Terminalia chebula:  Haritaki

Several studies have found this is effective against many of the over-growths of bacteria families seen in CFS, unfortunately it also impacts E.Coli which CFSers are low in. This herb was found to be as potent as ciprofloxacin, gentamycin, kanamycin, ofloxacin and cephalexin. This superior performance was reported in another study of 66 herbs.  It has no adverse effects on the growth of the lactic acid-producing bacteria.

Personally, I found that it caused a significant cognitive improvement within days. I was doing a capsule of Mutaflor daily after doing the haritaki.

According to Wikipedia[Wikipedia]:

Haritaki is a rejuvenative, laxative (unripe), astringent (ripe), anthelmintic, nervine, expectorant, tonic, carminative, and appetite stimulant. It is used in people who have leprosy (including skin disorders), anemia, narcosis, piles, chronic, intermittent fever,heart disease, diarrhea, anorexia, cough and excessive secretion of mucus, and a range of other complaints and symptoms. According to the Bhavaprakasha, Haritaki was derived from a drop of nectar from Indra’s cup. Haritaki is used to mitigate Vata and eliminate ama (toxins), indicated by constipation, a thick greyish tongue coating, abdominal pain and distension, foul feces and breath, flatulence, weakness, and a slow pulse. The fresh fruit is dipana and the powdered dried fruit made into a paste and taken with jaggery is malashodhana, removing impurities and wastes from the body. Haritaki is an effective purgative when taken as a powder, but when the whole dried fruit is boiled the resulting decoction is grahi, useful in the treatment of diarrhea and dysentery. The fresh or reconstituted fruit taken before meals stimulates digestion, whereas if taken with meals it increases intelligence, nourishes the senses and purifies the digestive and genitourinary tract. Taken after meals Haritaki treats diseases caused by the aggravation of Vayu, Pitta and Kapha as a result of unwholesome food and drinks. Haritaki is a rasayana to Vata, increasing awareness, and has a nourishing, restorative effect on the central nervous system. Haritaki improves digestion, promotes the absorption of nutrients, and regulates colon function.

Drug interactions are known[Online Herbal].

I have been back-channeled by several people on what tests to do. There are several approaches possible:

• Assume that you have similar to the reported gut-flora dysfunction presented at the 1998 Clinical and Scientific Meeting in Australia by Butt HL [1,2], Dunstan RH , McGregor NR , Roberts TK, Harrison TL and Grainger JR from Department of Biological Sciences, University of Newcastle, Newcastle Australia (partially confirmed by Richard Schloeffel, MD at the 2001 Clinical and Scientific Meeting)
• Test using one of the commercial gut bacteria packages
• Find a state of the art university department willing to test…

For myself, I assumed that I matched the pattern seen in the population of 27 CFS patients that was reported on.

Normal Gut Bacteria Populations

You should know that every person’s gut bacteria is different. Fecal transplants work much better from blood relatives than spouses or strangers. It appears that gut bacteria is inherited (possible influenced by DNA).

Commercial Tests

I will be reviewing these two tests today (please tell me of any additional tests that you are aware of). Note that most of these tests are marked with “assays are For Research Use Only“.

• Genova’s Metametrix, which is used by Dr. Sarah Myhill, MD in the UK. A sample report is here 
  
• Genova DigestiveTests (Great Smokies) – quite popular in the US, sample report is here and here. The use a 1-4 rating that can be confusing to interpret (a reading of “3” could be Normal, High or Low:
• [Source]:
• Diagnos-Techs GI Health Panel™:. Sample Here

So how do you evaluate these? My take is:

• Do they cover the families reported from Australia (if they cover other stuff, that is fine)?
• Do they provide information on overgrowth or undergrowth (Especially for E.Coli)? Is the information more than “No issue” or “Issue”?

* – indicate appearance of single species of the family test

My general opinion is that Myhill’s choice is the best for CFS. I will do a future post on the ideal test (IMHO).

