Chronic Fatigue Syndrome Treatment Using Functional Medicine

In this episode I dive into chronic fatigue syndrome and functional medicine from different angles.

1. CFS is a syndrome, not a disease, involving neurological, immune, and gut dysfunction, often leaving patients feeling dismissed.
2. Root causes include infections (Epstein-Barr, Lyme, mold), gut dysbiosis, and neuroinflammation, with immune weakness playing a key role.
3. Traditional medicine only manages symptoms with medications, failing to address the underlying issues, leaving many without lasting relief.
4. Functional medicine targets root causes, using personalized lab testing and treatments rather than a one-size-fits-all approach.
5. Functional neurology is crucial for CFS recovery, assessing brain function and connectivity to ensure a more effective treatment plan.

You may read our entire blog post version of this episode: https://peakbrainandbody.com/functional-medicine-approach-to-chronic-fatigue-syndrome/

Transcript

We are going to dive into one of the most common reasons that individuals go to a medical provider, really of any type, and that is chronic fatigue. Previously, I've already covered what chronic fatigue syndrome is. Now we are going to highlight that. But we're really going to focus more of our time on what actually drives chronic fatigue syndrome, as well as what functional medicine is, how it differs from traditional medicine and why people are switching to functional medicine when they have chronic and complex symptoms or they have chronic conditions with chronic fatigue syndrome being one of those. So the very first thing is it's really important to understand that when we look at chronic fatigue syndrome, it's important that when we look at the definition of syndrome, a syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. Now, this is super important because it is a syndrome. It's not a specific disease. So people say, well, I've got chronic fatigue. It's like, well, what does that actually mean? What symptoms do you have of chronic fatigue? Are you sure is chronic fatigue and that's actually an appropriate diagnosis or is there something else and more to the story? Now, chronic fatigue syndrome, it's going to impact females more than males. Um, but it does impact both. Now there's going to be a lot of issues that we are going to see with it. Now you should have had this for six months or longer, and you should have rolled out some of the obvious things, which we'll talk about those, but you know, iron deficiency, blood sugar issues, blood pressure issues, diabetes, and things like that. So now. This is all from a research article called Myalgic Encephalomyelitis, Chronic Fatigue Syndrome, The Biology of a Neglected Disease. So I thought that was interesting that they called it neglected disease because a lot of people are diagnosed with it. And then from that point on, they kind of feel gaslighted, which we're going to talk about why they feel that way and then what can be done about it. But whenever we look at chronic fatigue syndrome, we see a constellation of symptoms. You know, we see a lot of neurological based issues. So directly neurological impairment as well as autonomic dysfunction, which once again is neurological. We see gastrointestinal problems. We also get musculoskeletal based issues, the pain and post-exertional malaise. We have respiratory based issues and immune system based issues. Now, one of the things that it says is ninety five percent of myalgic encephalomyelitis or chronic fatigue syndrome patients have worsening of symptoms in the upright position. So when they go from laying or sitting to standing. And that's why when you look at this, you see POTS, which is postural orthostatic tachycardia syndrome. You know, there's a big overlap in the symptoms. So if you've been diagnosed with POTS, you're like, man, this looks just like me. and at the end of the day there is tremendous overlap and it's why you can actually use pretty much the same approach to treat pots as you would chronic fatigue syndrome because once again pots is a syndrome as well it is not a specific disease it's got certain things you're looking for and that's how you make a diagnosis same thing true with chronic fatigue syndrome but There's not a defined, this is the only process that occurs to cause it. We are going to discuss, you know, we saw all of those different systems of the body that impacts. We're going to look at what actually drives this syndrome and why it is hard to get better because a lot of people, you know, if you actually look at that research, they'll say it's five percent of people diagnosed will actually get back to where they were before they had it. Now, personally, I don't know that that's fully true in my clinical experience, but You know, if you do the regular treatment, then yeah, I definitely believe it. But maybe that's my biased opinion as I get people who've done the regular treatment. They've done even a lot of stuff on the natural side. So when we look at it, we have to say, what causes this syndrome? Now, that's the super important thing is what causes it? So we look at this and there's research on pathogens. So pathogens are going to be different viruses, bacteria, fungus, and even parasites. And when we look at the different viruses, we've got Epstein Barr virus. We've got SARS COVID, right? You've got different herpes viruses. You've got Lyme and its co-infections. You've got mycoplasma pneumonia. You've got cane data. So you've got a wide range of pathogens that can contribute to this. Now, one of the big things especially when we talk about epstein-barr virus is most of the population has a response to epstein-barr virus now there's a group that has reactivation of epstein-barr virus but the