Also indexed as: CFIDS, CFS
You can defeat chronic fatigue syndrome. With no single known
cause, this syndrome largely remains a mystery. According to research or other evidence, the
following self-care steps may be helpful:
- Gradually increase exercise
- Even if you must begin with only a few minutes at a time, exercise
can help you feel better
- Check out L-carnitine
- Take 1 gram three times a day to provide a nutrient important for
- Try NADH
- 10 mg per day of the active coenzyme form of vitamin B3
(nicotinamide adenine dinucleotide) may help your body produce more energy
- Consider vitamin B12 injections
- Consult a doctor for a trial of 2,500 to 5,000 mcg every two or
three days for several weeks to make up possible deficiency
- Consult an expert
- Find an experienced professional to help manage the symptoms of
this challenging disease
- Get stress-reduction counseling
- For coping strategies, find a qualified counselor experienced in
helping people with chronic fatigue syndrome
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full chronic fatigue syndrome
article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and
dietary and lifestyle changes that may be helpful.
About chronic fatigue syndrome
Chronic fatigue syndrome (CFS) is disabling fatigue lasting more than six months that
reduces activity by more than half. CFS is a poorly understood disease involving many body
systems. No single cause of CFS has been identified, therefore, it is diagnosed by symptoms
and by ruling out other known causes of fatigue by a healthcare practitioner.
Suggested causes include chronic viral infections, food allergy, adrenal gland dysfunction, and many
others. None of these have been convincingly documented in more than a minority of sufferers.
In some people there is also difficulty sleeping, swollen lymph nodes, and/or mild fever. When
there is muscle soreness, fibromyalgia may be
the actual problem. Although CFS is considered a modern diagnosis, it may have existed for
centuries under other names, such as “the vapors,” neurasthenia, “effort
syndrome” (diagnosed in World War I veterans), hypoglycemia, and chronic mononucleosis.
Product ratings for chronic
What are the symptoms?
In addition to fatigue, there may also be muscle pain, joint pain not associated with
redness or swelling, short-term memory loss, and an inability to concentrate. Some people with
chronic fatigue syndrome also experience
difficulty sleeping, swollen lymph nodes, and/or mild fever.
Prescription medications such as anti-anxiety drugs (benzodiazepines), antidepressants, hydrocortisone (Cortef®), and pain relievers
might be beneficial.
Some healthcare providers recommend a combination of lifestyle changes (aerobic exercise,
healthful diet, and stress reduction), light therapy, and psychological counseling.
Dietary changes that may be helpful
Some doctors believe that people with CFS who have low blood pressure should not restrict
their salt intake. Among CFS sufferers who have a form of low blood pressure triggered by
changes in position (orthostatic hypotension), some have been reported in a preliminary study
to be helped by additional salt intake.1 People with CFS considering increasing
salt intake should consult a doctor before making such a change. (See the Herb information,
below, for more information on blood pressure and CFS.)
Lifestyle changes that may be helpful
Exercise is important to prevent the worsening of fatigue. Many people report feeling
better after undertaking a moderate exercise plan.2 3 However, most
people with CFS are sensitive to overexertion, and excessive exercise may lead to consistently
worsening fatigue and mental functioning.4 5 6 Exercise
should be attempted gradually, starting with very small efforts. One small study found that
intermittent exercise, in which patients walked for three minutes followed by three minutes of
rest for a total of 30 minutes, did not exacerbate their CFS symptoms.7
Vitamins that may be helpful
The combination of potassium aspartate and magnesium aspartate has shown benefits for
chronically fatigued people in double-blind trials.8 9 10
11 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 deficiency may cause fatigue.
However, some reports,12 even double-blind ones,13 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.14 Nonetheless, some doctors have continued to take the
limited scientific support for B12 seriously.15 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.16 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.
A preliminary trial has shown that people with CFS have reduced functional B-vitamin status
when compared to people without the condition.17 The functional vitamin deficiency
seen in this study was most pronounced for vitamin
B6. Double-blind trials are needed to establish whether B-vitamin supplementation is effective in people with
chronic fatigue syndrome.
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.18 One gram of carnitine taken three times daily for eight weeks led to
improvement in CFS symptoms in one preliminary trial.19 Supplementation with 6
grams of L-carnitine per day for four weeks also improved fatigue in a preliminary study of
patients with advanced cancer.20
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.21 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.22 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.23 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.24
25 26 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.
Dehydroepiandrosterone, more commonly known as
DHEA, is a hormone now available as a supplement. In one report, DHEA levels were found to
be low in people with CFS.27 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.28 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
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.29 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
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Some research suggests that CFS may be partially due to low adrenal function resulting from
different stressors (e.g., mental stress, physical stress, and even viral illness) and
impacting the normal communication between the hypothalamus, pituitary gland, and the adrenal
glands.30 Licorice root is known to
stimulate the adrenal glands and to block the breakdown of active cortisol in the
body.31 One case report described a man with CFS whose symptoms improved after
taking 2.5 grams of licorice root daily.32 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.
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.33 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.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful
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.34
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