TO TABLE OF CONTENTS
Deficiencies You Can Deal
Studies show CFIDS and FM patients are likely to be
low in several important vitamins, minerals or amino acids, but smart
supplementation can help.
By Patti Schmidt
Our bodies need a steady supply of micro-nutrients — vitamins,
minerals and essential amino acids — to operate properly. If you have chronic
fatigue and immune dysfunction syndrome (CFIDS) or fibromyalgia (FM), you’re
prone to nutritional deficiencies.
"It’s likely that marginal deficiencies not only contribute to
clinical manifestations of CFIDS, but also are detrimental to the healing
processes," explains physician Melvin R. Werbach.1
Enlist your doctor and a nutritionist to help you discover
your nutritional needs and how best to meet them. Have a pharmacist look
periodically for potential interactions between the herbs, supplements and
prescription or over-the-counter medications you take.
Which supplements to take?
study suggests people with CFIDS (PWCs) are low in the B vitamins, vitamin C,
magnesium, sodium, zinc, L-tryptophan, L-carnitine, coenzyme Q10 and essential
fatty acids "primarily due to the illness process rather than to inadequate
Research also shows PWCs have a problem with oxidative stress:
one study recommended glutathione, N-acetylcysteine, alpha-lipoic acid,
oligomeric proanthocyanidins, ginkgo biloba and bilberry.2 Other studies have
reported growth hormone and NADH deficiencies.
Werbach suggests identifying deficiencies with objective
testing when possible, treating them effectively and retesting after treatment
to ensure success. But when testing is impossible, he suggests supplementing for
a trial period since "it’s often difficult to rule out marginal deficiencies,
because serious adverse reactions are rare and because nutritional supplements
offer a therapeutic benefit."
In other words, it probably won’t hurt and it may help.
How much to take?
Sensitivity is a
problem for many, so start with 1/8 – 1/4 of a normal dose and work up to the
dose your body can tolerate without side effects.
Begin one new thing at a time and write down when you began
taking it. (If you begin three things at once, how will you know which is
helping or hurting if you experience new symptoms or side effects?) By noting
symptoms, you may see patterns or trends.
Vitamins are nutrients in foods
that assist essential biochemical reactions within your body. There are 13
vitamins. Your body can store up to four months’ worth of the four that are
fat-soluble — A, D, E and K; and enough of the other nine water-soluble ones — C
(ascorbic acid) and the B-complex vitamins (B-1, B-2, B-3 B-5, B-6, B-12, folic
acid and biotin) — to last for several weeks.
found preliminary evidence of reduced functional B vitamin levels, particularly
pyridoxine (B-6), in CFIDS patients.3 Even people who aren’t B-12 deficient have
more energy after vitamin B-12 shots, so many physicians urge fatigued patients
to try B-12.
In one preliminary trial, 2,500–5,000 mcg. of vitamin B-12
given by injection every two to three days led to improvement in 50–80 percent
of a group of PWCs; most improvement appeared after several weeks.4 Oral or
sublingual B-12 supplements are unlikely to provide the same results as
injectable B-12 because the body cannot absorb large amounts orally.3
Recommendation: The B vitamins work
synergistically, so take a B-complex vitamin or other multivitamin supplement
that contains at least the U.S. RDA of each of the B-complex vitamins. Although
B-12 shots are most effective, sublingual lozenges help. Take either a shot of
1,000–5,000 mcg. hydroxycobalamin (which some patients say stings) or
cyanocobalamin, or one sublingual dose of 1,000 mcg. B-12 per day.
Studies show people
respond well to 1–6 grams daily of vitamin C — their risk of heart disease and
cancer decreases, they manage chronic illness better and they live longer. A
1996 Japanese study showed CFIDS patients improved after taking intravenous
infusions of vitamin C and DHEA.5 In Dr. Jesse Stoff’s study of 1,357 patients,
which he treated using 1,000 mg. of vitamin C three times daily and Biomune OSF,
an immune-modulating substance, he claimed 88 percent of those who had one
detected viral infection improved within one year. Those with multiple
infections improved at roughly half that rate.
Recommendation: Take 1–6 grams of
vitamin C daily, broken into even doses throughout the day.
A 1993 study found
vitamin E reduces stroke and heart attack risk by 57 percent and 52 percent,
respectively. A survey of American Heart Association members showed more than 62
percent are taking vitamin E. With recent research showing that CFIDS patients
may have a higher risk of heart disease,6 vitamin E is a potent antioxidant that
should be in every PWC’s regimen.
Recommendation: Take 400–800 IU of
vitamin E daily.
Minerals are often
overlooked, but they shouldn’t be. Without minerals, vitamins are useless. In
their dissolved state, minerals create and maintain a healthy internal
environment which allows other nutrients to do their jobs.
can cause immune and autonomic nervous system dysregulation. Experimental
magnesium deficiency produces fatigue, depression, poor exercise tolerance and
decreased resistance to psychological stress.
