Research has shown that people with CFS/FMS are under severely increased oxidative stress.11 In fact, noted CFS expert Dr. Paul Cheney believes that a major component of chronic fatigue syndrome stems from the heart muscle working poorly because of inadequate energy production. He theorizes that this occurs because the body’s mitochondrial energy furnaces (see Chapter 2) are unable to adequately handle oxygen free radicals and therefore shut down energy production. One antioxidant, called glutathione, is especially critical. This has also been supported by the work of Rich Van Konynenburg, Ph. D., who proposes a number of triggers for glutathione depletion. I have long respected Rich as being a leading thinker in CFS, and have added more-detailed information on his theories and the importance of antioxidants in the From Fatigued to Fantastic! notes at www.vitality101.com.
Although supplementation can be critical, there are even more fun ways to get your antioxidants. This is why when I recommend avoiding sugar to inhibit yeast overgrowth, I also add the three magic words “except for chocolate!” Chocolate, especially dark chocolate, contains high levels of antioxidants, as well as a natural mood enhancer. According to the results of a study conducted at Cornell University, the concentration of cancer-fighting antioxidants in hot cocoa was significantly higher than those in red wine, green tea, or black tea.
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Chocolate’s Sweet-Natured Side Effect
Chocolate has other benefits that go beyond its antioxidant power. According to a study at the University of Helsinki, in Finland, children born to women who regularly ate chocolate during their pregnancies were more likely to be “sweet natured.” Researchers asked three hundred pregnant women to track their stress levels and chocolate consumption. When their children were six months old, their moms were surveyed on their babies’ behaviors. The results showed that babies born to stressed women who ate chocolate daily smiled more frequently, laughed more often, and showed less fear of new situations than babies of stressed women who did not indulge in chocolate. Taking high levels of antioxidants during pregnancy also decreases the risk of the baby having asthma.12 I guess that eating chocolate is simply a sacrifice that we need to make for our children.
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In addition to being critical for the production of energy, antioxidants also seem to be very important for maintaining health and youth. In fact, doctors who specialize in “antiaging medicine” use antioxidants as key tools. In men, taking even low-dose antioxidants (120 milligrams ascorbic acid, 30 units vitamin E, 6 milligrams beta-carotene, 100 micrograms selenium, and 20 milligrams zinc versus a placebo daily for an average of 7.5 years) prolonged life dramatically.13 Antioxidants protect against stomach cancer,14 help in the treatment of liver disease,15 are associated with a decreased risk of hip fractures,16 and may protect against strokes.
VITAMIN C (500 MILLIGRAMS A DAY)
The antioxidant vitamin C is well known as a critical nutrient, being important for proper immune, adrenal, and antioxidant function. In addition, the antioxidant vitamin C can decrease hearing loss,17 and it is estimated that three hundred thousand cases of macular degeneration (35 percent of cases), a leading cause of blindness, could be prevented simply by supplementation with antioxidants and zinc.18,19 Vitamins C and E also help prevent osteoporosis,21 and vitamin C may protect against developing angina or strokes22 while also making it easier to lose weight.23 Vitamin C also helps improve sperm count and motility, and can be helpful in treating infertility24 (see the Web site notes on pregnancy and infertility at www.vitality101.com). With sperm counts dropping dramatically around the planet, it could be that natural selection will mean that only those taking their supplements will eventually be able to reproduce.
And, proving conventional wisdom right once again, vitamin C actually does make you less likely to catch a cold. In one study, people taking 500 milligrams of vitamin C daily had 18 percent fewer colds than those in the 50-milligrams-a-day group.25 To protect against illness and optimize your health as discussed above, I recommend that you get at least 500 milligrams of vitamin C per day.
