May is M.E. Awareness Month, aimed at promoting a greater understanding of Myalgic Encephalomyelitis, or Chronic Fatigue Syndrome, for patients, their families and healthcare practitioners. Part 1 looked at the most common symptoms of ME, along with common myths and misconceptions about this poorly understood disease. Part 2 presents five simple dietary guidelines for chronic fatigue suffers along with five supplements believed to help manage symptoms and improve their health and well-being.
In ‘Beating Chronic Fatigue’ Dr Kristina Downing Orr writes that many chronic fatigue sufferers have a dysregulation of blood-sugar levels (1). It is certainly true that poor blood sugar control can create symptoms such as fatigue, headaches, dizziness and emotional disturbances. It makes sense that managing blood sugar levels through smart dietary choices may be helpful. The following five guidelines should improve energy levels by regulating blood sugar throughout the day.
1. Include lean protein at every meal – chicken, game, fish, organic red meat, eggs, tofu, yoghurt, fresh nuts and seeds are good options.
2. Cut out alcohol and caffeinated drinks such as tea, coffee or cola.
3. Eliminate hidden sugars lurking in pre-packaged foods. Look out for ingredients such as dextrose, fructose, corn syrup, high-fructose corn syrup, fruit juice concentrate, galactose, lactose, polydextrose, mannitol, sorbitol and maltodextin.
4. Eliminate refined grains that release sugar into the bloodstream quickly. These include corn flour, white rice, and white flour.
5. Aim for a balance of one third protein to two thirds ‘smart’ carbs at every meal. This means roughly a handful of protein to two handfuls of veggies.
Nutritional supplements are often used by those with CFS as they may help correct deficiencies, support the immune system and the liver, and support processes such as cellular energy-production. Here we look at five supplements commonly recommended by nutritional practitioners.
Some small studies have suggested a link between B12 supplementation and relief of symptoms, possibly because B12 improves the delivery of oxygen to the body’s organs. Vitamin B12 injections have been found to result in increased wellbeing in CFS patients when compared to placebo injections (2).
A recent pilot study of 41 CFS patients found that D-ribose improved symptoms such as energy, sleep, mental clarity, pain intensity and well-being (3). In energy-depleted states, ribose levels tend to be low. Ribose increases cellular energy by raising levels of ATP (the body’s ‘fuel’) because ribose is a key component in these ‘energy molecules’. D-Ribose supplementation appears to be well tolerated. While the initial findings are promising, more research is needed in this area.
NADH (nicotinamide adenine dinucleotide) is simply a reduced form of vitamin B3, and it is essential in maintaining sufficient levels of the fuel ATP. One good quality crossover RCT showed statistically significant effects of NADH (10 mg daily) on symptom scores when compared with placebo after 1 month of treatment (4).
The onset of CFS is linked to stress, and stress in turn is known to deplete levels of magnesium (5). Many CFS specialists believe that CFS patients have low intracellular magnesium levels, even when blood levels of magnesium appear to be normal. A randomised, double-blind controlled trial found that treatment with magnesium sulphate injections improved energy levels, emotional state, and pain scores in CFS patients (6).
Essential Fatty Acids
Researchers have suggested that patients with chronic fatigue have problems metabolising essential fatty acids, leading to problems with the immune system, nervous system and endocrine system. It may be that supplementation with fatty acids such as EPA and GLA improves symptoms by bypassing these ‘metabolic blocks’. Two randomised controlled trials have indeed found that essential fatty acid supplementation to be of benefit in CFS (7,8).
1. Beating Chronic Fatigue: Your Step-by-Step Guide to Complete Recovery. Dr Kristina Downing-Orr. London: Piatkus. 2010.
2. Ellis FR, Nasser S. A pilot study of vitamin B12 in the treatment of tiredness. Br J Nutr 1973;30:277-283.
3. Teitelbaum JE, Johnson C, St Cyr J (2006) The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study. Nov;12(9):857-62. J Altern Complement Med.
4. Forsyth LM, Preuss HG, MacDowell AL, Chiazze L Jr, Birkmayer GD, Bellanti JA. (1999) Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann Allergy Asthma Immunol. 82(2):185–191.
5. Werbach M (2000) Nutritional Strategies for Treating Chronic Fatigue Syndrome. Altern Med Rev 5(2):93-108.
6. Cox IM, Campbell MJ, Dowson D. (1991) Red blood cell magnesium and chronic fatigue syndrome.Lancet. 337(8744):757–760.
7. Behan PO, Behan WM, Horrobin D. (1990) Effect of high doses of essential fatty acids on the postviral fatigue syndrome. Acta Neurol Scand. 82:209-216.
8. Warren G, McKendrick M, Peet M. The role of essential fatty acids in chronic fatigue syndrome: a case-controlled study of red-cell membrane essential fatty acids (EFA) and a placebo-controlled treatment study with high dose of EFA. Acta Neurol Scand.1999;99:112-116.
9. Image courtesy of artur84.