We’re all born with a stress-coping “savings account” filled with chemicals—such as hormones, amino acids, and nutrients—that can be deposited and then withdrawn when needed. Depending on our genes, some of us have large accounts, and some of us have smaller ones. The more stress we’re under, the more withdrawals we make. If we make more withdrawals than deposits, we get overdrawn, and poor health quickly follows. Individuals with fibromyalgia and/or CFS have bankrupted their stress-coping savings account.
Although some patients bankrupt their accounts with one overwhelming event, most experience a series of stressful events over the years. These events typically involve stressful jobs, marriages, family dynamics, surgeries, illnesses, loss of a loved one, divorce, financial failure, etc.
Many of my patients can remember the day when their account went belly-up. It might have been after a surgery or following the loss of a parent. Whatever happened, the person was never the same from that point on; she just couldn’t get well. My CFS patients often relate how they came down with a bad case of flu and just never completely got over it. Once these individuals get enough rest and stop making withdrawals, they may attempt to do something as mundane as sweep the kitchen floor only to be wiped out once again. And forget about grocery shopping! That could put them in bed for weeks.
FMS and CFS are the result of internal biochemical (hormonal, enzymatic, neuronal, and chemical) imbalances that manifest themselves as physical symptoms (pain, weakness, and mental impairment).
So in order to right the homeostatic system, you must correct the underlying biochemical problems. Just like an onion, you peel away one layer at a time until you get to the core. But we’ll discuss these practical steps soon. For now, let’s make sure that you understand all of these “layers of the onion.” One of these is dysautonomia.
Dysautonomia and the HPA Axis
Dysautonomia is defined by Taber’s Cyclopedic Medical Dictionary as “a rare hereditary disease involving the autonomic nervous system with mental retardation, motor in coordination, vomiting, frequent infections, and convulsions.” But dysautonomia symptoms are usually nowhere near this severe. Dysautonomia patients are more likely to be suffering from mitral valve prolapse and neurally mediated hypotension (dizziness upon standing) than mental retardation and vomiting.
A better description, then, of dysautonomia would be a malfunction in the body’s master regulating (homeostasis) system, which is known as the autonomic nervous system or the HPA axis. The HPA axis (comprised of the hypothalamus, the pituitary gland, and the adrenal glands) controls millions of involuntary actions such as breathing, releasing of endocrine hormones, blood flow, smooth muscle tone, immune response, heartbeat, detoxification, and elimination. We don’t have to think about breathing; we just do it. We don’t try to pump blood through the heart and into the muscles; it is initiated and monitored by our HPA axis.
Normally all the systems in the body speak to and coordinate with one another. This is the essence of homeostasis. But when a person depletes her savings account of stress-coping chemicals, her HPA axis begins to self-destruct. This is dysautonomia. It’s as if the immune system starts to speak in Spanish, the endocrine system in German, the musculoskeletal system in Greek, and the digestive system in French! And when no one can communicate, chaos results!
To check for dysautonomia, you don’t need a doctor’s tilt-table test. Instead, follow these simple instructions (or ask a health-care professional for help) to check for adrenal dysfunction: take your blood pressure while lying down. Then stand up. After 30 seconds has passed, take your blood pressure again. Normally the systolic (top number) pressure will go up 10 or more points. A decrease in the systolic number indicates adrenal dysfunction. If a person has mitral valve prolapse, NMH, and a positive adrenal dysfunction test, it’s pretty clear she has dysautonomia.
Hypothalamus gland Dysfunction
The actions of the autonomic nervous system are coordinated by the hypothalamus gland (The “H” of the HPA axis). This gland helps maintain water balance, sugar and fat metabolism, blood sugar levels, blood volume, body temperature, endocrine hormones, and a phenomenal portion of the body’s activity. The hypothalamus also releases several different chemicals, including epinephrine, norepinephrine, and corticosteroids. Plus, the hypothalamus has immunologic functions. It’s one amazing gland.
