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Chronic Fatigue Syndrome

Regaining Energy Through Nutrition

In most cases, CFS symptoms gradually improve over time. Life Extension believes that the best approach to CFS is to boost energy levels and support healthy immune function. A full evaluation of hormonal status can also be considered, with blood tests measuring the levels of hormones such as DHEA, pregnenolone, estrogen, testosterone, and others. If levels are low, bioidentical hormone replacement may be helpful. For more specific information on hormone restoration, see “Female Hormone Restoration” and “Male Hormone Restoration protocols.”

Several nutrients have been suggested to be deficient in CFS patients, including B vitamins, antioxidants, vitamin C, magnesium, sodium, zinc, L-tryptophan, L-carnitine, CoQ10, and essential fatty acids. Nutritional deficiencies influence the symptoms of the syndrome as well as the recovery process (Bounous 1999; Grimble 1994; Vecchiet 2003).

Fighting Fatigue: The Leading Candidates

Free radicals and other potent oxidants may contribute to the development of CFS. One study showed that protein oxidation was significantly elevated in the blood of CFS patients (Smirnova 2003).

A number of studies have looked at nutrients or hormones with immune-boosting properties and found promising results with CFS. In one study conducted at the University of Iowa, 155 patients with CFS were asked to report on their care regimens, including prescription medications, yoga, and nutrients. Three supplements in particular appeared to be beneficial (Bentler 2005).

Coenzyme Q10. Coenzyme Q10 (CoQ10) is a potent antioxidant that aids in metabolic reactions, including the process of forming adenosine triphosphate (ATP), the molecule used by the body for energy.

In one study of 20 female patients with CFS (requiring bed rest following mild exercise), 80 percent were deficient in CoQ10. After three months of CoQ10 supplementation (100 mg/day), exercise tolerance more than doubled, 90 percent had reduction or disappearance of clinical symptoms, and 85 percent had decreased post-exercise fatigue (Judy 1996).

In the University of Iowa study, CoQ10 emerged as the leading therapy for CFS, with 69 percent of patients reporting it was helpful.

DHEA. DHEA has also been singled out for its ability to help CFS patients. The DHEA levels of many CFS patients are low compared to optimal ranges (van Rensburg 2001; Scott 1999b). One study speculated that DHEA deficiency might be related to CFS symptoms (Kuratsune 1998).

Produced primarily by the adrenal glands, DHEA is a valuable hormone whose levels decline with age. DHEA has been shown to improve energy levels in chronic fatigue patients (Kuratsune 1998). Studies have demonstrated the following:

  • In a study of 15 subjects with CFS, 15 subjects with major depression, and 11 healthy subjects, DHEA levels were significantly lower in the CFS subjects compared to the healthy group. The authors concluded that DHEA has a potential role both therapeutically and as a diagnostic tool in CFS (Scott 1999b; Scott 1999a).
  • Another study of DHEA levels in 22 CFS patients found normal DHEA levels but a blunted serum DHEA response curve to adrenocorticotropic hormone (ACTH) injection. ACTH normally stimulates the adrenal glands to secrete DHEA. The authors concluded that endocrine abnormalities may play a role in CFS (De Becker 1999). See the Stress Management protocol for more information.

Nutrient Deficiencies

CFS patients are also frequently deficient in a number of other vital nutrients. While the research is not exhaustive, CFS-related deficiencies may be helped through supplementation.

Vitamin B6. Some data provide evidence of reduced functional B vitamin status, particularly of pyridoxine (vitamin B6) in CFS patients (Heap 1999).

Folate. An article in the journal Neurology described a study in which folate levels were measured in 60 patients with CFS. Researchers found that 50 percent of patients had values below 3.0 mcg/L (Jacobson 1993).

Glutathione. Glutathione has been shown to help prevent damage to DNA and RNA, detoxify heavy metals, boost immune function, and assist the liver in detoxification. Levels of intracellular glutathione decrease with age.

  • An article in the Medical Hypotheses journal proposed that glutathione may be depleted in CFS patients. The authors proposed that glutathione depletion also causes the muscular fatigue and myalgia associated with CFS (Bounous 1999).
  • Cysteine is a precursor to glutathione. It has been hypothesized that glutathione and cysteine metabolism may play a role in skeletal muscle wasting and muscle fatigue. The combination of abnormally low plasma cysteine and glutathione levels, low natural killer cell activity, skeletal muscle wasting or muscle fatigue, and increased rates of urea production define a complex of abnormalities that is tentatively called “low CG syndrome.” These symptoms are found in patients with HIV infection, cancer, major injuries, sepsis, Crohn’s disease, ulcerative colitis, CFS, and to some extent in over-trained athletes (Droge 1997).

Supplements used to raise cellular glutathione levels include N-acetylcysteine (NAC) (with vitamin C), lipoic acid, whey protein, L-cysteine, and glutathione.

Lipoic acid. Lipoic acid is known as the “recycler” antioxidant because it can restore the antioxidant properties of vitamins C and E after they have been neutralized by free radicals. It also stimulates the production of the antioxidant glutathione and helps in the absorption of CoQ10 (Balch 2000; Hendler 2001; Jamison 2003). The body produces glutathione in limited amounts.

