The SHINE method for Fixing Chronic Fatigue with Jacob Teitelbaum, MD

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Content By: Ari Whitten & Jacob Teitelbaum, MD

In this episode, I speak with Jacob Teitelbaum, MD – one of the world’s most frequently quoted integrative pain and fibromyalgia medical authorities. He’s the author of 10 books, including the new edition of the best-selling From Fatigued To Fantastic and the popular free smartphone app Cures A to Z. We will discuss the SHINE protocol and how you can go from Fatigued to Fantastic.  

Table of Contents

 In this podcast, Dr. Teitelbaum and I discuss: 

  • The current world climate and how it affects our health
  • Should I exercise when I have CFS?
  • Thyroid hormones – how they affect your health
  • Long-COVID can you overcome it?

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Transcript

Ari: Hey, there. This is Ari. Welcome back to the Energy Blueprint Podcast. With me today is Dr. Jacob Teitelbaum, who is one of the most frequently quoted integrative pain and fibromyalgia medical authorities in the world. He’s the author of 10 books, including the new edition of the best-selling From Fatigued To Fantastic and the popular free smartphone app Cures A to Z. He’s the lead author of eight studies on effective treatment for fibromyalgia and chronic fatigue syndrome.

He appears often as a guest on news and talk shows nationwide, including Good Morning America, The Dr. Oz Show, Oprah and Friends, CNN, and Fox News Health. You can follow his work at vitality101.com and entity.com. This is a wide-ranging episode covering a lot of territory from general fatigue to the specifics of post-exertional malaise and chronic fatigue syndrome, to supplements, to post-COVID syndrome or long COVID and effective treatments for that and some of the latest research that Dr. Teitelbaum has been involved in over the last couple of years. I think you’ll really enjoy it and get a lot out of this episode, so enjoy. Welcome back to the show, Dr. Teitelbaum. Such a pleasure to have you again.

Dr. Teitelbaum: Ari, it’s always good to be with you.

The current world climate and how it affects our health

Ari: Yes. First of all, let’s talk about why there is, in your words, a perfect storm for people suffering from chronic fatigue these days. What’s going on in our world? Obviously, COVID is a new layer to that story. What is this perfect storm that you talk about in your work?

Dr. Teitelbaum: Well, if you take a look at food processing, which includes 140 pounds of sugar per person added into our diet each year, white flour, basically, half of the vitamins and minerals are removed in food processing. The diet just doesn’t have that much left over to give us what I need. Virtually every American out there is vitamin and mineral deficient. Simple things like sleep, the average night’s sleep until light bulbs were invented was nine hours a night. Now it’s six and three quarters. That’s a 30% pay cut. Our immune system has to deal with 85,000 new chemicals in the environment.

Meanwhile, the speed and stress of life has increased. When I was a kid the media advertising mantra was ‘sex sells’. If you wanted to sell something to had good-looking girls, good-looking guys sitting there right next to the car or the beer or whatever it is you wanted to sell. The current media mantra seems to be fear of divisiveness sells. If they can scare you to death and make you hate half the population, they’ve done their job because that’s good for business. I like fiction. I like fiction as much as the next person. I read a couple of 100 pages of fiction today. I prefer my fiction to be labeled ‘fiction’.

I don’t care which side of the aisle you’re reading, whether it’s the right or the left. My politics are that the right-wing and left-wing are part of the same bird. A healthy society will have 40% of people who like stability, 40% who represent change, and a pendulum 20% in the middle. That’s how it should be. That’s why it is that way all over the world throughout history. This whole thing is like a tree with the roots of the tree the stability, and the branches of the trunk of the tree, and then the leaves and the flowers and everything else can change. Right now we have one half of the tree trying to cut off the other half on both sides. It’s crazy.

There’s this tai chi move I recommend when you’re watching the news or listening to the news, and you find yourself grinding your teeth and it just feels really bad is to take take a big breath, center, reach out to the side, grab the remote control and hit ‘off’. Your feelings will tell you. These are all nice people on both sides out there. It’s just this is what the job is these days. Mark Twain put it very well, “If you don’t watch the news you are uninformed, but if you do watch the news or read the news you’re misinformed.” It hasn’t changed. If you want to help your energy skyrocket, and you’ll be amazed at how little you’re missing, because anything that’s important, you’re going to hear about anyway.

It’s just all of this other nonsense that they’re making up. Just turn it off. COVID is one more example, that COVID, an important virus, important to be cautious, but they’re not teaching caution and they’re not teaching what to do. They’re trying to scare people to death. It’s like during the Nazi Germany when they packed up Britain with tons of bombs, they had the bombings. It would be the equivalent as if Winston Churchill was going, “Panic, everybody, panic, panic, panic.” People are saying, “We can hide in the airway shelters.” “No, there’s no proof that that works.” It’s like I was saying, that this is a media approach today. Turn it off. You will be amazed at how much more energy you have.

This is the context for why 31% of adult Americans not just have fatigue but have severe fatigue, almost everybody would want more energy these days, and why 2% to 4% are just totally out of the game. They’ve tripped a circuit breaker called chronic fatigue syndrome and fibromyalgia. All of these are easy to treat. If I can give you a simple way in one minute to double your energy. There’s just all kinds of things. This is very easy to take care of if you know what to do.

Is exercise safe for people with ME/CFS

Ari: Okay, in your book Fatigue To Fantastic you talk about the shine protocol, S-H-I-N-E. What does that stand for? What is this all about? What results do you get?

