From Fatigued to Fantastic!

by Jacob Teitelbaum

  Increased blood clotting54—a problem that is common in CFS (see Chapter 5)

  Breast cancer risk55

  FOLIC ACID (800 MICROGRAMS A DAY )

  The dosage recommended here is the highest that can legally be added to a vitamin, as there is a concern that folate could mask vitamin B12 deficiency—which is not a problem if the supplement also has high levels of B12. Optimal levels of folic acid (folate) are critical in CFS/FMS because of its role in immune function, and it can also improve memory. In fact, it may be critical in preventing Alzheimer’s dementia.56, 57 In addition, it is critical in methylation reactions, which are impaired in CFS/FMS.

  The benefits of folate begin early in life. Folic acid is known to protect against serious neural tube birth defects that develop in the earliest weeks of pregnancy, such as spina bifida, in which parts of the brain or spinal cord don’t develop properly. For this reason, doctors recommend that women who are pregnant or trying to get pregnant take a vitamin supplement that includes folic acid. Interestingly, since food makers began adding extra folate to flour in 1998 to prevent birth defects, the rates of heart disease, stroke, blood pressure, colon cancer, and osteoporosis have all fallen, suggesting that the general public may have been folate deficient. Folate may also decrease the risk of ovarian cancer.58

  BIOTIN (200 MICROGRAMS A DAY )

  Biotin is a cofactor for a number of enzyme reactions, but seems especially important for healthy hair, skin, and nails. People with CFS/FMS often suffer from hair loss, dull skin tone, and brittle nails. It may take a year for improvement in these areas, but many people are thrilled when their nails and hair have become strong and healthy along with the rest of their body.

  VITAMIN D (600 TO 4,000 IU A DAY )

  The importance of vitamin D deficiency is finally gaining increasing attention. This nutrient deficiency is critical, causing tens of thousands of unnecessary deaths in the United States each year. Because of this, and the deadly recommendation to avoid being out in the sun without sunscreen, I am going to cover the importance of this nutrient in depth.

  Vitamin D deficiency is common. In fact, a review in the Mayo Clinic Journal showed that approximately 36 percent of healthy young adults and 57 percent of general medicine inpatients in the United States have inadequate levels of the vitamin,59 and deficiency is even more common in people with chronic pain.

  This problem has increased ever since skin cancer awareness prompted many to forgo sunshine. The misguided advice from well-meaning doctors and media outlets was given to decrease the number of dangerous skin cancers called melanomas—a worthy goal. However, 90 percent of our vitamin D comes from the sun, and the skin cancers usually caused by sunshine (e. g., basal cell cancers) are usually benign and easy to treat. In fact, most melanomas are not in sun-exposed areas; they develop on skin covered by clothing. It is likely that the increase in melanomas is mostly occurring because of changes in diet, environment, and sleep, which are resulting in weakened immune systems. A good rule to remember is to avoid sunburn, not sunshine.

  Many other cancers increase in the face of vitamin D deficiency. It is currently estimated that the advice to avoid sunshine is resulting in as many as eighty-five thousand unnecessary cancer deaths each year.60 To give a few examples, increasing vitamin D levels is associated with:

  A decrease in lymphomas and leukemia (malignant white blood cell cancers) 61–64

  A fifty percent decrease in breast and colon cancer risk65–67

  A lower prostate cancer risk68

  Lung cancer protection69

  A thirty percent drop in ovarian cancer70

  In addition to causing upward of eighty-five thousand unnecessary cancer deaths each year, vitamin D deficiency contributes to weak bones and osteoporosis. Vitamin D is low in 98 percent of the elderly who break a hip, a major cause of these people losing mobility and therefore being in nursing homes.71, 72 Vitamin D deficiency in pregnant women actually increases the risk of their children developing osteoporosis.73, 74

  Vitamin D deficiency is also wreaking havoc in many other ways. Vitamin D is critical in regulating immune function, and a deficiency is implicated in multiple sclerosis, rheumatoid arthritis,75 inflammatory bowel disease,76 and diabetes.77–81 Treatment with vitamin D can also improve lung function and help people with asthma,82–85 while also decreasing the risk of heart disease86 and stroke.87

  This leaves the question of what level of supplementation is optimal. I concur with Dr. Heike A. Bischoff-Ferrari of the Harvard School of Public Health, who notes: “Recent evidence suggests that vitamin D intakes above current recommendations may be associated with better health outcomes…. An intake for all adults of [at least] 1,000 IU of vitamin D/day is needed.”88, 89

  VITAMIN K

  Although vitamin K plays a role in bone health, deficiency does not seem to increase osteoporosis.90 Because vitamin K stimulates blood clotting, which is already excessive in CFS/FMS patients (see Chapter 5), I do not recommend that those with CFS routinely take vitamin K.

