Tag: CFS

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Tips for Sleeping Well from The Fatigue Book

sleep

The following is an extract from ‘The Fatigue Book’ by Lydia Rolley and looks at the importance of sleeping well in managing the effects of Chronic Fatigue Syndrome.

It would seem to make logical sense that, if you suffer from fatigue, at least you would beable to have a good night’s sleep, right? Well, as you have no doubt discovered by now, the fatigue does not play by the normal rules of life, and what your body is craving from a good night’s sleep is sadly often denied.

As humans, we spend approximately a third of our lives sleeping. That is quite a lot of time. Sleep is essential for our mental and physical wellbeing. Sleep contributes to the proper functioning of our body’s systems. Lack of sleep, therefore, has negative health consequences.

I have worked with many chronic fatigue sufferers who, although they sleep a lot, struggle to sleep well. From my experience, people either tend to over-think sleep issues, which can lead to increased anxiety about getting to sleep, or not to think enough about these issues,
which can lead to disordered sleep habits. Chronic fatigue sufferers who have sleep difficulties usually wake feeling unrefreshed. Some may not be waking until late morning or even into the afternoon. Often it is hard to get out of bed, as the body feels weighed down and heavy. The heavy feeling and sleepiness can continue throughout the day. Some people report feeling more alert for a few hours later on, often in the early evening. Almost a small window of hope, but this can be followed by difficulty switching off at night and not being able to get to sleep.

Changing your sleep pattern does not happen by chance. It does take a lot of patience, being intentional and very consistent. Concentrating on your sleep and developing healthy sleep hygiene habits together make the biggest difference to your overall health and ability to function and cope well. I have seen countless people transform their sleep habits and have witnessed the benefits. The change started when they chose to try something different.

Sleep difficulties can be complex and multi-faceted, but most can be solved. Ignoring sleep issues, and hoping they will go away, does not work. Trying to sleep for a few extra hours to fill the gap only tends to prolong the problems rather than solve them. When sleep is disordered, our bodies need to be retrained to know when it is time to sleep and when it is time to wake up.

What I have learnt over the years is that, even though some of these tips seem obvious, they almost need to be exaggerated, repeated and magnified in order to have an effect. Please keep that in mind as you start to put into practice the following tips, which will give you some useful starting points.

I have full confidence that you will benefit from healthier sleep habits.

Tip 21: Separate Day and Night Clearly

sleep

This is probably not your present reality and that is okay for now, but please keep this fact clearly in your mind as a goal for your future sleep pattern. The boundaries between day and night can get very blurred with disordered sleep. The more disordered your sleep becomes, the more unrefreshing will be your experience. Reintroducing clear boundaries will prevent further deconditioning.

This is the direction we are heading towards to regain a healthier sleep routine. For now, just be aware of your current day and night sleep routine by drawing a line on the chart below where you think your sleep pattern currently is.

sleep

In the weeks and months ahead, be aware of how your current line gradually changes position and consider what has contributed to that shift. If you are sleeping excessively in the daytime and want to start changing that habit, see Tip 23.

Keep a Reflective Sleep Diary

The reason for keeping a sleep diary is to understand your current sleep situation and give greater clarity to what may need to change. This sleep diary is more of a reflective diary rather than a scientific measurement of your sleep cycles (such as on a sleep app). A reflective diary can be more useful in empowering you to make some changes.

In your reflective sleep diary (see Appendix 2, page 276) consider the following questions:

  • What was I doing an hour before bedtime?
  • How was I feeling in the evening?
  • What time did I get into bed?
  • How long did it take me to fall asleep? Why? Any reasons?
  • Did I wake in the night? How often? Why? Any reasons?
  • What time did I wake up?
  • What time did I get up?
  • How did I feel?
  • How would I rate my night’s sleep out of 10? (10 being excellent.)

I would recommend only doing this for a week or two, no more than that. That is enough time to recognise any patterns of sleep and highlight any particular areas that need concentrating on.

