Deficiencies in CFS & FMS Patients

[Guest guest]

" Deficiencies Chronic Fatigue Syndrome & Fibromyalgia Patients Can

Deal With: Studies show CFS 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 micronutrients — vitamins,

minerals and essential amino acids— to operate properly. If you have

a chronic illness like chronic fatigue syndrome or fibromyalgia,

you're especially prone to nutritional deficiencies; in fact, if you

have any physical disability, you're more likely to be deficient in

vitamin C, for example.(1)

Most nutritionists would agree that even sub-clinical deficiencies —

those at the bottom end of normal — can seriously effect your health.

" It's likely that marginal deficiencies not only contribute to the

clinical manifestations of [chronic fatigue] syndrome, but also are

detrimental to the healing processes, " explains Melvin R. Werbach,

M.D., a physician, psychiatrist and scientist from the from the UCLA

School of Medicine who suggests CFS patients are deficient in many

essential substances. Werbach's monthly column on nutritional

medicine appears in the International Journal of Alternative and

Complementary Medicine in the UK and is reprinted in the U.S Townsend

Letter for Doctors and Patients and the Australian Journal of

Nutritional and Environmental Medicine.

Sometimes—not always— science can help you determine which

supplements you need. 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 awhile, he can measure how

you're doing with another blood test.

But it's not always so simple. For example, doctors can test for

magnesium levels in the blood, although most of the magnesium in your

body is in bone and soft tissues.(2) If you have anemia, blood tests

will show an obvious B-12 deficiency; but since some researchers

believe even sub-clinical levels (those at the bottom of the normal

range) can cause severe fatigue,(3) many CFS specialists recommend a

trial of B-12 for most of their patients anyway.

The smart thing to do is enlist your physician and perhaps a

nutritionist to help you figure out what your individual nutritional

needs are and how best to meet them. It's also helpful to have a

pharmacist available who can tell you about any potential

interactions between the herbs, supplements and prescription or over-

the-counter medicines you take.

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. "

How do you know which supplements to take?

Those of us with CFS/FM usually have deficiencies as a result of

those illnesses— one study done in 2000 by Werbach suggests we're 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 diets. " (4)

Werbach suggests identifying deficiencies with objective testing when

possible, treating them effectively, and testing again after

treatment to ensure the deficiencies get resolved. But when that's

impossible, he suggests supplementing CFS patients with these

nutrients, along with a general high-potency vitamin/mineral

supplement, at least for a trial period.(4)

Why? " Because it's often difficult to rule out marginal deficiencies,

because serious adverse reactions are rare, and because nutritional

supplements offer a therapeutic benefit, " he said in his study.

In other words, it probably won't hurt and it's likely to help.

But that doesn't mean you should take every new thing that's

advertised as the next big cure. Instead, look at the science that's

being done and try those things that clinical research says might be

helpful.

Dr. Darryl M. See, M.D, a CFS specialist from California, suggests

that PWCs use " only those supplements that have been tested in a

laboratory. "

Most long-term chronic illness patients have learned to try something

for a relatively short period of time, gauge its effectiveness, and

stop taking it if it's not showing a clear health benefit.

" Sometimes it takes a few tries to be sure if something works —the

benefit may be small but worth it; and sometimes you only realize

something was helping you in retrospect, " says Connie Bladeo, a long-

term PWC from Arkansas whose current regimen includes B-12 shots, a

multi-vitamin and mineral mix and a powdered amino acid drink.

Because a number of recent studies have shown oxidative stress to be

a problem for CFS patients,(5) antioxidants are an important

treatment option. One study specifically mentions glutathione, N-

acetylcysteine, alpha-lipoic acid, oligomeric proanthocyanidins,

ginkgo biloba, and vaccinium myrtillus (bilberry) to be beneficial.

(5)

Other studies show we're deficient in growth hormone and NADH. We'll

take a detailed look at many of these substances later, but first

let's talk about proper dosing and efficacy.

How much to take?

This is a real issue with many CFS/FM patients, as well as those with

Irritable Bowel Syndrome and Multiple Chemical Sensitivity, because

many of us are sensitive to many substances.

" A PWC never can tell how they'll react to a supplement, so trial and

error are necessary, " said Dr. See.

In fact, it's common for people with these chronic illnesses to be so

sensitive that even a tiny amount of a drug, supplement or substance

will effect us the way a full dose would effect a healthy person.

This may mean that you should start out with lesser amounts.