Dr. Teitelbaum: Well, the key to optimizing energy is S is sleep, H in shine is hormonal support and optimization, I is infections, N is nutritional support, and E is exercise as able. For most people, a good party healthy exercise program. For people with chronic fatigue syndrome or fibromyalgia, some can only do 50 steps in a day without getting what’s called post-exertional malaise, so it’s as feels good. A simple way to begin, if you want to double energy, we’ve just finished our fourth study on looking at people with the most severe fatigue, including those with post-viral fatigue. We had a series of four studies in the last two years.

Ari: Okay, let’s get back to exercise, I want to talk about this a bit more because among people with MECFS exercise is a controversial subject. There’s a segment of people in that world who really reject the idea that exercise is helpful. They insist exercise is harmful to them. It creates post-exertional malaise. If they do even a little bit of exercise, it’s bad for them. They even, in some cases, attack people who are recommending exercise as being irresponsible, and so on. They’re just vehemently entrenched in the position that exercise is universally bad for people with MECFS. Have you encountered that type of thinking before? What comments do you have on it? Or do you have any rebuttal to that position?

Dr. Teitelbaum: I’m not going to give a rebuttal. I’m going to give understanding to both sides. You have to understand, their concern was not about exercise for conditioning. Their concern is that there’s an economic movement in the United Kingdom that tried to invalidate the OMUS. They would go on and say they really sick, but no, they’re not really sick, just give them exercise and cognitive behavioral therapy, but cut off any other treatment. Put them in insane asylums if they even go overseas to get treatment, or if they get treatment for the children besides cognitive behavioral therapy and exercise.

Arrest the parents. They literally were arresting parents and putting the children in insane asylums, because they tried anything besides those two. The cognitive-behavioral therapy as a graded exercise program were not used as a means to go ahead and add something to help conditioning and to help the mind-body component. It was, basically, an abuse of attack by well-meaning people who wanted the business all for themselves.

Sorry, but this is the simple politics of the thing. They were denying people their health insurance benefits. They were denying people disability benefits. The insurance companies are happy to go, “They’re just crazy. We don’t have to pay them. Good going.” They published a couple of studies. They were some of the biggest piece of crap studies ever done in human history.

Ari: Is that a technical scientific term?

Dr. Teitelbaum: Yes, it goes right after the p-value. The p-value is just a piece of crap. They were horribly done studies. They were used to, basically, abuse people in the community. These are nice people, they are not bad people. If you’re a psychiatrist, and you’re saying, “Everybody’s got heart disease, you got that. You got that for your neurology thing or for MS. We want ours and this population is ours, damn it. Whether they like it or not.” Since you’re painting one picture on one side, I’m going to paint the picture on the other side. [laughs]

Ari: Yes, absolutely. That’s important. What you just described created this response amongst some people to insist, “No, this is real. This is not just something that’s solvable by doing exercise.”

Dr. Teitelbaum: Yes, and they attack. What do I find in real life? People have a certain amount of energy, and they can use that energy to condition. Most of us can make much more energy to condition than we actually go out and exercise, so there’s not a limit really to our conditioning in real life for most of us, if we just get off our behinds and go for a walk and go for whatever. The problem is that the energy production is very limited in CFS and fibromyalgia. Instead of conditioning beyond a certain point, that they crash and burn. They have post-exertional malaise and are bed-ridden for two, three days. That is not hurting you. It’s not causing any permanent harm when that happens.

That’s really important to know. It will leave you wiped out for two or three days, but the thing is, if these people are afraid to exercise at all, and then they decondition, which is even worse, because deconditioning and this disease, especially with the autonomic dysfunction, is horrific. The middle path that I recommend is see how much you can walk comfortably each day if you have CFS/ME fibromyalgia, and feel good tired after, and better than next day. Slowly increase it by 50 steps a day. When you get to that post-exertional malaise then cut back 15% to 20% so you feel safe, rest for a couple of days, and then maintain that program even if it’s just 50 steps a day that you can do.

Whatever you can do, do that. What you’ll find is after eight weeks on the SHINE Protocol, which we’re going to talk about the details, your energy production will skyrocket. Our randomized double-blind placebo controlled study showed that using the SHINE Protocol, which is a comprehensive thing, there’s nothing expensive in it, so doctors didn’t hear about it, it was all low cost, people’s energy was skyrocketing. 91% of people had a 75% average improvement in energy. Then you can start to condition and you can increase your walking by 50 steps every couple of days as feels comfortable.

When you get up to 5,000 steps, you’re doing more than the average American. When you get up to 10,000 steps, which is five miles, you’re up at the optimal levels, so to speak.

The thing is, even if you can just get your way up to 500 steps a day or 1,000, for a lot of people out there that beats the hell out of being housebound and bedroom. The bottom line is, listen to your body, slowly increase and give your body what it needs to produce energy so you can condition.

Ari: I know that you alluded to this, but I think it’s worth emphasizing because of this subset of people that are entrenched in this idea that exercise is universally bad. Be extremely wary of deconditioning, because that in itself, the complete avoidance of physical activity itself creates enormous harm over time.

Dr. Teitelbaum: I think the word ‘enormous’ fits.

How hormone balance affects your energy levels

Ari: If we can jump around a bit, let’s talk about the H, hormones. What’s going on hormonally in people with chronic fatigue, chronic fatigue syndrome, and what kinds of things are you doing to correct those hormonal abnormalities?

Dr. Teitelbaum: Here’s the thing. This is an energy crisis. Your energy levels drop way down. It can be triggered by anything; infections, even poor exercise, poor nutrition, severe stress, anything that drains energy. When the energy goes below a certain level, the area in the body that uses the most energy for its size malfunctions. That’s a place called the hypothalamus, an almond-sized circuit breaker in the brain that controls sleep hormones and autonomic function. Your entire hormone system goes down. Now, the labs are geared to what’s called two standard deviations.

