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Fibromyalgia and Chronic Fatigue Syndrome- What is the cause?

Written by Dr. Tom Messinger, ND

    First, let’s talk about what these conditions are, and then I will discuss what are the possible underlying causes.
    Fibromyalgia (FM) is recognized as the most common cause of chronic widespread musculoskeletal pain. It is often accompanied by fatigue, sleep disturbance, Irritable Bowel Syndrome (abdominal bloating with change in bowel movements), depression and/or anxiety, and cognitive issues.  The cognitive issues include difficulty with concentration and/or memory and patients often refer to these symptoms as “brain fog” or “fibro fog”. Depression and/or anxiety are present in 30 to 50 percent of patients at the time of diagnosis. In addition to the above symptoms, it is not uncommon for patients to experience symptoms of autonomic nervous system (ANS) dysfunction such as low blood pressure when they stand up and variable heart rate
    Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), has many similarities to Fibromyalgia. Many of the patients I have seen have received both diagnoses. The Institute of Medicine (IOM) diagnostic criteria for CFS/ME focuses on the most specific features of this condition. Diagnostic criteria include that symptoms should be present for at least six months and have moderate, substantial, or severe intensity at least one-half of the time. In addition to fatigue, other criteria include post-exertional malaise, unrefreshing sleep, cognitive impairment, and orthostatic-related symptoms (autonomic nervous system dysfunction). Patients with CFS/ME also tend to receive the diagnosis of “Depression” and/or “Generalized Anxiety Disorder”.
     Now that you have some familiarity as to what symptoms constitute these conditions, this next point is one of the most important points for you to understand. When one has these symptoms, or given either of these diagnoses, it does not explain what causes these conditions.  
    Commonly recommended conventional treatment is aimed at targeting some of the main symptoms. This includes pharmaceutical prescriptions for aiding in sleep, addressing pain (usually NSAIDS, which are known to increase risk of heart attack and stroke), and anti-depressants. Clinically, I have not seen these to be effective treatments. It is common sense, that if you just treat the symptoms without knowing and treating the underlying cause, then it would be unreasonable to expect a resolution of these symptoms.
    As a result, in my experience, I have noticed a few things in treating people suffering with the above symptoms.  First, when patients come to me, they still have not gotten answers as to why they have these symptoms. Second, they have been to multiple, if not numerous doctors, and based upon their evaluation, they have been told by the doctors that they can’t find anything wrong. As a result, it is not uncommon for patients in this situation to be told that it is “all in your head” and get placed on an anti-depressant and told to reduce stress, exercise, and lose weight (if needed). Unfortunately, in most cases, this approach is not successful because the underlying cause is not addressed. In addition, I have often found the depression/anxiety piece is often a result of physical causes, not mental/emotional imbalances, thus treating with anti-depressants often does not give lasting results.
      So, what are the causes of CFS and Fibromyalgia? I have found that they are often multi-factorial, meaning there is often more than one contributing factor to a person’s health decline. 
Common contributing factors include undiagnosed Lyme disease, Mold toxicity, hormonal imbalances, disturbance in the microbiome balance, poor detoxification mechanisms leading to an over accumulation of environmental toxins, and food sensitivities. Regarding Lyme disease, I have had many patients who have told me that they were tested for Lyme disease by their PCP and was told the test was negative. However, when I have done additional testing, they have a clearly positive test. The reason for this discrepancy is that their PCP is following the standard of care guidelines for Lyme disease testing set up by the CDC. This is a test called the Lyme Elisa test. However, numerous studies have reported a sensitivity of just 13-49%. Sensitivity refers to the ability of a medical test to be able to detect an infection if present. The studies show that in people who have confirmed cases of Lyme disease, the majority of them will be missed by this test. Despite this, the CDC guidelines state that is the Elisa test is negative, then no further Lyme testing is needed.
   Through a thorough evaluation and proper laboratory testing, the root causes of a patient’s symptoms can be identified and then the indicated treatment is given to aid in the restoration of their health.

