http://www.cortjohnson.org/blog/2015/10/12/lactic-acidosis-causing-cfs-fm-symptoms/

CFS patients are often found to low on one vitamin, amino acid, etc. The logical approach has been to supplement those in the hope that it would help. Too often, there was no significant change found in clinical studies. The why may well be connected to an absence of gut bacteria needed to transform/transport these supplements into the body.

The following is a list of supplements demonstrated to have positive effects in clinical studies not on the prior lists.

• Vitamin D3 – Often 15,000 to 20,000 IU per day is need to keep a CFS/FM patient at the top end of the normal range where there can be a major reduction of symptom severity. Vitamin D2 is NOT recommended
• CoQ10  300 mg/day – Studies in this post.
• Magnesium

Other were included in earlier list: Piracetam, Licorice, D-Ribose.

B12 is also in the list, with preference for Lactobacillus Reuteri (produces B12 and this species is abnormally low with CFS patients). While L.Reuteri also produces lactic acid, the goal is to reduce lactic acid and not to totally eliminate it.

Probiotic are almost always antibiotics to some other species of bacteria. They can also be antivirals and antifungal. Determining if a strain produces the right antibiotics is beyond the limits of current knowledge, and will likely stay that way for decades. This paper will give you a general overview.

“Bifidobacterium and the Lactobacillus group were increased in active IBD patients and should be used more cautiously as probiotics during the active phase of IBD. Butyrate-producing bacteria might be important to gut homeostasis.”[2014]

What is known is that some specific probiotics have resulted in significant rate remission of IBS, a condition often co-morbid with CFS. There are:

• Prescript Assist
• Align

For other probiotics, we really want to try to filter them (based on available knowledge from PubMed) by:

• Ones that do not produce lactic acid (since lactic acidosis appears to be very common with CFS), or at least, produce lower amounts
• Ones that do not kill E.Coli (which is very low in CFS, and generally do not produce lactic acid)
• Ones that do not produce histamines (appears to impact a subset of CFS patients)

The first choice is obvious:

• Mutaflor – E.Coli Nissle 1917 (See this page for US ordering) – there was one compounding pharmacy that stocks it, but no more)

Second choices are:

• AOR Probiotic-3
• Miyarisan tablets (C. butyricum MIYAIRI) – AOR Probiotic-3 contains a different C. butyricum strain.

All of the above, except Mutaflor, is available on Amazon.com.

For other probiotics with known, demonstrated health benefits, See this earlier post.

Bacteria often form biofilms and similar tricks to defeat antibiotics and antivirals. The supplements to address these are:

• NAC
• EDTA

Like some of the anticoagulants, they can increase die-off herxing because they allow more bacteria to be killed. Some others are:

• Ginger [2013]
• Andrographis paniculata [2009] – available from specialist online herbals
• Horseradish [2012]
• Garlic[2005] – increases histamines so be careful
• Haritaki [2013]

These should be taken with antivirals/antibiotic herbs and spices.