text:
Top Five Differences between an Infrastructure Manager and a Cloud Management Solution
I get asked this question a lot. Cisco has multiple exciting Converged Infrastructure solutions with partners. There are actually two different software product "categories" covering the Infrastructure (or POD) Manager and the Cloud Management Solution. Let dig a bit deeper in what the differences are.
- Infrastructure managers are software stacks that manage the initial configuration and day-to-day management of hardware that include systems, networks and storage. These may or may not be related to a cloud project.
- Cloud management solutions include the operation and monitoring of applications, data and services residing in the cloud.
- Infrastructure Managers are used by server administrators to make their lives easy during the implementation and run-time operations of the converged infrastructure. In a cloud, infrastructure managers also provide end user the ability to order converged infrastructure resources across compute, networking and storage in an automated fashion.
- Cloud Management Solutions are targeted toward providing infrastructure as a service to IT and business users. Cloud solutions are designed to automate the end-to-end service across not only the infrastructure but middleware and applications to a specific service level such as gold, silver or bronze.
- Infrastructure Managers are used when a POD is purchased and stood up. Infrastructure managers have two use cases. Today the most common use case is to manage a "pod" such as FlexPod, vBlock of VSPEX where the infrastructure is designed to a specific bill of materials or reference architecture. The second use case is when a company wants to manage a best of breed infrastructure stack composed of different vendors at the compute, network and storage layers. This second use case is becoming less popular as companies discover the cost of standing up and ongoing maintenance for these types of solutions.
- Cloud Management Solutions are used after that to drive the "as a service" storefront and orchestration of those services. Cloud management is what makes the cloud solution work. Infrastructure management by itself is not a cloud. Cloud management creates the end-to-end service in an automated fashion. It allows the customer to come to a portal (store front) and order the complete solution they need. When "submit" is selected, that solution gets deployed across the entire stack and delivered within a matter of minutes.
- When infrastructure is turned on, you might have multiple PODs being deployed and the server administrator needs a console to accelerate the configuration of the infrastructure. The key here is the infrastructure managers speed up the turn on of the storage, network, compute and virtualization.
- IT shops deploy cloud solutions to transform their IT operating model to a "as a service" where you have self-service, elasticity, resource pooling and some form of show- or charge-back.
- Infrastructure managers are bound to the specific hardware stack in play. They have specific behaviors and "shelf reports" of what they support and what they dont. If you want the behavior of the Infrastructure manager to change then you generally need to wait until the next release of the software.
- Cloud management solutions are designed to be extensible. Through the configuration points in the portal and the orchestration layers IT shops can adjust and configure the specific behaviors that they looking for. It is definitely a combination of the out-of-the-box functionality and the specific customer behaviors that build a "true cloud".
Put all this another way, if the virtualization hypervisor is ground zero, infrastructure management involves all the activities south of the hypervisor and cloud management involves all activities north of the hypervisor.
In an effort to keep conversations fresh, Cisco Blogs closes comments after 60 days. Please visit the Cisco Blogs hub page for the latest content.
1 Comments
Dr. Jose A. Wong - Perez
…Simple and well explained. Thanks for sharing.


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Sam Allardyce baffled by West Ham's defeat at Aston Villa
Sam Allardyce could not believe his West Ham side left Villa Park empty-handed after losing 2-1 to Aston Villa.
Last Updated: 11/02/13 7:02am
The Hammers more than held their own but were undone by two quickfire late goals, with Christian Benteke netting from the penalty spot and Charles N'Zogbia scoring a fine free-kick, before Ashley Westwood's own-goal gave them false hope at the death.
Allardyce said: "I think anybody who watched that performance - apart from the Aston Villa fans - knew that we deserved something out of the game.
"The sad thing is after dominating the match for so long - particularly in the second half - and not converting the chances into goals, we paid a heavy price for that.
"We gave a free-kick away and Charles N'Zogbia scored from it and we gave a penalty away and they scored from it.
"Apart from Jussi Jaaskelainen spilling the early shot, Aston Villa, in terms of chances created, have contributed nothing. In terms of our chances we were really just waiting to see what Villa had to throw at us.
"We knew they'd come out of the blocks in the first half. We contained that really well and in the second half we knew we were going to go and go at them.
"We got at them and created chance after chance after chance and when you create that many chances and don't put the ball in the back of the net you can pay a heavy price in this league. We dominated the second half and ended up losing 2-1.
"Even right at the very end their goalkeeper was the hero for them. He was the man that saved them and got them the win and we are bitterly disappointed that we haven't got at least a point out of the game."
Defender Joey Brien will miss West Ham's warm weather break in Dubai this week after suffering a thigh injury.

subset: commoncrawl


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The Big Picture: Shock Treatment
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I guessed the twist fairly early on but the ending still surprised me with how brutal it was. Im more into artistic design when it comes to games, stuff like theming, music, visuals, etc and I can deal with a shaky narrative or boring mechanics as long as I can lose myself in the world. Bioshock Infinate isn't perfect, I found the combat system fairly dull until I got Undertow after which the game was bloody easy, but the world was damn awesome and the Lutece's are some of my new favourite God tier characters.
But what was the significance of those four gay blokes?
*ahem* Bioshock 1 & System Shock 2, nod, nod, wink, wink. "There's always a man and a city".
OT: I loved the game to pieces, but personally what I got from it (aside from the wibbly wobbly, timey wimey stuff), is that it kinda/sorta breaks the 4th wall, practically screaming "Hey!, remember Bioshock 1?, that counts too, you should totally play it / replay it", kinda like, there's Infinite possibilities about the stuff we as gamers do and react and how the game itself can be made, I swear, I thought that Elizabeth at one point would literally take you to the Von Braun, just for the lulz.
Great analysis. I kinda like how different people seem to interpret the ending! I found the ending a bit baffling myself but the game has some fast and slow paces but somewhen just keeps accelerating and it all flips out at the end and comes crashing down so in retrospect it is not that bad ;)
There were some (trailer?) scenes like the attempted hanging of Elizabeth that never appeared in the game... where's that stuff. It seemed awesome!
Welp. Guess I'm not watching this show for another two years, until I can get it for fifteen bucks on Steam.
When Bob paraphrases the subtext the way he does, the game comes off as a perfect critique of the very essence of American society.
In theory, but as MovieBob said, the game has that narrative about learning to deal with and accept your past. If he was able to go back and erase what he did, that wouldn't really be accepting it.
I'm happy that Bob shares an opinion with me on this. I've said it once and I'll say it again, Booker DeWitt was the stand-out character for me throughout the game, not everyone's favourite Elizabeth.
The unravelling of the story combined with the as always superb voice work from Troy Baker made me fully immersed in assuming the role of Booker. The drowning of Comstock, I felt his confusion and wild anger. When he realises he sacrificed caring for his only child, I broke down in tears. It goes to show that the silent protagonist is not always the best choice in games, and the player can succeed in being as expressive and emotive as those around him/her.
They were singing a song they couldn't possibly have heard. It was foreshadowing the Alternate worlds.
No one ever seems to want to talk about how much worse the gameplay was from the first game.
The first game is just the better all around game.
Story, mechanics, aesthetics.
All of it.
Seriously, spoilerific.
Alternate interpretations abound. I personally think, due to the way multiverses work according to my understanding, that Elizabeth essentially can't cease to exist. She was capable of going anywhere she wanted after the siphon was destroyed. Because of her unleashed power, she can be anywhere any time. Even if she does something that would result in her never existing, it wouldn't matter because she can essentially always exist, even if she had the freedom to travel all dimensions for even a millisecond.
This is like the quantum physics version of "It was all a dream" the better thing is that they don't tell you it's all meaningless and you get to argue about it rather than just be pissed off.
I think this is a pretty good analysis of Bioshock Infinite. And an especially good analysis of what I dislike about it - I strongly felt that the dog was more interesting than the elephant, and dumping the dog in a ditch at the end of act 2 to examine the elephant for the rest of the game was a huge disappointment to me.
Just so that everyone knows this game revolves around the science of hypertime and not so much alternate demensions it's similar but not the same thing
Or something like that.
Anyway what i'd like to know is... is Elizabeth still screwed? I mean isn't the booker who still has his daughter still in debt and does that mean he could still very well sell her off if the option exists? Assuming Booker is in the same position as he was before.
I remain unphazed in my opinion that it is a mediocre mishmash of ideas given no due time or honest treatment. The game has constituent elements I like (visual aesthetics, sound), but the overall product is terribly average and intellectually disingenuous at best.
Also I take issue with Bob's statement that the focus on the Booker/Elizabeth relationship makes the story "darker and bleaker". Surely the fact that the game renders a righteous rebellion against racist oppression a heinous act of barbarism which 'never should've happened' and proceeds to assume moral stances *for* the player is the darkest and bleakest and most depressingly cynical aspect of the game.