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Dr. Tom Messinger, ND, RN, was interviewed by Talent News and Review

Dr. Tom, are you new to the area?
  Yes, my wife and I moved to Talent 7/2019. We had lived in Portland, OR for 13 years. We loved it there but had a strong calling to live rurally and leave the city life. It was a big decision that we did not take lightly. I had an extremely successful practice and was the director of a busy integrative clinic with 10 other doctors. I was very close with my patients. However, my life was entirely work, typically putting in 70-hour work weeks. I had a desire to bring more balance into my life in addition to helping people heal. 
What made you choose Southern OR?
  Well, for anyone that has lived in Portland,  having more sun! Also, the people are really nice, and I love the beauty of nature that is pervasive here.
Tell me about your practice as a Naturopathic Doctor.
       Being trained as an N.D., with every patient, my first step is to figure out what are the possible underlying causes of their health issues. In medicine this is referred to as a differential.   If one does not identify the underlying causes and just treat the symptoms, then that is equivalent to a band-aid. As we all know, band-aids may help at first, but then they no longer stick. The readers may notice that I used the word “causes” plural. This is because I have found that with chronic illness, it is rare to have only one underlying cause. 
   In the first visit, which is often 2 hours, I take a very detailed history because that provides me with clues to what underlying causes are contributing to the patient’s symptoms. We perform testing to confirm the suspected underlying causes. While waiting for results, I start my patients on therapeutic treatments at the first visit. It is important to lay a strong foundation to successfully treat the underlying causes. This varies from patient to patient but includes optimizing the person’s diet and supporting key detoxification pathways. 
      Over the years, my practice has morphed into specializing in treating patients who have been to numerous providers, including MDs, DOs, and NDs, and have not found answers to their health issues. Many of the patients I have seen struggle with chronic fatigue, chronic pain, Fibromyalgia, gastro-intestinal issues, auto-immunity, hormonal, and neurological issues.  When a person has some or all of these issues occurring, there is usually a few common threads that are resulting in multiple body systems being involved. When I do workup on these patients, I often find that they are suffering from Mold Illness and/or Lyme disease and other tick-borne infections. 
     Lyme disease is known as the “great imitator” because it can mimic so many other conditions. However, there are certain symptoms that are strongly suggestive of Lyme disease. A valuable pre-screening tool that anyone can do is take the Horowitz Lyme Screening Questionnaire. It is available online for free. Published data has shown it is reliable on differentiating patients who may have Lyme disease from those who do not. I do not simply rely on the questionnaire. I arrive at a diagnosis based upon history, physical exam, and laboratory findings. Interestingly less than 50% of my patients who have been diagnosed with Lyme disease had recollection of a tick bite. Also, there is multiple peer reviewed published papers showing that the “classic bulls-eye” rash occurs in as low as 9% of the cases.
Due to various political and financial issues (that I will not get into in this article), in some circles the diagnosis of Chronic Lyme disease is controversial. However, there are over 700 peer reviewed papers showing that the spirochete causing Lyme disease (Borrelia burgdorferi) can persist in the body for years even after prolonged antibiotic treatment.
    I have had a number of patients who upon doing their own research suspected that they had Lyme disease and they went to their PCP. Their PCP, following the CDC Standard of care guidelines, will often run the Lyme Elisa test. If this test comes back negative, the CDC says no further testing is necessary. The patient is then told they do not have Lyme disease. The problem with this is that multiple studies have shown the sensitivity of the test (the ability of the test to detect a disease if present) is between 33-49%. Meaning, at best, the majority of patients who have Lyme disease would have the diagnosis missed if running this test. As a result, as part of my workup, I am ordering Lyme testing that is sensitive and has a greater chance of finding the infection if present.
Can someone recover from Lyme after having it for a number of years?
    Absolutely, there are a lot of great treatments that I employ that have shown a lot of benefit. Treatment is often comprehensive. We need to address the chronic infection, the biofilms, the downstream damage that has occurred from the infection, strengthen and regulate the immune system, and upregulate the detoxification pathways to clear debris.
How about Mold Illness?
    24% of the population has a genetic defect that when they are exposed to mold in a water damaged building, their immune system cannot identify it and thus it is not eliminated from their system. Mold, being a living organism, can then colonize in the body. The most common places it colonizes are the intestinal tract, sinuses, and sometimes the lungs. Mold then produces mycotoxins which activate the same inflammatory biochemical pathways in the body that the Lyme spirochete does. Thus, there is a great similarity of symptoms between the 2 conditions. The most common symptoms include fatigue, what is referred to as “brain fog”, chronic sinus congestion, and IBS type symptoms. There are many other symptoms that can occur, including neurological illnesses, kidney disease, and increased sensitivity to external stimuli. When someone reports being unusually sensitive to common stimuli, one thing to think about is Mold Illness and Bartonella. Mold, plus Bartonellosis (an infection contracted by  bites of a tick, flea, or cat scratch/bite), are great sensitizers of the nervous system. People can become hypersensitive to light, sound, smells, noise, EMFs, and chemicals.
How do you diagnose Mold Illness?
  It is by performing a urine test looking for the presence of mycotoxins. A person does not need to be currently living in a moldy environment to be harboring mold in their system.
How do you treat all of this?
   I wish I could tell you that there is a simple, straightforward protocol for each diagnosis. I wish it were that simple, because it would make my job easier. Each person is an individual, had their unique life experiences/infections/traumas and thus the treatment must be tailored to them as an individual. There are a lot of considerations that I take into account in developing the treatment plan.  I have seen a fair amount of patients that I place in the category of being extremely sensitive and in those cases, we have to do things to first calm down their nervous and immune system just to pave the way so we can treat the identified underlying causes without causing an aggravation of symptoms. With all of this being said, I use integrative treatments such as diet optimization, herbs, homeopathy, Neural Therapy, Shiatsu, Ozone, and will utilize pharmaceutical antimicrobials for treatments when indicated. I have had a number of mentors over the years, but a lot of what I do is based upon the teachings of Dr. Dietrich Klinghardt, MD, PhD, and Dr Neil Nathan, MD. Their wisdom in treating these chronic conditions has greatly helped me to help my patients.   
Where do you practice?    
  My practice is located at Bear Creek Naturopathic Clinic in Medford. To try and maintain balance in my life, I see patients 3 days per week, and devote 2 days per week to study, research and administration tasks. I am seeing patients in person with the proper precautions and the clinic is following OHA COVID guidelines. I also offer phone or virtual appointments.
  In addition, I do offer free 15 minute phone consults. That allows prospective patients the opportunity to explore if working together would be a good fit for them and if they feel I can help them