I lecture to 400 or 500 doctors at a time and I love Ari asked them the question, where do the normal ranges come from in lab tests? It’s like 400 deer in the headlights looking back at me like, “I don’t know.” Most of the doctors, all they do, they’d rather you stayed home and just sent them the lab results. They just want to look good lab results. If the lab results are in the normal range, you’re fine even if you’re dead. In fact, it’s fun again. In residency, if somebody died, as long as the tests were okay, you got a pat on the back and I said, “Now you did a great job, the test are fine. Too bad the person died.”

That’s really what it is. It was called dying with Harvard lights or with Harvard electrolytes. If the test looked perfect, you did a good job. Patient’s dead, too bad. The tests, the way we use testing for hormones is if you are in the lowest 5% of the normal range, it’s called two standard deviations. If you’re in the lowest 2.5% of the normal range, or the top 2.5% of the normal range, that’s 5% outside of normal, you are defined as abnormal and sick. If you were in the lowest 3% of the population, you’re fine.

To give an idea, if your shoe size, the normal range of your shoe size is 5 to 13 because that’s two standard deviations. Ari, I’m going to give you a size six shoe, you’re going to go to the shoe doctor, and the shoe doctor will check your shoe size and say, “It’s a size six. Ari is in the normal range. No problem.”

Ari: If I can interject one thing here, one little data point from the research that I’ve encountered. I don’t know if you’ve ever seen this. It’s not really a study. It’s more like a compilation of the evidence that was used to form evidence-based guidelines for physicians treating fatigue. It’s called Fatigue, An Overview. It was published in the Journal of the American Family Physician, something along those lines, maybe about 10 years ago. They talk about the four key recommendations that they’re considering “evidence-based recommendations” for doctors to treat their patients with fatigue, which are cognitive behavioral therapy, a recommendation to walk half an hour a day, antidepressants, and stimulants.

That’s pretty much all they got. Then the other part of this paper that’s really fascinating and remarkable is they talk about recommendations for tests to run with patients with chronic fatigue. They, basically, say unless there’s some indication of why you should perform some other more abnormal tests, like you suspect tuberculosis or something like that then you run a tuberculosis test. Otherwise, you do standard blood panel testing. They say in this paper that only 5% of people with chronic fatigue who go through standard blood panel testing show up with any abnormality. In other words, 95 out of 100 people have perfectly normal lab test results.

Dr. Teitelbaum: Therefore, we shouldn’t do anything for them because they’re not sick, because our tests are normal, and they have a size six shoe on. That 300-pound Texas guy who’s 6’7″, it’s a size six shoe, dammit. It’s normal, and we should not be wasting our money on this crazy little asshole. Do you get the cognitive dissonance? When we look at evidence-based medicine, we have to understand that what we’re looking at is p-value less than 0.5. It is a 95% statistical probability that’s something working. The thing is that for some illnesses, if you’re looking to look at COVID, for example, we hear over and over Ivermectin doesn’t work, Luvox doesn’t work.

It’s crazy, because what the studies show is that the last studies came out of 20 hospitals showed a 91% probability that ivermectin decreased death by 70%. The conclusion was Ivermectin doesn’t work. It’s incredibly unscientific as to religious statement, that instead of saying 91% probability, or worse, it’d be nicer with 95%. The studies are routinely underpowered. Whether something works in medicine has as much to do with how many people there were in the study as in how clinically effective it is.

Right now, what is, sadly, happening is anything that is cheap, just notice, anything that’s low cost for COVID is being attacked, because this is a goldmine for the pharmaceutical industry for whenever we get the new drugs out that are going to be very, very expensive, and we don’t want anything in the way.

Ari: Dr. Teitelbaum, you’re just a conspiracy theorist, and ivermectin is just a horse de-wormer.

Dr. Teitelbaum: [laughs] I don’t have a bias on either side except, of course, like I say, my politics is that right-wing and left-wing are part of the same bird.

Ari: I’m with you. My bias is towards scientific truth, and it’s very clear that what’s gone on in the last two years is very much opposed to that.

Dr. Teitelbaum: They’re setting up a study now at Duke University, a massive study now of Luvox, Ivermectin, and a steroid which a wrong steroid for inhaling. You look at the [unintelligible 00:19:57] “Yay, okay.” Then I looked at the study details at clinicaltrials.gov. People are being enrolled in the study 11 or 12 days after the test turns positive they’re starting their treatment. It’s insane.

Ari: Just explain that to people so they get why that distinction is important.

Dr. Teitelbaum: Well, I had COVID five weeks ago. I took my Ivermectin, my Luvox and I took some nutritional support. I had a wonderful four days reading my book in bed, and having some tea and stuff, and by day five I was healthy and back at work. Now, can you imagine if at day 12 after all of this when I was healthy and back at work and feeling great they gave me the test medicine. It would show no effect. I took the medicine on day one of the test being positive, and was feeling great for the four days, but resting. It’s called a study that is designed to fail.

Ari: Well, conversely the other side of this is let’s say you had gotten severely ill, and you were 10 days into it. I have a good friend of mine whose wife got hit pretty hard by COVID. She’s been in bed for a week. He and the kids were both fine, but his wife just had it very severely. Let’s say she’s on day 10 now. She’s already progressed into severe illness. There’s a huge distinction between starting a medication then once that condition has already taken hold already caused a lot of damage in the body, and you’ve already progressed into a severe state, not that she’s in a really severe state, but she’s going to recover fine, but let’s say she was in a real severe state by day 10, now you start the medication. There’s a big difference between that versus starting it on day one or two or three.

