Q and A on Chronic Fatigue Syndrome and Fibromyalgia with Jacob Teitelbaum, M.D. – #15

Q: How are additional Nutrients Helpful in the Initial Treatment of CFS and Fibromyalgia?

A: ) In the last two newsletters we talked about the main causes of nutritional deficiencies in CFS and fibromyalgia. To summarize, these are:

1. Poor digestion because of inadequate enzymes (they were removed from the food during food processing). Because of this problem, I suspect that most Americans (especially those with indigestion or gas/bloating) would benefit dramatically from taking digestive enzymes with their meals. This simply replaces the enzymes normally present in food that were lost in food processing. It is critical that the enzymes are plant based or they will not work in the acid environment of the stomach. I recommend CompleteGest by Enzymatic Therapy.
2. Food processing resulting in a nutritionally deficient diet- especially because of excess sugar and white flour
3. Bowel infections resulting in poor absorption, and
4. Increased nutritional needs because of your illness.

These problems result in widespread nutritional deficiencies. We talked about how using a powdered vitamin supplement (Daily Energy Enfusion Powder by Enzymatic Therapy) can take care of most of your basic micronutrient needs. Using this powder, one good tasting drink and one capsule a day replaces 25 vitamin tablets. This can give you a solid foundation for your (and most anyone’s) nutritional support. This product can now be found in most health food stores as well as on my web site at http://www.EndFatigue.com. As noted previously, 100 percent of my royalties for making these products are donated to charity.

I would now (and in the upcoming newsletter #16) like to discuss additional nutrients that, although not critical, can be very helpful in the initial treatment of CFS and fibromyalgia. Most of these only need to be taken for 3-9 months, after which time taking the powder and digestive enzymes by themselves should be adequate for most people.

1. CoEnzyme Q10 – Take 200 mg – 1 x a day. This nutrient is especially important for any one who is taking cholesterol-lowering prescriptions (e.g., Mevacor) as well as for people with CFS/Fibromyalgia. Take it with a meal that has fat, with oil supplements, or in an oil based form to improve absorption. Vitaline makes the best form. Many others have nowhere near the amounts they claim to have. This supplement helps your body produce energy.
2. NAC (N-Acetyl -L-Cysteine) – 500-650mg a day for 3 months. Makes Glutathione. Although the effects on your symptoms may not be quickly noticeable with NAC, I think it is incredibly helpful in rebuilding your immune system. I strongly suspect that overtime we’ll find that glutathione deficiency is a major trigger for the immune malfunction in CFS. NAC is cheap, safe, and one of the most effective ways of raising glutathione levels (especially when taken with the Daily Energy Enfusion vitamin powder). After three months of NAC use, the amount of NAC in the vitamin powder should be enough to maintain adequate levels.

   Although these nutrients (and the ones discussed in the upcoming newsletter) can be very helpful, most of you will find that for the long run using the Daily Energy Enfusion Powder and the CompleteGest digestive enzymes (both by Enzymatic Therapy), avoiding excess sugar and increasing your water and salt intake will do a good job of handling your nutritional support. Some patients also find that a high-protein, low simple carbohydrate “whole foods” diet is also helpful. Still, these additional nutrients can be very helpful for many people with CFS and fibromyalgia during their “recovery/rebuilding” phase. The products noted above are available in most health food stores and can also be found on my web site at http://www.endfatigue.com or by calling 800-333-5287(800-feel-btr).

   These supplements can also be helpful for 3-9 months during the initial treatment phase.

3. Essential fatty acids (EFA). Having dry eyes, dry mouth, dry skin, and a lot of earwax are some symptoms that suggest essential fatty acid deficiency. The deficiency can then cause pain, brain fog, and fatigue as well. Different types of fatty acids serve different needs in your body. The most important essential fatty acid for treating CFS is fish oil. In the past I used flax seed oil instead (which the body may convert to fish oil) because most fish oils on the market were rancid, tasted awful, and left people burping up fish oil all day. They also had the risk of containing toxins such as Mercury. Fortunately, there is now a brand available that does not have any of these problems and this is the only one I currently recommend. It is called Eskimo 3 Fish Oil (by Tyler). I recommend a 1/2 to 1 tablespoon a day for 6 to 9 months until the above symptoms resolve, and then as needed. Using this brand of fish oil (along with the vitamin powder) can be wonderful for pregnant moms as well!

   For those of you with PMS, I would also add evening primrose or borage oil (the latter is cheaper and as effective). I would take 3000 to 6000 mg a day for three months. At that time, when combined with the Daily Energy Enfusion Powder, you’ll probably find that the PMS has settled significantly. You can then take the primrose/borage oil as needed for just the week before your period.

4. Acetyl-L-Carnitine – 500 mg- 1 capsule twice a day for 3 months. Then 250 to 500 mg/day or stop it. Although important in CFS/FMS, it is even more important to take this if you also have Mitral Valve Prolapse and/or elevated blood triglycerides. This supplement also helps with weight loss.

