A:

1. Nutritional deficiencies can also occur because of the numerous bowel infections. This can result in poor absorption of nutrients as the bowel wall may not be functioning optimally and the infections may get to "eat" the nutrients before you do. In our study, for example, one out of six patients had a parasitic in their bowel. In addition, 22 percent of our CFS/fibromyalgia patients had an infection with a toxin producing bacteria called Clostridium Difficile. This contrasts to only one percent of a healthy population! The toxin produced by these bacteria can severely affect the bowel as well. Our experience also suggests that these infections can result in incompletely digested food being absorbed into the bloodstream (the so-called "leaky gut syndrome"). This results in your immune system having to complete the digestion process(exhausting it) and can also result in food sensitivities. This makes it critical to improve the digestion process.
2. Inadequate enzymes and stomach acid for digestion – In medical school, I was taught that the pancreas and salivary glands produce all the enzymes needed to digest food. What I was not told was that the enzymes necessary for the digestion of food are generally present in the food itself. This is because the same enzymes that result in the food ripening also results in its digestion. The enzymes produced by our pancreas and salivary glands are only meant to supplement the enzymes present in the food during the digestion process.

   Decades ago food processors realized that they could extend the shelf life of food from days to years by destroying the enzymes in the food (using salicylates –i.e.- aspirin). This is why cornflakes may have a four-year shelf life versus 1 week for an ear of corn. Although this was wonderful for food processing, it has severely and adversely affected our digestion. This is reflected in antacids such as prilosec and nexium being the number one selling medications in the United States. The problem is not too much stomach acid! If this was the case, we would be using fewer antacids as we got older and our stomach made less acid. Instead, as we get older and our pancreatic function and stomach acid production decreases, our digestion worsens and we get indigestion. Then, even minimal amounts of stomach acid can cause irritation and heartburn. Shutting down stomach acid then further worsens our digestion. Because of this problem, I strongly encourage you to take plant based digestive enzymes with your food so that your body can absorb the nutrients present in your diet. Many of you will find that you get a marked decrease in your indigestion symptoms when you do this and feel better overall. Stomach enzymes also need a warm temperature to work efficiently. Drinking sips of warm water with a meal instead of cold beverages can also improve your digestion. There are a number of good enzyme products available. I recommend "Complete-Gest" by Enzymatic Therapies (available at most health food stores and on my web site) .This company has an excellent reputation for Quality, Purity, and Potency. That is why I asked them to make my products.

3. Increased nutrient needs because of your illness. Recommended daily allowances for nutrients are based on what is needed in a healthy person. When you’re fighting infections, taking medications that can interfere with the absorption of nutrients, and have other medical problems, your nutrient needs to likely increase – often dramatically. In addition, there is a wide genetic variability in our population. While the RDA may be (often barely) adequate for a large percentage of a healthy population, there are many people who have markedly increased needs for certain nutrients. For example, many Americans die prematurely from elevations of a substance called homocysteine in their blood. This can be counteracted by taking large amounts of vitamin B12, folate, and vitamin B6. Supplementing with these nutrients would likely decrease heart attack and stroke deaths in United States significantly.

   Because of these and other problems, I find that most patients with CFS and fibromyalgia have widespread nutritional deficiencies. It became very frustrating early in my practice when we needed to give 25 tablets of nutritional supplements a day to effectively treat these deficiencies. It is because of this problem that I asked the Enzymatic Therapy company to make a vitamin powder that allows optimal replacement and treatment with most nutrients by simply taking one scoop of powder (in a cup of water) and one capsule a day instead. Although my initial attempt at making this powder was helpful, as time went on the powder became fairly foul tasting. Our new product actually tastes great (like orange drink). Because it is very hard for people to sort through all the marketing hype, I have a simple policy. I refuse to take any money from any company whose products I recommend . Even for the products that I have made such as the new all-natural "Fatigued to Fantastic Daily Energy Enfusion" powder and "Revitalizing Sleep Formula" by Enzymatic Therapies, I have instructed the company to donate 100 percent of my royalties to charity. I do this not because money is bad –I think it’s very good. I do it so that you can know that I recommend these products because I think they’re the best thing that is available for you. The Fatigued to Fantastic Daily Energy Enfusion Powder often increases energy and decreases pain in people who take it. The effect on how people feel has been likened to the increasing brightness that occurs when you turn up a dimmer switch. Because the product is a powder, it allows you to adjust the dose to your needs. Although one scoop /day supplies optimum therapeutic nutrition, you may want to start with half a scoop/day or a quarter scoop twice/day if you are sensitive or have diarrhea. You can then increase to the dose that feels best. Some people like the convenience of taking it once a day and others prefer to divide their nutritional supplements through the day. Either way is okay. I would recommend that you take the one capsule of B-complex that comes with the powder in the morning as the level in the capsule is optimum for most people. Additional B-complex capsules can also be obtained separately. The vitamin powder will be available at most health food stores although, since it just came out Sept. 3rd, it may take a while to arrive at some of them. It can also be ordered by mail through our web site or by calling 800-333-5287(800-feel-btr). I think you’ll find that this new product tastes great, helps you feel a lot better, and beats the heck out of having to take 25 nutritional supplement tablets a day!

Dr. Teitelbaum is a board certified internist and director of the Annapolis Research Center for Effective CFS/Fibromyalgia Therapies, where he sees CFS/Fibromyalgia/Chronic pain patients from all over the world (410-266-6958). Having suffered with and overcome these illnesses in 1975, he spent the next 28 years creating, researching, and teaching about effective therapies. He is the author of the best-selling From Fatigued to Fantastic!" and the newly released "Three Steps to Happiness! Healing through Joy". His web site can be found at: www.vitality101.com