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On The Smartest Doctor in the Room podcast, Dr. Dean Mitchell speaks with chronic fatigue syndrome expert and author of From Fatigued to Fantastic, Dr. Jacob Teitelbaum who shares his insights on how to overcome this complicated disease.

Dr. Teitelbaum has spent at least 40 years, maybe more of his career, helping patients with chronic fatigue syndrome and advancing the latest information on that. He is the author of the bestselling book From Fatigued to Fantastic! This is the third edition and we’re really quite excited in another week or so the fourth edition is coming out.

Podcast main points & discussion.

Dr. Mitchell: In February 2015, I found an article in The New York Times by science writer Julie Rehmeyer titled A Disease that Doctors Refuse to See. Mrs. Rehmeyer wrote about her own battle with chronic fatigue syndrome and how she felt so many doctors she saw dismissed her diagnosis or seemed uninterested in finding out more to help her. My guest today, Dr. Jacob Teitelbaum is quite the opposite of that type of doctor.

I can’t tell you how many patients I see in NYC who come in with the book From Fatigued to Fantastic marked up, dog-eared and asking me the most excellent questions on how they can overcome chronic fatigue. I’ve been fortunate to know Dr. Teitelbaum for about 10 years and my wife, Dr. Ricki Mitchell, and I were involved in the fibro and fatigue centers that were established back in 2010 where Dr. Teitelbaum was the medical director and helped to oversee so many of the protocols such as the  S.H.I.N.E.® Protocol which are being used in various centers around the country.

Dr. Teitelbaum: It’s awesome to be with you and with your viewers today, because so many of you are suffering with a human energy crisis, whether it’s fatigue, brain fog, insomnia, chronic pain, or in its most severe form, chronic fatigue syndrome or fibromyalgia, these are all reflections of the problem. We’re going to teach you how to optimize energy production, how to make fibromyalgia and chronic fatigue syndrome go away if you have that and even for those who just have day to day fatigue or pain, how to address that naturally as well. I like to use a mix of both natural and prescription therapies. I like to use a whole toolkit.

Dr. Mitchell: Patients with chronic fatigue syndrome have heart-wrenching stories. They are too ill to work. Sometimes they’re too ill to care for themselves. Sometimes their whole life and their family life falls apart.

Dr. Teitelbaum I want to ask you, because in your book, you do you open up with your own story of chronic fatigue syndrome. Could you please share with us a little bit, I mean, you mentioned how, I think you had a pediatric lecture and all of a sudden you were this healthy, vibrant guy going to medical school, and then it cascaded into you leaving medical school. I think you mentioned you were homeless for a while. Can you tell us your story, that what you remember, if it’s still pretty vivid in your mind?

Dr. Teitelbaum: It seemed to me the biggest curse that ever happened, and it turned into the biggest blessing. It’s funny. I was paying my own way through medical school and college. My dad was to finish college basically about two and a half years because you’re paid by the year. I was doing 60 credits a semester and it was just kind of rolling through things and medical school and my work was the easiest part of my life. I’m like I came from a family, that was basically a concentration camp community and a survivor community and the rest, and they all went to meltdown and I ended up putting myself in the middle. Fool that I was trying to be the peacemaker. It was funny. I mean, my uncles literally came to my apartment. I’m in medical school and had a heart attack in my living room. It was like one of those TV sitcoms. Like they’re all trying to manipulate me in different ways.

Basically that put me my energy on the edge with everything I was doing. Came down with the nasty viral, what I call the drop dead flu. The blood tests showed this high atypical lymphocytes. They couldn’t identify the virus, but six weeks later I was still nonfunctioning. All the professors were trying to figure it out. Then they figured, well, it must be what they call med student depression, all the rest. But eventually I just nonfunctional. I had to drop out of medical school. Since I couldn’t work, I found myself homeless, sleeping in parks. It was as if the universe hung a holistic, homeless medical school sign on my park bench. This was in 1975.

