Bowel Parasite InfectionsA while back, the news focused our attention on Milwaukee because of repeated fatal outbreaks of an infection by a bowel parasite called Cryptosporidium. A cartoon even made the rounds showing Mexican tourists being warned not to drink the water in Milwaukee! Although this infection usually resolves on its own within a week or two, it may persist in those with immune suppression. In fact, people with acquired immune deficiency syndrome (AIDS) are particularly susceptible and scores of Milwaukeens died from the Cryptosporidium outbreaks.Unfortunately, in many places throughout the United States, the water supply is contaminated, and parasites are no longer just a Third World problem. Doctors frequently see cases of infection by giardia, amoeba and numerous other bowel parasites. Parasitic infections can mimic CFS and, in immune suppressed situations like CFS, all parasites should be treated.Most laboratories miss the parasites when they do stool testing. I initially tested for bowel parasites by sending my patients' stool samples to a respected local lab. The tests kept coming back negative, so I eventually stopped testing. Finally, I started doing my own laboratory stool testing. Doing the test properly was very time consuming, taking up to five hours per specimen. However, processing it properly, my tests frequently turned out positive. In my experience - and in that of other physicians as well - when you treat a patient for parasites, the patient's fatigue and achiness often improves dramatically.If you would like your stool tested, make sure that the lab specializes in stool testing and that the sample is a purged specimen. A purged stool specimen is watery and loose, brought about by the use of one-and-a-half ounces of Fleet's Phospho-Soda (a laxative). The purpose of the stool purge is to get the best possible stool sample to check for bowel parasites and yeast. The laxative washes the organisms off the walls of the intestines so that they can be detected. The routine random tests performed in almost all standard labs are generally not adequate or reliable. In speaking with several lab technicians, I was told they had less than one hour of training in looking for parasites-which they found to be useless. In fact, during one of our "doctors'" poker games, I spoke with a gastroenterologist friend who noted that during a certain bowel exam he had performed, he saw a large number of parasites swimming in the patient's large bowel. He removed a big glob consisting of nothing but mucus and parasites and sent it off to the major local laboratory, just for confirmation of the infection and identification of the parasite. Even this sample came back negative for parasites! This is why I stress that stool testing must be done at a lab that specializes in parasitology. Because two excellent labs are now available to me to mail specimens to, I no longer have to do the testing in my office. These labs are The Parasitology Center, Inc. (480-777-1078) and The Great Smokies Diagnostic Laboratory (800-522-4762).At this point, no consistently effective prescription medication is available for Cryptosporidium infections. Artemisia annua, however, is an effective herbal treatment. For most of my patients, I recommend using 1,000 milligrams three times a day for twenty days. Leo Galland, M.D., a parasite specialist, recommends a form of Artemisia called tricyclin for many parasitic infections. He recommends taking 2 tablets, 3 times a day after meals for six to eight weeks. The cost of this antiparasitic herbal preparation is about $30 for fifty tablets. See the treatment protocol below for regimens for some other parasitic infections. The doctor who runs The Parasitology Center also has a review article discussing which natural remedies are effective against each type of parasite. Common parasite treatment regimens also used in our office are on the treatment checklist below.Antiparasitic Treatments1. Flagyl (Metronidazole) - 750 mg, 3 times a day for 10 days, followed by Yodoxin for many parasites. For Clostridium Difficile take 250 mg, 4 times a day, or 500 mg, 3 times a day. It may cause nausea and vomiting (uncomfortable but usually not worrisome). Do not drink alcohol while on this medication as it will make you vomit. The SR (sustained release) form is easier on the stomach (as is the brand-name form). If you get numbness or tingling in your fingers (or it worsens if you usually have it) stop the Flagyl.2. Yodoxin (Iodoquinol) - 650 mg, 3 times a day, for 20 days after Flagyl is completed.3. Tinidazole - 2000 mg, once daily, for 3 consecutive days with food (for Entamoeba Histolytica) - OR - 3 doses, each 2 weeks apart (for Giardia or Dientamoeba Fragilis); Available at Clark's Pharmacy (800-480-3432).4. Humatin (Paromomycin) - 500 mg, 3 times a day, for 10 days (for Cryptosporidium). For Blastocystis add Yodoxin.5. Zithromax - 250 mg, once a day on an empty stomach for 10 days, along with Bactrim, 1 tablet twice a day for 10 days (alternate treatment for Cryptosporidium). Add Artemesia.6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin 650 mg, 3 times a day with food for 10 days. Do not take Folic acid supplements (e.g., B Complex or multivitamins) during these 10 days (for Blastocystis).7. Amphotericin B - 100 mg, two times a day, plus Tinidazole 500 mg, twice a day, plus Furoxone (Furazolidone) 1 tablet, twice a day. Take these three together with food for 5 to 7 days (Amphotericin B and Tinidazole are available from Clark's Pharmacy 800-480-3432) (treatment for refractory Blastocystis).8. Lactoferrin - 350 mg, 1 to 3 capsules at bedtime. 