VITAMIN E (100 UNITS A DAY )
This critical antioxidant serves many functions, but taking more of any one antioxidant is not always better. Many nutrients, such as beta-carotene, are part of a larger “family,” so taking very high doses of only one type can actually suppress the others and become problematic. This is also the case with vitamin E, as there are many types of vitamin E in the tocopherol family. Research suggests that taking more than 150 units a day can cause this suppression,26 so I recommend taking 100 units a day as the optimal level in multivitamins. If you are taking higher levels to treat a specific problem, take it for only a few months and use natural vitamin E (mixed tocopherols), which contains all of the different types of vitamin E. Although more is not better, deficiency is a significant problem.27
Vitamin E in optimal doses (about 100 units a day) may also be cancer protective. Two studies presented at the 2004 annual meeting of the American Association of Cancer Research found that people who had a high intake of dietary vitamin E or who had high levels in their bloodstream were the least likely to have cancer. In one of the studies, vitamin E supplements in addition to a vitamin E–rich diet lowered the risk of bladder cancer. In the other, men with the most vitamin E in their systems had the lowest risk of prostate cancer. This was also discussed in another study, published in the Journal of the National Cancer Institute, where high blood levels of vitamin E cut the risk of prostate cancer by about 50 percent,28 and a third study that showed that vitamin E caused prostate cancer cells to “self-destruct.”29 Adequate intake of vitamin E may also decrease the risk of breast cancer.30
The cancer-protection benefit is not the only reason to take vitamin E, and it’s important to maintain optimal antioxidant support as you age. In a study on 1,033 people sixty-five and older, low plasma levels of vitamin E were found to be associated with a more than doubled risk of dementia and of suffering from cognitive impairment.31
Although there are many other antioxidants (and I discuss them in the following sections), simply looking at vitamins C and E gives us an idea of their importance. Each of the nutrients below is very important and the From Fatigued to Fantastic! notes at www.vitality101.com discusses each of them in depth. I invite you to read that information as well. In the sections below, I focus on the nutrients’ importance in CFS/FMS, while briefly listing some of their other benefits and noting the recommended daily amount after each nutrient.
Other Vitamins
VITAMIN A (3,500 IU A DAY )
Vitamin A is critical for mucosal immunity and zinc function, but be careful not to get too much. The risk of fetal birth defects can increase in pregnant women taking more than 8,000 units a day, and higher dosing of vitamin A can also aggravate osteoporosis. At doses of more than 50,000 units a day, vitamin A can even cause liver injury, so I would only use doses higher than 8,000 units daily under the supervision of a holistic practitioner. Higher doses may be used by your practitioner to treat two problems often seen in CFS/FMS: acne, which is associated with low vitamin A levels32 and which improves with high-dose vitamin A plus zinc (which augments vitamin A activity), and heavy menstrual periods during perimenopause. Called dysfunctional uterine bleeding (DUB), this bleeding often resolves without the need for a hysterectomy when patients take
50,000 units of vitamin A (with 25 milligrams of zinc) daily for three months. It is, of course, important to also treat low thyroid and iron levels, which are two other and more common causes of heavy periods.
BETA-CAROTENE (3,500 IU A DAY )
One of a large family of carotenoids (found in carrots), beta-carotene is the main one added to supplements. In proper dosing it can be helpful, and higher doses (to a point) are associated with increased longevity.33 However, like vitamin E, beta-carotene is part of a larger “family,” and taking very high doses of only one type can suppress the others and become problematic. For example, taking 25,000 units a day was associated with a
n increased risk of lung cancer. So more is not always better. Taking 3,500 units a day can keep you healthy—without this increased risk.
BIOFLAVONOIDS (500 MILLIGRAMS A DAY )
There are many members of this family, which can be found in the white part of citrus fruits just below the peel. They are important for blood vessel integrity and immune function. A high intake of flavonoids has been shown to lower heart attack risk,34 and 500 milligrams a day of the quercitin form decreases the symptoms of prostatitis.
B Vitamins
These are especially critical for energy production, and the RDAs are inadequate for those with CFS/FMS. B vitamins are also important for immunity, nerve and brain function, and much more. Using high but safe doses is important.
