Recovering from Chronic Fatigue Syndrome:
A Guide to Self-Empowerment

By William Collinge, Ph.D.

Table of Contents 

 Chapter 6. Changing Your Lifestyle
to Promote Recovery

      "I want to get rid of this thing as fast as I can, because I've got so much work to do." -- Joanne
     All the experts agree, especially in the absence of a medical cure, that lifestyle change is the necessary foundation for recovery from CFS. According to Paul Cheney, M.D., this is "easily the most important and often the least emphasized" part of treatment. And the body itself, if it too could be considered an expert on what it needs, seems to be saying the same thing. The illness demands dramatic and sometimes painful decisions to change one's way of life. In this chapter we will take a thorough look at all the areas of lifestyle that can contribute to recovery from CFS. The chapters that follow are intended to help you follow through with healthful changes.
     This discussion should not be construed as suggesting that CFS is a disease of lifestyle. Far from it, for we have already discussed the multicausal perspective. However, just as any disease process is multicausal, so too is recovery. The way various factors combine to allow disease does not necessarily dictate what factors will promote recovery. In other words, even if genetic vulnerability played a larger than usual role in one person's developing CFS, this does not mean that lifestyle factors cannot be the key in swinging the body's balance back in the direction of health. 
     How can changing your lifestyle influence the course of illness? Experience with what were formerly thought of as irreversible illnesses such as metastatic cancers, AIDS, and heart disease has proven that profound lifestyle changes can cause dramatic changes in the course of illness. In some cases people have been able to completely break the textbook rules of disease and arrive at previously unheard of recoveries. An example of this is Niro, a documented case of AIDS who recovered and converted back to HIV negative. Another is Larry who recovered from metastatic pancreatic cancer, even though his doctors agreed that what little chemotherapy he was taking could not possibly have made any difference.
     In the medical world, these are usually labelled "spontaneous recovery," implying that since the recovery could not be attributed to medical treatment, it must have happened all by itself as a random fluke of nature. It certainly could not have anything to do with the person with the illness!
     Dr. Kenneth Pelletier of the University of California-San Francisco Medical School studied the common denominators in people sharing the experience of such unexplained recovery. He found the following qualities to be often present:
  • profound intrapsychic change through meditation, prayer, or other spiritual practice; 
  • profound interpersonal changes as a result, placing relations with other people on a more solid footing; 
  • alterations in diet, no longer taking food for granted, but choosing food carefully for optimum nutrition; 
  • a deep sense of the spiritual as well as material aspects of life; and 
  • a feeling that recovery is not a gift or spontaneous remission, but rather a long, hard struggle to be won for oneself
      What can people with CFS learn from this? Clearly these are all factors that involve lifestyle change. Research has shown that these changes have their beneficial effects by altering the chemical and emotional environment within the body, thereby affecting the immune system. A lifestyle which has such beneficial effects may be called "salutogenic," in which "saluto" means health and "genic" means to generate or create. This is the opposite, of "pathogenic," or generating pathology.
     Tina's story offers us an example of what it means to make the transition to a salutogenic lifestyle:
     "I quit my job, got the stress out of my life, got into therapy and started becoming aware of myself and how I live. Fortunately, I could take a job as a consultant, and only had to work part time to make the same salary I made before. I'm not sure I could ever work full time again, unless it was something I loved so much it didn't matter. I now actually enjoy the company I work for. I no longer put myself in a position of getting so stressed out that I am likely to relapse."
     Let us now consider several aspects of a salutogenic lifestyle I have found important for people living with CFS.

OPTIMISM AND BELIEF IN RECOVERY
     Do you believe recovery is possible for you? Do you believe you can have some impact on it? And can you picture yourself recovered? Belief in recovery is square one. Whether it is recovering your pre-illness level of functioning, which many have done; recovering the quality of your life; or recovering a sense of balance and harmony even within limitations, there needs to be some positive expectancy that your life can be better than it is now. 
      There is mounting evidence that optimism has an effect on recovery from chronic illness. For example, studies by Michael Scheier, Ph.D. and his colleagues at Carnegie Mellon University in Pittsburgh have found faster recovery in optimistic patients with cancer and heart disease than in those who are pessimistic, findings that are likely to apply to people with other illnesses as well. Optimistic patients recovered faster from surgery, had fewer complications, and had higher quality of life six months later. The researchers found that when patients are optimistic, they formulate plans for action, and stay with them through pain and adversity.
      How can you strengthen your optimistic attitude? Give yourself a quiet time to form an image of what recovery truly means to you. Considering what you have learned about CFS and the experiences of former CFS sufferers, make a realistic appraisal of the severity of your illness, your strengths and inner resources, and then decide for yourself where you are headed with your recovery program. You may wish to have stepping stones along the way, small goals within reasonably easy reach, to encourage you along. But the belief must be there that life can be better, and that recovery of something you value is possible for you.
      Without belief in recovery, in whatever form, there will be no incentive to follow through with the lifestyle changes needed. This inner image of your recovery must be in place.