9. Multi-pure Water Filter - Most other filters (except for reverse osmosis) are ineffective. (Available from Bren Jacobson, 410-224-4877).10. Artemesia Annua (a herbal antiparasitic) - 500 mg, 2 tablets, 3 times a day for 20 days.11. Tricyclin (a herbal antiparasitic) - 2 tablets, 3 times a day, after meals for 6 to 8 weeks (concentrated Artemesia).12. Colostrum (mother's milk) - 3 capsules, 3 times a day, for 8 to 12 weeks. Then stop or use the lowest dose needed for symptoms. If nausea or indigestion occurs, lower the dose to a comfortable level for 1 to 2 weeks until it passes. Take on an empty stomach.13. Quinacrine - 100 mg a day for 5 days. May be useful for empiric therapy of suspected but not identified parasites (controversial).14. Albendazole - 400 mg a day for 5 days. May be useful for empiric therapy of suspected but not identified parasites.Filter Your WaterWater filters can be very helpful in the fight against parasitic infection. However, not all units are designed to filter out parasites. For a water filter to remove parasites, it must have a submicron solid carbon block filter. A good example is the Multi-pure Filter. Check the Consumer's Digest and Consumer's Report for other good units. Multi-pure Filters are available from Bren Jacobson at 888-801-8176 or 410-224-4877. He is a very reputable and knowledgeable person and does not believe in "high pressure sales" (again, I get no money from people or companies whose products I recommend). When shopping around for a water filter, request the National Sanitation Foundation (NSF) International Listing for the specific unit you are considering. NSF is an independent not-for-profit organization that tests and certifies drinking water treatment products. The unit you buy should meet both NSF Health Effects Standard 53 and NSF Aesthetics Standard 42, with Class I reduction of chlorine and particulate matter. Any unit that does not meet both of these standards, particularly the health standard, is not adequate. To verify that a unit does meet these standards, call the NSF at 313-769-8010.In addition to verifying that a water filter meets the NSF standards, ask to see its Product Performance Data Sheet. Many states require that this sheet be given to all prospective customers of drinking water treatment devices.Ask about the range of contaminants that the unit can reduce under NSF Health Effects Standard 53. Most units certified under Standard 53 list only turbidity and cyst reduction. The number of units that also reduce pesticides, trihalomethanes, lead, and volatile organic chemicals is very small. Make sure that the water filter you are considering can remove the specific contaminants that concern you.Ask if the unit is licensed in such states as California, Colorado and Wisconsin. These states have some of the toughest certification procedures in the United States.Finally, ask about the unit's service cycle, which is stated in gallons of water treated. Find out how often you will need to change the filter and what the replacement filters cost.As the American water supply becomes more contaminated, parasitic bowel infections will likely become more common. These infections, as well as the overgrowth of yeast or toxic bacteria caused by antibiotic use, contribute to feeling poorly.The Role Of Other Infections In CFIDS/FMSMany infections have been found in CFIDS. That people may have not just one, but several of these simultaneously is significant. It suggests that although these infections may be a trigger, in most patients the immune system is suppressed and therefore they become a setup for unusual infections that persist. These infections may then "drag you down," further suppressing your immune system. Fortunately, most people improve (and often get very healthy) by simply treating the sleep, hormonal, nutritional and yeast problems. Once these areas are treated, your body can usually eliminate any persistent infections by itself. A subset, though, have infections that need treatment with antivirals and/or antibiotics.How Can I Tell If I Need These Treatments? First, I would try the other approaches discussed in my From Fatigued To Fantastic! book and newsletters. I would try these treatments if symptoms persist: 1. Those with predominantly flu-like symptoms with debilitating fatigue and little or no pain or fever are more likely to have an underlying persistent viral infection (e.g., HHV-6, Epstein Barr, CMV, etc.). 