question is just because you have reactivation does that mean you have to kill epstein-barr virus or You have to identify why the immune system got weakened in the first place. And that is what allowed Epstein-Barr virus to come back out and play. So if you think about Epstein-Barr virus, like you do cold sores or shingles, your shingles or your cold sores, it never goes away. You just don't notice it because it lives in your nervous system. But when you get a period of stress, lack of sleep, you get sick, other things like that, now all of a sudden you can have the sores or the shingles comes out. And well, what's the best way to prevent it? While some people are doing antivirals to try to prevent viral replication, others would say, well, what are the things that are inciting or contributing factors to this? And let's identify what that is, treat it, and then see if you need anything beyond it. And this is where it's super important to work with a qualified provider who knows how to really differentiate between that and can bring you down the right path. I can't tell you how many people I've seen who are on this kill mantra for a year, two years, three years, when they didn't actually need to kill. They just needed to really support the immune system in a healthier spot. Next, we know that one of the hallmarks of chronic fatigue syndrome is neurological-based issues. Dizziness, brain fog, word finding, memory, concentration, also all the dysautonomia. Now, this is looking at it predominantly from a body to brain influence. So we see elevated inflammation and immune response in the periphery. So periphery is going to be anything outside of the brain. This gets elevated and ultimately can cause damage to what's called your blood brain barrier. Blood brain barrier is supposed to protect what comes into the brain and what leaves the brain. When those inflammatory chemicals come in, it ultimately activates the immune system in your brain, those cells known as microglial cells. When they activate more than they should, they become highly inflammatory and this does damage. And ultimately, you can end up with more of a immune-based or a chemical-based injury to your brain from the inflammation. And we see this a lot specifically with infections where people have had the flu, they've had COVID, they've had Lyme, they've had other things like that, even mold, toxicity, where it drives inflammation in their brain and they feel like they got hit in the head with a bat even though they never got hit. But despite that, They've got word finding, memory issues, concentration, mood issues, and other things. Now, it's important to realize that this drives inflammation in the brain. And when you dysregulate the brain, you change the output from the brain to the rest of the body. So the brain doesn't live in isolation and the body is connected as a whole. So your brain should be firing down to regulate blood pressure, heart rate. intestinal permeability, digestive enzyme release, stomach acid, pH, release of part of your immune system from your spleen known as your monocytes, your macrophages. And it's also anti-inflammatory when it does it through different receptors that we're not going to go through. Now, this is looking at it from a gut-based issue. So at the very bottom, we see managing cephalomyelitis and it's got different bacteria. Now, when the bacteria populations become abnormal in balance, it ultimately creates inflammation within the gut. This inflammation in the gut can disrupt the gut barrier. So this is where you hear a leaky gut or intestinal permeability. Whereas on the other side, it talks about, well, what happens if you get the gut bacteria back into a healthier state? they're able to produce what they should so they put anti-inflammatory butyrate so butyrate is what's called a short chain fatty acid and it's the most important short chain fatty acid for our colon and intestinal health because it helps to maintain our intestinal barrier it also helps to down regulate or reduce the amount of pro-inflammatory cytokines so cytokines basically a signaling molecule and as a result also has a big influence in the brain which we are not going to go into the benefits of butyrate on the brain but that is something to consider now when we also look at this right it looks at infection or we could also put other things in there right even someone who's diabetic who goes through a lot of stress doesn't get as much sleep as they should who's you know has autoimmune disease we can put them all there where it has infection This drives an inflammatory response that, as we've talked about, inflammation in the body doesn't necessarily stay in the body. It can get into the brain. But not only that, the inflammation from that, it can create dysbiosis. Dysbiosis is an imbalance of gut bacteria. And as we've briefly talked about, it disrupts the balance of of your main species or families of gut bacteria, impact short chain fatty acid production, leads to intestinal permeability, leads to inflammatory byproducts such as lipopolysaccharide, which is going to negatively impact the brain. And other things to consider is that stress is going to drive abnormal responses within the gut. But it also has NSAIDs because lots of people with chronic fatigue syndrome, they often are dealing with headaches. They often deal with muscle soreness or joint pain. But NSAIDs also can drive gut permeability and leaky gut. So there's downsides to that. Now, when they're looking here at therapeutic options, we'll talk more about this later, but you've got prebiotics, probiotics, fecal microbial transplant and then you also have nutritional changes and then this one here which is we're just going to wrap it together right so with myogenic cephalomyelitis chronic