Improper functioning of the hypothalamus can cause a variety of problems, including neurally mediated hypotension (NMH). This occurs when the blood pressure drops suddenly after standing, causing dizziness and weakness. And since the hypothalamus also plays an immune role, any dysfunction can interfere with your ability to stay well. Let’s investigate other conditions that can result from a dysfunctioning hypothalamus.
Dehydration
Dysfunction of the hypothalamus leads to low levels of vasopressin, which is an antidiuretic hormone. This causes decreased ability to hold on to fluid and results in frequent urination and increased thirst. Dehydration then occurs, despite increased water intake. And believe it or not, something as “simple” as dehydration can cause many of the chronic symptoms seen in FMS and CFS, including NMH, depression, excess body weight, high blood pressure, fatigue, low back and neck pain, and headaches. Dehydration also depletes the neurotransmitter tryptophan, and a reduction in tryptophan is associated with insomnia, increased pain, and depression.
Feeling thirsty yet?
Low Levels of Human Growth Hormone
When the hypothalamus is dysfunctioning, human growth hormone (HGH) levels drop. HGH helps increase energy, repair damaged muscles, stimulate immune function, reduce body fat, improve sleep, and enhance mental acuity (especially short-term memory). Does this sound like anyone you know? Long-term studies have revealed even more, as psychological well-being continues to go downhill for those short of HGH. The best way to increase HGH levels is by getting eight hours of deep, restorative sleep each night, but there are also over-the-counter supplements that can help. HGH-replacement injection therapy is available by prescription.
Exercise also helps build HGH levels.
Low Levels of DHEA
DHEA (dehydroepiandrosterone) is used by the body to make other hormones, including estrogen and testosterone. It’s important in creating appropriate energy levels and maintaining feelings of well-being, but a dysfunctioning hypothalamus can cause the adrenal glands to produce less DHEA than is needed.
Low Levels of Cortisol
Decreased levels of this adrenal stress hormone cause immune dysfunction, increased inflammation, hypoglycemia (low blood sugar), and hypotension (low blood pressure).
Low Ovarian and Testicular Function
We’ve talked about how a dysfunctional hypothalamus can lead to low estrogen levels. But did you know that low estrogen can contribute to decreased blood flow to specific areas of the brain? This may explain some of the “fibro-fog” that occurs in some CFS and FMS patients. And low testosterone, both in males and females, can cause immune dysfunction. (Research is now showing that males with low testosterone have an increased risk of heart disease.)
Hypothyroidism
The symptoms of FMS and CFS are consistent with those associated with hypothyroidism (low thyroid function): low body temperature, cold hands and feet, tingling in the extremities, fatigue, and depressed mental acuity.
Recent studies show that over 43% of FMS patients have low thyroid function, and it’s estimated that those with FMS are 10 to 250,000 times more likely than those without to suffer from thyroid dysfunction.
The Other Layers of The Onion
Intestinal Permeability (Leaky Gut Syndrome): Most of the individuals I evaluate are plagued by poor digestion. Much of this is caused by intestinal permeability, which occurs when the lining of the small intestine becomes irritated and leaks undigested proteins across the cellular membrane. This is like turning on a damaged garden hose and watching helplessly as water leaks from hole after hole.
In your body, this “leaking” creates a potentially hazardous situation as the food proteins become allergic irritants. The irritants initiate an immune reaction, and chronic inflammation results.
Malabsorption Syndrome: A close cousin of intestinal permeability, malabsorption is when many vital nutrients are simply not absorbed. Deficiencies of these nutrients lead to depression, insomnia, fatigue, pain, decreased immunity, poor memory, and other ill effects.
The Liver and Detoxification: The body’s ability to eliminate toxins largely determines its health, and detoxification is an ongoing, never-ending process. A number of toxins—including heavy metals, pesticides, solvents, and microbes—are known to cause significant health problems.
The body eliminates toxins either by directly neutralizing them or by excreting them by way of the urine, feces, lungs (breathing), and skin (sweat). Toxins that the body is unable to eliminate build up in the tissues, typically in our fat cells. Most individuals with FMS/CFS are suffering from an overburden of various toxins because of a dysfunctioning liver.