Dr. Teitelbaum: Yes. An analogy that is quite apt here is if you’re doing a study of fire engines for buildings that are on fire, and you purposely design the study so that we will send out the fire engines 12 hours after the fire is reported. Say you worked for builders who like buildings to burn down, and you designed the study. We sent out the firetruck 12 hours after the alarm, and it had no effect. Building was already burned to the ground, so fire trucks don’t work.

Ari: Exactly, yes.

Dr. Teitelbaum: What I’m amazed with is how that can be said repeatedly with a straight face. Anyway, the bottom line is evidence-based medicine, we have to understand what we’re calling evidence-based medicine in the United States is not scientific. In fact, if it’s something that’s placebo-controlled, it increases the accuracy of the study 30%. If it’s randomized it adds another 30%. If a large company pays for the study it decreases the accuracy 2,400% to 4,100% in the literature. Therefore, if you’re really looking at evidence-based medicine and you want to exclude things that are not randomized, double-blind placebo-controlled, then you have to eliminate anything paid for by the pharmaceutical industry.

Ari: Well, yes. Not to digress too much, but that’s highly relevant to some of the stuff that’s going on in the world right now with certain injections that are being rolled out to most of the entire world which were in fact funded by pharmaceutical companies.

Dr. Teitelbaum: Yes, and, again, I’m not against the vaccine. I don’t recommend it in children. It’s just that the science and the equation, 1 in 4 million children, this was as of two months ago, died from COVID. More people died of being strangled by their bedsheets than healthy children died of COVID. Now, children with leukemia is a different story, but healthy children there’s no acceptable risk from the vaccine given how children do fine with COVID. Therefore, there’s no way to make it work to make sense for children to be vaccinated unless they’re ill-

Ari: Yes.

Dr. Teitelbaum: –or they need to go to school. The baseline vaccine I did take mostly so I could visit my daughter in Berlin, and they let me in. Yes, I’m 31. I was born 70 years ago roughly, but I didn’t bother with the booster. I’m not going to bother with the booster.

Ari: If you don’t mind me asking, when did you get the vaccine, the two initial doses?

Dr. Teitelbaum: I just did the one. I still feel the Johnson and Johnson is better. It may not give quite as much protection, but it gives plenty of protection and it’s a much better known thing. With the exception of women who are aged 20 to 40 where there’s increased risk of clotting. In May I did the Johnson and Johnson.

Ari: In May of 2021?

Dr. Teitelbaum: Correct.

Ari: Okay, and you just got COVID five weeks ago you said?

Dr. Teitelbaum: About, yes.

Ari: Okay, not to digress too much, but [chuckles] have you seen the data on the decrease in efficacy of the vaccines, how rapidly they decline? [crosstalk]

Dr. Teitelbaum: Well, that’s why I’m telling people don’t bother with the booster, because unless you’re prepared to take the booster every two months for the rest of your life. As we see with chemo therapy, with vaccines the more doses you get, the less effective and the more toxic-

Ari: That’s right.

Dr. Teitelbaum: -over time. Again, I leave it up to each individual’s personal preference. It’s not a horrible thing either way. it’s just been politicized.

Ari: Yes, indeed. Okay, [crosstalk] I would love to talk to you for another hour about COVID related stuff, but let’s jump back to hormones. You’re dealing with an overall suppressed level of hormones. What are some of the key hormones, and what are some of the interventions you use to address that?

Dr. Teitelbaum: Number one, the thyroid which is your body’s gas pedal. Again, the blood tests are meaningless, because the tests rely on the hypothalamic function being accurate, and they’re not, so the TSH is a total nonsense test. It’s means nothing in this disease. The T3, T4 which is actual thyroid level most people are down in the lowest 4 to 5 percentile, so the doctors say they’re fine. They have that size six, or a normal income that starts at $8,000. If you have an income over $88,000 a year you’re in the normal range. Poverty is $16,000 and it goes up from there. Most people have a thyroid level of about $8,100 a year or so to speak. They’re right on low end.

How do you tell if you need thyroid hormone? Tired, achy, weight gain, cold intolerance, any two of those you deserve a trial of thyroid hormone. Adrenal, that’s just handler. Again, the test for that is not enough to be in the lowest 2% of the population. You have to be in the lowest 1 out of 100,000 to be abnormal. It has to be so low that it literally can kill you, so the level has to be over six. Most people are on 22 in the morning. If it’s under six it’s abnormal, and it can kill you. If it’s 6.1 it’s totally fine. 5.9 life threatening, 6.1 totally normal. I have several times seen the labs accidentally do two of the same tests on the same person on the same tube of blood.

They’re routinely four points apart if you do two of the same tests on the same tube of blood. 5.9 life threatening. 6.1 totally healthy. No problem if you’re bedridden even. How do you tell if you need adrenal support? Do you get irritable when hungry or hangry? That’s the best way to tell. That irritability when hungry, and if you’re a divorce lawyer [unintelligible 00:27:51], if you’re in marriage counseling, so often it’s because people have low blood sugar from the low adrenal.

If you simply give them adrenal support their marriages get a lot better, because they don’t have these claws come out whenever their blood sugar goes down. There’s a bunch of other symptoms; recurrence for [unintelligible 00:28:09] with stress, low blood pressure, just the outstanding.

Ari: I have a question on that. I happen to have done an extraordinarily deep dive into the literature. Probably I can’t imagine there’s more than a handful of people who have spent more time on the literature on this topic of the relationship of cortisol, adrenal function, HPA access function, and chronic fatigue syndromes as I have. Maybe there’s a handful, but I spent probably a good year of my life just digging through and analyzing that research. The idea that low cortisol levels are the cause along with the adrenal fatigue hypothesis has been around for 30, 40 years or so, and it was tested pretty heavily. There’s close to 70 studies that have been done around the world.