ACCEPTING YOUR LIMITATIONS
      One of the most difficult yet important challenges in CFS, as with any chronic illness, is accepting limitations. The fact is you are not the same person you were before, and we have already mentioned the importance of acknowledging this. Consider Sarah's experience:
      "I haven't pushed my limits. Before I got CFS, I was running 12 to 15 miles every day, training for half marathons and marathons. Even though I'm over it, I don't do that any more. I don't run more than 6 miles at any given time now for this specific reason: I'm no longer interested in testing my limits or competing. I've done it all, it's behind me. I learned that the hard way. That's an important point to put across because there are so many CFS patients who were athletic, who did push their limits, who are compulsive, high energy, goal-directed people. They have to learn a new way."
      In some cases, it may even be necessary step out of your familiar roles at home, as described by Debbie:
      "I have an understanding with my family that when it gets to be too much at home, I can just leave. I might stay at a friend's house or at a motel. I can even walk out on things in the middle. If I'm cooking something and I need to leave, I just leave." 
      Often the acceptance of limitations means a shift of identity away from your outward accomplishments, your "doing," as the indication of who you are and whether you are fully alive. This cultural emphasis on "doing" is deeply ingrained in us. It comes into direct conflict with the body's messages in CFS, that rest, or "simply being," is needed for healing.
      When the desires of the mind and the abilities of the body have parted company, our tendency is to resist, to argue with the body. We may take the attitude that limitations are a challenge or test, or, worse yet, a sign of defeat. Yet, to reiterate what has been said earlier, the more we attempt to push through limitations, the more we are likely to cause an exacerbation of symptoms or trigger relapse.
      For many people this means dramatic reduction in working  hours. In more extreme cases, it means stopping work altogether. To the degree that your work is your source of identity and meaning in life, this can be painful. And of course the financial hardships this may bring may be even more painful. Yet, the fact remains that in order for the body to have the optimal conditions for healing, rest is needed. Not only for the body, but for the mind as well.
      There are several stresses at play here. One is the stress of the illness itself. Another is the stress of work, which may not necessarily be thought of as a negative stress, but still, to the degree that it involves challenge and any demands at all, the body may experience it as stress. And third is the stress created by your reaction to the limitations being forced upon you. To be able to take a philosophical attitude or somehow accept and flow with these limitations will go a long way toward supporting your healing process.
      This of course is where the fifty percent solution takes on even greater significance. If reducing your work is forcing a reduction in your income, it may mean making major changes in your living arrangements. In a worst case scenario, this may mean moving to less costly accommodations or even living temporarily with relatives or friends. 
      Some would perceive this as a demoralizing situation, yet it may be the only viable alternative to struggling and stressing yourself to work more than you are able and interfering with your healing process. Again, your reactions to the limitations imposed on you can help you or can themselves be an added source of debilitating stress. Accepting such limitations gracefully can be difficult, but it can be done.