Every few days, respond to the following statement:

sleep

 

Tip 23: Set an Alarm

This tip is not always popular but it is of the utmost importance. When you are exhausted and perhaps have no particular reason to get up, it may seem sensible to rest for longer, but this is counterproductive. Staying longer in bed does not help poor quality sleep. Sufferers frequently report feeling worse for going back to sleep. Seeking balance and retraining your body to learn a sleep-wake cycle goes hand-in-hand with managing your activities, pacing and rest.

sleep

I recommend that you try the following method to create an ordered sleep-wake cycle:

  • Decide what time you would like to wake and get up, for example 8.00 am.
  • Use a simple alarm clock with a silent tick.
  • Place the clock somewhere that requires you to move to switch it off.
  • Check your reflective sleep diary and set the alarm for the average weekly time you currently wake and get up – for example, it maybe 11.30am.
  • Set your alarm at this time for a week, so that you get used to waking up with the alarm.
  • Avoid going back to sleep – open the curtains, turn the light on, sit on the edge of the bed, put your pillows on the floor, etc.
  • The following week, set your alarm for 30 minutes earlier.
  • The following week, set your alarm for another 30 minutes earlier.
  • Do this consistently for a few weeks, until you are waking and getting up at your preferred time.

If the 30-minute chunks are not successful, try 15-minute chunks of time.

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Nutritional approaches to CFS

Food choice and quality

The value of choosing, where possible, locally grown or produced food has been much reviewed and generally agreed upon in recent years. We all have access to news items, television programmes, magazine articles and, for many of us, internet information on this subject. The value and availability of local, seasonal produce have been discussed at length. Many authors in Europe and America have written controversial books covering such subjects as poor food quality, food commercialisation, food additives, pressure advertising and many other contentious topics. A selection of my favourite authors includes: Michael Moss, Bee Wilson, John Humphreys, Ben Goldacre, Barry Groves, Stanley Feldman with Vincent Marks, and Eric Schlosser.

Meanwhile our chefs and celebrity cooks have made us more aware of our poor-quality school meals (Jamie Oliver), the use of country produce (Hugh Fearnley-Whittingstall), or simply good quality food and healthy cooking methods (Gary Rhodes, Nigel Slater, Simon Hopkinson etc). Having scanned today’s main TV channels (Free-Sat) today being a typical quiet Thursday in March, I have identified 13 programmes whose subject matter is cooking or food. This does not include the radio programmes.

With such unrelenting advice on food selection, preparation and cooking it is difficult to believe that an unhealthy diet is possible in the UK. Although media and governmental advice on ‘healthy’ eating can be conflicting, we are all aware that refined, processed and generally harmful ‘junk food’ is best avoided. At the same time, I frequently encounter patients who admit that their diets are dreadful; their excuses range from lack of time to dislike of cooking or shopping, or simply a result of craving all the wrong foods.
Regrettably, a major motivation for many people’s food selection is a result of economic necessity. Such items as convenience foods, TV snacks, cakes, biscuits, crisps, chocolate, cola-drinks and alcohol feature as essential components in many weekly housekeeping bills. Quality proteins, in particular beef and fish, are beyond the household budgets of many families. The failure of many schools to give basic education in cookery is also very much to blame. It would be so easy for all teenagers (both sexes) to have basic cookery skills taught to them whilst at school, to form a basis upon which to draw in their adult life. It is common knowledge that many school children do not know where milk, eggs and common vegetables (potatoes, tomatoes etc) have come from, or how they are grown.

I have already outlined my opposition to high-carbohydrate diets and criticised the ‘healthy eating’ maxim that advocates five portions of fruit and vegetables daily. Such disorders as syndrome X, diabetes, obesity and a huge range of health problems can result from such diets. I have emphasised the value of eating proteins at each meal and also animal fats as part of a recommended diet. There is only one advantage to a high-carbohydrate diet: it is inexpensive. A diet rich in cereal foods and root vegetables has been defined as ‘peasant food’. Protein foods have for centuries been the preferred food of the middle and upper classes. One only has to look at the favoured food of different countries and cultures to identify this class bias. Obvious examples of ‘people’s foods’ are rice in China, cereals and pulses in India, pasta in the Mediterranean area, wheat in Europe and America and potatoes in Ireland. Carbohydrates are cheap, filling, tasty and usually easy to prepare.

This has made the current official recommendation for the diet to consist of 50–70% carbohydrates all the easier for people to adopt. However, it is seen by many as a major cause of the obesity, diabetes and heart disease epidemics that afflict the so-called civilised nations. Perhaps CFS should be added to the above list; certainly the prevalence of chronic fatigue, with the often related symptom of depression, is increasing each year.

