The Nature of the Condition
MY more than forty years' experience has led me to believe Chronic Fatigue Syndrome (CFS) is a condition of the neurohormonal and immune mechanisms of the body that produces a weakening of the body's ability to respond to stress of all kinds. The most common symptoms produced by this condition are unexplained exhaustion sometimes alternating with spells of anxiety or panic, a tendency to be oversensitive and/or allergic to certain substances or environments, a lessening of the ability to reason rationally and to make decisions readily, a tendency toward low blood pressure, sensitivity to cold, poor circulation (cold hands and/or feet), and brain fag or other mental aberrations which can mimic a large variety of mental diseases. Individuals in the Countershock or Resistance stage of CFS (see Dr. Selye's chart in Chapter Five) may not suffer the fatigue, but will experience mostly the anxiety and/or panic symptoms until they enter the Exhaustion stage. Most patients with CFS have at least one of these symptoms, and some have all and many others besides.This condition, to a lesser or greater degree, affects 20 to 25 percent of the American population. Fortunately, most of these are not severely afflicted, but today vast numbers of our people function at less than half their true potential because of CFS. Since it is the nature of the CFS patient to be a responsible, creative and productive citizen, the loss to America caused by this condition is significant.
As common as this condition is, only in the last few years has it been recognized, and it still is rarely treated effectively by most practitioners of the orthodox medical persuasion. In my early editions of this work, I called this condition, "The most ignored disease in the country today." Unfortunately, while the condition is not as ignored now as it once was, it does seem that the patients still are. A patient of mine, who is a vice president of a most prestigious university in Philadelphia, went to three of the best-known medical centers in Philadelphia with the symptoms of CFS. They all agreed that he had CFS, but they were equally unanimous in assuring him that they didn't know anything he, or they, could do to help his condition. Both he and his wife later came to us as patients and in a few weeks both were much improved.
Personally, I think that much of this medical apathy has been produced by the general vagueness of this disease's character, by the neurotic-like symptoms of its victims and by the slow and tortuous path of its correction even with the best and most advanced therapies. In our Clinic, I always meet the newly diagnosed CFS patient with mixed feelings. I am on one hand pleased to know that the patient has started on the road to becoming useful and productive again instead of languishing in a low-functioning state; on the other hand, I always groan a bit inside when I think of the amount of care, time and constant loving support that will be necessary to carry this patient through the seemingly unproductive early stages of treatment. With perseverance, however, all patients respond, and in the end they prove to be among our most appreciative patients. This thought-at times, this thought alone-gives us the ability and the strength to carry on with the CFS patient.
There seems to be a quirk in many doctors which, perhaps more than anything else, may explain their seemingly conspiratorial refusal to recognize CFS. Most physicians, in order to function as stable human beings, require a certain amount of personal ego satisfaction when they treat a patient. Even though there are vast fields of disease which are complete mysteries to modern medicine, the average day-to-day working physician often feels he must, at least in some manner, examine all the symptoms and problems that confront him. If he cannot rationally explain them, he must make up explanations, and if he cannot cure his patients, he must find some way to place the blame for his lack of understanding, knowledge and ability on the patient or on the circumstances. In the early days of medicine, physicians had ready explanations for causes of symptoms and ailments which were presented to them. The fact that today we realize that most of these early explanations were ridiculous has not prevented the medical profession from continuing this practice. To witch doctors, all diseases are caused by demons that inhabit their patients. Their job, of course, is to exorcise these demons. The "scientific" physician, when confronted with a patient who displays the symptoms of CFS, has a ready answer: "The patient is depressed, neurotic, mildly psychotic, unmotivated or just bored with life." With that self-satisfied stance that can be a "badge of our tribe," the patient is given a tranquilizer, antidepressant or both, and with the fatherly advice to stop worrying and to go to work he is sent home. It is just as impractical to tell a tubercular patient to go and play football as it is to tell a CFS patient to stop worrying.
Am I exaggerating? Am I a little too hard on my medical contemporaries? One has only to remember that a short time ago patients were literally bled to death in an effort to satisfy this medical ego-our first president being among those to be so helped into the next world.
There is, however, a specific cause that produces these wrecks of human society, and there are ways of returning these people to active, productive lives. This book defines this disease, lists the various symptoms produced by this condition, assesses the various stresses that trigger and aggravate this ailment and outlines a comprehensive plan of treatment to overcome this insidious disorder. This last paragraph was written in 1983 and I see no reason to alter it for this new 1999 edition. That is still what this book does and we trust that it does it better today than ever before.
The Adrenal Gland
Before proceeding with our discussion of Chronic Fatigue Syndrome, its causes and its treatment, let us consider the nature of the adrenal gland-the gland that our research has determined is the major culprit (or victim) of CFS. The adrenal sits like a bishop's cap on the top of each kidney; each weighs about as much as a nickel coin. The adrenal gland is recognized as one of the body's most important endocrine or ductless glands, that is, glands that produce hormonal or hormone-like substances and discharge them directly into the bloodstream. Each of the endocrine glands is subject to a chain of command. The pituitary gland, so-called master gland of the body, sends out stimulatory or trophic hormones which regulate each of the target endocrine glands, such as the adrenals, the thyroid or the reproductive glands. The pituitary in turn is regulated or controlled by the hypothalamus, which produces specific releasing factors for each of the pituitary trophic hormones. (Later in our text you will read more about this Hypothalamic–Pituitary Axis and its effect on CFS.)
The adrenal glands are composed of two parts-the medulla (inner portion) and the cortex (outer surrounding portion). The medulla fits inside the cortex like a walnut inside its shell. The medulla and cortex produce many substances, the most important of which are epinephrine (formerly called adrenaline), which is produced by the medulla, and various sterols, such as cortisone and aldosterone, produced by the cortex.
When the body is called upon to respond to stress, the adrenal gland is its primary agent and target. Stress on the body stimulates (probably by way of the sympathetic nervous system) the adrenal medulla to increase epinephrine production. This hormone increases the secretion of adrenocorticotrophin (ACTH) by the pituitary gland, which in turn activates the adrenal cortex to greater production of corticoids such as cortisone.
Diseases of the Adrenal Gland
Of primary concern in the discussion of CFS is its differentiation from Addison's disease (organic adrenal insufficiency) and from adrenal insufficiency secondary to hypopituitarism. The term Chronic Fatigue Syndrome as we use it here refers to a state of depletion of the adrenal glands in the absence of atrophy or destruction. In other words, it is a state of functional depletion, or exhaustion. This is in contrast to Addison's disease, in which there is physical atrophy or destruction of the adrenal glands, or to hypopituitarism, in which there is some form or degree of destruction of the pituitary gland. Both Addison's disease and hypopituitarism are relatively rare, whereas CFS as herein described is nowadays becoming more and more common.
Until recently the standard diagnosis of Chronic Fatigue Syndrome was a matter of exclusion; that is, such diagnosis was justified only after other causes of chronic fatigue, exhaustion, weakness and lassitude had been ruled out. Fortunately, the biological and biochemical changes that underlie this syndrome are now much better understood than in our early editions of this work. Definitive tests are now available in the form of the Adrenal Stress Index™ (ASI), a series of tests that chart the adrenal gland output throughout an entire day in comparison with the DHEA (the substance from which the hormones are produced) and immune system levels. With this test it is possible to determine not only if the patient has CFS or not, but also just what stage of the condition he is in and what is the best treatment for a complete recovery.
Unlike CFS, most patients with pathological adrenal function may be fully assessed by standard laboratory tests which include serum cortisol levels and urinary corticosteroids. In Addison's disease, even in advanced adrenal destruction or atrophy, the resting or basal levels of these tests may be within the lower levels of normal. For this reason, a diagnosis of Addison's disease may depend on results of a pituitary stimulation test in which corticotropin (ACTH) is injected into the patient. In normal persons a significant rise in serum cortisols follows ACTH injection, but in Addison's disease there is minimal or no response. In cases in which pituitary insufficiency is suspected, the metyrapone stimulation test is utilized. These tests are described in detail in standard medical texts.