THE VALUE OF SUPPORTIVE RELATIONSHIPS
      One of the fascinating areas of research in health psychology in recent years has been the effect of relationships on health. It is now believed that supportive relationships help "buffer" the person from the effects of stress. Some researchers even call social support a form of inoculation against illness.
      What is a supportive relationship? This would probably be answered differently by different people. But there are some basic attributes on which most would agree. One of these is open communication. This means honest sharing of feelings, wants, needs, and caring. It also means that the parties feel free to say "no" when they wish, without feeling guilty. In this environment of mutual respect, there is freedom to be oneself without fear of judgement. There is a feeling of acceptance, and an encouragement of self-acceptance on both sides. 
      On the other hand, relationships in which there is an undercurrent of tension, fear, or inability to freely be oneself may be described as toxic relationships. They can literally have a toxic effect on the body, in terms of the chemistry of stress that they stimulate.
      People with CFS benefit from supportive relationships in several ways. Mood and morale are likely to be better. Follow through with lifestyle changes and medical treatment are likely to be better because of the encouragement and support of others to do so. 
      Coping with stress may be more effective because of guidance or encouragement from others. Feelings of having purpose or meaning in life may be stronger, and contribute to greater will to live and hope for recovery. All these factors can translate into better immune functioning and resistance against illness.
      The people closest to you can play an important role in your healing. They can contribute the healing, supportive environment which you need. They can give you love, encouragement, and help in carrying out the various lifestyle changes you need to make. They can help you with practical matters such as getting to medical treatment, shopping, or completing tasks around your home. They can help you follow the fifty percent solution, accept your limitations and encourage you as you walk the path of self-empowerment.
      However, none of these forms of support will be forthcoming unless you communicate your needs. The key to social support, as in all human relationships, is communication. Those around you are going to need your help understanding what CFS is, as well as what forms of support you need.
      Some people with CFS are lucky enough to have a supportive network already in place. However, others are not so lucky and must orchestrate the support they need. If this is the case for you, one of the best ways to do this is for you or a loved one to call a gathering to communicate about your situation. Whether it is a pot luck dinner, a family meeting or a larger gathering with friends or co-workers, this can be a very effective way of organizing support. 
     Symbolically, such a gathering sends a powerful statement all those involved: we are part of a larger whole, a tribe, we are connected. Even though such an idea may sound bold, if you give it a try you are most likely in for a pleasant surprise. This is actually a tradition thousands of years old in simpler societies.
      The experience of giving to another in need brings its own rewards. By accepting support from others, you give them an opportunity to feel valued and included in your life. This is a form of intimacy that we all need in an age where separateness and independence are over-emphasized. However, you have to be open to asking for and receiving the support you need. Many people with CFS have been profoundly moved by the unexpected degree of care and support they have received.
      Families face special difficulties as a result of CFS, since illness in one family member affects the entire family system. One very helpful response is the family meeting in which all members are able to express their feelings and needs. Such a meeting can be set up so that everyone has a turn in talking about what is important for them, and can ask questions. Many families have a regular evening each week specifically devoted to this kind of communication. 
      Very often, marriage and family counseling sessions can help enormously in maintaining lines of communication. Whether such counseling is with a psychologist, clinical social worker, counselor, minister, or a member of your medical team, communication will be the key. Communication itself has a healing effect on relationships that are hurting. Many CFS patients have reported their families have grown closer and have benefitted from facing the adversity of CFS together.

SUPPORTING YOURSELF
      Do you consider yourself a person with high self-esteem? Can you find feelings of love, compassion and unconditional acceptance toward yourself? If so, then you will have an easier time following through with healthful lifestyle changes, and in general coping with CFS. But if there is an inner climate of self-criticism, self-judgement, or guilt, then the kind of inner support you need is not likely to be present.
      Many of us have lived lifestyles in which low self-esteem, high self-criticism, and a never-ending quest for the approval of others have dominated our behavior. If this is the case for you, CFS can serve to force you to re-evaluate your relationship with yourself, and make a shift toward valuing or esteeming yourself more highly.
      One way this positive shift can be expressed is in how you spend your time. Do you surrender your life to the television? Do you occupy your time reading romance novels, or perhaps worse, CFS research?
      Quality alone time is time in which you are fully present with yourself rather than being absorbed by something outside yourself. This kind of presence is not only a natural antidote to the effects of stress, it will help you remember who you are, to remain in touch with your needs as well as your higher goals and purposes, and remain intimately aware of the ebbing and flowing of your body's cycles.
      Rarely in our society are we encouraged to spend quality time alone. By quality time I mean time spent in introspection or self-care, really being present with ourselves. This can be time spent in meditation, prayer, journal writing, or contemplating nature. Perhaps you choose to pursue a self-healing discipline, such as deep breathing, deep relaxation, guided imagery, gentle yoga, or a number of other practices. Or it may simply mean sitting quietly doing nothing, watching the grass grow, and letting both mind and body rest. 