2. Those with fevers (i.e., anything over 98.6ï¿½F in this illness - even 99ï¿½) and/or lung congestion, sinusitis, skin pustules or other chronic bacterial infections seem more likely to have infections (i.e., bacterial, Mycoplasma, or Chlamydia) that respond to special antibiotics. Let's look at these two groups and how to approach them.Fighting Those Persistent Infections in CFIDSBy Jacob Teitelbaum, M.D. Medical science has known for quite some time that Chronic Fatigue Syndrome is associated with changes in the body's immune system. In fact, the acronym "CFIDS" stands for "Chronic Fatigue And Immune Dysfunction Syndrome." This can result in your having several different and unusual infections at one time. Many of these infections need to be treated directly. Other infections will go away on their own as your immune (defense) system comes back "on line" by using our treatment protocol. In this article, I'll discuss some of the more common, yet not usually thought of (in "regular" medicine), infections. What Kind Of Infections Am I Most At Risk For?Although CFIDS of sudden onset often seems to be triggered by viral infections (e.g., EBV, HHV-6, CMV), those infections, I suspect, are "simmering" or no longer active in many cases. However, the body acts as if they are. This may result in elevated interferon levels. I suspect this was what triggered my CFIDS.The body produces interferon to fight viral infections. When a cancer or hepatitis patient is injected with interferon, the patient becomes achy, fatigued and brain-fogged. An under-active adrenal can also cause interferon levels to become elevated. Because of this elevation, it is more accurate to say that the body's immune system is not functioning properly, than to say that it is underactive. Indeed, in many ways, the immune system may be in overdrive and soon exhaust itself. The immune system malfunctions in many other ways, too, including decreasing the effectiveness of the body's "natural killer" cells, which are an important defense mechanism.Many other recurrent or unusual infections can also occur because of your malfunctioning immune system. Chronic sinus, bladder, prostate and respiratory infections are common and are often treated with repeated courses of antibiotics. The large amount of antibiotics introduced into the system can cause a secondary yeast over-growth as it changes the natural balance between the bowel's healthy bacteria and yeast. The original immune dysfunction also contributes to the yeast overgrowth. Although it is controversial, a theory held by many physicians is that chronic overgrowth of yeast due to overuse of antibiotics is a potential and strong trigger for chronic fatigue, fibromyalgia and further immune dysfunction. What makes the theory controversial is that no definitive tests exist to distinguish fungal overgrowth from normal fungal levels. Also, many of the symptoms ascribed to yeast overgrowth can also come from the many other problems present in chronic fatigue syndrome and fibromyalgia. On the other hand, most doctors who try treating yeast in at least three or four CFS patients see how well it works and keep using it. CFIDS patients also frequently have bowel parasite infections. Bowel parasites can cause severe allergic or sensitivity reactions, which in turn can trigger fibromyalgia and fatigue. Often, a patient will finally recover from long-standing and disabling fatigue within a week or two after beginning treatment for bowel parasites.Many other CFS/FMS patients are left with disabling fatigue after a bout with viral infections such as polio, HHV-6, CMV, or EB viral infections. This fatigue also usually responds to the treatments discussed in this newsletter. In addition, infections with unusual organisms such as Rickettsia (e.g., Lymes Disease), chlamydia, and mycoplasma may also be problematic. Yeast OvergrowthEveryone's immune system has strong spots, as well as weak spots. Some people never get colds but have frequent bouts with athlete's foot or other skin fungal infections. Others never get fungal infections but tend to get colds. Many people seem to have a diminished ability to fight off fungal infections.Fungi are very complex organisms. Fungal overgrowth may suppress the body's immune system. The host body may also develop allergic reactions to components of the yeast.This allergic reaction was suggested in a study which connects Candida Albicans with Allergic Skin Dermatitis (Eczema). This study was published in The Journal of Clinical Experimental Allergy back in 1993 (Vol. 23, pp. 332-339). It found that there is a significant correlation between the body having antibodies to Candida and Allergic Dermatitis/Eczema. In addition, we have found that unexplained rashes that have lasted for many years often clear up with antifungal treatment as well! Many physicians feel that yeast overgrowth causes a generalized suppression of the immune system. In other words, once the yeast gets the upper hand, it sets up a cycle that further suppresses your body's defenses. Interestingly, a recent Mayo Clinic study