  Minerals

  BORON (2 TO 3 MILLIGRAMS A DAY )

  Boron is helpful in improving bone strength—especially when combined with adequate magnesium. It may also help cognitive function.

  CHROMIUM (200 TO 500 MICROGRAMS A DAY )

  Chromium (and glutathione) is critical for proper insulin function and preventing diabetes, and can also decrease many of the symptoms of hypoglycemia. It can even be useful in treating some cases of depression, particularly when carbohydrate craving is a prominent symptom. A study of 113 people found that chromium supplements reduced depression-related cravings for sweets and starches, and provided an overall general improvement in depressive symptoms.91 Some physicians feel that it also helps cause weight loss.

  COPPER (500 MICROGRAMS A DAY )

  Copper is a double-edged sword. Although critical for antioxidant production (such as super oxide dismutase [SOD], one of the body’s natural free-radical scavengers that reduces pain and inflammation), it also is a potent free radical trigger and is quite toxic in excess.92 To strike an optimal balance, I recommend 0.5 micrograms a day of copper.

  IODINE (150 TO 250 MICROGRAMS A DAY )

  Optimal levels of iodine are critical for both healthy thyroid and breast tissue function. Iodine deficiency with secondary goiters used to be endemic in the United States until the mineral was added to wheat flour, and to a lesser degree salt. This eliminated much of the problem—until flour makers started adding bromine instead of iodine. This not only resulted in iodine intakes dropping by as much as half in the last decade, but the switch can worsen the effects of iodine deficiency, as bromine may block iodine’s function.

  One of the main problems caused by iodine deficiency is hypothyroidism, which can cause a host of problems. These include not only fatigue, weight gain, and pain but also infertility and miscarriages.

  Iodine deficiency is also a common trigger for breast tenderness and fibrocystic breast disease, and I routinely supplement women who have these problems with iodine. It has even been suggested that seaweed, which is high in iodine, may lower breast cancer risk.93 In fact, one of the upcoming studies planned by our foundation will be to check iodine, bromine, and fluorine levels (all related chemical “halides,” which compete with one another) in tissue samples of women with breast cancer, fibrocystic breast disease, and healthy breasts. We suspect that low iodine, or excessive levels of bromides and fluorides, which may inhibit iodine, are factors that unnecessarily increase breast cancer risk.

  MAGNESIUM (200 MILLIGRAMS A DAY )

  Magnesium is involved in hundreds of different body functions, and is critically important in CFS/FMS. Unfortunately, the average American diet supplies less than 300 milligrams of magnesium per day, while the average unprocessed (e. g., Asian) diet supplies more than 600 milligrams per day. Magnesium is critical for producing energy in muscles. This means that low magnesium causes muscles to spasm and shorten, and this muscle shortening is a major cause of
FMS pain. We frequently see marked pain relief, as well as increases in energy, with IV nutrient infusions that include magnesium. Magnesium is also critical for heart muscle function, and has been shown to improve both exercise endurance and cardiac function 94—a key player in CFS.

  Because of this, if your magnesium level is low, your muscles will stay in spasm and your fibromyalgia will not resolve. This is one of the reasons that taking magnesium is so critical. In addition, magnesium is important for the muscles’ and body’s strength and energy.95 Most of your magnesium is inside your cells, but the blood test only measures the magnesium in your blood—making blood tests an unreliable measure. I suspect that magnesium has trouble getting into the cells in people with CFS/FMS. When CFS/FMS is properly treated, the magnesium may be better able to get inside the cells. The cells then soak it up like a thirsty sponge and your blood level may even drop—despite taking large amounts of oral and even intravenous magnesium. So keep in mind that magnesium blood tests do not drop below normal until severe magnesium depletion occurs,96 and everyone with CFS/FMS, fatigue, or muscle achiness should take magnesium. An exception is if you have kidney failure with a blood creatinine level over 1.6 milligrams per deciliter (mg/dL)—very rare in CFS/FMS. Your doctor can help you determine whether supplemental magnesium places you at risk.

