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Health Condition

Chronic Fatigue Syndrome

  • Iron

    In a double-blind trial, supplementing with iron significantly improved fatigue in women who were iron-deficient but not anemic.

    Dose:

    Refer to label instructions
    Iron
    ×
    Iron-deficiency anemia is a well-known cause of fatigue. Fatigue that is due to iron-deficiency anemia usually improves after iron supplementation. Iron deficiency in the absence of anemia can also cause fatigue, because iron plays a role in various biochemical processes involved in energy production. In a double-blind trial, supplementing with 80 mg per day of iron for 12 weeks, significantly improved fatigue compared with a placebo in women who were iron-deficient but not anemic.1 Iron supplementation has the potential to cause harm in people who are not deficient, so it should only be used when iron deficiency has been documented by laboratory testing.
  • L-Carnitine

    L-carnitine is an important nutrient for energy production. Supplementation can make up for a possible deficiency.

    Dose:

    1 gram three times daily
    L-Carnitine
    ×
     

    L-carnitine is required for energy production in the powerhouses of cells (the mitochondria). There may be a problem in the mitochondria in people with CFS. Deficiency of carnitine has been seen in some CFS sufferers.2 One gram of carnitine taken three times daily for eight weeks led to improvement in CFS symptoms in one preliminary trial.3 Supplementation with 6 grams of L-carnitine per day for four weeks also improved fatigue in a preliminary study of patients with advanced cancer.4 Similar improvements were seen in another study of patients with advanced cancer given up to 3 grams of L-carnitine per day for one week.5

  • Magnesium

    Some researchers have reported that magnesium deficiency is common in people with chronic fatigue syndrome. Supplementing can help make up for a deficiency.

    Dose:

    Refer to label instructions
    Magnesium
    ×
     

    NADH (nicotinamide adenine dinucleotide) helps make ATP, the energy source the body runs on. In a double-blind trial, people with CFS received 10 mg of NADH or a placebo each day for four weeks.6 Of those receiving NADH, 31% reported improvements in fatigue, decreases in other symptoms, and improved overall quality of life, compared with only 8% of those in the placebo group. Further double-blind research is needed to confirm these findings.

    Magnesium levels have been reported to be low in CFS sufferers. In a double-blind trial, injections with magnesium improved symptoms for most people.7 Oral magnesium supplementation has improved symptoms in those people with CFS who previously had low magnesium levels, according to a preliminary report, although magnesium injections were sometimes necessary.8 These researchers report that magnesium deficiency appears to be very common in people with CFS. Nonetheless, several other researchers report no evidence of magnesium deficiency in people with CFS.9,10,11 The reason for this discrepancy remains unclear. If people with CFS do consider magnesium supplementation, they should have their magnesium status checked by a doctor before undertaking supplementation. It appears that only people with magnesium deficiency benefit from this therapy.

  • NADH

    Supplementing with NADH may help your body produce more energy.

    Dose:

    10 mg daily
    NADH
    ×
     

    NADH (nicotinamide adenine dinucleotide) helps make ATP, the energy source the body runs on. In a double-blind trial, people with CFS received 10 mg of NADH or a placebo each day for four weeks.12 Of those receiving NADH, 31% reported improvements in fatigue, decreases in other symptoms, and improved overall quality of life, compared with only 8% of those in the placebo group. Further double-blind research is needed to confirm these findings.

  • Potassium-Magnesium Aspartate

    Potassium-magnesium aspartate has shown benefits for chronically fatigued people in some trials.

    Dose:

    1 gram of aspartates is taken twice per day
    Potassium-Magnesium Aspartate
    ×
     

    The combination of potassium aspartate and magnesium aspartate has shown benefits for chronically fatigued people in double-blind trials.13,14,15,16 However, these trials were performed before the criteria for diagnosing CFS was established, so whether these people were suffering from CFS is unclear. Usually 1 gram of aspartates is taken twice per day, and results have been reported within one to two weeks.

  • Vitamin B12

    Vitamin B12 deficiency may cause fatigue, but B12 injections have been reported benefits even without deficiency. A doctor should evaluate deficiency and whether B12 injections may help.

    Dose:

    Consult a qualified healthcare practitioner
    Vitamin B12
    ×
     

    Vitamin B12 deficiency may cause fatigue. However, some reports,17 even double-blind ones,18 have shown that people who are not deficient in B12 have increased energy following a series of vitamin B12 injections. Some sources in conventional medicine have discouraged such people from taking B12 shots despite this evidence.19 Nonetheless, some doctors have continued to take the limited scientific support for B12 seriously.20 In one preliminary trial, 2,500 to 5,000 mcg of vitamin B12 given by injection every two to three days led to improvement in 50 to 80% of a group of people with CFS; most improvement appeared after several weeks of B12 shots.21 While the research in this area remains preliminary, people with CFS considering a trial of vitamin B12 injections should consult a doctor. 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.