The treatment of many health problems requires nutritional intervention and advice. Problems that are directly food related include gastro-intestinal complaints, leaky gut, candidiasis and food allergies, but systemic general health problems may also benefit from this approach.

Food digestion

Having reviewed the relative value of fresh, locally produced food versus processed ‘junk’ food, the next topic must be the part digestion plays in the breakdown of our health.
I want to start by considering several, generally held misconceptions concerning our digestion:

1. It doesn’t matter what we eat, as rubbish is eliminated and all the nutrients are absorbed.

2. The typical symptoms of indigestion – such as stomach fullness and wind, diarrhoea and/or constipation, heartburn and nausea – are all transient symptoms resulting from hurried meals or stress and are not serious health disorders.

3. The symptoms of indigestion can usually be solved by ant-acids, Immodium, paracetamol and other self-prescribed medicines. Advice or treatment is rarely necessary.

These misconceptions may be reassuring, but they prevent us from seeing what the problems really are. Digestive disorders, as with many ailments, do not always present matching symptoms. Achlorydria (lack of stomach acid), reduced pancreatic enzyme status, leaky gut, and low short-chain fatty acid levels do not present predictable diagnosable symptoms. To put it simply, a lot can go wrong before you are aware of the problem. This can result in a situation where quite serious gut problems can develop over several years before real action is taken to accurately diagnose and effectively treat the condition. I have a patient who had been prescribed ant-acids for eight years, for an acid stomach, before a gastroscopy was requested and a stomach tumour diagnosed. This resulted in surgery to remove one third of his stomach, yet this life-saving emergency surgery was preceded only by occasional heartburn and nausea until a few days before the stomach operation, when he developed severe blood loss and black stools. Not surprisingly, he had no awareness of the potential seriousness of his condition.

The gastro-intestinal tract is vital for energy production for our entire metabolism. The efficiency of every body organ can be compromised by digestive disorders. Naturopathic medicine, or ‘functional medicine’ as it has been termed in America, has promoted many clinical approaches designed to treat gastrointestinal disorders.

A brief review of these diets and treatment methods will serve to emphasise the value of the drug-free systems that have been prescribed to normalise gut function. I do not endorse all of these regimes, but I do agree with the common theme of non-invasive therapies to treat indigestion, without recourse to drug-based symptom relief.

This blog is taken from Why Am I So Exhausted? by Martin Budd.

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CFS/ME: Are you sleeping too much?

CFS/ME: Are you sleeping too much

Difficulty with sleep is common for people with CFS/ME. Some people find they are sleeping too much, while others find they are not sleeping enough. If you experience problems with sleep there are several things you can do to help yourself.

There is no such thing as an ideal amount of sleep. For example, some people need 10 hours, while others only need five. An average night’s sleep is around eight hours. When the amount of sleep someone is getting is causing an increase in fatigue that is when it becomes a problem.

When people first have CFS/ME they often over sleep. People who have had CFS/ME for a longer period of time often go from over sleeping to not being able to sleep enough, despite high fatigue levels. Continue reading CFS/ME: Are you sleeping too much?

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Books on Prescription: Reading Well for Long Term Conditions

We are delighted to announce that Fighting Fatigue and Irritable Bowel Syndrome: Navigating Your Way to Recovery have been placed on the Reading Well scheme for long term conditions.

If the pen is mightier than the sword, perhaps the book is mightier than the drug.

These stirring words from Professor Martin Marshall at the 2017 Reading Well launch really summed up the miraculous effect that books have on us.

Bibliotherapy –  the use of books and reading to facilitate management of and recovery from illness – is not a new concept, but it has found increased recognition in recent years thanks in part to the Reading Well scheme. Continue reading Books on Prescription: Reading Well for Long Term Conditions

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CFS/ME – Vicious circles and multitasking

As co-admin of Dr Myhill’s Facebook groups, I often see members asking what the single most important intervention in a person’s recovery from CFS/ME has been. I totally understand the reasoning behind this question – having limited funds where should attention be directed first to achieve the best results? Where does one find the most bang for one’s buck!

Dr Myhill instinctively takes this approach too, preferring her patients to do the ‘easy’ cheaper things first because these interventions are often enough on their own to elicit recovery. So, correcting sleep, doing the right diet and taking nutritional supplements are right at the top of the list. This is laid out in her CFS/ME checklist.

However, for some this is not enough and it is then that we must face the complexity of our intricate biological system with its many feedback loops and synergistic effects.