Nutritional Deficiencies: “If you eat a balanced diet you’ll get all the nutrients you need.” The “health experts” who continue to cling to this draconian idea must not have read the research studies written on nutrition over the past 20 years. The standard American diet (even if you eat fruits and vegetables every day) is overloaded with toxic, artificial chemicals. And modern processing methods remove 25–75% of the original nutrients.
An FDA study analyzing 234 foods over two years found that the average American diet contains less than 80% of the RDA of one or more of the following: calcium, magnesium, iron, zinc, copper, and manganese. Other studies have demonstrated magnesium deficiency in well over 50% of the population. A magnesium deficiency can contribute to arteriolosclerosis, fatigue, tight muscles, leg cramps, insomnia, constipation, cardiac arrhythmia, and heart disease. More junk food, anyone?
Let’s look at what a deficiency in just one common vitamin can mean to your body. Vitamin B6 deficiencies are common in women of childbearing age, as estrogen and progesterone tend to consume B6 during its metabolism in the liver. So how much harm could one deficiency cause?
Well, optimal levels of the neurotransmitter serotonin are dependent on adequate quantities of B6. Some cases of PMS have also been attributed to B6 deficiency. A deficiency of B6 results in the loss of cell-mediated immunity and a reduction in the size and weight of the thymus gland, an important part of the immune system. Numbers of lymphocytes decrease, and the body is compromised in its fight against infection and disease.
In short, there is no such thing as a superfluous nutrient! And this doesn’t only include vitamins and minerals. Well intentioned health professionals have been recommending low fat diets for the past 10–15 years, and this has been disastrous for our nation’s health. Americans are now the most overweight country in the world, and we’re still low in the fats that we really need. While on this so-called health diet, the average American has gained over 10 pounds. And cases of heart disease, cancer, type-2 diabetes, and other chronic conditions have actually increased.
A low-fat diet is also usually a low-protein diet, and protein deficiency contributes to depression, fatigue, poor concentration, poor detoxification, and many other illnesses. This is because our bodies need the essential amino acids that make up a protein. They regulate our neurotransmitters, sex hormones, immune system, glucose-insulin levels, wound healing, and thousands of essential bodily functions.
Parasites: Based on medical records and disease patterns, public health experts estimate that 60% of Americans will experience parasitic infections in their lifetime. Over 1 million Americans are infected with roundworm (Ascaris lumbricoides), and 20–30 million are infected with pinworm (Enterobius vermicularis). Giardia lamblia infects 8–10 million and has been implicated, along with Entamoeba histolytica and roundworm, as a contributing factor to CFS.
Food Allergies and Hypersensitivities: Albert Rowe, MD, past president of the American Association for the Study of Allergy, has described a syndrome known as “allergic toxemia” that included the symptoms of fatigue, muscle and joint pain, drowsiness, difficulty concentrating, nervousness, and depression. This syndrome was known as the “allergic tension-fatigue syndrome” in the 1950s, and it sounds to me a lot like CFS or FMS!
Hypersensitivity to environmental chemicals is a growing public concern, afflicting an estimated 15% of the American public. The offenders include odors from cosmetics, perfumes, new carpet, paint, smog, cigarettes, newsprint, copier machines, fabrics, vinyl, household cleaners, and other man-made products.
Candida Yeast Syndrome/Intestinal Dysbiosis: Candida albicans is a yeast that lives in your intestinal tract. It cohabits in a symbiotic relationship with over 400 forms of healthy intestinal bacteria, which help produce many nutrients and also keep the Candida in check. When these good bacteria die (from antibiotics) or are suppressed (by steroids), Candida is allowed to grow to unhealthy levels, causing intestinal dysbiosis. Candida can also increase during times of stress.
Trauma, Especially Neck Injuries: Many FMS patients can trace the beginning of their illness to some type of trauma. And recent findings reveal that people with neck injuries are more likely to develop fibromyalgia than are those with other types of injuries. One study published by Arthritis & Rheumatism in 1997 focused on 102 subjects with a neck injury and 59 who had had a leg fracture, assessing them all one year later. Of those with neck injury, 22% developed fibromyalgia, compared to 2% of those with lower-extremity fractures.