Great analysis, and one that I think might be right on the money. Might. It's hard to tell with that ending (look, it's not a bad ending, I just feel that it is a bit rushed is all).
However, the greatest realization I had when watching the video, was about the choices that you make throughout the game, which leads you to believe that they will have some kind of great impact on the ending, but in the end are just there to mess with your expectations. Because for as much as the choices are being painted as black and white, there actually one choice which threw me for a loop, and made me ponder which decision was the "right" one.
The choice in question: whether you shoot Cornelius Slate or let him live. Normally, this would have been a cakewalk; killing is EVUL, and thus you let him live as an act of G00D (and instead leave the old coot to rot in a museum, which is just so nice of you). However, there were two things, two simple things, that made me question that decision.
1. Cornelius himself asks you to kill him.
2. The choice where you kill him is positioned where the "good" options normally are.
The simple act of placing one choice where it isn't expected to be in a dialouge option made me question what was the "right" choice.
Food for thought...
Or maybe they just crammed so many ideas together because they couldn't commit to a single thought. Not that there's anything wrong with that. Human Revolution doesn't have a central theme, and yet all the different perspectives on Augmentation help to expand the world itself.
I'm surprised he didn't mention the after-credits cutscene.
The fact that the weapons were bland, the vigors were spread out through the game so you couldn't mess with them from the beginning and that Booker's course of action was mostly stupid as hell throughout the game might have something to do with it.
Before anyone pins me down with accusations about how wrong I am, I'd just like to state that I didn't think the game was bad, just very average.
Booker is suicidal, but he's taken the job because he doesn't want to die. So he goes not to suicide-by-cop, but suicide-by-army-robots-magic-and-monsters. You could say Elisabeth is what's keeping him alive, but there's a fair bit to where he starts giving a shit about her and sees her for more than his ticket out of debt.
It's not the major loopholes(if there are any, since most have been debunked by now), it's the small things that, for me, don't make sense and rip me out of the story and gameplay. I'd rather have read a book with the same story and I kind of regret my purchase.
I'm somewhat surprised that no one is complaining about the weapon limit, something that Duke Nukem Forever was brutally hated for. I didn't much enjoy that here either and there were no weapons that I felt had something different or interesting to offer. You just picked up the occasional gatling gun and felt sort of awesome with it, but then relied on whatever you could scrounge up ammo for(at least on hard).
Sorry for the rant, feel free to pick my post apart as usual. But only if you to it in a fit of rage :)
Anyway, those were my two cents about the game. I'm wondering what's going to happen with the Bioshock series. Are they going to make another sequel or is Ken Levine finally going to pull the System Shock license away from the greedy hands of EA? Well, time will tell.
It is still the Fringe in the end... and that stopped me to like this game. Also I wanted to get bigger things as an ending here and then ... nothing. For example a final epic bossbatle with the birdmachine on a falling city while the girl is opening new citywide portals to other dimensions to give me time to fight ... and such. No, I'm drowned and Fringe.
You know, that's actually the most acceptable interpretation of the ending that I've heard. Really want to thank you for this video because you reminded me that the Bioshock games are about anything other than what actually happens. It's all about symbolism and commentary. It's hard to describe, it's like the story that it's telling is bigger than the story thhat's actually experienced. This whole time I've been stewing over the ending because - quite honestly - I don't think their plan would have worked, I don't think there's any way they could perma-kill Comstock.
But really that's not what matters at all. The story is about the character, not what happens at the end.
In short: Thanks Bob, great video.
Now I can go back to loving Bioshock Infinite like I did before I got to the ending. :D
I'm confused, you're saying you prefer the first Bioshock, right?
If so, I completely agree. I have one example.
Big daddies were a presence in the game, that if not scared you, made you nervous. They had a very specific role in the game, they were a deep part of the story and they were something you could completely avoid(as far as I remember, maybe apart from one or two instances) if you wished to, giving you a vital gameplay option.
Handymen were yet another wonder of Columbia that was never really explored, explained or any big part of the story, but merely hinted at, when you weren't fighting them. Which was rare. I remember meeting them twice or so.
This is one of the things that made Infinite feel rushed, along with the Boys of Silence that served as overglorified sentries.
Yea, I'm saying the first one was better.
They're not even in the same ball park in my opinion.
This was probably the best review of Bioshock Infinite I've seen.
One thing, though - a bunch of the clips show stuff that I've never seen in the game - and I've played it through twice. What's up with that?
I'm glad Bob liked it, just as I'm glad he liked the ME3 ending.
Can't say that I did, on either one. Although, to be fair, comparing the two is like comparing drinking acid to eating stale bread.
And no, I don't believe that BS:I's ending was a "sad" ending, it was positively joyous, esp if you stick around after the credits. However, to me the ending seemed pretentious and needlessly complicated (which is not the same as nonsensical).
Remember when Bob bagged on Tarantino for his show-boating in Inglourious Basterds? Yeah, that's how I felt here. I didn't care much for the twists either.
The world, however, was extremely engaging, the characters were compelling (even the ones you felt compelled to kill), and the game as a whole was a peerless experience (totally deserving of 8.5 or 9 out of 10).
Cinematics and preview material from before the release. I get the impression they iterated a decent number of details between then and now. Like Elizabeth coming across as more of a telepath than dimension hopper.
Exactly my question. It's the internet, there are an infinite number of bytes available. Why shouldn't Bob be able to make a half-hour episode? Who exactly is imposing this supposed time limit?
Or, perhaps significantly more relevant to the topic at hand, the American Revolution.
That's probably why I don't watch game trailers, or care very much about anything that's written or shown before the actual release of a game. The question is, why did Bob use this footage, when it's not actually representative of the game as it was released?
Such a pathetic character that steeps so low that he's a step away from suicidal.
Completely agree.
They hyped up all these enemies, especially Songbird, and I expected a lot more explanation, as well as more depth in their relationship to Columbia.
What I got was "Yeah, robot dudes" "Yeah, magic powers" "Yeah, flying Big Daddy". I really felt underwhelmed overall, and the simplified gameplay (compared to Bioshock, which even itself wasn't that innovative in that department) didn't help my impressions. The 2-weapon limit, the re-skinned gun variants, the unsatisfying upgrade system, the removal of crafting/hacking/ etc.
Bioshock just felt like a much more complete game overall.
Both the game's 'end battles' sucked though.
The only thing that bothered be about Infinite was that it felt like a lot of bits were cut and stitched together, and thus it felt like a lot of the narrative was missing or hastily patched with quick explanations amounting too "Because multiverses!" I just didn't feel like I'd gotten the whole experience at the end.
This is also, roughly, my interpretation of the story, except I didn't even really dwell on the hows and whys, because I just viewed the whole story as a Jacob's Ladder-style personal hell that Booker has to undergo. The effect on the dead-but-not-really enemies also helped the comparison quite a bit.
That actually makes me feel quite a bit better about the ending. Nice theory. :D
This is something I never/seldom do.
Well, it really never should have happened, the folk of the Vox were murderous thugs, there are multiple instances of them just murdering unarmed people because they are a bit annoyed.
OT: The reason they needed guns, even though they had Vigors all over the place, they were never as effective as going only using your guns, for example, try taking out a fireman with nothing but vigors, or a mechanical patriot.
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|Part Number: AF0450502-22
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|Description : Baffle Assembly
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October 14, 2009
By Justin Tang
JPMorgan Chase Commercial Banking CEO, Todd Maclin, spoke on the status of the financial sector at UCLA Anderson's Korn Hall on Thursday, October 8. While the company survived the banking crisis and now holds billions of dollars in assets including the recent purchase of Washington Mutual, Maclin still believes areas of the financial sector look bleak.
Speaking to several hundred Anderson students about the continuing decline of the financial services landscape, Maclin noted that it is fortunate that banks no longer face systematic risk, but he still advocated caution within the sector. "America is still in a soft recovery, especially as unemployment rises," Maclin said, pointing to the Federal Deposit Insurance Corporation's finding that there are still 416 problematic banks.
The commercial real estate market shows the greatest indication of trouble, Maclin said, adding that the "signs of distress are only beginning." Statistically, reports claim that five of the fifteen largest regional banks have more than 200% of their capital exposed to significant risk. Additionally, commercial real estate has an overall outstanding debt of $3 trillion that needs to be refinanced soon.
Banks have not been paying enough attention to these glaring numbers Maclin admitted. He emphasized the importance of the portfolio theory, which tells investors to spread risk by diversifying their assets and he also expects Congress to pass greater bank regulation soon, which could completely overhaul the entire sector for the future.
In his response to the concerns of ethical bank practices, he responded by saying that JPMorgan is a "leader in Washington, in the banking landscape, and in civic duties." Maclin concluded the event by insisting that, "JPMorgan Chase is healthy and well capitalized ... and we will protect our franchise from unethical banking practices."