   Several studies have now shown that most patients with CFS have carnitine deficiency. Carnitine is critical for both energy production and the ability to lose weight, and I suspect that this deficiency is an important cause of the average 32 pound weight gain that is seen with CFS and fibromyalgia. Taking thyroid, increasing growth hormone (especially by getting eight hours of deep sleep a night) and eliminating the yeast over- growth are also very helpful in stopping the weight gain and make it easier to lose weight that has been gained.

   Unfortunately, we have found that taking carnitine by itself is nowhere near as effective as taking the acetyl l-carnitine form. Research suggests that the acetyl part is necessary to get it into the cells where it is needed. Nonetheless, L-Carnitine can be substituted if the cost is prohibitive. Lysine (1000-3000 mg a day) is cheap and can also help your body to make its own carnitine.

5. Calcium – 500 to 1000 mg daily (a chewable calcium or Calcium Chelate is recommended). If you get a non-chewable tablet, see if it dissolves in 2 to 3 inches of vinegar over 1 hour (swirl a few times). If not, it won’t dissolve in your stomach, and you need to get a different brand. (Do not drink the vinegar). You can also avoid this problem by using capsules or liquid filled gel caps. Taken at bedtime, it may help sleep. In some people with CFS/FMS, calcium can be very beneficial and in others it seems to aggravate symptoms. It should be taken at night time to help sleep and not taken within three hours of thyroid hormone as calcium can block the thyroid hormone’s absorption. For these and other reasons, calcium was left out of the Daily Energy Enfusion powder.
6. Lipoic Acid – 200mg a day (protects the liver). Take this whenever you’re on Sporanox or Diflucan (antifungals) to protect your liver. If you have active Hepatitis, Cirrhosis, or any other liver problem consider 300 to 2000mg a day depending on its severity. Although this can be a powerful antioxidant, I have never had any one note that it made them feel better in the absence of their having liver disease.
7. Vitamin B-12 – although the Daily Energy Enfusion powder has a very high level of vitamin B12 (500 micrograms per day), if your vitamin B-12 blood level is under 540 it is worth considering a series of vitamin B-12 injections. I would recommend I.M. injections (1cc = 3000 mcg) 3 to 7 times weekly for 15 doses, then as needed (e.g., 1
   to 12 times a month). I would recommend the hydroxycobalmin form of vitamin B12 instead of cyanocobalmin. This needs to be made by a compounding (holistic) pharmacy (e.g., Cape Drugs 800-248-5978) as regular pharmacies only have a 1000 mcg strength and the cyanocobalmin form. This requires a prescription.

8. Iron –only use this if your iron percent saturation (blood test) is under 22 percent and/or your Ferritin level is under 40. Otherwise iron can cause more harm than good. Do not take within 6 hours of thyroid hormone preparations or Cipro (antibiotic), as iron can prevent their absorption. Take on an empty stomach (i.e., take between 2 and 6PM on an empty stomach). It is OK to miss up to 3 doses a week. Stop in 4 to 6 months or when your Ferritin blood test is over 40. Iron may turn your stool black. Flora Dix iron is much easier on the stomach if this is a problem.
9. Grape Seed Extract – 50-100mg a day for 6 months. This is a powerful antioxidant and can help people feel better.
10. Partially denatured whey protein with active immune factors. This is a good way to raise glutathione, fight infections, and treat protein deficiencies all at once. The Daily Energy Enfusion vitamin powder has 7 grams of whey protein in it. An excellent additional source for more whey and the other factors is “Physician’s Protein Complex” by NF Formulas. (1-2 scoops/day with 10 gm per scoop).I prefer this to Iimuplus.
11. Magnesium/Potassium Aspartate – two 500mg capsules- 2 x a day (need to use a “fully reacted” brand) for 3 to 4 months. Helps energy production.
12. NADH (Enada brand) – 5 mg- 2 tablets each morning. Take it on an empty
    stomach first thing in the morning (leave it by your bedside in the bottle or foil wrap with a glass of water) at least _ hour before eating, drinking or taking any medication or supplements (except thyroid, which you can take with the NADH). It takes 2 months to see if it works. If it does help, 15 to 20mg a day may be more effective and is safe. Don’t take vitamin C, Malic Acid, Lipoic Acid, vitamins or other acids within 2 to 3 hours of NADH, as acid destroys NADH (i.e. –take the vitamin powder at lunch). About 25% of people find it helps enough to be worth staying on.

These supplements can be found at most health food stores, at
http://www.endfatigue.com , or by calling 800-333-5287(800-feel-btr)

Dr. Teitelbaum is a board certified internist and director of the Annapolis Research Center for Effective CFS/Fibromyalgia Therapies, where he sees CFS/Fibromyalgia/Chronic pain patients from all over the world (410-266-6958). Having suffered with and overcome these illnesses in 1975, he spent the next 28 years creating, researching, and teaching about effective therapies. He is the author of the best-selling From Fatigued to Fantastic!” and the newly released “Three Steps to Happiness! Healing through Joy”. His web site can be found at: http://www.vitality101.com