What Is Brain Fog? – An Article by Lawrence Wilson, MD

What Is Brain Fog? – An Article by Lawrence Wilson, MD

BRAIN FOG by Lawrence Wilson, MD

© January 2013, The Center For Development


            The brain is the crowning organ of the human being.  Therefore, dysfunctions involving it are always important.  Brain fog is one of the most important symptoms today, even though I have not seen it listed as a diagnosis or recognized health condition in most medical or psychological texts.


A clinical definition of brain fog.  Brain fog may be described as feelings of mental confusion or lack of mental clarity.  It is called brain fog because it can feel like a cloud that reduces your ability to think clearly.  It can cause a person to become forgetful, detached and often discouraged and depressed.  It usually is present most of the time, meaning it does not come and go, although it may become better or worse depending on what a person eats, or one’s state of rest and hydration.

Brain fog is not recognized as a clinical diagnosis because it is not easy to test for it.  It is quite subjective, in other words.  The person just knows that they do not function well, and the mind often seems foggy or cloudy.  This is not the same as dementia, mental retardation, anxiety, depression or other common mental symptoms.  I hope that medical doctors will soon expand their diagnostic ability to assess brain fog, but for now it is a subjective condition, though it is very real.


            Brain fog is quite common.  It affects thousands of people, including children as well as adults.  It contributes to school and work problems, low self-esteem, accidents, unhappy relationships and often is a factor in crime and delinquency because it can cause intense frustration and inability to function well in society.


            The onset of brain fog.  Some people have had brain fog for most of their lives, and may even think their state of mind is normal.  In some other cases, it comes on slowly with age or time.  In still other instances, it may develop almost overnight, perhaps after a mild flu or other illness, or perhaps after a toxic exposure.




            Brain fog can have many causes.  However, the most common, by far, are nutritional and biochemical imbalances that affect the brain and central nervous system of the body.  In my experience, the cause is usually somewhat complex.  It can involve a combination of many factors.  The most common contributing factors are:  

            Toxic metals that can cause or contribute to brain fog.  The most common metal imbalances with brain fog that we see include:


            Copper.  Excessive or biounavailable copper is strongly associated with feelings of confusion, disorientation, racing thoughts, mood swings and confusion.  Some women notice this condition is worse before the menstrual period, a time of the month when the cellular level and probably the blood level of copper level rises.

However, many people, and more so women, have elevated copper levels all the time.  Using birth control pills or patches makes this problem much worse.  Copper imbalance also affects the thyroid gland, and this, in turn, can create the symptoms of brain fog.

            Copper imbalance can be very hard to diagnose.  Blood and urine tests are often normal.  Serum ceruloplasmin may be normal.  Hair tissue copper is often normal.  A liver biopsy for copper is considered diagnostic, but it is a painful and somewhat invasive and costly test that is not worth doing in most all cases.

Dr. Paul C. Eck, my teacher, figured out how to assess copper imbalance easily using a properly performed and correctly interpreted hair mineral analysis.  He called the indicators hidden copper toxicity.  This means the hair copper level is normal, but one can use other indicators on the test to infer its presence.  These include a hair calcium level above about 60 mg% or so, a hair potassium level less than about 6 mg%, a hair mercury level above about 0.02 mg%, a hair zinc level less than about 14 mg%, a four lows pattern, or a ratio of sodium to potassium less than 2.5:1.  Other indicators that can be less reliable are a hair zinc level above about 16 mg%, or a hair phosphorus level less than about 12 mg%.

            Causes of copper imbalance include weak adrenal glands, vegetarian diets or semi-vegetarian diets, zinc deficiency, stress, fatigue, use of birth control pills, copper intra-uterine devices or copper contamination of water supplies or food.  Many children are born with copper imbalance today from their mothers. 

Problems with vegetarian diets.  Vegetarian diets are high in copper and low in zinc, a mineral that balances copper.  These diets are also often low in other nutrients essential for the brain such as taurine, carnitine, essential fatty acids, alpha lipoic acid, B-complex vitamins and others.  Stay away from vegetarian diets if you have brain fog, and be sure to eat meat every single day, at least at one meal. 

            Many vegetarians believe their diet makes them feel ‘spiritual’, when in fact their feeling of detachment is often a symptom of brain fog brought on by their diet or other factors.

            Correcting copper imbalance. Most of the time, copper imbalance cannot be corrected with just a diet or just taking a few supplements.  The best way to correct it is a complete nutritional balancing program.  Just taking copper antagonists or chelators often does not work well.  See the article on Copper Toxicity Syndrome for more information about this common problem.


            Other toxic metals.  Toxicity with mercury, aluminum, cadmium, lead or other metals may also cause symptoms of brain fog.  Most everyone has some of these metals today.   Mercury toxicity is extremely common, as it is found in large fish like tuna in high amounts, and in dental amalgams.  Aluminum is added to table salt and drinking water, and found in anti-perspirants, anti-acids and many cosmetics.

            Fortunately, sauna therapy and a nutritional balancing program can slowly remove ALL of the toxic metals – about two dozen of them.  I do not recommend chelation therapy, as it always depletes some vital minerals and thus makes a lot of people worse in subtle ways that may not show up for years.  See the article on the Dangers of Toxic Metals for more information about this important topic.


            Toxic chemicals and brain fog.  Everyone is exposed to high levels of toxic chemicals today.  Often, one is not even aware it has occurred.  They are everywhere, from car interiors, to upholstery, to plastic equipment, to lawn chemicals, paints, inks, insecticides on food, and always in the water supply.  In cities, the air is often contaminated as well.

Most chemicals are not too toxic, but some severely affect brain function in some people.  A nutritional balancing program will almost always remove all of them, without the use of drugs.  However, one must be patient and, if possible, use a near infrared sauna daily to promote their elimination much faster.

Food chemicals can cause brain fog if one is sensitive to them. One person recently reported that soy lecithin, found in many foods such as chocolates and candy, caused brain fog for her.


            A calcium shell and brain fog.  Another toxic mineral problem occurs when the level of soft tissue calcium increases in the body.  We call this a calcium shell.  The calcium tends to dull or numb the brain somewhat.  One usually becomes somewhat out of touch with reality.  It can cause diminished awareness, heaviness, depression, mental fatigue and other symptoms of brain fog.  This usually corrects quickly with a nutritional balancing program. Click here to read more about a Calcium Shell.


            Other mineral imbalances.  Excessive levels of other trace elements such as iron, manganese andchromium also affect brain activity and may give rise to symptoms of brain fog. 




            This is another common cause of brain fog.  Improperly digested food rots, putrefies or ferments in the intestines.  This generates powerful toxins such as indols, skatols, cadaverine and others.  These slowly poison the liver and other organs as well.  Some can migrate to the brain and cause symptoms of brain fog.  Constipation, or a slow bowel transit time, makes the problem much worse.  A slow bowel transit time means that food takes a long time to pass through the intestinal tract.  It should pass through in about 8-20 hours, at the most.  Many people require 2 or even 3 days for their food to pass through.  This gives the food more time to rot, releasing toxic substances into the bloodstream.

            One may not be aware of bowel toxicity, as there may be no specific or precise symptoms.  Blood tests for liver function and general health will not reveal problems in most cases.  However, liver toxicity is the norm today. The brain is one of the first organs affected by these toxins, as it requires a lot of blood and its functions are delicate and intricate.


            Causes for bowel toxicity include an improper diet containing sweets or fruit, for example.  Fruit causes problems for many people due to its yin quality and its higher sugar content.  Most fruit is also sprayed with pesticides, even if labeled organic.  Other causes are weak digestion, a slow bowel transit time, a need for supplementary digestive enzymes, intestinal infections, stress, poor eating habits, or even just negative emotions.


            Drinking too little water or the wrong type of water is important for the intestinal tract.  Inadequate water or worse, drinking soda pop, fruit juices of any kind, more than one cup of coffee or other caffeinated drinks, and other irritating beverages can damage or overwhelm the kidneys and impair their ability to remove poisons from the blood.

Everyone needs to drink at least three quarts daily of only distilled or spring water.  Second best is carbon-filtered tap water.  All other types of drinking water may not hydrate the body as well, no matter what is claimed for them.  Just changing the drinking water helps many people to some degree by helping to release toxins that can build up in the blood and the organs.  Especially bad is reverse osmosis water, for example, that is sold at most health food stores and supermarkets as “drinking water” or “purified water”.  Most designer waters, alkaline water, clustered water and others are also not as good, and some are harmful.  Read the article entitled Water For Drinking on this website for more on this subject.


            Do not fast to clean out your liver.  Be wary of cleansing programs such as fasts to correct liver and kidney toxicity.  These may give some temporary relief, but usually do not address basic causes such as food allergies, toxic chemicals in the diet or environment, and many nutrient deficiencies.  I used to supervise fasting for several years, and believed it was helpful.  However, today people are so toxic that fasting can easily cause one to become even more nutrient deficient, making things worse in the long run.

            The answer for bowel toxicity is a slow regeneration of the intestinal tract, which may easily take several years.  It begins with cleaning up the diet, eliminating the chemicals and junk foods.  Excellent eating habits and lots of rest are important as well.  Everyone also needs a digestive enzyme supplement today, in my view.  I believe that animal-based enzymes such as ox bile and pancreatin work far better than the vegetable enzymes that are quite popular.

Many other nutrients may be needed, and guessing is not a good idea.  We use hair mineral testing to assess nutrient needs, but only in accordance with the interpretation method designed by Dr. Paul C. Eck and myself.  I have also added sauna therapy and coffee enemas for detoxification.  In other words, a comprehensive program is generally best. 




            This is an unusual condition in which the body is too yin, in Chinese medical terminology.  The causes for this rather common condition today include:

  • Eating a lot of fruit, drinking fruit juices, or eating a lot of any kind of sweets or sugars.

Ø  Vegetarian diets, or worse, vegan diets.

Ø  Drinking alkaline water or even drinking distilled or reverse osmosis water.  All of these waters are very yin. 

Ø  The use of marijuana on a regular basis.

Ø  Too much sex with fluid loss, say more than once a day.

Ø  Too much travel, in a few cases.

For more on this important cause of physical and mental imbalance, read Yin Disease on this website.




            Adrenal burnout differs from fatigue in that it is a deeper derangement of the body’s energy system.  It is incredibly common today.  In fact, the majority of mineral analyses I review show some degree of adrenal exhaustion.  On a hair mineral analysis, the calcium and magnesium levels are elevated while the sodium and potassium levels are generally quite low.

            Adrenal burnout is often an underlying cause for toxic metal accumulation.  It is also the underlying cause of a calcium shell pattern, and for iron and manganese toxicity. 

