Courtney Craig recovered from ME/CFS/FM using both conventional and integrative medicine.

Courtney Craig is something of a rarity. For one, it took her years, and a lot of study and trial and error, but she was able to become, in her words, a very “high-functioning” person with chronic fatigue syndrome/fibromyalgia (ME/CFS/FM).

Coming down with ME/CFS/FM at age 16 changed her. As she noted on her website, her “academic and career trajectory was fueled by the constant need to understand and overcome the illness”. To that end, she became one of the few nutritionists focused on the needs of ME/CFS/FM patients. For her, that means finding dietary and other ways to reduce inflammation in the body, improve intestinal health and metabolism, and boost immune function.

She received her clinical training at Palmer College of Chiropractic, Florida, graduated with honors from the University of Bridgeport’s Human Nutrition Institute Master program, studied at the Technical University of Munich, Germany, with a focus on nutrition and biomedical research, and was a visiting scientist at Cornell’s Center for Enervating Neuroimmune Disease under Maureen Hanson.

Courtney produced some blogs for Health Rising and many for her website but kind of dropped off the map around the time of the pandemic. It turns out that a move to Germany (and the immigration problems that came with that), relationship issues, family stress, etc., triggered problems with depression.

I asked her how her ME/CFS fared, how she found a way to put her depression in remission, and about her new online course on diet and nutrition for people with ME/CFS/FM and long COVID.

The Interview

Narration! Thanks to Geoff for providing an audio narration of this blog 🙂

I was diagnosed some 25 years ago now. Of course, the condition changes over time and with age. (I turned 40 last year!) At this point, I can say that at times when my mental health is bad, my ME/CFS symptoms are not so bad (less fatigue). And times when my MECFS symptoms are severe, my depression is less so or nonexistent. I have no explanation for that.

I can say that the fatigue of depression is very different than the fatigue of ME/CFS. Perhaps other readers can relate to that as well. For me, the fatigue of depression is an existential paralysis whereas fatigue of ME/CFS is, of course, PEM, immune response, widespread pain, etc.

Could you go more into how the fatigue of depression is different than the fatigue of ME/CFS? –  It sounds like you don’t experience PEM with depression?

No, I would say I do experience PEM when my depressive symptoms are bad. It’s just that I’m not very active during those times. I’m not out and about or doing anything mentally strenuous that would trigger PEM, usually. Depression, for me, is a paralyzing existential crisis.

The fatigue feels different though. The fatigue of depression feels like loss of interest, loss of motivation, loss of hope, loss of spark. Fatigue of ME/CFS, for me, is loss of battery life and often widespread pain and weakness. It’s utter physical exhaustion but being mentally wired and unable to sleep. It feels like I’ve played a 90-minute soccer match without rest. It’s a physical fatigue versus a mental fatigue, perhaps is a way to put it.

I want to emphasize that I wouldn’t be where I am today without Dr. Teitelbaum’s protocol. That was the catalyst that improved my condition, thanks to a whole system approach and a compassionate physician. That was back in 2009 and I’ve been able to maintain my level of function from that new baseline.

• Check out Dr. Teitelbaum’s approach

I don’t like to use words like cure or recovered. I’m neither, but I have a very high level of function that I can maintain. I am able to exercise in the gym 3-4 days a week now. But I can’t work a 40-hour work week, do loads of travel, or go for a jog. I’m super grateful but humble.

Diet has been crucial in that maintenance—a diet that is good for the gut, normalizes blood sugar, and is anti-inflammatory. I also intermittently fast almost daily. The other big factor is low-dose naltrexone (LDN), which I continue to take on an as-needed basis to mitigate PEM. Without these, I’d be far less functional and probably unable to work as much as I do.

To a lesser degree, I rely on some supplements, but those are targeted and also used as needed. For example, I will use a probiotic (Seed) when I feel my gut is off. I like to use ATP Fuel on days when I need to exert a lot of mental or physical energy. It consistently gives me that boost and makes my legs feel much stronger so I can bike and take my dog on long walks. And then there are some standards for good health that I always take, like a quality multivitamin, fish oils, and bioavailable anti-inflammatories.