B1 (75 MILLIGRAMS A DAY )—THIAMINE
Vitamin B1 is critical for proper brain functioning, making it especially important for those with brain fog. It is also critical for heart function, which in CFS patients suffers because of decreased energy production. In fact, a major cause of death in the United States is congestive heart failure, which is one symptom of vitamin B1 deficiency. Although 33 percent of people with congestive heart failure are low in thiamine,35 this easy treatment aid is often ignored. Thiamine is also used therapeutically in dementia, anxiety, neuropathy, fatigue, alcoholism, confusion, depression, pain, memory loss, and disequilibrium.
In a double-blind study by Dr. David Benton, an expert on thiamine, supplementation with vitamin B1 improved mood, possibly by increasing synthesis of acetylcholine, a neurotransmitter that is associated with memory.36 Deficiency of this neurotransmitter has also been suspected to occur in CFS, and supplementation with choline (see Chapter 6) can also be helpful. Dr. Benton also found that giving 50 milligrams a day of thiamine (versus placebo) was associated with reports of being more clearheaded, composed, and energetic. These influences took place in subjects whose thiamine status, according to traditional criteria, was adequate.37 Interestingly, symptoms of thiamine deficiency can mimic symptoms often seen in CFS/FMS, including:
Increased auditory, tactile, or visual perceptions, which are acute enough to be unpleasant
Rapid pulse, unusual sweating, and abdominal pain with or without diarrhea
Sense of panic/anxiety and fear
Mitral valve prolapse, premenstrual syndrome, temporomandibular syndrome, and irritable bowel syndrome38
Thiamine may also have antiviral effects in addition to improving cognitive function.39
B2—RIBOFLAVIN (75 MILLIGRAMS A DAY )
This B vitamin is especially critical for energy production. In higher doses of 75 to 400 milligrams a day, it has been repeatedly shown to decrease migraine frequency (a common problem in CFS/FMS) by 67 percent after six to twelve weeks. Vitamin B2 even helps decrease the risk of postpartum depression.40
B3—NIACIN (50 MILLIGRAMS A DAY )
Niacin is also critical for energy production, being a key part of the energy molecule NADH, which also helps make the neurotransmitter dopamine. Niacin may also prevent Alzheimer’s. A five-year study of more than 3,700 people published in the Journal of Neurology, Neurosurgery, and Psychiatry showed an inverse relationship between niacin intake and both Alzheimer’s disease and age-related mental decline. While some benefits were noted to begin at 17 milligrams per day, a daily niacin intake of 45 milligrams offered the most protection from Alzheimer’s disease and other causes of cognitive decline.41 High doses over decades also seem to decrease the progression of arthritis.
PANTOTHENIC ACID (50 MILLIGRAMS A DAY )
Pantothenic acid and its cousin pantethine play many key roles in the body. Most importantly in CFS and fibromyalgia, pantothenic acid is critical for proper adrenal gland function. In addition, pantethine is also critical for proper handling of fats.42
B6—PYRIDOXINE (85 MILLIGRAMS A DAY )
Vitamin B6 (pyridoxine) serves many critical functions, including enhancing immune function43 and decreasing the risk of heart disease44 and colon cancer.45
I have also found that the fluid retention seen in CFS/FMS often improves with vitamin B6 at a dose of about 200 to 250 milligrams a day—especially if you also optimize thyroid hormone levels. This has implications way beyond the rings on your fingers being too tight. For example, B6 at a dose of 250 milligrams a day is very helpful in alleviating carpal tunnel syndrome (CTS), a common condition in CFS/FMS that is linked with fluid retention. The book Pain Free 1–2–3 gives information on how to treat carpal tunnel syndrome simply and without surgery.