Jeanne Redmon, a PWC for 30-plus years who now lives in Georgia, has

become increasingly more sensitive to supplements during the course

of her illness. The only thing she's been able to take consistently

is Tylenol #3.

" I hope I never become unable to take it, " said Jeanne.

While there are some physicians who believe in mega-dosing (taking

much higher amounts than the US Recommended Dietary Allowances), most

doctors recommend staying at or near the RDA unless research backs up

the validity of taking more and you have a medical reason for taking

higher amounts.

" Stay within recommended dosages, which are usually conservative,

unless your doctor recommends otherwise, " says Degnan, M.D., an

Associate Professor in Family and Community Medicine at Dartmouth

Medical School, and a practicing integrated medicine specialist at

Equinox Health & Healing in Portsmouth, NH. " As the number of users

of nutritional supplements and herbal preparations rise, there are

increasing reports of both efficacy and side effects. It's important

that people taking herbs and supplements work with experienced and

knowledgeable practitioners, especially if there are complicating

medical problems and prescription medication use. "

Experts say if you've ever been sensitive to a drug, herb or

supplement before, start out with 1/8 or 1/4 of a normal dose and

work your way up to either the dose that your body can tolerate or

the recommended amount.

Bobbie Sellers, a PWC and an ex-nurse from San Francisco, finds " with

supplements it is best to start low and work up to dosage

recommended. Even those that help can sometimes cause temporary

physical problems unless the dosage is slowly increased, " she said.

How can you tell if it's working?

Most long-term CFS/FM patients will tell you to begin only one new

supplement at a time. If you start taking three things at once, how

will you know which is helping or hurting you if you begin to show

new symptoms?

Sellers will try something new for 3-6 months, if it doesn't cause an

unpleasant reaction; she usually notices the effects of a new drug or

supplement " when a symptom goes away or somehow my condition improves

in a noticeable way. "

Write down when you begin taking something on a calendar or datebook;

if you pay attention to symptoms, write those down, too. That way,

you'll be more likely to see patterns or trends. Ask your family and

friends to help you determine if something is helping you — you may

not be as aware of a benefit in cognition as those around you.

Vitamins

Vitamins are nutrients in foods that assist essential biochemical

reactions within your body. There are 13 vitamins: Four fat-soluble—

A, D, E, and K— which your body stores up to four for months; and

nine water-soluble: C (ascorbic acid), and the B-complex vitamins:

B1, B2, B3 B5, B6, B12, folic acid and biotin. Your body is able to

store enough of these vitamins to last for several weeks.

B complex vitamins

The B complex vitamins are essential for the synthesis and repair of

your genes. Vitamin B1 (thiamine) helps the nervous system operate

properly, and with appetite and energy processes. Every cell of the

body requires vitamin B1 to form ATP —the fuel the body needs.(6)

Vitamin B2 (riboflavin) helps the body's oxidation processes and is a

key component in certain enzymes. It's important in proper health of

the skin and eyes and in energy production. Vitamin B-3 (niacin) is

important to the proper functioning of the skin, the nervous system

and mental performance. Vitamin B-5 (pantothenic acid) develops

acetylcholine, a neurotransmitter that helps the adrenal glands

operate.

Vitamin B-6 (pyridoxine) helps metabolize protein and fat and is

needed to make red blood cells and in hemoglobin synthesis. B-12

(cobalamin) is a part of this group, but I talk about it separately

below.

Research

One study found preliminary evidence of reduced functional B vitamin

levels, particularly pyridoxine (B-6), in CFS patients.(7) Women with

premenstrual syndrome have also shown B-6 and magnesium deficiencies,

and after taking supplements, many showed improvement in symptoms,(8)

especially mood changes,(9) and depression, irritability and

tiredness were reduced as well, with no side effects.(10,11)

In some studies Vitamin B6 supplements were useful in treating

headache, chronic pain and depression, all of which are associated

with serotonin deficiency. This makes sense, since B6 raises

serotonin levels.(12)

US Recommended Dietary Allowance (RDA):

B-1: 1.5-2 milligrams per day.

B-2: 1.7 mg. per day.

B-3: 20 mg. per day.

B-5: 10 mg. per day.

B-6: 1.6 milligrams per day for women 19-50 years of age and 2

milligrams for men 19-50 years of age.

B-12: (see below)

Recommendation: The B vitamins work synergistically, so nutritionists

suggest you take a B-complex vitamin or other multivitamin supplement

which contains at least the US RDA of each of the B-complex vitamins.