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Middle Eastern satirical website The Pan-Arabia Enquirer got in hot water with a public relations firm over a recent article it wrote which said the company was representing the terrorist group ISIS — and it ended up deleting the article — but not without issuing a brilliant and hilarious public "apology" of sorts.
The site, which bills itself as "the world's only 7-star satirical news site," published an article on Sunday under the headline, "PR giant Bell Pottinger lands $US10 million Islamic State account."
It was a pretty short article — just two paragraphs — but offered this deadpan quote typical of PR types: "We've been closely watching ISIS transform into the Islamic State and are now delighted to reveal that we'll be able to use our expertise to help steer this engaging and fast-moving brand onto the next stage of its exciting journey," a Bell Pottinger spokesperson said in a statement.
Obviously, it's fake news, and that quote is in no way real. And while it would seem crazy for a PR firm to represent ISIS, the Enquirer's story isn't terribly off the mark.
A profile in The Guardian newspaper noted a number of Bell Pottinger's big clients:
The government of Sri Lanka; FW de Klerk, when he ran against Nelson Mandela for president of South Africa; Thaksin Shinawatra, the ousted Thai premier, whom protesters claim still controls the country; Asma al-Assad, the wife of the president of Syria; Alexander Lukashenko, the dictator of Belarus; Rebekah Brooks after the phone-hacking scandal broke; the repressive governments of Bahrain and Egypt; the American occupying administration in Iraq; the polluting oil company Trafigura; the fracking company Cuadrilla; the athlete Oscar Pistorius after he was charged with murder; the Pinochet Foundation during its campaign against the former Chilean dictator's British detention; the much-criticised arms conglomerate BAE Systems — Bell or Bell Pottinger has represented all of them.
Still, the company apparently took issue, and the Enquirer took down the post and issued a brilliant apology (You can see still the satirical article via Google cache):
Earlier today we deleted a story of ours. We shall me making a statement shortly (possibly tomorrow when we've had a chance to write it).
— Pan-Arabia Enquirer (@arabiaenquirer) August 25, 2014
"Yesterday we received a complaint about one of our articles and subsequently removed it from The Pan-Arabia Enquirer website," the site wrote on its Facebook page (although this too was later removed). "Following on from this, we would like to offer our apologies to PR firm Bell Pottinger for a satirical story that suggested it had won the account to represent the Islamic State. Although the article was entirely in jest, we feel we must apologise for any sullying of the name of a company whose standing in the international community is reflected in a client list that has included the likes of Augusto Pinochet and the government of Bahrain. Oh, and the government of Sri Lanka. And Rolf Harris."
The Pan-Arabia Enquirer started out as The Dubai Enquirer back in 2005 and has grown considerably, now attracting more than 400,000 pageviews each month, the site claims. The site, which is written in English by anonymous writers, has other headlines like "New Islamic State jihadist accidentally packs wrong black flag" and "Egypt relieved as threat of democracy recedes."
Business Insider reached out to Bell Pottinger and the Pan-Arabian Enquirer for comment and will update if we hear back.
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Tagged: Nick Stavinoha
5-7-2010 PNC Park
Since today is a Friday, I thought that it might by a little more difficult than the other two days this week, where I had snagged 8 and 10 balls.
The Cardinals can be a tricky team to deal with due to their hitting approach. Twice last year I only snagged one ball in games that the Pirates played the Cardinals. My best game against the Cardinals was a 9 ball performance on May 12, 2009. I would break that today.
My first ball was a Steve Pearce ground rule double that bounced over the fence and I caught in the second row. It was career ball #6-6-6. Hopefully the dubious distinction of being tied to that ball number doesn't jinx Pearce in the big leagues.
Ball #2 was another ground rule double off the bat of Lastings Milledge, and ball #3 was a home run that I had to battle the sun for, and made the catch in the aisle way between section 136 and 137.
Near the end of the group, I got two balls within 10 seconds of each other. Both were from Lastings Milledge. He hit a home run that I caught on the fly, and as soon as I made the catch and started drifting back to my right to go to my spot, another home run was hit to my right. I sprinted over and picked the ball up as it was trickling down the bleachers.
The Pirates finished up at 5:26. The Cardinals began hitting.
I glove tricked ball #6 in left field, as none of the Cardinals' shaggers had made it over to left field yet.
I then ran over to center field and found ball #7 in the center field seats.
I returned to left field and got a home run from an unknown Cardinals player . The ball hit two sections from the foul pole and ricocheted like a rocked directly at me. I actually caught the ball between my side and my forearm, as I didn't have enough time to react. That was ball #8, and it was only 5:38, exactly half way through batting practice.
Would I be able to continue this pace and challenge the PNC Park Jabs/Pelescak record of 14.
Things slowed way down, as people started blocking off the rows, and limiting my range.
I did catch a Nick Stavinoha home run on the fly in section 137.
Game: 10 balls (8 hit, 1 device, 1 found)
Season: 97 balls (61 hit, 16 thrown, 10 device, 11 found)
Games: 13 games
Average: 7.46 balls per game
2010 Game Balls: 3
Career: 675 balls
Streak: 109 consecutive games attended with at least 1 ball snagged.
Attendance: 16,473


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apple, raspberry and pear pâtes de fruits
Lately I have been busy with life and work, so unfortunately I haven't had much time to blog. I did however make time to research and make one of my favourite confections, pâtes de fruits (fruit jellies).
My post this week is my entry for two different blogging events. First, Canadian Blogging By Post #2 hosted by the lovely and wonderful Jasmine of Confessions of a Cardamom Addict. The theme for this second installment of CBBP is "Our Seasons Bounty", which is where I got the inspiration for making pâtes de fruits in the first place. I started with apples because they are in season, inexpensive and contain lots of pectin.
The other blogging event I am participating in is Sugar High Friday
#24, hosted by Jeanne of Cook Sister!. This month's theme is Little Bites of Delight (petit fours, mignardises, friandises). Since I was making the pâtes de fruits, I thought that it was a great fit as a mignardises. I remember it being served to me as a mignardises when I had a spectacular dessert tasting at Les Chèvres when I was in Montréal earlier this year.
I tried a few different recipes for pâtes de fruits. This recipe is relatively simple and gave good results. The recipe is from Lenotre's Ice Creams and Candies. In this book, there is more specfic information regarding different flavours of pâtes de fruits and cooking times. These homemade fruit jellies are softer than commercial ones but taste just as good. If you are wanting to make the ones exactly like what you find in the stores, use apple pectin. Apple pectin is however quite difficult to find, but if you are able to find it, I suggest using it for a firmer jelly.
Pâtes de Fruits (Basic Fruit Jelly Recipe)
500 g fruit pulp/puree
600g sugar
15g butter
170ml liquid, pectin based, jelling agent (Certo)
For coating (optional)
Coarse, granulated sugar
Preparing the fruit: wash, peel, and seed the fruit as necessary. Most fruits are then pureed. Some fruits are used as they are and others are mixed with syrup from canned fruit. Because of their relatively neutral taste, pear, peach or apricot syrups are the best; they can even be mixed together.
Preparing the Mold and Jelling Agent: On a baking sheet or other surface that can stand high temperatures without cracking or warping, place a sheet of nonstick parchment paper and set the metal frame, flan ring, or metal rulers on it; or simply line a small brownie pan with parchment paper.
Cooking the Fruit Jelly: In a large saucepan, place the fruit pulp or fruit pulp-syrup mixture and the sugar. Bring to a rapid boil over high heat, stirring constantly with a spatula. Once a full, rolling boil is reached, start the cooking time; this will be from 4 to 9 minutes, always at a rapid boil and stirring constantly, depending on fruit used. Add the butter halfway through the cooking time. When it is time, remove the saucepan from the heat and immediately add the liquid jelling agent; stir vigorously for a few seconds to be sure that is completely mixed into the jelly mixture.
To Mold, Cut, and Serve the Fruit Jellies: As soon as the jelling agent has been stirred in, pour the boiling hot fruit jelly into the frame or brownie pan. Allow to set and cool completely, which will take at least 2-3 hours. When the jelly is completely cold, run the blade of a knife all around the edge to detach it from the frame or paper; then cut it into squares about 1 inch. Lift off the frame; then roll the squares one at a time in granulated sugar (preferably large grained). This step is not absolutely necessary; it does, however, keep the jellies from sticking to each other if piled on top of each other when served and makes them more attractive.
To Store: The uncut jellies will keep for 2 months wrapped in the non-stick parchment paper it is molded on. Placed in a box, and kept in a cool cellar or the refrigerator. If kept in the refrigerator, the jelly picks up a little moisture but it keeps its shine better. Once cut and rolled in sugar, the jellies will keep for a week in a closed container in the refrigerator; it is preferable to place them in individual paper cases if they are to be stored in this way to keep them from sticking together; these homemade fruit jellies are softer than commercial ones.
