Recently I was asked by my medical professional (who is also an Instructor at Bastyr University if I was pulsing my artemisia. I said yes, my rule of thumb is to always pulse anti-viral and antibiotics. This came out of the grandfather of all CFS protocols, the Jadin / Rickettsia approach, which found that pulsing was far more effective in dealing with occult infections than continuous application.

My medical professional mentioned that artemisia, if taken more than 2 weeks, will result in the body adapting to it, reducing it’s effectiveness. Unfortunately, I have not been able to find any PubMed studies to confirm it for artemisia.  I did find one 2004 study where pulsing was clearly as effective as continuous dosage. An additional study found that it was more effective against less susceptible bacterial strains as as effective for susceptible strains, which appears to confirm the experience from the 1950’s Rickettsia approach.

A 2012 mathematical modeling study pulsing may be the preferred application of anti-pathogens: “We find that constant dosing is not the optimal method for disinfection. Rather, cycling between application and withdrawal of the antibiotic yields the fastest killing of the bacteria.”

It should be noted that in some cases, supplements use their effectiveness after a few months (there are studies showing this with NADH with CFS patients). So there is a legitimate concern for taking anything continuously — you will likely loose the benefit sooner than with pulsing.

Remission and the wisdom of pulsing

If you are loaded up with substances modifying cytokines, coagulation, etc, how can you tell if there is actual progress to true remission (or are you just addressing the symptoms?).

I find that pulsing almost everything that is intended to lead to remission and then having a 1-3 week washout to see how much benefit persisted. For example, I pulsed Mutaflor(E.Coli Nissle 1917). After the first pulse, the benefits persisted when I stopped. When I proceeded to take Amoxicillian, which kills E.Coli, I noticed that niacin flush returned, but is a very minor manner. Once I stop items that kill E.Coli, I will promptly do another pulse to restore E.Coli levels. The same applies to all probiotics, for example, re-establishing Lactobacillus Reuteri so the need to supplement B12 disappears.

My general impression from reading studies on antibiotics and restoration of gut bacteria after antibiotics, suggests that 2 weeks is the maximum duration needed.

There’s another significant benefit to pulsing, it reduces the costs of treatment without adversely impacting the outcome (in fact, it may improve the outcome).

So what should pulsed? IMHO

• Antibiotics
• Antivirals
• Anticoagulants
• Most herbs (because they often act in the above areas)

To rephrase this another way: If you intend to treat CFS mitochondrial dysfunction by supplementing the vitamins, amino acids and minerals that are deficient, then you likely need to keep on them continuously.  If you intend to treat CFS mitochondrial dysfunction by eliminating pathogens causing it (including gut bacteria), encouraging good bacteria, adding probiotics that is causing the dysfunction, then you should pulse and taper off once the correction is established.