B 12 (500 TO1000 MICROGRAMS A DAY )
Vitamin B12 is another key nutrient in CFIDS. Technically, the B12 level is considered normal if it is over 208 picograms per deciliter (pg/dL) of blood. However, studies have shown that this “normal” level may be much, much too low. People can suffer severe and sometimes long-term nerve and brain damage from B12 deficiency even if their levels are 300 pg/dL46 and signs of B12 deficiency sometimes occur with levels higher than 500 pg/dL.47
Why are the “normal” levels set so low? In part because the normal values were initially set according to what prevents anemia. But the brain’s and nervous system’s needs for vitamin B12 are often much higher than the levels needed to prevent anemia. Also, as much as I hate to admit it, the medical establishment has greatly enjoyed poking fun at the old-time doctors who gave vitamin B12 shots for fatigue. The use of B12 shots despite “normal” levels is considered almost a symbol of unscientific, archaic medicine. As noted in an editorial in the New England Journal of Medicine, however, current findings suggest that those old-time doctors might have been right.48
Other studies suggest that many people need significantly higher B12 levels than what is currently considered normal.49 More importantly, recent research shows that despite their having normal B12 levels in the blood, CFIDS patients often have very low and sometimes absent B12 levels in their brains.50 This suggests that because of the metabolic problems present in CFIDS/FMS, you may need quite high B12 levels in your blood to get adequate levels past the blood-brain barrier (the membrane that separates the brain from the blood to protect the brain from circulating toxins) and into the brain, where B12 is needed.
One benefit of vitamin B12 is that it helps reduce excessive levels of nitric oxide, a neurotransmitter that can be too high in people with CFIDS/ FMS and that can easily contribute to symptoms. More and more, research studies are supporting what doctors who effectively treat CFIDS/ FMS using B12 shots have said for years. Whatever the cause, I have found that treating patients with vitamin B12, even if their levels are technically normal, often results in marked improvement in both energy and mental clarity. This is good, as vitamin B12 is both very safe and cheap, and using high doses can be critical in CFS/FMS.
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The Importance of Vitamin B12
Why is a low B12 level such a common problem in CFIDS patients? Several possibilities exist. Among them are the following:
Vitamin B12 has trouble getting across the blood-brain barrier.50
Nitric oxide excess is suspected in CFS, and B12 is a nitric oxide scavenger. For more information on this, see the article by Professor Martin Pall in the Web site notes section.
Vitamin B12 is important for the repair of nerve injuries. Evidence suggests that brain dysfunction occurs in CFIDS. In repairing this injury, the body may overutilize vitamin B12 and deplete its stores.
If an autoimmune process impairs the thyroid or adrenal glands, it may also attack the area responsible for our ability to absorb vitamin B 12.
Overgrowth of yeast, bacterial infections, or parasites in the bowel causing problems with absorption may prevent the proper absorption of vitamin B12.
Vitamin B12 may be important for, and used up in, detoxification.
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It is no surprise then, when their other problems are also treated, that many people respond dramatically to B12 injections. If your B12 level is under 540 pg/ml, your doctor may want to start treatment with a 1-cc (1,000-to 3
,000-microgram) injection one to five times a week, giving at least fifteen total injections. These shots are safe and fairly inexpensive. Although most regular pharmacies carry only the 1,000-microgram-per-cc strength, holistic pharmacies (see Appendix E: Resources) can make up injectable vitamin B12 that contains 3,000 micrograms per cc. The methylcobalamin form of B12 is best (or if cost is an issue, hydroxycobalamin) when taking high-dose injections. If you are going to benefit from the shots, you’ll see improvement by ten weeks. If you feel worse when the injections are stopped, your doctor may resume the shots, usually every one to five weeks (but as often as daily in some cases) for an extended period of time. Most people, however, can maintain their B12 level after fifteen injections by taking the Energy Revitalization System or by supplementing with 500 micrograms B12 per day.
In addition to directly addressing CFS/FMS, vitamin B12 helps other problems such as:
Depression
Neuropsychiatric disorders such as mental confusion, memory changes, cognitive slowing, mood disorders, violent behavior, fatigue, delirium, and paranoid psychosis51
Osteoporosis52
The risk of stroke53
From Fatigued to Fantastic! Page 21