Supplements (and diets) I've tried for CFS/ME
Since you're here, you might be interested in my CFS/ME/fibromyalgia treatment book.
Note: because this list was growing extremely large, I have decided to separate it into two pages. This list containsthe over-the-counter treatments I have tried - herbs, vitamins, minerals, amino acids and other supplements as well as diets - while the other page contains medications. Note that I have mostly followed Finnish classification, hence things like melatonin and DHEA are listed here, even though they are considered nutritional supplements in many countries.
After I got sick with CFS/ME in 2000 I have tried many different herbs, nutritional supplements and medications in search of relief. This search has not been arbitrary or based on advertisements and anecdotes. I have tried things that have been shown to be helpful for CFS/ME, similar conditions or similar symptoms. Some of these things haven't had that much evidence to back them up, but they are safe and have been very cheap to acquire so I have tried them anyway. On the other hand, there are many things I would have tried, if I only could afford them or acquire them.
As a disclaimer, I'd like to remind you that this page exists only for informational purposes. It cannot be used to treat or diagnose any medical condition and it is not intended to substitute or replace professional medical care or advice. I assume no responsibility for any of the information presented here. Always discuss treatment options with your doctor and tell your doctor about every medication, supplement and herbal product you're taking.
If you have any questions, I'd be happy to answer your email, but I can't provide you with information on how to acquire these products. People have asked me for product names, but they usually vary from country to country and many of the products I've used are not available outside of Finland or outside of Europe. Also, please read my main CFS/ME page before asking questions.
- Remember that people are different and the effects of herbs, supplements and medications vary from person to person.
- Always start out with a small dose, in case of allergy, intolerance or sensitivity.
- When acquiring herbs, buy pure herb if available (or grow your own, if possible). If not, tinctures are usually the second best (and cheapest) choice.
- Avoid anything sold by MLM chains.
- Don't take anything until you have researched its safety, contraindications, side effects and interreactions with other drugs. There is no excuse not to look it up. Be particularly careful if you suffer from other serious illnesses (e.g. with your heart, liver or kidneys) if you're taking medications with plenty of possible drug interactions, such as beta blockers, epilepsy medications or MAOI drugs. Most products are not recommended for use during pregnancy or breastfeeding.
- Check whether the supplement or medication has to be taken on an empty stomach or with food. For example many amino acids should be taken on an empty stomach, but some supplements can irritate the stomach if taken alone. Also check if you should take it in the morning, at night, or several times a day.
Try these to look up information about a particular treatment/product
This list is arranged in an alphabetical order. In the Usage field I have listed the dose I have used, which is often the recommended dose. However, doses vary on individual basis so the dose that works for me may be too large or too small for your needs. The Supposed to help field lists conditions and symptoms the supplement is believed to help with, but it does not mean it actually works for them. The field Science lists some the factual information and research, which is not conclusive and mostly pertains to symptoms that have to do with CFS/ME.
My results are listed in the Results field. If there's something you need to be careful about (such as side effects or contraindications), they're listed in Watch out for. Remember that there can always be idiosyncratic side effects, allergic reactions or drug compatibility issues that are not listed here. Finally, the field Recommendation lists my personal opinion about the treatment and whether it's worthwhile to try for CFS/ME. Even if it says I recommend the treatment it doesn't mean it will work for you, but it's something I believe one should try if it's not contraindicated for you (and conversely, even if I don't recommend it it doesn't mean it's bad or that it won't work for you).
Amino acids (and similar substances)
Carnosine
Usage: 400 mg a day
Supposed to help: fatigue, muscle endurance, immune system, tolerance to stress, brainfog, heart problems, mood, migraine prevention
Science: Carnosine is a dipeptide composed of the amino acids beta-alanine and histidine. Some of its effects are due to the histidine, but most due to the complex. It is found naturally in the body especially in the muscles and in the brain. Carnosine is a strong antioxidant and can chelate heavy metals. It is touted as an e.g. anti-aging supplement, smart drug and a muscle endurance improver, and there are many studies to back up these claims. It is used to treat e.g. autism. Doses starting from 75 mg may have some effect and doses up to several grams a day are safe.