            Burnout is extremely common and cannot be corrected simply by having a few good nights of sleep.  It is sometimes called chronic fatigue syndrome or CFIDS.

            It requires a complete program of diet, nutritional supplements and rest.  I also highly recommend infrared lamp saunas to help rebuild the body’s energy system.  See the article on Adrenal Burnout for more information.

            In adrenal burnout, the body is nutritionally depleted, toxic metals have replaced vital elements, chronic infections have often set in, and many biochemical imbalances may be present.  These include impaired thyroid activity, weakened adrenals, impaired digestion, heavy metal toxicity, chronic candida albicans infection, chronic viral infections and others. While the burnout itself can cause symptoms, often it is these secondary imbalances that cause symptoms.  Let us discuss a few of these.




Most people today have a low-functioning thyroid.  The reason is quite simple.  They either have copper or mercury in the thyroid gland, and/or they have iodine antagonists affecting their thyroid gland.  These are fluorine, bromine and chlorine compounds.  For more information, read Thyroid Imbalances And Their Healing.




            Candida albicans overgrowth is extremely common today.  It produces alcohol and acetaldehyde, both of which are toxic to the nervous system and often contribute to symptoms of brain fog.

            A person may feel or behave as if slightly inebriated, although they consume no alcohol.  The symptoms are often worse if one eats a lot of carbohydrates, especially sugars including sweet juices and fruits.  Starches and sugars feed the yeast organisms.  In extreme cases, the yeast can actually invade the brain.
            Occasionally, brain fog may be caused by yeast die-off.  This may occur due to a dietary change or health program, or just a shift in metabolism.  As the yeast die, they may release various toxins that induce temporary symptoms of brain fog.  See the article on Yeast Infections for more information.




            Hypoglycemia or low blood sugar is associated with brain fog.  When the level of glucose in the brain become too low, the brain essentially starves for fuel.  The brain uses about one-third of all our calories.  Unlike the muscles, the brain does not store any fuel.  Therefore, it must have a continuous supply.  If for any reason the supply varies, it is like someone varying the voltage of a computer or other piece of delicate electronic equipment. 

            Common symptoms of low blood sugar include confusion, irritability, forgetfulness and even blackouts.  One patient who called me during a hypoglycemic episode could not remember her own name.  Symptoms usually occur several hours after a meal, and may come on suddenly. 

            Eating something that contains sugar may relieve the symptoms in a few minutes, but only temporarily. Sweet cravings are a symptom of hypoglycemia.  However, eating sweets is one of the main ways to perpetuate candida albicans and adrenal problems. 

            Many people, including school-age children and many adults, experience huge blood sugar swings all day long!  Their breakfast of sweetened cereal, donuts or juice drives up their blood sugar.  This is followed by a drop at mid-morning that is relieved by a sweet snack, more juice, soda pop or a cup of coffee.  This rockets the sugar up again, followed by a fall around noon.

            Lunch may include soda pop, sweetened ketchup, mustard, sweet salad dressing, sweetened rolls, chocolate milk, fruit or other sugary food.  The sugar rises again, then falls rapidly at mid-afternoon.  It is time for another pick-up, or maybe time for happy hour, since alcohol will lift the blood sugar again for a short time.  And we wonder why many students have difficulty learning, and why thousands can’t think clearly?



            Brain allergies, as they are called, can be a cause of brain fog.  Here are some examples:


Perchlorate and brain fog. Cindy had always had boundless energy and was ready to take on the world.  She ate a lot of salad greens, which she thought were very healthful.  However, two years ago she became exhausted and developed brain fog.  She finally traced the problem to perchlorate, a chemical that was added to the town’s water and became very concentrated in leafy green vegetables.  It interfered with her thyroid.  When she switched to bottled water and reduced her salad intake, her mind cleared and her energy returned.


              Lecithin and brain fog.  Mrs. Richards, age 70, began to forget things and could not remember what she had said during a conversation just an hour before.  She finally figured out that soy lecithin was causing her problem.  She used it as a supplement and ate it with her food as well.  When she stopped all soy lecithin, her brain fog cleared.


            Nutrasweet (also labeled as Equal, Canderel, Spoonful, aspartame, aspartic acid, neotame (a newer variant) or phenylalanine) is notorious for causing brain fog, fatigue, dizziness, depression and panic attacks, to name just a few of its symptoms.  It is found in over 5000 products and affects some 25% of Americans who use it. It is often hidden in prescription medication, vitamins, toothpaste, breath mints and all types of diet products. Everyone should avoid this food chemical.  See the article on Caffeine and Sugar Substitutes.

            Other food chemicals that affect sensitive people include excitotoxins such as MSG (monosodium glutamate), caffeine, pesticide residues, bacterial and fungal toxins, fluoride, chlorine and hundreds of other substances that either contaminate or are added to drinking water and food.  Caffeine and other stimulants can give one a boost, but eventually contribute to adrenal exhaustion.


              Foods can cause brain fog.  Not only the chemicals added to foods, but the foods themselves can cause brain fog symptoms.  The most common allergic foods are wheat, spelt, soy and cow’s milk dairy products.  Anyone with brain fog ought to try eliminating these foods from the diet, as this will often help speed recovery.  Gluten-containing foods such as rye, oats, wheat, kamut, spelt and barley also cause reactions in susceptible individuals that may affect the brain.




            A long list of prescription and over-the-counter drugs can cause mental confusion and other brain fog symptoms.  The list includes drugs for allergies, pain, high blood pressure, heart arrhythmias, glaucoma, infections, depression, anxiety, inflammation and other disorders.  Birth control pills, the patch and the birth conrol IUD can sometimes cause brain fog.

            Many people are taking two to five of these drugs at once.  Combinations of drugs may be toxic in ways that no one can predict.  Combining medication with alcohol or recreational drugs may also produce unusual symptoms. 
            If you must take medication, check the side effects and know that there may be side effects that are not listed on the label.  Also, know that combinations of drugs are a complete unknown in terms of adverse effects.  Try to avoid them as much as possible.



            The brain requires many nutrients, including protein, high-quality fats and starches, many vitamins and two dozen or more minerals.  Among the most important nutrients are calcium, magnesium, zinc, chromium, selenium, iodine, L-glutamine, L-taurine, choline, thiamine, B6, B12 and other B-complex vitamins.  Others are the omega-3 fatty acids, vitamin D, and in fact all of the vitamins.

            The Merck Manual, the most common doctor’s handbook, notes that symptoms of B-vitamin deficiency include confusion, irritability, and stupor. Correction is often quite simple and inexpensive.

            The author recalls a 7-year old patient who had recurrent ear infections.  The ear infections cleared up on a nutritional balancing program.  During a follow-up visit, her mother mentioned the girl’s school grades also went from Cs to As.  This is not an unusual story.  Though part of the reason may have been better school attendance, improved brain function is often a ‘side effect’ of nutritional balancing correction of body chemistry. 




Viral and other infections can affect the brain by excreting toxins into the blood, for example, or by weakening the mind, or by depleting certain nutrients that are needed in the brain.  Many viruses can directly or indirectly affect the brain such as Epstein-Barr virus, cytomegalovirus, hepatitis C, and others. 

Infected root-canal filled teeth, or any teeth for that matter, or cavitations in the mouth are also common and can also release toxins that definitely cause brain fog.  See the article on Infections for more information.




            Occasionally, brain fog can be due to Lyme disease infection, trichina worms or cysts from consuming pig products, and even fish tapeworm eggs and other parasitic organisms that are very common today. 

            This cause of brain fog is subtle and hard to detect with any standard testing procedure.  In my experience, however, a nutritional balancing program, especially with GB-3 as a digestive aid and the use of a near infrared light sauna daily, will slowly kill and remove all of these parasites from all areas of the body, including the brain.  This will take some years, however, so one must be patient.

            Taking drugs or herbs to kill the parasites are rarely necessary or helpful for several reasons.  First, most of them will not penetrate deeply enough to kill all the organisms, and as soon as the drug or herb is discontinued, the parasites may begin to multiply again.  Also, and far worse, the drugs and herbs are themselves somewhat toxic. They must be removed from the body for complete healing to occur, and this can take months to years to do with a nutritional balancing program. 




            Electrical fields are quite harmful for some people.  They can affect sleep, school performance and can cause brain fog in selected people.  Sources include computer screens, cell phones, dimmer switches in the home or office, living near cell phone towers, or occasionally just the electrical wiring in the walls of your home.

            Be sure to turn off computers, televisions, radios and all electrical devices when you sleep.  Especially keep all electrical devices at least 8 feet away from your head when you sleep and, if possible, where you work.  Sit as far way from computers as possible, and get up frequently if you must use them all day. 

            If you notice you feel better away from home or out of doors, investigate this cause further.  There are people who specialize in checking and fixing electrical and electromagnetic disturbances in houses, offices, cars and elsewhere.




Many people are overstimulated and perhaps easily distracted.  Some are diagnosed as ADD.  However, that is not a helpful assessment because it is mainly a descriptive term and does not tell us the cause.  However, hair tissue mineral testing may reveal the cause.

Remaining overstimulated and distracted can become a mental habit or way of life.  Many bright, loving people are this way because they are very sensitive and respond quickly to many stimuli in their environment.  Their weakened body chemistry and high copper level, in particular, may make them even more prone to this condition. The ancient Taoists would say “their chi is in their heads”.

            The solution to this problem, and it is recommended for everyone, is to set aside time each day for a specific type of mental exercise.  Just any mental exercise will not work.  Many types of meditation and even some prayer, for example, just keep one floating in one’s head.

            I can only recommend one type of Judeo-Christian exercise taught by Mr. Roy Masters because it is extremely grounding and helps develop a quality called the witness.  This is most helpful.  Read more about it by clicking on the   Observation-Meditation Exercise.

            Other helpful activities may include a slow, conscious daily walk, and even writing each day in a journal. Other methods that may help grounding are gardening, extremely gentle yoga, or extremely gentle tai chi or chi kung.  One should do these on a daily basis, as part of your routine, to reap the benefit.  Be very careful with yoga, tai chi or other Oriental methods as many people are subtly injured doing these.  This is the rule, not the exception. A website about Earthing sells pads that one places the feet upon to help with grounding, and this will help some people as well.



            Mental/emotional conflicts.  In some cases, brain fog can be due to mental or emotional conflicts, unresolved traumas or other psychological causes.  Essentially, in such cases, one does not really want to see or think clearly about something or someone.  Thus brain fog becomes one’s defense mechanism. 

            In these cases, brain fog may be your way to deny reality when your life is not going well.  I recommend to always ask for and seek the truth, and cultivate a belief that “the truth will set you free”.  This does not mean the truth will be pretty.  However, seeing and accepting the truth about oneself and everyone else does lead to clearer thinking and, eventually, to happiness, in my experience.  I hope the articles on this website (www.drlwilson.com) will help you sort things out. 


