In 2015, the Institute of Medicine provided this definition of the condition:

1. a substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest;
2. postexertional malaise (often described by patients as a “crash” or “collapse” after even minor physical or mental exertion);
3. unrefreshing sleep; and
4. cognitive impairment and/or orthostatic intolerance.

There have been recent developments in this field that take some steps forward. In late 2016, the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFSME) research conference emphasized the role of postexertional malaise (an energy “crash”) following physical exertion or emotional distress, rather than just general fatigue, as the most important aspect of ME/CFS. This has been verified through experiments that test physiologic function in ME/CFS patients following exercise.

Conference speakers also reported on some possible laboratory tests that could identify the abnormalities associated with ME/CFS. Kenny L. DeMeirleir, MD, PhD found that the four blood tests that were most helpful were prostaglandin E2, interleukin 8, soluble CD14, and CD57+ lymphocytes — all of which are associated with an inflammatory immune response. This combination of tests is already being used as a panel to diagnose ME/CFS in Belgium, where Dr. DeMeirleir is originally from. Jose Montoya, MD, professor of medicine at Stanford University, found abnormalities in levels of 17 specific cytokines (chemical messengers used by immune cells) that correlate with the condition. U.S. researchers caution that larger studies are needed before either panel is adopted in this country for diagnosis of ME/CFS.

Researchers at the University of California San Diego School of Medicine published an extensive study in 2016 about what is actually going on inside the body’s cells in ME/CFS. Without getting too deep into the technical information, they found several problems with the cell’s ability to produce energy from the nutrients that we get from food. Other scientists presented information at the IACFSME conference that suggested that a slightly altered gene (called a single nucleotide polymorphism, or SNP [pronounced “snip”]) may be responsible for the body’s inability to process energy correctly.

What is emerging, then, is a picture of a genetic predisposition toward less efficient energy production, that may be aggravated by some outside factor, such as infection or environmental toxins. Those outside influences then set up a chronic inflammatory state that affects the brain in particular. Physical exertion or emotional distress can aggravate the inflammatory messengers in the body, leading to “crashes” (postexertional malaise). I speculate that this could be the explanation of why some people are “wiped out” for years by something that should be temporary, such as a Lyme disease infection, or an adverse reaction to medication like Cipro. This is also why trying to fight the inciting factor is so often ineffective (like years of antibiotics for Lyme, or elaborate detox protocols for medication reactions). Careful evaluation of a patient’s metabolic state, and appropriate lifestyle and nutritional support (in particular, for mitochondrial energy production) is probably the more effective strategy.

References:

1. IOM Gives Chronic Fatigue Syndrome a New Name and Definition. Medscape. Feb 10, 2015.
2. Postexertion ‘Crash,’ not Fatigue per se, Marks Syndrome. Medscape. Nov 04, 2016.
3. Biomarker Research Advances in ‘Chronic Fatigue Syndrome’. Medscape. Nov 08, 2016.

Why “cold”? Before the dawn of our understanding of infectious organisms, people thought that cold weather caused these symptoms. It wasn’t until the 1950s that scientists first identified the viruses that actually cause cold. Since then, over 200 different types of virus that can cause it have been identified – that’s why the cold is so common!

Even with our understanding of its infectious origins, it’s still clear that the cold is much more common during cold winter weather. The most frequent explanation for this has been that people spend more time indoors in close quarters in the winter. However, in our modern world, people spend much more time indoors year-round, yet the winter prevalence remains.

There are several factors that can explain this phenomenon:

• Cold air and indoor dry air (think furnaces) carry droplets of coughs and sneezes much farther and more easily.
• The shell of the influenza virus gets tougher in cold weather, making it hardier and easier to spread.
• The hairs and mucus in our nose have a harder time stopping germs when it’s cold.
• The rhinovirus (the most common type of cold virus) reproduces more easily in cold weather.

One thing most people don’t think about is that most of the symptoms of the cold are actually caused by our immune system fighting off the virus, not the virus itself. And our bodies have an amazing adaptation to those viral factors listed above: our genes that control inflammation are actually expressed at much higher rates in the winter than in the summer. This is great to combat those more aggressive viruses, but it also explains the symptoms we experience. This is another step in the field of epigenetics: our modern understanding that while our DNA does not change, the way that DNA is expressed does.