Standard medical texts state that clinical adrenal insufficiency (Addison's disease) usually does not occur unless at least 90 percent of the adrenal cortex has been destroyed by idiopathic atrophy, granulomatous destruction, or some other form of destructive process. By the same token, currently available tests, including the ACTH stimulation test, may not show abnormal results except in the case of advanced disease or depletion. On the basis of present information, it would appear that these tests lack the sensitivity to detect or diagnose lesser degrees of adrenocortical depletion, as in CFS. Therefore, the condition of CFS is largely undetected by these orthodox measures. The ASI is still at this time not well known except in the alternative medical community.
Causes of the Condition
What causes this system breakdown? Why are some people affected and others not? There are two common causes of this condition. They are often mixed in the sufferer to the point that it is difficult to say which actually caused the disorder in any specific case. The two causes are hereditary weakness and overwhelming, unremitting stress. After more than forty years of working with this condition, I feel that inherent hereditary weakness of the system is probably the most consistent cause of the difficulty. The glandular weakness seems to be passed down from one generation to another, the most common relationship being from mother to daughter, although any genetic combination is possible. Without adequate treatment, each succeeding generation often becomes weaker than the previous generation. Therefore, in most CFS cases, the sufferer has inherited a lessened ability to adapt to the stresses of life. To make this more readily understandable to the patient, I usually refer to this situation as the inheritance of a weakened or poorly vascularized adrenal gland. While this is not entirely scientifically correct, there being other factors in a deficient general adaptive system, this is easy for the patient to comprehend and is not that far from the truth.
Some persons' adaptive mechanisms are so weak that no matter how they govern their lives, they are destined to have a problem with this system. Such a problem usually begins shortly after puberty from the stresses of the glandular changes which occur at this time. These patients come to us and say, "I've been tired as long as I can remember, Doctor. I never have had the energy or the ability to do what other people do with ease." The majority of hereditary adrenal cases, however, have sufficient adrenal functioning to live a relatively stable, normal life until a truly overwhelming, unremitting stress presents itself-a stress that exhausts the adaptive mechanism and finally throws these patients into full-blown CFS. These persons show the interplay of the two basic causes of CFS: first, a hereditary weakness of the basic adrenal system itself, and, second, unremitting stresses that are able to inhibit the normal functioning of the mechanism.
The combination of these factors, however, varies tremendously in any specific
individual. For instance, as previously mentioned, it is possible for an individual
to be born with such a weakened adaptive system that almost any of the normal
adaptive needs of life can throw that person deeply into CFS at some point in
his life. Patients with this weakness are to be greatly pitied, for until they
receive proper treatment, they are never able to experience the real pleasures
and satisfactions of life.
A larger number of individuals have some weakness of the adrenal system, but can live fairly normally until the stresses in their lives pile up to such a degree that they, too, will begin to manifest the symptoms of CFS. The majority of our patients fall into this category. With wise and dedicated treatment they can be returned to normal functioning, but will need to live within their adrenal ability if they desire to keep from returning to the CFS state.
Next, there are individuals who are blessed with a fairly normal adrenal mechanism, but who are unfortunate enough in life, as Shakespeare put it, "To suffer the slings and arrows of outrageous fortune," and to have stresses and pressures so enormous and so unresolved that the normally functioning adrenal system with which they are blessed is no longer capable of sustaining their needs. It eventually weakens and plunges them into some variety of CFS. These individuals should be the easiest to return to productive life, but this is not always the case. The main problem is that since they were healthy for so long, it is difficult to get them to make the needed changes in their life-style that are essential for their recovery.
Last, there are the fortunate persons whose adrenal or general adaptive mechanism
is so strong that almost nothing in life can affect it. They are capable of
going through all possible stresses, and therefore, at least in the past, have
not succumbed to CFS, no matter what occurs. We say "in the past"
because as the stresses of life continue to increase, it is possible that even
the strongest adrenal may give way to CFS in time.
Most of us fall somewhere in between the extremes of the last category of individuals who possess a strong general adaptive mechanism and the first-mentioned case of the unfortunate patients with serious hereditary inadequacy.
Almost all of us feel the effects of temporarily lowered adrenal functioning
at some time in our lives, usually following a bacterial or viral infection
or after some particularly grueling mental or emotional stress. At such a time,
we often experience a short-term weakness and inability to do our regular tasks
as efficiently and as accurately as we would like. This is the result of acute
adrenal exhaustion. If we are wise, at this time we will rest and not attempt
to force ourselves to do more than our weakened ability readily allows. If we
obtain sufficient sleep, stay on a healthful diet and do not force ourselves
to work until our strength returns, our adrenal system will shortly regenerate.
Now, imagine yourself constantly in this state of weakness and exhaustion and
you will know what the CFS patient feels every day. In Chapter III of this book,
"The Nature of the Patient," this state is discussed at great length.
As can be seen from the above discussion, CFS is due to a malfunctioning of the neurohormonal system of the body. It is caused by a breakdown of a physical component of the human system. Unfortunately, the vagueness of most of the symptoms produced by CFS leads the patient to feel that the main difficulty is one of a mental or emotional nature. Indeed, the symptoms of CFS are almost identical to those caused by anxiety, depression or various other mental conditions. When we are fearful or in a state of depression, these emotional states cause various glandular mechanisms of the general adaptive system to produce secretions which cause symptoms similar to mental disorders. Cold sweating, dry throat, rapid and irregular heartbeat, dizziness, cloudiness of the mind, nausea, flushing of various parts of the body, and so on can all be caused by various emotional effects on the general adaptive system. These symptoms are the body's attempt to prepare us for a possible threat which does not exist except in our fears. For instance, if we were out in the woods hunting, the cry of a wildcat behind us would create a certain sense of fear. This fear would cause the body to prepare for what is known as the "fight or flight" mechanism-either to fight this danger or to run away from it as rapidly as possible. When in our modern life we develop an emotional fear or apprehension, the body mechanism is not capable of distinguishing it from a true danger; therefore, through the glandular system, it prepares us in the same manner as if we needed to face a real danger. Since there is no real danger and subsequent action, we do not readily utilize the hormones which were pumped into our systems, and thus a variety of symptoms are produced as these hormones first register, intensify and then slowly dissipate.
Many modern psychologists and psychiatrists recommend physical activity such as running or jogging to help allay the symptoms of anxiety and similar difficulties. What is occurring, of course, is that the various anxiety-produced substances are being utilized by the physical activity and are not left lying around, as it were, to create more physical symptoms to aggravate the original anxieties further. This therapy has some merit, although it is not an answer to the original anxiety. In CFS, this same admixture which is produced by the anxious patient is produced by the weakened glandular system itself in an effort to bring its body hormone levels up to the normal level. Thus we have a situation in which a person is not necessarily anxious or emotionally distraught, and yet the physical weakness (CFS) produces symptom patterns which are almost identical to those produced in the nervous, neurotic individual.
Just imagine what can happen to the patient suffering from this condition who goes to the average physician! Since there are no specific laboratory tests that identify CFS in its earlier stages, the doctor finds no known disease process; and since the patient's symptoms mimic those of an emotional or mental difficulty, it is little wonder that the physician usually diagnoses the condition as mental anxiety. The patient is advised to stop worrying, told to go home and relax, given either a tranquilizer or an antidepressant or both, and summarily dismissed. This is not meant as criticism of the doctor, who followed recommended medical therapy; in fact, almost any competent medical authority not conscious of or skilled in the diagnosis and treatment of CFS would come to the same conclusion.
In our early years, by the time we saw most CFS patients they were convinced that they really were mental cases. They have been assured by their physicians, their friends and even their loved ones that there was nothing wrong with them that a change of mind, a change of the way that they look at their lives or a few tranquilizers would not help. This was not true then, nor is it true today. CFS patients are individuals with a true physical disorder as specific as if they had pneumonia or tuberculosis. You might as well tell the tubercular individual to stop coughing as to tell the CFS patient to stop worrying or to stop feeling so tired and do an honest day's work like any normal human being. Persons afflicted with CFS simply are not normal human beings; they are individuals with a real problem who need real treatment and real understanding.