I am a mathematician and so the assumption is that I like linear arguments progressing from one irrefutable logic step to another, and so on, until we arrive at the ‘answer’! In my case, nothing could be further from the truth. For example, when first introduced to James Watt’s centrifugal governor, I was fascinated. This governor is essentially a continuous feedback system that controls the rate of a steam engine so as to maintain a near-constant speed, irrespective of the load or fuel-supply conditions. The constant speed of the engine achieved in this way is the mechanical equivalent of a well-functioning biological system. I enjoyed learning about these feedback systems but never had a chance to study the many biological examples because aged 12, I chose Latin and Ancient Greek over Biology for my school options.

However, life, and more specifically CFS, has forced me to become more acquainted with these biological systems because I am one of those for whom the ‘easy’ cheaper things have not fully worked.

As laid out in much more detail in Dr Myhill’s upcoming and fully revised book, Diagnosing and Treating CFS/ME – It’s mitochondria, not hypochondria and in Sustainable Medicine, there are many vicious circles in CFS/ME and these make the recovery process so much harder.

For example, if mitochondria go slow then the heart, being a muscle and so dependent on good mitochondrial function, will also go slow. The heart delivers fuel and oxygen to all cells in the body and so, if fuel and oxygen delivery is impaired then this too further impairs mitochondrial function. This can be seen below:

cfs-myhill-mitonchondria-vicious-circle

As further illustration, magnesium is of central importance for mitochondria. Having low levels of magnesium inside cells and mitochondria is a symptom of CFS but also a cause of it. This is because 40 per cent of resting energy simply powers the ion pumps for sodium/ potassium (Na/K) and calcium/magnesium (Ca/Mg) across cell membranes. When energy supply is diminished, as in mitochondrial dysfunction, there is insufficient energy to fire these pumps, and so magnesium cannot be drawn into the cells for oxidative phosphorylation to work. If there is insufficient energy to drag magnesium into cells, then there is a further diminishing of energy delivery, because of the lack of magnesium, and hence we have another vicious circle.

But all is not lost! We have at least two things in our favour – we now understand these vicious circles, and so can ‘break’ them, and many of the nutritional interventions we use can ‘multi-task’.

So, considering the two examples above, we can ‘break’ those vicious circles and so restore mitochondrial function by using Dr Myhill’s standard mitochondrial package of supplements, and by supplementing with magnesium we can further support the ion pump:

  • Coenzyme Q10 as ubiquinol – 200 milligrams
  • Vitamin B3 as niacinamide – 500-1500 milligrams – slow release
  • Acetyl-L-carnitine – 1-2 grams
  • D-ribose – up to15 grams
  • Vitamin B12 – 5 milligrams sublingually or ideally B12 by injection
  • Magnesium – ½ ml 50% magnesium sulphate, ideally, or 300mg orally

So, what of this multi-tasking then? Many interventions multi-task. High-dose vitamin B12 may be used to improve mitochondrial function, for detoxing via the methylation cycle, as an antioxidant and for its anti-inflammatory properties by damping down the pro-inflammatory fire of the NO/ON/OO cycle. This makes correcting multiple co-existent problems that much ‘easier’!

And then we have a ‘lovely’ example which I came to learn through both my own experience and also very many questions on Dr Myhill’s Facebook groups, essentially asking the same thing:

Why is it that when I have a sudden energy dip, I also feel weepy and emotionally fragile, weepy beyond what I would expect to feel?

Well, here is one way of looking at it – ATP is not only the energy molecule but also a neurotransmitter – to be precise, a co-transmitter. Other neurotransmitters, such as serotonin, dopamine, GABA and acetylcholine, will not work unless they are accompanied by a molecule of ATP. So, if ATP levels fall precipitously low, then one feels dreadfully fatigued [ATP as the energy molecule] and simultaneously one feels very low emotionally [ATP as co-transmitter]. To mitigate this ‘double whammy’ effect, I carry a bottle of water with D-Ribose dissolved in it and this works as a great ‘rescue remedy’ for when I experience these sudden ATP dips.

So, I suppose what I am saying is that CFS/ME sufferers should try the ‘easy’ things first but that if these don’t work out for you, then don’t despair. We know the circles that must be broken and we have some great helpers, like Vitamin B12 and D-Ribose, which can multi-task and solve more than one problem at once! Never ever give up!