Know that it’s not your imagination or superstition that we get colds more frequently in the winter. And it’s worth reiterating the natural steps we can take to prevent and treat URIs that I wrote about last month:

• Frequent hand-washing: remember, it does not need to be antibacterial soap (the common cold is caused by viruses, not bacteria). Just scrub your hands thoroughly for at least 20 seconds.
• Ensure good vitamin D status: Studies have found that individuals with low levels of vitamin D are more susceptible to flu. A supplement of vitamin D3 (the active form), 2000-5000 IU daily, is a cheap and safe insurance policy through the winter months.
• Don’t skimp on sleep: This is often the “forgotten” foundation of health from a naturopathic viewpoint, because it’s not sexy. But turning off the electronic screens and getting your 7-9 hours of sleep per night is one of the main things you can do to boost your immune system.
• Get extra herbal support when needed: If you’re around a lot of people with upper respiratory illnesses, try beta-glucan rich immune boosters like WholeMune by Ortho Molecular Products. If you get a cold or the flu, load up on andrographis, elderberry, echinacea, vitamin C, and zinc. The keys are to start early (at the first sign of a sniffle or a tickle in your throat), and to dose frequently (every two hours while awake for the first two days). The combo I most often recommend for this is Viracid by Ortho Molecular.

Reference: Why you’re more likely to get sick in the winter — and how to stay healthy. http://news.yahoo.com/why-youre-more-likely-sick-174310738.html

Researchers at Brigham and Women’s Hospital in Boston compared people who read on an iPad screen before bed to those reading a traditional paper book before bed. The study confirmed what has long been suspected: that exposure to a screen decreases sleep quality, shortens the amount of REM sleep, and leads to worse moods and poor productivity the next day. Ideally, you should avoid all light-emitting screens for at least an hour before bedtime.  The main problem seems to be with the blue wavelengths of light, that suppress our body’s natural melatonin production. If you really have to read a screen late in the evening, use a physical filter that blocks bluelight, or use free software such as f.lux that achieves the same effect. For Android users, there are several apps available, such as Twilight.

Another problem associated with difficulty sleeping is the presence of intrusive or repetitive thoughts. Interestingly, researchers at Binghamton University have discovered that one of the best way through to cease anxious thoughts is actually to get to bed earlier. Staying up late at night and having a short duration of sleep just aggravate the problem.

It can be a challenge to adjust your habits to get to bed earlier, but it’s worthwhile. Maybe you could stop watching those electronic screens late in the evening. If repetitive thoughts are actually preventing you from falling asleep, you could try and herbal sleep aid such as valerian root, or a do-it-yourself behavior modification programs such as SleepStar.

When you sign up for SleepStar, use code PetersND25 for a discount.

Jacob A. Nota, Meredith E. Coles. Duration and Timing of Sleep are Associated with Repetitive Negative Thinking. Cognitive Therapy and Research, 2014; DOI: 10.1007/s10608-014-9651-7

Researchers in the UK (1) recently published the results of a survey of over 100,000 women covering a 10 year period.  They found that light exposure at night disrupted the normal circadian rhythm (day-night cycle), and led to increased body mass index, and increased waist circumference.

If you are trying to shed pounds by increasing exercise, then bravo!  Just don’t exercise late in the evening.  Night should be a time for winding down, decreasing activity, and definitely minimizing exposure to light (no falling asleep with the TV on).  The infographic below is a handy reminder of what’s known as good sleep hygiene.  Use it to optimize your sleep, and maintain a healthier body weight.

1.  McFadden E et al.  The Relationship Between Obesity and Exposure to Light at Night.  Am J Epidemiol. 2014;180(3):245-250.

Recent research from the Albert Einstein College of Medicine in New York City (1) examined almost 9000 preschool aged children, and looked at the relationship between sleep and behavior.  They found that kids who average fewer than 9.44 hours of sleep per night have a 30 to 40% higher rate of anger, impulsivity, overactivity, and tantrums.  Significantly, these kids were also 80% more likely to be aggressive.  More than two hours of television viewing per night was also associated with worse overall behavior.

Inadequate sleep for adults may result in mood problems, increased pain sensitivity, and even a greater risk of diabetes and cardiovascular disease.  Now, we have further evidence of just one more way that sleep is critical for kids as well.  Follow these guidelines to ensure a good nights rest for your little ones:

• Stick with a scheduled bedtime and wake-up time.  Aim for at least 10 hours of sleep per night.  So if the kids have to be up at 7 AM, make sure they’re in bed by 9 PM.
• Turn off all screens (TV, computer, smartphone, tablet, etc.) at least one hour before bedtime.
• Keep the bedroom cool and dark to make falling asleep easier.
• If your child is having trouble falling asleep, consult your naturopathic physician before trying any sleep aid — even natural ones.

1.  Scharf RJ et al.  Nighttime Sleep Duration and Externalizing Behaviors of Preschool Children.  J Dev Behav Pediatr. 2013;34:384-391.

Yes, once again, it’s my favorite supplement: exercise.  In March 2013, a study published in the journal Menopause found that women with high levels of leisure time physical activity over eight times as likely to experience good sleep quality.  While the authors did not quantify exactly what types or how much physical activity was involved, we can presume that any activity is better than being sedentary.  It’s amazing how much of our leisure time is taken up with electronic screens: computers, TVs, iPads, smartphones… we never have to be without these magical devices that keep our brains engaged, while allowing our bodies to wallow in torpor.