showed that most cases of chronic sinusitis seem to be associated with a reaction to yeast in the sinuses - something I proposed years ago. None the less, as I already noted, this theory is controversial. Yeast are normal members of our body's "zoo." They live in balance with bacteria - some of which are helpful and healthy and some of which are detrimental and unhealthy. The problems begin when this harmonious balance shifts and the yeast begin to overgrow. As noted above, many things can prompt yeast to overgrow. One of the most common causes is frequent antibiotic use. When the good bacteria in the bowel are killed off by antibiotics (along with the bad bacteria) the yeast no longer have competition and begin to overgrow. The body is often able to rebalance itself after one or several courses of antibiotics, but after repeated or long-term courses - and especially if the body has an underlying immune dysfunction - the yeast can get the upper hand. Other factors are also important. Studies have shown that animals who are sleep deprived and/or have increased sugar intake develop bowel yeast overgrowth. Many physicians feel that eating sugar stimulates yeast overgrowth in people, as well. Sugar is food for yeast. Yeast ferment sugar in order to grow and multiply. Yeast overgrowth due to sugar overuse also seems to cause immune suppression, which facilitates bacterial infections, which then requires even more antibiotic use. Poor sleep also results in marked suppression of your immune function. How Does One Know If They Have Yeast?There are no definitive tests for yeast overgrowth that will distinguish yeast overgrowth from normal yeast growth in the body. There is one test which may be useful, though. This is a Urine Tartaric Acid test done by The Great Plains Lab in Kansas City, Missouri, run by William Shaw, Ph.D. Tartaric Acid is a waste product of yeast growth. In fermenting wine, for example, it is critical to remove the Tartaric Acid. Otherwise, the wine could be toxic to people. Dr. Shaw has found elevations in Urine Tartaric Acid that decrease with antifungal treatment in both CFIDS/FMS patients and autistic children. Interestingly, both these illnesses often improve with antifungals (specifically, Sporanox or Diflucan, plus Nystatin). Dr. Shaw likes to use the Urine Tartaric Acid to decide when to treat yeast overgrowth and to follow-up the effectiveness of treatment.In my experience, however, using Dr. Crook's Yeast Questionnaire (available in my book, From Fatigued To Fantastic!) is still the most reliable way to tell if a person is at risk of yeast overgrowth. If the symptom score is over 140 points, I recommend treatment. In addition, anyone who has been on recurrent or long-term antibiotic use (especially Tetracycline for acne) or anyone who intermittently has painful sores in different parts of the mouth that last for about ten days at a time and who has CFIDS/FMS, should be treated with antifungals. Bowel symptoms are some of the more overt symptoms that are caused by yeast and I feel that most people who have "spastic colon" have yeast overgrowth or parasites.How Is Yeast Treated?A number of very effective methods can be utilized to take care of a yeast problem. Primary among the methods is to avoid sugar and other sweets. One can enjoy one or two pieces of fruit a day, but should not consume concentrated sugars such as juices, corn syrup, jellies, pastry, candy or honey. Stay far away from soft drinks, which have ten to twelve teaspoons of sugar in every twelve ounces. This amount of sugar has been shown to markedly suppress immune function for several hours. Be pre-pared to have withdrawal symptoms for about one week when sugar is cut out of the diet. Several excellent books have been written on the yeast controversy and offer additional methods to try. One of the best books is The Yeast Connection and the Woman by William Crook, M.D., a physician who has done a spectacular job advancing the understanding of CFIDS/FMS.Many patients have found that acidophilus (that is, milk bacteria, a healthy bacteria for the bowel) helps restore balance in the bowel. Acidophilus is found in yogurt with live and active yogurt cultures. Indeed, one cup of yogurt a day can markedly diminish the frequency of recurrent vaginal yeast infections. Acidophilus is also available in capsule form. Although many claims are made for one type of acidophilus being better than the other, I'm not sure this is so. I usually recommend 3 to 6 billion units a day (1 unit = 1 bacteria) on an empty stomach. If on antibiotics (not antifungals), take the acidophilus at least 3 to 6 hours away from the antibiotic dose. Nystatin, an antifungal medication, has also been helpful in the treatment of yeast overgrowth. Unfortunately, some fungi seem to be resistant to Nystatin. In addition, Nystatin is poorly absorbed, which means that it has little impact on the yeast outside of the bowel. Other anti-fungal medications, such as Diflucan and Sporanox, seem to be effective systemically (throughout the body) but they