Supplements are a challenge for many CFSer. Often their criteria is the very subjective “if I don’t feel better, then they are not working”. If there is improvement and it takes 4 weeks, they may not be able to remember how they were, and thus perceive no improvement.

Supplements Shown to Improve CFS – Reported  by PubMed studies

I am filtering the studies to CFS, IBS and FM since they tend to be co-morbid. There are many supplements that were found to have no impact. I would recommend these supplements be used (and lab results increased to the desired level) before trying speculative supplements. Many supplements help other conditions but not CFS/FM/IBS – and in a few cases may make things worst. Be careful with items “that are good for you (general population)”, they may be contraindicted for CFS.

Very few things are reported to help all CFS patients — with the exception of Vitamin D.  To get to and keep at the recommended level, I find that I need to take 15,000 to 20,000 IU of Vitamin D3 per day. If you are low, it can take months even at that dosage to raise your level. Many things are reported low in CFS, and too frequently supplementation has no impact on symptoms.

In my next post I will look at items that help with “low level” hypercoagulation (which is reported in some 90% of CFSers). By low-level, I mean not sufficient to cause stroke or deep vein thrombosis (which a hematologist would deem to be “significant”), but sufficient to cause mental fog and fatigue.

Zinc

• Lower in CFS patients[http://www.ncbi.nlm.nih.gov/pubmed/16380690 (2005)] [http://www.ncbi.nlm.nih.gov/pubmed/16338007 (2006)]
• Associated with low Omega-3 levels
• Glutamine, N-acetyl cysteine and zinc in combination improves symptoms [http://www.ncbi.nlm.nih.gov/pubmed/19112401 (2008)]

Vitamin-D

• 22% of CFS patients are very deficient (≤20 ng/mL)http://www.ncbi.nlm.nih.gov/pubmed/21886073 (2011)
  • 61% http://www.ncbi.nlm.nih.gov/pubmed/21894355 (2011) –
  • 70% http://www.ncbi.nlm.nih.gov/pubmed/16850115 (2007)-
  • 80%http://www.ncbi.nlm.nih.gov/pubmed/21375201 (2010) of FM patients are deficient (≤20 ng/mL)
• Moderately to severely suboptimal in CFS patients http://www.ncbi.nlm.nih.gov/pubmed/20209476 (2009)
• Associated with orthostatic intolerance http://www.ncbi.nlm.nih.gov/pubmed/21886073 (2011)
• Associated with headaches, hypersomnia http://www.ncbi.nlm.nih.gov/pubmed/21206551 (2010)
• Treatment with high-dose vitamin D resulted in clinical improvement in all patients http://www.ncbi.nlm.nih.gov/pubmed/22221390 (2012)
  • improvement became more significant when their blood level of 25(OH) D exceeded 50 ng/ mL http://www.ncbi.nlm.nih.gov/pubmed/21894355 (2011)
• Patients with 25-OHD ≤20 ng/ml are more likely to have http://www.ncbi.nlm.nih.gov/pubmed/22311432 (2012)
  • impaired short memory
  • confusion
  • mood disturbance
  • sleep disturbance
  • restless leg syndrome
  • palpitation
• With myalgia in statin-treated patients, 92% were resolved when levels reached 50 ng/mL http://www.ncbi.nlm.nih.gov/pubmed/19100953 (2009)

Comment: a level of 50+ ng/mL appears to be a critical threshold for improvement, this is the level where parathyroid hormone stimulation occurs.

B12

• 40% are good responders, 60% are mild responders for B12 Injections [2015] – unbelievably, there appears to be only one study.

Coenzyme Q10

• ~ 45% of CFS patients have low levels http://www.ncbi.nlm.nih.gov/pubmed/20010505 (2009)
• Supplementation helped ~70% http://www.ncbi.nlm.nih.gov/pubmed/15889950 (2005),
• reduced headaches http://www.ncbi.nlm.nih.gov/pubmed/22532869 (2012)

• Low levels are associated with worst headaches http://www.ncbi.nlm.nih.gov/pubmed/22532869 (2012)
• Reduces blood clotting http://www.ncbi.nlm.nih.gov/pubmed/20617421 (2010)
• Improves mitochondrial function http://www.ncbi.nlm.nih.gov/pubmed/16205466 (2005)

Ginseng

• Supplementation helped 56% http://www.ncbi.nlm.nih.gov/pubmed/15889950 (2005)

Glutamine

A non-essential amino acid.

• Significant reduced, as well as ornithine (another amino acid)http://www.ncbi.nlm.nih.gov/pubmed/22728138 (2012)
• Reduced level associated with Magnesium deficiency http://www.ncbi.nlm.nih.gov/pubmed/10872900 (2000)
• Glutamine, N-acetyl cysteine and zinc in combination improves symptoms http://www.ncbi.nlm.nih.gov/pubmed/19112401 (2008)

Licorice

Spezzata (pure Licorice – Glycyrrhia).