Your mental health was a challenge, though, and you turned to ketamine to support it – and it worked. Ketamine – for a long time used solely as an anesthetic – is a fascinating story that is continuing to evolve. It’s been approved to treat treatment-resistant depression and is also used to relieve pain. How did you end up trying ketamine and what happened? Do you have any advice for people who want to try that route?

I’ve had periods of depression off and on since I was 20 years old. Of course, I’ve tried numerous things over the years but always pushed through it, knowing it would pass in time or when my life became less stressful. Multiple rounds of talk therapy I personally never found helpful. I also trialed various antidepressants but never found them to elevate my mood and the side effects were impossible. Like any other chronic condition, depression requires a frustrating degree of patience to find any relief.

Since most of that psychological treatment was performed in the US, I had zero patience to start from square 1 here in Germany. I did try for a few months just to see if the approach was different (it wasn’t) but quickly lost confidence in those types of solutions.

I had read a lot of promising research regarding psychedelics and was intrigued. I even experimented with LSD, which was eye-opening but didn’t have any sustained effect on my depressive symptoms. Whereas LSD’s effects are on the serotonin system, ketamine works on the NMDA receptor and has effects on the amygdala. Indeed it was a totally different experience.

I found a private clinic here offering IV ketamine therapy consisting of a 6-treatment protocol. I found it surprisingly affordable. (Public insurance will only pay for such things if treatment-resistant depression is well documented, and again, I didn’t have the patience for that.) Truly, as we all know, when you’re chronically ill for so long, it doesn’t really matter the cost. I’d pay any expense for a life-changing treatment and ketamine was just that.

It completely put my depression in remission, sustained 1 year out. I’m not using any rescue medication or wasn’t prescribed the nasal spray alternative for maintenance. If I feel a relapse again, I will go seek additional IV treatments, though may not need another 6.

I started at a 30mg dose, and each session titrated up to a maximum dose of 100mg by the 6th infusion. It is a very intense therapy. I mean it’s a horse tranquilizer, after all! You are awake and conscious but can’t feel your body. You’re encouraged to close your eyes and experience where the mind takes you. It is not done in conjunction with talk therapy at such doses as you also lose the ability to speak.

I kept very detailed notes after each session and found it truly fascinating. Psychedelic experiences are sometimes described as ego death, which can be quite frightening. For me, ketamine felt more like an ego unraveling—peeling away the layers of self and cleaning out all the messy bits between. It was a deeply philosophical experience for me.

I paid careful attention to how long it took post-treatment for the depression to return. With increasing doses and more treatments, the effects were more prolonged until, by at least treatment 4-5, I didn’t feel depressive symptoms much at all. My anxiety also improved a lot. (I had prior been having a few panic attacks here and there and was triggered by crowds/noise and the like. I also have a history of PTSD from 10ish years ago.)

My sleep wasn’t very affected but probably did improve a bit. My chronic myofascial pain certainly improved but would wear off quickly between sessions. I didn’t experience any episodes of PEM during the time but also tried to not do too much during those 2-3 weeks since the treatment is pretty intense.

You’ve been thinking about creating an online nutrition course focused on diet and now you’ve done it – and more courses on fasting and how to do it properly, how to manage food sensitivities, etc., are on the way. How important was finding a good diet in your ME/CFS journey?

Before I moved to Germany, I was a teacher. I’ve always wanted to create nutrition-related educational material. I have now basically transformed the information that commonly arises in my 1-1 consultations, and turned it into a concise course. I plan to create a library of courses and, at the moment, won’t be doing 1-1 consultations anymore. I’m currently finishing up a course on digestive issues and food sensitivities that are common to postviral conditions. I also want to dive into supplements to provide some help there since most of them are ineffective.

I do have a day job! I’ve always had a day job. It’s a lot to take on. I’m actually in the middle of a total career change. I’m completing a medical writing program with a focus on continuing medical education. Perhaps I will find an avenue to create CME for doctors on the topic of ME/CFS. Heaven knows we need that!

I’ve taken a lot of online courses myself and found that few keep my attention long enough to finish them. I didn’t want to do that here. This course is concise and meant to be completed quickly and re-watched easily. I don’t geek out on details but keep the material simple, for a lay audience, and very actionable.

