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People often ask “Which vitamin or mineral do I need?” the answer, simply put, is “All of them!”

Fortunately, we do not have to become part of the “handful club”, where you are taking handfuls of pills each day, to get what you need. It can be done very easily with one drink and 2 to 5 pills daily.

Let’s begin with an exploration of why high potency nutritional support is so important to optimize health in those with CFS/fibromyalgia:

  1. With half of the calories in our modern diet coming from sugar, white flour and fats, which are empty calories which have been stripped of nutrients, most Americans have lost over half of the vitamins and minerals they should be getting, before they even get out of the starting gate. In fact, this is the first time in human history where a very large percent of the population is both obese and malnourished at the same time.
  2. Fibromyalgia is associated with increased nutrient needs. This occurs for a number of reasons which we discuss below. Because of this, the RDAs (which I call the Ridiculous Dietary Allowances) are often woefully inadequate for those with CFS and fibromyalgia
  3. Because of the gut infections, poor absorption of nutrients is also a concern
Begin with Diet
  • Increase salt and water intake! Especially with the adrenal fatigue and low blood pressure/dehydration issues routinely found, people who salt restrict in an attempt to be healthy will crash and burn. Salt is your friend, and I would especially recommend high quality sea salts such as Celtic or Hawaiian sea salt. Mediterranean sea salt can also be found at low-cost at Costco. Increase water intake as well.
  • Most people with CFS/FMS do best with a high-protein diet and frequent small meals during the day. Everyone is different though, and eat what leaves you feeling the best.
  • As much as it is convenient, add in whole unprocessed foods and cut down the junk food.
  • Consider a 1 ounce protein snack at bedtime (e.g. a hardboiled egg, some meat, cheese, or fish), as this may prevent some of the 2–4 AM drops in blood sugar that wake people up. You will know if this is helpful for you in the first three days. A carb snack may worsen sleep.
For Key Areas Where Nutritional Support to Optimize Health Is Needed
  1. B-vitamins. These form the backbone of energy production in our body, and I recommend at least 40 mg of vitamin B1 to vitamin B6, 400 ìg of folic acid (with at least half of this being in a form that is methylation friendly, called 5 MTHF), and 500 ìg of vitamin B12 (as methyl or hydroxycobalmin, again to support methylation). These nutrients, especially vitamin B1 and B12, are also critical for having a clear mind. Research has shown that despite normal blood levels of vitamin B12, levels in the brain in CFS are very low or nondetectable. Because of this, very high levels of B12 are required to get optimal levels in the brain in this illness. Research suggests that very high levels of the other B-vitamins may also be important.
  2. Magnesium. This is another key nutrient for both energy metabolism, calming, and relief of muscle and nerve pain. The average American diet only has 275 mg per day, where a healthy unprocessed your diet has over 600 mg. It is likely that the vast majority of Americans suffer the effects of inadequate magnesium levels.
  3. Vitamin C, glutamine, glycine, and cysteine. These four nutrients are critical for making the key human antioxidant, called glutathione. It has been suspected that glutathione deficiency is one of the most important common denominators contributing to CFS/FMS. Although we hear a lot about antioxidants, it is important to realize that humans make just two antioxidants, glutathione and SOD, suggesting that these are the two that are most important for people. Having optimal levels of these antioxidants is critical for optimizing immune function.
  4. Zinc and vitamin A. These are also critical for immune function, and zinc deficiency is routinely seen in people with chronic infections or inflammation. Zinc and copper are also critical for making the other key human antioxidant, super oxide dismutase (SOD). More is not better though, and I recommend 15 mg a day. Consider taking an additional 20–25 mg a day for 3 months to “fill your tank”
  5. Vitamin D. In those with chronic pain and also those with immune dysfunction, vitamin D deficiency is routine and a significant player. Too much however can be problematic, as it can be converted to a form called calcitriol (1,25 hydroxy vitamin D) which may suppress immune function. Because of this, sometimes people have falsely low vitamin D levels on their blood testing, despite massive amounts being taken. I consider it ill-advised to chase these blood levels. Instead, I recommend that people simply take 1000 units of vitamin D daily and get sunshine.
  6. Tryptophan, tyrosine, and serine—these amino acids are critical for a number of functions including optimizing neurotransmitter levels(e.g., serotonin and dopamine) that are low in fibromyalgia
  7. Selenium. This mineral is critical for immune function, but has a very narrow optimal dosing range. For most people, I recommend 55 ìg daily, as higher doses can unnecessarily increase the risk of diabetes. For those with Hashimoto’s thyroiditis, taking the higher dose of 200 ìg a day can be helpful, with the benefits outweighing the risk of the diabetes.

To keep it simple, all of the above, and essentially all of the other key micronutrients that should be found in an optimal diet (except for calories, essential fatty acids, iron, and enzymes) can be found in a simple vitamin powder called the Energy Revitalization System by Enzymatic Therapy. This allows you to get them in one simple low-cost drink each day, instead of requiring 35 to 50 pills. Try getting get what’s in the one drink in less than 50 pills. Most people will not be able to! I designed the powder to be excellent for optimizing nutritional support in everyone, and it has recently been redesigned to improve methylation as well. I will note that all of my royalties for this product are donated to charity.

The other key nutrients that I recommend for everyone with CFS/FMS include:

  • Ribose. This special sugar produced by our body is the backbone of the energy molecules ATP, NADH, FADH, etc. We have now published two studies showing a dramatic average increase in energy of 60 percent after three weeks of taking 5 g three times a day. Two thirds of the people taking it were helped. After three weeks, the dose can be dropped to 5 g a day. I personally take one scoop of the Energy Revitalization System vitamin powder plus 5 g of ribose each morning. Just add water and stir with a fork. It will be the best 30 seconds for energy production you spend each day! It also was shown to decrease muscle pain, improve cognitive function, and improve sleep. I recommend the ribose and Energy Revitalization System vitamin powder for everyone. More good news? SHINE Ribose is now available. The same Bioenergy ribose used in the studies—at the lowest cost for Bioenergy ribose—anywhere!
  • Omega-3 support. Fish oil support is critical for mood, balancing inflammation, and a host of other processes. Fortunately, you no longer have to take eight big fish oil pills each day, while putting up with the “fish oil burps”. Using a pure omega-3 with phospholipids (such as Vectomega by EuroPharma), one small pill replaces eight big fish oil gels
  • Coenzyme Q10 at 200 mg daily. Take this with a meal containing some oil to optimize absorption
  • Acetyl l-carnitine 1500 mg daily for four months. Most people with CFS/FMS are carnitine deficient, but I would not bother with muscle biopsy needed to show it. Carnitine is critical for both energy production and the ability to lose weight (a topic we will discuss at length in the future). It also is helpful for helping the nerves to heal. Use the acetyl l-carnitine form, as this is better able to get into the parts of the cell where it is needed.
  • If the ferritin blood tests is under 60, I strongly recommend supplementing with iron. Take at least 50 mg of vitamin C along with the iron to support its absorption, and do not take the iron within six hours of taking thyroid hormone

Using the above approach, nutritional support can be done very easily. Give it six weeks to see the effects. Most people find it to be very helpful!

Jacob E Teitelbaum, MD

Jacob Teitelbaum, MD, is a board certified internist and Medical Director of the national Fibromyalgia and Fatigue Centers and Chronicity. He is author of the popular free iPhone application "Cures A-Z," and author of the best-selling books

Dr. Teitelbaum knows CFS/fibromyalgia as an insider — he contracted CFS when he was in medical school and had to drop out for a year to recover. In the ensuing 25 years, he has dedicated his career to finding effective treatments.