            I am stupid.  An interesting psychological aspect of brain fog has to do with a belief that one is stupid and cannot think clearly.  This can be a result of parental or school influences, or perhaps nutritional imbalances in the brain.  While there are a few exceptions, I believe the public school system, with its authoritarian style, its emphasis on grades instead of on learning, its one-size-fits-all approach, and its lack of spiritual focus, damages thousands upon thousands of children’s brains.  See the article Why is the School System in Trouble?

The Indigo Children, in particular, often suffer through school and they number in the millions today in all nations of the world.  They do not learn well in school, and many come to believe they are stupid and may give up on clear thinking.  The school issue is very important today because:


  • Parents are often not helping their children with school work as much as in earlier generations because they are exhausted, or too busy.
  • Television sets, Ipods, computers at home and other electronic toys may further confuse and overload the children’s brains.
  • So many children are not functioning as well to begin with due to nutritional and other biochemical imbalances.


            Several methods can help one let go of negative programming that gives one the impression that one is incapable of clear thinking.  The most important is to make a decision that you are loved by your creator, and that you have many gifts and skills.  This must first be an intellectual decision.  Usually, one will only begin to feel it later.  Counseling, bodywork, meditation, nutritional balancing, chiropractic and other natural healing techniques and methods may also help in some cases.



Chiropractic imbalances.  Misalignment of the spine, or any impingement on the cranial, cervical or other nerves may cause or contribute to symptoms of brain fog.

Reduced oxygen to the brain. This may be due to clogged arteries, low blood pressure, shallow breathing or holding one’s breath.  Fear and worry can cause shallow breathing.  Sometimes a physical disease such as asthma, chronic bronchitis or emphysema impairs breathing.

Other illnesses.  Brain fog is rarely caused by an illness such as a brain tumor, epilepsy, meningitis or encephalitis.

Vision problems. This is a more rare cause

Dyslexia and autism.  These often result in mental confusion and psychological dysfunctions.  The cause for these conditions is usually the same as for brain fog.  Many autistic children and those with ADD improve dramatically when the underlying factors above are addressed.

Emotional conditions such as neuroses, paranoia or mental fixations.  These might rarely contribute to brain fog.

Too much sweating during exercise.  This is an unusual and uncommon cause of brain fog.  It occurs due to electrolyte imbalances.

Poor circulation to the brain due to low blood pressure or arteriosclerosis.  This can easily cause brain fog, usually in older people, although low blood pressure can occur at any age.

Kidney problems. This is another less common cause.  Even not drinking enough water could result in metabolic waste products in the blood that could travel to the brain and interfere with its functioning.

Too much sex.  This may sound odd, but sex depletes the body of certain nutrients in both men and women. Sex once a week is fine in most cases, but more can contribute to a type of brain impairment that causes a foggy type of sensation.




            I am not aware of any specific medical tests to identify brain fog.  Instead, diagnosis is usually based upon the symptoms.  These include lack of mental clarity, some usually mild memory loss, mental confusion, inability to perform simple mental tasks such as calculating or writing well, and mental sluggishness.

            I do not believe that this constellation of symptoms fits into any known “mental illness” or dementia, and that is why I believe brain fog is a separate health condition that needs to be investigated more.


Hair tissue mineral analysis.  I use this test specifically to set up a corrective program, and we have excellent success with this method. There is no single mineral imbalance that shows up on all mineral tests of people with brain fog.

However, most of the mineral analyses show a sluggish oxidation rate, copper imbalance, and the presence of several toxic metals in the body.  Most of the people are also chronically low in the many nutrients provided by cooked vegetables, so I increase their intake of these drastically.

I believe that the exact cause of brain fog varies, and is different in different people.  Some day it may be possible to separate it into more specific categories.




            Most cases of brain fog respond well to a nutritional balancing program.  If one is fortunate, the brain fog improves in a few weeks on a nutritional balancing program.  All that may be needed is to clean up one’s diet.  Just eliminating sugar, wheat, fruit and a few other foods from the diet can do a lot in some cases, often in matter of days, in fact.  Also, be sure to drink 3 quarts of spring water daily, rest more, breathe more deeply and make other simple lifestyle changes.

            In most cases, however, one must deeply remove many toxins from the brain, liver and kidneys.  This can easily take several weeks, and in bad cases to several years.  I don’t know that it is possible to know in advance how long healing will take, but almost everyone who follows a nutritional balancing program eventually feels much better.  I advise clients to just begin a complete program to rebalance and strengthen body chemistry.  To do this, read Introduction To Nutritional Balancing and other articles on this website.  You may also begin a program using instructions on this website.  Time tends to pass rapidly as one usually begins to feel a little better each day.

            Very rarely, the brain is so damaged with drugs, for example, such as marijuana, that complete recovery is difficult.  This is not to discourage anyone, but just stating a fact.  If you want your brain to be healthy, avoid all unnecessary drugs, toxins and especially recreational drugs of all kinds.  Marijuana may be good for cancer pain, but it is horrendous for your mental health.


Detoxification procedures. One or two coffee enemas daily and two near infrared sauna sessions for about a half hour each day are also very helpful and very safe when done properly.  See the articles on Sauna Therapy andDetoxification Procedures for more on these excellent detoxification methods, and why avoid many of the other methods of detoxification.


Other natural therapies to use along with a nutritional balancing program.  Daily foot reflexology, along with gentle chiropractic, osteopathic manipulation, craniosacral therapies, Rolfing or other structural therapies may be very helpful.   At times, they are essential as part of a complete healing program.


            If you are not yet ready for nutritional balancing, begin with the free parts of the program, as outlined in the article The Healing Lifestyle.  Improve your diet and lifestyle as recommended on this website, rest a lot more, and meditate as recommended twice or more daily.  Do not do other meditations that can make the problem worse by ungrounding a person more.  These are simple, but powerful ways to improve your brain and the entire body as well until you are ready for a complete program.

In rare cases, if emotional causes are foremost, then meditation, counseling and other types of counseling and therapies may be more critical, at least at first.  However, a properly designed nutritional balancing program seems to be a basic need and will also assist any other therapy to succeed better.


The use of remedies for brain fog.  Many doctors use remedies for brain fog that vary from herbs, homeopathic remedies, vitamins, minerals, hormones or medical drugs.  Interestingly, in most cases they do not work well.  In fact, they often make things worse.  Instead of remedies, we find that balancing the body chemistry is the most powerful approach for brain fog in almost all cases.

Rarely, more extensive testing for brain diseases may be necessary.  Physicians often begin with a CAT or MRI scan.  Avoid CAT scans if possible due to high radiation exposure.  In my experience, however, almost all cases of brain fog will clear up without a need for costly and perhaps high-radiation exposure medical diagnostic tests.



            I have not found much medical research on brain fog.  There needs to be more!  This article represents my experience and that of other physicians and nutrition consultants with whom I have worked or whose work I have studied.  Some of the other articles on this website referred to above contain lists of references, but I have found little in the way of clinical studies.  Of more importance is that the condition can be healed in almost every case with a nutritional balancing program.


Ola Loa and the Healing Power of Methylation

Ola Loa and the Healing Power of Methylation

Ola Loa and the Healing Power of Methylation PDF Print E-mail
Written by Dr. Richard Kunin

What is Methylation?

Methylation refers to the controlled transfer of a methyl group, made up of a carbon atom and three hydrogen atoms, abbreviated CH3. Such movement of carbon atoms goes on in every cell and tissue of the body, for methylation is involved in hundreds of chemical reactions that regulate cell energy, healing, immunity and genetic expression of DNA and RNA. All of these reactions are responsive to environmental conditions. Thus methylation is a central feature of adaptation to the ever-changing physical and chemical conditions of life.

The Importance of Methylation

As a result of methylation, hundreds of molecular products change physically and functionally in the microscopic world of cellular biochemistry. For example the amino acid, methionine, carries an available but inactive methyl group on its sulfur atom. However, within the confines of the cell, methionine encounters adenosine as ATP and magnesium which are energized by a transferase enzyme, thus forming adenosylmethionine, or SAMe. This natural alchemy energizes themethionine so as to release its methyl group into the orbit of cellular enzymes, appropriately called methyltransferases. There are about 400 known methyl transferase reactions that produce vital products that affect our health, quality of life and survival.

Click to view a large image of the methylation process diagramDiagram of the Methylation Biochemical Pathways

This diagram is but a simplified rendition of this complex process. No wonder most health professionals have yet to master the vast amount of basic chemistry, physiology and clinical information in this field.


The Top Methylation Products

1) creatine, 2) carnitine, 3) coenzyme Q, 4) calmodulin, all required to regulate energy in every cell in the human body.Methylation also converts the phospholipid, ethanolamine to 5) choline (trimethyl-ethanolamine), essential for cell membrane structure and repair, including 6) myelin, the substance that insulates nerve fibers. Choline is also essential for the production of brain-regulating neurotransmitters: 7) acetylcholine, 8) dopamine, 9) nor-epinephrine, and 10)epinephrine. 11) Melatonin, the neuro-transmitter that initiates sleep and regulates the circadian sleep-waking rhythms is also a product of methylation, specifically of the neurotransmitter, serotonin. 12) And sarcosine, formed bymethylation of the amino acid glycine, has recently attracted research attention as a treatment for schizophrenia. And there is more, for the transfer of a methyl group from folic acid to cobalamin (B12) and thence to methionine is required in order to regenerate active folate, THF, which is required for methylation of the nucleic acid, uridine, which thus becomes 13) thymidine, the specific nucleic acid required for production of lymphocytes, active against viruses, cancer and microbial enemies. Failure to produce adequate thymidine hampers 14) methylation of DNA and RNA, thus depriving these genetic materials of protection against mutation. In short, methylation is an absolute requirement for immunity, fertility, and protection against birth defects, accelerated aging and susceptibility to cancer. Methylation is also essential for production of 15) polyamines, regulators of cell growth, mitosis, and healing. The chemistry involvesdecarboxylated SAM, which reacts with decarboxylated ornithine to form spermidine and then spermine in successive reactions along with 16) methyl-thioadenosine, thus producing a family of products that regulate cell division, growth, healing and reproduction. 17) Homocysteine, is a potentially toxic intermediate in the methylation process. When S-adenosyl-methionine (SAM) donates its methyl group, it becomes S-adenosyl-homocysteine (SAH), a free radical able to combine with other reactive molecules within the cell or in the blood stream. Inside the cell homocysteine is likely to react with copper for their attraction is strong enough to pull copper out of its binding sites in enzymes, including thecytochrome enzymes of the mitochondria. This interrupts electron flow and thereby lowers cell energy. a process that jibes with the fact that patients with chronic fatigue states tend to have high homocysteine levels. Within the vasculaturehomocysteine reacts with other homocysteine molecules, thus forming an inert dimer, homocystine, that is excreted in the urine, where it sometimes precipitates, causing kidney stones. Homocysteine can safely react with albumin and other proteins in the blood stream and the blood vessel wall. On the other hand, it can activate blood clotting by reacting with sulfur atoms, including fibrinogen and lipoprotein(a), which amplifies coagulation risk and interferes with the anticoagulant, plasminogen. This is particularly risky in people carrying high blood levels of fibrinogen and/or Lp(a) and can increase clotting risk by about 20-fold.