Most of these studies, basically, compare levels of cortisol between people with a fatigue syndrome. That might be chronic fatigue syndrome, or there’s other studies where they’ve looked at burnout syndrome, clinical burnout, or stress-related exhaustion disorder. There’s a few different names that they go by in the literature. They look at the cortisol levels between the people with the fatigue syndrome versus normal healthy people, age-matched, gender-matched and all that. Overwhelmingly the research supports no discernible difference.

Now, of course, to break what that means down, it means that there’s no compelling case that cortisol abnormalities are the primary cause of chronic fatigue, but there’s also a subset of people who do have cortisol abnormalities. What’s interesting is, looking at another line of evidence that researchers have tested within this realm, based on this idea that low cortisol levels could be to blame for fatigue some researchers in the past administered hydrocortisone or fludrocortisone, other type of cortisone therapies, to people with chronic fatigue.

Overwhelmingly those studies showed no benefit. In addition to that, there’s even one study really well designed, it was a randomized placebo-controlled crossover study, as good as science gets. They found that even the subset of people who had genuinely had low cortisol also didn’t receive benefit from elevating their cortisol levels via hydrocortisone. I’m just curious if you have any insight into why they would’ve found that.

Dr. Teitelbaum: A couple things. Remember we talked about this being a stress on the body that drops the energy levels and then trips the circuit breaker. The thing is that what you’re going to see is a bi-phasic pattern for cortisol, where you’re going to have with healthy people more of them will be 16 to 21 for most people who run, where with this illness it’s going to be 11 to 12 to 14, or 27, 28 from the high stress. They’re either going to be lower because their adrenals are exhausting or they’re going to be higher because they’re still facing the stress and making this chronic thing.

If they’re sitting at 28 and 16 then the average of those two extremes is 22, which is where everybody, the healthy people are. What they’re doing is instead of saying, “Let’s look at patterns of where these data points fall out,” and say they overlap, versus we’ve got most of the people in the middle who are healthy and most of the people at the extremes. Therefore, if we take an average they’re all the same.

Ari: Got it.

Dr. Teitelbaum: If you look at the early work of [unintelligible 00:32:14] and Dale of the NIH, the HPA access dysfunction was clearly shown. In my own research and in my own clinical practice, we had routinely done courses and stimulation tests earlier on, and we found that many were low. What I’m going to say, Ari, is that the adrenal fatigue is not the cause of the illness, but the illness causes adrenal malfunction and it’s one contributing factor. If you look at the doses that they’re given in most of these studies and you look at Benett’s study where he gave five milligrams of prednisone, it doesn’t work. It’s not the right type of steroid.

You look at the NIH study, I don’t want to say the guy’s name because I hate spitting, he never created a single study that was positive and anything that worked every study he did, it didn’t work. He was the only person routinely booed at conferences who was an NIH head because he never came. He never asked experts in the field. He had no familiarity with the disease, and he was the one who was put in charge when Congress forced the NIH to study natural therapies. They took the same guy who crowed that he had no experience and knowledge at all about natural therapies and they put him in charge of it. You look at the study on cortisol, he was giving 25 milligrams a day.

If he had asked anybody in the field with any experience, they would’ve told him that’s way too high a dose. It’s not going to work. You need to go back and look at those deep-dive studies and take a look at what was the scatter of the data. Was the proper dosing used? Was the proper form used? Did you see clinic effect? Don’t just look at the P value, but look at, clinically, was there a 30% increase in energy, but not powered enough to be of statistical significance? I’m going to invite you to revisit that.

Ari: Yes, they did analysis and really found no distinctions, and the theory was mostly abandoned after the early 2000s. There hasn’t been really any research in the last 20 years on that because of those negative studies, but it’s certainly possible that they’re flawed in some way. The other thing I wanted to mention about that research, something that I’ve hardly heard anyone talk about but is there very solidly in the research and it’s been repeated in many studies, as an explanation for the idea that to explain a few things, one, why most people with chronic fatigue do not have notable HPA access dysfunction or adrenal dysfunction or cortisol abnormalities compared to normal healthy people, according to the bulk of the research, and combined with the fact that administering hydrocortisone the studies on that didn’t show benefit.

There is a compelling case that low cortisol levels in the subset of people that they do exist in who have chronic fatigue of various kinds that it’s an epiphenomenon and that it’s there for other reasons. There’s a few variables that heavily influence this, but one is circadian rhythm and sleep. The single variable of being a late chronotype versus an early chronotype has an absolutely massive impact on cortisol levels and the diurnal curve.

Dr. Teitelbaum: Absolutely.

Ari: There are studies where they’ve taken just normal healthy people, not even people with fatigue or any illness, normal healthy people, you just compare morning people to night people, to night owls. Those studies show that in night owls, they have about half the cortisol in the morning compared to morning people, both normal and healthy, but massive differences in cortisol levels. There’s also studies where they’ve looked at night shift workers or taken people who are not night shift workers and asked them to work night shifts and show that that massively influences the cortisol curves during the day and we know there is also a subset of people with chronic fatigue syndrome that have sleep disorders that also heavily influences that.

Dr. Teitelbaum: I totally concur with what you’re saying with the exception, again, of– Let me go back to the shoe analogy. If I’m going through a population, I’m going through people who feel great, and I’m finding that their shoe size scatter is normal, and I’m going through people who say my shoes don’t fit, they’re going to have the same shoe size scatter. To simply take a look at that and say the shoe sizes fall out the same, doesn’t say that your size seven is wrong. You have to look at what’s the shoe size relative to the symptoms, and then if they are symptomatic, what’s the effective treatment?