PLEASURE AND ENJOYMENT
      Even if it means settling for pleasures much simpler than those you became accustomed to before becoming ill, find ways to include pleasure and enjoyment in your daily life. Whether it comes in the form of physical touch or contact with another, watering flowers, cultivating your taste in music, or becoming a connoisseur of bath oils, you can develop your own repertoire of simple pleasures. 
      Keeping pleasure in your life sends a powerful message to your subconscious--one which supports your self-esteem and feelings of worthiness, and helps maintain your morale. But this contribution to your inner harmony and balance is only half the benefit. Pleasure also causes beneficial changes in your blood chemistry, which help your body's healing responses. 
      The health benefits of pleasure have been studied by David Sobel, M.D., M.P.H. Dr. Sobel is Regional Director of Patient Education and Health Promotion for Kaiser Permanente Medical Care Program of Northern California. He points out that our affinity for pleasure played a major role in our evolution as a species. The experience of genuine pleasure alters our biochemistry in a way that promotes our host resistance. Hence there are real links between health-promoting acts, positive feelings, and health. 
      The simple pleasures listed above can all have a calming and relaxing effect on the body, soothing body and soul from the effects of stress. However, as Dr. Sobel emphasizes, pleasure is not limited to experiences of the senses. Acts of generosity, altruism, and gratitude also are pleasurable and bring about beneficial responses in your body. He concludes that these acts represent not only moral virtues; they may be essential contributors to a longer, healthier life.
      However ill you are, you can probably find a way to experience selfless giving and reap the health benefits of altruism. Simple acts of kindness or consideration can be done with people around you, as well as with pets or plants. You will be doing your body a wonderful favor.

SPIRITUALITY
      As the experience of illness draws your attention more and more within yourself, you may find yourself increasingly interested in the spiritual aspects of your life. And indeed, there are questions which science and medicine cannot answer which are more the domain of the spiritual. 
      Why do I have this illness? Is there any meaning in it? For many, the crisis of CFS has provoked profound spiritual searching and introspection. This in turn has borne fruit in the form of a greater sense that we are more than either our bodies or our minds, and that there are sources of support and energy within that can help us get through the hardest times. Whether you explore your spiritual life through a form of organized religion, on your own, or with friends or loved ones, there is a good chance this will contribute to the quality of your life. 
      In addition, there is now evidence that physical health is influenced in a positive way by religious faith. David Larson, M.D., a psychiatrist with the National Institute of Mental Health, recently reported a twenty year study in which people's belief in the importance of religion was linked to healthier blood pressure levels. In another study, Larson found that religious older women recovered more quickly from broken hips and with less depression that their non-religious counterparts. 
      A related line of research connects religious faith and mental health. Here too there is mounting evidence of benefit. In a review of 200 studies, a team of Maryland researchers concluded that religious faith eases depression and is linked to better recovery from mental illness. It is not difficult to see that people with CFS will benefit from anything that eases or buffers the emotional stress of the illness. Indeed, several patients have told me that their faith has strengthened through this ordeal. According to Mike, "I've been pretty religious all my life, but through CFS I think my prayers had more depth and intensity, and more thought went into them than before. Now, that hasn't changed."
      This illness may provoke you to reconsider your life goals and purposes. What is your purpose for getting well? Is it simply to resume being a productive worker? Is it to resume the pleasures you are currently being denied? Or are you becoming aware of higher goals and more important dimensions of your life that give it real meaning? Are you living according to your deeper values? Many people with CFS find that the purpose or meaning of their life shifts, that their values change, and that the changes brought by illness have enriched their lives.

BASIC NUTRITION
      Understanding the role of nutrition in health is not one of modern medicine's strengths. Our fascination with pharmaceuticals, microbes, and high tech medicine has diverted our attention away from simpler, more fundamental factors that influence our health on a moment to moment basis. Yet food and nutrition directly and continuously influence the body's resistance to illness.
      There are common substances in the normal western diet that are now known to weaken immunity, and should be especially avoided by people with immune-related illnesses. These include refined sugar, caffeine, alcohol, and many kinds of food additives. Other substances are known to be the raw materials of the immune system, actually used in building white cells. Such substances include many vitamins and minerals, especially vitamin C and zinc.
      It is easy to become overwhelmed by the mountain of information and claims about various nutrients and immunity. Rather than having to be a research scientist to eat intelligently, there are some broad guidelines which should help you arrive at a reasonably healthy nutritional program.