have two main drawbacks. First, they are expensive, costing more than $450 to $900 for a two-month course. Second, any effective anti-fungal can initially make the symptoms of yeast infection worse. Although uncommon, Sporanox and Diflucan can also cause liver inflammation (as can Advil and Tylenol). If you are taking Sporanox or Diflucan for more than 6 to 12 weeks, I would consider intermittently checking liver blood tests (ALT and AST). If you have preexisting active liver disease, be cautious in using (or don't use) Sporanox or Diflucan. I strongly recommend taking Lipoic Acid (a natural supplement which protects and helps heal the liver), 200mg a day, whenever you take Sporanox or Diflucan. I also strongly recommend Lipoic Acid for anyone with active liver disease (e.g., hepatitis) at doses up to 1000mg to 3000mg a day as it may prevent and/or treat cirrhosis.Natural Yeast TreatmentsBelow, I have summarized the nonprescription part of the treatment checklist that I use in my office. 1. Avoiding sweets is still the single most important thing. Using Stevia as a sweetener is a wonderful substitute. Stevia is a safe, natural remedy and you can use all you want. There are even cookbooks for using Stevia (available from my office or 800-4STEVIA). A new natural sweetner, Sweet Balance, also tastes good and is 12 times as sweet as sugar. It is a natural product from the Lo Han fruit and appears to be safe. Although it is 70% sugar (fructose), you only need a small amount. Order it from 877-997-9338, my office at 800-333-5287 or my Web site at www.endfatigue.com. 2. Acidophilus or Milk Bacteria can be very helpful. Take 3 to 6 billion units a day (a unit is the same as a bacteria). Do not take acidophilus within 3 to 6 hours of an antibiotic. Take it either on an empty stomach or with milk. 3. Caprylic Acid is another natural remedy that can be helpful. The usual dose is 1800 to 3600mg a day with 1/3 of the dose being taken at each meal. Unfortunately, it often causes an acid stomach with a "funky" tasting reflux. 4. Oregano Oil - enteric coated oregano oil - 1 to 2 capsules, 2 to 3 times a day with food, may be more effective and better tolerated than Caprylic Acid (both can cause stomach acid reflux). 5. Fresh Garlic, if you can handle it well, can also be very effective. Daily, crush 1 to 3 garlic cloves in olive oil, add salt, spread it on bread and eat it. It can be quite tasty and lethal to whatever infections you have in your gut. 6. Olive Leaf 500mg, 2 to 4 capsules three times a day between meals, can also be very helpful in treating yeast overgrowth. 7. Pau De Arco in either tea or capsule form is also helpful in yeast suppression. Although I use Pau De Arco infrequently for yeast over-growth, many people find that it can be helpful. 8. Grapefruit Seed Extract (e.g., Citrucidel) is a popular treatment for yeast overgrowth and is well-tolerated. More Information On Yeast TreatmentsIf symptoms of yeast are caused by an allergic or sensitivity reaction to the yeast body parts, the symptoms may flare when mass quantities of the yeast are suddenly killed off. This is called a yeast "die-off" reaction. If you get this reaction, start your treatment with acidophilus and a sugar-free diet for a few weeks followed by oregano oil and/or olive leaf (1500mg to 2000mg, 3 times a day between meals) before beginning Nystatin. Take Nystatin (by mouth) in the form of 500,000-IU tablets or powder. I generally recommend beginning with 1 tablet a day for 1 to 3 days, and increasing by 1 tablet every 1 to 3 days (or slower if yeast "die-off" is a problem) until 2 tablets 2 to 4 times a day is reached. If you get nausea, take a lower dose. Take Nystatin, 4 to 8 tablets daily, for 5 to 8 months. I add the Diflucan or Sporanox one month after beginning the Nystatin. Take 200mg every morning for six weeks. If symptoms flare, take just 100mg per morning for the first 3 to 14 days. If symptoms recur after stopping the Diflucan or Sporanox, I recommend continuing the medication for an additional 6 weeks at 200mg a day.Sporanox should be taken with food. If it is taken alone, its absorption is greatly reduced. When taking Diflucan or Sporanox, DO NOT use the antihistamines Seldane or Hismanal, Quinidine (a heart medicine), cholesterol-lowering medications in the Mevacor family, or the bowel medicine Propulcid. These can be fatal combinations! Also, antacid medications (such as Tagamet, Axid, Zantac, and Pepcid) prevent the proper absorption of Sporanox. At the high price of Sporanox per dose, you will want to absorb every last bit of the medication. If you need to be on an antacid medication, use Diflucan instead of Sporanox. Unfortunately, a less expensive antifungal, called Lamisil (at 250mg a day), does not seem to work very well for candida yeast overgrowth (although it works well for nail infections). I am currently trying patients on 500mg of Lamisil a day to see if this dose works better. I feel that once the yeast has been effectively decreased and kept that way for six to twelve months, it is safe to