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Written by Dr. Tom Messinger, ND

     Mold illness is a relatively newly recognized phenomena in medicine. It has been found to be a common underlying cause of chronic, unresolved health issues. It is a condition that results from an accumulation of mycotoxins in the body. It is different than a mold allergy. Mold allergy symptoms from mold exposure are temporary and usually consist of runny nose, sneezing, and itchy eyes. Research has shown that 24% of the population has a genetic defect where their immune system cannot properly identify mold toxins in the body and therefore, they are unable to eliminate them.

    A person could have elevated mycotoxins in their body either due to a current mold exposure from a water damaged building or due to an exposure(s) from the past. Some people who have had a prior mold exposure, and have proper genetics, detox pathways, and have favorable epigenetic factors, and able to clear the mold from their system once they removed themselves from the exposure. However, due to several factors, including the HLA genetic defect mentioned above, some people’s bodies will not clear the mold. Mold can colonize in the body and if not eliminated, can cause symptoms in any body system.

    There are multiple environmental contributors to the rise of mold illness. One major reason is that buildings have been built much “tighter” to conserve energy, yet, often at the expense of adequate ventilation. This causes an increased risk of mold accumulation.  In 20111, NIOSH reported that up to 50% of buildings in the U.S. have sustained water damage. If you think about the fact that 50% of buildings has a history of mold growth and almost a quarter of people cannot properly process mold toxins once inhaled, then you can imagine that mold illness is much more prevalent than commonly recognized.