An Ominous Triad
Thus CFS may be viewed as a triad, all three parts of which must be considered in every case: First, the heredity factor on which all prognosis or outcome is based. Second, the stress component which is composed of stresses that may cause the CFS or be caused by it. Third, the group of symptoms which due to the nature of the condition are not only caused by the condition, but can become stresses which further aggravate the condition.
Therefore, we can amplify our original definition by stating that CFS is that condition of the neurohormonal system which can be produced in an hereditarily weakened structure by a multitude of possible stresses which, in turn, cause a variety of symptom patterns which can in themselves eventually become stresses, thus creating a self-perpetuating disease-one that is able to feed upon its own symptoms.
The whole condition sounds ominous and almost hopeless of resolution, and so it must seem to the afflicted patient. For it is a condition that not only can be triggered in sensitive people by ordinary stresses of life, but which actually produces its own stresses via its symptomatology. We might say it is a beast that flourishes on its own excrement. As we come to understand more about the character of this disease, we see why it is so neglected and also so prevalent.
To understand it more fully and to become knowledgeable in its treatment, we must comprehend the interplay and rami-fications of its three sides: heredity, stresses, and symptoms.
Little can be done about the inherited factor except to attempt to determine its extent, since all treatment and prognosis (length of treatment and chance of complete recovery) depend on this fact. If inherited weakness is great, treatment must be extensive and great efforts must be made to reduce all patient stresses to a minimum. Conversely, if the heredity factor seems slight, treatment and stress reduction can be much less stringent and a quick recovery can be assured.
There is unfortunately no simple, exact way to determine the degree of hereditary weakness in any specific case. However, a clinician with much experience can usually make a fair estimate from the case history. Three matters are of prime importance: the age at which the symptoms began, the severity of the symptoms and the amount of stress that was required to produce the symptoms. If the symptoms began early, were severe and seemed to set in with little or no appreciable external stress, the heredity factor is strong, and such a case will require the best and most extensive therapy we have.
As a general guide, we can say that the degree of inherited neurohormonal weakness is in direct proportion to the severity of the patient's symptoms and inversely proportional to the stresses involved and the age at which they began.
Much has been written here concerning stress, but little has been written to define stress. To understand the stresses that affect CFS-not only those that cause it but also those that exacerbate it-is to understand the syndrome itself.
A stress in this context can be defined as any factor that stimulates the general adaptive system. These stresses may be divided into several types:
First, those stresses that would affect all human beings somewhat alike, i.e., cold, heat, physical exertion, infectious diseases, toxic substances, malnutrition and such things as exposure to war, flood, earthquake and fire.
Second, stresses that are individual due to personal background and experience. For instance, you may have a relative to whom you owe a large sum of money that you are unable to repay. Word of his return from a long journey may gladden the hearts of the rest of his family, but it can strike fear and consternation in yours because of the debt. This example of personal duress is the type of unseen stress that is usually the most difficult to diagnose and correct.
Third, stresses that develop from the condition itself. The CFS usually causes a weakened digestive function, which in turn has an effect on the pancreas to produce a hypoglycemic condition which in turn produces more stress. This weakened digestion also allows many foods to enter the bloodstream incompletely broken down, thereby stimulating the body to produce antibodies to attempt neutralization of the foreign substance (leaky gut syndrome). These antibodies, when they next contact this food substance, produce certain end products that may act as cerebral allergens, causing a variety of stress symptoms. These are only two of the stresses caused by this condition of the adaptive mechanism, but the list is long and readily shows the self-perpetuating nature of CFS.
A full understanding of the stresses involved in CFS is vital to recovery because all treatment is based on two simple principles on which the physician and the patient must work together. One, do everything possible to build strength into the adaptive mechanism, and two, remove as many stresses from this mechanism as possible. Unless the nature of the stresses are understood, they cannot be removed from a person's life. Some stress admittedly is useful, but long experience has taught me that no matter how hard a physician and a patient work, there will always be some stresses left. It was Benjamin Franklin who said, "Those who have nothing to worry about will worry about nothing."
Symptoms of CFS are unique-not so much because of their basic character, for these are symptoms common to other conditions, but because they themselves can have a profound effect on the course and progress of the disease. To understand this facet of CFS, let us examine a typical patient. Let's take a working mother who is developing the condition and who of late has been experiencing unusual and unexplainable symptoms, such as strange tinglings, dizziness, mild nausea, the inability to concentrate, difficulty in remembering and in making decisions, being constantly and usually tired, digestive disturbances, apprehensions and anxieties that do not seem to have a basis in fact but that come sweeping over her for no apparent reason. Every little thing seems like a mountain to her, every cry of one of her children sounds like a screaming siren in her ear, every request of her husband seems like an unwarranted demand. Why would she not be anxious? Why would she not wonder if she is losing her sanity? Why would she not manifest all forms of worries and fears which by their very nature create further stresses that in turn worsen the CFS, which creates more symptoms, and so on, ad infinitum?
As we have described, the symptoms of CFS produce a snowballing effect, and unless this effect is controlled, there is little hope of helping the patient. Once the worse CFS symptoms begin, they are often sufficient in themselves to perpetuate the condition regardless of outside stresses.
In order to truly treat this condition successfully, all the above factors must be taken into consideration. An entire new paradigm of doctorpatient relationship needs to be established. No doctor can do more than about half the work needed to overcome this condition-the rest is up to the patient. He must come to understand the condition and work in harmony with his physician. The doctor needs to take the reins of the case but must hold them loosely so that the patient can learn to overcome that which is in his province.
Chronic Fatigue Unmasked 2000
History of CFS
IN the past as in the present there have been physicians who were not afraid to investigate the true nature of the functional adrenal weakness that modern medicine calls Chronic Fatigue Syndrome (CFS). The first truly clear-thinking researcher in this field was Charles E. de M. Sajous, M.D., LL.D., Sc.D. A Fellow of the American College of Physicians and of the American Philosophical Society, professor of therapeutics at Temple University in Philadelphia, professor at the Medico-Chirurgical College, and clinical lecturer at Jefferson Medical College, he produced a text in 1903 entitled The Internal Secretions and the Practice of Medicine.(1)
(1) Sajous, Charles E. de M. The Internal Secretions and the Practice of Medicine. Philadelphia, F. A. Davis Company, 1903. (10th ed., 1922)
In his book, he credited the physician Brown-Sequard as first bringing attention to the importance of the adrenal glands, in 1856. It was, however, through the experimental research work of Dr. Sajous himself, in our own city of Philadelphia, that the full significance of the adrenal mechanism, and particularly that part concerning the modern CFS, was brought into full realization. In his book he devoted an entire chapter to functional hypoadrenia, much of which I include here, not with the assumption that all of its conclusions are accurate nearly ninety years later, but to show the amount of knowledge accepted as standard medical information and procedure at that time.
According to Dr. Sajous:
"The adrenals playing so important a role in the maintenance of the life process itself, it is obvious that, apart from any organic lesion in these organs, any marked depression of their functional activity should manifest itself by symptoms corresponding with this depression. To the symptom-complex of this condition I have given the name of 'functional hypoadrenia' [what I later called "the Adrenal Syndrome"] to distinguish it from the forms due to destructive disorders of the adrenals, which constitute Addison's Disease and offer, of course, a far graver prognosis. As a definition of this condition, I would submit that 'functional hypoadrenia' is the symptom-complex of deficient activity of the adrenals due to inadequate development, exhaustion by fatigue, senile degeneration, or any other factor which, without provoking organic lesions in the organs or their nerve paths, is capable of reducing their secretory activity. Asthenia, sensitiveness to cold and cold extremities, hypotension, weak cardiac action and pulse, anorexia, anemia, slow metabolism, constipation, and psychasthenia are the main symptoms of this condition. [Certainly sounds like CFS, doesn't it?]
"The field covered by 'functional hypoadrenia' is necessarily a vast one, since it includes the asthenias so often met within the four main stages of life: infancy, childhood, adulthood, and old age, usually attributed to a 'weakness' or 'exhaustion,' and often 'neurasthenia,' which have been traced to no tangible cause. All I can submit herein, therefore, is a cursory analysis of the subject." [We feel that so-called neurasthenia was what CFS was known as in the early days of this century.]