Viewers will walk away knowing exactly how to create a diet for post-viral conditions. That is one that is low net carb, high-protein, nutrient-dense, anti-inflammatory, low glycemic, and high in fiber. It’s, of course, also the diet I try my best to adhere to as much as I can. Beer and pretzels, here in Bavaria, are hard to ignore.

I also didn’t create a one-size fits all plan. Working with patients for the last decade has taught me that that just doesn’t work. Instead, I’ve created a framework and provided the insights to adjust it to each individual’s needs. However, many will still need additional diet/nutrition help and that will be addressed in other courses.

Courtney’s course provides a framework people with post-viral illnesses can use to create their own diet plan.

With so much diet-related info online these days, I think it’s important to teach the basics to help people be well-informed and have realistic expectations. Diets are not cures; they are merely tools. I think the most important thing is helping people understand how food can affect specific symptoms. This wasn’t something I understood early on in my illness. Now I realize which specific foods or classes of foods worsen my fatigue, aggravate my gut, etc. That’s powerful knowledge to have as we live with our chronic illnesses.

It was also made with accessibility in mind. I have beautiful color handouts for caregivers or partners who do the shopping. The video was edited without any flashy animations or loud music. As someone who has to hear and speak German every day, I understand how exhausting it can be to take in information not in your mother language.

From my international friend community here in Munich, I had native speakers assist with subtitling the course in multiple languages (Spanish, French, Italian, Danish, German). It’s not simply AI-generated. More languages by request!

The videos are also short (3-5 minutes each) so the course can be completed bite size or easily re-watched. I want it to be re-watched for mastery. A dietary change takes time and trial and error. It will be important to go back through the course and address the troubleshooting areas.

• Check it out here:  https://www.drcourtneycraig.com/enroll

Also with diet – what about staying away from large meals? Dr. Putrino recently suggested staying away from those.

Absolutely. The Japanese use the phrase “hara hachi bun me,” which means eat to 80% full. Eating large meals stresses digestion and requires a lot of cellular energy, ATP. With a long-term high protein, high healthy fat diet, the easier this becomes. These foods are more satiating and provide more sustained energy with less quantity.

Carbohydrate-heavy diets that are low in fiber are easier to load up on and quick to burn through. This can lead to unstable blood sugar and worsen HPA axis issues seen in ME/CFS. (I talk a lot about this in my course.)

Sleep is such a big issue with ME/CFS – is there anything you do that helps with sleep? (I recently started eating dinner early in the evening (5-5:30) and am finding that helps (I do need a little snack before bedtime)...

Absolutely. An early dinner is a good idea to limit digestive processes too late before bed. It is also a key part of implementing intermittent fasting as a routine. My usual dinner time is also about 5-5:30. I don’t usually snack, but if I do, it’s something that has tryptophan – like a small spoonful of nut butter.

I have tried everything under the sun regarding sleep. It has been one of my greatest struggles since my youth. Prescription hypnotics work very well but aren’t meant to be taken indefinitely. Sedating antidepressants give me terrible restless legs. Supplemental sleep aids (e.g. herbs, melatonin, etc.) may work but only for a short time.

I’ve found the most effective things for me are the simplest. I try to keep the room cool. I ensure complete darkness by using a good-quality eye mask. I use a lavender sleep patch on my wrist. I also like white noise, which seems to keep my wired mind from wandering.

With regard to Germany. After seeing virtually no research on ME/CFS/FM from Germany for decades, ME/CFS research has really taken off there. How is it perceived at the physician level – can you say?

I haven’t had good experiences with healthcare here, generally. I don’t frequently go to doctor appointments, but even the general doctor (Hausarzt) has been disappointing. Like anywhere else, it’s hard to find a good physician who will listen and be empathetic. Here, the patient has to advocate for themselves to get the most basic testing done. Then you don’t even get the results. The doctor just says we’ll call you if anything is abnormal.

I don’t usually mention my ME/CFS diagnosis when I’m at a doctor, but occasionally it comes up. No doctor I’ve been to knows what it is. Also when I talk with German friends and acquaintances, they don’t know what it is. Haven’t even heard of it!

Courtney Craig’s ME/CFS/FM Nutrition Course

• Check it out here:  https://www.drcourtneycraig.com/enroll

Health Rising is not affiliated with, nor receives funding, from Courtney and/or her course