The amount of B vitamins found in many multivitamin supplements is

more than adequate for most people. (Women with PMS may want to make

sure they take extra magnesium with their B-complex vitamin just

before their periods.)

B-12

Vitamin B12, also known as methylcobalamin, is important for

producing new blood cells and some chemicals the nervous system needs

to operate. B-12 is directly involved in synthesis of genetic

material (DNA).

Research

Reports,(13) including high-quality, double-blind ones, have shown

that even people who aren't deficient in B12 have more energy after

vitamin B12 shots; so many physicians urge patients with fatigue to

try a trial of B-12 to see of it helps.(14) Some discourage those

without an obvious deficiency from taking B12 shots despite the

evidence of efficacy.(15)

In one preliminary trial, 2,500-5,000 mcg of vitamin B12 given by

injection every two to three days led to improvement in 50-80 percent

of a group of People With CFIDS (PWCs); most improvement appeared

after several weeks.(16) Oral or sublingual B12 supplements are

unlikely to obtain the same results as injectable B12, because the

body's ability to absorb large amounts is relatively poor.(17)

One small preliminary study found that CFS and FM patients had

increased levels of homocysteine in their cerebrospinal fluid, which

the study authors believed to be due to low levels of B-12 in the

fluid.(18) This study also found a correlation between homocysteine

and fatigue levels. (Vitamin B12 acts with folic acid and vitamin B6

to control homocysteine levels. An excess of homocysteine may

increase the risk of heart disease, stroke, and perhaps osteoporosis

and Alzheimer's disease.)

Dr. Britt Ahlrot-Westerlund from Sweden has had success treating CFS

and FM with methylcobalamin. She uses it conjunction with folic acid,

Vitamin B6 and antioxidants.

US RDA: 2 mcg. (2.2 for pregnant and lactating women in the first six

months and 2.6 for the last six months)

Recommendation: Although shots are most effective, sublingual

lozenges are also helpful, especially for those who can't take shots.

Take either a shot of 1000-5000 mcg. hydroxycobalamin (which some

patients say stings) or cyanocobalamin, or one sublingual dose of

1000 mcg. B-12 per day.

Vitamin C

Vitamin C mobilizes your body's self-defense mechanisms that assist

your immune system in overcoming disease. It is also a powerful

antioxidant required to produce collagen, the main supportive protein

in cartilage, tendon and connective tissue. A potent antioxidant,

Vitamin C is also credited with destroying or minimizing the effects

of free radicals and nitrosamines related to carcinogens.

Although most animals manufacture their own vitamin C — on average, a

150-pound animal produces 4,000 to 13,000 mg. of vitamin C daily—

human beings are among only a handful of animals that do not.

(Researchers believe that a genetic accident occurred 25 millions

years ago in one of our evolutionary ancestors, eliminating our

ability to produce this vitamin.)

Research

Studies show that people do respond very well to 1-6 grams daily of

vitamin C: Their risk of heart disease and cancer decreases, they

manage diabetes and other chronic, systemic illnesses better and they

live longer. An interesting 1996 Japanese study showed that CFS

patients improved after taking intravenous infusions of vitamin C and

DHEA.(19) In Dr. Stoff's study of 1,357 patients, which he

treated using 1000 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.(20)

US RDA: 60 mg. per day.

Recommendation: Nutrition Reporter™ Jack Challem suggests humans

should take about the same amount as gorillas, among our nearest

biological relatives, who eat about 4,000 mg. of vitamin C daily in

the wild. Take between 1-6 grams of Vitamin C daily. Break it up into

even doses over the course of the day.

Vitamin E

The two most well known antioxidants are vitamin C and E. Thousands

of research reports have been published in scientific journals all

over the world about their importance to health. Vitamin C is water

soluble and is important in protecting the " aqueous " parts of our

cells and tissues, while vitamin E is oil soluble and protects

the " lipid " portions, especially cellular membranes. Prevents

oxidation of proteins, fats and vitamin A, protects red blood cells.

Research

A study in 1993 found that Vitamin E reduces the risk of stroke and

heart attack by 57 percent and 52 percent. A survey of the members of

the American Heart Association showed that over 62 percent of them

are taking Vitamin E. With recent research showing that CFS patients

may have a higher risk of heart disease,(21) Vitamin E is a potent

antioxidant that should be in every PWC's regimen.