   Body accumulation of mold and mycotoxins can result in a wide range of chronic symptoms. The most common symptoms include chronic fatigue, cognitive difficulties, and chronic sinus issues. Other symptoms that can occur include gastro-intestinal symptoms such as bloating, constipation, and/or diarrhea, joint pain, dizziness, unusual patterns of numbness, unexplained weight gain, depression. anxiety, and sharp or shooting pains. Children often present with ADHD/ADD in addition to some of the above symptoms. In 2013, a study published by Dr. Joseph Brewer demonstrated that 93% of patients with chronic fatigue syndrome had elevated mycotoxins in their urine.

   In addition to the above symptoms, when a patient reports that they have become increasingly reactive to chemical and/or environmental stimuli, the healthcare provider should regard that phenomena as a red flag that there is a high probability that a mycotoxin body burden is present. Dr. Michael Grey and his team published several papers in 2003 clearly demonstrating immune and nervous system dysfunction in more than 200 patients who had mold exposure from water damaged buildings. The immune and nervous system dysfunction caused by mold can cause person’s system to become overly sensitive. People report becoming increasingly reactive to more foods, chemicals, EMFs, and in more severe cases, even light and sound.

  The diagnosis is confirmed by doing a provoked urine mycotoxin test that is performed by a specialty lab. The test screens for levels of mycotoxins that have been found to cause illness in humans. If the test results are positive, there are definitive treatments that have been shown to be helpful in removing the mycotoxins and help restore health. In addition to facilitating the removal of mycotoxins from the system, an important component to treatment is treating the colonization of mold that occurs in the body. Colonization refers to the inhaled mold spores basically “setting up shop” in certain areas of the body, becoming mycotoxin producing factories. The 2 most common areas of colonization are the gastro-intestinal tract and the sinuses. These areas require anti-fungal treatment. In a landmark study done at the Mayo clinic in 1999, it was found, treating chronic sinus issues with nasal anti-fungals demonstrated marked improvement. Prior to this, chronic sinus symptoms  were thought that to be due to allergy and/or bacterial infections, not fungal infections.

   I have found Mold Illness remains to be underappreciated by most physicians. Of course, if it not looked for, then it will not be found. Many patients who have had a significant decline in the health have found that removing mold and mycotoxins from their system resulted in great improvement in many of their chronic health issues.