I came across the write-up on my 2001 recovery in the Townsend Letter online here. The key aspect cited in the article still applies: “eliminate the infection(s) that cause the antibodies, eliminate items that trigger coagulation; get assistance in reducing coagulation”

There have been some refinements on the meaning of these words — the infections have been expanded to include invasive gut bacteria (which are indeed infections).

There have been significant viable alternatives to the treatment components. Some of these changes are needed — for example, infection-specific transfer factors have disappeared from the market place.  Another change is the PubMed publication of many studies of traditional medicines that appear to be as effective as prescription antibiotics and antivirals. The options for prescription treatment have not changed. The options for “alternative” treatment have increased greatly.

In 2000, I was injecting low dosage heparin, a prescription item — today, boswellia has been reported in at least one study as being as effective as heparin!  Yes! No track marks from shooting up daily! 😉

In 2000, I had to take a prescription from my MD to Canada to get Lumbrokinase, a substance that dissolves fibrin deposits.  Today, it is available on many web sites without prescription.

In 2000, I used a CFS patient in the Czech Republic to get Piracetam (where it was available over the counter). In most of Europe, it was prescription only. In the US, it was not available (except by specialized compounding pharmacies).

Unfortunately, I am still needing to drive to Canada — but this time it is to get Mutaflor, the E.Coli Nissle 1917 probiotic. The FDA deems it to be a drug at present which require years of effort to get approved for sale. In Canada and Europe, it may be easily ordered. It has been used since 1917 (just 95 years!).

Unfortunately, many of the traditional medicines are not easily available. Fortunately, many of them are available as spices and herbs from East Indian suppliers in the US in one pound bags. The pill making is a frequent evening activity.

This remains an inconvenient disease to treat!

However, the critical problem remains unchanged from 2000 — finding a MD that willing to venture off “standard medical treatment” (for CFS, this means prescribing pain killers as needed). A MD willing to enter the world of non-pharmaceutics (i.e. herbs, spices and other things) as well as going against the current fad of minimizing antibiotics usage (which may still be needed if traditional medicines are ineffective)..

For Christmas I got an Infrared Sauna from CostCo. Costco had a special with a price less than $1000.00 and was effectively my entire Christmas present (and several other occasions). I don’t know if I may be able to write it off as a medical expense, but it is good to review the reported medical benefits on PubMed.

• FIR means Far Infra Red saunas.
• Waon theraphy uses infrared saunas and according to Wikipedia:
  ” increases blood flow by stimulating endothelial nitric oxide synthase protein production (eNOS). eNOS makesnitric oxide, which is a vasodilator and increases blood flow.^[4] Waon therapy also increases blood flow by stimulating the mobilization endothelial progenitor cells marked with CD34 molecules. CD34 positive cells promote angiogenesis to increase blood flow, improving cardiac perfusion and decreasing vascular resistance.^[4] Nitric oxide is also a regulator of the sympathetic nervous system, and an increase of nitric oxide via endothelial nitric oxide synthase may help to controlautonomic nervous system.^[5]“

Some PubMed articles:

• Efficacy of Waon therapy for fibromyalgia. 2008,
  “All patients experienced a significant reduction in pain by about half after the first session of Waon therapy (11-70%), and the effect of Waon therapy became stable (20-78%) after 10 treatments. Pain VAS and FIQ symptom scores were significantly (p<0.01) decreased after Waon therapy and remained low throughout the observation period.”
• Remarkable efficacy of thermal therapy for Sjögren syndrome.(2007)
• [A new treatment: thermal therapy for chronic fatigue syndrome]. (2007)
  “11 patients with CFS, physical symptoms such as fatigue and pain improved”
• The effects of repeated thermal therapy for two patients with chronic fatigue syndrome(2005)
  “Symptoms such as fatigue, pain, sleep disturbance, and low-grade fever were dramatically improved after 15 to 25 sessions of thermal therapy.”
• Sauna as a valuable clinical tool for cardiovascular, autoimmune, toxicant- induced and other chronic health problems. 2011
  A single case report describes the response to FIR saunas of two women with severe chronic fatigue. Both had been treated with prednisolone, which only seemed to maintain the status quo. Both participated in 30 FIR sauna sessions lasting for 15
  minutes at 60°C followed by 30-minute sessions of resting under a blanket. “is protocol was followed !ve days per week for the !rst six weeks; subsequent once or twice weekly sessions continued over the next 11 months. Both women reported
  “dramatic improvements” in fatigue, pain
• Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis. A pilot study showing good tolerance, short-term improvement of pain and stiffness, and a trend towards long-term beneficial effects. (2009)
  “In the RA and AS patients, pain, stiffness, and fatigue also showed clinical improvements during the 4-week treatment period, but these did not reach statistical significance. No relevant changes in disease activity scores were found, indicating no exacerbation of disease activity. In conclusion, infrared treatment has statistically significant short-term beneficial effects and clinically relevant period effects during treatment in RA and AS patients without enhancing disease activity. IR has good tolerability and no adverse effects.“
• Far-infrared saunas for treatment of cardiovascular risk factors: summary of published evidence. 2009
  “there is limited moderate evidence supporting FIRS efficacy in normalizing blood pressure and treating congestive heart failure; fair evidence, from a single study, supporting FIRS therapy in chronic pain; weak evidence, from a single study, supporting FIRS therapy in chronic fatigue syndrome; weak evidence, from a single study, supporting FIRS therapy for obesity;”

My Own Experience

The first day of trying it, was uneventful, in fact, I stayed in much longer than specified in the Waon protocol. The next morning, I found that there were digestive issues – upset, increased cough, etc of mysterious origin until the wife pointed out that I had tried the sauna on the previous day. My interpretation was that some gut bacteria was not happy with the sauna and that there was some die-off/herx.

The next day using the FIR, was similar to the first — no issues on the day of use, but gut went off about the same time the following day. Taking L. Reuteri, Mutaflor eliminated this quickly. The severity was less.  I did notice two changes according to my Saturated O₂ meter: My heart rate was lower over the following day (I have the high pulse rate induced by CFS), and the O₂ level dropped for a few hours.

Digging into possible Whys..

I found several studies where gut-bacteria was impacted by heat, but nothing that was directly applicable. The best article is found here, with an interesting quote “compounds inducing heat shock response may be important for the development of new therapeutic strategies for colonic inflamatory disease” which references Role of heat shock proteins (molecular chaperones) in intestinal mucosal protection. Otaka M, Odashima M, Watanabe S. Biochem Biophys Res Commun. 2006 Sep 15;348(1):1-5. summarized as:

Most studies into the pathogenesis of inflammatory bowel diseases (IBD) have primarily focused on the cytotoxic agents and processes involved in producing mucosal injury, including the immune system. However, less consideration has been given to the inherent mechanisms of cytoprotection and cellular repair in the intestinal mucosa. This review will focus on intestinal mucosal protection against cytotoxic agents and cellular stress mainly from the viewpoint of expression and function of heat shock proteins, in their role of “molecular chaperones,” as internal cytoprotectants. Elucidation of such stress-responses in the intestinal mucosa may provide a better understanding of the mechanisms of cytoprotection and cellular repair, and present new strategies for IBD therapy.

The bottom line appears to be with the appropriate temperature, the chemicals that the body uses to respond to the heat can impact the intestinal system positively.

For Christmas I got an Infrared Sauna from CostCo. Costco had a special with a price less than $1000.00 and was effectively my entire Christmas present (and several other occasions). I don’t know if I may be able to write it off as a medical expense, but it is good to review the reported medical benefits on PubMed.

• FIR means Far Infra Red saunas.
• Waon theraphy uses infrared saunas and according to Wikipedia:
  ” increases blood flow by stimulating endothelial nitric oxide synthase protein production (eNOS). eNOS makesnitric oxide, which is a vasodilator and increases blood flow.^[4] Waon therapy also increases blood flow by stimulating the mobilization endothelial progenitor cells marked with CD34 molecules. CD34 positive cells promote angiogenesis to increase blood flow, improving cardiac perfusion and decreasing vascular resistance.^[4] Nitric oxide is also a regulator of the sympathetic nervous system, and an increase of nitric oxide via endothelial nitric oxide synthase may help to controlautonomic nervous system.^[5]“