  • Asian Ginseng

    Adaptogenic herbs such as Asian ginseng have an immunomodulating effect and help support the normal function of the body’s hormonal stress system.

    Dose:

    Refer to label instructions
    Asian Ginseng
    ×
     

    Adaptogenic herbs such as Asian ginseng and eleuthero may also be useful for CFS patients—the herbs not only have an immunomodulating effect but also help support the normal function of the hypothalamic-pituitary-adrenal axis, the hormonal stress system of the body.22 These herbs are useful follow-ups to the six to eight weeks of taking licorice root and may be used for long-term support of adrenal function in people with CFS. However, no controlled research has investigated the effect of adaptogenic herbs on CFS.

  • DHEA

    DHEA is a hormone that has been found to be low in some people with chronic fatigue syndrome.

    Dose:

    Refer to label instructions
    DHEA
    ×
     

    DHEA (dehydroepiandrosterone) is a hormone now available as a supplement. In one report, DHEA levels were found to be low in people with CFS.23 Another research group reported that, while DHEA levels were normal in a group of CFS patients, the ability of these people to increase their DHEA level in response to hormonal stimulation was impaired.24 Whether supplementation with DHEA might help CFS patients remains unknown due to the lack of controlled research. DHEA should not be used without the supervision of a healthcare professional.

  • Eleuthero

    “Adaptogenic” herbs such as eleuthero have an immunomodulating effect and help support the normal function of the body’s hormonal stress system.

    Dose:

    Refer to label instructions
    Eleuthero
    ×

    Adaptogenic herbs such as Asian ginseng and eleuthero may also be useful for CFS patients—the herbs not only have an immunomodulating effect but also help support the normal function of the hypothalamic-pituitary-adrenal axis, the hormonal stress system of the body.25 These herbs are useful follow-ups to the six to eight weeks of taking licorice root and may be used for long-term support of adrenal function in people with CFS. However, no controlled research has investigated the effect of adaptogenic herbs on CFS.

    One study found that an eleuthero extract improved symptoms in patients suffering from mild-to-moderate chronic fatigue. However, after one month of treatment, the benefit began to wane, and eleuthero was not more effective than a placebo after two months of treatment.These findings support the observation of herbalists that eleuthero is more effective when used in a pulsed manner (a few weeks at a time) than when used continuously.

  • Fish Oil

    In one study, patients with chronic fatigue syndrome reported an improvement in their symptoms after taking a supplement containing the essential fatty acids EPA and DHA.

    Dose:

    Refer to label instructions
    Fish Oil
    ×
     

    In a preliminary study, four patients with chronic fatigue syndrome reported an improvement in their symptoms after taking an essential fatty acid supplement daily for at least 12 weeks.26 The amount used was 10 to 18 capsules per day, and each capsule contained 93 mg of eicosapentaenoic acid (EPA), 29 mg of docosahexaenoic acid (DHA), and 10 mg of gamma-linolenic acid. Because there was no placebo group in this study and, because fatigue often improves after treatment with a placebo, additional research is needed to confirm this report.

  • Licorice

    A case report described a man with CFS whose symptoms improved after taking 2.5 grams of licorice root daily.

    Dose:

    Refer to label instructions
    Licorice
    ×
     

    One case report described a man with CFS whose symptoms improved after taking 2.5 grams of licorice root daily.27 While there have been no controlled trials to test licorice in patients with CFS, it may be worth a trial of six to eight weeks using 2 to 3 grams of licorice root daily.

What Are Star Ratings
×
Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Holistic Options

Highly stressful situations should be avoided by people with CFS. Coping mechanisms for dealing with stress can sometimes be maximized by behavioral therapy, which has been shown helpful for people with CFS in several controlled studies.28

References

1. Vaucher P, Druais PL, Waldvogel S, Favrat B. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ 2012;184:1247–54.

2. Kuratsune H, Yamaguti K, Takahashi M, et al. Acylcarnitine deficiency in chronic fatigue syndrome. Clin Infect Dis 1994;18(1 suppl):S62-7.

3. Plioplys AV, Plioplys S. Amantadine and L-carnitine treatment of chronic fatigue syndrome. Neuropsychobiology 1997;35:16-23.

4. Gramignano G, Lusso MR, Madeddu C, et al. Efficacy of L-carnitine administration on fatigue, nutritional status, oxidative stress, and related quality of life in 12 advanced cancer patients undergoing anticancer therapy. Nutrition2006;22:136-45.

5. Cruciani RA, Dvorkin E, Homel P, et al. Safety, tolerability and symptom outcomes associated with L-carnitine supplementation in patients with cancer, fatigue, and carnitine deficiency: a phase I/II study. J Pain Symptom Manage 2006;32:551-9.

