Jacob Teitelbaum, MD, knows firsthand how devastating fibromyalgia and chronic fatigue syndrome can be. Because of these diseases, he had to drop out of his third year of medical school. He lost his scholarship and ended up sick and homeless, faced with the challenge of finding himself and putting his life back together again. Find himself he did. When he finally completed his studies, he decided to specialize in fibromyalgia and chronic fatigue syndrome.
Dr. Teitelbaum is now the medical director of the national Fibromyalgia and Fatigue Centers, a group of medical facilities across the country that specialize in treating people with these two conditions. He is also a researcher and the author of two best-selling books that deal with fibromyalgia syndrome (FMS), chronic fatigue syndrome (CFS), and other conditions that involve chronic pain—From Fatigued to Fantastic and Pain Free 1-2-3: A Proven Program for Eliminating Chronic Pain Now.
Nutrition plays a huge role in the treatment that he recommends for these two conditions. In fact, the recommended nutrients are the same for both conditions, which is why we’ve placed them in the same chapter. Actually, the two conditions are closely related. If you have chronic fatigue syndrome, you’re tired and achy all the time. If you have fibromyalgia, you’re tired and achy all the time and you also hurt in a number of specific points on your body.
Otherwise, symptoms that can manifest for both conditions are the same. The main ones are:
Aches and pains
Sleep disturbances
Bowel problems
Fuzzy thinking, also known as brain fog
Fatigue and low energy
The list of possible symptoms is a lot longer—a lot. It ranges from sexual dysfunction to recurring infections, from headaches to weight gain. Looking at the full list doesn’t begin to do these two conditions justice, however. Millions of people have each condition, or both, and for most of them, life gets turned upside down. The two conditions are so complicated, confusing, and varied from individual to individual that it took medical science many years to even acknowledge that they exist. Even today, when deciding whether either diagnosis applies, doctors refer to a list of possible symptoms and also a chart of possible painful areas of the body.
Let’s simplify things a bit: People who have one condition tend to have the other, says Dr. Teitelbaum. The hallmark of both conditions, he says, is that “you’re exhausted, but can’t sleep. You have basically blown a fuse.” What we’re dealing with here, he says, is “an energy crisis in the human body.” So there’s no need to fuss over which condition you might have or what the correct label might be. If you can’t sleep, you’re so exhausted that you can’t function, and your body aches, the nutrients and other treatments that we’re going to look at in this chapter could make a significant difference in your energy level and in how you feel.
Dr. Teitelbaum uses an acronym for the range of treatments that he recommends for FMS and CFS, and each component has a nutritional aspect to it. S-H-I-N-E stands for sleep, hormones, infection fighting, nutrition, and energy. Finding a doctor who will work with you closely is essential and will make a significant difference in your prognosis, says Dr. Teitelbaum.
Do whatever you need to do to get a full night’s sleep, stresses Dr. Teitelbaum. You need 8 to 9 hours of deep, solid sleep. Nutrients and herbal remedies are helpful, he says, but if you need to take a prescription sleep aid for a time, go for it. Your body must have the restorative sleep it needs in order for you to heal. Nutrients that support your body’s sleep efforts, he says, include calcium, 500 to 600 milligrams; magnesium, 200 to 300 milligrams; the amino acid theanine, 50 to 200 milligrams; and 5HTP, 200 to 400 milligrams. The calcium and magnesium should be taken at bedtime.
If you are also taking an antidepressant that raises serotonin levels, you should not take more than 200 milligrams of 5HTP, or you’ll end up with too much serotonin in your body.
Your body needs adequate levels of certain hormones in order to function properly, assure adequate energy levels, and help you deal with stress, fight off infections, and keep pain at bay. Your doctor can help determine whether you’re producing enough of the hormones that are particularly important for people with CFS and FMS—thyroid hormone and the adrenal hormones, which include cortisol, DHEA, and the sex hormones estrogen and testosterone. (The sex organs produce sex hormones, but the adrenal glands also add to the supply.)
It’s possible that your doctor may give you prescriptions for one or several hormones to make up any deficiency. Be aware that even if your blood tests for certain hormones are normal, you may need a prescription anyway, says Dr. Teitelbaum. If you’re tired, achy, and have a weight problem, you might need thyroid hormone, he says, and if you’re irritable when hungry and have difficulty handling stress, you may need adrenal hormones.