Dr. Zoltan P. Rona, M.D., MSc believes that in low doses (under 800

I.U. per day), vitamin E may have little or no effect on auto-immune

disease. In doses well above 2000 I.U., vitamin E weakens (down

regulates) autoimmune disease. (She considers CFS/FM a probable

autoimmune disease.)(22)

US RDA: 10 mg for males and 8 mg. for females (10 mg. for lactating

women)

Recommendation: Take 400-800 IU of Vitamin E once each day.

Minerals

Minerals are often overlooked in nutritional programs, but they

shouldn't be. In fact, without minerals, vitamins are useless. In

their dissolved state, minerals— known as electrolytes or ionized

minerals— create and maintain a healthy internal environment which

allows other nutrients to do their jobs.

Minerals work with enzymes, hormones, vitamins and other vital

transport substances, and participate in nerve transmission; muscle

contraction; the maintenance of cell permeability, tissue rigidity

and structure, and acid-base balance; blood formation; fluid

regulation and movement across cell membranes; protein metabolism;

and energy production.

Many minerals such as zinc, copper, selenium, and manganese are

antioxidants, protecting against the damaging effects of free

radicals. They scavenge these highly reactive radicals and change

them into less harmful compounds, helping to prevent cancer and other

degenerative diseases such as premature aging, heart and autoimmune

and Alzheimer's diseases, arthritis and cataracts.

Magnesium

Magnesium deficiency can cause dysregulation of the immune and

autonomic nervous systems, and clinical or experimental magnesium

deficiency produces fatigue, depression, poor exercise tolerance,(23)

and decreased resistance to psychological stress.(24)

Research

One study estimated that 15-20 percent of the population have a

magnesium deficit because most people manage to ingest only slightly

more than 4 mg/kg day versus the Recommended Daily Allowance (RDA) of

6 mg/kg day.(25)

" The average daily need for magnesium for an adult is between 500-

1000 mg. and a lot of people simply aren't taking in that much, " said

Dr. Sidney Mac Baker, a scientist who researches the mineral.

For his patients, Baker recommends 1-2 teaspoons a day of a 25

percent solution of oral magnesium chloride, diluted in water or

another liquid to make it palatable. After a good response, he

sometimes switches patients to Searle's Slow-Mag, the pill form of

magnesium chloride.

Leo Galland, M.D., a former associate of Dr. Baker, recommends

protecting your magnesium stores by avoiding what he calls " the

magnesium wasters: " — saturated fats and soft drinks, especially those

containing caffeine.

In a 1991 study carried out in the United Kingdom, investigators

described the efficacy of intramuscular magnesium in people with CFS.

(26) In a randomized, double-blind, placebo-controlled trial, 20

patients with CFS had lower red cell magnesium levels than 20 healthy

control subjects matched for age, sex and social class.

At the November 1990 CFIDS Conference in Charlotte, N.C, Dr. Carol

Jessop commented, " Low magnesium levels are common and can only be

found using a test whereby you collect a 24-hour urine sample to test

for magnesium. You then load the patient with 400 -500 mgs. of

magnesium a day for three days. You take another magnesium urine test

on the third day to see how much the body retains. If they retained

greater than 50 percent, it is significant because magnesium is very

important in muscle relaxation. Many of my fibromyalgia patients

improved with the addition of magnesium to the diet. "

A study in Paris(27) found a link between magnesium deficiency,

chronic fatigue syndrome and mitral valve prolapse (MVP), an

abnormality in which the valve between the heart's left atrium and

ventricle malfunctions or is weakened and blood cannot circulate

through the heart in the way it should. As many as 75 percent of

those with fibromyalgia have MVP, say experts.

But only some MVP sufferers respond to magnesium treatment. Magnesium

supplements may not always work because they're alkaline and can

neutralize the hydrochloric acid in the stomach. Nutritionist Adelle

is just one nutritionist who has noted that people with

digestive problem shouldn't take magnesium supplements for this

reason.

Dr. Zoltan P. Rona, M.D., MSc, believes magnesium deficiency is quite

a common finding in conditions like FMS despite a high magnesium

intake through the diet or supplementation.(22) He attributes that to

leaky gut syndrome, which creates a long list of mineral

deficiencies, including magnesium, because the various carrier

proteins present in the gastrointestinal tract that are needed to

transport minerals from the intestine to the blood are damaged by the

inflammation process in CFS/FM. He said if the carrier protein for

magnesium is damaged, magnesium deficiency develops as a result of

malabsorption. Muscle pain and spasms can occur as a result.

