This document discusses chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS), which are conditions with overlapping symptoms including fatigue, pain, and brain fog. CFS affects about 3 in 1000 Americans, while FMS affects 3-6 million in the US. Both conditions can be triggered by infections, stress, autoimmune diseases or hormonal imbalances. Modern medicine has had limited success treating these complex syndromes. The author describes his RISE and SHINE approach to integrative and functional treatment which focuses on reducing inflammation, improving sleep, hormonal balance, immunity, nutrition, and energy levels through diet, lifestyle changes, and natural supplements.

1. August/September 2014 Health&Medicine BCWJ ~ Page xx
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.
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