So get out there, and enjoy some walking, biking, swimming, or gardening, and get a better night’s rest tonight.

Physical activity and sleep among midlife women with vasomotor symptoms.  Menopause. Published online March 25, 2013. 

Pomi-T Follow Up…
My article about the beneficial effects of a new botanical supplement, Pomi-T, for prostate cancer patients brought a flood of interested feedback.  However, I have been hard-pressed to find the actual product.  It was produced by a British company called nature Medical Products, and sold out as a response to the publicity about the research study.  An internet search yielded no further reliable information about the availability of Pomi-T or nature Medical Products.  So until we have a source for Pomi-T in the U.S., keep eating your veggies, and look for other standardized supplements for pomegranate, broccoli, green tea, and curcumin (turmeric extract).

A common class of medications prescribed for sleep (and anxiety) is the benzodiazepines (“benzos”) — with trade names like Xanax and Valium, or generic names alprazolam, diazepam, and others.  The main problem with these drugs is well known:  they’re addictive, and can lead to physiological dependence.

A new study published this month (1) found an unexpected danger with benzos:  a 54% increased risk of pneumonia.  Pneumonia is one of the more serious complications of seasonal influenza, which I wrote about last week.  If you’re currently taking benzos for sleep, or considering them, think about all the natural ways you can improve sleep instead.  Of course, discuss changing your medication with the prescribing physician, since it’s best to wean down carefully on this type of drug.  Now if you’re thinking, “I’ve tried all that natural stuff before!  It didn’t work,” my response is… really?  Everything?  Review the list below, and give these suggestions an honest try for a period of several weeks.

IMPROVING THE QUALITY OF YOUR SLEEP

1. Maintain consistent sleep and wake times. Do not push yourself to stay up past the initial signs of sleepiness. This can create epinephrine production, causing more difficulty getting to sleep later. It is good to have a “getting ready for bed” routine to relax and prepare your body for sleep. Avoid taking naps if you have trouble sleeping at night.

2. Reserve the bed for sleep and sex only. Do not read, watch TV, eat, or worry in bed. Solve daily dilemmas outside of the bedroom. If you find that you’ve been lying awake in bed for 15-20 minutes, get out of bed.  Do something mundane until you feel sleepy, and then go back to bed. Repeat this as often as needed.

3. Your sleeping environment should be quiet, cool (70 degrees or less), and comfortable. The room should be clutter-free. Reduce the amount of ambient light as much as possible. Electronic devices such as clocks, stereos, TVs and computers generate electromagnetic fields that can disturb sleep for some people. Experiment with moving these into another room or using EMF shields. Feng Shui, the Chinese art of placement, can be valuable in creating an optimal sleeping environment.

4. Exercise regularly. Exercising during the day or early evening decreases the time it takes to get to sleep and increases the amount of deep sleep obtained. Most people do better avoiding exercise late in the evening.

5. Exposure to sunlight early in the morning and late in the afternoon or evening encourages a strong circadian rhythm. The hormone melatonin, which helps create a sleep state in the body, is suppressed in light and secreted in darkness.

6. As much as possible, ensure complete darkness at night.  Darkness encourages your body’s natural production of melatonin.  Do not fall asleep with the TV or lights on.  Turn off all screens (TV, computer, video games, etc.) 30-60 minutes before bedtime.  If you wake at night to go to the bathroom, do not turn the light on.  Even this brief exposure to light at night may suppress your melatonin significantly, drastically reducing the quality of your sleep.

7. If you have problems with waking during the early hours of the morning, have a small protein snack just before bed to ensure consistent blood sugar levels throughout the night. Consistently get exposure to sunlight as late in the day as possible.

8. Improving overall health will improve the quality of your sleep. Work towards improving or eliminating health problems. Treatment modalities such as Neurostructural Integration Technique will help to relax the body. Effective stress management is essential.

THINGS THAT RELAX THE BODY AND PREPARE IT FOR SLEEP

• Warm baths, possibly adding Epsom salts or lavender oil
• Meditating for 5-30 minutes
• Breathing exercises, progressive muscle relaxation (various recordings are available) or any other means of inducing the “relaxation response”.  Daily practice brings greater results.
• Special acoustic recordings that increase specific brain wave patterns for relaxation and sleep
• Botanical treatments and aromatherapy using herbs and their essential oils (examples include chamomile, valerian, vervain (verbena), hops, lavender, passionflower, avena (oat straw), lemon balm and scutellaria (skull cap).  Consult Dr. Peters for dosages and recommendations.
• Calcium and magnesium supplementation.  Consult Dr. Peters for dosages and recommendations.
• 5-hydroxytryptophan (5-HTP) or melatonin supplementation may be necessary in individual cases.  Consult Dr. Peters for dosages and recommendations.