  I generally recommend taking 200 to 450 milligrams of magnesium glycinate in conjunction with 1,800 milligrams of malic acid (discussed in Chapter 2) a day for eight months, and then cutting back to 200 milligrams a day of magnesium. If diarrhea and cramps are not a problem, you can take up to twice this amount. If you get diarrhea from the magnesium, cut the dosage back and then slowly increase it as is comfortable. Magnesium absorption is very difficult, which is why I like to use the glycinate forms.

  Let’s discuss some of the key functions of magnesium.

  Magnesium is critical for life. For example, one study showed that subjects who were in the highest 25 percent of serum magnesium values had a 40 percent decreased risk of dying during the study, with a 40 percent decrease in cardiovascular mortality and a 50 percent decrease in cancer deaths, compared to subjects whose magnesium levels were in the lowest 25 percent of the population.97

  Magnesium helps build bones, regulate body temperature, produce proteins, and release energy stored in muscles. Because of the latter, magnesium deficiency causes muscle spasm/shortening, contributing markedly to fibromyalgia, migraine headaches, and other pains.

  Magnesium deficiency likely contributes to brain fog. A study by Massachusetts Institute of Technology researchers found that magnesium helps regulate a key brain receptor that plays an important role in learning and memory. The finding indicates that magnesium deficiency may result in reduced ability to learn and memorize, while cognitive function may be improved by an abundance of magnesium.98

  Magnesium deficiency also contributes to obesity by causing insulin resistance. The average weight gain in CFS is 32.5 pounds, and this weight gain often triggers sleep apnea. Preventing insulin resistance, then, is one more benefit of magnesium supplementation.99 Also, people with high magnesium intakes followed over fifteen years had a 31 percent lower chance of developing metabolic syndrome—a major cause of heart disease,100 as well as a decreased risk of developing diabetes.101

  Magnesium also:

  Helps protect against osteoporosis.102, 103

  Is associated with decreased inflammation levels (C-reactive protein, [CRP]), offering further heart protection.104

  Is associated with a 23 percent lower risk of colon cancer.105

  Improves asthma.106

  Decreases the frequency of migraine headaches.107, 108 In fact, the quickest and most effective way to eliminate a migraine headache is by giving 2 grams of magnesium IV over five to ten minutes.

  Helps children with hyperactivity and attention deficit disorder when combined with vitamin B6.109

  For patients with CFS/FMS, magnesium (along with B vitamins and D-ribose) represents the most critical nutritional need.

  MOLYBDENUM (250 MICROGRAMS A DAY )

  This mineral can be helpful for those with allergies, especially for those with sensitivities to the sulfites found in wine. It may also help detoxify acetaldehydes, which are made by yeast.

  SELENIUM (200 MICROGRAMS A DAY )

  Selenium is critical for optimal immune function. This is important to both eliminate the many infections seen in CFS/FMS, and to prevent cancer.110–112 Selenium is an antioxidant, and deficiency is associated with a shorter life, thyroid deficiencies, and immune dysfunction.113 In fact, low selenium is one of the problems that causes an underactive thyroid with normal blood tests, as it is critical for converting inactive thyroid to the active form, which is not measured on the tests.

  ZINC (15 TO 25 MILLIGRAMS A DAY )

  Zinc, which has been shown to be deficient in FMS, is critical for optimal immune and antioxidant function. Recurrent infections cause high zinc losses, which then further weaken immune function.