Depression: Some physicians would like us to believe that FMS is nothing more than depression. Studies show, however, that FMS is not caused by depression. But FMS can be a cause of reactive depression (depression due to circumstances). Who wouldn’t be depressed with such an illness? Individuals with FMS have lost their lives to an illness they can’t control and largely don’t understand. Some level of depression is natural.
Infections: Although viral infections are more closely associated with CFS than FMS, remember that these two syndromes are two sides of the same coin. Viral, bacterial, fungal, and mycoplasmal infections are common in both types of patients that I treat, through viral infections like Epstein-Barr have received the most attention.
Poor Sleep: Nonrestorative sleep reduces the production of serotonin and HGH, lowers the pain threshold, and—of course—causes fatigue and mental decline.
All of these “layers of the onion,” as I call them, can force you to make continuous withdrawals on your stress-coping savings account until you simply don’t have a dime left to your name.
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Dysfunction of the hypothalamus-pituitary-adrenal (HPA) axis.
This condition is not fully understood, but we know that this imbalance creates inconsistencies in communication among certain cells, disrupting the body’s ability to maintain homeostasis.
Many of the most common fibromyalgia symptoms (including widespread muscle pain, fatigue, poor sleep, gastrointestinal problems, and depression) regularly occur in people with various hormonal disorders, including those manifested by HPA-axis dysfunction. I believe that suppression of the HPA axis begins with chronic stress, and several studies have demonstrated this. And a survey by The Fibromyalgia Network reports that 62% of their respondents list physical or emotional stress as the initiating factor in their fibromyalgia.
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As described above, the HPA axis is comprised of the hypothalamus, the pituitary gland, and the adrenal glands. The pituitary gland is responsible for releasing many important hormones, ....
As for the hypothalamus, its main function is homeostasis, or maintaining the body’s status quo. Because of its broad sphere of influence, the hypothalamus could be considered the body’s master computer. It receives and transmits messages with the nervous and circulatory systems, keeping continuous tabs on the state of the body. It must be able to initiate compensatory changes if anything drifts out of line. The hypothalamus regulates many bodily functions:
• Blood pressure: this is often low in those with fibromyalgia.
• Digestion: bloating, gas, indigestion, and reflux are common in FMS patients.
• Circadian rhythms (the sleep/wake cycle): this is consistently disrupted in FMS cases.
• Sex drive: loss of libido is a common complaint for FMS patients.
• Body temperature: this is often low in FMS patients.
• Balance and coordination: FMS patients typically have balance and coordination problems.
• Heart rate: mitral valve prolapse (MVP) and heart arrhythmias are a common finding in FMS patients.
• Sweating: it’s not unusual for FMS patients to experience excessive sweating.
• Adrenal hormones: these are consistently low in FMS patients.
• Thyroid hormones and metabolism
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1. Chronic stress disrupts the HPA axis, leading to allodynia (lowered pain threshold) and chronic pain.
2. Chronic pain disrupts the circadian rhythm (normal sleep/wake cycle).
3. Dysfunction in the circadian rhythm results in poor sleep.
4. Poor sleep reduces growth hormone production, leading to poor repair of damaged muscle fibers, poor memory, fatigue, suppressed immune function, and more pain.
5. Increased pain further disrupts sleep and leads to depletion of stress-coping chemicals, including serotonin.
6. A reduction in serotonin causes an increase in substance P, which enhances pain receptors, creating even more pain.
7. Poor sleep and ongoing stress lead to fatigue, mood disorders, irritable bowel syndrome (IBS), adrenal fatigue, decreased DHEA, possibly thyroid dysfunction, and lowered resistance to stress.
8. Decreased stress-coping abilities leads to lowered immune function, and lowered blood volume from adrenal dysfunction leads to further fatigue.