THINGS THAT INTERFERE WITH SLEEP

• Although alcohol may make you fall asleep, the sleep obtained after drinking is fragmented and light.
• The stimulating effects of caffeine may last up to 10 hours in some people. Avoid it in the afternoon if getting to sleep is a problem. Caffeine is present in coffee, green tea, black tea, chocolate and some medications (pain relievers, decongestants, thermogenic weight loss products, energy supplements, etc.)
• The stimulating effects of nicotine (first- or second-hand smoke) can last several hours.
• Sleeping pills, aside from being highly addictive and full of side effects, decrease the amount of time spent in deep sleep and only increase light sleep.
• B-vitamin supplements can increase energy that keeps some people awake, if taken before bed. Take B-vitamins earlier in the day.
• Do not go to bed with a very full stomach. Large quantities of protein are stimulating to the body as digestion occurs. It’s best to finish eating at least three hours before going to bed.

1.  The impact of benzodiazepines on occurrence of pneumonia and mortality from pneumonia: a nested case-control and survival analysis in a population-based cohort.  Thorax doi:10.1136/thoraxjnl-2012-202374.  

Yes, we do have a biological clock — a part of the brain called the suprachiasmatic nucleus (SCN); its job is to keep track of the daily cycle of our body’s functions (also known as our circadian rhythm).  Research has shown that for most folks, the SCN is actually set to a 25-hour cycle, which means that we have to reset it every day based on cues in our environment.  That’s why it’s easier to stay up late, but harder to wake up earlier in the morning.

Up till about 200 years ago, our biological clocks mostly relied on the signals of sunlight to reset ourselves each day.  With the advent of reliable timekeeping, we now go by a strict 24-hour day; with electric lights, we can give in to our tendency to want to stay up later, if we choose.

Use the “extra” sleep you got this weekend to honor your body’s natural circadian rhythm.  Don’t complain about the early sunset, but rather use it as a signal to get to bed at a reasonable time — and enjoy the earlier sunrise these days.  Sleep is one of the foundations of health, and most adults need around 7-8 hours per night.  Getting adequate sleep helps not only with our daytime energy, but also with preventing diabetes, cardiovascular disease, and obesity.

This is a repost of an article that appeared in 2011.

Melatonin is produced by a tiny gland at the base of the brain called the pineal gland.  The pineal gland releases melatonin in response to darkness, and this signals the brain to go into sleep mode.

Recent findings have shed more light (so to speak) on the importance of darkness and melatonin.  Melatonin has antioxidant effects in the body that protect against cancer.  Nurses who work the night shift (and therefore get round-the-clock light exposure) produce less melatonin, and are at significantly higher risk for breast cancer (1, 2).

A new study found that even low light levels in the sleeping room at night can produce symptoms of depression (3).  Granted, this study was done using hamsters, but the biological effects were clear:  depressive symptoms after four weeks of dim light at night.

Depression?  Insomnia?  Cancer risk?  Turn out the lights:  shut off all screens (TV, computer, iPad, smartphone, etc.) 30-60 minutes before bedtime.  Get rid of the night lights and television in the bedroom.  You might even want to move that bright LED alarm clock away from your head.  Allow a few weeks for your body to readjust to what is becoming a scarce, but highly valuable, commodity:  darkness.

1. Cancer Epidemiol Biomarkers Prev. 2012 Apr;21(4):609-18. Epub 2012 Feb 7.
2. Cancer Causes Control. 2006 May;17(4):539-45.
3. T A Bedrosian, Z M Weil and R J Nelson.  Chronic dim light at night provokes reversible depression-like phenotype: possible role for TNF.  
   Molecular Psychiatry , (24 July 2012).

A recent study added to the evidence that inadequate or disrupted sleep induces metabolic changes in the body that can lead to diabetes and weight gain.  These changes occurred with sleep at about five and a half hours per night.  Shift work aggravates the problem, with the disruption in circadian rhythm (our body’s daily biological clock) making sleep even more difficult.

As the weather gets hot, falling asleep might get harder — but there are ways to deal with that.  A lack of optimal amount of sleep can lead not only to obesity and diabetes, but also may aggravate high blood pressure, and even raise the risk of certain types of cancer.  Not to mention the fact that this is probably the most common cause of fatigue — and the first thing to address before we go reaching for “energy drinks,” supplements, etc.

How much sleep should we get?  Between 7 and 9 hours per night is what most research indicates.  If you think you’re too busy to get that amount, reassess your activities during the day:  If you’re staying up to have time to watch TV or surf the web, reconsider your priorities in light of the very real negative health effects.

Lack of sleep linked to disease