fatigue syndrome you can have an infection once again whether it's covid whether it's the flu whether it's mycoplasma pneumonia whether it's mold toxicity whether it's artinella babesia you know those co-infections of lyme This ultimately can create intestinal dysbiosis, which leads to gut permeability, which allows inflammatory molecules to leave the gut, enter systemic circulation. The circulation, ultimately, because everything's connected, it gets in the brain through a breach of the blood-brain barrier, creates neuroinflammation, and it's a revolving door. It is a revolving door where everything is basically on fire. Autodrive. And we're not going to go into all of the components here, right? We're once again, short chain fatty acids. Um, you are called the kind of renin quinolinic acid, which we're not going to go into that, but you know, you've got a lot of things here and you just see it's a revolving door. And some people, you know, it doesn't have to be an infection that starts this, right? You can have head injuries that lead to intestinal dysbiosis, gut permeability. That's known. You can have a stroke that does it. Okay. So there's a lot of different things here at play, which brings us to, well, what does the traditional treatment look like now? This is back from that original research paper. And I was kind of shocked they have this much on there because my experience of treating people with chronic fatigue syndrome, they've haven't got this from traditional medicine. So this must be from a different country. Um, Okay, because this is not what traditional treatment looks like here in the United States. So they've got it broken down in a pharmacological versus non-pharmacological. And you're seeing though, everything is really based upon the symptoms an individual is dealing with. So headaches, right? Traditional basis is saying, well, take your ibuprofen, take your Tylenol, take your Excedrin Migraine. Now let's go into your migraine meds, Sumatriptan, Ertec, and other things like that. You've got gut issues, right? You've got diarrhea, boom, take this. You've got constipation, take Miralax. You've got chronic fatigue. They're really using stimulants, okay? Adderall, Vyvanse, Modafinil. Sleep issues, once again, meds, even melatonin, it's got there. But honestly, I don't really see regular providers ever even tell people to take melatonin, which is a shame because melatonin does have a role in the immune system. And it's cheap, it's safe. And, you know, side effect profile compared to meds is nothing. You know, we get a lot of medications with pain. And the thing is, you know, a lot of the medications that are used from pain to headaches and all this stuff is it comes with its own side effects. So individuals with chronic fatigue syndrome are already dealing with fatigue and brain fog and word finding and memory and concentration and dizziness. But a lot of the medications that are used, they all have those side effects. And so a lot of people are frustrated. They're not getting better. Now, there is a little bit of this where we look at some of the non-pharmacological that you see mostly in those that are pots where they will do the electrolytes. They tell them, hey, you do salt tablets. You just need to increase the salt intake and then compression socks. But that's about it. And we're to come back to this in a moment, but that is what traditional looks like. Short office visits, medications, completely based around the symptoms of what's going on and people end up on multiple medications and what they didn't put here. And I think they should, um, I guess they've got up there in pain, but it's not used for pain. they ultimately all end up with depression anxiety diagnoses in my experience and they usually come on on a cocktail of mental health meds which do they really have mental health issues or is it because they feel like crap because no one understands them and they're struggling to get better and unfortunately that is what the insurance model is covering for stuff like this and in the united states Anyone that's dealing with chronic illness and it's no surprise, insurance is horrible. Insurance is completely horrible with chronic illness and it doesn't do the job. It's good for life-saving surgeries. It can be great for the emergency room, but with chronic disease management, it falls woefully short. And that's why all the leading clinics, they don't take insurance because insurance would say, what are you doing? And here, is what we're going to go into next, is what does that actually look like? So first, what is functional medicine? So we spent a bit of time looking at what are some of the processes that go on to contribute to chronic fatigue syndrome. And as we looked at, right, you can have neurological-based issues, you can have gut-based issues, you can have infection. Well, regular-based medicine is going to say you have an infection, here's your drug to kill it. Whereas functional medicine is going to say, well, you know, you keep getting these herpes cold sores outbreak. What is going on in your life that's making your immune system weak and susceptible? So functional medicine at the end of the day is a root cause to say, what is the underlying process? So let's use headaches as an example. You go to a traditional medical provider. You tell them you have headaches. They're usually going to say, Okay, well, you know, have you taken ibuprofen? Have you taken Tylenol? Yes or no? Well, then do this. A functional medicine provider is going to say, well, what are things that contribute to headaches? How is your sleep? How is your posture? How is your blood pressure? How is your blood sugar, right? How is your nutrition? How is your exercise? How is your weight? They're going to go through a