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Most people with FMS/CFS haven’t slept well in years. Many of our patients take tranquilizers, muscle relaxants, or over-the-counter sleep aides to get them to sleep. But most of them never go into deep, restorative sleep. It is in this delta-wave sleep that the body repairs itself by making human growth hormone (HGH) and other hormones that help repair damaged muscles, tissues, and organs. Deep sleep also builds and rejuvenates the immune system.
We’ve all heard that we need eight hours of restful sleep each night. The amount of sleep an individual actually needs will vary from person to person. A five-year-old might need 11–12 hours of sleep; an adult, 7–9 hours. Poor sleep has been linked to various health problems including depression, fatigue, CFS, FMS, and headaches. This is not news to those who suffer from FMS and CFS. They already know that their symptoms get worse when they don’t get a good night’s sleep.
One study showed that college students who were prevented from going into deep (REM) sleep for a week developed the same symptoms as those with FMS and CFS: diffuse pain, fatigue, depression, anxiety, irritability, stomach disturbances, and headache.
Another study, conducted by the University of Connecticut School of Medicine, compared the sleep patterns and associated symptoms of 50 women with FMS. The study showed that a poor night’s sleep was followed by an increase in symptoms, including body pain. This increase in symptoms then went on to prevent the subject from getting a good night’s sleep the next night, even though the person was exhausted. For FMS/CFS patients, this cycle continues and creates a pattern of declining health.
Research presented in June 2002 at the Endocrine Society in San Francisco showed that sleep deprivation markedly increased inflammatory cytokines (pain-causing chemicals)—by a whopping 40%.
Poor sleep also affects your human growth hormone (HGH) levels, and low HGH causes further fatigue, reduced capacity for exercise, muscle weakness, impaired cognition, depression, pain, and decreased muscle mass. Deep sleep, however, initiates the pituitary to release more HGH. Eighty percent of HGH is produced during delta-stage sleep, so the best way to boost HGH levels is to get 8–9 hours of sleep a night.
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Stress Leads to Poor Sleep
As mentioned earlier, we are all born with a stress-coping savings account filled up with chemicals we need for the body to work properly. These chemicals—serotonin, dopamine, norepinephrine, cortisol, DHEA, HGH, and others—help us deal with stress.
Every time we are exposed to stress (chemically, emotionally, mentally, or physically), we make withdrawals from our stress-coping savings account. These withdrawals can be triggered by any stimulus, including sounds (especially loud or irritating noise), odors, and bright light. You may have noticed that the longer you’ve had your illness, the less tolerant you are to certain odors, chemicals, or noises.
Emotionally stressful situations cause the body to release adrenaline, cortisol, and insulin, and these stress hormones stimulate the brain to secrete serotonin. Long-term stress and poor dietary habits can therefore deplete the body’s serotonin stores. If we aren’t careful we’ll find that we are making more withdrawals than deposits, bankrupting our own account. And when we do, FMS and CFS are often the result.
But when a person enters deep, restorative sleep, she makes more serotonin, which then gets deposited into her stress-coping savings account. The more stress a person is under, the more serotonin she’ll need to replenish. It’s a vicious cycle. If she doesn’t have enough serotonin, she won’t be able to go into the stage of sleep in which she is able to make more serotonin!
Serotonin and Tryptophan
The neurotransmitter (brain chemical) serotonin helps regulate sleep, digestion, pain, mood, and mental clarity.
• It raises your pain threshold by blocking substance P,
• helps you fall asleep and stay asleep through the night,
• regulates your moods, reducing anxiety and depression,
• reduces sugar cravings and overeating,
• increases mental abilities,
• regulates normal gut motility (transportation of food-stuff),
• and reverses irritable bowel syndrome (IBS) (surveys have shown that as many as 73% of FMS patients suffer from IBS).
One source of serotonin is tryptophan, an essential amino acid. Ninety percent of tryptophan is used for protein synthesis, 1% is converted to serotonin, and the balance is used to make niacin.