Recommendation: Magnesium 250 mg 3 times daily has produced very good

results in fibromyalgia.(28,29) It may be combined with malic acid,

1200 - 2400 mg daily. Dr. Teitelbaum's treatment protocol for

CFS/FM calls for 2 tablets of Pro Energy (a magnesium/malic acid

supplement) 3 times a day for 8 months, then 2 tablets a day (less if

diarrhea is a problem). He recommends starting with 1-2 a day and

slowly working your way up as able without getting uncomfortable

diarrhea. (He points out that you can take up to 10 a day for

constipation and that taking it with food may lessen diarrhea.) Pro

Energy is available from www.immunesupport.com or dial .

Sodium

Sodium helps regulate blood pressure and water balance in the body.

In people who are sensitive to it, sodium can elevate blood pressure.

Many CFS specialists tell their patients with neurally mediated

hypotension (NMH) to eat extra salt and drink lots of water (two to

three quarts a day ) as a way to naturally increase blood volume. NMH

is an autonomic system dysfunction in which blood doesn't pump up to

the brain when you stand; instead it pools in your legs, denying your

brain the blood, and hence, the oxygen it needs to operate normally.

People with severe NMH can faint when standing too quickly and often

find that taking hot showers or baths makes them feel woozy. If you

have these symptoms, have your doctor schedule you for a tilt table

test, which is how doctors determine if you have NMH or any other

orthostatic intolerances (OI).

Research

In several controlled studies, CFS patients had a higher rate of OI

than healthy controls.(30,31,32,33,34) In one preliminary study, most

of those with NMH were helped by additional salt intake (saline).(35)

Klimas, MD, a Professor of Medicine at the University of Miami

VA Medical Center who conducts research on immunologic abnormalities

in CFS, pointed out at a recent conference that if the patient has a

positive tilt-table test and increasing salt and water makes her feel

better for a few weeks, the kidneys become efficient at getting rid

of the extra sodium. When that happens, Klimas prescribes

fludrocortisone (Florinef). Another route is to prescribe alpha1-

agonists, such as pseudoephedrine. She said the most selective alpha1-

agonist is Midodrine.

US RDA: Experts recommend that healthy people not take more than 2400

milligrams a day.

Recommendation: If you have NMH, buy buffered salt tablets available

at any pharmacy and follow your physician's directions in taking

them. (Dosage instructions are highly dependent on your individual

health concerns.) If they don't help, you may need a prescription

medication. Many with NMH find their symptoms get worse in summer or

other hot conditions. Don't forget to drink lots of water — taking

extra salt without extra water isn't nearly as helpful.

Zinc

Next to iron, zinc is the second most abundant trace mineral in the

body. It's important in the activity of enzymes needed for cell

division, growth and repair (wound healing, for example), as well as

proper functioning of the immune system. Zinc also plays a role in

the acuity of taste and smell, the metabolism of carbohydrates, and

the replication on DNA.

Research

In a conversation between physician and author G. Crook,

M.D., (The Yeast Connection) and Dr. Davies, editor of the

Journal of Nutrition in Medicine, in August 1991 that appears on Dr.

Crook's website, Dr. Davies noted that " CFS patients are nearly

always deficient in magnesium. Our research studies show that they're

frequently deficient in zinc and copper, too. "

At the November 1990 CFIDS Conference held in Charlotte, N.C., Dr.

Carol Jessop commented, " Low zinc levels are common, although only 32

percent of patients show this on the blood tests. "

She pointed out that blood tests are not as accurate as sweat tests,

which are hard to do in the office.

" But many patients either have poor wound healing or leukonychia

(white spots on the fingernails) which are signs of zinc deficiency, "

she said. " Both of these trace minerals are absorbed in the gut and,

I think, are being malabsorbed by our patients. "

Dr. Zoltan P. Rona, M.D., MSc, believes CFS/FM can cause zinc

deficiency due to malabsorption, which can result in hair loss or

baldness as occurs in alopecia areata, another autoimmune disease.

(22)

US RDA: 15 mg. For males, 12 for females. (lactating women should

take 19 mgs. In the 1st six months and 16 mgs. in the second six

months)

Recommendation: Take a 15-25 mg. zinc supplement every day.

