he discovered by accident. They were doing research on something else on the animals. And then he said, Hey, I got a… And they found like two-minute, Croesus factor. All these things went back to normal. And again, what you’re really saying too is to get to what we call that parasympathetic state for patients, understand me. People, our listeners, they will understand the fight or flight, the sympathetic nervous, as we all know that we something, something, we hear some bad news.
I know myself two weeks ago, I thought I was exposed to COVID all of a sudden. I felt great that morning, that afternoon, I was like, something’s wrong with me? And you just feel your body surging with these chemicals. But if you do that on a chronic basis, we know that you deplete your cortisol and your other immune-fighting chemicals. And to really get to that what they call parasympathetic more even balanced state, which is obviously quite difficult to do, unless you really have. I really feel like unless you have a formula or a subset plan to do that. I mean, you go for walks, go swimming, keep some people like to meditate. Some people pray. I mean, I think all of those things could work. You don’t have one or none to get the benefits. So I think we’re going to wrap up, I’m going to have a little summary.
Final Thoughts
Dr. Mitchell: Is there anything else that you want to add?
Dr. Mitchell: Yeah, I think there’s a such great point. I think it’s a lot of hope for patients who sometimes feel hopeless. So the last few key points that I just want to make that chronic fatigue syndrome and they can give it different names.
Now they call it systemic exertion and tolerance disease, and they have a lot of names to these things, but it is a real disease and as Dr. Teitelbaum mentions a really good well-trained doctor can help you navigate this illness with a strong supportive team. I think it’s really, it is good to try to plan out to some degree the underlying fact, and then they have true cause. Then when you can zero in more with your doctor, and I love Dr. Teitelbaum’s positive way of looking at this, because that is also important. Because being positive and having hope, as we all know, as good physicians too have to play a role in somebody getting better.
And I think also we touched upon really interesting that the COVID-19 cases of chronic fatigue, I think I can really bring to light a lot of, some of the immune pathology, especially what we call the innate immune system. I teach in medical school, and I think it’s such a fascinating thing because always focusing on antibodies, but this primitive part of our immune system is possibly so important to our health. So I just want to thank Dr. Teitelbaum again from Hawaii, taking the time to do this podcast. I’m excited for his new book, the fourth edition of From Fatigued to Fantastic, the green cover one. So try to get it and good luck with everything. Thanks for taking the time.
About the Author – Dr. Dean Mitchell, M.D.
Dr. Dean Mitchell M.D. is a Board-Certified and Immunologist based out of NYC. He graduated from the Sackler School of Medicine and completed training at the Robert Cooke Allergy Institute in New York City. He is also a Professor of Clinical Immunology at Touro College of Osteopathic Medicine, a fellow of the American Academy of Allergy, Asthma and Immunology, and the author of Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time. Dr. Dean Mitchell, M.D. has also been featured in The New York Times, The Huffington Post, Fitness Magazine, Dr. Oz and News NY 1. Dr. Mitchell also hosts the podcast The Smartest Doctor in the Room – a combination of a lively, personal and in-depth interview with top healthcare specialists.
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