try to add small amounts of sugar back into the diet. If symptoms recur, however, stop the sugar again. Continuing to eat yogurt with live and active acidophilus cultures (unless you are lactose-intolerant) or continuing to take acidophilus capsules may also help.Many books on yeast overgrowth (including Dr. Crook's) advise readers to avoid all yeast in the diet. This advice is based on the theory that an allergic reaction to yeast is the cause of the problem. The predominant yeast that seems to be involved in yeast overgrowth is Candida Albicans, although I would not be surprised if researchers discovered that many other kinds of fungal infections are also involved. The yeast that is found in most foods (except beer and cheese) is not closely related to candida.In my experience, trying to avoid all yeast in foods results simply in a nutritionally inadequate diet and little benefit. Although a few people do appear to have true allergies to the yeast in their food, they number less than 10 percent of my patients with suspected yeast overgrowth. These patients may benefit from the more strict diet in Dr. Crook's book. Interestingly, once their adrenal insufficiency and yeast overgrowth are treated, most people find that their allergies and sensitivities to yeast and other food products seem to improve or disappear.Nutritional deficiencies such as low zinc or low selenium may also decrease resistance to yeast over-growth. A good multivitamin supplement, as recommended in my last newsletter, should take care of these deficiencies. This is further evidence that all the factors involved in CFS are closely interrelated.The best thing that one can do to combat yeast overgrowth is to try to avoid it in the first place. When you get an infection, begin treating it naturally immediately. Hopefully, you can prevent it from turning into a bacterial infection which might require an antibiotic. Ask your doctor what measures you can take before resorting to antibiotics. Many good over-the-counter remedies are available. A knowledgeable pharmacist may also be a wealth of information. Your local book or health food store has books on natural measures. Your health food store proprietor can also steer you to appropriate natural remedies. For examples of the many helpful measures that one can take, see my newsletter article, Treating Infections Without Antibiotics, page ___).If you find however, that you must take an antibiotic, all is not lost. One can still lessen the severity of yeast overgrowth by avoiding sweets and by either taking acidophilus capsules (again, not within 3 to 6 hours of an antibiotic) or by eating one cup of yogurt with live and active acidophilus cultures daily. Don't use the yogurt (or milk) if you have sinusitis or pneumonia because the milk protein thickens mucus and makes it hard for the body to fight these infections. How Can One Tell If The Yeast Is Coming Back? It is normal for yeast symptoms to resolve after treatment. After 6 weeks on the Sporanox or Diflucan, patients are usually feeling a lot better, but may have symptoms recur soon after stopping the antifungal. In this case I would continue the Sporanox or Diflucan for another 6 weeks, or as long as is needed, to keep the symptoms at bay. More frequently, people will feel better after treatment and stay feeling fairly well for a period of 6 to 24 months. At that time, it is common to see a recurrence of symptoms, especially if one is eating too much sugar or is taking antibiotics. The best marker that I have found for yeast overgrowth would be a return of bowel symptoms with gas, bloating and/or diarrhea or constipation. If these symptoms persist for more than 2 weeks, especially if there is also even a mild worsening of the FMS symptoms, it is very reasonable to retreat yourself with 6 weeks of Nystatin and perhaps Sporanox or Diflucan. In addition, I would also retreat if there's a recurrence of vaginal yeast or sinus infections. If re-treatment resolves the symptoms, one may opt to repeat this regimen as often as is needed (usually every 6 to 24 months). By using some of the natural remedies listed above, however, you may be able to avoid repeated use of these antifungals and the possible risk of becoming resistant to them. Some patients also find that they need to stay on the antifungals for extended periods of time (years) or the symptoms will recur. When this is necessary, I add the natural remedies. I will, however, also use the medications when needed. The main risk of long-term use of the antifungals Sporanox and Diflucan would be liver inflammation. If these medications are being used for extended periods, consider checking liver tests (SGOT and SGPT) every 3 to 6 months and anytime that a severe flu-like feeling or worsening of symptoms occur. As noted above, it is very important to take Lipoic Acid 200mg a day when on Sporanox or Diflucan. Although I am not aware of any studies using Lipoic Acid with antifungals, in my experience I have seen no worrisome elevation on liver tests if patients are using this natural