  Zinc may also help with cognitive function, especially when taken with stimulants that can help in CFS. One study gave forty-four children with ADHD either 55 milligrams of zinc or a placebo each day for six weeks along with Ritalin (which I think is overused in ADD and underused in CFS). While the behavior of all of the children improved during the study, those who had taken zinc had a more marked improvement. The study’s authors believe that zinc may play a role in regulating the production of dopamine in the brain, which is associated with feelings of pleasure and reward and which has been linked to ADHD by other scientists. Dopamine is often low in CFS/FMS, and there is reason to believe zinc supplementation will be of marked benefit in these disorders as well.114

  Amino Acids

  Amino acid supplementation, especially with whey protein, has many benefits. Using partially denatured whey protein has been shown to increase glutathione production and has been helpful in CFS. In a study conducted at James Madison University in Virginia and reported in the journal Medicine & Science in Sports & Exercise, whey protein also increased endurance and decreased the muscle wear and tear that comes with intense exercise.115 Whey protein also coats harmful bacteria, preventing them from adhering to the gut wall, where they can be infectious.

  Although all of the amino acids are important, I will focus on the ones that are most critical in CFS/FMS. As is the case with most nutrients, optimal levels are good (and likely better than the RDA), but more is not always better. The vitamin powder has more than 7,500 milligrams of amino acids.

  ARGININE (100 TO 200 MILLIGRAMS A DAY )

  This key amino acid is another double-edged sword. Although it may help raise growth hormone, which would be beneficial in most CFS/FMS patients, arginine can also raise nitric oxide, which is postulated by Professor Martin Pall to be too high in CFS (for more on his theories see the notes at www.vitality101.com). My main concern with arginine is that it promotes the growth of some viruses in the herpes family, and therefore may also stimulate HHV–6 and Epstein-Barr viral growth. Therefore, I recommend that only the low levels recommended here be used in supplements for CFS/FMS.

  METHIONINE (100 TO 300 MILLIGRAMS A DAY )

  Although the amino acid methionine is a key part of the production of SAMe (a nutrient that is helpful in CFS/FMS), high levels seem to paradoxically decrease SAMe production and may also be associated with an increased heart attack risk.116 Therefore, I recommend that only the low levels recommended here be added to supplements.

  N-ACETYL-CYSTEINE (NAC) (250 TO 650 MILLIGRAMS A DAY )

  NAC is critical for making a key antioxidant called glutathione and for keeping vitamins C and E in their active forms. It has been speculated that glutathione deficiency may be a major root cause of CFS. Although taking glutathione by mouth has no effect on blood levels (it simply gets digested), taking NAC, glutamine (1,000 milligrams a day, which also helps bowel healing), and glycine (500 to 1,000 milligrams a day) plus vitamin C can markedly increase glutathione levels. Supp
lementing these three amino acids is especially important in CFS, as NAC, glutamine, and glycine levels can decrease by 30 to 50 percent in this disorder. For NAC, I recommend 650 to 1,000 milligrams daily for three to four months and then 250 milligrams a day for maintenance. Low glutathione levels may contribute to your immune dysfunction, including low “natural killer cell” activity, as glutathione protects your immune system from harm.

  NAC has other benefits as well. In one study, taking high-dose NAC increased time to muscle fatigue by 30 percent while preventing a drop in glutathione.117 It may even help to protect the heart muscle during a heart attack.118 Antioxidant supplementation that includes NAC at doses of 600 to 3,000 milligrams a day may even significantly decrease symptoms of obsessive-compulsive disorder,119, 120 which can trigger CFS/FMS. NAC also plays a role in detoxification. For three months, I would take 500 to 650 milligrams of extra NAC in addition to the 250 milligrams in the powder.

  SERINE (500 TO 1,000 MILLIGRAMS A DAY )

  In one study presented at the Myopain Research Conference in Italy, 500 milligrams a day significantly decreased symptoms of FMS. It supports antioxidant, brain, and immune function.

  TAURINE (500 TO 1,000 MILLIGRAMS A DAY )

  Taurine has been shown to increase energy, and can even be found in a few energy drinks. Unfortunately, most of these “energy drinks” largely contain caffeine and sugar—which are loan sharks for energy and should be avoided.

  TRYPTOPHAN (100 TO 500 MILLIGRAMS A DAY )

  Tryptophan aids the production of serotonin, which is critical for sleep and decreases depression. The law limits how much tryptophan can be added to supplements, since a toxic batch made many years ago in Japan caused a reaction called eosinophilia myalgia syndrome. However, the 100 to 500 milligrams recommended here should be sufficient.