Technorati Tags: Canadian blogging by post, CBBP#2, Pâtes de fruits, SHF24, Sugar High Fridays


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Welcome to ProHealth's Live Chat with Cort Johnson, held Friday, March 7 in the ProHealth.com Community Chat Room.
Cort Johnson is a research reporter and founder of the highly respected Phoenix Rising website and newsletter, which readers agree "puts out some of the best news and info with regard to ME/CFS/FM, period."
After getting a graduate degree in Environmental Science, Cort dedicated himself to sifting and clarifying the latest information on ME/CFS. He tracks the studies and research-funding politics, talks to the doctors, investigates the new therapies and protocols, and has personally tried many of them. He's always looking for answers, and is a mine of information.
For more about Cort, see the profile "Cort Johnson: Making ME/CFS Research Readable and Accessible."
Q: Hi Cort! Do you currently have ME/CFS and/or Fibromyalgia yourself? If so, how long have you had it?
Cort Johnson: I've had what I guess you would a call a moderate case of ME/CFS since about 1980, although I must say it doesn't feel moderate! But I've generally been able to work or go to school at least part time since then. That ended about five years ago when I developed a severe case of MCS (multiple chemical sensitivity). That has slowly gotten better over time, but I have a long way to go in that area.
I also meet the criteria for FM, but it's the fatigue after exertion, by which I mean relatively short walks, that is the biggest issue for me.
Q: What areas of CFS research do you think are the most exciting right now?
Cort: There are lots of interesting research findings right now, but one of the most interesting involves more of a trend than a single finding. Throughout the CFS research arena, you generally find more abnormalities in tests that stress ME/CFS patients' systems than in those that measure them at rest.
For instance, brain MRI tests have been largely inconclusive, but functional MRI tests that measure brain activity when an ME/CFS patient is doing a task almost always show abnormalities.
Cortisol ('fight or flight stress hormone') tests are the same way. They're sometimes mildly low and sometimes not, but if you put the system that's responsible for producing cortisol – the HPA (hypothalamic-pituitary-adrenal) axis – under stress, it usually performs abnormally. Natural killer cells are the same; sometimes NK cell levels are low, sometimes they're not. But when you try to get them to act – that is, to kill an infected cell – they usually underperform. The cardiac abnormalities Dr. Cheney reports seeing appear to follow this same scenario: they're worse when he puts his patients under the stress of standing.
This makes me think that ME/CFS patients' bodies do not react well to activity at any level, and that some sort of abnormal stress response is an essential part of this disease. I suspect that as researchers focus more and more on different kinds of 'stress tests', whether they be immune, endocrine, nervous system, or whatever, they'll find more and more abnormalities. I think the tendency the research community has to look at systems at rest has probably impeded their understanding of ME/CFS.
[Note: Dr. Paul Cheney, MD, PhD, will offer an update on his studies of the mechanism underlying ME/CFS – which he believes involves an adaptation to protect against a problem with oxygen metabolism – as opening speaker at the Institute of Functional Medicine's Pain Symposium on May 22.]
Q: Do you believe ME/CFS and Fibromyalgia are one and the same?
Cort: I wouldn't know but I can tell what I've read. These two diseases share a lot of similarities. The symptoms are very similar, both have similar HPA axis problems, both appear to have similar stress response issues. Opinions differ, however, on how similar at the core they are. The degree of pain in FM far exceeds that in ME/CFS, and fatigue in ME/CFS reaches levels that exceed those in FM, with some patients hardly able to move.
Some immediate differences regarding treatment stand out:
- FM patients seem to do much better at exercise than "pure" ME/CFS patients.
- And the ME/CFS patients appear to have more problems tolerating drugs.
Dr. Benjamin Natelson, MD, who's a co-director of the New Jersey Medical School's Pain & Fatigue Study Center, thinks that people with ME/CFS and FM have a different type of disease than people with just ME/CFS. Which brings up Dr. Peterson. I've been told that Dr. Daniel Peterson, MD, believes that:
- About 80% of ME/CFS patients have what's called "central sensitization" – which appears to be what's happening in FM. These patients can respond to many of the supplements and protocols associated with ME/CFS and FM.
- But about 20% of his patients have a distinct neuro-immune disease. They typically require antivirals and other complex treatments and they are much more difficult to treat. It's interesting that a largely treatment resistant 10-20% subset shows up again and again when physicians talk about ME/CFS.
ME/CFS and FM are two very heterogeneous diseases – it'll take time before they're winnowed down into subsets. FM is probably ahead of CFS in that area (as in most areas), as researchers think they'll be able to match specific genotypes within FM populations to specific drugs in the near future. This is because they're beginning to find different variations in 'pain enhancing' genes in the FM Population.
Q: I feel much worse after I exercise, and a day or two later I often feel even worse. What do researchers say is going on?
Cort: It's really surprising to me how poorly this area has been studied. There is some evidence of immune activation. Several studies suggest that the brain is not activating the usual number of muscles in ME/CFS patients as they exercise. Brain imaging scans suggest ME/CFS patients have to recruit more areas of their brains to do simple tasks – and using more of our brain to do something is thought to be inherently fatiguing. Some recent research suggests that oxidative stress may be harming muscle cells. There's no sign of overt muscle damage in ME/CFS, however.
There are some theories, but there's been no comprehensive look at this very important area. One part of the problem may have been the ability of many ME/CFS patients, rather bizarrely, to pass cardiovascular exercise tests. But the Snell repeat exercise studies that the CFIDS Association of America funded at the University of the Pacific Fatigue Lab are finding that while ME/CFS patients may get through a first exercise test, if you ask them to do it again then they start falling apart in a very fundamental way. [See "Diminished Cardiopulmonary Capacity During Post-Exertional Malaise."]
I think this is tremendously exciting, since not only does it validate ME/CFS patients' experiences but it could finally make the post-exercise period, which is when people with ME/CFS really start to fall apart, a key research topic. If these studies are replicated – and other researchers are trying to do that – they could really open up this area for research. This could be huge for ME/CFS patients.
Q: When I was first diagnosed with CFS, I tested positive for Epstein-Barr virus, but my doc told me that it didn't mean anything because everyone is a carrier. What is your take on it?
Cort: Everybody IS a carrier – that's true but not everybody has levels that indicate Epstein-Barr virus (EBV, a type of herpesvirus associated with infectious mononucleosis) is reactivated. This is a strange area because some people who have evidence of EBV reactivation are not sick and some are! Dr. Jose Montoya has had success in his ValcyteR (valganciclovir) trials at Stanford, treating people with both EBV and HHV-6 (Human Herpesvirus 6) reactivation.
So it's a real gray area – does your level of reactivation mean anything? I couldn't presume to know. A further complication is that Dr. Ronald Glaser, MD, Director of the Mind/Body Center at Ohio State University, believes only certain types of testing will uncover the kind of EBV reactivation present in ME/CFS patients. The CFIDS Association is funding him right now. An overview paper on EBV coming out soon on the Phoenix Rising website will discuss this. Sign up for my newsletter and you'll get it.
Q: How many diagnosed with FM or ME/CFS might really have Lyme disease?
Cort: All I can repeat is what I hear. Some people appear to think almost everybody has Lyme and others think very few do. Both Dr. Charles Lapp, in his recent ProHealth Q&A, and Dr. Natelson, in his new book (Your Symptoms Are Real: What to Do When Your Doctor Says Nothing is Wrong) state they find that few of their patients have Lyme. On the other hand there's a lot of controversy over how to test for Lyme. Speaking as a layman I would venture to guess that Lyme is like the other pathogens in ME/CFS/FM; a percentage of patients have problems with it. How many is a question.
Q: What kind of role does chronic infection appear to play?
Cort: That's one of the great questions in ME/CFS. The research community was really backing away from the idea that a chronic infection is important in ME/CFS, but recent studies by virologists Dr. Jose Montoya, Dr. John Chia, and Dr. A. Martin Lerner, MD, suggest it is important at least in some patients. The best proof that a chronic infection causes ME/CFS in some patients comes from the success of different antivirals in patients with evidence of infection. How big a subset of patients that is, however, is unclear.
Dr. Chia appears to think it's a majority of patients (see his report, "Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach"). As I said, I was told that Dr. Peterson believes that about 20% of his patients have a distinct kind of neuro-immune illness. Probably only a small percentage of ME/CFS patients fit Dr. Montoya's criteria, but I imagine he's only looking at taking patients he's most sure will benefit from antiviral drugs; those with high viral titers. If the current study works out I'll bet he'll start to relax his standards a bit to see if he can broaden that group. An interview with Dr. Chia will appear shortly in the Phoenix Rising newsletter.