substance while taking these antifungals. As an alternative, instead of taking the antifungals every day, many people find they can get long-term suppression of the yeast by taking Sporanox or Diflucan 200mg twice a day, one day each week (e.g., each Sunday). Help For Chronic Bladder InfectionsAlthough we will be discussing some unusual infections, CFIDS/FMS patients also get more of the day-to-day variety of infections. These include Urinary Tract (bladder) Infections (UTI). The main symptoms of a UTI are discomfort (e.g., burning) when urinating (dysuria), urgency (which is the feeling that you have to go very badly and right away when there is not much urine there), and frequency with low volume. These symptoms are also common in CFIDS/FMS patients in the absence of bladder infections and, when severe, is called Interstitial Cystitis. I would not label someone as having Interstitial Cystitis unless this is the major symptom of their CFIDS/FMS, because almost everyone with this illness has some urinary urgency and frequency. Because bladder symptoms can be seen in both UTI and CFIDS/FMS, it is important to have a urine culture done before treatment with antibiotics to make sure that there is an infection and not just muscle spasms in the bladder that are causing these symptoms. If there is an infection, over 90% of the time it will be E-coli. This bacteria is normally found in everyone's gut and, with the exception of a few rare dangerous forms, is a healthy part of our normal bowel bacteria. The problem occurs when the E-coli gets out of the bowel where it belongs and into the bladder. Usually the bladder will wash out most infections when the urine comes out. The E-coli however, have little velcro-like projections that stick to the bladder wall so that they can not be washed out by urination.Taking antibiotics will kill a bladder infection but will also kill the healthy bacteria in the bowel. This sets one up for yeast overgrowth and other problems. Because of this, unless there is fever or back pain over the kidneys or a toxic feeling, it is reasonable to try natural remedies for one to three days before going with the antibiotics. One can start these treatments while waiting for the urine culture to come back. What Natural Remedies Can Be Used For Bladder Infections?There are two excellent natural remedies that can keep the E-coli from sticking to the bladder walls so they can be washed out. In addition, taking vitamin C in high dose (e.g., 500 to 5000mg a day) can acidify the urine, making it inhospitable to the bacteria. Drinking a lot of water also helps to wash out the infection.The two natural remedies that keep the bacteria from sticking are:1. Cranberries-Because approximately 20% of the female population suffers from UTIs, several studies have been done looking at this remedy. An early study of 44 female and 16 male patients with acute bladder infections drank 16 oz. of cranberry juice a day for 15 days. Of these patients, 53% had positive responses and another 20% showed modest improvement. Six weeks after stopping the juice, 27 patients did have persistent recurrent infections and 8 of these had no symptoms. Seventeen patients had no symptoms and negative urine cultures. In another study of elderly women (who are more likely to have bladder infections), 153 women either received 10 oz. of cranberry drink or placebo every day for 6 months. The group that got the cranberry drink had 68% fewer bladder infections during that period. In this study, the juice was sweetened with saccharin instead of sugar. Other studies have also shown benefit using cranberry juice in bladder infections.Significant benefits are achieved by using 6 to 16 oz. of cranberry juice a day. Because cranberry juice has a lot of sugar and can promote yeast overgrowth and aggravate other symptoms in CFIDS/FMS, I think it is much better to use pure cranberry juice powder in capsule or tablet form (standardized to contain 11% to 12% quinic acid). The therapeutic dose is 1 to 2 capsules a day. Conversely, you can use unsweetened cranberry juice and add Stevia as a natural sweetener. In general, if one gives the usual cranberry juice cocktails a strength of 1 unit - then, cranberry juice drinks have a strength of ï¿½; cranberry sauce a strength of ï¿½; fresh or frozen cranberries are 4 times as potent; pure cranberry juice is 4 times as potent; and cranberry juice capsules from unsweetened cranberry juice powders are 32 times as potent. Cranberries work to help bladder infections because they have a chemical (proanthocyanidins) that prevents the bacteria from sticking to the bladder wall. They may also decrease the risk of kidney stones (although magnesium with B6 is much better for this), as well as possibly reduce urine odor.2. D-Mannose - This is more effective than cranberry juice. Mannose is a natural sugar (not the kind that causes symptoms or yeast overgrowth) that is excreted promptly into the urine. Unfortunately for the E-coli bacteria, the fingers that stick to the bladder wall stick to the D-Mannose