Ari: Right, at the individual level.

Dr. Teitelbaum: At the individual level.

Ari: As opposed to the study where they’re taking the averages of a group.

Dr. Teitelbaum: Yes. What you’re doing is washing out the thing, because you’re including people who are not having symptoms of low adrenal or who have high adrenal and you’re just throwing them altogether. I’m going to say, clinically, what you found in our study using the comprehensive protocol, I can’t say that it was just the adrenal treatment, we did have in a randomized blind placebo-controlled study of SHINE, P less than 0.0001. There is data that as part of a larger protocol it works. We did do pre and post [unintelligible 00:38:05] there’s no adrenal suppression because of the low doses. Where in Steve’s study, he gave the 25 because he didn’t ask anybody with any experience and he had none himself.

He did see adrenal suppression. Then it was, well, we can’t give cortisol. Well, you don’t give that dose. Nobody in their right mind does that. [laughs] You need to look at the data a bit with a bit of a grain of salt. I agree, the cortisol and candida, those are the two areas where there’s the least data in support of what I’m saying. There is clearly HPA access dysfunction in the literature.

Ari: Yes, at least in a subset of people, for sure.

Dr. Teitelbaum: Right, you’ve got to go ahead and break out which groups sound like they have that component and then test them. You can’t just lump them all together.

Ari: Any other notable hormonal abnormalities, testosterone, estrogen, progesterone, things like that?

Dr. Teitelbaum: 70% of men are in the lowest 30th percentile for testosterone and many women are having estrogen deficiency. Here’s the way that you tell for the women and whether they need estrogen-progesterone. Are there fibromyalgia symptoms for [unintelligible 00:39:27] their menses? I’m not talking about PMS, but the fatigue, the headache, the insomnia, the widespread pain, the brain fog, are those worse around the menses? If so, the low estrogen and possession are likely contributing. Then a therapeutic trial of bio-identical hormone is warranted. In men, again, the normal range, if your testosterone level is 240, the doctor will tell you your are normal even if you’re 35 years old when you should be closer to 1,200. “No, you’re not the lowest 2.5%.” “Does that include 80-year-old men?” “Yes, of course.” I will give bioidentical in younger men up to 50, I will give [unintelligible 00:40:10] to stimulate their own testosterone to wake up the hypothalamic function. Older, I will use the bioidentical cream or pellets. The women I’ll use the bioidentical hormones. Those are the three main hormones. I can give you a dozen other hormones. We could spend a couple hours. Those are the three biggies.

Post-COVID fatigue treatment

Ari: Got you. Okay, let’s talk about post-COVID. You’ve become very interested in post COVID fatigue. Talk to me about that. What are your findings on the prevalence of what they call long COVID? I’ve seen several studies that have widely varying estimates of the prevalence of long COVID, anything from, I think, I’ve seen 35% down to 2% depending on how they define it in the length of time and the types of symptoms that they include.

Dr. Teitelbaum: Some go up to 50%. In real life it’s 15%. First of all, long COVID is defined as any symptom that persists, which is absurd. You need to break it into subsets. Number one, you have chronic shortness of breath or cough. If you have that, but you don’t have fatigue, brain fog, and these other CFS-like symptoms, if you have a shortness of breath, get a pulse oximeter. They’re a little finger clip device, $20 on Amazon, and see what your oxygen saturation is doing during your shortness of breath.

If it’s 96% or even 95% or higher, and it goes up with exercise, your heart and lungs are probably fine. If it’s 95%, 96% and goes down with exercise, you need to see the cardiologist or the pulmonologist. At that point, for those who had pneumonia and persistent lung symptoms, I will use something called Curamed, which is of highly absorbed curcumin and clinical glutathione, to turn off both the inflammation and the free radical. We don’t have research for this. It’s too early for it. The average study, that’s a randomized double-blind placebo-controlled study, that’s used for presentation before the NIH, per study the average cost is $17 billion.

Ari: It’s pocket change.

Dr. Teitelbaum: Exactly. Which, basically, means that only very expensive things can go through that protocol. What I’m using is common sense because nobody’s going to pay. If you have $17 billion, I’d love to do the study on it.

Ari: There’s a lot to be said for highly knowledgeable people, especially those with a lot of clinical experience, who know physiology really well and biochemistry really well, who are engaging in logical speculation. Based on the mechanism of how this symptom, this problem is being caused, and we know that these other things act on that mechanism. By this and this way we can engage in that logical speculation and often get great results.

Dr. Teitelbaum: When you use it and you find people get better and it’s cheap, it’s safe, then I think it’s feasible to do. I give those two. The thing for those of you who have the pneumonia and are recovering from that, is the research for this type of pneumonia. It’s called ARDS. From numerous other causes so that it usually heals itself by two years. The progression is it’s normally going to get better on its own. For those with heart disease, we have the cardiomyopathy, had the myocarditis, we have shortness of breath and symptoms of heart failure, your oxygen level goes down, your doctor will do what they can. It’s not going to be much, but there’s four things you can do.

There’s a fair bit of research looking at Ribose for cardiac, basically, systolic diastolic failure, actually coenzyme Q10, B vitamins and magnesium, [unintelligible 00:44:10] dynamic of the heart. Those four simple things, so low cost. It’s funny. I live in Hawaii and we were met this fellow. He and his wife were both [unintelligible 00:44:22] types. He was an elderly engineer. We asked, “What made you decide to come?” His wife said, “Well, the doctor said my husband has two months to live,” and there’s nothing she can do about it because he has heart failure and they’re from Alaska. She said, “You’re not going to freeze to death in Alaska. If you’re going to die, well, die where it’s warm.” So they came to Hawaii.