Hypoadrenia in Infancy and Childhood
In discussing functional hypoadrenia of infancy and childhood, Dr. Sajous pointed out that, although the adrenals at birth are one-third the size of the kidney, and therefore relatively large, their functions are limited to the carrying on of the vital process, at least during the first year of life. During this time the mother's milk supplies the antitoxic products capable of protecting the infant against the destructive action of poisons. Dr. Sajous stressed the protective influence of mother's milk:
"It is an important function of the mother to transfer to the suckling, through her milk, immunizing bodies, and the infant's stomach has the capacity, which is afterwards lost, of absorbing these substances in active state. The relative richness of the suckling's blood in protective antibodies as contrasted with the artificially fed infant explains the greater freedom of the former from infectious disease."
He cited as striking proof of this immunizing function J.E. Winters' statement regarding the siege of Paris in 1870-1871 during the Franco-Prussian War: "While the general mortality was doubled, that of infants was lowered 40 percent, owing to mothers being driven to suckle their infants."
Children have a predilection to certain infectious diseases not only during infancy, but through at least their first ten years. Dr. Sajous stated that mother's milk helps provide protection to the suckling against such diseases; vulnerability in older children is overcome as the adrenals, with other organs, acquire the power to supplant the mother in contributing antitoxic bodies to the blood. These facts, Dr. Sajous stressed, point to the adrenals and other prominent organs, whose inadequate development explain the special vulnerability of children to certain infections. He believed that degrees of this hypoadrenia cause a child to be more or less liable to infection. He continued:
"That degrees of hypoadrenia exist in children is in reality a familiar fact to every physician when the signs of this condition are placed before him. The ruddy, warm, hardmuscled, heavy, out-of-door, romping child with keen appetite and normal functions is one in whom the adrenals are as active as the development commensurate with its age will permit. He is ruddy and warm because oxidation and metabolism are perfect and the blood pressure sufficiently high to keep the peripheral tissues well filled with blood; his muscular, skeletal, cardiac, and vascular systems are strong because, in addition to being well-nourished, they are exercised and well-supplied with the adrenal secretion, which ... sustains muscular tone. As normal outcome of this state, we have constant stimulation of the functional activity of the adrenals. The muscular exercise and maximum food intake involve a demand for increased metabolism and oxidation, and the resulting greater output of wastes imposes upon the adrenals, as participants in the oxidation and auto-protective processes, greater work, more active growth and development, with increase of defensive efficiency as normal result.
"The pale, emaciated, or pasty child with cold hands and feet, flabby muscles, whose appetite is capricious or deficient-the pampered house plant so often met among the rich-represents the converse of the healthful child described, just as does the ill-fed, perhaps overworked child of the slums. The emaciation, the cold extremities, indicate deficient oxidation, metabolism, and nutrition owing to the torpor of the adrenal functions; the pallor is mainly due to a deficiency of the adrenal principle in the blood and to the resulting low blood pressure, which entails retrocession of the blood from the surface. This child is not ill, but the hypoadrenia which prevails normally, owing to the undeveloped state of its adrenals, is abnormally low and it is vulnerable to infection."
Sajous believed that all conditions which in the adult tend to produce functional hypoadrenia affect the child at least to the same extent.
Hypoadrenia in the Adult
"Adults in whom adrenals may be inherently weak do not, as in hypothyroidia, show signs of myxedema; but their circulation and heart action are feeble, they tend to adiposis and show other signs of hypoadrenia. I have witnessed suggestive bronze spots in such cases. As a rule, however, the development of the adrenals in adults is an accomplished fact-as also that of their co-workers in the immunizing process, the thyroid and pituitary.... The adrenals, fully capable of sustaining oxidation and metabolism up to highest standard in all organs, also preserve the efficiency of all other defensive resources, including phagocytosis, with which the body is endowed to their highest level. On the whole, the normal adult whose adrenals function normally is relatively resistant to infection. The infrequency with which the physician is infected, notwithstanding daily exposure in his professional work, attests to this fact." Dr. Sajous explained that functional hypoadrenia appears when irrespective of any disease, as the result of the vicissitudes of life, the adrenals are exhausted by excessive secretory activity that exaggerated labor or exercise-fatigue-imposes upon them. He cited a striking difference between patients with Addison's disease and those with other types of illness whose muscles are organically normal: signs of fatigue appear quickly and muscular impotence asserts itself in functional hypoadrenia patients, but, for example, in an advanced case of tuberculosis the patient may be able to show appreciable muscular strength. He used other illustrations of the influence of adrenal secretion over muscular tone to show the close relationship between fatigue and the functions of the adrenals:
"The unusual prevalence of disease among soldiers in the field is, of course, partly due to the defective sanitation that a campaign entails; but fatigue-particularly that due to heavy marching, carrying heavy accoutrements-is, in my opinion, an important predisposing cause, through its influence upon the adrenals. Not only are these organs called upon to sustain general oxidation and metabolism at a rate exceeding by far that which amply suffices for normal avocations, but the fact that they also serve to destroy the toxic products of muscular activity constitutes another cause of drain upon their secretory resources."
From studies of other investigators into the influence of fatigue on adrenal function in animals he noted that debility from any source-starvation, loss of blood, or other factors- makes the body vulnerable to disease. In a healthy animal, an injection of combined toxin and antitoxin resulted in no harm, but in an animal weakened by starvation or slight bleeding, death usually followed such an injection, with all the signs of poisoning by the toxin, including congested adrenals.
He pointed out the relationship between the adrenal gland and infection, adding that hypoadrenia from any source weakens the body so that it becomes vulnerable to disease. Among humans, he pointed to deficient food and excessive work as causes of the disease. Other important morbid factors in this condition, according to Sajous, include masturbation and excessive venery. He wrote:
"The pallor and asthenia witnessed in these cases, so far unexplained, can readily be accounted for if, as I believe, the liquid portion of the semen is rich in adrenal principle. This is suggested by the fact that spermin, the purest of testicular preparations, given the same tests, acts precisely as does the adrenal principle. The latter is an oxidizing body acting catalytically; it resists all temperatures up to, and even, boiling; it is insoluble in ether and practically insoluble in absolute alcohol, and gives the guaiac, Florence, and other heamin tests. Now spermin not only raises the blood pressure, slows the heart and produces all other physiological effects peculiar to the adrenal principles, but its solubilities are the same; it gives the same tests; it resists boiling. Moreover, it is regarded in Europe as a powerful 'oxidizing tonic' and has been found equally useful in disorders in which adrenal preparations had given good results. The inference that spermin consists mainly of the adrenal product suggests that it is not specific to the testes, but instead, a constituent of the blood at large; not only did this prove to be the case, but it was found in the blood of females as well as in that of males."
Hypoadrenia in the Aged
To Dr. Sajous, the ductless glands greatly influence old age. He wrote:
"All living organic matter is subjected, after more or less precarious periods of growth and adult existence, to one of decline and final disintegration. This applies particularly to the adrenals, if their functions are, as I hold, to sustain oxidation and metabolism, the fundamental process of the living state. Indeed, the senile state may be said to be as evident in these organs as it is in the features of the aged."
He quoted from investigators who had found that fat occurred in increasing quantities in the adrenal fibrous tissue between the cortex and medulla in very old animals and in the medulla of aged individuals. A marked-occasionally very great-reduction was found in the size of adrenals in the aged. In a study in which adrenals of three young men were compared with those of aged individuals, the adrenals in the young were well developed and in "full bloom," while in the aged they were shrunken and deficient, showing lowered activity, implying a lessening of the vital process the adrenal glands sustain.
"The asthenia of old age," he continued, "thus finds a normal explanation in the defective supply of adrenal secretionprecisely as it does in Addison's Disease. In factatrophy of the glands in the young may produce this disease." To Dr. Sajous, old age was caused by degeneration of the ductless glands. He believed that a condition of autointoxication existed in old age "quite in keeping with a decline in the antitoxic power shown by the adrenals." He also found a functional relationship between the adrenals and the thyroid in the genesis of old age.