Some PubMed articles:

• Efficacy of Waon therapy for fibromyalgia. 2008,
  “All patients experienced a significant reduction in pain by about half after the first session of Waon therapy (11-70%), and the effect of Waon therapy became stable (20-78%) after 10 treatments. Pain VAS and FIQ symptom scores were significantly (p<0.01) decreased after Waon therapy and remained low throughout the observation period.”
• Remarkable efficacy of thermal therapy for Sjögren syndrome.(2007)
• [A new treatment: thermal therapy for chronic fatigue syndrome]. (2007)
  “11 patients with CFS, physical symptoms such as fatigue and pain improved”
• The effects of repeated thermal therapy for two patients with chronic fatigue syndrome(2005)
  “Symptoms such as fatigue, pain, sleep disturbance, and low-grade fever were dramatically improved after 15 to 25 sessions of thermal therapy.”
• Sauna as a valuable clinical tool for cardiovascular, autoimmune, toxicant- induced and other chronic health problems. 2011
  A single case report describes the response to FIR saunas of two women with severe chronic fatigue. Both had been treated with prednisolone, which only seemed to maintain the status quo. Both participated in 30 FIR sauna sessions lasting for 15
  minutes at 60°C followed by 30-minute sessions of resting under a blanket. “is protocol was followed !ve days per week for the !rst six weeks; subsequent once or twice weekly sessions continued over the next 11 months. Both women reported
  “dramatic improvements” in fatigue, pain
• Infrared sauna in patients with rheumatoid arthritis and ankylosing spondylitis. A pilot study showing good tolerance, short-term improvement of pain and stiffness, and a trend towards long-term beneficial effects. (2009)
  “In the RA and AS patients, pain, stiffness, and fatigue also showed clinical improvements during the 4-week treatment period, but these did not reach statistical significance. No relevant changes in disease activity scores were found, indicating no exacerbation of disease activity. In conclusion, infrared treatment has statistically significant short-term beneficial effects and clinically relevant period effects during treatment in RA and AS patients without enhancing disease activity. IR has good tolerability and no adverse effects.“
• Far-infrared saunas for treatment of cardiovascular risk factors: summary of published evidence. 2009
  “there is limited moderate evidence supporting FIRS efficacy in normalizing blood pressure and treating congestive heart failure; fair evidence, from a single study, supporting FIRS therapy in chronic pain; weak evidence, from a single study, supporting FIRS therapy in chronic fatigue syndrome; weak evidence, from a single study, supporting FIRS therapy for obesity;”

My Own Experience

The first day of trying it, was uneventful, in fact, I stayed in much longer than specified in the Waon protocol. The next morning, I found that there were digestive issues – upset, increased cough, etc of mysterious origin until the wife pointed out that I had tried the sauna on the previous day. My interpretation was that some gut bacteria was not happy with the sauna and that there was some die-off/herx.

I found several studies where gut-bacteria was impacted by heat, but nothing that was directly applicable. The best article is found here, with an interesting quote “compounds inducing heat shock response may be important for the development of new therapeutic strategies for colonic inflamatory disease” which references Role of heat shock proteins (molecular chaperones) in intestinal mucosal protection. Otaka M, Odashima M, Watanabe S. Biochem Biophys Res Commun. 2006 Sep 15;348(1):1-5. summarized as:

Most studies into the pathogenesis of inflammatory bowel diseases (IBD) have primarily focused on the cytotoxic agents and processes involved in producing mucosal injury, including the immune system. However, less consideration has been given to the inherent mechanisms of cytoprotection and cellular repair in the intestinal mucosa. This review will focus on intestinal mucosal protection against cytotoxic agents and cellular stress mainly from the viewpoint of expression and function of heat shock proteins, in their role of “molecular chaperones,” as internal cytoprotectants. Elucidation of such stress-responses in the intestinal mucosa may provide a better understanding of the mechanisms of cytoprotection and cellular repair, and present new strategies for IBD therapy.

The bottom line appears to be with the appropriate temperature, the chemicals that the body uses to respond to the heat can impact the intestinal system positively.