I told them, “You’re right. The doctor was right. There’s nothing she could do, but there’s a lot of natural things that have reasonable enough research on it. Maybe not the $17 million studies, but some that are a million dollar studies and other things.” I said, “Take those four things.” I got an email two years later, subject line, “You saved my life.” This is not rocket science stuff. There’s a phone app, Cures A-Z. That’s free phone app. You look up heart disease as one of the hundreds of things that are in it. I’ll just say here’s your recipe, and then if you have more severe, you have Hawthorne, magnesium bespartate. It goes on.

Ari: What did you prescribe to him? You prescribed d-Ribose, Hawthorne.

Dr. Teitelbaum: I didn’t do the Hawthorne, but I gave him d-Ribose, B vitamins, magnesium coenzyme Q10. Had he not responded to that, I would’ve added Hawthorne and magnesium bespartate for the aspartate component.

Ari: The aspartic acid. I actually don’t know what that does on the heart.

Dr. Teitelbaum: This is a Russian study where they gave it to people with heart failure versus a placebo group. They found a 50% more survival rate with a marked increase in function. The mechanism in the Kreb’s cycle or whichever cycle, I don’t know. It’s just that it was one of those simple studies that nobody hears about because it’s cheap stuff, but it was a double blind study.

Ari: Excellent.

Dr. Teitelbaum: There’s a lot can be done. What if you have the fatigue, brain fog, maybe insomnia, widespread pain, long COVID? That’s what I’m really calling the long COVID. That affects about 15% of people who have COVID who are symptomatic. The SHINE Protocol works very well because long COVID is this post-viral chronic fatigue syndrome. It’s the 576th type of infection. I’m pulling that number out of my arse. Basically, there are dozens of infections that can trigger chronic fatigue syndrome and, son of a gun, COVID is one of them.

MARS is one of them, SARS is one of them. All of these are doing about the same numbers and it’s going to fall out, I think, 15% if you go out six months. The SHINE Protocol works. There’s four studies we’ve done in the last two years. Now, two were on a [unintelligible 00:47:05] peptides called recovery factors, not available in the US. Available everywhere in the world besides US.

Ari: These are peptides that are–

Dr. Teitelbaum: Oral peptides.

Ari: What the name of this specific peptide?

Dr. Teitelbaum: Recovery factors.

Ari: Is it like BPC 157?

Dr. Teitelbaum: I’m not familiar with that one. It says oral serum-based bi-peptide product.

Ari: Okay.

Dr. Teitelbaum: We did one study where we took people who had low immune functions, specifically the IGG and IGG-1, the four subsets were low. We took a subgroup of those. In the recovery factors group, it went up 14%, which is quite substantial. Energy went up about 60%, cognition improved. For those of you who are outside of the United States, you can go to recoveryfactors.com and you can get to make a big difference. I would definitely do that. Another study was the HRG80 study. Ginseng is a powerful herb, but then it became pretty useless or not very good because it got hunted out.

You had to use the wild ginseng and that went up to about $900 a pound in countries where the total income might have been $900 a year or less. You can imagine they got hunted out pretty much, but they’ve developed a hydroponic way to create the same levels of active components. This stuff’s been pretty remarkable. I tried it myself and it was– In fact on busy days, I take one. It’s cheap. It’s a chewable capsule. The chewable tablet is the one I would recommend. In the study, this is 188 people in the study, half of them had post-viral chronic fatigue and the effects on energy and stamina were quite dramatic. That’s why I started that as the first thing, because it’s just one pill.

Recovery factors is eight pills a day. It’s cheap, it’s one pill, it’s easy and it could be taken as needed. The other one, the smart energy system that I mentioned, that we just got the data back from the statisticians. I was very happy to see it was quite stunning data. [unintelligible 00:49:29] and also for the post-viral fatigue group that worked well. Those were the brain fog. Low dose Naltrexone is a prescription made by compounding pharmacies. Not expensive, about 80 cents a day. Need to take it at bedtime for about 6-8 weeks. At about the eight-week mark the effect on the cognitive function what’s called microglial activation is what that’s approaching and helping.

Fairly marked, very good. There’s a lot of things you can do. Post-viral and post-COVID persistent symptoms. Again, this is all very, very treatable. The problem is not lack of effective treatment, but lack of effective physician education. You have to understand most what’s called continuing medical education by physicians has been described by a past editor of New England Journal of Medicine as slick advertising masquerading as science. We’d like to think we’re evidence-based. Medicine is not evidence-based. Medicine is money-based, and if something is profitable, it will be packaged by the PR departments of the industry. These are nice people. They’re all good people. They’re not a bad person.

They’re some of the nicest people I’ve ever met, but their job is to sell drugs and get [unintelligible 00:50:51] the competition. Basically, you look at the conferences, you look even at the journals at who’s paying the ads. There’s no advertisements for golf clubs or Lexuses in these journals because no company in the right mind would pay what [unintelligible 00:51:08] $15,000 so they hide where nobody sees it. Are the drug companies incredibly stupid or are they putting these advertisements because they know that if they advertise in this journal, their studies will get published? The editor will find a reviewer who happens to work for that company to send it to.

Another editor of The New England Journal of Medicine puts very bluntly that he notes- he said, “With no pleasure, I state that I no longer believe much of what I read in medical journals anymore.” Again, what the journal conclusion tells me when I look at studies is it tells me who paid for the study. Then when I tear the data apart and the methodology, it tells me what the study actually shows, and often that has nothing to do with what the results are being reported as.