Regarding the causation of old age, Sajous quoted an earlier researcher, Lorand: "It is evidentthat all hygienic errors of diet or any kind of excess will bring about their own punishment, and that premature old age, or a shortened life, will be the result. In fact, it is mainly our fault if we become senile at 60 or 70, and die before 90 or 100." As Seneca said, "Man does not die, he kills himself."
Summary of Sajous' Work
Sajous, then, believed that the lesions to which the adrenals are subjected during infections and autointoxication from birth to the last day of life greatly shorten life by limiting the functional area of the organs through the local fibrosis they entail. "It is quite probable," he wrote, "that centenarians owe their prolonged longevity mainly to integrity of their adrenals." To this end he saw hygiene, particularly its influence on the prevention of infectious disease, "as one of the most useful of sciences" because it helps prevent even seemingly benign diseases (diseases from which people recover), which "in the end shorten our existence by compromising the integrity of the organs which sustain the vital process itself."
Sajous discussed also the prophylaxis and treatment of the hypoadrenal condition. While much of the prophylaxis he discussed is not germane to the present day, he made several pertinent comments. In discussing prevention of hypoadrenia in infants, for example, he said:
"In infants, we should by every possible means prevent infection or intoxication to preserve the integrity of their adrenals and other auto-protective organs. The key of the whole situation lies in the fact thatnearly all the cases and nearly all the deaths are in bottle-fed babies. Physicians are, as a rule, entirely too ready to yield to the demands of social and other claims put forth by mothers who do not wish to nurse their offsprings. The responsibility assumed by both mother and physician under these circumstances is overlooked. I cannot but hope that if this continues, and the sacrifice of countless infants proceeds, laws may be enacted to prevent it by imposing upon the physician the duty of submitting to the State authorities a certificate in which sound reasons shall alone account for his consent to a departure from Nature's methods which entails deaths untoldThe death rate among foundlings in New York City reached almost 100 percent until wet nurses were provided. Manyauthorities have written forcibly upon this subject, but seemingly to no avail. The holocaust continues."
Dr. Sajous devoted several pages to proving that mother's milk contains antitoxic
substances that are not present in the bottled variety. Surprisingly, only in
the last few years has so-called modern medical science caught up with Dr. Sajous.
In referring to the prophylaxis and treatment of the adult patient, Sajous discussed the importance of rest and of what physical stress with inadequate rest can do to the weakened adrenal gland. This factor has changed little to this day. He goes on to state:
"The influence of excessive fatigue on the adrenals, we have seen, is
such as to weaken greatly their functional activity and, therefore, their oxygenizing
and immunizing functions of the blood. The main harmful feature in this connection
is the relative deficiency of rest, which means, from my viewpoint, inadequate
opportunity afforded the adrenals to recuperate. This, of course, should be
proportionate to the amount of strain imposed upon these organs, and the resistance
of which they are capable. It is probably owing to lack of this that apparently
strong men are often the first to "give out" in forced marches. The
physical examination being based mainly upon the status praesens, and the adrenals
being necessarily (for we are now dealing with a new line of thought) [Apparently
still new today! - Author] overlooked as factors, there is marked inequality
in the resistance of the men to strain. This applies as well to the pathogenesis
of chronic disorders. In a personal analysis of 40 cases of hay fever, for instance,
the severity of the disease corresponded to a considerable degree with the number
of children's diseases the patient had had, the worst cases having had six of
these diseases in comparatively quick succession." [Even here the child
was not subjected to more than one disease at a time as is done at present in
the use of multiple vaccines.]
To Dr. Sajous, this suggested the need of ascertaining the number and severity of children's and other diseases to which a recruit in the armed forces had been subjected and to add this factor to others in deciding upon his admission to the service or the arm to which he is to be assigned. He continued:
"The mounted man suffers less from actual fatigue than the infantry man
who must carry his accoutrements, arms, cartridge, etc., aggregating in some
armies as much as 70 pounds. When, besides, defective or poor food, impure water,
exposure, etc., and other frequent accompaniments of a campaign are taken into
account, one need not wonder that disease is a far greater factor as a cause
of debility and death than wounds.
"Briefly, fatigue should be considered, owing to its inhibiting influence on the adrenals and the immunizing process in which they take part, as an important predisposing cause of disease. The periods of rest should be so adjusted, therefore, as to counteract this by far the most destructive factor of active warfare. In civil life, such hardships are seldom endured, but here likewise much could be done to prevent infection by means calculated to insure the functional integrity of the adrenals.
"To stimulate the adrenal functions when marked fatigue prevails would, of course, only aggravate the hypoadrenia after perhaps a period of temporary betterment. The powdered adrenal substance should, on the other hand, judging from the effects of injections of adrenal extracts in experimentally fatigued animals, serve a useful purpose."
I always correct my patients when they call our treatment a "stimulation" of the adrenal gland. We assure them that it is a regeneration of the gland, not a stimulation. Drugs may be used to stimulate the adrenal, but as Dr. Sajous assures us, such treatment can offer only a short period of "temporary betterment" followed by an aggravation of the hypoadrenia. It is for this reason that the medical profession has so much trouble treating CFS. The word "regeneration" does not seem to be in their lexicon.
In this last paragraph Dr. Sajous also recommended taking powdered adrenal substance. To show that there is nothing necessarily new under the sun, this substance, properly prepared so as not to lose any of its natural factors, still remains the backbone of our treatment of CFS today. The work of this pioneering endocrinologist can never be sufficiently appreciated. We can only thank God for his great insight and candor and attempt to carry forth the work he began. It is only sad to see how few of his own compatriots have had the incentive and wisdom to follow his lead.
Expanding Understanding of the Disease
A few years after Dr. Sajous' initial work, Henry R. Harrower, M.D., F.R.S.M. (London), in his book, Practical Organic Therapy, The Internal Secretions in General Practice, (2) asserted:
(2) Harrower, Henry R. Practical Organic Therapy, The Internal Secretions in General Practice, 3rd ed. Glendale, CA, The Harrower Laboratory, 1922.
"Since the adrenals are so extremely susceptible to so many outside influences, it is likely that they would be easily worn out, and as a matter of fact, 'functional hypoadrenia' is as common a condition as any endocrine manifestation. From a practical standpoint, this is an extremely important symptom complex."
This was written a short time after World War I! Dr. Harrower continued:
"It is quite some years since Sajous began to emphasize the importance of this condition, and while his opinions were scorned, and some of his ideas declared visionary, it must be admitted that our present knowledge of this subject is very much in harmony with the following quotation from Sajous' monumental work: 'Functional hypoadrenia is the symptomcomplex of deficient activity of the adrenals due to inadequate development, exhaustion by fatigue, senile degeneration, or any other factor which without provoking of organic lesions in the organs or their nerve paths, is capable of reducing their secretory activity. Asthenia, sensitiveness to cold and cold extremities, hypotension, weak cardiac action and pulse and anorexia, anemia, slow metabolism, constipation, psychoasthenia are the main symptoms of this condition.' "
Harrower went on to say:
"Asthenia is the rule and muscular tone (both striped and unstriped muscles) is poor. Exertion is impossible and the fatigue syndrome is prominent. The intestinal musculature is inactive and stasis, a common cause of hypoadrenalism, is also a usual result of it. Mental exertion, even the simplest exertion, often causes so much weariness and exhaustion as to be prohibitive. Mental elasticity is lost, and there is both mental and physical depression with the fear that the individuals now cannot accomplish their accustomed good mental work; and the story that they 'have lost their nerve.' With this, one frequently notes a fearfulness of making wrong decisions and vacillating and indecisive frame of mind. This is the most usual form of adrenal insufficiency. It is chronic both in origin and in its course."
Another section in Harrower's book is entitled "Neurasthenia as an Adrenal Syndrome."(3) The word "neurasthenia" is not used as much today as it once was, nor is it as well understood by the general public as it was at one time. Neurasthenia means weak nerves. Although they may not have heard of neurasthenia, people frequently speak of their weak or sensitive nerves and upset nervous system. I personally still find neurasthenia an acceptable term and an exact description of many patients I see daily. My own feeling is that most of the so-called neurasthenia of old was plain old (or should I say new) CFS.