even better. When one takes a large amount of D-Mannose, it spills into the urine, coating all the E-coli's little "sticky fingers" so that the E-coli are literally washed away with the next urination. The nice thing about the natural approach, as opposed to antibiotics, is that the cranberries or D-Mannose will not kill the healthy bacteria, thereby not bothering the normal balance of bacteria in the bowel. In addition, the D-Mannose is absorbed in the upper gut before it gets to the friendly E-coli that are normally present in the colon. Because of this, it helps clear the bladder without causing any other problems. In addition, the D-Mannose even tastes good. The D-Mannose is quite safe, even for long-term use, although most people will only need it for a few days. Those who have frequent recurrent bladder infections may, however, choose to take it every day. The usual dose of D- Mannose is 1/2 teaspoon every 2 to 3 hours, while awake, to treat an acute bladder infection; and 1/4 to 1/2 teaspoon 3 to 4 times a day to prevent severe chronic bladder infections. It is best taken dissolved in water. For those who get bladder infections associated with sexual intercourse, one can take 1/2 teaspoon of D-Mannose 1 hour before and then just after intercourse to prevent an infection. Remember, though, the D-Mannose (and cranberries) only work in the 90% of bladder infections caused by E-coli bacteria. D-Mannose is available from several sources: 1. The Tahoma Clinic Dispensary (253-850-5661), which is associated with the well-known nutritional physician, Jonathan V. Wright, M.D. 2. The Biotech Company (800-345-1199). 3. My office (800-333-5287) or my Web site at www.endfatigue.com. The usual cost of D-Mannose is approximately $60 for 100 grams and $35 for 50 grams. A 1/2 teaspoon is approximately 2 grams. One should feel much better within 24 to 48 hours on D-Mannose. If not, see a doctor for a urine culture (you may want to get the culture at the first sign of infection) and consider antibiotic treatment after two days if the culture is positive. Some evidence exists that Macrodantin causes less yeast over-growth than do other antibiotics. Even with other antibiotics, most bladder infections are knocked out by one to three days of antibiotic use (instead of the old seven-day regimen).ProstatitisAlthough women tend to be the ones plagued with bladder infections, men don't get off unscathed either. It is very common in men with CFIDS/FMS to have Prostatitis. Prostatitis is an inflammation or infection of the prostate which is usually seen in younger men between the ages of 20 and 50. It falls into three main categories: 1. "Bacterial" Prostatitis is a acute or chronic infection in the gland that causes prostate swelling and discomfort. 2. Nonbacterial Prostatitis is when you feel swelling of the prostate without being able to detect an infection. My suspicion is that it is not uncommon for prostatitis to be associated with yeast overgrowth or other infections that cannot be cultured (tested for). 3. Prostadynia is a general irritation of the prostate which causes urinary burning, urgency and frequency but without there being any infection or swelling of the prostate. This can come from a number of causes including, I suspect, chronic spasm or tightening of the muscles of the pelvic floor. The symptoms of chronic Prostatitis can come and go and be mild or severe. The symptoms include: 1. Pain or tenderness in the area of the prostate. It is also common to have burning on the tip of the ***** . 2. Discomfort in the groin and, occasionally, lower back pain. 3. Urinary urgency and frequency with pain on urination. 4. Sometimes a slight ***** discharge. If the discharge is cloudy and larger than one drop, or even a large drop, it is most likely a bacterial Prostatitis and I would then prescribe antibiotics. If a discharge is present, I would also check to make sure that there is not also a sexually transmitted disease (such as Chlamydia or Gonorrhea) before beginning treatment. 5. Pain with ejaculation. If severe symptoms with fevers, chills and extreme fatigue are present (symptoms of acute Prostatitis), antibiotics should be used. The main treatment for bacterial Prostatitis consists of using the antibiotics Tetracycline (e.g., Doxycycline), Cipro, or Sulfa (Bactrim or Septra DS). Unfortunately, since it is hard for the antibiotics to be absorbed into the prostate, the symptoms often recur even after six weeks of treatment. If antibiotics are required, use Doxycycline or Cipro because these may be effective against other hidden infections that can cause CFIDS/FMS. Although there are a number of causes of Prostatitis, excess caffeine, alcohol and spicy foods can also contribute to the symptoms. Sitting for long periods while traveling (e.g., being a truck driver) can also cause irritation of the prostate. Although normal bacteria are common causes, a few bacteria transmitted through sexual contact can also cause Prostatitis. Some feel that the main psychological component of Prostatitis is shame.