A number of specific nutrients help support your body’s own hormone production, says Dr. Teitelbaum. These include the following:
Iodine
Your thyroid gland absolutely must have the mineral iodine in order to function. A number of years ago, salt manufacturers started adding iodine to table salt because so many Americans had goiter, a condition that develops from insufficient iodine intake. “Iodine deficiency seems to be making a comeback in this country,” says Dr. Teitelbaum. This is happening, he explains, because of a recent change in the chemical used as an anti-caking agent for wheat. For a long time, iodine was used for that purpose, he says. But now manufacturers are using bromine, which is cheaper. Bromine, however, is an antagonist, or acts in opposition, to iodine. So as people consume more bromine, their need for iodine goes up. You need to get at least 200 micrograms of iodine daily.
Pantothenic Acid
This is a B vitamin that supports the adrenal gland. You need 100 to 150 milligrams a day. Some physicians may advise much higher amounts, specifically for adrenal gland support.
Selenium
Your body needs selenium in order to convert the hormone that your thyroid gland makes (T4) into an active form of the hormone that your body can use (T3). You need to get 100 to 200 micrograms a day. It’s important not to go over 200, as selenium is toxic at higher levels.
Tyrosine
Tyrosine is an amino acid that helps build proteins in the body. This particular amino acid also helps form several important neurotransmitters. Also, thyroid hormone is made of iodine plus tyrosine. You need to get 500 to 1,000 milligrams a day.
Vitamin C
The brain and adrenal glands contain the highest levels of vitamin C anywhere in the body. You need 500 to 1,000 milligrams a day.
Finally, there’s one negative to mention here. You should be limiting your consumption of processed soy products like soy milk and soy cheese, as these can reduce your thyroid gland’s production of thyroid hormone, says Dr. Teitelbaum. Soy sauce and tofu are okay. But if you use soy milk, you should switch to rice milk or almond milk instead.
People with FMS and CFS are prone to respiratory and other kinds of infections, and a number of nutrients play a significant role in fighting them off. These include folic acid, 800 micrograms; and selenium, 200 micrograms. (You also need selenium for hormone support. A single 200-microgram dose serves both functions. Selenium is toxic at higher levels, so you never want to exceed 200 micrograms.)
Zinc
People who have FMS or CFS tend to urinate frequently, and urinary losses of zinc are a particular problem, as you need this mineral to fight infections, says Dr. Teitelbaum. He generally recommends 15 to 25 milligrams a day. Your doctor may want you to go higher. If you exceed 50 milligrams a day, you also need to take a copper supplement, as zinc can deplete the body’s copper stores. If you take 50 milligrams of zinc a day, you should also take 1 or 2 milligrams of copper.
“People ask me, ‘What nutrients do I need to take for fibromyalgia and chronic fatigue syndrome?’ The answer is, ‘All of them,’” says Dr. Teitelbaum. Of particular importance, he says, is vitamin D, of which you need 1,000 to 2,000 IU.
To ensure that you’re getting the full range of nutrients that you need, take a high-potency multivitamin. You’ll need to compare the dosages for individual nutrients recommended in this chapter with what your multi provides to determine if you need to do any extra supplementation. In addition, you’ll want to add fish oil, which is a rich source of essential fatty acids.
Essential Fatty Acids
Fish oil contains essential fatty acids that are helpful for fighting infections. You should also consider taking fish oil if you’re fighting depression or have dry eyes or dry mouth—all symptoms that can be part of FMS or CFS. Take 1 tablespoon a day. If you are a vegetarian or vegan, take flaxseed oil instead.
It’s especially important to make sure that your oils are not rancid. “If you’re burping the fish oil, it’s rancid,” says Dr. Teitelbaum. “If you would not eat a piece of fish that tastes that way, throw it away.” Particularly good brands are Eskimo 3 and Nordic Naturals, he says. And Barleans is good for flaxseed oil.
Just about everything we’ve discussed in this chapter should help you put fatigue behind you and boost your energy levels. But there are a couple of nutrients that deserve special mention, according to Dr. Teitelbaum.
In 2007, an Italian study evaluated acetyl L-carnitine supplements as a possible treatment for fibromyalgia. Some 102 people with fibromyalgia were given either acetyl L-carnitine or a placebo and evaluated over a period of 10 weeks. There was no change in the two groups until the evaluations at the 6th and 10th weeks. During these examinations, researchers found that those receiving acetyl L-carnitine had fewer painful tender points on their bodies, less musculoskeletal pain, and less depression.
“Although this experience deserves further study,” the researchers noted in their published paper, “these results indicate that acetyl L-carnitine may be of benefit in patients with FMS, providing improvement in pain as well as the general and mental health of these patients.”
Acetyl L-carnitine is a compound found only in animal flesh that your body makes from a couple of amino acids, which are the building blocks of protein. Besides helping with energy production, this supplement could help you burn fat and possibly deal with the weight gain that so often accompanies CFS and FMS. You need to take 500 milligrams twice a day, says Dr. Teitelbaum. You can discontinue this one after taking it for 3 months, he says.
