Nutritional Strategies for Treating Chronic Fatigue Syndrome — Part 3: Accessory Nutrients

Townsend Letter for Doctors and Patients,  Jan, 2001  by Melvyn R. Werbach

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L-Carnitine

Because of its important role in muscle metabolism, a carnitine deficiency may well impair mitochondrial function. If so, it would cause symptoms of generalized fatigue along with myalgia, muscle weakness and malaise following physical exertion. [1] The evidence to date does suggest that some patients with chronic fatigue syndrome (CFS) may suffer from a clinically-relevant carnitine deficiency. While findings concerning free serum carnitine levels are mixed, two studies have noted significant decreases in serum acylcarnitine. [1,2] Moreover, a third study found an increased ratio of acylcarnitine to free carnitine, [3] a finding suggesting that insufficient carnitine is available for metabolic requirements. [4]

One of these studies found that both total and free serum carnitine levels were inversely correlated with the patients' symptoms, and that serum carnitine levels were directly correlated with their capacity to function. [2] Moreover, another of these studies found a similar relationship between serum acylcarnitine, symptoms and functional capacity. [1] In other words, in CFS, serum carnitine levels appear to be a biochemical marker for both symptom severity and the ability to function.

Open trials of oral L-carnitine using 1 gram 3 to 4 times daily have shown mixed results. [2,5] Plioplys believes that this is because only about one-third of CFS patients are carnitine responders. Of the responders, some improve so dramatically that, even if they were fully disabled initially, they return to normal functioning and remain well so long as they continue taking the supplement. Unfortunately, he found that baseline serum levels of L-carnitine failed to predict who was going to respond. [2]

Coenzyme Q10

Since CoQ10 facilitates cellular respiration, and because clinicians have been under the impression that it is of therapeutic value, it has long been prescribed to CFS patients. [6,7] Recently, Judy reported on a formal study of 20 female patients who required bed rest following mild exercise. Eighty percent were deficient in CoQ10, while 100% had increased CoQ10 deficiency over the course of the day or following mild exercise.

Three months following supplementation with 100 mg daily of CoQ10, exercise tolerance (400 kg-meters of work) more than doubled. All patients improved, 90% had reduction and/or disappearance of clinical symptoms, and 85% had decreased post-exercise fatigue. [8]

Essential fatty acids

Low levels of essential fatty acids (EFAs) appear to be a common finding in chronic fatigue syndrome, [9,10] possibly due to abnormalities in EFA metabolism. Changes in the ratio of biologically active EFA metabolites may be an exaggeration of normal physiological responses to stress and could cause the immune, endocrine and sympathetic nervous system dysfunctions seen in CFS. [11] Also, viruses, as part of their attack strategy, may reduce the ability of cells to make 6-desaturated EFAs while interferon requires 6-desaturated EFAs in order to exert its anti-viral effects. [12]

EFA supplementation was studied in 63 patients who had post-viral fatigue syndrome for at least one year and low baseline plasma EFA levels. They randomly received 4 capsules twice daily of either an olive oil placebo or of Efamol Marine (a mixture of 80% of evening primrose oil and 20% of concentrated fish oil).

After 3 months, 85% of treated patients rated themselves as better than at baseline compared to only 17% of those on placebo, a highly significant difference. Without exception, all the individual symptoms, including fatigue, aches and pains, and depression, showed a highly significantly greater improvement on the fatty acid supplement than on placebo. Moreover, in the treated group only, plasma EFA levels had risen to normal. [10]

Doctor Werbach cautions that the nutritional treatment of illness should be supervised by physicians or practitioners whose training prepares them to recognize serious illness and to integrate nutritional interventions safely into the treatment plan.

References

(1.) Kurastsune H, Yamaguti K, Takahashi M, et al, Acylcarnitine deficiency in chronic fatigue syndrome. Clin Infect Dis 18(suppl 11:S62-7, 1994

(2.) Plioplys AV, Plioplys S. Serum levels of carnitine in chronic fatigue syndrome: clinical correlates. Neuropsychobiology 32(3):132-8, 1995

(3.) Grant JE, Veldee MS, Buchwald D. Analysis of dietary intake and selected nutrient concentrations in patient with chronic fatigue syndrome. J Am Diet Assoc 96(4):383-6, 1996

(4.) Campos Y, Huertas H, Lorenzo, G, Bautista J, et al. Plasma carnitine insufficiency and effectiveness of L-carnitine therapy in patients with mitochondrial myopathy. Muscle Nerve 16:150-3, 1993

(5.) Grau JM, Casademont J, Pedrol, E, et al. Chronic fatigue syndrome: studies on skeletal muscle. Clin Neuropathol 11(6):329-32, 1992

(6.) Lapp CW. Chronic fatigue syndrome is a real disease. North Carolina Family Physician 43(1):6-11, 1992

(7.) Goldberg A. CFIDS Chronicle, Summer/Fall 1989