6. Forsyth LM, Preuss HG, MacDowell AL, et al. Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann Allergy Asthma Immunol 1999;82:185-91.

7. Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic fatigue syndrome. Lancet 1991;337:757-60.

8. Howard JM, Davies S, Hunnisett A. Magnesium and chronic fatigue syndrome. Lancet 1992;340:426.

9. Clague JE, Edwards RH, Jackson MJ. Intravenous magnesium loading in chronic fatigue syndrome. Lancet 1992;340:124-5.

10. Gantz NM. Magnesium and chronic fatigue. Lancet 1991;338:66 [letter].

11. Hinds G, Bell NP, McMaster D, McCluskey DR. Normal red cell magnesium concentrations and magnesium loading tests in patients with chronic fatigue syndrome. Ann Clin Biochem 1994;31(Pt. 5):459-61.

12. Forsyth LM, Preuss HG, MacDowell AL, et al. Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome. Ann Allergy Asthma Immunol 1999;82:185-91.

13. Shaw DL, Chesney MA, Tullis IF, Agersborg HPK. Management of fatigue: a physiologic approach. Am J Med Sci 1962;243:758-69.

14. Crescente FJ. Treatment of fatigue in a surgical practice. J Abdom Surg 1962;4:73.

15. Hicks J. Treatment of fatigue in general practice: a double-blind study. Clin Med 1964;Jan:85-90.

16. Formica PE. The housewife syndrome: treatment with the potassium and magnesium salts of aspartic acid. Curr Ther Res 1962;Mar:98-106.

17. Kaufman W. The use of vitamin therapy to reverse certain concomitants of aging. J Am Geriatr Soc 1955;3:927-36.

18. Ellis FR, Nasser S. A pilot study of vitamin B12 in the treatment of tiredness. Br J Nutr 1973;30:277-83.

19. Lawhorne L, Rindgahl D. Cyanocobalamin injections for patients without documented deficiency. JAMA 1989;261:1920-3.

20. Gaby AR. Literature Review & Commentary. Townsend Letter for Doctors & Patients 1997;Feb/Mar:27 [review].

21. Lapp CW, Cheney PR. The rationale for using high-dose cobalamin (vitamin B12). CFIDS Chronicle Physicians' Forum 1993;Fall:19-20.

22. Brown D. Licorice root - potential early intervention for chronic fatigue syndrome. Quart Rev Natural Med 1996;Summer:95-7.

23. Kuratsune H, Yamaguti K, Sawada M, et al. Dehydroepiandrosterone sulfate deficiency in chronic fatigue syndrome. Int J Mol Med 1998;1:143-6.

24. De Becker P, De Meirleir K, Joos E, et al. Dehydroepiandorsterone (DHEA) response to i.v. ACTH in patients with chronic fatigue syndrome. Horm Metab Res 1999;31:18-21.

25. Brown D. Licorice root - potential early intervention for chronic fatigue syndrome. Quart Rev Natural Med 1996;Summer:95-7.

26. Puri BK. The use of eicosapentaenoic acid in the treatment of chronic fatigue syndrome. Prostaglandins Leukot Essent Fatty Acids 2004;70:399-401.

27. Baschetti R. Chronic fatigue syndrome and liquorice. New Z Med J 1995;108:156-7 [letter].

28. Price JR, Couper J. Cognitive behaviour therapy for adults with chronic fatigue syndrome. Cochrane Database Syst Rev 2000;(2):CD001027 [review].

29. De Lorenzo F, Hargreaves J, Kakkar VV. Pathogenesis and management of delayed orthostatic hypotension in patients with chronic fatigue syndrome. Clin Auton Res 1997;7:185-90.

30. Fulcher KY, White PD. Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. Br Med J 1997;314:1647-52.

31. McCully KK, Sisto SA, Natelson BH. Use of exercise for treatment of chronic fatigue syndrome. Sports Med 1996;21:35-48 [review].

32. Blackwood SK, MacHale SM, Power MJ, et al. Effects of exercise on cognitive and motor function in chronic fatigue syndrome and depression. J Neurol Neurosurg Psychiatry 1998;65:541-6.

33. LaManca JJ, Sisto SA, DeLuca J, et al. Influence of exhaustive treadmill exercise on cognitive functioning in chronic fatigue syndrome. Am J Med 1998;105:59S-65S.

34. Paul L, Wood L, Behan WM, et al. Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome. Eur J Neurol 1999;6:63-9.

35. Clapp LL, Richardson MT, Smith JF, et al. Acute effects of thirty minutes of light-intensity, intermittent exercise on patients with chronic fatigue syndrome. Phys Ther 1999;79:749-56.

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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2019.

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