RETURN TO TABLE OF CONTENTS
Fall 2003 

Chronicle Q&A
Fixing the “brain sprain” of CFIDS
By Mark Giuliucci

Eric R. Braverman, MD, believes that an integrative approach is the key to successfully treating CFIDS. His practice, The Place for Achieving Total Health (PATH Medical), utilizes a wide range of alternative and complementary therapies — in addition to Western medical techniques and drugs — as part of its treatment protocol. In this edition of the Chronicle Q&A, Dr. Braverman outlines some of his unconventional beliefs about the care of people with CFIDS.

Q.        In your opinion, what causes CFIDS?

A.        Fatigue is a multi-factorial problem. Chronic fatigue syndrome patients come here with a very rich history. They may have had Lyme disease in the past, or Epstein-Barr virus — but it’s not uncommon for people to come in with past head trauma, or having undergone chemotherapy. I’ve had patients with infections of unknown origin, or with borreliosis (diseases, such as Lyme, caused by spirochetes), Q fever, you name it. I have treated every rare, treatment-resistant condition imaginable. And fatigue is commonly part of that picture.

The key, however, is that it doesn’t really matter that much what happened in the past. The key is what’s going on now in the patient’s brain. The brains of chronic fatigue patients don’t make enough dopamine (a neurotransmitter, similar to serotonin) — and this is what causes the problem.

People end up looking for a direct cause. But in most cases, the infection or trauma or immune episode is gone, no longer active. What patients are left with are residual effects. MRIs or CAT scans come out normal, and the patients are told that it’s all in their heads. But MRIs don’t show anything useful.

Q.        What’s wrong with MRIs and CAT scans?

A.        They’re anatomy tests. If a person comes to you and says, “I have three arms,” all you have to do is look at them and count the arms. That’s all you get with an MRI. It’s an internal anatomy look.

Most disorders of the brain are functional. You get no value from an MRI in that respect. What’s revealing is the function of the brain, the speed of the brain, the energy of the brain. The sleep cycle, the rhythm.

That’s why we do a procedure called the BEAM (Brain Electrical Activity Mapping).

It takes about 40 minutes. Basically you put a cap with electrodes on the head of a patient and you stress the brain. It’s kind of like a cardiac stress test. The BEAM gives us a functional look at how your brain is working. We can see how you respond to different stimuli, and compare that to how a typical brain responds. This gives a much better picture of what’s really going on, and how we can treat the problems.

Brain health check-ups are the cornerstone of our practice. We have discovered a lot about fatigue this way. We think that fatigue, for instance, is why a lot of people use cocaine. It’s the same for overuse of caffeine in working men, and for nicotine use and other stimulants. Fatigue is really a very multi-factorial diagnosis. But, as I’ve said, while chronic fatigue has a lot of etiologies, the etiology is not as important as the repair.

I don’t need to know that to fix people.

Q.        So how do you fix people with CFIDS?

A.        Here’s an analogy for you. When you sprain a leg, you treat it in several different, synergistic ways. You put ice on it. You elevate it. You do some physical rehab. And maybe you treat the pain with medication.

Chronic fatigue is a sprained brain. In all cases. It’s a sprained brain that gets rehabbed with electrical therapy, massage therapies like chiropractic, relaxation therapies, adequate sleep, proper sleep. You add in neuro-rehabilitative approaches including hormones, nutrients, lifestyle changes. It’s multi-modal human repair.

Every program is different, but we match them all to the four great areas. The first is the brain and brain chemistry. Each patient has a brain print, so to speak, based on the BEAM results. There are also psychological needs, and emotional needs, that have to be met. Plus, heavy metals and toxins need to be removed.

Number two is the hormonal state. If a woman is in perimenopause, for instance, she may need progesterone. That could be contributing to fatigue. She may be missing estrogen. A man might be missing testosterone. Both could be missing growth hormone. 

Third, you match it to their nutritional state. Better diet. Nutritional supplements, amino acids, whatever it takes to make them whole nutritionally.

Finally, conventional medicine can bail people out. This is generally a short-term fix, whatever they need immediately. But sometimes people are very broken. Some-times people are like Humpty Dumpty, and they need medication to hold them together. In that case, they can be on medication the rest of their lives.

Q.        What works best?

A.        I can say that dopamine agents, stimulants, are the single most effective agents in dealing with chronic fatigue. Also amino acids, tyrosine and phenylalanine. Hormones are essential. And conventional drugs, from antidepressants like Wellbutrin and Effexor to the mega-drugs like Provigil, and drugs like Ritalin.

How long they stay on these treatments depends on how well they heal. Remember, it’s a brain rehab program, just like someone would rehab a sprained leg. You immobilize it and treat it until it’s working OK on its own.

Q.        How is compliance with your program?

A.        We ask people to do a lot more than just take a pill. Compliance is a challenge. A physician has to be his patient’s therapist. You have to deal with people’s emotions.

Probably 80 percent of what a doctor knows will help patients, what will improve them, is not complied with. My success is when I can connect with a person. Building rapport is successful. We have to convince them that what we’re doing is going to work — but only if they’ll follow the program.

Q.        Why do you feel that your approach works?

A.        It’s integrative. It’s multi-disciplined. It doesn’t stop at taking a pill.

When I interviewed at Harvard Medical School 23 years ago, the interviewer rejected me. He said that nutrition had no role in health care. He said that the EPA was right when it said that lead wasn’t toxic to children. Since then, I’ve seen the FDA, the EPA, Harvard Medical School — all the so-called geniuses of 23 years ago — admit that they were wrong. These things do play a role in health and well-being.

American medicine makes a bundle on specialization. The economic niche of promoting overall well-being for citizens was lost. That’s what we have returned to, and that’s why our integrative approach has been successful in chronic fatigue and many other conditions.

PATH Medical has offices in New York City, greater Philadelphia and New Jersey.  For more information, visit www.pathmed.com, or call (212) 213-6155.

The CFIDS Association of America does not endorse any products, claims or practices mentioned in the Chronicle’s Alternative and Complementary Therapies features.