• Reduces (TNF-α), interleukin (IL)-6http://www.ncbi.nlm.nih.gov/pubmed/22422925 (2012), and IL-1β http://www.ncbi.nlm.nih.gov/pubmed/21644799 (2011)and IL-8 http://www.ncbi.nlm.nih.gov/pubmed/18771378 (2008)
• Improves CFS symptoms http://archinte.jamanetwork.com/article.aspx?articleid=210216
• Potentiate the action of hydrocortisone http://www.ncbi.nlm.nih.gov/pubmed/1970371 (1990)
• Prolong the biological half-life of cortisol http://www.ncbi.nlm.nih.gov/pubmed/2384181 (1990)

L-carnitine

• Improvement seen after 4 weeks [1997]
• 60% response rate [2004]

Magnesium

• transdermal magnesium chloride (spray) applied on upper and lower limbs may be beneficial to patients with fibromyalgia. [2015]
• Remission seen with 2000-10000 IU/day of Vitamin D with magnesium and phosphate http://www.ncbi.nlm.nih.gov/pubmed/8138812 (1993)
• Decreased in CFS, supplementation reduces symptoms
  • http://www.ncbi.nlm.nih.gov/pubmed/1672392 (1991)
  • http://www.ncbi.nlm.nih.gov/pubmed/21982120 (2011)
  • http://www.ncbi.nlm.nih.gov/pubmed/10872900 (2000)
  • http://www.ncbi.nlm.nih.gov/pubmed/1492795 (1992)
  • http://www.ncbi.nlm.nih.gov/pubmed/1672392 (1991)
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907931/?tool=pubmed (2008)
  • http://www.prohealth.com/library/showarticle.cfm?libid=17108

Melatonin

• 3mg helped in FM http://www.ncbi.nlm.nih.gov/pubmed/10752492 (2000) http://www.ncbi.nlm.nih.gov/pubmed/17894923 (2007) http://www.ncbi.nlm.nih.gov/pubmed/21158908 (2011)
• Ambiguous results http://www.ncbi.nlm.nih.gov/pubmed/20423309 (2010)

NAC N-Acetyl-Cysteine (NAC) or acetylcysteine

• Improves 59% of CFS patients after 10-14 months http://www.ncbi.nlm.nih.gov/pubmed/19112401 (2008)

 NADH

Nicotinamide adenine dinucleotide (NADH). This is precursor for niacin

• Effect may last only 3 months http://www.ncbi.nlm.nih.gov/pubmed/15377055 (2004)
• Helpful for 31% of CFS patients http://www.ncbi.nlm.nih.gov/pubmed/10071523 (1999)
• Reported effects not confirmed in later studies http://www.ncbi.nlm.nih.gov/pubmed/20447621 (2010)

Dehydroepiandrosterone (DHEA)

• Supplementation helped 65%http://www.ncbi.nlm.nih.gov/pubmed/15889950 (2005) http://www.ncbi.nlm.nih.gov/pubmed/19078357 (1999)
  • pain improved: 18%
  • fatigue decreased: 21%,
  • daily living improved: 8.5
  • helplessness decreased: 11%,
  • anxiety decreased: 35%,
  • thinking improved: 26%,
  • memory improved: 17%
  • sexual problems improved: 22%
• No effect but belief that it may help is significant factor in comorbid syndrome http://www.ncbi.nlm.nih.gov/pubmed/17545193 (2008)
• No effect on patients with adrenal insufficiency http://www.ncbi.nlm.nih.gov/pubmed/19773400 (2009)
• Lower levels found in CFS patients  http://www.ncbi.nlm.nih.gov/pubmed/16264414 (2005)  http://www.ncbi.nlm.nih.gov/pubmed/11470334 (2001) http://www.ncbi.nlm.nih.gov/pubmed/10403156 (1999) http://www.ncbi.nlm.nih.gov/pubmed/9852212 (1998)  http://www.ncbi.nlm.nih.gov/pubmed/15110921 (2004)
• Higher levels found in CFS patients with higher level more fatiguedhttp://www.ncbi.nlm.nih.gov/pubmed/15110921 (2004)
• Lower level correlate with fatigue in other illnesses http://www.ncbi.nlm.nih.gov/pubmed/17669554 (2008)
• No significant difference found http://www.ncbi.nlm.nih.gov/pubmed/15730417 (2005) http://www.ncbi.nlm.nih.gov/pubmed/15058215 (2003) http://www.ncbi.nlm.nih.gov/pubmed/12700181 (2003)
• CFS patients respond different to DHEA stimulationhttp://www.ncbi.nlm.nih.gov/pubmed/11104854 (2000) (a blunted serum DHEA response curve) http://www.ncbi.nlm.nih.gov/pubmed/10077344 (1999)

  Evening Primrose Oil

• Effective in some CFS patients http://www.ncbi.nlm.nih.gov/pubmed/8616424 (1996)
• No significant difference in a long term study http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907931/?tool=pubmed#BMJ_1101_I8 (2008)

To Be Avoided

Glutamate

Monosodium glutamate (MSG) is often added to food to improve favor.

• Significant return of symptoms in FM http://www.ncbi.nlm.nih.gov/pubmed/22766026 (2012)
• Decreased quality of life in regards to IBS symptoms http://www.ncbi.nlm.nih.gov/pubmed/22766026 (2012)
• Worsening of fibromyalgia severity http://www.ncbi.nlm.nih.gov/pubmed/22766026 (2012)