Over the past couple of decades, chronic fatigue syndrome (CFS) has gone from an it’s-all-in-your-mind diagnosis to a recognized disease that zaps the energy of an estimated 1 million Americans. It affects four times more women than men, according to the Centers for Disease Control and Prevention. In addition to profound fatigue, which interferes with daily activities, symptoms can include depression, insomnia and brain fog.
Also called myalgic encephalomyelitis, CFS is often triggered by a viral infection, such as the Epstein-Barr (which also causes mononucleosis) and is commonly described as a flu that doesn’t go away. Some patients report symptoms after a chemical exposure, such as to pesticides.
“CFS represents an energy crisis, centered in our body’s mitochondrial energy furnace,” says Jacob Teitelbaum, MD, author of From Fatigued to Fantastic (Avery, 2007). Teitelbaum says he cured himself of CFS through nutrition.
Because the primary CFS symptom is extreme fatigue for more than six months, nutritional treatments should focus on enhancing cells’ mitochondria, tiny structures that burn food for energy. Eating a high-protein diet low in sugars and gluten-containing grains is another approach that, some claim, has helped them combat CFS. Additionally, getting regular, moderate exercise will increase the numbers of mitochondria in muscle cells and boost energy.
Here are six nonstimulant supplements, listed in order of likely effectiveness, that can also help you fight fatigue:
1. B-complex vitamins.
The production of energy in cells depends on most of the B vitamins. Of these, B2 and B3 play central roles in converting food to energy, and B1 and pantothenic acid are also of fundamental importance. These vitamins work in what’s called the Krebs cycle, which can be visualized as an energy-making waterwheel.
Dose: Try a B-complex or multivitamin with 50 mg each of B1, B2 and B3.
2. Coenzyme Q10 (coQ10).
This vitaminlike nutrient was the basis of the 1978 Nobel Prize in chemistry. Research has shown that people with CFS have low coQ10 levels and that supplements can improve energy levels. Some studies combined coQ10 with nicotinamide adenine dinucleotide plus hydrogen (NADH), the form of vitamin B3 found in mitochondria, leading to less fatigue.
Dose: 200 mg of coQ10 or 100 mg of its ubiquinone form, with an optional 5 mg of NADH daily; take coQ10 with a little oily food to enhance its absorption.
This nutrient helps transport fats deep into cells so they can be burned for energy, and it is synergistic with coQ10. One study found that L-carnitine reduced CFS symptoms, and another reported that it improved physical and mental fatigue in centenarians, who tend to have age-related energy issues. However, the acetyl L-carnitine form may be more biologically active.
Dose: 1,000 mg daily.
4. Vitamin C.
You need this nutrient (along with B vitamins) to make your own carnitine. An early symptom of low vitamin C levels is fatigue, which may be related to decreased carnitine production. A recent study found that high doses of vitamin C reduced Epstein-Barr antibodies in people with CFS, a sign that immune responses were normalizing.
Dose: 1,000–5,000 mg (divided doses) daily.
5. Alpha-lipoic acid.
This antioxidant hasn't been used in human CFS studies, but supplements were reported to benefit a patient with a genetic fatigue disorder. Alpha-lipoic plays key roles in cells’ energy-generating mitochondria, so it makes sense to include it to enhance energy production.
Dose: 200–300 mg alpha-lipoic acid or half that amount of the R-lipoic acid form.
Ribose helps form DNA and RNA and also makes the body produce energy. “Our published research showed that the energy nutrient ribose increased energy an amazing average of 61 percent in people with CFS,” says Teitelbaum.
Dose: 2,000–4,000 mg daily.
Our energy-boosting supplement picks
Shoppers often have to read between the lines when it comes to identifying “mitochondrial nutrients.”
Ask the staff of your local natural food store for guidance, or try these top picks.
Doctor's Best Fully Active B Complex. What distinguishes this high-potency B-complex supplement is that it contains the “active” forms
of most B vitamins. It also contains a small amount of vitamin C.
Natural Factors Coenzyme Q10. In research that garnered the 1978 Nobel Prize in chemistry, researcher Peter Mitchell described the “electron transport chain” (a series of biochemical steps in energy production) and how the chain depended on coQ10. This product provides 100 mg of coQ10 in each softgel capsule.
Source Naturals Acetyl L-Carnitine & Alpha-Lipoic Acid. This supplement combines acetyl L-carnitine and alpha-lipoic acid, both of which are vital for energy production. Specifically, the doses are 500 mg of acetyl L-carnitine and 150 mg of alpha-lipoic acid.
Nature's Way Alive Fruit Source Vitamin C. Although the dose is low compared with most other vitamin C supplements, Nature’s Way claims a distinction: that the vitamin C is derived from organic fruits, including acerola, goji, kiwi and amla. Four capsules provide 500 mg of vitamin C.
Jarrow Formulas Acetyl L-Carnitine Arginate + Alpha Lipoic Acid. This unique formula contains two different forms of carnitine: alpha-lipoic acid and arginine. Specifically, each capsule provides 500 mg of acetyl L-carnitine arginate dihydrochloride, 200 mg of acetyl L-carnitine, 100 mg of alpha-lipoic acid and 170 mg of arginine.
Country Life R-Lipoic Acid. Alpha-lipoic acid breaks down in the body into equal parts of R and S forms, technically known as isomers. The R-lipoicacid half is the biologically active form, and some supplements provide only that R form. Each vegetarian-source capsule provides 100 mg of R-lipoic acid.
Sedona Labs D-Ribose. Ribose is essential for cellular energy production. This 9.9-ounce (280 grams) product provides a whopping 5 grams of ribose per scoop (approximately 2 teaspoons). Each jar contains 56 servings.