Amino acids

The human body, minus water, is 75 percent amino acids. All of the

neurotransmitters (proteins) but one are composed of amino acids; and

95 percent of hormones are amino acids. Amino acids are key to every

human bodily function with every chemical reaction that occurs.

" Amino acids are incredibly important, " said Dr. Darryl M. See, M.D,

a CFS specialist from California. " No PWC absorbs amino acids well. "

Glutathione

A potent antioxidant, glutathione eliminates free radicals,

detoxifies and removes heavy metals like lead, mercury and cadmium

from the body, recycles oxidized vitamin C back to useful vitamin C,

and protects cells from damage from oxidative stress.

Research

A healthy person produces several grams of glutathione daily, but Dr.

Salvato of Houston, Texas, has found that CFS patients are

often deficient. It may help to take magnesium and glutathione

together: in a high-quality study in Belgium, patients who were

magnesium deficient (47 percent) had significantly lower total

antioxidant capacity in their blood. Magnesium deficient patients

whose magnesium stores didn't improve even after oral supplementation

with 10 mg magnesium per day also had persistently lower blood

glutathione levels.(40)

Recommendation: Have your physician do a whole blood glutathione or

glutathione peroxidase test. If they're low, Dr. Salvato reports that

oral glutathione does not enter the cells even taken in massive doses

and proposes intramuscular injections instead. Some CFS patients have

taken 100 mg. glutathione combined with 1 mg. of ATP injections twice

weekly with good results. (In a study of 276 CFIDS patients —218

women and 58 men— who received weekly injections of glutathione/ATP

injections, 82 percent (226 patients) reported less fatigue and 196

experienced improvement in memory and concentration, while 171

experienced lower levels of pain. A few patients had heart

palpitations thought to have come from the ATP.)

Get the compounded injections from Family Pharmacy () or

College Pharmacy (). You'll need a prescription. If you

don't want to take the shots, you could try 500 mg. of reduced

glutathione once or twice daily (Positive Health News, Spring 1998

recommends Jarrow Formulas brand.)

Dr. Teitelbaum's protocol calls for 500 mg. of NAC (N-Acetyl -

L -Cysteine) each day for 9 months, then as needed; or 200-250 mg.

glutathione a day. (He considers the glutathione better than NAC but

realizes it's more expensive.) (24)

NADH

NADH (nicotinamide adenine dinucleotide) is an enzyme facilitator

that occurs in all living cells and plays a central role in the

body's energy-producing capacity. NADH also helps make ATP, the

energy source the body uses for fuel.

Research

In a small randomized, double-blind, placebo-controlled crossover

study, PWCs received 10 mg. of NADH or a placebo every day for four

weeks; 31 percent of the PWCs who got the NADH reported improvements

in fatigue, decreases in other symptoms, and improved overall quality

of life, compared with only 8 percent of those who received a placebo.

(36) The statistical analysis of this study was subsequently

challenged, however.(37)

NADH has also been shown to reduce the effects of jet lag on

cognitive performance and sleepiness.(38)

Recommendation: Take 10 mg. NADH every morning. Many PWCs use the

Enada brand, because that what's was used in the research study.

Growth Hormone

The anterior pituitary gland produces a hormone called somatotropin,

known as " human growth hormone " (HGH), which your body uses by

converting it into an insulin-like growth factor (IGF-1) for tissue,

bone, muscle generation and generally maintaining healthy bodily

functions. Your pituitary gland released HGH most heavily in your

teens, but as you age, however, production of HGH decreases.

It's interesting to note how similar CFS and acquired growth

deficiency symptoms are. GH deficient patients' muscle mass and

muscle strength are diminished, with a resulting striking decline in

exercise capacity. They also suffer from lack of concentration and

memory impairment. Self-rating questionnaires consistently

demonstrate reduced vitality, fatigue, social isolation and

depression, but they're unsure whether that's due to GH deficiency or

to another factor associated with hypopituitarism. Most of these

symptoms improve after 6 months of low-dose growth hormone therapy.

(39)

G. s, DO, of Dallas, said growth hormone " has made

treating those with CFIDS and some of my other patients much easier

because now we can help the person's body regain and recapture some

years. "

Research

ME patients with low growth hormone levels who took growth hormone

showed no improvement in the quality of life in one study.(40) In one

small preliminary study of just 14 patients, Cheney and Keever

reported that of the 14 patients with CFS who were treated with a

growth hormone secretagogue (to raise IGF-1 levels), 57 percent noted

a beneficial response.(41) Another study by the same group concluded

that it isn't clear whether the tendency for impaired nighttime

growth hormone secretion in patients with CFS is a cause or an effect

of the condition.(42)

Despite anecdotal reports of improvement with bovine (from cows)

growth hormone in selected CFS patients with low GH levels, at the

AACFS Conference in Seattle, Wash., in January 2001, participants in

a panel discussion agreed that treatment remains controversial

because of side effects.