B Vitamins
B vitamins support energy production in a variety of ways. You should be taking a B-complex supplement.
Coenzyme Q10
Your body uses coenzyme Q10 as an essential part of its energy production system. Many cholesterol-lowering drugs (statins) and birth control pills lower the body’s reserves of coenzyme Q10. You also need more when your body is facing an energy challenge. You do get coenzyme Q10 from your diet, but you should also be taking a daily supplement of 200 to 400 milligrams. You can discontinue this one after 3 months.
Your muscles use magnesium to produce energy. You need 200 to 300 milligrams a day. (Magnesium was mentioned earlier as support for a good night’s sleep. This same amount supports both functions.)
Malic Acid
This nutrient plays a critical role in your body’s energy production process. Take 900 to 1,200 milligrams a day.
Ribose
At the Fibromyalgia and Fatigue Centers in Dallas, Dr. Teitelbaum and colleagues conducted a pilot study that took a look at the simple sugar Dribose as a treatment. Forty-one people with a diagnosis of either fibromyalgia or chronic fatigue syndrome took a d-ribose supplement. Researchers reported that participants experienced an average of 45 percent improvement in energy scores and an average of 30 percent improvement in feelings of well-being.
“Ribose is a good, healthy sugar that really increases energy a lot,” says Dr. Teitelbaum. He advises taking 5 grams three times a day for the first 3 weeks you use the product, then dropping down to a single 5-gram dose each day. Otherwise, he says, you should do your best to avoid sugars. He advises using stevia as a sweetener. Many brands of stevia have a bitter taste; two brands that taste good, he says, are Body Ecology and Stevita.
From Fatigued to Fantastic, Completely Revised Third Edition, Pain Free 1-2-3: A Proven Program for Eliminating Chronic Pain Now by Jacob Teitelbaum, MD fmaware.org, Web site of the National Fibromyalgia Association
This chapter contains perhaps the longest list of dietary supplements in the book. Most dietary experts currently recommend foods as the best source for nutrients. However, in people with CFS or FMS, so many of the body’s systems are affected that nutritional support in the form of supplements can make a critical difference in symptom relief, according to Dr. Teitelbaum.
In addition to taking all these supplements, is there anything to be said about diet in general?
“No one diet is best for everyone,” says Dr. Teitelbaum. “We all have different needs at different times. How do you tell what’s good for you? It’ll make your body feel good.”
If you have either fibromyalgia or chronic fatigue syndrome, it is essential that you be under the care of a doctor and that you find a doctor who will work with you on nutrition and nutritional supplements.
5HTP* |
200 to 400 milligrams |
Acetyl L-carnitine |
500 milligrams, twice a day (can discontinue after 3 months) |
B vitamins |
B-complex supplement, follow the package directions |
Calcium† |
500 to 600 milligrams, taken at bedtime |
Coenzyme Q10 |
200 to 400 milligrams (can discontinue after 3 months) |
Essential fatty acids |
1 tablespoon of fish oil‡ or flaxseed oil |
Folic acid |
800 micrograms |
Iodine |
200 micrograms |
Magnesium |
200 to 300 milligrams, taken at bedtime |
Malic acid |
900 to 1,200 milligrams |
Pantothenic acid |
100 to 150 milligrams |
Ribose |
5 grams, three times a day for the first 3 weeks; then 5 grams a day |
Selenium§ |
100 to 200 micrograms |
Theanine |
50 to 200 milligrams |
Tyrosine |
500 to 1,000 milligrams |
Vitamin C |
500 to 1,000 milligrams |
Vitamin D |
1,000 to 2,000 IU |
Zinc** |
15 to 25 milligrams |
*If you are taking an antidepressant that raises serotonin levels, do not take more than 200 milligrams of 5HTP.
†If you are taking thyroid hormone, you need to allow at least 6 hours before you take calcium, as calcium can block the absorption of the hormone.
‡Fish oil has a blood-thinning effect. If you’re taking any kind of blood-thinning drug, talk to your doctor before taking fish oil supplements.
§Do not exceed 200 micrograms a day. Selenium is toxic at higher levels.
**Your doctor may recommend that you take a larger dose of zinc than this. If you exceed 50 milligrams of zinc a day, you should also take 1 or 2 milligrams of copper.
For most people with FMS or CFS, a diet low in carbohydrates and high in protein works best, he says. But that is not a hard-and-fast rule.
Also, you need to drink more water and get more salt than most people. People with these two conditions tend to urinate a great deal. So, says Dr. Teitelbaum, the rather colorful saying applies: “Drink like a fish and pee like a racehorse.” And, unless you also have high blood pressure, feel free to enjoy some salty foods. If you live in a hot climate and tend to get dizzy when you first stand up, you might even need to take salt tablets.