What Is myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)*?

Fatigue is a very common complaint. Like pain, fatigue serves a protective function in getting us to rest when we are tired or sick to help our bodies recover. Thus, fatigue is a natural part of a wide variety of medical conditions, including those caused by infections, autoimmune disorders, cancer, and injuries. Chronic illness generally leads to chronic fatigue, regardless of the cause of the illness.

One relatively-common cause of severe, chronic fatigue is myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS). In ME/CFS, and generally unlike other conditions, fatigue is:

  • Overwhelming: leading to various degrees of disability
  • Post-exertional: worsened after any activity, whether physical or mental
  • Non-refreshed: not improved by rest/sleep

In ME/CFS, fatigue is both physical and mental. The latter, includes loss of concentration, poor memory, and/or difficulty in thinking, and is often referred to as “brain fog”.

An excellent place to learn more about ME/CFS is on the CDC website. Per that site:

  • People with ME/CFS are not able to function the same way they did before they became ill.
  • ME/CFS changes people’s ability to do daily tasks, like taking a shower or preparing a meal.
  • ME/CFS often makes it hard to keep a job, go to school, and take part in family and social life.
  • ME/CFS can last for years and sometimes leads to serious disability.
  • At least one in four ME/CFS patients is bed- or house-bound for long periods during their illness.”

The diagnostic criteria for ME/CFS can be found on their website. This is a good link to share with your physician or other care provider. Another excellent link is the European Network on ME/CFS .

ME/CFS is thought to be common, but the true prevalence is unclear as 90% of sufferers are believed to be unaware of the diagnosis. Recently, about 1-3 million Americans are estimated to be affected! Are you or someone you care for one possibly of them?

* While previously known as chronic fatigue syndrome in the USA, In the United Kingdom, the condition was generally known as myalgic encephalomyelitis (ME) to emphasize that it is a real physical/medical disorder, to highlight the commonality of muscle pain (myalgia), and to include the presumed role of inflammation in its cause. Nowadays, both sides of the Atlantic generally combine their terms, and the condition is best known as “Myalgic Encephalomyelitis/Chronic Fatigue Syndrome” (ME/CFS).

Beyond Fatigue, What Else is Common in ME/CFS?

  • ME/CFS generally is accompanied by symptoms beyond fatigue. The most common are pain (especially in the muscles and joints), dizziness (especially on standing), and troubled sleep.
  • ME/CFS is one of multiple conditions known as functional disorders. Many functional disorders/symptoms are listed on da Vinci’s Vitruvian man to the left.
  • People with any one functional disorder are likely to suffer from additional functional disorders, and ME/CFS overlaps with them.

What Causes ME/CFS?

The short answer is that the cause is unknown. However, substantial evidence suggests that the following concepts are involved in ME/CFS:

  • Energy metabolism: Including mitochondrial dysfunction, impaired ability to generate ATP, redox imbalance, and a general hypometabolic state.
  • Immune system: Including systemic inflammation, neuroinflammation, reduced natural killer (NK) cell function, and aberrant response to viral/bacterial infections.

Mitochondria: powerhouses of the cell

A neutrophil:
one of the immune cells

Consistent with the cause of disease being unknown, there is no widely-accepted treatment for the underlying condition of ME/CFS. Most physicians attempt to treat the symptoms with medications including pain, dizziness, brain fog, etc., but there is no good drug treatment for fatigue.

However, dietary supplementation is common, and is increasingly being recommended by clinicians in patients with ME/CFS.

For more information, see the CDC diagnosis page for ME/CFS, the CDC treatment page, and PMID: 34400495 [a published article].

Dr. Richard G. Boles is a geneticist who has been treating ME/CFS for over 25 years. He recently sequenced all of the DNA (whole genome sequencing WGS) in 18 of his patients with ME/CFS, revealing ion channels and energy metabolism as an important cause in most. This has direct ramifications in treatment. Click here to see a summary. Dr. Boles is the Medical & Scientific Director and a founder of NeuroNeeds®.

Is ME/CFS Treatable with Dietary Supplementation?