Replacing optimal serotonin stores by supplementing amino acids—such as tryptophan—is the first step toward a better night’s sleep for you. Once this has occurred, and it may take months, your body starts to normalize, and you start to feel a whole lot better. But tryptophan is hard to come by, to say the least. It was taken off the market and labeled a prescription drug in 1989. So what do you do?
I’ve got good news for you. It’s called 5-HTP, and it’s what tryptophan becomes on its way to becoming serotonin. It’s perfectly natural, perfectly legal, and inexpensive. And it’s a better way to “get” your serotonin for other reasons:
First, whereas tryptophan needs to be helped by a transport molecule to cross the blood-brain barrier, 5-HTP moves easily into the brain, so it does not compete with other amino acids for passage. And unlike tryptophan, which is made from bacterial fermentation and is hence subject to contamination, 5-HTP is plant-derived (Griffonia simplicifolia.) Lastly, 5-HTP is converted directly into serotonin, unlike tryptophan, which must first be broken down.
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Why Your Serotonin Levels are Low
Stress often plays a role in serotonin deficiency. Emotionally stressful situations cause the body to release adrenaline, cortisol, and insulin, and these stress hormones stimulate the brain to secrete serotonin. In this way, long-term stress and poor dietary habits can deplete the body’s serotonin stores.
Stimulants like caffeine, nicotine, chocolate, diet pills, sugar, and nicotine also cause a rapid rise in blood insulin levels, which is followed by serotonin release. That’s why you feel better and think clearer after using them. The feeling is only temporary, though, as a stimulate high is always followed by an unpleasant low. This low leads to stimulant cravings and eventually to addictions, as people become dependent on stimulates to raise serotonin levels. Sadly, this addictive process causes further depletion of serotonin. Eventually, no stimulant will help.
Normally we get plenty of tryptophan and thus 5-HTP from the protein foods we eat. However, those with FMS have physiological or biochemical glitches that prevent dietary tryptophan from converting into serotonin. We know this because studies have found FMS patients to have higher levels of metabolites in the kynurenine pathway, and this situation diverts tryptophan away from serotonin production.
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The Myriad Benefits of 5-HTP
5-HTP treats insomnia beautifully, improving sleep quality by increasing REM sleep and increasing the body’s production of melatonin by 200%.
It’s also common for the symptoms of irritable bowel syndrome (diarrhea and constipation) to disappear in 1–2 weeks once essential nutrients, especially serotonin levels, are normalized. In fact, there are more serotonin receptors in the intestinal tract than in the brain. The brain and gut are connected through neuroreceptors that regulate the perception of visceral pain and gastrointestinal motility (the speed at which food moves through the intestinal tract). These receptors are one reason that people get butterflies in their stomach when they’re nervous.
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Supplement 5-HTP to Restore Sleep
All my FMS patients start their therapy by taking 50 mg. of 5-HTP 30 minutes before bed, on an empty stomach (90 minutes after or 30 minutes before eating), with four ounces of grape juice. The juice causes the body to release a little insulin, which, though not necessary for 5-HTP to pass the blood-brain barrier, seems to heighten the supplement’s effect. (If you have problems with your blood sugar levels, try taking your 5-HTP with water or milk.) Patients continue to increase their dose over time, and I’ve typically found 300 mg. to be the optimal therapeutic amount.
One of three things will happen when you start by taking 50 mg. of 5-HTP:
1. You fall asleep within 30 minutes and sleep through the night. If so, you should stay on this bedtime dose and add an additional 250 mg. at dinner (for a total of 300 mg. daily). You may find you sleep even better by taking 100 mg. at bedtime and 200 mg. with dinner.
2. Nothing happens. This is a typical response to such a low dose. You should add an additional 50 mg. each night (up to a max of 300 mg.) until you fall asleep within 30 minutes and sleep through the night. Once you’ve discovered your bedtime dose, subtract that amount from 300 mg. and take the remainder with dinner to keep serotonin levels optimal. If you are taking 300 mg. at bedtime and still can’t get to sleep and stay asleep after two days on this dose, then see “Still Can’t Sleep?” on p. 167.