(3) Since it seemed most appropriate, "Adrenal Syndrome" was the term I used for Chronic Fatigue Syndrome until the latter name became very popular. I still think the Harrower term is more informative and descriptive.
Again, Harrower's report was so lucid that I include here the entire section on "Neurasthenia as an Adrenal Syndrome":
"The minor form of 'functional hypoadrenia' is more common than some have appreciated, and the fact that there is a psychic origin as well as the other physiologic causes already considered, allies it to the fashionable neurasthenia of today. In fact, some have stated that what is improperly called 'neurasthenia' is not a disease per se, but really a symptomcomplex of ductless glandular origin and that the adrenals are probably the most important factors in its causation. Campbell, Smith, Osborne, Williams, and others, including the writer, have directed attention to the importance of the adrenal origin of neurasthenia (though a pluriglandular dyscrasia is practically always discoverable), but so far this is not understood as well as its frequency and importance warrant.
"A few quotations from the literature will firmly establish the importance of this angle from which to study this common and annoying symptom-complex. Quoting from the Journal of the A.M.A. (Dec. 18, 1915): 'The typical neurotic generally has, if not always, disturbance of the suprarenal glands on the side of insufficiency. The blood pressure in these neurasthenic patients is almost always low for the individuals and their circulation is poor. A vasomotor paralysis, often present, allows chillings, flushings, cold, or burning hands and feet, drowsiness when the patient is up, wakefulness on lying down and hence insomnia. There may be more or less tingling or numbness of the extremities.'
"Kinnier Wilson in'The Clinical Importance of the Sympathetic Nervous System' makes the following pertinent remarks: 'Many of the common symptoms of neurasthenia and hysteria are patently of sympathetic origin. Who of us has not seen the typical irregular blotches appear on the skin of the neck and face as the neurasthenic patient works himself up into a state'? The clammy hand, flushed or pallid features, dilated pupils, the innumerable paresthesias (tinglings), the unwonted sensations in head or body, are surely of sympathetic parentage. In not a few cases of neurasthenia, symptoms of this class are the chief or only manifestations of the disease. Here, then, is a condition of defective sympatheticotonus; may it not have been caused by impairment of function of the chromophil system [adrenal system]?There does not appear to me any tenable distinction between the asthenia of Addison's Disease and the asthenia of neurasthenia. Cases of the former are not infrequently diagnosed as ordinary neurasthenia at first. It is difficult to avoid the conclusion that defect of glandular function is responsible for much of the clinical picture of neurasthenia[Wilson] makes the following apothegm: 'Sympathetic tone is dependent on adrenal support, and until the glandular equilibrium is once more attained, sympathetic symptoms are likely to occur.' "
Interestingly, the 1915 quotation from the Journal of the American Medical Association postulated a relationship between neurasthenia and low adrenal function. Yet to this day, such a relationship is rarely considered in medical treatment. At our Healing Research Centers, we consider such cause and effect to be very common and we treat it accordingly. Undoubtedly, because of this, we have become internationally known for our treatment of the weakened nervous system.
The most important advances in endocrinology made by Dr. Harrower were in connection with what he called the "plural glandular treatment." In this form of treatment, he found it far more efficacious to use a variety of glandular substances than to use a single one in attempting to correct this or any of the glandular imbalances. In preparations he himself made and marketed, he, for instance, combined thyroid, pituitary and sex-hormone substances along with what he called "remineralization" techniques, that is, the use of certain mineral elements plus his adrenal-gland substance to treat "Adrenal Syndrome." Such plural glandular technique is used to this day. With modern methods of tissue-nutrition analysis, however, we are able to individualize the therapy for the specific case at hand to a far greater degree than was possible in Dr. Harrower's day.
While Dr. Sajous brought the condition of functional hypoadrenalism to light, described its symptoms, illustrated some of its causes and suggested certain types of therapy, the further development of this therapy was in the hands of Dr. Henry Harrower. Dr. Harrower's work, however, was little appreciated by his contemporaries, and although he was able to help thousands of individuals during his lifetime, he was never able to convince more than a handful of his medical colleagues of the value of the plural-glandular substance therapy. Since this therapy was based on supporting nutritionally the glandular components of the body, the results, though definite and long-lasting, were slow in developing. This fact probably led the medical profession to disregard them in favor of the quicker-acting (but noncurative) single-hormone preparations and synthetic compounds.
It is important to make a distinction between the use of endocrine hormones and endocrine substances. Even these early investigators realized that if the body is given a hormone which is produced by an endocrine gland, the gland, due to the natural functioning of the body's homeostatic mechanism, will stop producing its own hormone as long as the external hormone is being supplied. If this process is carried out long enough, the gland involved will actually atrophy, and eventually it stops producing hormones. If, on the other hand, a patient is given glandular substance that is free from hormones but contains the other nutrient elements of the gland intact, this substance acts as a food to build and regenerate the gland, so that it may once again be able to regain proper functioning on its own. This is the basic difference in theory and practice between the medical practice of endocrinology and the natural or nonmedical practice of endocrinology. These early researchers realized that except in emergencies, nutritional glandular therapy was the only practical, physiological way of reestablishing normal function among the endocrine glands. In emergencies, it may be essential to give pure individual hormones for a short time, but these should be exchanged for the glandular substance therapy as soon as possible.
Of course, if the involved gland has been destroyed and there is no hope of regeneration, it may be necessary to give hormonal agents for life. However, this is not the case in most chronic glandular deficiencies such as CFS, and the use of single hormones (such as cortisol derivatives) is usually to be avoided except in a true emergency. We spend a great deal of time and energy working our CFS patients off of such medication that they have been put on by medical practitioners who do not understand the nature of this condition.
While on the subject of glandular substance therapy, I need to warn our readers that all glandular materials are not the same. As the use of these products has become increasingly popular, many unqualified producers have sprung up to supply the demand. Some of these are only out to "make a buck" and have little comprehension of the processes required to make a therapeutically effective preparation. In earlier editions of this book, we recommended several trade name products that we found effective in treating CFS, but we will not do so in this edition. The reason for this change is twofold: (1) New and sometimes better products are being produced at an accelerated pace now that our work is becoming better and better known and (2) some of our old standbys have not kept up with advances made in nutritional science and may no longer be the state-of-the-art they were when we first wrote this text. Therefore, we will discuss generic remedies in this edition, but will not suggest specific manufacturers. For specific products we invite you to call us at 1-800-300-5168. In this way we will always be able to give the names of state-of-the-art glandulars and other remedies needed to treat CFS.
The work of Dr. Sajous and Dr. Harrower has been continued by a small group of medical practitioners, one of the most dynamic of whom is John W. Tintera, M.D. In 1955 Tintera reported on the hypoadrenocortical state and its management, and in 1966 he advanced the hypothesis that reactive hypoglycemia may result more from hypoadrenocorticism with deficient counterregulatory responses of the adrenal cortex than from insulin excess.(4-5) (A later study on hypoglycemia in insulin-dependent diabetic patients acknowledged indeed that deficiency in counterregulatory hormonal responses is important in hypoglycemia reactions(6). Tintera described, in lay terms, the functional insufficiency of the adrenal glands in an article in Woman's Day in February 1959, entitled "What You Should Know about Your Glands and Allergies" (7):
(4) Tintera, John W. The hypoadrenocortical state and its management. New York
State Journal of Medicine 55:1869, 1955.
(5) Tintera, John W. Stabilizing homeostasis in the recovered alcoholic through endocrine therapy: Evaluation of the hypoglycernic factor. Journal of the American Geriatrics Society 6:126, 1966.
(6) Polonsky, Kenneth, and others. Relation of counterregulatory responses to hypoglycernia in type I diabetes. New England Journal of Medicine 307 (18):1106 1112, October 28, 1982.
(7) Tintera, John W. What you should know about your glands and allergies. Woman's Day February 1959, pp. 28-29, 92.
"Think of your adrenal glands as the two central command posts, one perched above each kidney from which your body's chemical defenses are mobilized and directed. Think of pollens, house dusts, and all other allergy-producing substances as attacking invaders (which they are, of course). Now you're right up against the basic and real reason why many people suffer from allergies while some people hardly know what the word means.