In a randomized, double-blind, placebo-controlled study,
investigators described the efficacy of intramuscular magnesium in 20 PWCs who
had lower red cell magnesium levels than 20 healthy controls.7
In 1990 Dr. Carol Jessop reported that low magnesium levels
are common and can be detected with a 24-hour urine sample. She instructs the
patient to take 400–500 mcg. magnesium for three days and then repeats the test
to determine how much the body retained. "If they retained greater than 50
percent, it’s significant because magnesium is very important in muscle
relaxation. Many of my fibromyalgia patients improve by adding magnesium to
their diet," she said.8
Magnesium supplements don’t always work because they’re
alkaline and can neutralize the stomach’s hydrochloric acid, which is why
nutritionist Adelle Davis notes people with digestive problems shouldn’t take
Dr. Zoltan P. Rona believes magnesium deficiency is common in
FM despite a high magnesium intake. He attributes that to leaky gut syndrome,
which creates mineral deficiencies because gastrointestinal proteins that
transport minerals to the blood are damaged by inflammation. He says if the
carrier protein for magnesium is damaged, magnesium deficiency develops and
muscle pain and spasms occur.9
Recommendation: 250 mg. magnesium
three times daily has produced good results in FM patients, especially when
combined with 1,200–2,400 mg. malic acid daily. Dr. Jacob Teitelbaum’s CFIDS/FM
treatment protocol calls for two tablets of Pro Energy (a magnesium/malic acid
supplement) three times a day for eight months, then two tablets a day (less if
diarrhea is a problem).10 He recom-mendsstarting with one or two a day and
slowly working up. Taking it with food may lessen diarrhea. Pro Energy is
www.immunesupport.com or at
In several controlled
studies, PWCs had a higher rate of orthostatic intolerance (OI), an autonomic
nervous system condition where blood pools in your legs when you stand, denying
your brain the blood and oxygen it needs to operate normally. Sodium helps
regulate blood pressure and water balance and it can elevate blood pressure. If
you have OI, eating extra salt and drinking two to three quarts of water a day
can naturally improve the condition.
Dr. Nancy Klimas suggested that increased salt and water
intake can make the kidneys efficient at getting rid of the extra sodium after a
few weeks. When that happens, Klimas prescribes fludrocortisone (Florinef).
Another route is to prescribe alpha-1 agonists, such as midodrine (ProAmatine).
Recommendation: If you have OI, buy
buffered salt tablets available at a pharmacy and follow your physician’s
directions concerning dosage. Also increase your water intake. If these don’t
help, you may need a prescription medication.
Zinc is important in the
activity of enzymes needed for cell division, growth and repair (wound healing,
for example) and immune system functioning. Zinc also plays a role in taste and
smell, carbohydrate metabolism and DNA replication.
Dr. Stephen Davies, editor of the Journal of Nutrition in
Medicine, noted, "CFS patients are nearly always deficient in magnesium … [and]
frequently deficient in zinc and copper, too."
Dr. Carol Jessop stated, "Low zinc levels are common, although
only 32 percent of patients show this on blood tests … But many patients either
have poor wound healing or leukonychia (white spots on the fingernails), which
are signs of zinc deficiency" she said.8
Recommendation: Take a 15–25 mg.
zinc supplement every day.
Sometimes science can help
you determine which supplements you need. For example, your physician can test
how much iron is circulating in your blood; if you’re low, he can prescribe iron
supplements. After you take them for a while, he can measure how you’re doing
with another blood test. This isn’t always the case, though.
In your search for a balanced supplement regimen, take this
advice from Jack Challem, The Nutrition Reporter™: "Vitamin supplements have
their place, but they’re additions to a sound diet, not replacements for it.
Instead of trying to compensate for what you do wrong, strive for balance. Eat a
wholesome diet as consistently as possible, and then add supplements."
This is an edited version of a longer article that was
Werbach MR. Nutritional strategies for treating chronic
fatigue syndrome. Altern Med Rev 2000; 5(2):93-108.
Logan AC, Wong C. Chronic fatigue syndrome: oxidative
stress and dietary modifications. Altern Med Rev 2001;6(5):450-459.
Heap LC, Peters TJ, Wessely S. Vitamin B status in
patients with chronic fatigue syndrome. J R Soc Med
Lapp CW, Cheney PR. The rationale for using high-dose
cobalamin (vitamin B-12). CFIDS Chronicle Physicians’ Forum 1993;Fall:19-20.
Kodama M, Kodama T, Murakami M. The value of the
dehydroepiandrosterone-annexed vitamin C infusion treatment in the clinical
control of chronic fatigue syndrome (CFS). In Vivo
Richards RS, Roberts TK, Mathers D, Dunstan RH, McGregor
NR, Butt HL. Investigation of erythrocyte oxidative damage in rheumatoid
arthritis and chronic fatigue syndrome. J CFS 2000;6(1):37-46.
Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium
and chronic fatigue syndrome. Lancet 1991;337:757-60.
Jessop C. Clinical features and possible etiology of
CFIDS. CFIDS Chronicle 1991;Spring:70-73.
Rona ZP. A natural fibromyalgia treatment protocol.
Immunesupport.com, Feb. 22, 2002.
Teitelbaum J. Treatment protocol for CFS/FM.
Immunesupport.com, Feb.13, 2002.