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Dr. Charles Lapp’s Recommendations on Supplements for ME/CFS and Fibromyalgia

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This article, which was reviewed and edited by Dr. Lapp, is reproduced with kind permission from Dr. Campbell’s CFIDS & FM Self-Help site. Drs. Lapp & Campbell jointly support a new site that takes ME/CFS & FM patients step-by-step through development of an individualized treatment plan (www.treatcfsfm.org) – for those who may not have access to a knowledgeable healthcare team.

Should you take supplements? If so, which ones and what benefits are reasonable to expect?

For some answers, we turned to Dr. Charles Lapp, director of the Hunter-Hopkins Center in Charlotte, North Carolina. Dr. Lapp has treated CFS and FM patients for over 25 years. The clinic is one of the few medical practices in the United States to specialize in CFS and FM. Dr. Lapp is one of only two people to be given the Outstanding Clinician Award by the IACFS (International Association for CFS/ME), an organization of leading CFS researchers and doctors.

Dr. Lapp has developed three tests a supplement must pass before he recommends it.

• It must be safe.

• There must be a scientific basis for its use.

• It must produce a positive effect in at least 50% of people who use it.

He has found 11 supplements that qualify.

The first six described below are useful for many people with CFS or FM. The first five together cost together about $15 a month and the sixth about $20 a month (2009 prices). The remainder are used for specific purposes; he recommends them for only some patients.

Dr. Lapp stresses that there is no cure so far for either CFS or FM, and supplements are not the heart of treatment. But they may be used to optimize health and may produce modest improvement in some symptoms. As he has written, the most important treatment of CFS and FM is acceptance of the illness and adaptation to it by means of lifestyle change, which focuses on pacing and includes other adjustments such as stress management.

• Dr. Lapp advises that people try only one new supplement at a time, keeping it if it works and dropping it if it is ineffective.

• He also suggests stopping the use of a supplement for several weeks once a year to test whether it is still effective. If you experience no change in symptoms during that time, you can save yourself some money by dropping that substance.

* * * *

1. Multi-vitamin

To optimize overall health, he recommends using a multi-vitamin that includes B complex, folate, vitamin D, calcium and magnesium.

2. Vitamin B-12

He recommends the injectible form and says that up to 80% of people with CFS/FM who use it experience a 10% to 15% energy boost.

[Note also that clinical research indicates sublingual (under the tongue) tablets delivering B-12 directly into the bloodstream can be equally effective.(1)]

3. Vitamin D3

He has found that virtually all his patients have low levels and recommends 2,000 units per day.

D3 reduces pain and morning stiffness.

Also, it protects against stroke, heart attack and breast cancer, and promotes the absorption of calcium.

4 & 5. Calcium and Magnesium

The recommended calcium dosage is 1,000 mg to 1,500 mg daily, the amount available in two Tums tablets.

The magnesium dosage he recommends is 500-750 mg daily, but magnesium is inappropriate for those with kidney disease and may cause diarrhea.

People often take these two together in a calcium-magnesium tablet.

6. D-Ribose

This is a naturally-occurring sugar used in cell metabolism and the production of energy. It is metabolized differently from table sugar and has little effect on blood sugar levels or diabetes.

The dose is 5000 mg three times daily for two weeks, then 5000 mg twice daily.

Results are usually obvious within three weeks.


This substance, often used with the next item, helps increase ATP [cellular fuel] in mitochondria.

It takes three to six months to produce a response and the response is often subtle.

Dr. Lapp recommends a dosage of 10 to 20 mg per day and uses this and # 8 only with his sickest patients and those with the worst brain fog.

8. Acetyl-carnitine

This supplement [aka Acetyl L-Carnitine] is often used with NADH to increase energy production.

Since acetyl-carnitine is frequently low in brain tissue, many believe that supplementation may improve cognition.

Dr. Lapp recommends a dosage of 1,000 mg twice a day.


This supplement can help with energy level and libido. It is not needed if a person is already taking estrogen and/or testosterone via hormone replacement therapy.

Side effects may include oily skin, acne and excessive hair growth.

Dr. Lapp recommends 25 to 50 mg daily for women and 50 to 100 mg for men.

10. Lysine

This supplement [aka L-lysine] can be used to reduce the frequency and severity of herpetic mouth ulcers (mouth sores).

The recommended dosage is 1,000 to 2,000 mg per day.

11. Fish Oil

This supplement is used to treat pain and to lower cholesterol.

The recommended dosage is three to four grams a day.

Dr. Lapp recommends using the enteric-coated version to reduce burping.

Caution: Before you start taking a supplement, check with your doctor. She can take into account your individual situation, something not possible with the general advice offered in this article.

Related Article: “How Your Doctor Can Help If You Have CFS/ME”
Dr. Lapp explains four ways your primary care physician can help you.

ProHealth Note: The supplements mentioned here are available at your local health food store, and of course may be purchased in the ProHealth Store.

1. See “B-12 Deficiency in ME/CFS and FM,” by Dr. Dana Myatt, MD, footnotes 214 and 217-220.

* Dr. Bruce Campbell, PhD, is a leading ME/CFS & FM educator, and is himself an ME/CFS patient who slowly achieved improved health more than a decade ago by researching and practicing an ongoing regimen of significant lifestyle changes. His website (www.cfidsselfhelp.org) offers a searchable library with scores of free articles on coping with ME/CFS and fibromyalgia, as well as low-cost online self help courses in moderated discussion group format.