The fact that most of the pathogens ME/CFS researchers are interested in are opportunistic pathogens (i.e., either we carry them within us or they're abundant in the population) suggests some immune dysfunction is allowing them to be activated. Where that comes from is unclear. Is it primary, or is it caused by problems elsewhere in the body? ME/CFS is a multi-systemic disorder; a lot of the really interesting research right now is focused on teasing out how these different systems might interact to cause problems.
With regard to infection, let's just say that in the past year the answer to the infection question has become less clear, and that's a good thing. The subject looks like it will be back in the research arena in a big way.
Q: What role do researchers think sleep plays in these disorders?
Cort: If you read the books, you see physicians say again and again that sleep is the key symptom in ME/CFS. If they can get their patients to get a good night's sleep, they can help them improve. If they can't, then you're in real trouble.
The sleep studies, on the other hand, have had really mixed results; some show major problems and others do not. Like so much in ME/CFS, it's a confusing area. The CDC, though, is finding some abnormalities that I think everyone will be able, over time, to agree on. They've found that ME/CFS patients' heart rates are increased, their heart variability is decreased, their norepinephrine levels are increased, and some brain wave patterns are altered when they sleep.
These suggest that one side of the stress response – their fight or flight response (i.e., the sympathetic nervous system) – is turned on while the other side – the rejuvenating side, the 'rest and digest' side (the parasympathetic nervous system) is turned down even when ME/CFS patients are asleep.
This seems to be one area where physicians agree that prescription drugs are warranted for ME/CFS and FM. There's a Phase IV XyremR (sodium oxybate) sleep treatment trial for ME/CFS patients underway that unlike previous trials excludes patients who also fulfill the case definition for FM – to see if there's a difference.
Q: I've suddenly got insomnia and my doc says I've got to put up with it, because it's the ME/CFS. I don't want to take sleeping pills. Is there anything I can do, as it's making me feel ill.
Cort: I'm not a doctor… All I can tell is what I read, and based on what physicians say – which is that sleep is THE KEY SYMPTOM in ME/CFS, and you should do whatever you can to get a good night's sleep. In my recent interview with Martha Kilcoyne – a recovered ME/CFS patient – she talks about her initial reluctance to take sleeping pills. She later thought she wasted quite at bit of time doing that.
In Fatigued to Fantastic, Dr. Jacob Teitelbaum states that he'll give ME/CFS patients low doses of up to six sleep medications if that's what it takes to give 8 to 10 hours of good sleep a night. It's also believed that up to 20% of ME/CFS patients don't have ME/CFS at all; they have an undiagnosed but treatable sleep disorder. I was just in communication with someone whose ME/CFS cleared up when they fixed their sleep.
In his latest book Seven Proven Steps to Less Pain and More Energy, Dr. Fred Friedberg states that it's possible to minimize or even eliminate the need for sleep prescription drugs by using meditation/relaxation exercises before you go to bed. I have an interview coming up with him in which we'll talk about this. If you subscribe to the Phoenix Rising newsletter you'll get it in the next month or so.
Good luck! There's a sleep section on my website that has information on sleep hygiene, alternative treatments, and pharmaceutical drugs (http://www.phoenix-cfs.org/TrtSleepIntro.htm).
Q: Hi Cort! Are there any new theories regarding CFS?
Cort: There are always new theories! Dr. James Jones, MD, a viral diseases research expert at the Centers for Disease Control & Prevention (CDC), just published a fascinating and rather controversial theory paper ("An extended concept of altered self: Chronic fatigue and post-infection syndromes"). Researchers have always been intrigued by how closely ME/CFS resembles what is called 'sickness behavior'.
Sickness behavior refers to the symptoms such as fatigue, sleepiness, cognitive problems and muscle aches/pains, etc. that we experience when we catch a cold. It's believed the brain sends these fatigue, sleepy, etc. messages in order to get the body to slow down. A lot of ME/CFS patients in fact say they got a cold that never ended. If I understand him correctly, Dr. Jones believes ME/CFS patients' brains somehow got stuck in a mode of 'sickness behavior'. (In Fibromyalgia, pain may be a primary message.)
He believes that the infection is gone but the ME/CFS patient's brain believes it isn't, and it's doing the things it does during an infection to force the body to slow down, to retreat, etc. That's obviously not true in all cases; some ME/CFS patients do well on antivirals, but what about the rest of us?
I think it's a very interesting theory. I have an overview coming out on it and the Centers for Disease Control's approach to ME/CFS coming out next week in my newsletter.
Q: What does Dr. Jones recommend we do?
Cort: That's a good question. He says 'behavioral' therapies to stop those nasty brain messages in some cases; and practices like meditation to slow down a rambunctious autonomic nervous system (nerves controlling involuntary functions like heart rate, etc.) in others; and drugs in other cases to do the same with the autonomic system. How much of a difference these different therapies can make is still unclear but they're definitely at least helpful for many.
It's pretty clear, right now, that there will never be one course of treatment for ME/CFS patients. Some will respond very well to antivirals, others to antibiotics, others to more comprehensive system-based treatment plans. Some people are helped by blood volume enhancers, others are not. Behavioral modifications, meditation/relaxation exercises definitely help some, as do the kind of intense lifestyle examinations suggested by Ken Friedman, PhD, Bruce Campbell, PhD (creator of the web-based CFIDS & Fibromyalgia Self-Help Program), William Collinge, PhD (http://www.collinge.org/research.html), and others. There are a lot of different ways to get at ME/CFS.
Q: Hi Cort. Where do researchers think the fatigue in CFS comes from?
Cort: There are two general ideas about the fatigue in ME/CFS; it's caused by a problem in the body such as an infection or immune problem, or it originates in the brain (or it's both!).
The type of fatigue found in ME/CFS – which affects patients both mentally and physically – is called 'central fatigue' and it appears to originate in the brain. Several studies suggest that when they move, ME/CFS patients are not activating as many muscles as healthy people.
Fatigue can occur in many ways; it can result from problems sending signals from the brain to muscles – that's not happening in ME/CFS. Another way is to have problems generating the signal itself -that's what appears to be happening in ME/CFS. ME/CFS patients' brains appear to have problems processing the information needed to generate movement in the body.
One of the most consistently found neuropsychological problems in ME/CFS is a slowed motor response. When asked to tap their fingers repeatedly they invariably can't do it as rapidly as normal. This is not due to finger fatigue! If I understand it correctly, this appears to originate in a difficulty their brains have in figuring out how to put the pieces together to carry out movement.
The CDC is currently looking at what happens in the brain when ME/CFS patients move a part of their body. They're focusing in on an area of the brain called the basal ganglia. What's really encouraging about this is that about 6 years ago another set of ME/CFS researchers proposed that this is where the problems in ME/CFS lie. A paper on my website, "The Fatigue in CFS: Is it Central?" has more on this. A warning, though; it's a very difficult paper!
ME/CFS isn't the only disease with a mysterious fatigue problem; some post-cancer and liver disease and multiple sclerosis patients look very much like ME/CFS patients. They're fatigued, they sleep poorly, they have troubles standing, and they have cognitive problems. In lots of ways they look exactly like ME/CFS patients!
Interestingly, they also have some similar laboratory findings:
- They all have evidence of an overactive 'fight or flight' response and an under active 'rest and digest' response.
- They often have to recruit more areas of the brain when they do a task.
- There's evidence of basal ganglia dysfunction and some brain atrophy.
- And they often have evidence of HPA axis dysfunction.
I think this confluence of results is so encouraging. We know infection can trigger ME/CFS, and 'stressors' appear to be able to, so why would we stop there? Why wouldn't another kind of stressor (i.e., another kind of disease) do the same? It makes me wonder if these fatigue/pain/cognitive scenarios occur in other diseases. You can get an overview of this in a past issue of Phoenix Rising.
Q: What role do you think the so-called 'cognitive behavioral therapies' (CBT) play in the treatment of Fibromyalgia and ME/CFS?
Cort: Most physicians recommend them, some of them quite highly. The idea that behavioral therapies – which appear to have evolved greatly over time – are helpful in CFS (and FM) makes sense if it's true that the stress response is involved in ME/CFS. The therapies I read about (which emphasize strategies like staying within one's 'energy envelope' and slowly increasing energy levels without crashing, and avoiding negative thoughts) do things that appear to turn down the stress response.
How far they can get is another question. Some people do very well with them, others have only modest results, and about 25% of patients don't seem to tolerate them. They're no panacea, but there's no denying they're helpful for some.
Again, if the stress response really is a key part of ME/CFS, I think we're going to see an increased emphasis on toning it down. And since we can do things mentally to turn down the stress response, we may see an increased emphasis on 'behavioral therapies' over time. I would point out that even if these therapies don't fix ME/CFS, since both axes of the stress response regulate the immune system benefits could show up in a better immune response. It's conceivable, therefore, that even people with chronic infections could benefit in some ways from these therapies.
Q: Your input on CFS, FM, and anxiety? Since CFS my anxiety has hit the roof.