Homocysteine Can Cause Damage in Healthy People

When homocysteine binds to the arterial endothelium it can provoke spasm of the muscle layer, thus raising blood pressure but also lowering blood flow in major arteries, on average by 85 percent. The vasospasm effect lasts over four hours, long enough to cause programmed cell death and permanent organ damage, even in healthy young adults. The good news is that the drop in arterial blood flow after methionine load was cut to only 30 percent by pre-treating with 1000 mg of vitamin C. A 500 mg dose of vitamin C proved inadequate in the research by Drs. Chambers andMacGregor. Thus, it is likely that ischemia is an important mechanism by which homocysteine causes hypertension, atherosclerosis and arterial aneurysm. It is also likely that homocysteine-induced apoptosis is a major part of the aging process.

On the Other Hand, Homocysteine Is Not All Bad

In the first place, by accepting a methyl group from the folate-cobalamin methylation pathway, homocysteine can be restored to methionine. And by combining with serine, homocysteine is converted to cystathionine and then totransmethylation products, namely, 18) cysteine, 19) glutathione, 20) taurine and 21) sulfate—all valuable components of antioxidant adaptation and detoxification.

OLA LOA and Methylation

OLA LOA ENERGY is the single most powerful supplement available today for the control of homocysteine and to support methylation. It provides gram doses of vitamin C, glycine, and betaine (aka TMG) along with synergistic co-factors, coenzyme Q10 and acetylcysteine. Nutrient synergism is further enhanced by arginine, lysine, selenium, chromium and, of course, folic acid and hydroxycobalamin, which serve to methylate homocysteine, which thus is converted into methionine, an essential amino acid.

TMG, A Strategic Nutrient

TMG, is an acronym for trimethylglycine. The traditional name, betaine, refers to beets, a rich dietary source. The importance of betaine is underscored in research that consistently finds lower homocysteine after betaine than folic acid and cobalamin. The reason for this is evident in the fact that betaine can donate methyl groups that require only a single enzyme, BHMT, by which to remethylate homocysteine. Folic acid and cobalamin require at least three enzymes to accomplish the same! The reaction constants of the enzymes involved are feed-back linked in such a way as to make it clear that the BHMT pathway is activated during famine and fasting, whereas the remethylation pathway of folate andcobalamin requires adequate diet, digestion, and absorption.

Cyanocobalamin Is Excluded from Ola Loa

Patient safety is important. We have excluded cyanocobalamin because it is a known anti-vitamin, actually interfering with the methylation pathway it is purported to serve. It has been known for fifty years that cyanocobalamin can cause blindness, especially in smokers, blacks, and people who have relatives with Leber’s optic atrophy. Dr. Kunin has had direct contact with one patient who was blinded permanently after just three injections of cyanocobalamin at a major hospital medical center. It is not by accident that we have chosen hydroxycobalamin as the best choice for everyday use.

Patient Compliance Is Important

OLA LOA has won popular acceptance from coast to coast because it tastes good, is economical, and most people feel better soon after drinking it. We call it the Ola Loa Feeling. It is a composite of the dozens of methylation reactions that are supported by the OLA LOA formula. This is a case where a packaged and sealed nutrient supplement is more effective and more reliable than table foods.

Doctor Satisfaction Is Important Too

OLA LOA is the most complete effervescent nutrient formula available today. It is convenient and considerably cheaper than the formula would be as single vitamin capsules. Furthermore, the sealed package protects the ingredients from hygroscopic activation, oxidation and deterioration.

OLA LOA Stands Alone as the Best Multivitamin Product for Every Medical Practice

Here are but a few key points. Please browse the Our Products and the Why Ola Loa pages of this web site to learn about the advantages that Ola Loa products have over other multivitamin products on the market.

  • Sealed pack is portable and maintains full potency despite weather changes.
  • Instant effervescent drink is always fresh.
  • Hydrated colloid solution provides best absorption compared to tablet or capsule.
  • Non-irritating to digestive tract.
  • Reduced risk of choking in debilitated or neurologically injured patients.
  • The OLA LOA formulas are medically sound, safe even for children. There have been no serious adverse reports after years in the national health food store market.
  • Enhanced applications when combined with other OLA LOA products:
  • OLA LOA REPAIR® (Bone and Joint Formula) (Gotu kola, vitamin K, calcium, magnesium, carnitine, taurine)
  • OLA LOA Brain (n-3 EFA, acetylcarnitine, tocopherols, bioflavonoids, DMAE, PS)

Dr. Richard Kunin MD is the formulator of all of Ola Loa’s products. He pioneered the use of vitamins and minerals in today’s medical practice and was a co-founder of the Orthomolecular Medical Society with Dr. Linus Pauling in 1976. He is a San Francisco based nutrition oriented physician and Orthomolecular specialist with over thirty years of experience in the nutrition medicine field. Please visit Dr. Kunin’s page on our webs site to LEARN MORE.

Chronic Fatigue Syndrome A Roadmap For Testing And Treatment

Chronic Fatigue Syndrome A Roadmap For Testing And Treatment

Chronic Fatigue Syndrome
A Roadmap For Testing And Treatment

Chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME), is a neurological condition characterized by cognitive dysfunction, mood disorders, fatigue, post-exertional malaise, and many more symptoms.

The following guidelines are an aid to determining: (1) whether you have chronic fatigue syndrome, and if so: (2) which laboratory tests should be performed to identify the infections and other causal factors that underpin your ME/CFS, and: (3) what treatments you can follow to address these infections and causal factors, and treat the symptoms that arise from them.

Chronic Fatigue Syndrome Diagnosis
There are currently no laboratory tests or biomarkers that can be singularly used to diagnose ME/CFS, so diagnosis is performed on symptoms alone. ME/CFS manifests a whole array of clinical symptoms,1 2 both physical and mental, which typically include the following:


Persistent fatigue not due to ongoing exertion, and not really relieved by rest. The fatigue is of a new onset, and and greatly reduces activity levels, compared to before the onset. Cognitive dysfunction (brain fog): short-term and working memory deficits, problems recalling words or names, disorientation, loss of focus and awareness. Mood disorders which may include: depression, anxiety, panic attacks, irritability, mood swings. Post-exertional malaise: symptoms profoundly worsen after physical and/or mental exercise, leaving an individual very incapacitated for several days, or even weeks, after exertion.
Headaches of a type not previously experienced. Tinnitus, dizziness, balance problems, fainting, irregular heartbeat. Abdominal pain, irritable bowel, diarrhea. Unrefreshing sleep. Chronic sore throat or recurring sore throat (often from the virus that initiated the ME/CFS condition), chronic cough, chest pain, dry mouth, dry eyes, blurred vision. Sensitivities to light, noise and chaotic or busy environments. Sensitivity to heat and/or cold. Increased allergies or sensitivities to foods, alcohol, odors, chemicals or medications. Muscle aches or weakness, tingling sensations. Enlarged or painful lymph nodes in neck and armpits. Joint pain moving from one joint to another without swelling or redness.

For the formal diagnostic rules of ME/CFS, see the:

Canadian Consensus ME/CFS DefinitionCDC 1994 CFS Criteria.

Ruling Out Other Conditions

The inherent problem with diagnosing ME/CFS by its symptoms is that many of the same symptoms manifest in other diseases and conditions such as: Lyme disease, hypothyroidism, celiac disease, lupus, anemia, hepatitis B or C, and many others. Thus if you have symptoms resembling chronic fatigue syndrome, you and your doctor first need to rule out diseases and conditions with very similar symptoms before a diagnosis of ME/CFS can be given with reasonable certainty.


Condition Tests and Results Interpretation
Lyme disease
Lyme disease is caused by a chronic infection with certain species of Borrelia bacteria, these bacteria being contracted through the bite of infected Ixodes ticks. Bites from Borrelia-infected ticks often (but not always) cause a characteristic erythema migrans rash. Early symptoms of Lyme disease include: fever, headache, fatigue and depression.
Borrelia culture. This is a more reliable test for the Borrelia bacteria that cause Lyme disease. It is available at Advanced Laboratory Services.Borrelia IgM and IgG antibodies. Dr A Martin Lerner uses Western blot and ELISA to test for Borrelia burgdorferi IgM and IgG antibodies.1More info on testing for Lyme disease: Lyme TestingLyme and ME/CFS differences in symptoms: Lyme often causes pain and swelling in the large joints, most often the knees; by contrast in ME/CFS there can be pain in the joints, but this occurs without swelling. Facial palsy can occur in Lyme, but this does not occur in ME/CFS. These symptoms can thus help distinguish Lyme disease from ME/CFS.
Hypothyroidism Hypothyroidism occurs when your thyroid gland does not produced enough of the thyroid hormone thyroxine. The symptoms of hypothyroidism are quite similar to those of ME/CFS. Hypothyroidism is diagnosed by a blood test which measures the levels of various thyroid hormones.
Celiac disease
Celiac disease is an autoimmune reaction triggered by gluten, causing damage to the small intestine and nutrient malabsorption. Celiac disease symptoms vary widely between patients. 

Transglutaminase antibody blood test and an upper endoscopy with biopsy of the duodenum are used to diagnose celiac disease. Since celiac symptoms greatly improve after removing ALL gluten from the diet, if you feel much better going gluten-free, it hints you might have celiac disease (though gluten-sensitive people without celiac disease will also feel better going gluten-free).
Systemic lupus erythematosus Most people with systemic lupus erythematosus (SLE) will have a positiveantinuclear antibody test (ANA), but ANA is usually negative in ME/CFS patients. Thus the ANA test is a useful tool to help distinguish SLE from ME/CFS. Around up to 50% of SLE patients exhibit a red butterfly rash on the face, which is not found in ME/CFS.
Anemia Anemia is a decrease in the number of red blood cells, or a decrease in the amount of of hemoglobin in those cells, either of which results in a reduced ability of the blood to carry oxygen. The symptoms of anemia are similar to those of ME/CFS. Anemia can be diagnosed by a full blood count.
Hepatitis B or C virus infection Chronic hepatitis B and hepatitis C viral infections can produce symptoms that resemble those of ME/CFS. Hepatitis B virus can be caught from unprotected sex, including anal and oral sex, and also from sharing needles to inject street drugs. Hepatitis C virus is most commonly caught by sharing of needles to inject street drugs, and is sometimes caught from unprotected sex. Your doctor or a sexual health clinic can provide testing for hepatitis B and hepatitis C virus infections.