Ari: I think this is, again, not to digress in COVID stuff, but I think this is critically important for people to understand right now because there’s a huge percentage of the population that is operating under the very naive assumption that what goes on in science is just this idea, and I had the same idea when I was younger, that it’s just all the most brilliant minds in the world, just trying to help people and find answers to all of our problems and it’s all just honestly presented to the world. There’s an element of truth in that. There’s a lot of good people, well-meaning people, brilliant people who are working in the field of science and it’s also the case that that is highly corrupted by financial interests.

Dr. Teitelbaum: There are good people. They’re no bad people. I haven’t met a bad person out there in any of this. The institutions are corrupt. The people are good.

The SHINE protocol study

Ari: Are there any concluding thoughts that you have? Actually, I have a question out of just pure curiosity. You’ve mentioned a couple times that you did The SHINE Protocol and it was a randomized placebo-controlled study. How do you do a placebo-controlled study in more or less [unintelligible 00:53:23]

Dr. Teitelbaum: We didn’t control exercise. Both groups had the exercises able and for the diet that wasn’t controlled.

Ari: You’re controlling the supplements mainly, the supplements–

Dr. Teitelbaum: And the medications.

Ari: Got it. My brain was going crazy this whole conversation.

Dr. Teitelbaum: For the study, it was The SHINE Protocol. [laughs]

Ari: SHINE, yes. You mentioned you’ve done four studies in the last two years and you’ve mentioned at least two of those.

Dr. Teitelbaum: Well, two had recovery factors and one study on HRG80 Red Ginseng, and one on Smart Energy System. These are open studies. They were done in people who qualified for severe CFS and fibromyalgia. Their energy level had to be a 5 or less overall on a 0 to 10 visual analog scale. The study was about a month of, basically, doing the treatment. There was pre and post-visual analog scale, and self-rating.

Ari: Got it. Excellent. One more random question on Ribose. Ribose is something that generally requires larger doses meaning multi-gram amounts as opposed to milligram amounts.

Dr. Teitelbaum: Well, yes.

Ari: There’s a subset of people who seem to be reactive to Ribose where it causes hypoglycemia. I’m curious-

Dr. Teitelbaum: [unintelligible 00:54:53]

Ari: That’s what you feel causes that, the hypoglycemia?

Dr. Teitelbaum: It’s clearly what. Here’s the thing. It causes the reactions. Basically, ribose in the studies routinely lowers blood sugar. It will directly do that by energy consumption, but most people, their adrenal function is fine and it takes care of that just brings the blood sugar back up before they have symptoms. If people have symptoms from d-ribose where they get irritable or they get hyper, that to me is almost like a provocative test for adrenal fatigue. Then I have them take adrenal support and then usually, one, they feel better from the adrenal support and, two, they can then tolerate d-ribose.

Ari: Got it. One more question on ribose. I have seen some studies, forgive me, I’m forgetting some of the details of this, but I’ve seen some studies where they’ve actually shown ribose can lead to enhanced glycation of tissues. Are you familiar with any of that and does it concern you at all?

Dr. Teitelbaum: The answer is I don’t know.

Ari: Got it.

Dr. Teitelbaum: I’ve not seen any problems from that, but that is a question mark.

Ari: Got it. Dr. Teitelbaum, this has been awesome. I’ve really, really enjoyed this. Do you have any concluding thoughts? If you were going to leave people with three key things you want people to take away from this or to remember if they’re trying to improve their energy, what would they be?

Dr. Teitelbaum: Number one, if you get yourself more energy so you can go back to a life that totally sucks, you’ve done nothing for yourself. Use that energy for things that feel good, not for things you think you should do. If you think you should do it but it makes you feel awful, don’t do it. Your body will call you on it and pull you over to the side of the road until you get it. Use it for what feels good. I’m not talking about [unintelligible 00:56:53] but what feels good, what works for you. Number two, simple way to begin, again, is with the nutritional stuff. Cut out sugar. For most of you who have fatigue, increase salt and water unless you have heart failure.

Salt has a minimal effect on blood pressure [unintelligible 00:57:13] one millimeter in most people. That’s all the effect it has. Use the Smart Energy System, use the Energy Revitalization System, use the HRG80. These are quick, simple things you can do that will dramatically increase energy. I know your body has a little bit of a use or lose it approach to exercise.

When you’d go out and exercise, find something that’s fun and do it with a friend because if you have a scheduled time where somebody else is going to show up, you’re going to show up even though, and if not, you’re going to have an excuse, “Well, I can’t today because I have to scratch my ass.” You know how the mind comes up with all the excuses, “Well, we can’t do it today,” but if you’re doing it with a friend and it’s fun, going shopping is exercise. Sex is exercise. Use your willpower to get out there and once you’re out there, let it be fun.

Ari: Beautiful. Thank you so much. Really enjoyed this, Dr. Teitelbaum. Where can people follow your work or learn more about what you’re doing or get in touch with you?

Dr. Teitelbaum: Well, the book, From Fatigued to Fantastic will give the information. Get the blue cover. For informational website, vitality101.com. For products, I do have those at endfatigue.com. My email address is fatigue, F-A-T-I-G-U-E-D-O-C, like doctor @gmail.com. If you have questions, that’s my personal email address.

Ari: Wonderful. Thank you so much and on a personal note, thank you for writing a nice little blurb on my upcoming book, Eat for Energy, which is coming out in May. I really appreciate you looking through that and writing a nice endorsement of it. Thank you so much.

Dr. Teitelbaum: My pleasure, Ari. Be well, everybody. Bye.

Show Notes

The current world climate and how it affects our health (01:40)
Is exercise safe for people with ME/CFS (06:00)
How hormone balance affects your energy levels (13:30)
Post-COVID fatigue treatment (40:37)
The SHINE protocol study (53:15) 

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