Cort: Me too, although maybe in a subtler way. Our minds seem to be wired – that could the sympathetic nervous system driving and driving.
Israeli researchers did a really interesting study examining nervous system signals in the heart. They found that they could differentiate FM from CFS, and all these other diseases from CFS, but they could not differentiate CFS from generalized anxiety disorder. Based on how much more anxious I am than before, that makes sense to me. Some doctors use Klonopin to tune down the central nervous system. Some info is on my website (http://phoenix-cfs.org/TrtKlonopinhtm.htm). There are meditational practices as well.
Q: Cort, what do you know about the new Fibro and Fatigue Centers? Are they helping anyone get well?
Cort: Absolutely they are. I've never visited one, but they're based on Dr. Kent Holtorf's protocol. Dr. Holtorf has been treating FM and ME/CFS for many years now. I'm actually seeing a physician at his clinic now. See "A Trip to the Doctor." The centers appear to take a comprehensive look at Fibromyalgia and ME/CFS, and I read they're currently conducting a large study on patient outcomes. Nobody's ever done something like that before, and it shows they have confidence in their protocols.
They were apparently started by a businessman who got well under Dr. Holtorf's care. They're directed by Dr. Teitelbaum, who's very active, which means new treatment options should filter down to them quickly. They're not a chop shop for ME/CFS patients!
I think they're a sign that the medical community is starting to respond to the needs of the ME/CFS community. The only question I would have regarding them is their newness. My physician visits suggest that ME/CFS isn't easy even for experienced physicians to treat. I'm sure it takes time for new doctors to learn the ins and outs of the very variable ME/CFS population. On the other hand, in many communities you can't find a knowledgeable doctor.
Q: Are these centers using/experimenting with any new therapies that others are not?
Cort: As far as I can tell from visiting Dr. Holtorf's clinic, one thing they're doing that many physicians are not is using small amounts of bio-identical hormones to rebalance the stress systems. Dr. Holtorf believes that: a) most labs don't measure hormones correctly, and b) many people with 'low normal' readings actually have low readings and should be treated. Dr Holtorf's office also looks at the immune system, infections including Lyme, heavy metals, coagulation, etc.
Q: Have you heard about the Ashok Gupta DVDs?
Cort: Yes, I'm trying them out right now. As I understand him, Ashok Gupta, who actually had ME/CFS at one time, believes that a part of our brains – the amygdala – is kind of stuck in something like a panic mode. It's constantly sending out signals that ramp up the stress response. His training, which is quite multi-dimensional, has techniques designed to ramp that stress response down.
My experience with the Gupta training thus far suggests that there may really be something to that. I'm kind of surprised and impressed.
Q: Do you know anyone who's tried "Lightning" therapy? Can it be that FM & ME/CFS are just results of "an unconscious pattern" that produces too much adrenalin?
Cort: That's interesting. That's Gupta's theory as well, except he goes well beyond adrenalin (epinephrine) when he talks about the stress response. Both these approaches utilize neuro-linguistic programming. I've heard good things about the Lightning ProcessTM, but really don't know much about it.
Because the stress response is so encompassing, you could look at a variety of therapies designed to treat ME/CFS/FM and wonder if that's what they're focusing on. Dr. Holtorf and Dr. Teitelbaum believe that ME/CFS/FM is seated in the hypothalamus, which is just a tick away from the amygdala. The recent CDC report at the CFSAC meeting suggests the CDC's CFS research team is interested in the hypothalamus as well. So, while Gupta and others may be turning down the stress response from one side, Holtorf and others may be turning it down from another.
Q: Cort, does 'mitochondrial dysfunction' play a major part in FM and ME/CFS?
Cort: This is a really interesting question. (Mitochondrial dysfunction is when the mitochondria – the "energy factories of the cells" that burn sugar to produce ATP – aren't functioning properly.) I think a lot of researchers who would have pooh-poohed this five years ago are taking a new look at it, and an increasing number have become interested in the idea that ME/CFS patients may have a problem at the cellular level in producing energy. Whether it's the mitochondria or the environment they're found in is unclear. Dr. David Bell believes ME/CFS basically reflects a system-wide breakdown in mitochondrial production.
Q: I'm not aware of any effective interventions to improve mitochondrial function, are you?
Cort: Some supplements are able to help some people. There's this kind of bag of mitochondrial enhancers that have become popular. They include D-Ribose, CoQ-10, L-carnitine, and whey protein and other glutathione enhancers. Dr. Teitelbaum recommends D-ribose, based on his own studies. (See "Many FM & CFS patients in D-ribose study report quality of life improvements.")
Others suggest L-carnitine and CoQ-10 and whey protein. Different things work for different people, and some people don't get help from any of them. A section of my website is focused on these energy enhancers.
Q: Have you yourself found that any of these therapies seems to help?
Cort: My response to treatments has changed dramatically over time. For the first 10 years or so nothing helped, but about 1992, starting with zinc solution, oddly enough, I've found I respond positively to almost everything I try.
However, I'm only able to take treatments for a short period of time before I have an odd reaction. I really love D-Ribose, for instance, but as soon as my energy levels really start climbing I start to fall apart; I get really jittery, my joints ache, I start feeling fluey…. It's very puzzling. As I mentioned, right now I'm trying an entirely new type of treatment for me, in the mind-body area. It's been successful – it does raise my energy levels – but again I'm afraid I'm experiencing the same problem.
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Q: What type of activity do you recommend for those of us with CFS?
Cort: From what I've read, the key to managing your activity is to find your 'energy envelope' and slowly increase it. The best way to do this is to create what's called an activity log that charts your activity levels, symptoms, sleep, medications, etc. You need this log because the symptom exacerbations can occur days later, and it's difficult to figure out what is causing what.
There are ways to 'exercise' that are appropriate and good for ME/CFS patients; they're not what most people think of as exercise, obviously, but some people very slowly have been able to significantly build up their strength and their feelings of well-being using them. There's a section on exercise on my website.
I recently interviewed Martha Kilcoyne, a past ME/CFS patient, who's now recovered and wrote a book about her experience. The activity log was very important for her, as she explains in the interview.
Q: Could you tell us the title of the book so we can get a copy?
Cort: It's Defeat Chronic Fatigue Syndrome: You Don't Have to Live with It – An Eight Step Protocol. [To read an excerpt of the book describing how to use an activity log, see "Formerly Bedridden CFS Patient Climbs Mt. Kilimanjaro."]
Q: I've heard a lot about stress and ME/CFS/FM lately. Are researchers really suggesting that patients are just 'stressed out'?
Cort: I would give that a conditional yes, with the proviso that you take 'stressed out' to a whole new level. As I said, there's increasing evidence that 'fight or flight' response is turned on, and the 'rest and digest' response is turned down in ME/CFS/FM. This could be why patients have trouble really relaxing and sleeping well. Personally this makes sense to me; I've generally felt unsettled, anxious, and 'amped up' since I got ME/CFS.
I think the stress response angle is fascinating because of the many ways it can affect the body. Blood flow, blood volume, breathing, heart rate, digestion, metabolism, and the immune system are all regulated by the stress response. You could look at many of the symptoms in ME/CFS/FM: fatigue, stiffened muscles, problems standing, chronic infections, racing heart, 'wired and tired feeling' and attribute them at least partially to an out-of-whack stress response.
My muscles are tight and painful, I know I tend to hold my breath – I just can't seem to really relax. I've always felt like there's this little motor that's constantly running in me that doesn't allow me to settle down. So the stress response theory really makes sense to me on a personal level. Some of the more interesting therapies; focused breathing, using biofeedback machines, Gupta's Amygdala Retraining Program, the low dose hormone approach, etc. are aimed at turning down and resetting the stress response.
Is it going to be a key part of ME/CFS or some secondary manifestation of it? I really don't know.
Q: In the meantime, what advice would you give to someone with M.E. who lives each day feeling utterly tired out and who has tried exercise and graded exercise and CBT but to no avail? I don't feel stressed, just feel worn out.
Cort: I just saw a paper which suggested that people with certain physiological problems do not respond well to some behavioral techniques. I can't say more than that – it's not out yet – but sign up for my newsletter and you'll hear about it. It could signal some hope for you, since it does suggest, I think, a different kind of therapy that could be helpful for you. I think of 'utterly worn out' as the next step beyond being 'wired and tired'. That's the state I'm usually in.
Q: How did you learn that you have multiple chemical sensitivity? Is that related to the CFS/FM at all?
Cort: If you have MCS, believe me you will know! It'll be painfully obvious when you start reacting to all these substances you never thought of before. It is a part of ME/CFS and FMS for some patients – they're connected – somehow.
Q: Do you know of any new drugs on the horizon?
Cort: I'm not aware of any, but then again I probably wouldn't know. What I can say is that physicians are getting more innovative in using the drugs they already know about to treat ME/CFS and FM.