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Reversing Cognitive Decline

Written by Dr. Tom Messinger, ND

Alzheimer’s disease is one of the most significant global health threats we face today. It is an ailment that, as our population ages, is forecasted to become a worldwide epidemic. It is estimated that more than 1 in 8 Americans alive today will die of Alzheimer’s disease if effective prevention and reversal interventions are not implemented.  The good news is, as you will read later in this article, there is now proven interventions that can prevent and reverse Alzheimer’s disease. There are multiple types of Dementia that can occur, but since Alzheimer’s Dementia is by far the most common, we will focus on this for the purpose of this article When one is getting evaluated for potential cognitive changes, I will start with the patient doing cognitive testing with a test called CNS Vital Signs and/or the MoCA test (Montreal Cognitive Assessment). These are sensitive screening tests to assess the degree of cognitive impairment. The score out of 30 on the test categorizes the degree of cognitive impairment. A patient can have Subjective Cognitive impairment (SCI), Mild cognitive impairment (MCI), or Alzheimer’s disease. SCI means that the patient and/or family member know there is a problem, but standard testing does not show it. The CNS vital signs test is extremely sensitive, so it can often detect an issue even if prior cognitive testing was normal. The pathophysiology (this means the physical changes) of Alzheimer’s disease (AD) begins approximately 20 years prior to diagnosis. This has been found with cerebral-spinal fluid and PET scan tests. This is paramount for anyone suffering from even subjective cognitive impairment to understand. If one notices that their brain does not seem to be working like it used to, then this may be a warning that there are changes already occurring in the body that need to be addressed. Even though AD can be reversed, it is much easier to have effective interventions in the SCI and MCI stages. You may be thinking that AD cannot be reversed. Well, that is what has been thought and is still the current line of thinking in most mainstream medical circles. There are drugs developed to treat AD, but they have not been shown to be effective. However, in 2014, Dr. Dale Bredesen, MD, shocked mainstream medicine when he published research in a peer review journal proving that using a multi-step precision medicine approach, cognitive decline was reversed in 9 out of 10 patients. Dr. Bredesen has been practicing and doing research in this field for over 30 years. With continued refinement of his clinical approach to cognitive decline and AD, several years later he published case reports of 100 patients demonstrating detailed clinical reversal of cognitive decline. The program that he developed, called ReCODE 2.0, also known as the Bredesen protocol, has fundamentally changed the way we understand and treat cognitive decline. We know that the aggregation and accumulation of different forms of amyloid beta is a key pathological feature of Alzheimer’s disease (AD). What causes the body, which has an innate intelligence, to go awry and make excess Amyloid beta? As a result of over 30 years of laboratory research, Dr. Bredesen  has written hundreds of peer-reviewed publications that have uncovered the biochemical mechanisms behind the erosion of memory associated with Alzheimer’s disease. He has identified 36 different factors that can contribute to excess amyloid beta and other brain changes How do these 36 factors contribute to the development of AD? Well, it starts with a protein called Amyloid Precursor protein (APP). APP can signal for either nerve cells and synapses to grow or to retract. If retraction is in excess, the body will lay down more amyloid beta plaques as a response. What causes APP to signal for excess retraction? The presence of one (but often more than one) of any of the 36 factors. The current pharmaceutical approach is focused on developing a drug to combat Alzheimer’s. As you can see, if one were to create a single drug specific to Alzheimer’s, it would have to perform so many different functions by addressing the 36 potential factors that it would be unlike any drug ever developed. Therefore, it is not surprising that there have been over 400 failed clinical trials using a monotherapeutic (single drug) approach. While the single-pill approach may not be a viable option, we can address the underlying causes and get results. The 36 potential triggers can be analogous to 36 holes in the roof of a house. It is the responsibility of the clinician to identify which of these holes exist for the patient and remove and repair them. On average, the patient may have 10-15 holes. These holes or contributing factors to cognitive decline include chronic unidentified infection, such as viruses, Lyme disease, Bartonellosis; poor nutrient status, inadequate hormones, excess burden of toxins including heavy metals, mycotoxins from mold exposure, and chemicals; alterations in nighttime oxygenation (such as in sleep apnea), periodontal disease leading to neuroinflammation, metabolic changes including insulin resistance, genetic factors, and more. 100% of AD brains on autopsy have been found to be insulin resistant, meaning the brain is unable to use sugar for metabolism. The brain is literally starving. This is where dietary interventions to promote the body utilizing ketones as the primary fuel source is important. One may be surprised that Lyme disease is included as a possible contributing factor to AD. Dr. Alan McDonald, a well known pathologist, studied brains from deceased AD patients from the Harvard brain bank, and 100% of them had Borrelia, the Lyme spirochete, in the brain tissue. Treatment involves first identifying the main “holes in the roof”. This results in an individualized treatment approach for each patient. Patients may have similar symptoms; however, the underlying causes of those symptoms can differ considerably. Once the causes are identified, treatment to target things such as chronic infections, removal of toxin accumulation, providing trophic support for nutrients and hormone optimization, optimizing sleep and oxygenation, utilizing brain stimulation techniques, resolving inflammation, balancing the immune system, and providing support for synaptogenesis (regeneration of nerves) are implemented. The Bredesen Protocol has dramatically changed the lives of many people and their loved ones where there had been no hope for recovery BIO: Dr. Messinger is a Naturopathic Doctor practicing a Bear Creek Naturopathic Clinic in Medford. Prior to being an ND, he worked as an ER nurse for over 20 years. His clinical focus is treating patients with complex, chronic illnesses. He is an active member of ILADS, ISEAI, and is certified in the ReCODE 2.0 Bredesen Protocol.

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