A study of 51 women with fibromyalgia and low levels of insulin-like

growth factor was split into two groups. One was given injections of

growth hormone (up to 250 ng/mL) the other a placebo. Twenty-three

patients in the treatment group, 11 of whom fulfilled criteria for

CFS, showed a significant improvement over the placebo group at 9

months on measures of symptoms and disability.(43) (There was often a

delay of 6 months before improvements were noted.) After

discontinuing treatment, there was a worsening of symptoms. Adverse

reactions included carpal tunnel symptoms.

Recommendation: If you have fibromyalgia, it might be worth trying,

but otherwise, wait for more conclusive research.

DHEA

Dehydroepiandrosterone, commonly known as DHEA, is a hormone now

available as a supplement. It influences cognition, along with metals

such as aluminum, iron, and zinc. DHEA should not be used without the

supervision of a healthcare professional.

Research

In one study, DHEA levels were found to be low in PWCs.(44) Another

study found that while DHEA levels were normal in a group of CFS

patients, they were unable to increase their DHEA level in response

to hormonal stimulation.(45) Whether supplementation with DHEA might

help CFS patients is yet to be studied.

Another study found that women with CFS showed significantly lower

iron and DHEA levels in the blood than controls. Total cholesterol

level, on the other hand, was significantly increased, and

significantly negatively correlated with dehydroepiandrosterone

sulphate.(46)

Recommendation: Have your doctor test your iron and DHEA levels and

supplement if necessary. Since CFS patients may have a higher risk of

developing cardiovascular disease, have your cholesterol levels

checked regularly, especially if you're over 40.

Carnitine

Carnitine is essential for mitochondrial energy production. Without

enough carnitine, a person's cells can't break down fatty acids or

remove toxic wastes.

Research

A 1994 Japanese study done at Osaka University Graduate School of

Medicine showed CFS patients had an acylcarnitine deficiency.(47) A

year later, a study done by AV Plioplys of Mercy Hospital and Medical

Center in Chicago found CFS patients had significantly lower serum

total carnitine, free carnitine and acylcarnitine levels, and found a

correlation between levels of total and free carnitine and symptoms.

(The higher the carnitine levels, the better people felt.) (48)

A 1998 Japanese study found low levels of acylcarnitine in the blood

of CFS and Hepatitis C patients, but not in some other diseases;(49)

a study by the same team a year later found lower levels of serum

acylcarnitine in CFS patients but not in a majority of patients with

fibromyalgia.(50) A Dutch study done by a team at the University of

Nijmegen in the Netherlands in 2000 which measured the levels of

total carnitine, free carnitine, acylcarnitine and carnitine esters

in 25 female CFS patients and 25 healthy, matched controls found

normal levels in PWCs, however.(51) One study found oral L-carnitine

supplementation improved many CFS symptoms after just eight weeks of

treatment.(52)

Medical studies and doctors treating fibromyalgia have found that

supplements which cause a decrease in glutamate, or protect against

its effects, have a positive effect. Some that have been found to be

effective include vitamin B6, B12, L-carnitine, choline, ginseng,

Ginkgo biloba, vitamins C and E, nicotine, and omega 3 fatty acids

(fish and flaxseed oil-GLA,EPA,DHA).(53)

Recommendation: If you can get a prescription from your doctor for

Carnitor, you'll know exactly what you're getting in each pill: 330

grams of levocarnitine. Take 3 pills twice a day. Otherwise, take a

commercial brand with roughly the same amount.

Drug-induced nutritional deficiencies

Don't forget that both prescription and over-the-counter medications

can deplete the body of vitamins and minerals. Susceptibility to

these drug-induced nutritional deficiencies depends on numerous

things, including your disease state(s), what other drugs you're

taking, how much of those drugs you're taking, your diet, and whether

you use alcohol, street drugs, or nutritional supplements, to name

just a few.

For a complete list of drug-induced nutritional deficiencies, go to

http://www.vitamin.com/vandsinfo/interactions/

*Posted by Moderators