Essential fatty acids. Essential fatty acids are the fatty acids that cannot be made by the body. Essential fatty acids are crucial for rebuilding and producing new cells, and required for normal brain development (Balch 2000).

  • The use of essential fatty acids for post-viral CFS was examined in a double-blind, placebo-controlled study of 63 adults. The patients had been ill for one to three years after an apparent viral infection and had severe fatigue, myalgia, and a variety of psychiatric symptoms. Study subjects received either placebo or a preparation containing linolenic, gamma-linolenic, eicosapentaenoic (EPA), and docosahexaenoic (DHA) acids (eight 500-mg capsules daily) over a three-month period. The treatment group showed continual improvement, compared with uneven results in the placebo group (Behan 1990). The essential fatty acid composition of the subjects’ red cell membrane phospholipids was analyzed at the first and last visits. The essential fatty acid levels were abnormal at baseline and corrected by active treatment. The authors concluded that essential fatty acids provide a rational, safe, and effective treatment for patients with post-viral CFS.
  • In a case series of CFS patients, researchers administered essential fatty acids with other treatment protocols and observed a 90 percent gain in improvement within three months among two-thirds of CFS patients (Gray 1994).

Energy Boosters

A number of nutrients have been studied for their ability to boost cellular energy—a possibly important concern among CFS patients. These include the following:

NADH. Reduced B-nicotinamide dinucleotide (NADH), along with CoQ10, is essential for the production of cellular energy.

  • A randomized, double-blind, placebo-controlled crossover study examined the use of NADH in CFS: 26 eligible patients diagnosed with CFS received either 10 mg of NADH or placebo for a four-week period. Eight of 26 (31 percent) responded favorably to NADH, in contrast to two of 26 (8 percent) to placebo (Forsyth 1999).

L-carnitine. Although the research is somewhat inconsistent, several studies have found deficiencies of the amino acid L-carnitine among CFS patients. L-carnitine is known to boost energy levels. The lack of consistency in research suggests a number of other nutritional deficiencies, including carnitine, B-complex vitamins, essential fatty acids, L-tryptophan, zinc, magnesium, and others, may be related (Werbach 2000).

  • Studies show that carnitine given as a supplement to CFS patients results in better functional capacity and lessening of disease symptoms (Plioplys 1995; Plioplys 1997). Other studies have shown a dose of 1000–2000 mg daily has resulted in improvement (Kelly 1998; Werbach 2000).
  • Acetyl-L-carnitine relieved mental fatigue, and propionyl-L-carnitine alleviated general fatigue in a study comparing the two in CFS patients (Vermeulen 2004).

Magnesium. Magnesium participates in energy metabolism and protein synthesis. The body vigilantly protects blood magnesium levels, in part because 350 enzymatic processes depend on magnesium for activation. Magnesium is stored in tissues and bone, sharing skeletal residency with calcium and phosphorus (Dimai 1998).

A randomized, double-blind, placebo-controlled study was conducted of CFS patients found to have low magnesium levels. In the clinical trial, 32 CFS patients received either placebo or intramuscular magnesium sulfate weekly for six weeks. Patients treated with magnesium reported improved energy levels, better emotional state, and less pain (Cox 1991).

A new magnesium compound, magnesium -L-threonate, allows for oral administration while boosting levels of magnesium in the brain (Slutsky 2010).

However, another study found that magnesium supplementation resulted in a significant worsening of symptoms between 6 and 24 months (Bentler 2005). Although some people may find magnesium supplementation helpful, if symptoms worsen, it should be discontinued.

Glutamine. Glutamine is a conditionally essential amino acid needed during periods of excessive stress. Glutamine is the preferred energy for enterocytes, the cells lining the gastrointestinal tract. Glutamine is also one of the three amino acids necessary to make glutathione, a potent scavenger of free radicals.

  • Supplementation with glutamine might benefit chronic fatigue patients by enhancing gut motility, improving plasma glutamine levels, and boosting glutathione (Kingsbury 1998a; Kingsbury 1998b)

Rhodiola. Rhodiola (Rhodiola rosea) has been extensively studied in cell cultures, animals, and humans. It has shown anti-fatigue and depression, physical endurance, anticancer, immune enhancing and sexual stimulating effects (Brown 2002).

A study conducted at the Russian Academy of Natural Sciences demonstrated that rhodiola helps boost physical working capacity. In an animal study, an oral rhodiola extract boosted ATP content in the mitochondria of skeletal muscles, such that rhodiola-supplemented rats were able to swim 25% longer than control rats before reaching exhaustion (Abidov 2003). This is consistent with research demonstrating that rhodiola helps improve exercise endurance in humans after a single dose (200 mg of Rhodiola rosea, containing 3% rosavin and 1% salidroside) (De Bock 2004).

Similar results were observed in a study that measured capacity for mental work within the context of fatigue and stress (Shevtsov 2003). Scientists at the Centre of Sanitary and Epidemiological Inspection in Moscow gave rhodiola to 161 young cadets and measured the results using an anti-fatigue index. The results indicated a highly significant reduction in fatigue.