That’s now 45 years. They all taught bits and pieces herbalists, naturopaths, energy workers, physicians would come and find me sitting on my park bench and if they had some pizza with them I would actually eat that day. I was able to go back to medical school. It’s funny when you’ve been on the other side of the white coat, cause somewhat if you have the experience. If you go to the doctor and the doctor says, I don’t know what’s wrong with you. You’re crazy. Which by the way is abusive and totally unacceptable.

We’ve treated successfully thousands and thousands of people of this illness. We have five studies that are published or submitted so far for publication out of factor treatment, a number of other studies as well. This is a very, very, very treatable illness. Unless you rely on most doctors to treat you.

Immune Signature

Dr. Mitchell: In 2017, Mark Davis and Jose Montoya out of Stanford, they put out a nice paper. It was pretty interesting showing and they’re both immunologists and they wrote a paper what they called about immune signature. I think my list is going to find this very fascinating cause it relates to COVID now that they found in chronic fatigue patients versus healthy patients, and I believe even rheumatoid arthritis patients, that there was a difference in what’s called cytokine profile that certain inflammatory markers were clearly elevated in these patients compared to healthy control patients and even I think to rheumatoid autoimmune arthritis patients. I wanted to just ask you if you have anything to offer and we’re going to get into a lot of other things that you do in evaluated patients, but just on this basic level anything that you find striking from those papers or anything? I mean, do you look at cytokine levels in patients with chronic fatigue?

Dr. Teitelbaum: I don’t personally do it because it does not affect my treatment approach. What you will find for those of you who are wondering, is this a real disease? Absolutely. There are dozens of abnormalities on the lab tests that are commonly seen. The thing is that there’s no single one test that is only abnormal in this disease and not in anything else. For example, somebody has a very high blood sugar they’re diabetic period. Somebody has for high blood pressure, they’re hypertensive.

Where chronic fatigue syndrome is a much more complex multisystem disease. There are less severe, but devastating permutations from literally dozens of different tests. But it’s not only seen in this disease. You can see this permutation and eight other diseases as permutation others.

The bottom line for diagnosis, there’s very, very simple test that works very, very well. I asked the person, are you exhausted? Yes. Do you have trouble sleeping? Yes. You can’t sleep even though you’re exhausted and you don’t have anything else overt. It doesn’t go away. The vacation. You have the process. That paradox of can’t sleep despite exhaustion. Tells you that there’s hypothalamic dysfunction in play. You basically tripped a circuit breaker. Really that’s all you need because even if it’s being triggered by other diseases like lupus or rheumatoid arthritis that can’t sleep, even though exhausted paradox, it tells you this fibromyalgia process for CFS processes is going on.

 S.H.I.N.E.® Protocol 

Dr. Mitchell: In your book in the different editions From Fatigue to Fantastic I know you talk about the shine protocol, which I found to be super helpful because when I got involved with this with my wife 10 years ago, I gave the example. I said to my wife, Ricky, I said because I had to help out in the office when she wasn’t feeling well at one point and get involved in this. I have an immunology background, infectious disease background. I said to her, I felt like I was thrown in the ocean and in every direction that I looked, I didn’t see land. It was that complex dealing with these patients initially. But really, through a lot of hard work, I did the same thing that Ricki did, my wife. I studied at night, your book. I looked at articles and every patient became my teacher to hopefully get better at treating the patients. But I want to focus on the S.H.I.N.E protocol just quickly for the listeners is, S stands for sleep, H is for hormones, I is for infections and immune dysfunction, N is for nutrition and E is for exercise.

So my question is, “What insight can you give to patients and the doctors if they feel it’s an infectious etiology?” A lot of patients come with Epstein-Barr, which we have to sort through, because I always feel like Epstein-Barr’s a maker, not necessarily the actual cause in these chronic patients. So I was just curious. I’m interested to know because, as you know, there’s just so many factors involved in chronic fatigue. But when you have one that you think it’s a clear cut infectious, like if a patient traveled to Africa, came back, and they’ve ruled out everything, but they’re really sick, or a patient had severe Epstein-Barr infectious mononucleosis. Do you treat that differently? We’ll talk about some things that you trained Ricki and I to do. But I was just curious, again, if you look at the patient a little differently than you would, if somebody had obviously, some type of traumatic life thing where they went through a divorce and it was all stress, which causes illness in its own way.