lot of those factors to decide which ones are working for you and which ones aren't so it's all about identifying what is driving a process and to stop what's driving it versus traditional medicine unfortunately is more based upon saying well we don't really care about what's driving the process even though it's really sad because the researchers have done a beautiful job of researching a lot of this and people obviously like well I don't know functional medicine you know I mean it just seems weird well we take the underlying processes that go in the body and we say what's driving this versus once again traditional medicine is saying where's the end point so there's a big philosophical difference even though we can study the same research but the point we take to use is different now there are differences from one functional medicine provider to the next that I'm going to briefly cover So I've got what I call the four different types of functional medicine providers. Number one, this is the functional medicine marketer. Functional medicine has become a lot more popular over the past few years. And individuals are putting on their website, putting on their business cards, or even on their signs that they are a functional medicine provider. While that's true for some, others, they don't do any functional medicine. Maybe they do weight loss meds. They don't think taking supplements is a waste of money. They think nutrition is important, but they don't go in depth with any labs. They don't really understand the processes, but, you know, they do like the concept. And so that's what I call the functional medicine marker. Number two, this is the functional medicine dabbler. they've went a little bit further they're excited they've signed up for some courses through places to learn about what these processes are they're doing a little bit more lab so you're getting your vitamin d you're probably getting high sensitivity c-reactive protein you may be getting a more expanded thyroid panel just beyond a tsh and a t-four but they don't really understand it in depth they don't have a lot of true experience they do some basic supplements But they kind of just give everyone the same basic things because they're just, you know, they're learning, they're excited. And that's where they're at. Number three, this is what I call the functional medicine extremists. These are the people who, when you walk in their office, you're guaranteed to spend two to four thousand dollars in labs. Every single person comes in, they're going to do the same labs on everyone. This isn't the same initial three hundred dollars worth of labs to get a good initial picture and then decide how to progress from there. No, these are the people who say, I went to courses and I think a lot of the stuff is cool. So let's run urine heavy metal, urine mold, urine environmental toxin. Let's run stool testing, urinary hormones, right? They're going the gamut and they're running everything. And then when people get treated, they're trying to treat it all at once. And people ultimately come in on twenty bottles of supplements. some of them have done okay but obviously if they're coming in and seeing me they have not done okay and they are on overkill and they are on burnout and then lastly number four this is the functional medicine expert or the ninja this is the individual who's been in functional medicine for a bit and they understand that functional medicine is about understanding the underlying root causes They also understand the importance of a evaluation and history. When you're talking to them, in their mind, they're already piecing together the pieces of your puzzle. That way, whenever they make lab recommendations, they're going to make it as targeted for you as possible. So you may get mold testing, or you may get infection testing, or you may get a stool test. But it's rare that they come out and say, hey, you know what? I just want to run these six specialty tests on you up front. Now that may happen if you have Parkinson's disease, dementia, other things like that. But for most things that are coming in, that is not the case. Then when they get your results, they're going to prioritize and say, what are the main contributing factors? How does it overlap? Let's be targeted for that. They're not going to treat everything because they understand that as some areas improve through treatment, Other things that haven't directly been treated will actually still improve. And then we'll actually talk about the fifth type of functional medicine provider at the end. And this is the most rare type of functional medicine providers by far. But those are the four main types, and that is how they differ. So if you are looking for a functional medicine provider, please go look at their websites, look at their social media, interview them before you go in, even if you have to pay a little bit, it's worth it. because you want to make sure you've got someone who truly understands the process and is going to be able to walk you through what you need. So what exactly does functional medicine treatment look like for chronic fatigue syndrome? As we talked about, there's a lot of issues that go on. We know there can be GI-based issues. So this is a brief example of two different individuals still testing. Oh, I guess I made a mistake and picked the same one. But we look at short-chain fatty acids. So some people have low butyrate. Others don't. Calprotectin, that's an inflammatory marker. Zonulin, secretory IgA, beta-glucuronidase. So there's a lot of things in here that give us a good idea of what's happening in the gut. There are some people who have bacteria, viruses, or parasites that have to be dealt with. And you could generically try to treat everyone with their gut issues, or