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SHINE Protocol: Nutritional Support – Simplifying Nutritional Support in Fibromyalgia / M.E. & Chronic Fatigue Syndrome

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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 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

  1. 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.
     
  2. 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.
     
  3. As much as it is convenient, add in whole unprocessed foods and cut down the junk food.
     
  4. Consider a 1 ounce protein snack at bedtime (e.g. a hard-boiled 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.

In a future article, we will discuss nutrition health myths that you will be happy to see busted. For example, did you know that chocolate is a health food that helps CFS? It is!

Key Areas Where Nutritional Support 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 µg of folic acid (with at least half of this being in a form that is methylation friendly, called 5 MTHF), and 500 µg 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 µg daily, as higher doses can unnecessarily increase the risk of diabetes. For those with Hashimoto’s thyroiditis, taking the higher dose of 200 µg 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:

  1. 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% after three weeks of taking 5 g three times a day. http://benthamscience.com/open/topainj/EBM.htm   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.
     
  2. 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.
     
  3. Coenzyme Q10 at 200 mg daily. Take this with a meal containing some oil to optimize absorption.
     
  4. 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.
     
  5. 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 Teitelbaum, MD, is author of the popular free iPhone application “Cures A-Z,” and of the best-selling books From Fatigued to Fantastic! And The Fatigue and Fibromyalgia Solution (Avery/Penguin Group). He is lead author on 4 studies of effective treatment for fibromyalgia and chronic fatigue syndrome, and a recent study on effective treatment of autism using NAET. Dr. Teitelbaum does frequent media appearances including Good Morning America, CNN, Fox News Channel, the Dr Oz Show and Oprah & Friends. He lives in Kona, Hawaii. His free Energy Analysis Program can be found at: www.EndFatigue.com

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3 thoughts on “SHINE Protocol: Nutritional Support – Simplifying Nutritional Support in Fibromyalgia / M.E. & Chronic Fatigue Syndrome”

  1. IanH says:

    I know that Dr T was attempting to simplify the nutrient needs but A few things to add:

    Firstly to say that 1000IU is sufficient with adequate sun is to be impractical.

    Who gets adequate sun even during the summer? Cer5tainly winter, fall and spring have little sun required to make adequate vitamin D. If you do get adequate sun exposure (20 mins full body with noon sun), then do not take vitamin D on those days as you will make plenty.

    However there is still no problem taking a good dose even on these days.

    Time and time again doctors wrongly stick to doses below 2000IU believing that amounts above 2000IU are toxic. The fact is that it is 2000IU per kilo that is regarded as toxic.

    The accepted optimal blood value of 25(OH)vitamin D is 40ng/ml (100nmol/L) for a healthy person. Most research now shows that to achieve this level (without adequate sun) most people will require around 5000IU daily. For people with illnesses which drive down 25(OH)vitamin D, may require more than this. For most people 10,000IU is safe and is a NOAEL (No adverse events level). Rarely a person may have a reaction to this sort of level and for those people it may be ill-advised to chase a blood level but before accepting this I would like to see the studies concluding this.

    It is also naive to say that calcitriol suppresses immune function. Calcitriol modulates immune function and for people with FM, ME or MCS their illness significantly involves homeostatic imbalance. In these cases immune modulation is exactly what is needed.

    To dose with vitamin D one must also take Magnesium and Vitamin K2 (menaquinone4 and menaquinone7). These are as important as the vitamin D itself.

    Secondly as I already stated in relation to vitamin D, Vitamin K2 is essential. People with FM, ME and MCS are at risk of developing vascular stiffness and cardiomyopathy. Vitamin K2 is the one nutrient that reduces vascular stiffness.

    Thirdly, Melatonin is missing. To say that people with FM have reduced levels of serotonin and dopamine is incorrect. Some people do but some do not. Most people with FM do have lower melatonin output, probably due to very disturbed sleep, especially those who tend to wake up between 2am and 4am.

    Melatonin is a critical anti-inflammatory and anti-oxidant. It is the one substance where a whole gland is dedicated to making it (the pineal gland) but its output is nocturnal and depends on a good nights sleep. Many people still think that melatonin’s function is to affect circadian rhythm and modulate sleep. This thinking is outdated and melatonin’s great range of function shows it to be the bodies most essential “healer”, doing its job throughout the body overnight. Relevant to some people with homeostatic illness is over production of cortisol at night, this can be due to inadequate levels of melatonin, which reduces cortisol output. Melatonin modulates blood glucose levels and many other modulating effects.

    Things which adversely affect melatonin output are:

    too few hours of sleep
    broken sleep
    staring at bright (blue) lights (computer screens) before sleep
    insufficient sun exposure during the day
    lack of daily exercise
    tryptophan deficiency (although poor melatonin output cannot easily be increased by increasing tryptophan or 5HTP intake) While synthesis depends on the following:
    folate, B6, zinc, magnesium and B12, elevating these does not seem to increase melatonin output unless they are severely deficient.
    Factors like alcohol and caffeine are not consistent in effect so little can be said at this stage.

    1. Been There Done That says:

      I would be very wary about Vit D supplementation. There are variables involved that have not yet been fleshed out by researchers, and there are researchers today who reject the notion that low D levels in blood represent deficiency or that this perceived deficiency initiates or contributes to illness. Instead, they believe most deficiencies actually represent rapid conversion of 25-D to its metabolites like 1,25D, that a person with this issue is ALREADY sick and the rapid conversion is just another symptom of the illness. Supplementation just adds more fuel to the fire by raising 1,25-D.

      Like the doc mentioned above, conversion of D to its metabolites like 1,25D, a secosteroid with strong adverse effects at high levels, has consequences. One rather nasty consequence is stimulating the leaching of calcium from bones–osteoporosis! This property has allowed for the use of D as a rodent poison that induces death through hypercalcemia. Because of its steroidal properties, 1,25-D can calm symptoms much like pharma steroids (by suppressing the immune system). Not really a good thing long term, particularly if there might be a bacterial component, like undiagnosed Lyme disease, contributing to the malaise.

  2. IanH says:

    Someone pointed out that melatonin is not a nutrient or a vitamin.
    Of course it is not. Very little is obtained from the diet and over 90% is produced by the pineal gland but other tissues also produce melatonin including the placenta.

    I was pointing out the importance of melatonin in FM and how it can be little influenced by taking more tryptophan, this is also true of serotonin and dopamine except in cases of severe acute drop in tryptophan or tyrosine, rarely seen in FM.

    Because of it’s vital importance in “healing” and its output during sleep is badly affected in FM. It is a very unusual substance having many of the properties of neuro-trophins but is an indolamine.

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