Dr. Teitelbaum: Well, it’s not rocket science. If somebody comes in saying, “I had a nasty flu-like symptom or flu-like illness and it never went away, and I’m constantly feeling like I have the flu,” ain’t rocket science.

The reason that they’re getting a persistent disease is because of the virus. These are not horrible mutant viruses. These are just run-of-the-mill viruses, like Epstein-Barr, CMB, FHHV-6 that over 90% of the population has had.

So you really need to tune up their entire body, especially getting the sleep and nutritional support, getting adrenal support. These are the critical things for immunity to act properly. And then I will go with Famvir and Celebrex, a combination, and I usually tend to start with that. If that doesn’t work on the FHHV-6 or CMB, very, very high titers, I go with the Valcyte Equilibrant from suspecting enterovirus, and this is all in the book. How do you tell? Okay, what makes you think one? What makes you think the other? How do you dose it? It’s all there. On the other hand, if I have somebody who’s having more chronic lung congestion, scalp scabs… There are a number of things that make me think more antibiotic sensitive, and I’m going to go and head down and consider a trial of Doxycycline, or Erythromycin, or Cipro, although Cipro, you need to be a little more careful with than the others, and we’ll go with these different things. The testing is not very helpful for the infection. More matter of history and see what works.

Dr. Mitchell: Yeah, I found Flexeril to be very good for the fibromyalgia patients cause in some cases it’s been remarkable. But what battles are just for these chronic fatigue patients have no energy. I mean, do you, will you use the Adderall? I’ve seen like the Adderall on some patients.

Dr. Teitelbaum: I think the Adderall is overused in hyperactive kids and underused in CFS and fibromyalgia. It optimizes dopamine. It helps the orthostatic intolerance or pop. It basically can be very, very helpful. And as long as people are keeping up to 20 milligrams a day or less, I’ve never seen anybody get addictive issues at 20 milligrams a day or less. I think that is underused and can be very, very helpful.

Dr. Mitchell: What else I find underused, which again, I learn from you and I have used with patients with success is the floor nap. And I just want the listeners to understand what that’s for. That’s an adrenal, essentially adrenal type of hormone. And what’s very interesting in chronic fatigue is that you have patients that tend to run very low blood pressures. I think it puts them at risk that women can in general tend to have a little bit lower blood pressure than men. But when I see even a woman that comes in with a blood pressure of 90, over 60, that’s just her normal blood pressure. I sometimes say to them, and they’re having all this severe chronic fatigue and other things are going on. I said, you know what? Your blood pressure dips 5 or 10 points in a day, for whatever reason, how something in the atmosphere or just whatever’s going on in your body.

You’re now in a state of where your body doesn’t want to be fully erect. And I will check their baseline cortisol levels before I started now dostrom levels. And in some of the cases, I’ll check. As you mentioned, like in adrenal fatigue, they’re like the saliva test just to see the levels throughout the day. So I was curious if that’s, again, something that you tend to see a lot with the chronic T patients basically borderline hypotension, low blood pressure.

About the Author – Dr. Dean Mitchell, M.D.

Dr. Dean Mitchell, M.D.

Dr. Dean Mitchell M.D. is a Board-Certified and Immunologist based out of NYC. He graduated from the Sackler School of Medicine and completed training at the Robert Cooke Allergy Institute in New York City. He is also a Professor of Clinical Immunology at Touro College of Osteopathic Medicine, a fellow of the American Academy of Allergy, Asthma and Immunology, and the author of Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time. Dr. Dean Mitchell, M.D. has also been featured in The New York Times, The Huffington Post, Fitness Magazine, Dr. Oz and News NY 1. Dr. Mitchell also hosts the podcast The Smartest Doctor in the Room – a combination of a lively, personal and in-depth interview with top healthcare specialists.

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