A Whole Foods Diet
      Our bodies evolved throughout history on a diet very different from that which we eat today. We would spend a fortune in health food stores to eat the way our ancestors did. They lived on what we would call a "special diet," one of natural, organic, whole, unprocessed foods. Their fruits and vegetables were only fresh and in season, in their natural state, free of chemical residues. 
     They ate meat, eggs and poultry that were uncompromised by growth stimulants, antibiotics, or preservatives. They ate fresh fish from unpolluted waterways and oceans. They drank water untainted by agricultural or industrial chemicals. Their immune systems were not burdened with the toxic by-products of modern chemistry.
      The concept of a whole foods diet is central in a salutogenic lifestyle. This means unprocessed foods, whole grains, untainted with preservatives or additives, and ideally, if available, organically grown fruits and vegetables. Unchemicalized poultry, eggs and meat can be purchased in many areas (without growth hormones or antibiotics). Fresh water fish should be avoided because of pollution by industrial or agricultural chemicals. Likewise, shellfish tend to collect toxins and should also be avoided. A good rule of thumb is to read the ingredients on packaged foods. The fewer ingredients, the better. And if there is anything you cannot easily pronounce, don't buy it!

Drinking Water
      Pure drinking water is increasingly hard to come by. Yet the body is mostly water, and uses water to dissolve toxins and cleanse its tissues. As we have already seen, the activity of the immune system in CFS produces many toxic by-products which must be dissolved and released from the body. The more pure water is, the more "aggressive" or effective it is in dissolving impurities and toxins. Hence, drinking purified water is an important contribution to a healing environment in the body.
      There are several kinds of water purifiers available, and using any one of them is probably an improvement over drinking tap water. Two major types are carbon filters and reverse osmosis. While reverse osmosis is slower and more expensive, it is generally more effective in filtering out impurities. The ultimate best have both carbon filtration and a reverse osmosis membrane working together, but again, anything is likely to be better than nothing. Most filters are accompanied by lab test results which, if you feel you can trust them, give a way of comparing the effectiveness of filters.
      An alternative is to purchase bottled water. The drawback to this is that you may not know the quality of the water, or what method of purification was used. It is possible that so-called "natural spring water" can have high levels of impurities even though it is packaged beautifully. And, of course, not all impurities are man-made. Water coming from natural sources can be contaminated with toxic levels of substances occurring naturally in the environment. Thus, the safest course is usually to have your own purification process. 

NUTRITIONAL SUPPLEMENTATION
      "Hypovitaminosis" is thought by some physicians to be an important feature of CFS. This refers to vitamin deficiency at the cellular level, which may not be reflected in conventional tests of vitamin levels in the blood. According to Paul Cheney, M.D., the elevated cytokine levels in CFS can block the vitamin utilization pathways in immune cells, producing a "hypovitaminosis syndrome" which further impairs immune functioning. For this reason Dr. Cheney recommends multivitamin therapy for CFS patients.
      This gives us even more reason to consider supplementation as an important part of your recovery plan. Your immune system is already working overtime and depleting its resources by being in a state of hyper-arousal. In order for it to heal it needs the energy and raw materials that can only be provided through nutrients.
      One physician who integrates a nutritional approach into treatment of CFS is Murray Susser, M.D., who states: "The body is designed for aboriginal eating. So if you're not eating beetles and worms and grubs and the like, then you're not going to be healthy no matter how smart you are about nutrition--unless you find the right supplements to make up for that lack."
      According to Dr. Susser, "functional" vitamin tests can be used to determine to what degree your cells are actually using the vitamins you take in. Such tests are not yet widely available in mainstream medicine, but, along with therapeutic trials, have revealed a great deal of hypovitaminosis in CFS patients. 
      An abundance of research has shown that certain vitamins are important in healthy immune functioning. These include vitamins A (retinol), B1 (thiamin), B2 (riboflavin), B6 (pyridoxine), B12 (cyanocobalamin), folic acid, pantothenic acid, C (ascorbic acid), D, and E. Minerals affecting immunity include copper, iron, magnesium, manganese, selenium, and zinc. There are also essential amino acids and essential fatty acids that play a role in immunity. An excellent summary of research on nutrition and immunity is offered in Nutritional Influences on Illness, by Melvyn Werbach, M.D. (Third Line Press, Tarzana, CA, 1987). This kind of information is widely available now, and there are many other books that could be recommended in popular book stores.

What Should I Take, and How Much?
      Most people are best advised to get individualized help in answering this question. Vitamin and mineral supplementation should be guided by a knowledgeable health professional. Proper amounts must be taken, because both deficiencies and over-supplementation of some nutrients can adversely affect immunity. Also, some nutrients need to be taken in combination with others (zinc with copper, for example). Do not rely on the RDA (recommended dietary allowances) for guidance. These were never intended as therapeutic guidelines, but rather were designed for minimal nutritional requirements of mass populations during World War II. It is beyond the scope of this book to give specific recommendations, and it is essential to work closely with a qualified nutritionist or physician in planning your supplementation. 