you can do stool testing and be more specific. Since doing this test, I've been way more targeted. I know if I'm going after a parasite versus a bacteria versus I don't need to do any of those. And I just need to focus on certain bacteria strains. There are some people who say you have low butyrate and want to give you a butyrate supplement, but there are also bacteria. It's their job to produce butyrate. So this is kind of where we go in the hierarchy of providers, right? So if you have low butyrate production because you don't have the right bacterial composition, the functional medicine expert at Ninja, if they give you butyrate, they're going to let you know, hey, this is kind of a short-term thing because we're going to get you going on the right probiotics. to naturally increase your body's production but they're also going to talk to you about make sure you get good undigestible fibers things that can be used as prebiotics because ultimately that is what your gut microbiome uses to make short chain fatty acids so that's one example next mold is another big thing so mycotoxins which are produced by molds are a big contributor to chronic fatigue syndrome and pots once again not every single person with mold will have those issues and not everyone with chronic fatigue syndrome will have mold issues my preference is to look at the immune system based testing to say what is that response through both an ige and igg based response now this is still debated in the functional medicine space but I do think it is swinging more to the immune system versus those that are doing urinary-based tests. I don't consider urinary-based tests accurate because it tells you, here's what you're excreting. So if you, and which it kind of goes against what functional medicine has believed for the longest time. An example, if you have ten people in the room where someone's sick with the flu, well, all ten people are exposed to a flu virus, but yet only one person gets it. Why? Understanding the why is functional medicine. Well, it's because of their immune response versus the others didn't get it. And it's because they had a different immune response. So looking at urine would be like saying, well, they all got exposed. Well, yeah, exposure, I mean, it matters, but it's not as important as the immune system test. So if I'm doing urinary mycotoxin test, which I really don't do, it would only be after I know someone has an immune response to it. And that's when I would then do it. So mold is another test that can be considered. Next, we have different blood tests. So this is a specialty blood test that looks at intestinal permeability, damage to the intestinal lining, as well as an inflammatory compound known as lipopolysaccharide that can enter into the systemic circulation and can create a lot of issues. So if there's problems with this, it kind of lets you know what you need to do. and it should be known that you don't have to have digestive based issues or gastrointestinal based issues or you have an abnormal test of your stool or this so that's really important to know because a lot of people say well I don't have any issues I think I'm okay I've had some people I've actually been the most shocked where they didn't think they had issues and their results were off the worst And so when we treated it, they then improved and got better. Next, we can do immune system-based testing because we do know the immune system gets thrown off with chronic fatigue syndrome. When most people get an immune system-based panel done, it's just their CBC. It's a five dollar test. They get a red blood cell, white blood cell, lymphocytes, neutrophils, monocytes, vasophils, eosinophils. But you'll see what this test does. It actually does your white blood cells, lymphocytes, and then it breaks down your lymphocytes into T cells, B cells, and then it further subdivides all of your T cells into different phenotypes. And this is not the whole test. Now, this test has its value, but it also has its limitations. It tells us which way the immune system is being swung, but it doesn't tell us why it has been pushed in that direction. So if it is done, It is good to know certain things, but I also don't use it as a end all be all. The other thing is this is looking at what's floating around in your systemic circulation. There's a difference in your immune response in tissues versus your systemic circulation. So for example, right, you may have swollen lymph nodes that if we stuck something in your lymph node and we did the same test, it would look different than if we took it from your blood. it's important to understand that if this test is normal it doesn't mean everything is normal it just means what it was meant to detect and and I do want to say I get it there's a lot of stuff that we're talking about this can be confusing and that's why it's important to work with someone who knows what they're doing because the wrong provider is just going to run all of these on you at once and it just leads to massive confusion if I heavily think it's something versus another, I just lean into that test because mold can cause these issues. Gut issues can cause these issues, right? So sometimes if I suspect that, I will actually do that before I ever do an immune test. But if I'm not sure, I will kind of do an immune test first on others to decide which way I should go. So when we come back to this approach, well, We've already looked at the pharmacological, which is mostly what traditional medicine does. Whereas functional medicine is going to not necessarily do all the non-pharmacological stuff, but it is going to look at, well, what's happening with the food you're eating? You know, should you make nutrition changes? Should you do fasting? Do you need to make sure you're