Dr. Sarah Myhill: Roadmap for Dealing with Problems of CFS

Dr. Sarah Myhill is a well-known UK fatigue specialist who has discovered that following certain fundamental rules may offer better health to those suffering from ME/CFS and other illnesses as a result of the ME/CFS.  Dr. Myhill says about her checklist for treating the comorbidities of ME/CFS:

….I used to do things one at a time in order to see what does and does not work. I now do things the other way round – treat everything I think to be important, get the patient better, then relax the regimen to end up with a balance between the patient’s wellness and the toughness of the regimen.

The following is the program of treatment I go through with every patient. If I try to cut corners, I often end up missing important problems. The patient who thinks about their illness and works out things for themselves has the best chance of getting better. I can point you in the right direction, but you have to do the donkey work!

Dr. Myhill’s Checklist:  (Click the source link below to view the entire article and further information on each item in her checklist).  Dr. Myhill says that you shouldn’t go onto the next stage on the checklist until all the earlier ones have been fully explored.

Stage 1:  Make sure the patient truly has ME/CFS

  • Is the diagnosis correct?  Have all other illnesses been excluded?
  • Really think about what might have caused your CFS?  Myhill says:  “…this will give a guide to treatment. Think about the time building up to the start of the illness, what the trigger was, which illnesses run in the family?”
  • ME/CFS is a diagnosis of exclusion.  Recent onset of symptoms which may be worsening would suggest serious underlying disease.

Stage 2:  Observe Six Fundamental Rules


• Adopt the 80% rule (which means: know what you are capable of in a day and do just 80% of that – 20% is “getting better” energy).

• Get enough mental and physical rest.

• Get organized.

• Accept help. Arrange for deliveries to house. Delegate work.

• Prioritize: List the 10 most important things in your life, then ignore the last five. You can’t do everything.


  • Getting good quality sleep is crucial.  Dr. Myhill says, “Don’t be afraid to use tablets to restore the normal day/night diurnal rhythm.”


  • Dr. Myhill says it takes about 6 months for body stores to replete.  She says everyone should take a basic nutritional package of supplements daily.  She says that for people with ME/CFS there are mitochondria support supplements that these patients should take.


  • There are two dietary problems often linked to fatigue:  allergies and hypoglycemia.  Dr. Myhill recommends the Stone Age Diet – it has a low glycemic index and avoids the major food allergens.

Avoid infections whenever possible:

  • According to Dr. Myhill, “At the first sign of a cough, cold or sore throat use vitamin A (not if pregnant), vitamin C, zinc, selenium and propolis [a substance produced by bees from resins with antimicrobial properties].”

Do a chemical clean up:

  • Throw out all of the scented items in your house, avoid sprays, polishes, aerosols, new paint, new carpets, and have the house well ventilated. 

Stage 3:  Fighting & Nurturing

The interventions below need to be done over and above all the interventions listed in Stage 2 above.

At this stage you should consider having the Mitochondrial Function Profile and bring into your recovery plan the nutritional regimen specifically designed to support the mitochondria.

Some interventions work for a high proportion of sufferers (B12 injections, magnesium injections, D-ribose, Coenzyme Q10, etc.). Do as many of these things at the same time as you can. By the time you have been ill for several years, more than one thing will be wrong – you need to tackle them all at the same time to see improvement. The priority is to get well. Once you are better, these things can be knocked off one at a time to find out which is important. See “Pattern of Recovery.”

The maneuvers to try, in order of importance, are:

  • Feed your mitochondria:  See Mitochondrial Function Profile
  • Pain:  See Dr. Myhill’s Pain article on dealing and controlling pain.
  • B12 injections.  She says these should be tried at some stage. 
  • Correct hormone dysfunctions.  These are usually the adrenal glands and hypothyroidism.
  • Get intestional symptoms under control.  See Fermentation In the Gut & CFS
  • Birth control & HRT can actually worsen CFS symptoms so Dr. Myhill recommends caution when using these.
  • Low dose antidepressants seem to work well on CFS patients.  She says, “Many CFSs do well on tiny doses of tricyclic antidepressants such as amitriptyline 10mgs, dothiepin 10mgs, trimipramine 10mgs at night. In these doses I would not expect much effect on depression.”
  • Chronic low-grade undiagnosed infection.  See “CFS – Can Be Caused by Chronic Infection.”
  • Hyperventilation can cause fatigue. Often driven by food intolerance and low magnesium levels. Helped by relaxation techniques.
  • Chemical poisonings:  See  “Chemical Poisons and Toxins.”
  • Multiple Chemical Sensitivity:  “Suspect if symptoms better out of doors, better in the summer, better away on holiday. Do chemical clean up. Eat organic where possible. See “Multiple Chemical Sensitivity (MCS) – A Common Problem and Often Triggered by Exposure to Chemicals.”

Stage 4:  Considering Allergies

  • Dr. Myhill says that if you are still struggling despite having tried all of the above information, and if you have honestly done followed the above properly, then your problems may be caused by multiple food allergies, chemicals and/or molds. 
  • She recommends getting mold allergy tested.  Myhill says, “Either by skin tests… or by going abroad to a warm dry climate, ideally for one month, but two weeks may give you an idea. Make sure that the holiday house is chemically clean. I know it is not easy, but it is important.”
  • Desensitization:  She suggests neutralization or the technique she prefers, Enzyme Potentiated Desensitization (EPD) for foods and possibly chemicals.

Stage 5:  New Ideas

One of the problems with CFS is that it is a quack’s charter! It is important to look at new ideas and treatments, but not before all the known treatments have not succeeded. Especially the psychological treatments should not be considered until the physical issues have been sorted….


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  1. I have had fibromyalgis and cfs all of my life that I can remember,,I thought the CFS was depression when I was younger, I would get a good self help book and get new ideas on improving life. In about 3 days to a week it would go away. The older I have gotten the worse it has gotten. I do have allergies and stomach problems/ I took allergy shots for 11 years, being military I traveled constantly and had to be retested every new pcs. I have been a cosmetoligist for 36 years(lots of chemicals). In 2004 my symptoms of fibro and cfs got so bad I had to give up my passion totally. This really wrecked my life and crushed my ego. I had one tough time getting through that and right in the middle my phys Dr. passed away and he was the most wonderful man, just like your best friend(elderly).
    I have learned to live day by day a very simple life. Had it not been for my wonderful husband my 3 children(all grown now) would have really missed out on so many activities in school and church. He has been my rrock for 40 yrs, so after all I consider myself blessed. I do pray that something will be known soon about this.

    • I am responding to Sherry’s comment, although she may never read this, since she posted such a long time ago….Sherry, I hope you are aware that there IS so much info out there that may potentially help you. Dr Myhill’s work is very helpful and informative and her website is drmyhill.co.uk. But, as her writings make clear, there is a strong need for the patient to be very proactive in all this… My suggestion would be start by looking at Dr Myhill’s site, or buy her e-book. Then branch out into researching onine other aspects that she touches on that feel relevant to you. Find a medically trained doctors out there who is open-minded and not afraid of an integrated approach to your care. The ideal approach is one based on good science, but one that looks with discernment too. Doctors who are jaded, lacking in sufficient curiosity, or who religiously adhere to treatment protocols that are too far from the cutting edge, can sometimes be just as dangerous as the quacks.

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