  • Mitochondrial dysfunction/abnormal energy metabolism is involved in ME/CFS.
  • Inflammation/abnormal immunity is involved in ME/CFS.
  • Both mitochondrial dysfunction & inflammation are often treated with natural dietary supplementation.
  • Multiple different dietary supplements are recommended for ME/CFS by various sources.
  • While there are differences, a core group of supplements is often recommended by multiple sources: including vitamin B complex, vitamin C, vitamin D, magnesium, zinc, L-carnitine, coenzyme Q10, and omega-3 essential fatty acids.

Dietary supplementation for ME/CFS is listed on both the websites for the USA CDC and the European Network on ME/CFS. Some additional references: PMID: 30551349, PMID: 34400495, PMID: 34262415, and PMID: 24419360.

ME/CFS, the Mitochondrial Connection, & Mito-cocktail

It is not surprising that a deficiency of energy in your life can be due to a deficiency of energy at the cellular level. The vast majority of energy made by our bodies is produced in the mitochondria, and cellular energy deficiency is thus often referred to as mitochondrial dysfunction.

Optimal mitochondrial function is highly dependent on the presence of multiple vitamins, minerals, and other nutrients that have important roles in energy metabolism. When energy metabolism is not working correctly, a wide range of disorders can arise as illustrated around da Vinci’s Vitruvian Man (shown above). The answer often is a mitochondrial cocktail designed to nourish your system.

For decades, many progressive physicians have been advocating a treatment regimen for mitochondrial dysfunction, and for ME/CFS, consisting of high doses of multiple dietary supplements. The term “mitochondrial cocktail” (mito-cocktail) refers to a large group of vitamins, minerals, and other nutrients that have important roles in energy metabolism. Dietary supplementation with these nutrients, generally at higher dosing than that achievable by diet or contained in standard multivitamins, can often improve mitochondrial function, restore health, and mitigate disease.

The Mito-Cocktail Made Easy and Affordable by NeuroNeeds®

  • Among the dietary supplements recommended for ME/CFS by multiple sources, several are components of the mito-cocktail, including multiple B vitamins, vitamin C, vitamin D, magnesium, L-carnitine, and coenzyme Q10.
  • Supplements sometimes recommended in ME/CFS that are part of the mito-cocktail include alpha-lipoic acid, N-acetylcysteine (NAC), and selenium.
  • SpectrumNeeds® (powder) and EnergyNeeds® (capsules) are high-powered mitochondrial supplements designed by a collaborative of prominent physicians and scientists. They are often used to optimize nutrition for a wide range of disorders associated with mitochondrial dysfunction.
  • Both products include all of the above listed components of the mito-cocktail that are available without prescription in the USA*, as well as many additional ones.
  • These products are designed to offer a high-powered mitochondrial cocktail, which is best combined with optimized general nutrition.
  • Additionally, both products are designed to be a safe nutritional supplement for anyone regardless of the underlying genetics, signs or symptoms, severity of mitochondrial dysfunction, age, and/or general health. However, as with any supplement, it is recommended to discuss with your physician.

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* NAC is a powerful antioxidant that was available over-the-counter until recently in the USA. It cannot be found in most stores, although it is still available online. The USA FDA has restricted it in order for pharmaceutical companies to sell a far-more-expensive prescription instead. Nausea is commonly an obstacle with its use. Discuss with your physician whether NAC is appropriate for you or your child.

The Case for Ubiquinol/Coenzyme Q10 in ME/CFS ®

QNeeds facts
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  • Many chronic conditions, especially those involving mitochondrial function, can increase the body’s demand for coenzyme Q10 (coQ10), leading to deficiency.
  • CoQ10 supplementation is often recommended for a variety of different medical conditions, including ME/CFS.
  • In a randomized controlled trial, coQ10 (200 mg) plus NADH* improved “the health-related quality of life in a ME/CFS patient” PMID: 34444817.
  • CoQ10 was also beneficial in ME/CFS in another randomized controlled trial PMID: 27125909.
  • In a third study, coQ10 (400 mg**) and selenium* resulted in “significant improvement…for overall fatigue severity…and global quality of life.”, PMID: 35229657.
  • Blood coQ10 levels are significantly (p=0.00001)! lower in ME/CFS patients than in normal controls, and nearly half of people with ME/CFS had values beneath the lowest coQ10 value detected in the normal controls.
  • Also, in that ME/CFS study, lower coQ10 levels were associated with higher amounts of fatigue, autonomic symptoms (e.g., dizziness on standing), and difficulties with concentration and memory PMID: 20010505.

