CFS/FM/IBS are difficult conditions to treat. One of the major challenges for physicians is that patients often hyper-react to drugs, do not react at all, or react contrary to the results with normal patients.

Microflora changes may be the source of this unpredictability.  A difference of microfloras can result in a half life of a drug changing from 6 days to 100 days as found by this 1988 [study]. This would explain the observed difficulty  in predicting how patient actually responds.

Assuming this is true, then mountains of “reasoned recommendations” for CFS / FM / IBS become illogical because the core assumption is that the absorption and processing will be like normal patients.

Stale Recommendations and Knowledge

Often I see patient refer to books that were written 15 years ago. Our knowledge have greatly increased and are not in these old books. To Illustrate this look at the following charts from PubMed.

Number of new Articles on PubMed by Year  - each bar is 1 year
Our knowledge on CFS/FM/IBS has exploded. Most MDs are unable to keep current. Each Year is One Bar

Recommended Books

There are two recent books that should be on most patients’s bookshelf (or tablet). They are recent and reasonably complete.

While these books are current and of value, I often find that they recap information only without a critical analysis. Since both authors have CFS, weakness in executive decision making is normal. While I have this weakness (for the same reason) also, I have a simple rule for evaluating supplements:

“The supplement must be documented by human studies to improve symptoms with no contradictory reports. Contradictory reports include no effect found.”

Supplements are classified under this menu item into the following classes:

  • Core — excellent studies showing positive effects on at least 50% of CFS patients
  • Basic — studies indicate that they should be of benefit but they have not been trialed in studies yet