The Absorption Issue
      One important issue in supplementation is that of absorption. Supplements taken by mouth are of course not as well absorbed as those taken by injection. In fact, many CFS patients have benefitted from vitamin B12 injections. However, since oral administration is most common, it is important to know that certain forms are better than others. 
      Tablets which have been pressed together are less well absorbed than encapsulated crystallized vitamins. The hard tablets are often heated to a temperature far above where the vitamins can maintain their effectiveness. Vitamins B and C, for example, lose their potency at 180 degrees, but in tabulation machines often reach temperatures of 400 degrees.

Maintaining Colon Health
      Finally, supplementation can be a means of maintaining colon health. As discussed earlier, yeast overgrowth in the colon and in the rest of the body is a common problem in people with CFS which contributes to immune dysfunction, allergies, food sensitivities, and immune over-activation. Yeast problems often develop when antibiotic therapy kills the healthful bacteria that populate the colon. Further, the standard American diet (the "S.A.D.") promotes yeast overgrowth with its refined sugar and highly processed foods.
      As Carol Jessop, M.D., states: "I think that there is a lot of strong information to suggest that (CFS) patients have yeast overgrowth or parasitic intestinal overgrowth. In my clinical experience, when I document yeast and prescribe treatment, the patient's immune system seems somewhat less activated, and therefore, may be better able to deal with the agent or agents that are causing this syndrome... I think that this is one of the reasons my patients improve over a period of time."
 The first line of defense against yeast overgrowth is a diet high in complex carbohydrates (such as whole foods, whole grains), and low in simple carbohydrates (such as sugar, white flour, refined products). There are many good books available on anti-yeast diets and recipes. Essentially, a whole-foods diet with minimal refined products or simple sugars will help prevent yeast overgrowth.
      Supplementation with acidophilus, especially during and after any antibiotic therapy, will help restore a balance of healthful bacteria in the colon. Unless the form of acidophilus is of a type which is unaffected by stomach acid, it needs to be taken on an empty stomach (usually first thing in the morning) so it is not destroyed on its way to the colon. 
      There are also supplements such as odorless garlic tablets, Mycocidin, and ParaMicrocidin which help fight yeast overgrowth. Holistically-oriented physicians are usually well-informed about the issues of yeast treatment.
      Yeast overgrowth is best diagnosed by purged stool testing and blood testing, and may need to be treated with antifungal drugs. According to Dr. Jessop, the great majority of patients with CFIDS are not tested using purged stool samples and are not correctly evaluated for this condition. There are effective antifungals available now, and as Jessop reports, such treatment gets into the nervous system and results in improvement in the symptoms of cognitive dysfunction affecting many people with CFS.

CHANGING YOUR PHYSICAL ENVIRONMENT
      Changing the physical environment around you can have a surprising effect on your moods and inner states. Plants or flowers, cleanliness and neatness, clean windows, repositioning furniture, and lighting are all subtle changes that can create a more emotionally comfortable environment. When you make such changes, the mere action of doing so makes a statement about taking charge and valuing yourself.
      Beyond the aesthetics, however, is an even more important issue of avoiding toxic materials in your environment. In Chapter 5 we discussed how the environment is involved in sensitivities and sensory dysfunction in CFS. To reiterate, cleaning materials in particular are offenders in terms of exposing you to immunosuppressing toxins. Given your state of vulnerability, it is best to use only natural and nontoxic cleaning materials.
      Other possible offenders include the glue in carpeting. Especially avoid new carpeting unless it is clearly marked as natural and nontoxic. Also problematic are toxins and fumes escaping from paint and new building materials, such as the glue and formaldehyde in plywood. In fact, in many cases of CFS, encounters with toxic substances appear to have played a significant role. Make sure those around you are also aware of materials which are harmful for you.
      Very often creating the environment you need requires standing up for your needs, as Marge tells us: "My contractor installed this fiberboard in the attic that released terrible glue fumes. I just decided I wouldn't accept it, and I didn't have to understand the chemistry or justify it in order to tell him to remove it. At first I did a real number on myself about `inconveniencing' him, but I decided, after all, it was my house. So I asked him to return it and just use wood."