3. You have a reaction. Instead of making you sleepy, the dose makes you more alert. This occurs more often in CFS and chemically sensitive patients who have a sluggish liver. If this happens, discontinue 5-HTP at bedtime. Instead take 50 mg. at a mealtime for two days. (Taking 5-HTP with food slows its absorption, allows the liver to process it more effectively, and shouldn’t make you too sleepy). After two days on 5-HTP with food, increase to 100 mg. with each meal (300 mg. a day). You may need to play around with your dosing. For instance, you can try taking 100 mg. at breakfast and 200 mg. at lunch. If you are only taking 5-HTP at meals and none at bedtime, then you can increase your dose up to 400 mg. daily if it helps.
If your reaction to serotonin goes beyond alertness to rapid heart rate, increased pulse, elevated blood pressure, and agitation, see your doctor. But don’t be alarmed. I have thousands of individuals on 5-HTP, and I assure you that such a reaction is rare. Just be sure to follow the instructions in this chapter carefully.
Increasing serotonin levels is beneficial for 95% of my patients. But there are those—usually at the far CFS end of the spectrum—who have the serotonin sensitivity reaction described in number 3 above, and it just can’t be helped, even by taking 5-HTP with food. Excessive serotonin levels can cause these patients insomnia, headaches, hyperactivity, and increased heart rate.
Some doctors have theorized that CFS patients actually have too much serotonin already, and this is why they are so tired. So more serotonin just makes them feel worse. I suspect, however, that most patients who have a serotonin reaction do so because of a sluggish liver. These are usually the same patients who have trouble taking most medications. They get depressed on antidepressants and hyperactive on sleeping pills. And they usually need less than the normal dose of any given medicine they take.
I have recommended 5-HTP to thousands of people and have had thousands more order it from my web site and office. In 10 years, I’ve had three individuals who have reported a serotonin sensitivity reaction. Two of them had heard me at a speaking engagement and, in their excitement to enjoy 5-HTP’s benefits, had taken 300 mg. at bedtime the first night. They then experienced rapid heartbeat, increased pulse rate, and agitation for a few hours. Each one called my office for guidance and eventually built up to 300 mg. a day with food and adjusted great to the supplement. Incidentally, both of these individuals had CFS, a history of funny reactions to medications, and elevated liver enzymes in past blood tests (a sign of a poorly functioning liver). Had they been patients of mine with such obvious signs of sluggish liver, I would have suggested from the beginning that they take 5-HTP only with food and never at bedtime. The third individual is actually a patient of mine. She has extreme sensitivity and just can’t take anything without having a reaction.
5-HTP CoFactors
5-HTP is amazing stuff, but it can’t make serotonin alone. It needs help from calcium, magnesium, and some B vitamins. So make sure that you’re getting plenty of these along with your 5-HTP.
Your first step is to take a high-dose broad-spectrum multivitamin and mineral formula daily with a minimum of 700 mg. of magnesium (like my CFS/Fibro Formula). If you aren’t having a daily bowel movement, then you’re probably still deficient in magnesium.
Increase your magnesium by 140–150 mg. (use magnesium chelate, citrate, or taurate) at dinner each night until you begin to have normal bowel movements each day. If you start to have loose bowel movements, reduce the amount.
If you’re not dreaming at night, you’re probably deficient in vitamin B6. So make sure there’s enough B6 (50–100 mg.) in your multivitamin.
Some folks can’t convert vitamin B6 into it’s chemically active form, pyridoxal-5-phosphate (P-5-P). This isn’t common in my patients, but it does show up occasionally. And in that case, all the supplemented B6 in the world isn’t going to help. So when I have a patient who isn’t improving on 5-HTP and my CFS/Fibro formula, then I’ll try them on a trial of P-5-P. This is sometimes the missing link.
basically a healthy amount of physical activity during the day, which it sounds like you do. i have been riding the bike to work recently, which adds up to about 25 miles each day - and then i don't find myself being really tired at the end of the day, but going to bed at a normal time has become much easier.
I will try this as well as taking Mg at night instead of when I get up. I've been taking pills only thus far. 