Craig Robinson first met Sarah in 2001, as a patient for the treatment of his CFS, and since then they have developed a professional working relationship, where he helps with the maintenance of www.drmyhill.co.uk, the moderating of Dr Myhill’s Facebook groups and other ad hoc projects, as well as with the editing and writing of her books.

A fully revised and expanded 2nd Edition of Dr Myhill’s book Diagnosis and Treatment of Chronic Fatigue Syndrome: it’s mitochondria, not hypochondria will be published in January 2017.

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Diagnosis and Treatment of Chronic Fatigue Syndrome at the BMA Medical Book Awards

We’re very proud to announce that Dr Sarah Myhill’s book Diagnosis and Treatment of Chronic Fatigue Syndrome was highly commended in the Popular Medicine category at the BMA Medical Book Awards 2015. The book has quickly become one of our best sellers and is helping Sarah’s groundbreaking chronic fatigue syndrome protocol reach thousands of people around the world who wouldn’t otherwise have the chance to learn the tests and treatment methods she’s worked so hard to develop. It was up against some pretty stiff competition in its category so it’s a real achievement to have been highly commended.

Dr Myhill (middle right) with her team at the BMA Medical Book Awards for her book on Chronic Fatigue Syndrome
Dr Myhill (centre right) with her team at the BMA Medical Book Awards

Sharing expert knowledge about areas of medicine and health that aren’t so well represented by the mainstream is our goal at Hammersmith Health Books, and Dr Myhill’s book is a perfect example. In it Dr Myhill explains the importance of mitochondria and their role in every aspect of our lives, showing how we fail if they fail. She shows how their activity can be measured and how her recently published research supports her programme for mitochondrial recovery spelt out here as the basis for recovery from CFS/ME.

Congratulations to Sarah and her team who helped produce the book and support the many hundreds of chronic fatigue syndrome patients who visit her clinic and countless more who seek her advice and help remotely.

Dr Myhill's book Diagnosis and Treatment of Chronic Fatigue Syndrome was highly commended at the BMA Book Awards 2015

If you’d like to learn more about Dr. Myhill’s work visit www.doctormyhill.co.uk or join the Facebook group to meet other CFS/ME patients and get inside info on the protocol.

Diagnosis and Treatment of Chronic Fatigue Syndrome is now on sale in paperback and ebook formats from £4.50

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Sustainable Medicine: the path to a patient-centred future

I have worked with Sarah Myhill for over 15 years, both as a Chronic Fatigue Syndrome (CFS) patient and also academically. As such, I have witnessed the crystallisation of the ideas that led to the concept and writing of Sustainable Medicine from both sides of the fence. These ideas were applied to me personally and I also saw them develop in my role as editor of Sarah’s writings, and also of her website – http://www.drmyhill.co.uk/wiki/Main_Page

Sustainable Medicine: swinging the pendulum back in favour of the patient

Sustainable Medicine follows a logical path, with the ultimate goal of empowering readers to take charge of their own health. This empowerment will not only help to heal diseases already present in readers, but also, and equally crucially, will lay down a route map for the healthy to remain healthy. It is for everyone.

Sustainable Medicine by Dr Sarah Myhill
Sustainable Medicine by Dr Sarah Myhill

The starting point of this journey was the realisation that 21st Century Medicine is not working for the benefit of the patient. So much of modern medicine is driven by vested financial interests that the patient is almost completely forgotten in this process. The patient, the one who knows their body, and the one who is suffering from the symptoms and diseases, is often ignored or, at best, side-lined or even patronised, in the diagnosis and treatment of their disease. Worse than this, modern medicine is not “sustainable”, either for society or the patient, because the use of powerful symptom suppressing drugs often escalates the disease process, rather than reversing it.

Sustainable Medicine has the simply stated objective of swinging the pendulum back in favour of the patient and away from those vested interests.

Sarah Myhill is an inquisitive person. As a patient, you notice this the very first time you speak with her or meet her. She is not like other doctors; there is a genuine desire to know you, and your life, and where you have worked and lived, and so on. In short, Sarah wants to know the ‘whole’ you; she is not a “Symptom List” doctor, by which I mean a physician who asks for your symptoms and then “replies” with a prescription pad. Put crudely, by knowing you better, Sarah can treat you better, although this underplays her most endearing quality; she likes her patients and treats them as equals.