prioritizing your sleep? Maybe you need to do neurofeedback, biofeedback, massage, chiropractic. should you do breath work which is getting really big in the functional medicine space should you do vegas nerve stimulation which once again is getting very big in the functional medicine space over the past couple of years right so we are seeing more and more things but at the end of the day it is blending lifestyle things with the labs and targeted nutritional supplements so the supplements in a good functional medicine provider's office are not meant to make up for the lifestyle factors that is the functional medicine extremists the marketer and the dabbler they're using the supplements to compensate for everything whereas the functional medicine expert in ninja they're going to let you have it if you're not making appropriate nutrition changes not prioritizing your sleep not getting the exercise you need and everything else because they understand that Those are the foundational aspects of health. And the supplements build upon it. They're not made to replace it. Now, for as good as functional medicine is, functional medicine has a major blind spot. And that is the brain. Now, they will talk to you about brain health. They will ask you about your brain-based symptoms. But, The evaluation is usually devoid of the brain. The brain is never evaluated pretty much ever beyond symptoms, maybe a cognitive test, maybe they send you for imaging, but that's it. Now, there are four things that healthy brains have in common. One is that they connect appropriately and efficiently. Number two is energy production utilization, good mitochondrial function. Number three is healthy immune system function, appropriate inflammatory levels. Number four is good vascular supply, good blood flow and oxygen. Functional medicine does most of these really well, except number one, which is connectivity. There's nothing that they do to evaluate how well the brain's connecting or to treat it. And This is where individuals come in and they see me or some of the other providers who have more of my training, where we are both functional medicine and this other side is called functional neurology, which really should be more of just a subset of functional medicine because we do care about how the brain's functioning and connecting Because I can tell you my experience. You can give someone all the supplements. If their brain is not connecting appropriately, they will not get better from their chronic fatigue. And real quick, the simple reason is your brain uses more energy than any other part of your body, period. So, twenty-five percent of the entire body's calorie intake. And that's if it's healthy, if it's unhealthy, it's not going to be efficient. It's going to burn through things poorly. And now the more you do, the worse you feel having Conversations makes you worse. Driving in cars can make you worse. Emails, watching movies. And if you've got chronic fatigue syndrome, a lot of this stuff sounds familiar. And it can be due to abnormal connectivity within your brain. Now, this is where what we go to next is absolutely critical. There are those who, if you fix their inflammation, their mitochondrial function, those symptoms that we talk about, they improve and they get better. But there are others who it does not get better, no matter how many supplements and how well they optimize everything else. And this is why up front, I think everyone should have this evaluation because one, it's easy to do. Two, if it's an issue, we know how to fix it. If it's not, then guess what? We keep going on. But the more pieces of the puzzle of what's driving an underlying process, the more certain we can be when someone gets helped. The less pieces of a puzzle, the more you have to guess and the more you have to give more credit to something than it maybe deserves. So this testing here is called video oculography or video nystagmography. Someone wears goggles and we record everything that their eyes do because your eyes are a reflection of the health of the brain. When we look at eye movements, it tells us about numerous different pathways and connections between your optic nerve to your occipital lobe to your temporal lobes to your predal lobes to your frontal lobes down into your mesencephalon to your pontine area to your integrators that live in your pons in your mesencephalon to your cerebellum and more okay so there's a lot of relay stations that have to occur for eye movements even though it may seem simple it's anything but and that's why Eyes are one of the most profound things that we test. So here, this is a test known as smooth pursuits. An individual's following a target that's moving nice and smooth. Now, what you notice if you're watching this through YouTube, and if you're listening to this, I encourage you to go and watch this. These eyes are shifting as they're tracking, okay? It is not nice and smooth at all. So this is a breakdown in the pathways and the networks responsible for this movement. In my experience, if someone has a breakdown in their eye movements, and now it doesn't have to be everything, but if they have a breakdown in their eye movements, and by the end of the testing, they say, wow, that made me have more symptoms, whether it was headaches, neck pain, nausea, dizziness or just more fatigue or fog, then I know with a very high level of certainty that when we fix it, they're going to feel a lot better versus someone who they ace the testing and they feel bad. You know what? Usually if we treat it, they don't feel a lot better. Sometimes they do, but it's not as predictable. So that is one thing. Next, it's looking at balance. So balance is a big issue with many people with chronic fatigue syndrome as well. We need to look at both eyes open