- Dr. Jonathan Kerr, MD, PhD (at St. George's University of London) is probably the most proactive physician in this area. His studies have reported seven genomic subtypes in ME/CFS, and he's using gene expression results to target pharmaceuticals to patients whose gene activity suggests they have immune problems.
- A really fascinating Vanderbilt University study – "Autonomic Nervous System and Chronic Fatigue Syndrome" – is determining if saline solution and nitric oxide inhibitors can reverse the blood volume problems in ME/CFS patients with and without orthostatic intolerance (problems standing). They're targeting the sympathetic nervous system, a part of the autonomic nervous system.
- Dr. Raymond Perrin, an osteopath in the UK, recently reported success using lymphatic massage and chiropractic manipulations to get the sympathetic nervous system functioning better. He believes a sluggish sympathetic nervous system allows toxins to build up in the brain (http://www.immunesupport.com/library/showarticle.cfm?id=6628).
- One group just reported success using Dexedrine (!) – an amphetamine – in overweight women with ME/CFS. Dexedrine is a stimulant but the positive effects reportedly came from its ability to interact with the sympathetic nervous system to reduce fluid retention. In his latest book, From Fatigued to Fantastic, Dr. Teitelbaum reports similar findings, provided a comprehensive treatment program is followed. I'll be covering that paper in the newsletter.
I think it's interesting how much focus there is on the sympathetic nervous system right now. It's an area that was hardly even mentioned five years ago.
Q: What are your views on 'mind-body' techniques like meditation & yoga?
Cort: If there is a strong mind/body connection in ME/CFS, the autonomic nervous system (ANS) is probably involved. The ANS regulates "unconscious" functions, but is also one of the few systems that we can consciously affect. The really intriguing thing is that through practice you can apparently 'reset' some of the body processes that function under the level of our consciousness. These include how rapidly we breath, how rapidly our heart beats, how our body reacts to 'stress'.
If Ashok Gupta and Dr. Jones and others are correct, some of those unconscious processes include thoughts. We usually think of ourselves as 'having thoughts' but it may be in some cases that these deeply buried thoughts 'have us', so to speak.
One of things I'm checking out now is the idea of what I call "intensive coping." This involves really going after therapies designed to rebalance the autonomic nervous system, such as slowing down one's breath through focused breathing or meditation or other means. Dr. Fred Friedberg, PhD – who wrote Fibromyalgia & Chronic Fatigue Syndrome: 7 Proven steps to Less Pain & More Energy – has reported that he got much better results from doing rather long periods of meditational type activities than doing the standard 20 or 30 minutes. I have an interview coming up with him on my website.
Only time will tell how important these treatments are.
Q: Gene expression studies, any views?
Cort: This is an area with huge promise but not the payoff we wanted yet. As I mentioned, Dr. Jonathan Kerr in the UK seems to be onto something with his ME/CFS genetic subtype research, though. I'm looking forward to his findings. I'll bet more research money has been poured into gene expression studies than any other subject in the past five years or so. The best 'expression' study I've seen was Dr. Baraniuk's study on protein expression in the brain.
Q: What do you know about Dr. Chia's finding enteroviral infection in the gut?
Cort: The gut is becoming an increasingly interesting place in ME/CFS. There are more immune cells in the gut than anywhere else in the body. Plus, the gut is called the 'second brain' because of all the nervous system tissues down there.
Dr. Kenny DeMeirleir, MD, PhD, appears to believe that ME/CFS starts there. So you have this big neuro-immune connection, plus Dr. Chia's newfound evidence that many of his patients have an enteroviral infection in the lining of their gut. There's evidence that some patients have problems with the gut which could ramp the immune system up big time.
Q: Do researchers know why more females than males get these diseases?
Cort: You'd think that for diseases where two-thirds of patients are women and after 20 years of research they'd have some answers to this. But guess what? If you don't ask the question you don't get any answers, and nobody's asked the question.
The fact that this question hasn't even begun to be answered is really indicative of the abysmal research funding ME/CFS (and FM) receives. The NIH (National Institutes of Health) CFS research program, for example, is based in the Office of Research for Women's Health (ORWH) – and they're not even interested. They're not even interested!
As far as I can tell the answer to the question is that no one knows, but estrogen and the 'stress hormone' cortisol could be involved.
Q: Are there any research breakthroughs that could make a big difference?
Cort: I think there are a few things that if they are successful could change the research landscape and perhaps our lives pretty quickly.
The foremost is the report by Japanese researchers Dr. Akikazu Sakudo, et al. that they've used a technology called NIR spectroscopy in a novel way to find a blood biomarker for ME/CFS. The Japanese seem to be very high on this new test. The word from the recent biomedical research conference in Norway was that they still feel they're on the right track. If they can replicate their results it would be big, big, big news indeed.
The other is the subset work being done in the UK by Dr. Jonathan Kerr, and in the U.S. by Dr. Nancy Klimas, MD, at the University of Miami.
ME/CFS research has been bedeviled by inconsistent findings. It's quite possible that the reason for this is the different types of ME/CFS patients who show up in research studies. If this is true, then the number one objective in ME/CFS should be to establish subsets. Again this is an area where little comprehensive work has been done, which really surprises me since researchers have been wondering about subsets for 20 years now.
There's also a really intriguing attempt to tie the sympathetic nervous system and immune functioning – to really establish a neuro-immune connection. And there's another that's looking at a sympathetic nervous system/blood volume connection – all hot stuff! The repeat exercise studies by the Snell group that I mentioned are another.
Q: Do you know, is anybody doing studies to test Dr. Pall's concept that antioxidants and other nutrients can downregulate the "Nitric Oxide Cycle" for any of the 'unexplained' diseases?
Cort: I think the answer to this demonstrates one of the key problems we have in ME/CFS and FM. Here we have a researcher – Dr. Martin Pall, PhD, who's published several research papers and produced a book (Explaining "Unexplained Illnesses") on his theory for explaining these illnesses, and whose theory has really caught on, at least amongst ME/CFS/FM professionals. But my understanding is that he has had difficulty rounding up money to really do a full court press on his ideas.
I really don't know if anyone is doing these studies or not, but if not, this is par for the course; lots of good ideas – little funding available to pursue them.
Q: What is Rich Van K's protocol? Have you tried it?
Cort: Rich Van Konynenburg, PhD, has an interesting theory, which is that depletion of glutathione, the body's master anti-oxidant, produced via the 'methylation cycle', is the underlying cause of ME/CFS in a subset of patients, and that a protocol of certain nutrients will help.
I think the theory's weak on the front end; I don't think there's much evidence of low glutathione in ME/CFS. But it's stronger on the back end, in that some people really seem to get helped by glutathione supplementation and/or supplements to improve the methylation process. And that, of course, is the important thing.
To some extent one would expect, given the very consistent evidence of increased oxidative stress in ME/CFS, that these kinds of supplements would help. The antioxidant protocol that Dr. Pall produced in conjunction with Dr. Grace Ziem, MD, founder of Chemicalinjury.net, is designed to support reduced oxidative stress. And some anecdotal reports suggest that Dr. Ziem has had some real success with it. I don't know a lot about the methylation process; but you can find a lot of information on Rich's protocol on my website (http://phoenix-cfs.org/ResearchIntro.htm).
Q: What do you think is the biggest problem facing the ME/CFS community right now?
Cort: There are two problems, and they're related. People aren't going to like to hear this, but as a whole, the CFS "community" is not really involved in anything other than finding treatments, and our research funding at the federal level absolutely sucks. And I think the first affects the other.
I think people have this underlying idea that there's some large team of government researchers out there working on our behalf. I did! But I can tell you that that's not true. Out of over 20,000 employees at the NIH, there's 1 person – that's 1 person – working on CFS. Actually it's a half a person, since she doesn't do it full time. That's for a disease that affects a million people in the U.S.
After looking at the research issue for several years, I've come to the conclusion that it's more a political problem than a science problem. We can make a great case for ME/CFS now. Thanks, ironically, mostly to the CDC, we have solid statistics showing high prevalence rates, a high rate of disability, and astonishingly high economic costs to the country. We've amply demonstrated that the NEED is there but we're still being funded like we're a minor, inconsequential disease.
There are diseases that affect only tens of thousands of people that get substantially more funding than ME/CFS. Our funding actually fell by 50% over the last couple of years – this in a disease that already had one of the lowest funding rates.
This is not going to change in anything like the timeframe that anyone who has ME/CFS would find satisfactory, unless we make it change; unless we exert enough political pressure to force the NIH to pay attention to ME/CFS. Political pressure got us in, and it keeps us in there. If the CFIDS Association of America hadn't stepped in, the federal CFS Advisory Committee (CFSAC) very likely would have been axed a few years ago. A top official there very plainly said that the Institutes that make up the NIH don't think CFS is a priority.