"What happens when the central command posts of allergic bodies fail to command the chemical defenders? Attacking invaders are on the ramparts, but the defenses are enfeebled and disorganized. The invaders get in and bring about the damage which results in wheezes and sneezes, sniffles, hives, rashes, skin eruptions, and other miseries and also sets the body up, chemically, for endless repetition of the same.
"This new knowledge was discovered and proved by endocrinology, that branch
of medical science devoted to the study of the body regulating system of internally
secreting glands, the endocrines, of which the adrenals are kings. Until endocrinology
came up with the all-important knowledge, no one knew the basic cause of allergies."
Rightly, Dr. Tintera said that until recently there was no real, lasting cure for allergies-only temporary relief which often required heroic measures. Usual treatments for allergies and infections were aimed at body chemistry disturbances at or near the surface. He continues as follows:
"Actually, many allergies are only the end results of processes that have their beginnings in adrenal gland failure. Most people stand up well against attacking invaders-so well that they do not know they're under attack. But 17,500,000 Americans [almost 10 percent of the population] succumb so readily to the same invaders they know only too well they are being attacked!
"Endocrinology has now gotten deep down below the end results of allergy processes. In learning about the intricate and subtle chemistry of the adrenal glands, it discovered that the difference between the non-allergic majority was the difference between strong, alertly responsive adrenals which can and do marshal the body's defenses in a flash, and weak, sluggish glands which are incapable of doing what they should.
"I'm an endocrinologist. In more than 20 years of a busy practice with thousands of patients, I've yet to work with an allergic patient whose troubles weren't basically due to his poorly functioning adrenals, or who wasn't relieved of his allergic woes when his adrenals were put into proper working order. Included among these patients were sufferers of asthma as well as of hay fever, people 'sensitive' to beef protein as well as those 'sensitive' to house dust or to tomatoes or parsnips or whatever the so-called 'sensitizing agent' happened to be."
To Tintera there are not "kinds" of allergies, only one "kind"-impaired adrenal glands. For many years before this glandular basic cause was discovered, it was held that allergic persons were allergic to many substances-not just one. He found the identity of the "sensitizing agents" of little more than academic interest because the controlling and only important matter is the state of the central command posts of bodily defenses, the adrenals. He continued:
"In understanding why this is so, let's begin with the fact that body chemistry is exceedingly intolerant of all substances not strictly its own. Foreign substances, for the most part, are broken down and converted chemically; animal proteins into human proteins, vegetable carbohydrates into human carbohydrates, etc.
"But there are many foreign substances which body chemistry can't handle by conversion. Some have to be neutralized chemically and so made harmless, and these are the 'allergens' which cause allergies if neutralization doesn't come about. Others have to be killed or at least prevented from multiplying, and these are the living bacteria which cause infections if body chemistry fails to deal with them.
"Taking ragweed pollen, for example, the pollen gets into the body through nostrils or mouth and burrows into nasal membranes. It cannot be dislodged by mucous flow or by sneezing, and it cannot be absorbed through conversion into a compatible chemical. If something isn't done, there will be inflammation and swelling of membranes of indefinite duration as more and more pollen gets in.
"So there is an emergency. The alarm runs along nerveways to the cores of the adrenals (the 'medulla,' in medical parlance). They respond by secreting a chemical or hormone. The blood carries it to heart, lungs, and other glands of the endocrine system, and back to the adrenal casings, the 'cortex' The medulla hormone stimulates lungs into providing added oxygen, heart into producing a faster blood flow, and the cortex into secreting a host of hormones which first call forth the neutralizing chemicals from various body cells, then put them together in assorted ways, and finally command their assault on the attacking invaders. All this happens in a flash. The amounts of chemicals involved are so very tiny they're hardly measurable. The increases in heart and lung actions are not enough for the mind to be aware of them. Just the same, a highly successful defensive operation has taken place. Definitely the body in which it happened is not allergic."
This defense, he asserted, takes place no matter where the attack occurs-in
the membranes of the bronchial passages, the stomach lining, or the skin.
"The principal defensive weapon on the battlefront of surface membrane is the 'antibody.' For successful defenses there must be antibodies for every variety of disease-causing bacteria or viruses; specific antibodies for pollen, for house dusts, tomatoes or parsnips, or whatever the foreign substance which is both inert and foreign and, therefore, is an 'allergen.'
"The amazing thing is that the antibody for any given invader cannot exist until the invader actually attacks. Body chemistry takes the invader's chemical measurements, so to speak, and proceeds to tailor an antibody which fits the invader to a 'T'. This intricate, fast-moving chemistry takes place in the spaces between cells which are bathed in the body fluid called lymph. Lymph has chemical interchanges with the blood through the lymph channels and those channels have way stations or depots, the lymph nodes.
"In the nodes, from materials fetched through the channels, are manufactured floating cells, lymphocytes, which first collect the newly-formed antibodies and then carry them to the membranes where the invaders, having caused the antibodies to be formed in the first place, are digging in. Now, we are at the key point. Antibodies cannot be formed and the lymphocytes cannot discharge their burdens of antibodies without the assistance of the hormones of the adrenal cortex. If the adrenal cortices are underfunctioning, if they are semiexhausted and unable to respond fully to stimulation, these essential hormones are either insufficient in amounts or they are chemically out of balance. Here, then, is the basic cause of allergies and infections."
Dr. Tintera explained that the cortex of the adrenal secretes no fewer than thirty-two hormones (we now know of several more) when functioning healthily. They and the hormones of the medulla are so vital in body chemistry that without them life is impossible.
"Routinely they regulate the chemical conversion of our food into both fuel and building materials; they regulate the transport of the fuel throughout the body for 'burning' with oxygen in each and every tissue, and the transport of the building materials and its uses in repairing and replacing old cells and tissues. On the emergency level, adrenal hormones prepare the body to withstand stress of whatever kind and degree."
Regarding stress, he wrote, "Walking is stress because it burns more body fuel. Running is a greater stress and so are heated arguments, tearful, and other powerful emotions, and thousands of other things which require changes in blood flow rate, in the diameters of arteries and veins, in the tensions of muscles....
"All these stresses are perfectly normal and it is no less normal for our bodies to be under constant attack by 'foreign' invaders since everything outside ourselves is foreign. But this constant attack is constant stress. Add everything together and you get the idea of how much work our adrenals are required to do. They are uncomplaining strong organs when all is well with them, but some people are born with undersized or weak adrenals, due to the accidents of heredity. [Emphasis added.] Under the stress and strains of living, the question for any individual is how much his adrenals can take; how much reserve strengththey have.
"A person with very poor adrenals may never be affected by it if he lives a completely sheltered life, free of extraordinary stress. But that kind of life is neither desirable nor possible. Stress is the essence of living; from it comes pleasure and happiness. But if the adrenals are not thoroughly competent, each stressful incident cuts into their reserves. The day must come when those reserves are exhausted and the whole body is in trouble.
"That explains why some people are allergic and susceptible to infections from birth while others are adults before those calamities befall them. One had poor adrenals from birth and the other had adrenals without enough reserves to last. And you can almost be positive that in any of these cases, the built-in weakness has been compounded many times by the common American diet which is bad enough to pull down even the strongest adrenals."
Dr. Tintera asserts that the adrenals in all his allergic patients are weak and semiexhausted, secreting their hormones in insufficient and unbalanced amounts. His treatment to cure them of their allergies is an injection of an extract of beef adrenals which contains the whole assortment of adrenal hormones in the balance drawn up by Nature. This permits the beaten-down glands of the patient to rest by adding hormones to body chemistry that take over the work. He does not use cortisone or its derivatives except in emergencies because, to be successful, the drug must be given in amounts that would upset the balances between the different groups of secreted adrenal hormones and would cause adrenal atrophy if given over a protracted period. His patients were required to follow a high-protein, medium-fat, and lowcarbohydrate diet. This permitted all meats and fish, all dairy products, all fruits, and all vegetables, except the very starchy ones. It forbade all stimulating drinks, especially alcoholic ones. This diet was designed to place the least possible stress on the adrenal glands, thereby permitting them to function at top efficiency. This diet does not exhaust, but rather builds, adrenal reserves.