and eyes closed on a firm surface as well as a perturbed surface. What happens on the perturbed surface is the most important. That is that vestibular component. This is what you see with someone before and after care. So they went from abnormal to rock star status. Now it is important to note that with chronic fatigue syndrome, because there tends to be a lot of muscle weakness, I don't put a ton of stock into the balance test if it's the only thing off. If both the eyes are off and the balance is off, then I lock it in. But if it's just the balance, I keep an eye on other things because just immune system dysfunction and mitochondrial dysfunction cause abnormal balance results through weakness. Not necessarily due to vestibular dysfunction on its own. So we've got to make sure that when we look at this, we take this as part of a picture. And this is why seeing the fifth type of functional medicine provider, the functional medicine who combines with functional neurology is so rare because with the amount of pieces that get looked at, now we can be much more predictive of what can happen. Now it should be known that there are providers that just do functional neurology who are not going to look at the functional medicine side. So then that whole side becomes a blind spot too. And the most predictive results are going to come when you work with someone who actually understands both sides. So whenever we look at this, it's important to understand that everything in the body influences the other parts of the body. So your body impacts the brain. Your brain impacts your body. Your brain impacts your gut. Your gut impacts your brain. Your immune system impacts your brain. Your brain impacts your immune system. All of these things go round and round, and it needs to all be evaluated, not just your favorite part. Now, the evaluation isn't necessarily always you have to order a bunch of tests. You need someone who's able to help you hone in and focus where you should focus. I like asking patients, what are the three to five things that if you do it, it makes you feel better? what are the three to five things that you do if you do it it makes you feel worse with that based upon what people tell me I know is it more neurological is it more immune because at the end of the day when I look at chronic fatigue syndrome those are usually the two underlying buckets if I had to bring everything together it's neurological and immune if I had to put a third it'd be mitochondrial dysfunction but know a lot of people like well what about the gut well I put the gut underneath immune system so there's a lot of umbrellas where things can go underneath but it's getting all of those piecing it together lets you know where you need to be so for example if someone tells me well every time I have a menstrual cycle or I get stressed or I'm getting sick frequently then I may say well This is inflammation and immune mediated response versus someone who's like, well, I mean, I get a little bit of issues with that, but what I find is driving in a car, being in a busier environment, being on the computer, that is what destroys me. Now that's telling me way more neurological, but in the end of the day, it's about looking at a variety of different metrics and markers to identify the patterns. And the more things that can be identified, the easier it is to identify the pattern that needs to be addressed for an individual. Upfront, everyone should be evaluated as fifty-fifty. But the testing then says, hey, maybe you are actually seventy percent immune system, thirty percent neurological, or maybe you're seventy percent neurological, thirty percent immune. And this is super important because if you don't know which part of the process should get the most attention, If you do the right thing in the wrong order, you don't get the results you're looking for. So if you think about like cooking, doing too much, too little doesn't give you the outcome. Also doing things out of sequence also doesn't give you the outcome you would like. And this is where working with the ninjas and specifically the ninjas who combine functional medicine with neurology is the most important thing to do. But even just a regular functional medicine ninja can be a great place to start off. if you feel you're stalling and you're not getting to where you need to be whether it's three months or six months down the road then it is worth considering and getting that neurological evaluation up front because it does allow more predictability for what needs to be done because there's nothing worse than getting a year or two down the road and finding out that you bombed the neurological testing and have that been addressed you would have been better in three months But now you're once again, you're a couple of years down the road and it's like, yep, that's why nothing worked because this part was completely ignored. So to summarize, Chronic Fatigue Syndrome is something that impacts many, many individuals. And people struggle to get better with chronic fatigue syndrome because they don't exactly know what needs to be addressed. It's very complex. And having the right provider work with you is going to make all the difference. I hope you found all this information useful. If you have questions or comments, let me know. Comment on these videos. or in the podcast as well, because we will use this information as we make further videos. I also bring in experts in the field to talk about a variety of topics. And this was more of a surface level discussion of mold, different infections, gut health, and other things like that. And based upon the comments is where I will go deeper in those areas. And we will literally spend forty to sixty minutes on just isolated topics versus going more surface level.