It's a tough, tough situation. That's why we really can't afford to have a politically inactive community. That's why we need to support the CFIDS Association of America. They're our "in" at the federal level. But you can't expect them to successfully battle the big disease lobbies for a cut of the pie when only a few thousand patients support them. They can't get the job done with a pea shooter; they need a cannon. I really can't emphasize enough how important it is that we have that organization be strong. There's simply an enormous amount of money available at the NIH – we've got to find a way to get a hold of it.
Q: I've heard some negative things about the CFIDS Association. Why are you so high on the CAA?
Cort: I really wasn't interested in the CAA until I learned how abysmal the research funding for ME/CFS is at the federal level. And once I did, I realized that the most important thing we can have is a strong national group advocating for our interests on the federal level. The federal level is where the big – and I mean really big – research money is. If we're going to get a piece of that pie we need someone who can advocate for us there, and the only group that can do that effectively is the CAA.
But I saw some really negative editorials about them – about how they weren't working for the patients any more, and how they were depending on the federal government to keep them financially afloat, etc. So I began to dig into their records. I read all their annual reports, and I looked at their advocacy efforts, their testimony before the federal government, their criticisms of the same agencies that some said they were beholden to. And instead of feeling worse about them I came away impressed. I saw an organization working very much in the patients' interests!
I think the CAA got penalized doing something I thought was very innovative when they convinced the CDC to fund the first media campaign they're ever done on a disease. I thought they should have received some sort of award for bringing more national attention to ME/CFS, but that was just too much for some.
The CAA puts out a beautiful magazine, they have wonderful educational materials, a sharp website (http://www.cfids.org), etc. but they're actually quite a small organization. When I see that the funding level for ME/CFS falls among the lowest of any disease, it's just such a no-brainer, an absolute no-brainer, to me to support the CAA. There are lots of ways to help our cause, but the easiest is simply to become a member of and donate to the CAA. I just found out they have this easy monthly payment plan that I'm signing up for. My funds are tight, but I can afford $20 a month for my future. I'm absolutely astonished at how few people actually support that organization. I really am.
Q: Are there any specific initiatives that might help to turn this research funding situation around?
Cort: Yes, at least three important things are happening.
The first is the Whittemore Peterson Institute for Neuro-Immune Disease (ME/CFS, Fibromyalgia, and closely related illnesses), that will be opening at the University of Nevada Medical School in Reno within the next year or two. Annette Whittemore's daughter had treatment refractable ME/CFS until she began taking the antiviral drug AmpligenR, which helped her greatly. The really intriguing thing about this Institute is that they appear to be focusing on a research area – the immune system – that the federal government has largely abandoned. I've been told to expect some rather startling papers to come out of this group in the near future.
A second important initiative is the CFIDS Association's attempt to bring some cohesion to the very diverse ME/CFS research field by hiring an eminently qualified Scientific Director – Dr. Suzanne Vernon, PhD (see "An Interview with Suzanne Vernon"). I think we really need someone who can put the pieces together and try to optimize our research efforts. Dr. Vernon will also be an invaluable voice in Washington for the CAA.
Another positive is the growth of OFFER (Organization for Fatigue and Fibromyalgia Education and Research); a support/advocacy organization begun by Dr. Lucinda Bateman, MD, in Salt Lake City. In a rather short time, Dr. Bateman has built an organization that is attracting interest from regional healthcare providers and university researchers; two important groups that usually ignore ME/CFS/FM. If OFFER could be duplicated elsewhere, it could have a major effect on ME/CFS patients' ability to get good healthcare.
Q: I don't hear anything good about the CDC from anybody but you in the patient community. Why do you like the CDC so much after all they've done?
Cort: I wouldn't say I like the CDC SO MUCH, but I think we're really dealing with two CDC's: the CDC that messed up the Incline Village studies and took money out of the CFS program and then lied about it, and the CDC program headed by a very vigorous, if at times controversial, researcher (Dr. William C. Reeves). I don't think most of the ME/CFS community has caught up to the second CDC.
There's a tendency in some parts of the ME/CFS community to demonize certain institutions or individuals and I think that's a big mistake. After years now of reading the scientific literature, I find it's difficult to really pigeonhole most groups or individuals. I think most researchers, including those at the CDC, really want to figure what has happened in ME/CFS; they are after all spending a good part of their careers doing that – they want to be right!
Every time Dr. Reeves opens his mouth in public, though, he seems to have the ability to say something that's sure to raise patients' hackles. But it's the studies that really matter, and that's what I focus on – and if you look at CDC research over the past 5 years, you find they are producing results. They may be wrong! But they're trying, and that's a huge difference from the past. This is not a research group that's sweeping CFS under the rug.
Q: On the subject of the CDC, Cort, what's your thinking on the ME/CFS diagnostic criteria situation in the U.S.?
Cort: It's a mess. You have one rather large group of researchers pushing for criteria that are focused on post-exertional malaise, and you have another group (the CDC) that published a new definition that just about threw that symptom out the window.
The CDC is basically driving the show. Not long ago they invited a diverse bunch of CFS professionals to give them recommendations about a new definition, and then they went into their own corner and drafted a new definition that really shocked some people. We don't know how they decided what they did, and the CDC hasn't been inclined to say much about it.
We really don't know how the definition will affect ME/CFS research. It doesn't seem to have driven it in a psychological direction yet, but it's still early. Interestingly, a Dutch group took allostatic stress ideas developed by CDC researchers and used them to assert that post-exertional malaise must be a key part of any ME/CFS definition. I don't know why the CDC doesn't think that way as well.
Q: Are there any books you recommend about ME/CFS & FM?
Cort: We've really had a run of good books lately. I think that for overall treatment of ME/CFS and FM, From Fatigued to Fantastic by Dr. Teitelbaum is the clear winner. It's almost encyclopedic in its coverage and is studded with insights – it's a very impressive work.
I really loved Dr. Natelson's new book – Your Symptoms are Real. Dr. Natelson is quite conservative; he's not really interested in alternative therapies but he gets you right into the doctor-patient relationship, explains the research really well, and has thought a lot about how to manage these diseases. It's a wonderful read.
For a personal, historical and sociological look at ME/CFS, Dorothy Wall's Encounters with the Invisible is just fantastic. It's my favorite book overall on ME/CFS.
For personal essays pick up any of Floyd Skloot's books – and Rik Carlson's gritty We're Not in Kansas Anymore springs to mind.
Dr. Friedberg gives patients an idea of the rather surprisingly positive effects an intensive lifestyle management program can produce, in Seven Steps to Less Pain and More Energy.
And Martha Kilcoyne gives ME/CFS patients hope and excellent advice in her story of overcoming ME/CFS: Defeat Chronic Fatigue Syndrome.
Those are my current favorites.
Q: The name issue again. 'Chronic fatigue syndrome' doesn't sound important enough to take seriously.
Cort: I agree; it's an albatross. That's why I've joined Rich Carson's Name Change Campaign (http://www.afairname.org). We have an enormous number of issues to face, and the name problem just adds fuel to the fire. I like the way Rich and the Name Change group reasoned the name change out. They thought long and hard about it and came up with a name that both the research community and the patient can hopefully accept.
I have ulterior reasons for joining the campaign as well. I think this is a chance for ME/CFS patients to get united – it would be great if we could somehow get us all together working for an end to this disease. Maybe we can build on the momentum we generate.
Q: Perhaps if all the people with CSF/ME were to lie down in the middle of the highways all at the same time, maybe they would take it seriously?
Cort: Well that's creative…if we could get them all out there and nobody got hurt, I'd go for it!
Closing Remarks
Our chat with Cort Johnson is now drawing to a close. ProHealth wishes to thank Cort for his continuing dedication to finding hope and explanations for all with 'unexplained illnesses', and for so generously contributing to this educational exchange.
Thank you, Cort, it's been a joy listening to you!
Cort, many thanks for all you do to keep us informed.
Cort: Thank you – and thanks very much to Prohealth and Rich Carson for inviting me. I invite you all to subscribe to my monthly Phoenix Rising newsletter and to visit the website (http://Phoenix-cfs.org). We have interviews with authors, advocates, researchers and physicians coming up, plus we follow all the new research.
Note: This information has not been evaluated by the FDA. It is generic information provided by a layperson and is not intended to diagnose, prevent, treat or cure any illness, condition, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.


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Coach Women's HC8272 HC/8272 Fashion Square Sunglasses by Coach
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Julianna Margulies in a Floral Gown at the Emmys 2012
Julianna Margulies Goes Floral For the Emmys
Julianna Margulies made a dramatic entrance at the Emmy Awards in LA this evening. She wore a floral gown by Giambattista Valli on the red carpet. Julianna is up for outstanding lead actress in a drama series for The Good Wife after winning the honor at last year's show. Her costars Christine Baranski and Archie Panjabi are also up for awards, though the series isn't nominated in the outstanding drama category this year. Make sure to vote on all of our Emmys polls here!