Fortunately for all CFS sufferers, our adrenal glands have great recuperative power; they will again be our willing servants if we but give them the chance. We can see from Dr. Tintera's work that not only is the Adrenal Syndrome problem flourishing today, but it is actually much more pronounced than it was in the times of Sajous and Harrower. Why? Simple. Its causes are becoming more and more pronounced on all levels of our daily life with the continued assaults to our body by more and more sophisticated drugs and medicines and continued assaults from the outside due to increasing forms of pollution, contamination and toxicity. The wonder is not that there are people who are affected by CFS; the real wonder is that there is anyone in the country who does not have this condition. It is amazing that any of us is able to function in a truly normal fashion and adapt to the great number of stresses and general assaults to our body, mind and soul that abound today.
Dr. Tintera's work also reveals new aspects of the adrenal gland, particularly its control of allergies. Most patients who have allergies are victims of CFS even though they do not as yet have the other classic symptoms. Dr. Tintera's comment on inherited adrenal weakness is also interesting. My work has consistently verified this point, and I now refer to these patients as having "Chronic, CFS."
Despite all the recent concern about CFS relatively little has been done in recent years to explore and clarify the biochemical alterations in the body which cause this condition. One research study that reviewed the relationships between adrenocortical function and infectious illness stressed the presence of depressed adrenocortical secretion during chronic infection, although most information was based on studies of tuberculosis.(8)
(8) Rapoport, M. I., and Beisel, W. R. Inter-relations between adrenocortical functions and infectious illness. New England Journal of Medicine 280(10):541 -546, May 6, 1969.
Perhaps the most exciting and promising advance toward understanding clinical disorders and illnesses brought about by early delicate hormonal imbalances has been in the realm of thyroid physiology.(9-13) This research has been concerned with relationships between hormonal secretions and depression. In studies of depressed patients, testing with the hormones was the only early method of detecting hypothyroidism, as results of usual laboratory tests remained in the normal range. This research is exciting, because revelations in this area may provide clues which will lead to better understanding of CFS-not only its causes, but the disease process as well.
Meanwhile, Dr. Hans Selye, the Canadian physiologist, in his long-term study of stress and its effect on the human body developed a theory he called "General Adaptive Syndrome" (GAS).(14-15) According to Dr. Selye (see his chart in Chapter Five), the body contains a complex mechanism designed to permit it to adapt continually to the various stresses and pressures that assault it from all sides, inwardly and outwardly. As long as this system is capable of functioning in a more or less normal fashion, the human body and mind are able to adapt successfully to a wide range of stresses and assaults, whatever their nature-chemical, physical, bacteriological, viral, mental, or emotional.
(9) Prange, A.J., and others. Effects of thyrotropin-releasing hormone in depression.
Lancet 2:999-1002, 1972.
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"Actually, this ability to adapt is common to all forms of life. When a life form can no longer adapt, it becomes extinct. In other words, this ability to adapt is the very essence of life itself. The mechanisms in the human body which produce this adaptation are, admittedly, complex and, as yet, not fully understood, but one of the most important entities in this adaptation is the adrenal gland. Without this small but mighty gland sitting like a bishop's cap on the top of the kidney, we would not be capable of adaptation. With a strong and vital adrenal gland, we are capable of adapting to almost everything Nature and life can throw at us. With a weakened or poorly functioning adrenal gland, the ability to adapt becomes more and more difficult until a point is reached at which it is difficult for an individual to function productively in our stress-filled, high adaptability-requiring society."-Hans Selye.
Because of the central position of this gland in Dr. Selye's General Adaptive Syndrome, I originally called Chronic Fatigue Syndrome, which basically is a poorly functioning ability to adapt, Adrenal Syndrome (taking it, as mentioned before, from the works of Dr. Harrower). The name was short and descriptive, though certainly not all-inclusive. As previously mentioned, it should not be confused with other presently known conditions, except possibly Addison's disease; but, since this latter condition is caused by distinct pathology of the adrenal gland, differentiation should be easy. Henceforth in this book, when I speak of Chronic Fatigue Syndrome (no longer Adrenal Syndrome), I refer to that condition of the neurohormonal system that produces a weakening or breakdown in the body's general adaptive mechanism.
The whole theory behind the adrenal gland as the culprit (or is it the victim?) in CFS can be stated simply if we take into consideration the previous discussion. There is within the body a mechanism that controls: (1) tissue repair and regeneration, (2) one's ability to fend off substances that might cause allergic or similar reactions in the body, (3) one's ability to withstand stress and to be capable of meeting the needs of the environment at any specific time, and (4) the prevention and overcoming of all forms of disease. It is this system that animates and vitalizes us to become vibrant, useful members of society. As long as this system functions normally, there are few problems of life, be they physical, mental, or emotional, which we cannot overcome. It is the great productive center of all strength and vitality in the body. No matter what difficulties the body may encounter, as long as this adaptive mechanism is functioning well, we have every opportunity to overcome these problems. If there is a weakening or a breakdown in this system, everything else in life falters. Every molehill which the average person would leap with ease becomes an insurmountable mountain to the individual with CFS. The simplest of life's tasks becomes complicated and monumental when the general adaptive mechanism is not up to par. At first the mind still functions and ambition is alive, but the body is not capable of carrying out the directions of these motivators. Eventually, frustration develops which causes depression, further exhaustion occurs due to stress and worry, and finally even ambition and mental capabilities themselves come under the influence of this weakened system. In extreme cases, suicide is not unknown among the victims of this disorder. There have even been reports of Dr. Jack Kevorkian (the death doctor) helping CFS patients to attain what is to them the final cure.
While the history of the condition now known as CFS is long, there is every reason for hope for the CFS patient. The proper treatment is safe and sure if the patient can but understand and accept the true nature of this condition. Once this is accomplished then he has only to follow our instructions, and his adrenal glands can begin their journey back to strength and vigor.
Functional Hypoadrenia, Adrenal Syndrome or Chronic Fatigue Syndrome, a condition of the neurohormonal system, produces a weakening in the body's ability to respond to stress and if not arrested can lead to a breakdown of the body's ability to function. Until recently this condition was not easily diagnosed. In fact, for most of its existence diagnosis of this condition was usually accomplished only by a process of exclusion. Although CFS under various names has been recognized for more than a century, it has changed little in symptom pattern and in treatment required to help it until recently. I personally feel that the "chickens" of infant multiple immunizations, overuse of man-made drugs, suppression of natural disease processes by antibiotics, increased pesticides and other toxic substances in our environment "have come home to roost" and the result is an exponential increase in this weakened adrenal syndrome.
At the turn of the century, Charles E. de M. Sajous, M.D., pioneered in the study and the treatment of adrenal gland malfunction, citing fatigue and other bodily abuses as major causative agents. He understood this condition so well that the admonitions he gave to his patients are still the backbone of the life-style we recommend for all our CFS patients. Although we may be able to refine his suggestions to make his admonitions more specific and sophisticated for a more rapid and complete recovery, the basis of all CFS treatment was outlined long ago by this intrepid pioneer.
Henry H. Harrower, M.D., in the period following World War I made advances in treatment of adrenal malfunction, using what he called plural-glandular treatment-a treatment still used today in our Healing Centers.John W. Tintera, M.D., continued studying functional adrenal disease, especially the relationship of adrenal malfunction to allergens.
Another doctor who made an important contribution to this subject is Hans Selye, Ph.D. He identified the General Adaptive Syndrome theory, describing it as the mechanism by which the body adapts to various stresses and pressures by controlling tissue repair and regeneration, fending off substances which might cause allergic or similar reactions, withstanding stress, being capable of meeting the needs of the environment at any time, and preventing or overcoming all forms of disease. In CFS, the general adaptive mechanism is unable to perform these functions.
In our own more than four decades of working with CFS, we have discovered that the malfunction of the adrenal gland results from a negative interaction of heredity, stresses of all sorts and a combination of individual symptoms or idiosyncracies.