CoQ10 is sold in two different forms, ubiquinone and ubiquinol. Ubiquinol is about five times more bioavailable [see study], and is the form recommended by Dr. Boles and generally by other Mitochondrial Medicine specialists as well.

QNeeds® soft gel capsules provide additional coQ10 in the ubiquinol form to help boost antioxidant support. It comes in limonene oil, the natural oil of lemon peel, which boosts bioavailability without soy, which is present in most commercially-available preparations.

*NADH is not found in NeuroNeeds® products, but NADH is made by our bodies from nicotinamide (vitamin B3), which is present at high dosing in EnergyNeeds® and SpectrumNeeds®. Selenium is also present in both products.

**Dr. Boles recommends a starting dose of 200 mg twice daily (400 mg per day) of coQ10 in the ubiquinol form in most his patients over 10 years of age. However, we cannot anticipate all clinical situations, and it is recommended to discuss supplement dosing with your physician.

Beyond Mito, the Treatment of Inflammation in ME/CFS

Multiple anomalies of the immune system have been reported in ME/CFS, including systemic inflammation, neuroinflammation, reduced natural killer cell and other T-cell functions, and aberrant response to infections. Symptoms of ME/CFS often start after a common illness, such as Epstein-Barr virus, mycoplasma, influenza, or Lyme. One hypothesis is that ME/CFS is the result of damage caused by an overactive immune system responding to common infections. It is unclear as to why most people easily recover from these infections, yet a small number of people have chronic symptomatology, and genetic factors are likely involved.

Multiple progressive physicians have noticed that treating inflammation often helps with the symptoms of ME/CFS. Inflammation can be reduced with certain natural dietary supplements, as well as medications, yet a listing is beyond the scope of this article. Discuss with your physician whether anti-inflammatory treatment is appropriate for you or your child.

However, people with ME/CFS may want to consider safe and natural dietary supplements for inflammation.

The Case for Omega-3 Fatty Acids in ME/CFS

Omega-3 fatty acids (“omega-3s”) are an excellent choice for a safe and natural dietary supplement for inflammation.

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  • Omega-3 fatty acids are low in people with ME/CFS: PMID: 14744043, PMID: 30471769.
  • The omega-3 to omega-6 (another kind of fatty acid) ratio was low in another study (PMID: 16380690), was associated with T-cell anomalies (a type of immune cell), and for which the authors suggested omega-3 supplementation.
  • One article discusses why the omega-3s might be helpful in ME/CFS: PMID: 12018979.
  • Omega-3 supplementation was beneficial in ME/CFS in the following studies: PMID: 15041033, PMID: 15117099.

OmegaNeeds® is a blend of krill and fish oils providing omega-3 fatty acids including DHA & EPA. Krill oil omega-3s are phospholipid bound, allowing for direct access into brain. Fish oil provides high dosing of omega-3s, which is important for general health, including that of heart, skin & hair. It also includes astaxanthin from krill, a powerful antioxidant, and phosphatidylserine from sunflower seed oil.

Summary & How to Start

  • ME/CFS is a real condition that is relatively common and generally disabling.
  • Abnormal energy metabolism and inflammation are associated with ME/CFS.
  • Studies have shown that safe and natural dietary supplements can often help.

OPTION #1: Start with EnergyNeeds®: Mitochondrial cocktail in capsules with 40-active ingredients

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OPTION #2: Address energy metabolism, coenzyme Q10 deficiency,  and inflammation with the Brain Bundle

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