More comprehensive lists of diseases that have similar symptoms to ME/CFS:
Chronic Fatigue Syndrome Diagnosis
Chronic Fatigue Syndrome: Evaluation and Treatment
CFS can be caused by chronic infection
Diseases similar to ME/CFS

Causes and Treatments of ME/CFS
Once you have ruled out common diseases with similar symptoms, and have settled on a diagnosis of ME/CFS, then next stage is to try to identify the underlying infections and other factors that may be causing or contributing to your ME/CFS. This is best performed with the help of a doctor specializing in chronic fatigue syndrome laboratory testing and treatment.

There are many laboratory tests that people with ME/CFS might choose to take. In this roadmap to ME/CFS testing and treatment, the tests suggested are grouped into various rounds, with the most important tests placed in the earlier rounds. After each round of testing, depending on the test results, advice on an appropriate course of action for treatment is given.

Tests for causal factors that have a corresponding treatment or cure are prioritized, since the main goal of this roadmap is to guide people with ME/CFS to treatments that may improve or cure their condition. Tests that provide insight into your circumstances of health, but having done so, do not lead to corresponding treatments, are deferred to later.

The suggested treatment plans are those generally employed by leading chronic fatigue syndrome doctors and researchers in the field. There are no hard and fast rules for chronic fatigue syndrome treatment, and you may wish to follow different courses of action to those given here. These guidelines are an ongoing project which aims to be reasonably comprehensive; but they are not an exhaustive chart of ME/CFS treatments.

Research indicates that treatment-resistant ME/CFS of unproven etiology generally appears to be associated with viruses from the enterovirus genus (specifically: coxsackievirus B and echovirus) and/or to viruses from the herpes family (specifically: human herpes six virus, cytomegalovirus, Epstein-Barr virus). More treatable or curable forms of ME/CFS may be caused by parvovirus B19, Chlamydia pneumoniae, as well as other microbes. Non-microbial causes or contributory factors to ME/CFS include: mold toxin exposure and pesticide exposure. The first round of testing detailed below suggests you consider or get tested for all these microbes and causal factors.

Notes on Pathogen Testing
Most ME/CFS-associated microbes are very commonly found in the general population: Epstein-Barr virus, for example, is found in 95% of adults. Microbes found in the body are generally acquired from infections earlier in life, but once the immune system has them under control, these infections become largely inactive and dormant; so microbes from past infections normally exist in the body in a latent state (though these pathogens can reactivate and become more active if there is weakness in the immune system).

When a test is performed for a microbe, we want to know not only whether you have it in your body, but more importantly, whether it is active or not. In chronic infections, the level of activity of a microbe can be gauged to a certain extent by the amount of IgG antibodies your body produces in response to that microbe. High levels of IgG antibodies tend to suggest an active chronic infection.

Note that the activity of some microbes, notably enteroviruses, cannot be so accurately determined by antibody tests, due to the fact that these microbes can also live inside human cells, as an intracellular infection. The immune system does not readily make antibodies to microbes living inside human cells, so you may have a significant intracellular enterovirus infection, but show relatively low antibody levels when you take a test. Other means of pathogen testing may be employed in these situations. Alternative methods of testing for the presence of pathogens in the body include: PCR (polymerase chain reaction) and viral culture. Viral culture is usually the “gold standard” by which other viral detection methods are judged.

Empirical testing. While it is always better to test for pathogens or health conditions before using treatments, because some tests are expensive, not available in all countries, or might not always be reliable or sensitive enough to detect certain pathogens, you may choose to bypass the test and go straight to treatment. This is known as empirical testing: using a treatment itself as a test for a pathogen or health condition. Empirical testing makes the assumption that if you get better on the treatment, you may well have the pathogen or the health condition that the treatment targets.

1st Round Tests
The first set of ME/CFS causal factors to consider and/or test for is shown in the table below. The various microbial (and other) causal factors are listed in the left hand column, and recommended tests for these causal factors (plus some basic guidance on interpreting the test result) are given in the right hand column of the table. 


Causal Factor Tests and Results Interpretation
Epstein-Barr virus (EBV)
There is a high 95% prevalence of Epstein-Barr virus in the adult population, so most people will have this virus in their system, but usually in a latent inactive state. However, if you have an active EBV infection, it is possible this may be contributing to or causing your ME/CFS symptoms. New evidence indicates that some subtypes of ME/CFS may be due to partial reactivation of Epstein-Barr virus.1 2
Epstein-Barr virus antibodies. A blood test showing an EBV VCA IgG antibody titer of 1:1280 or more suggests an active infection.1 Dr A Martin Lerner says that a positive diagnosis of Epstein-Barr virus infection requires a positive EBV early antigen (EA) diffuse test, and/or a positive EBV IgM viral capsid antibodies (VCA) test.1Epstein-Barr virus PCR.Lymphocyte subset panel. If this test shows elevated CD8 T-cells, this can indicate an ongoing viral infection with EBV or cytomegalovirus, which both raise CD8 T-cells.1
Human herpes virus six (HHV-6)
HHV-6 is found in over 90% of adults, usually in a latent inactive state. If you have an active HHV-6 infection, this may be contributing to or causing your symptoms, as active HHV-6 is linked to ME/CFS.1 2 There are two main variants of HHV-6: variant A and variant B, often denoted as HHV-6A and HHV-6B. Tests for HHV-6 do not usually distinguish between the two variants. 
Most individuals that test positive for HHV-6 will have the more benign HHV-6B variant; but just under 3% will have the more nasty HHV-6A variant. It is this HHV-6A variant which is more strongly linked to ME/CFS.1 So a positive test for HHV-6A may be quite significant if this virus is active.Dr Kazuhiro Kondo has a theory that partial reactivation of HHV-6 may cause ME/CFS, as well as depression and bipolar disorder.1
HHV-6 antibodies. A blood test showing an HHV-6 IgG antibody titer of 1:320 or more suggests an active infection. Dr Jose Montoya believes that IgG antibody levels are a better guide to the HHV-6 activity in the central nervous system than viral culture from the blood.1 Nested PCR for HHV-6A. Regular tests do not distinguish between the these two variants of HHV-6, so if you tested positive for HHV-6, you could have either (or both). However, nested PCR tests can specifically determine if you have HHV-6A.HHV-6 PCR.Further info:

Cytomegalovirus (CMV)
Cytomegalovirus is found in 50% of adults, usually in a latent inactive state. If you have an active CMV infection, this may be contributing to or causing your ME/CFS symptoms.
Cytomegalovirus IgG antibodies. Dr A Martin Lerner says that a diagnosis of cytomegalovirus infection is made by examining the CMV IgG antibody titer. (Lerner says the IgM titer for CMV is inaccurate and insensitive.) The higher the CMV IgG titer, the greater the viral load.1 Cytomegalovirus PCR.
Coxsackievirus B and echovirus
There are six coxsackievirus B types and thirty-two different echoviruses. All are part of the enterovirus genus. Coxsackievirus B is found in 55% of adults, according to a study in Scotland.1 
If you have an active coxsackievirus B or echovirus infection, this may be contributing to or causing your ME/CFS symptoms.1 2 3 4Part of the difficulty in treating a chronic enterovirus infection is that this virus can exist in two distinct forms in the body: the regular enterovirus, and the non-cytopathic enterovirus. The infection begins with a regular enterovirus, but then some of these viruses convert into non-cytopathic enteroviruses within the body. Non-cytopathic enteroviruses reside within human cells, and are hard to detect. Dr John Chia thinks non-cytopathic enteroviruses may be a causal factor in ME/CFS.1 2 3
Coxsackievirus B and echovirus antibodies. Only one testing lab has an enterovirus antibody test sufficiently sensitive to detect the low-level “smoldering” chronic enterovirus infections of ME/CFS: ARUP Lab, in Utah. These test are:coxsackievirus B antibodiesechovirus antibodies. Titers of 1:320 and higher are good indicators of an active infection. ARUP tests can be ordered directly, or ordered through Labcorp. Stomach biopsy (immunohistochemistry). This test, which requires a sample of stomach tissue obtained by an endoscope, is the most reliable for detecting a chronic enteroviral infection. Dr Chia’s lab can process the stomach tissue sample.PCR testing is not sensitive for chronic enteroviral infections, as these viruses disappear from the blood after the acute phase of the infection is over (the acute phase of an enterovirus infection is a short window that starts just after initial exposure, and last for around 10 days).Complement fixation test (CFT) is useless for testing enteroviral activity in chronic infections. The CFT is only of value within the acute phase (first 10 days) of an enterovirus infection.Non-cytopathic enterovirus testing. There are no commercially available tests for non-cytopathic enteroviruses, which reside within human cells.Further info:


Parvovirus B19
Parvovirus B19 is found in 50% of adults, usually in a latent inactive state. If you have an active parvovirus B19 infection, this may be contributing to or causing your symptoms.1 2
Parvovirus B19 antibodies. A blood test showing a parvovirus IgG antibody titer of 1:?? or more suggests an active infection.
Chlamydia pneumoniae
Chlamydia pneumoniae is an intracellular bacterium (one that lives inside human cells) which is found in a latent state in 74% of the adult population, according to a study conducted in Israel. About 10% of this population had a persistent active infection with this bacterium.1 
Further info:

Chlamydia pneumoniae
Mold toxin exposure
Mold can synthesize toxic substances (mycotoxins) that can damage the central nervous system, intestines, kidneys. These toxins have been linked to the triggering of ME/CFS. 1 2
Mold growth can be visible, or it may be hidden behind walls and domestic appliances. People can become ill from hidden mold growths without knowing the cause (though a moldy, musty smell in the environment provides a warning to the possible presence of mold). Usually several species of mold can be found in a mold infestation. Mold species that have very potent mycotoxins include: Stachybotrys, Memnoniella and Acremonium. These three species depend on damp cellulose material (wood, paper, cotton) for nutrition, and thus typically thrive in water damaged-buildings that contain plenty of wood, wallpaper, etc.
Pesticide exposure
Chronic exposure to significant amounts of organophosphate or pyrethroid pesticides can cause ME/CFS-like illnesses, or act as a co-factor in precipitating ME/CFS. 1      
Further info: PAN
Sources of pesticide exposure include garden sprays used by you or your neighbor, which can be tracked into the house on shoes. Agricultural exposure may occur in rural areas through crop spraying. Pyrethroids are found in pet flea control products. Pesticide residues on foodstuffs are generally very minimal, and are not of concern.1 Organophosphate pesticides are detoxified from the body by an enzyme called paraoxonase; differences in the paraoxonase gene can increase an individual’s susceptibility to organophosphates.1 2