This innate inquisitiveness naturally led Sarah always to ask the question ‘why?’ and in the practice of medicine this question is translated into a quest to find the root causes of disease and symptoms.

This is where Sarah’s 30 years of clinical experience made its mark known and also where the “logical path” was laid down.

First, Sustainable Medicine discusses symptoms, not as something to be immediately squashed with powerful prescription drugs, but rather as signposts as to what may be going wrong. Symptoms are the early warning system of the body that all is not right.

The next step along this logical path is an exposition of what mechanisms may be causing these symptoms and how one can identify which particular mechanisms are at play in this patient. The identification of these mechanisms is achieved by tests and clinical signs and symptoms.

At this point along the logical path, the reader will have identified their symptoms and also isolated the mechanisms causing those symptoms. The next step is to lay out the “tools of the trade”, that is the interventions, that can be put in place to treat those mechanisms as identified. These interventions are “sustainable” in that they reverse, not escalate, disease processes.

The logical path is now complete:

Symptoms => Mechanisms of disease => Sustainable Treatments (“tools of the trade”) to treat and reverse these Mechanisms

By way of example, Sustainable Medicine then looks at very many individual diseases, identifies the underlying mechanisms of these diseases and then applies the “tools of the trade” required to reverse these disease processes. To further illustrate this logical path, Sarah concludes with some case studies of her own patients, ranging from diseases such as chronic lymphatic leukaemia to inflammatory arthritis to CFS.

Sustainable Medicine was launched at a Biocare Advanced Education Day on 13 July 2015, where Sarah detailed her views on the mechanisms and sustainable treatments as applied to CFS, as well as discussing the critical roles played by inflammation and immune system issues in many modern diseases.

Craig Robinson, Editor, Sustainable Medicine.

 

Read the first chapter of Sustainable Medicine for free here or order your copy. Want to tell us what you think of the book? Leave a review on Amazon, and if you have any questions you can contact Craig and other followers of Dr Myhill’s protocol for CFS in the Facebook group.

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Chronic Fatigue Syndrome seminar

Dr Sarah Myhill will launch her new book Sustainable Medicine on Monday 13 July 2015. The launch will coincide with a seminar on Chronic Fatigue Syndrome as part of Biocare’s Summer 2015 Advanced Education programme. The seminar will explore the causes of CFS, assessment techniques, and a ‘sustainable medicine’ approach to treatment. Read the event flyer below for more info.

Chronic Fatigue Syndrome: It’s mitochondria, not hypochondria

Dr Myhill’s new book Sustainable Medicine aims to empower readers to heal themselves through addressing the underlying reasons for ill health. It is based on the premise that contemporary Western medicine is failing to address the root causes of disease processes. She spells out her programme for maximising health and keeping lifestyle illnesses at bay without recourse to pharmaceuticals.

Her previous book, Diagnosis and Treatment of Chronic Fatigue Syndrome is one of our most popular titles and tells sufferers that ‘CFS is all in our cells, not in our minds…it’s mitochondria, not hypochondria!’ You can read the opening chapter of each book for free using Book2Look:

Read the first chapter of Sustainable Medicine for free

Read the first chapter of Diagnosis and Treatment of Chronic Fatigue Syndrome for free

Chronic Fatigue Syndrome seminar Dr Sarah Myhill
Dr Sarah Myhill Sustainable Medicine book launch at Diagnosis and Treatment of Chronic Fatigue Syndrome seminar with BioCare, at Cavendish Conference Centre in London.

About Dr Myhill

Dr Sarah Myhill qualified in medicine (with Honours) from Middlesex Hospital Medical School in 1981 and has since focused tirelessly on identifying and treating the underlying causes of health problems, especially the ‘diseases of civilisation’ with which we are beset in the West. She has worked in NHS and private practice and for 17 years was the Hon Secretary of the British Society for Ecological Medicine (renamed from the British Society for Allergy, Environmental and Nutritional Medicine), a medical society interested in looking at causes of disease and treating through diet, vitamins and minerals and through avoiding toxic stress. She helps to run and lectures at the Society’s training courses and also lectures regularly on organophosphate poisoning, the problems of silicone, and chronic fatigue syndrome. She has made many appearances on TV and radio. Visit her website at www.drmyhill.co.uk.

For more information and books on CFS and other chronic health problems, including thyroid problems, fibromyalgia, ME and Pernicious Anaemia visit Books on Chronic Fatigue Syndrome.