      Is CFS a disease of lifestyle? No. Can lifestyle change  provide the major impetus to recovery? Absolutely. As we have seen, there is a great deal you can do to create a lifestyle that will support you. I have suggested a lot of changes here. However, there is no need to feel overwhelmed and think that you have to do everything according to this or any other book. Beware of any voices in the head saying you have to `do it right'! And, fortunately, with the growing recognition of CFS in the health community, you do not have to do it alone. In the next chapter we will explore the variety of psychosocial support services are available to help you make the changes you wish, and make them last.

EXERCISE 1: ASSESSING YOUR LIFESTYLE
      The exercise below is offered as a review and summary of major points to consider in evaluating your own lifestyle. All of the items listed affect your ability to resist illness. Take plenty of time to consider each answer, and go deeper than your first impressions. 

Instructions: Place one of the following symbols beside each item, signifying how well you feel you are doing with that item:
  + means you are doing well with this
  o means you are doing "so-so" and could improve
  - means you definitely need to improve with this 
1.  Nutrition:
    A. I drink purified water.
    B. I drink enough purified water.
    C. I eat breakfast.
    D. I eat on a regular schedule.
    E. I am careful to avoid processed foods.
    F. I eat fresh fruits and vegetables.
    G. I take appropriate supplementation.
    H. I avoid refined sugar.
    I. I minimize red meat intake.
    J. I avoid alcohol.
    K. I avoid caffeine.
    L. I read the labels on food packages.
    M. I avoid foods with chemicals I can't pronounce.

2.  Habits:
    A. I avoid smoking or breathing smoke.
    B. I watch minimal television.

3.  Environment:
    A. I keep my environment free of toxic chemicals and fumes.
    B. I keep my environment relatively quiet and peaceful.
    C. I keep my environment beautiful and uplifting.

4.  Relationships:
    A. I communicate my feelings clearly.
    B. I communicate my wants and needs clearly.
    C. I say "no" without feeling guilty.
    D. I am free from unresolved, festering conflicts.
    E. I am free from preoccupation with old hurts.
    F. I avoid "toxic relationships."
    G. I have relationships which nourish me.

5.  Emotional expression:
    A. I allow and express sadness.
    B. I cry freely.
    C. I allow and express fear.
    D. I allow and express anger.
    E. I allow and express love.
    F. I allow and express joy.
    G. I laugh freely.

6.  Self-esteem:
    A. I am free of guilt and self-judgement.
    B. I forgive myself for past mistakes.
    C. I love and accept myself.

7.  Alone time:
    A. I spend some quality time alone each day.
    B. I let my mind rest.
    C. I relax.
    D. I spend time in introspection.

8.  Activity:
    A. I get mild, comfortable exercise when I feel able.
    B. My work activity is free of anxiety and compulsiveness.
    C. My home-making activity is free of anxiety and compulsiveness.
    D. I allow myself to rest when I need to.

9.  Pleasure and enjoyment:
    A. I get some genuine pleasure or enjoyment each day.
    B. I initiate contact with friends I enjoy.

10. Physical touch and contact with others:
    A. I have physical contact with others.
    B. I give and receive affection.
    C. I accept affection gracefully without having to talk about it or having to give something back right away.

11. The spiritual dimension of life:
    A. I have a spiritual or religious understanding for my life which assists me to feel peaceful, hopeful, and at ease with my life.
    B. I have personal goals which make my life worthwhile.
    C. I have a deep, valuable purpose for being well.
    D. I truly believe in my purpose for being well.
    E. I am living life according to my deeper values.

12. Self-Help:
    A. I actively seek information about my health on my own.
    B. I ask my doctor questions and keep asking until I am
 satisfied. 
    C. I practice some form of self-help activity each day.

EXERCISE 2: IMAGINING A HEALTHY LIFESTYLE
      Develop an image of what would be the optimal lifestyle to promote your healing. Include all the areas discussed in this chapter and anything else you feel would be important. Especially include seeing yourself doing what would be most fulfililing and inspiring to you.
      It may be helpful to write down a description in first person, present tense, of how you are living in this healthy lifestyle. Let this image become something you contemplate regularly, and gradually it will begin to influence your lifestyle choices day be day.


Audio CD Program Available
Recovering from CFS:
The Home Self-Empowerment Program

For information about Dr. Collinge's four-CD audio program of inspirational talks and guided self-healing exercises that accompany this book, click here.