1st Round Treatments
In the light of the results of the first round of tests:

Epstein-Barr virus infection. If your tests indicate you have a chronic Epstein-Barr virus infection and no other infections, it is quite possible that your symptoms are in fact a case of chronic Epstein-Barr virus syndrome (chronic mononucleosis syndrome), which closely resembles ME/CFS. Dr. A. Martin Lerner suggests that chronic Epstein-Barr can be considered a subtype of ME/CFS. Chronic Epstein-Barr infection often clears itself up within 6 months or less, and you should then achieve remission from your symptoms. Antivirals such asvalacyclovir (Valtrex) can hasten the healing process.1 Nexavir (formerly Kutapressin) may have some in vitro activity against Epstein-Barr virus.1
Herpesvirus infection. If your tests indicate you have an active infection with one or more of the three herpesviruses: HHV-6, cytomegalovirus and Epstein-Barr virus, then Dr. A. Martin Lerner has recently shown that an anti-herpesvirus treatment comprising the antiviral drugs valacyclovir (Valtrex) and/or valganciclovir(Valcyte) can return ME/CFS patients to a near-normal to normal life, provided you have no active co-infections with pathogens other than these three herpesviruses. Those who experience side effects from valacyclovir can substitute with famciclovir (Famvir), an antiviral which is usually much better tolerated. Unfortunately, if you have active co-infections with pathogens other than these three herpesviruses, this antiviral treatment on its own has proved ineffectual, according to Dr Lerner. However, it is possible (though not proven) that this anti-herpesvirus treatment, when combined with treatments for the other pathogens, may get results.1The antimalarial drug artesunate has efficacy against cytomegalovirus, and against HHV-6.1 2 Nexavir(formerly Kutapressin) displays potent in vitro activity against HHV-6.1 2 The HIV drug raltegravir may be effective against the whole family of herpesviruses.1
Enterovirus infection. If your tests indicate you have active an infection with one or more enteroviruses of the coxsackievirus B or echovirus species, then Dr John Chia has found that around 25% of people will noticeably improve with a herbal treatment named oxymatrine (although Dr Chia suggests that patients with autoimmune tendencies should not take oxymatrine).1 More info: Dr Chia: OxymatrineOxymatrine, Autoimmunity, ME/CFS and FM.Dr Chia has also used interferon therapy for CFS patients with enterovirus infections; many patients went into full remission after this therapy, but unfortunately tended to relapse within around six months, so this is not a permanent cure, but perhaps an encouraging result.1 More info: Chia’s Interferon Therapy.
Parvovirus B19 infection. If your tests indicate you have high parvovirus B19 antibodies and nothing else, then intravenous immunoglobulin treatment may fully cure you.1
Chlamydia pneumoniae infection. If you have Chlamydia pneumoniae and no other infections, then antibiotic treatment with azithromycin or rifampin may clear this bacterium, and may cure fully your ME/CFS. Chlamydia pneumoniae infection is an uncommon but treatable cause of chronic fatigue.1 More info: Cure from Chronic Fatigue Syndrome with Dr. Stratton’s original protocol.
Toxic mold. If you have been exposed to high amounts of toxic mold, ensure you prevent or minimise further exposure. If exposed in your home, carefully clean off the mold growths (wearing a face mask is advised), and reduce humidity by increasing ventilation, in order to inhibit mold regrowth.
Chronic organophosphate and/or pyrethroid pesticide exposure. If you have been chronically exposed to organophosphate or pyrethroid pesticides, ensure you prevent any further exposure. The amount of pesticides residues found in foodstuffs is very minimal, and not of concern.

Note: some cases of ME/CFS may be due to a combination of the above pathogenic infections (as well as other causal factors). In which case, conceivably, it may be possible to combine the above treatments in order to tackle the various individual infections.

Before undertaking any treatment, however, you should first become familiar with any risks of taking that treatment, and if unsure, you should run it by a good ME/CFS doctor first.

More info: Antivirals and Antibiotics for ME/CFS.

Adjunct Therapies for ME/CFS
As well as specific pathogen-targeted therapies, there are many adjunct or additional therapies that can be helpful in chronic fatigue syndrome. These include:

Immunomodulators. These are drugs and supplements that modulate the immune system. Many immunomodulators used in ME/CFS shift the immune response from the Th2 mode to the Th1 mode. There is evidence that ME/CFS patients are stuck in the Th2 mode, whereas they should really be in the Th1 mode; it is the Th1 mode immune response that fights viruses and intracellular bacteria.1 These Th2 to Th1 mode shifting immunomodulator drugs and supplements include: low-dose naltrexoneImunoviroxymatrine (probably),Nexavir (formerly Kutapressin), pine cone extractheparin, and transfer factor.1 2Note that Th2 to Th1 mode shifting immunomodulators can make you feel worse for the first few months, but benefits accrue after that initial period. Note also that Dr Paul Cheney believes immunomodulators lose their effect if you do not take regular breaks from them. Regular breaks means an on/off regimen, such as for example: taking them for 5 days, stop for 2 days; and taking them for 3 weeks, stop for 1 week.Other immunomodulators used in ME/CFS include: artesunate (often used by Dr Cheney; it inhibits the effects of TNF-alpha 1), azithromycin (an antibiotic that lessens ME/CFS symptoms 1), etanercept (inhibits the effects of TNF-alpha), Ampligen (a powerful but very expensive immunomodulator drug that modulates interferon and RNase L).Low-intensity exercises like walking, tai chi and yoga help shift towards the desirable Th1 mode, whereas higher intensity exercise and longer workout durations shift towards the undesirable Th2 mode.1
Low-dose naltrexone (LDN). A low-dose naltrexone regimen (3 to 4.5 mg daily, taken before bed) can help halt the progression of various autoimmune and neurodegenerative diseases, including multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s, Parkinson’s, Crohn’s. Many ME/CFS and fibromyalgia patients find LDN beneficial.1 LDN acts as an immunomodulator that stimulates the desired Th1 immune response, and LDN is believed to increase natural killer cell function (NK function is often low in ME/CFS patients). More info: LDN for ME/CFSLDN Overview.
Vitamin B12 injections or B12 sublingual tablets. Many ME/CFS patients find that high dose vitamin B12substantially reduces the cognitive dysfunction (brain fog) symptoms. The recommended forms of vitamin B12 are: methylcobalamin, adenosylcobalamin, and hydroxocobalamin. Injectable vitamin B12 doses are around 1000 mcg three times a week; sublingual doses are 5000 mcg taken daily. Improvements in symptoms usually appear after a few weeks of taking B12. Further reading: Rationale for using vitamin B12 in CFSMethylation, B12, Glutathione, Chelation.
Methylation protocol. Dr Richard van Konynenburg says that insufficient methylation is a factor behind ME/CFS, and recommends boosting methylation using supplement regimen based on the treatment program developed by Dr Amy Yasko for autism. The Health Diagnostics and Research Institute in New Jersey (email:lab@vitdiag.com) provide a test for methylation, as do the European Laboratory of Nutrients (see their “amino acids analysis”). More info: Glutathione and the Methylation CycleSimple Methylation Treatment Protocol for CFS.
Very low dose tricyclic antidepressants (TCA). Low doses (10 to 25 mg daily) of tricyclic antidepressants (TCA) such as amitriptyline or imipramine can be particularly helpful for ME/CFS. TCA antidepressants not only provide a mood-boosting for ME/CFS patients, they also are known to increase energy levels (though low doses are stipulated, as higher doses are usually found too stimulating for ME/CFS patients).1 2 TCAs can reduce vitamin B2 levels, so taking vitamin B2 with TCAs is beneficial, and may improve the effects of these antidepressants.1
Nexavir injections. The injectable drug Nexavir (formerly Kutapressin) is an antiviral, an anti-inflammatory and an immunomodulator that has demonstrated overall benefits for ME/CFS, and this drug is often employed by ME/CFS doctors, including Dr Cheney, Dr Enlander and Dr De Meirleir. Nexavir treatment protocols vary, but in one study, ME/CFS patients were given one subcutaneous 2 ml injection of Nexavir for the first 25 days of treatment; thereafter one injection every two days, for the next 50 days; and thereafter one injection three times a week for the next 105 days. This study reported a 42% remission rate in these patients at the end of this course of Nexavir treatment.1Dr De Meirleir reports that around 70% of his ME/CFS patients experience at least a 20 point increase on theKarnofsky scale as a consequence of taking Nexavir. Dr Enlander says that Nexavir helps about 30% of his ME/CFS patients. Nexavir is usually taken in conjunction with vitamin B12 injections.
Other drugs and supplementsAcetyl-L-carnitine improves mental fatigue in ME/CFS.1 L-carnitine helps ME/CFS.1 Omega 3 with omega 6 fatty acids (fish oil plus evening primrose oil) improve ME/CFS symptoms.1Magnesium (either applied transdermally on the skin, or given by injection) can be of benefit in ME/CFS.1DHEA improves pain, fatigue, anxiety, memory and sexual problems in ME/CFS patients.1 NADH helps ME/CFS.1Co-enzyme Q10 may increase energy in ME/CFS.1 Undenatured whey protein may help ME/CFS by boosting intracellular glutathione.1 Malic acid taken with magnesium can increase energy in ME/CFS and reduce pain in fibromyalgia.1 2

More info on various ME/CFS therapies:
ME/CFS Immune System Treatments at Phoenix Rising
Dr Jacob Teitelbaum’s 30 Top Tips for Treating CFS
Dr MyHill Fatigue Treatments
ME/CFS Medications Database

2nd Round Tests
This second round of tests and possible causal factors focuses on a few of the comorbid diseases and conditions that are frequently found in ME/CFS patients —€” in many cases, prior to the triggering factor that precipitated the ME/CFS condition (triggering factors such as an enteroviruses, herpesviruses, mold exposure, etc).

Comorbid conditions that are statistically more prevalent in ME/CFS or fibromyalgia patients (either prior to ME/CFS onset, or subsequent to onset) include: irritable bowel syndrome, small intestine bacterial overgrowth, interstitial cystitis and overactive bladder, chronic pelvic pain syndrome (prostatitis), endometriosis, Raynaud’s disease, multiple chemical sensitivity (increased allergies), temporomandibular joint disorder, myofascial pain syndrome, attention deficit hyperactivity disorder, eating disorders, Hashimoto’s thyroiditis, prolapsed mitral valve, and Sjogren’s syndrome (sicca syndrome).1

Some of these comorbid conditions likely play a causal role in the development of ME/CFS (though there is no direct proof of this; all we know at present is that these comorbid conditions are statistically more prevalent in ME/CFS patients).