This material is posted for informational and educational purposes only and is not intended to substitute for medical or other professional advice, or to prevent, diagnose, treat or cure any illness, condition, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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6 thoughts on “Dr. Charles Lapp’s Recommendations on Supplements for ME/CFS and Fibromyalgia”

  1. IanH says:

    Much recent evidence supports the use of colostrum for “Leaky Gut”. A significant number of people with ME/CFS have IBS symptoms due to immunological dysfunction affecting the gut. Leaky gut occurs when the protein bridges across the intestinal wall do not function properly and toxins and bacterial cells cross into the blood stream along with nutrients specific for the Proetein pore.

    In addition, their is also much evidence that intestinal imbalance accounts for some of the neurological dysfunction seen in ME/CFS.

  2. Sandy10m says:

    Multi-vitamin: if you have intestinal problems, you are likely not absorbing any vitamins or supplements well. The best vitamins to take are the natural food-based ones, not chemicals. Take Nature’s Way Alive (or other similar), instead of Centrum or One-a-Day (which are fairly useless because they’re just chemicals).

    B-12 sublingual: I blood-tested low for B-12, then I started taking the B-12 Extreme sublingual from Prohealth. My results were off the scale due to the high dose, so this stuff really works. I reduced to 1/4 of a pill sublingual every other day, and had great results.

    Vit D3: These are supposed to reduce inflammation, but for some reason they create migraines for me which do not respond to medication, even at the lowest 400 mg dose. Just be aware that you might have some weird reaction to ANY supplement, and you should always add ONLY one new one at a time so you can watch for strange side effects.

    Calcium and Magnesium: I tried taking Mg for muscle cramps (common in fibro), but the pill form was not absorbed by my body when I had the intestinal problems. I had great success with the liquid ionic forms (such as Trace Minerals 400 mg). You can slowly increase the dose because they are drops. It tastes bad, so I mix it in coconut milk, and I notice a significant improvement in muscle cramps taking the liquid form.

    Fish oil: it only gives burps if it’s poor quality. I found Spectrum brand to be burp-free and high quality, and many of my friends agree (I referred them to it). Spectrum uses deep ocean small fish and routinely test for heavy metals to ensure there are none. If you don’t have this testing, you can’t be sure about the metals. And you don’t need more metals with the problems we already have. This supplement, BY FAR, is the one that helps me the most because it is a huge anti-inflammatory. Inflammation is one of our biggest enemies, and my pain threshold is much improved when I take 4000-6000 mg per day (up to 2 capsules, with every meal).

    As for the intestinal problems, there is a good chance many of us have an active candida infection of our intestines. The candida dig into the intestinal wall and hang on. That digging in makes a small hole in the intestinal lining, which is why we have leaky gut. I stool-tested with a specialized parasite lab in Arizona, found the candida, then tried every herbal preparation known to man or beast. While they helped, they didn’t get rid of it. I had to resort to 3 months of anti-fungal prescriptions AND a Caveman diet. The only anti-fungal medications that worked were the oral powdered Nystatin (not absorbed by the body, so it works only in the intestines) along with 2 weeks up front of Diflucan oral (which is absorbed so you attack the candida from both sides of the intestinal wall). I’ve been candida-free, IBS-free, leaky-gut-free, and doing much better for about 2 years.

    Good luck, everyone,

  3. Sandy10m says:

    For D-Ribose to have its maximum effect, you should take it on an EMPTY STOMACH. This is not written anywhere, but I did this by accident and noticed a HUGE difference in my energy level and brain fog in particular. I now take 5000 mg powdered form in water when I wake up, then another 5000 mg about 30 min before lunch, and another 5000 mg mid-day around 3:30. It has been a god-send, but only if taken on an empty stomach. You should feel results using it this way in the FIRST DAY (don’t need to wait 2 weeks). If it makes you jumpy, reduce the amount until you just feel great. And it won’t spike your blood sugar or insulin because it’s already in its basic form, so it goes straight to your cells. Good luck.

  4. Notsohealthysarah says:

    I have Fibro and Cfs. Magnesium, calcium and vitamin d definitely helps along with q10. I tried to add a multivitamin to this and it made me feel soooooo emotional and teary…but my energy was great. Does anyone know why this happened?? Wheatgrass also helps me too.

    1. Sandy10m says:

      Not all multi-vitamins are created equal. Some contain added ingredients that can cause all sorts of reactions in sensitive people like us. I take LDA vitamin, which goes with the Low Dose Allergen therapy that worked for me for a while but then stopped working. But I liked the vitamin because it was in lower doses and didn’t cause any reactions. I recommend whole-food vitamins like Alive to most people, though, because the vitamins are still connected to food molecules (not just chemicals), so your body recognizes them and absorbs them much better. I hope that helps.

  5. Sandy10m says:

    Be careful about the type of Calcium and Magnesium that you use. Most naturopaths and nutritionists recommend Calcium Citrate because it is readily absorbed and not too expensive. Calcium Carbonate is completely useless (also called Coral Calcium or anything from shells). It might actually suck calcium out of your body. For Magnesium, same thing, Magnesium Citrate has good absorption without too much expense. However, I disagree in taking them together in the same pill. My doctor says that you can take too much calcium as an older woman, which can cause heart problems. I need to take HUGE amounts of Magnesium to control IBS (1000 mg per day) and help me sleep, so taking the calcium with the magnesium would be way too much calcium. I hope this helps.

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