Garth Nicolson, Ph.D.’s Approach to the Care of Chronic Fatigue Syndrome & Fibromyalgia

By John W. Addington

At the core of Garth Nicolson, Ph.D.’s approach to Chronic Fatigue Syndrome (CFS) and fibromyalgia (FM) are his findings on chronic infections in these disorders. Dr. Nicolson, who heads the California based Institute for Molecular Medicine, has found through research studies that the majority of CFS and FM patients have chronic viral and bacterial infections.

Infective agents receiving particular attention from Nicolson are mycoplasmas. This scientist and avid researcher describes mycoplasmas as “bacterial microorganisms lacking cell walls that are capable of invading several types of organs, tissues and cells.” In his investigations, Dr. Nicolson has found that two-thirds of his patients with CFS or FM test positive for mycoplasmal infections in their blood.

Dr. Nicolson does not necessarily believe mycoplasmas are the initial cause of CFS or FM. Rather he feels that possibly exposures to chemical toxins, acute viral illnesses or trauma of some sort can open the door for these infections. Once in the door, Dr. Nicolson explains that mycoplasmas become “stealth” invaders because “they can avoid immune surveillance and penetrate and hide in various tissues and organs.” The results of this invasion are immune suppression, allowing further viral attack and promoting chronic inflammation with associated symptoms of chronic fatigue, muscle weakness and pain.


Dr. Nicolson recommends a series of tests important in charting the proper course of treatment for his CFS and FM patients. To determine the presence of mycoplasma infections, a Polymerase Chain Reaction (PCR) test is crucial because of its being “very sensitive and highly specific.” Sensitivity is required to detect mycoplasma presence since these microorganisms hide in the tissues and organs and are not as evident in the blood stream.

Dr. Nicolson also suggests PCR tests to detect chlamydia, Lyme disease, HHV-6, and cytomegalovirus as these infections are also commonly found in CFS and FM patients. Tests to spot various coagulation problems are also encouraged. To receive accurate results for most of this lab work, patients should be off all antibiotics and immune-enhancing products for at least four weeks prior to testing. (For more information on testing see Important Tests for Chronic Fatigue Syndrome and Fibromyalgia Patients,

Antibiotic Therapy

If tests confirm mycoplasma infections, Dr. Nicolson suggests long-term antibiotic treatment with drugs such as doxycycline, cyprofloxacin, azithromycin, or clarithromycin. By long-term he means a continuous 6-month course of antibiotics followed by multiple 6-week cycles. The extended antibiotic treatment is needed because of “the intracellular locations of mycoplasmas… the slow-growing nature of these infections, their inherent insensitivity to most antibiotics and the persistence of the infections in metabolically inactive forms.”

Patients are cautioned that antibiotic care can initially result in a worsening of symptoms. Dr. Nicolson explains that this is “due to die-off or release of toxic materials from damaged microorganisms, but patients eventually stabilize within days to a few weeks and then slowly begin to recover.”

As for results, Dr. Nicolson says “recovery is usually very slow. Patients who have been sick for many years are unlikely to recover within a year of therapy.” In following up on one group of CFS/FM patients after three years who received antibiotic therapy, it was found that around 80 percent recovered from 50-100 percent of their pre-illness health.

On the other hand, some patients only “recover to a certain point and then fail to respond to the recommended antibiotics, suggesting that other problems, such as viral infections, environmental exposures, other toxic events, and even stress” play an important if not predominant roll in the patients’ symptoms.

Patients who are suffering from chemical and environmental toxins often have a variety sensitivities to various chemicals and even foods. This situation is quite different from patients suffering from infective microorganisms, and therefore requires different care. Dr. Nicolson’s treatment of chemically exposed patients “usually involves removal of offending chemicals from the patient’s environment, depletion of chemicals from the patient’s system and treatment of the signs and symptoms caused by chemical exposures.”

Oxygen Therapy

Dr. Nicolson explains that “another useful therapy for some patients is oxygen therapy. This can be administered as hyperbaric oxygen, ozone therapy or even oxygen-releasing products…The reason that these products are often useful in patients with ‘stealth’ infections is that these infections grow better under low oxygen conditions.”

The hyperbaric chamber involves the exposure to high amounts of oxygen at increased pressure. In other disorders, hyperbaric oxygen therapy has been shown to increase the benefit of antibiotics. Nicolson believes that CFS patients with acute episodes or diagnosed mycoplasmal infections particularly stand to benefit from hyperbaric oxygen therapy.


Dr. Nicolson recommends a controlled diet, two-thirds of which is composed of vegetables, one-sixth starch and one-sixth protein. The vegetables should be green, orange, and yellow and the majority of vegetables eaten should be cooked. The starch should be whole grain and include complex carbohydrates. The protein can include chicken, fish, beans and lean, well-cooked meats.

While some fruit is okay, a large concern of Dr. Nicolson is keeping dietary sugars low. Thus, fruit lower in sugar content is better and fruit juices are discouraged. On the other hand, vegetable juices, herbal teas and plenty of water are beneficial to keep the body cleansed.

Dr. Nicolson’s concern about sugar is based upon sugar’s promotion of mycoplasmas and other harmful microorganisms. For this reason, as much as possible food and drink containing sugars should be eliminated from the diet. Refined, fatty, and yeast containing foods are also good to avoid. Likewise tobacco, alcohol, and caffeine would not be included in a diet most helpful for CFS.


Dr. Nicolson encourages the use of supplements to strengthen patients’ immune systems and to improve overall health. B complex vitamins in easily assimilated forms, such as sublingual, are important. Vitamins C, E, CoQ10, amino acids, and minerals such as zinc, magnesium and calcium should be taken. Dr. Nicolson also recommends fish, flaxseed oils and mixtures of friendly bacteria including lactobacillus acidophilus. Especially beneficial for a strong immune system are bioactive whey products, lemon/olive drinks, olive leaf extract, fresh garlic, oregano oil and mushroom extracts.

For More Information:
The Institute of Molecular Medicine (
15162 Triton Lane, Huntington Beach, CA 92649-1401
(714) 903-2900; Email:

Source Materials:

Nicolson, New Treatments for Chronic Infections Found in Fibromyalgia Syndrome, Chronic Fatigue Syndrome, Rheumatoid Arthritis and Gulf War Illnesses, Am. Acad. of Environmental Medicine Newsletter (1997)

Nicolson, Update on Gulf War Illnesses: Relationship to Fibromyalgia Syndrome, Chronic Fatigue Syndrome/M.E. and the Possible Role of Vaccines, The Fibromyalgia Survivor (2001)

Nicolson, Bacterial and Viral Co-Infections in Chronic Fatigue Syndrome Patients, Myalgic Encephalopathy/Chronic Fatigue Syndrome Conference, Australia (2002)

Nicolson, Diagnosis and integrative treatment of intracellular bacterial infections in Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness, Rheumatoid Arthritis and other chronic illnesses. Clin. Pract. Alt. Medicine 2000; 1(2): 92-102

Nicolson & Ngwenya, Dietary Considerations for Patients with Chronic Illnesses and Multiple Chronic Infections (2001)

Nicolson, Important Tests for Chronic Fatigue Syndrome and Fibromyalgia Patients (2002)