Causal Factor Tests and Results Interpretation
Intestinal dysbiosis
People with ME/CFS often have bacterial or fungal overgrowth in their intestines, and may also have some pathogenic microbial species present. These conditions may be contributing to your ME/CFS symptoms.
Full digestive stool analysis. A digestive stool analysis will determine whether you have bacterial or fungal overgrowth in your intestines, and will determine whether there are any pathogenic or potentially pathogenic microbes present (potentially pathogenic microbes are those that only cause problems if their populations in the gut become too large). More info on gut dysbiosis: Fermentation in the gut and CFS
Leaky gut (intestinal permeability)
Leaky gut is an intestinal dysfunction that can allow toxic contents of the small intestine to enter the bloodstream. Leaky gut arises from dysfunction of the tight junctions in the lining of the intestine.
Leaky gut test (lactulose/mannitol test). The lactulose/mannitol test can detect if you have a leaky gut. More info: Fixing Leaky Gut Helps ME/CFS.
Irritable bowel syndrome (IBS)
IBS symptoms may include: abdominal pain and bloating; bouts of diarrhoea and/or constipation. 
Irritable bowel syndrome is a very common comorbid condition in ME/CFS and fibromyalgia.1 2 One study found 92% of ME/CFS patients, and 77% of fibromyalgia patients had IBS in their lifetime (compared to 18% for healthy controls).1
IBS is generally diagnosed by its symptoms; there are no specific tests for IBS.
Small intestine bacterial overgrowth (SIBO) SIBO is a condition in which abnormally large numbers of bacteria grow in the small intestine. SIBO symptoms are very similar to those of IBS, and include nausea, bloating, vomiting, diarrhea, nutrient malabsorption (and thus malnutrition), and weight loss. SIBO is found in 84% of IBS patients, and some hypothesize that SIBO may be the cause of IBS in these cases.1SIBO is a common comorbid condition in ME/CFS and fibromyalgia.1 Hydrogen breath test. SIBO can be detected using a hydrogen breath test, which involves drinking some lactulose sugar, and measuring the hydrogen or methane gas produced by bacteria in the small intestine as they metabolize this sugar. (These gases enter the bloodstream and are expelled by the lungs, where they are detected in the breath). D-xylose test. Malabsorption due to SIBO can be detected by the D-xylose test, which involves drinking D-xylose, and measuring levels in the urine and blood; if there is no D-xylose is found in the urine and blood, it suggests that the small bowel is not absorbing properly.More info: Testing for SIBOLabs that offer hydrogen breath tests.
Interstitial cystitis (bladder pain syndrome) and overactive bladder
These two conditions involve an excessive urgency, and increase frequency, to urinate. Bladder pain is involved in interstitial cystitis.1Interstitial cystitis and overactive bladder are comorbid conditions in fibromyalgia and ME/CFS.1 2 3 Research on cats with interstitial cystitis shows that they may have mild primary adrenal insufficiency.1
Allergies or food intolerances
Allergy or food intolerances are commonly found in ME/CFS.1 2 Allergies or food intolerances, especially to gluten or dairy products, may exacerbate ME/CFS symptoms.

2nd Round Treatments
In the light of the results of the second round of tests:

Intestinal dysbiosis. If your digestive stool analysis test indicates bacterial overgrowth and/or the substantial presence of potentially pathogenic gut bacteria such as Aeromonas, Bacillus cereus, Campylobacter jejuni, Citrobacter, Clostridium difficile, pathogenic strains of Escherichia coli, Klebsiella, Morganella morganii, Proteus, Pseudomonas, Salmonella, Shigella, Staphylococcus aureus, Vibrio and Yersinia, then a course of antibiotics, and/or probiotics may help reduce these bacterial populations. Note that some people ME/CFS, typically those who have had this disease for a decade or more, may find their gut is too sensitive to take probiotics.
Irritable bowel syndrome. If you have been diagnosed with irritable bowel syndrome (IBS), note that IBS can be caused by the intestinal protozoan parasites Giardia lamblia, Blastocystis hominis and Dientamoeba fragilis, all of which are treatable. There is also evidence of bacterial infection in IBS (in that the antibiotic rifaximin can put IBS into remission for weeks).For Giardia lamblia, a single dose of antiprotozoal drug tinidazole is an effective treatment.1 For Blastocystis hominis and Dientamoeba fragilis treatment: see the triple drug cocktail (comprising secnidazole, diloxanide furoate and bactrim DS) at the Badbugs website. A two week course of rifaximin, a unique antibiotic which is not absorbed in the intestines (and so remains in the bowels), improves IBS symptoms for three months.1 Fecal transplant (bacteriotherapy) may be worth considering: it has a 58% response rate for treating ME/CFS patients with IBS.1
Small intestine bacterial overgrowth. If you have been diagnosed with small intestine bacterial overgrowth (SIBO), there are a number of treatment options, including: the antibiotics rifaximinneomycin andmetronidazole; an elemental diet (to starve the bacteria); and dietary treatments that reduce food sources for the bacteria. See: Treatments Strategy for SIBO. Once the the bacterial overgrowth in the small intestine is brought under control by theses treatments, it is then necessary to adopt a prevention strategy(such as an ongoing dietary treatment) to stop SIBO from reappearing. Without adopting a prevention strategy, recurrence of SIBO is common.
Leaky gut syndrome. If you find you have a leaky gut (intestinal hyperpermeability), this means that the potent endotoxins such as lipopolysaccharide (LPS) made by bacteria in your gut can escape into your bloodstream. LPS leaking into the bloodstream can create significant system-wide inflammation. LPS also reduces the antiviral Th1 immune response, making it harder for your body to fight off viruses.1 A leaky gut diet can help resolve leaky gut problems. Fixing leaky gut in ME/CFS can lead to clinical improvement in symptoms.1 Sometimes, complete remission from ME/CFS can be obtained by normalizing a leaky gut.1

3rd Round Tests
This third round of tests focuses on rarer microbial causes and contributory factors of ME/CFS.

Causal Factor Tests and Results Interpretation
Giardia lamblia
Giardia lamblia is a protozoan parasite that colonizes and replicates in the small intestine, causing giardiasis. Prior infection with Giardia lamblia predisposes to acquiring ME/CFS.1 2 3
Giardia lamblia antigen test.
Toxoplasma gondii
This intracellular protozoan parasite, which can be caught from undercooked meat and cat feces, can cause toxoplasmosis, a mild condition that usually clears up on its own. However, Toxoplasma gondii can sometimes cause or contribute to ME/CFS. Toxoplasma gondii does not spread from person to person. 
The prevalence of Toxoplasma gondii in humans varies from country to country. It is found in around 11% of people the US, 22% in the UK, and in around 88% in France.
Toxoplasma gondii antibodies.
Mycoplasma species bacteria
60% of ME/CFS patients are found to have blood infections with one or more of the following: Mycoplasma pneumoniae, Mycoplasma fermentans, Mycoplasma hominis and Mycoplasma penetrans. By contrast, such infections are detected in the blood of only 10% of healthy adults). ME/CFS patients infected with more than one mycoplasmal species generally had a longer history of illness, suggesting that they may have contracted additional mycoplasmal infections with time.1 2 
It has been speculated that Mycoplasma species may contribute to ME/CFS symptoms.
Mycoplasma pneumoniae IgM and IgG antibodies. Dr A Martin Lerner only considers a ME/CFS patient to have a persistent Mycoplasma pneumoniae infection unless the titer is 1:600 or more (Lerner uses LabCorp for testing).1 Mycoplasma PCR.
Coxiella burnetii
This rare bacterium causes a disease named Q fever, which has ME/CFS-like symptoms. Direct, person-to-person infection occurs rarely, if ever. It can be treated with antibiotics. The incubation period of Coxiella burnetii 2 to 3 weeks. 1    
Coxiella burnetii antibodies.
Brucella bacteria can cause ME/CFS-like symptoms. This bacterium can be treated with antibiotics. Brucella’s incubation period is 1 to 3 weeks.
Brucella antibodies.
If living in an endemic area, like Florida, infection with the HTLV virus is a remote possibility to explain a ME/CFS-like condition, though the symptoms of this virus take decades to appear (it has a very long incubation period).
HTLV I and II antibodies.
Ross River virus
This mosquito-borne virus is only found in parts of Australia (and some other countries). This virus has been associated with ME/CFS, though most infections of Ross River virus do not produce clinical symptoms and go unnoticed.
Ross River virus antibodies .
Herpes simplex virus 1 & 2 (HSV) 
HSV 1 is found in 58% and HSV 2 is found in 16% of the adult population. It has been suggested that HSV 1 & 2 may play a role in ME/CFS.1
HSV 1 & 2 antibodies. A blood test showing a HSV IgG antibody titer of 1:?? or more suggests an active infection.
Varicella zoster virus (VZV)
VZV is the virus which causes chickenpox. VZV may be linked to ME/CFS (it has been hypothesized that some cases of ME/CFS may be caused by the reactivation of VZV in peripheral nerve ganglia).1
VZV antibodies. A blood test showing a VZV IgG antibody titer of 1:?? or more suggests an active infection.

3rd Round Treatments
In the light of the results of the third round of tests:

Giardia lamblia infection. If you tested positive for an Giardia lamblia infection, then either a week course ofmetronidazole, or a single dose of tinidazole or ornidazole is curative in 90% of cases.1
Mycoplasma infection. If you have a Mycoplasma infection, macrolide and tetracycline classes of antibiotics (such as azithromycin and doxycycline) are effective treatments. For healthy people, two or three weeks treatment is required; longer treatment is usually needed in chronic illness like ME/CFS.1Dr A Martin Lerner treats Mycoplasma pneumoniae infection in his ME/CFS patients with intravenous doxycycline 150 mg for six weeks, followed by oral doxycycline 100 to 150 mg twice daily or moxifloxacin400 mg once daily for three months.1
Varicella zoster virus infection. If you have an active infection with varicella zoster virus, then the supplement L-lysine (1000 mg twice daily) may be useful.
Herpes simplex virus infection. If you have an active infection with herpes simplex virus I or II, then the supplement L-lysine (1000 mg twice daily) may be useful.1

4th Round Tests
This fourth set includes rarer causes/contributory factors of ME/CFS.

