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