Simplifying nutritional support in CFS/Fibromyalgia - Highly Effective Treatments for Pain and Fatigue

Townsend Letter for Doctors and Patients, April, 2003 by Jacob Teitelbaum

In last month's issue we talked about the causes of widespread nutritional deficiencies in Chronic Fatigue Syndrome and Fibromyalgia CFS/FMS). These included poor quality diet and digestion (which can be helped dramatically with plant-based digestive enzymes -- e.g. Similase by PhytoPharmica), bowel infections, and increased nutritional needs secondary to the illnesses. This has resulted in an immense number of recommendations for different nutrients, each of which have been purported to be critical for people getting better. This has caused patients to become very confused and overwhelmed with the vast number of supplements that they're told they need to take.

Because of this, we have worked on a simplified approach that makes it easier for most people to get the nutritional support they need -- both easily and effectively. I would like to begin, however, by reviewing the importance of long-term nutritional support with key nutrients in CFS (and for most people). In the next issue, I will review the nutrients that only need to be taken for three to nine months while the body is in its "Repair Phase."

Why are vitamins and minerals so important in CFS/Fibromyalgia?

Dr. Janet Travell, White House physician for presidents John F. Kennedy and Lyndon B. Johnson and professor emeritus of Internal Medicine at George Washington University, co-wrote Myofascial Pain and Dysfunction: The Trigger Point Manual, which is acknowledged as the authoritative work on muscle problems. In one chapter alone, Dr. Travell and coauthor Dr. David Simons reference 317 studies showing that problems such as hormonal, vitamin, and mineral deficiencies can contribute to pain and muscle disorders. Numerous other studies have also shown that adequate amounts of vitamins and minerals, especially folic acid, zinc, and selenium, are critical for proper immune function. Zinc levels in particular have been found to be quite low in people with CFIDS/FMS (and also in AIDS).

Every vitamin and nutritional mineral is very important in some way to health. If the patient is low in any of a number of vitamins and minerals, their fibromyalgia simply will not subside. B vitamins, for example, are the backbone of energy production and it is important that patients with CFS/fibromyalgia get at least 50 mg of most of these, plus 800 micrograms of folic acid and 500 micrograms of vitamin B12. These can have a dramatic effect on your patients' well being.

Why such high levels of Vitamin B12?

Vitamin B12 is a key nutrient in CFS. Technically, a patient's B12 level is normal if it is over 208 pg/dL. Studies, however, have shown that people can suffer significant nerve and brain dysfunction from B12 deficiency, even if their levels are as high as 300 pg/dL. In addition, a recent study using the respected Framingham database showed that metabolic signs of B12 deficiency occur even with levels over 500 pg/dL.

Why are the "normal" levels set so low? In part, the normal values were initially set according to what prevents anemia. This is problematic, however, because the brain and nervous system's needs for vitamin B12 are often much higher than those of the bone marrow. Also, the medical establishment has greatly enjoyed poking fun at the old-time and holistic 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 may have been right. I suspect, though, that our modern medical establishment will be a little slow to eat crow.

Recent research shows that despite having low normal B12 levels in the blood, CFS patients often have very deficient (and sometimes absent) B12 levels in their brains! This suggests that, because of the metabolic problems present in CFS/FMS, patients may need a very high B12 level in their blood to get adequate levels past the blood-brain barrier and into the brain, where B12 is needed. In addition, vitamin B12 helps to reduce excessive levels of nitric oxide, a neurotransmitter that can be too high in CFS/FMS and that can easily contribute to symptoms. More and more, research studies are supporting what holistic doctors who effectively treat CFS/FMS using B12 shots have said for years!

It is no surprise then, that when their other problems are also treated, many people respond dramatically to B12 injections. If a patient's B12 level is under 540 pg/ml, I treat with a 1-cc (3,000-microgram) injection of hydroxycobalamin (from a compounding pharmacy; e.g. Cape Drug at 410-7573522 or the Apothecary at 800-869-9159 are two excellent ones), one to five times a week, for fifteen injections. These shots are very safe and fairly inexpensive. If a patient feels worse when the injections are stopped, I resume giving the shots, usually every one to five weeks (but as often as three to four times a week in some cases) for an extended period of time. Most people, however, can maintain the benefit after fifteen injections by taking the 500 mcg/day of oral B12 which is present in the Daily Energy Enfusion vitamin powder.