Causal Factor Tests and Results Interpretation
Jaw bone infection
Cases of ME/CFS have occasionally been caused by bone infections (osteomyelitis) inside the jaw bone. Such infections can develop inside jaw bone cavitations (the hollow pockets in the jaw bone left after a tooth extraction). 
Further info:

I think I put the puzzle together

Jaw bone infections can be very hard to detect, as they often cause only very minimal local symptoms. Yet a local infection in the jaw bone can cause symptoms identical to ME/CFS.A simple test for jaw bone infection is applying pressure to jaw bone with a finger; if any area feels painful, this indicates a possible bone infection.Jaw bone infections will usually not show up on X-rays. However an MRI can detect jaw bone infections. Ultrasound and thermal imaging cameras can also be used to help detect a jaw bone infection. A handheld device called the Cavitat scanner can detect infections hidden within the jaw bone.Jaw bone infections come under the category of focal infections, which are defined as infections localized in a small region of the body. Focal infections within the tonsils may also lead to fatigue symptoms.Dr Graeme Munro-Hall and Dr Lilian Munro-Hall are UK dentists that specialize in testing for and treating jaw bone infections.
Sinusitis (sinus infection)
Sinusitis can cause chronic fatigue, and so conceivably sinus infections may worsen ME/CFS.1
Patients suffering chronic fatigue (but not proper ME/CFS) due to obstructive sinusitis have reported significant improvements in fatigue after undergoing sinus surgery. The improvements are likely to derive from the easing of sinus inflammation after surgery.Further info:

Lymph fluid obstruction/stagnation
Some patients with ME/CFS have improved, and some have even been cured, by massage that circulates lymph fluid. Thus lymphatic congestion and/or dysfunction in the thoracic duct which pumps the lymph fluid may be a factor in underpinning ME/CFS.
Further info:
Perrin Technique
Testing for lymph flow obstruction. Raymond Perrin, a osteopath who has developed lymph massage techniques to treat ME/CFS, found that his patients have a sore and tender spot just under the third rib on their left side. The presence of this soreness indicates a lymph flow stagnation. To test this spot in yourself, press your fingers into a point around 2 cm above and to the left of your left nipple; if there is soreness or tenderness at this point, this indicates to Perrin that there is a lymph flow blockage. Perrin theorizes that lymph stagnation prevents proper cerebrospinal fluid drainage, thus creating a toxic build-up in the central nervous system that underpins or contributes to ME/CFS.1
Physical trauma (eg: car accident)
Physical trauma such as a road accident or a fall can precipitate fibromyalgia and ME/CFS, particularly if a head or neck injury is sustained (such as whiplash or concussion). 
Further info:

Fibromyalgia and ME/CFS can appear immediately after an accident, or begin to develop over the subsequent months.The mechanisms that precipitate fibromyalgia and ME/CFS after a physical trauma producing anatomical damage or misalignment are not clear, but it is easy to hypothesize that causal factors may include anatomical misalignment restricting lymph flow from the head and through the neck; or anatomical misalignment pinching on the vagus nerve.1 2 Note that trauma to the spine can sometimes cause a syringomyelia to later form in the spinal cord, which may result in ME/CFS-like symptoms. Syringomyelia can be treated surgically.
Temporomandibular joint dysfunction (jaw misalignment) 
Temporomandibular joint dysfunction (TMJD) is an inflammation and misalignment of the temporomandibular joint (the joint which connects the jaw bone to the skull). TMJD can cause symptoms similar to fibromyalgia and ME/CFS.
More info:

Temporomandibular joint dysfunction can be diagnosed by dental professionals. One theory on how jaw misalignment precipitates fibromyalgia-like symptoms relates to a compound called substance P. Substance P is normally raised in fibromyalgia patients (but not in ME/CFS patients) and some believe it may play causal role in fibromyalgia. Now, higher levels of substance P are also found in TMJD patients. Substance P is released into the cerebrospinal fluid when the trigeminal nerve (which runs through the lower jaw) is stimulated. So substance P, originating from TMJD, offers a possible explanation of how TMJD might trigger fibromyalgia-like symptoms, and may explain how treating TMJD can lead to remission from fibromyalgia.
Silicone breast implant
Silicone used for breast and other implants, as well as silicone injections, can in rare cases cause an ME/CFS like illness, as well as autoimmune conditions. Silicone is known to affect the immune system (silicone is used as an immune stimulating adjuvant in vaccines for this reason).
More info on silicone illness here.
Hepatitis B vaccination
In very rare cases, ME/CFS is reportedly triggered by hepatitis B vaccination (and this is usually a rapid onset: that is, the symptoms of ME/CFS appearing almost immediately after the vaccination). 1   

4th Round Treatments
In the light of the results of the fourth round of tests:

Jaw bone infection. If you suspect you may have an focal infection within the jaw bone, you need seek help from a knowledgeable dentist, but these are hard to find. More info hereDr Graeme Munro-Hall and Dr Lilian Munro-Hall are UK dentists that specialize in testing for and treating jaw bone infections.
Lymph flow obstruction. If you think you may have a lymph flow obstruction, you may wish to try the Perrin Technique, which improves lymphatic and cerebrospinal fluid drainage using osteopathic massage and manipulation. Patients also follow a massage and exercise routine at home, involving spinal twists (Perrin twists) which manually activate the thoracic duct (the body’s main pump for lymph fluid).
Physical trauma. If you think your ME/CFS or fibromyalgia may be due to a physical trauma, such as a car accident that involved a head or neck injury, physical therapy spinal manipulation such as cranial osteopathy or chiropractic may perhaps yield benefits.
Temporomandibular joint dysfunction. If you have fibromyalgia-like symptoms, and you have been diagnosed with temporomandibular joint dysfunction (jaw misalignment), consider treating this, because it may help improve your fibromyalgia-like symptoms too.

Testing Laboratories
Testing laboratories (pathology labs) where the tests recommended in this document can be obtained are listed below.


USA UK / Europe Canada
Australia New Zealand Ireland
MedLab Pathology

ME/CFS Doctors and Clinics
Some of the world’s leading ME/CFS doctors and clinics are listed in the table below. More info on ME/CFS doctors and clinics here: Co-Cure ME/CFS & Fibromyalgia Good Doctor ListPhoenix Rising Forum ME/CFS Doctors.

Dr John Chia (Torrance, California)      Article on Dr Chia
Dr Chia is an infectious disease specialist with special interest in enteroviruses (which include coxsackievirus B and echoviruses), and is the leading researcher in enterovirus-associated ME/CFS. 
Dr A Martin Lerner (Oakland, Michigan)      Article on Dr Lerner
Dr Lerner is a leading researcher in ME/CFS associated with herpesvirus and used antivirals to treat these infections. He also has particular interest in the cardiac problems and insufficiency often found in ME/CFS.Dr Jose Montoya (Stanford University, California) 
Dr Montoya is a leading researcher in ME/CFS associated with herpesvirus such as HHV-6, EBV, cytomegalovirus, and uses powerful antivirals to treat these herpesviruses where appropriate.Dr Daniel Peterson (Sierra Internal Medicine, Nevada)      Article on Dr Peterson
Dr Peterson is a very experienced ME/CFS doctor and researcher, and has a special interest in natural killer cell functioning in ME/CFS.Dr Paul Cheney (Asheville, North Carolina)      Article on Dr Cheney
Dr Cheney is an innovative doctor and researcher using leading edge medicine to treat ME/CFS.Dr Nancy Klimas (Miami, Florida)      Article on Dr Klimas
Dr Klimas is a ME/CFS doctor and researcher who runs a ME/CFS clinic. She has significant experience in using immune modulators for treating ME/CFS.

Dr Charles W. Lapp (Charlotte, North Carolina)      Article on Dr Lapp
Dr Lapp runs clinical trials for drugs for ME/CFS and fibromyalgia, and has been using ampligen for ME/CFS.

Dr Derek Enlander (New York) 
Dr Derek Enlander uses immune modulators for treating ME/CFS.

Dr Garth Nicolson (Huntington Beach, California) 
Dr Nicolson works with ME/CFS, autoimmune diseases, Gulf War illness, and the infectious causes of autism and neurodegenerative diseases.

Dr Daniel Dantini (Ormond Beach, Florida)      Article on Dr Dantini
Dr Dantini uses antivirals (famciclovir and valacyclovir) for herpesviruses in his treatment of ME/CFS where appropriate.

Dr Andreas M. Kogelnik (Mountain View, California) 
Dr Andreas M. Kogelnik is an infectious disease doctor, and an ME/CFS specialist and researcher.

UK / Europe
Dr Sarah Myhill (Powys, Wales, UK) 
Dr Myhill is GP with significant experience of CFS, and has a website from which various lab tests can be ordered and interpreted by Dr Myhill.Breakspear Medical Group (Hertfordshire, UK) 
Breakspear focuses on allergy and environmental illness. For ME/CFS treatment they use antivirals, gammaglobulins for parvovirus, and test and treat rickettsial and bacterial co-infections.Dr Kenny De Meirleir / Red Labs (Belgium) 
Dr Kenny De Meirleir is a ME/CFS doctor and researcher who runs a ME/CFS clinic in Brussels with a particular focus on the intestinal dysfunction and intestinal dysbiosis of this disease.
Australian ME/CFS Good Doctor List 

Sourcing Pharmaceutical Drugs
Good ME/CFS doctors who provide the appropriate drugs for ME/CFS patients are few and far between, and the average primary care doctor is often reluctant to prescribe drugs for off-label or experimental use in ME/CFS. Thus it may be necessary to buy the drugs you need directly from a reliable online pharmacy.

The law in most counties allows 3 months worth of prescription drugs for personal use to be imported from abroad (though these drugs of course cannot be controlled substances). Courtesy of this law, it is possible to easily and legally obtain drugs from online overseas pharmacies, usually without needing to provide a prescription. There are many online overseas pharmacies to choose from, but it is important to find a good one that is trustworthy and reliable. The following sources for reliable overseas pharmacies are very useful:

Updated lists of reliable overseas online pharmacies are maintained by the following website, in which each pharmacy is rated by user-feedback:

Before you consider taking any pharmaceuticals, make sure you are fully informed about them, and check for any contraindications or drug interactions with other medications or supplements you are taking, via a website such as the:Drug interactions checker at drugs.com
Sourcing Cheap Supplements

ME/CFS patients often take a range of supplements to help combat the myriad symptoms of this problematic disease. To save on costs, note that vitamin, herbal and amino acid supplements can be obtained at substantial discounts —€” around 80% to 90% less than the regular price —€” if you buy these supplements in bulk powder form, rather than tablet or capsule form. Supplements in powder form can taken by swallowing the powder with a little water. It may be an idea to buy a digital weighing scales to accurately measure the power dosage (digital scales can be obtained for as little as $10).

Some bulk powder supplement suppliers include:

USA UK Australia