Results: I didn't notice any benefits at all, except that after taking it for a week or two the skin in my face started to look a lot more lively, as in healthy and rosy instead of pale and almost grayish (and this was in the winter so it couldn't have been the sun). Maybe I'd have got some results with 800 mg a day, but in those doses it would cost more than my LDN does and almost as much as all my other supplements combined, so I don't think it would be worth it. I didn't get any migraines during the two months I was on it, but I don't get migraines very often anyway so it could have well been a coincidence.
Watch out for: Carnosine may deplete the body of magnesium and zinc, which is why it should be taken with them. I wasn't taking magnesium and I did feel like I feel when I'm low on magnesium, so I resumed taking magnesium citrate. Both are good supplements for CFS/ME in general.
Recommendation: Worth a try (though more expensive than most other supplements), but if you don't see any effects in a month or two it's probably no use in continuing for longer. Most of the benefits should be noticeable in a month. Some people may have to go up to 800 mg to get benefits, which gets rather pricey. A Finnish complementary medicine doctor greatly recommends carnosine for CFS/ME - but then again he sells it.
Creatine
Usage: first 5 g a day, then 3 g a day
Supposed to help: muscle weakness and endurance, heart, fatigue, brainfog
Science: The amino acid creatine is best known as one of the favorite supplements of body builders, but it can also help the muscles in CFS/ME, including the heart muscle. According to studies it can also help improve and maintain cognitive function. It has been used in the treatment of e.g. Parkinson's disease.
Results: I was fairly sure it would help me, but didn't notice any effects.
Watch out for: If you have kidney problems or risk factors predisposing you to them (such as diabetes or chronic NSAID use), you probably shouldn't take creatine without your doctor's approval. Fluid retention is possible. Large doses may cause diarrhea.
Recommendation: Yes. It is inexpensive and well-tolerated. Creatine pyruvate may be more effective, but is also a lot more costly.
DL-phenylalanine
Usage: 500-750 mg a day
Supposed to help: pain, fatigue, tiredness, cognitive problems, immune system, depression, weight loss, orthostatic hypotension
Science: DL-phenylalanine (DLPA) is a racemic mixture of the amino acid phenylalanine. It slows down the breakdown of endorphins (which is why it is recommended as an adjunct to LDN) and converts to dopamine and phenylethylamine (a mood elevating chemical also found in chocolate) to some extent.
Results: The first time I tried it for a few weeks I didn't notice anything. The second time I got an irresistible urge to clean up (every day), probably caused by the increased brain levels of dopamine, which is very important for motivation.
Watch out for: Some people believe that phenylalanine is somehow harmful, because aspartame-containing soft drinks have a warning about it. It is actually an essential amino acid, which is only problematic if you have phenylketouria (a rare genetic condition and you would know if you have it). It should also be avoided if you have a history of schizophrenia/psychosis or malignant melanoma or are taking levodopa or MAOI antidepressants. Don't take it without your doctor's approval if you have hypertension or are taking other antidepressants or stimulants. Taking it late in the day may cause insomnia. It can also cause nausea, anxiety, stomach upset and headache.
Recommendation: Yes, if you're taking low dose naltrexone or have chronic pain. Otherwise probably no, unless you've tried just about everything else (or want to try LDN, but cannot get a prescription).
L-carnitine / acetyl-L-carnitine / L-carnitine fumarate
Usage: 1-2 250 mg capsules of L-carnitine / 1-2 500 mg capsules of Acetyl-L-carnitine / L-carnitine fumarate a day on an empty stomach
Supposed to help: fatigue, muscle endurance, immune system, brainfog, arrhythmias, anti-inflammatory, cardiac health, neuropathic pain, weight loss
Science: L-carnitine is a non-essential amino acid found naturally in many foods, particularly meat, dairy, nuts, seeds and legumes. It has an important function in the metabolic processes in the body. It is also one of the few supplements whose effects on CFS/ME have actually been studied and the results have been promising. Acetyl-L-carnitine is supposed to have a better bioavailability than plain L-carnitine and slightly different effects (e.g. more cognitive improvement). There is little research of L-carnitine fumarate, but the fumarate is supposed to improve energy metabolism and there are some very impressive anecdotal reports for conditions other than CFS/ME.
Results: 250 mg doesn't seem to do that much, but 500 mg and 1,000 mg definitely helps with reducing the uncomfortable, heavy feeling I often experience in my muscles and increasing endurance. Acetyl-L-carnitine seems to also help a bit with the brainfog and the fatigue, but I'm not entirely sure about this. Neither of the forms seem to help my heart problems. Some friends with fairly mild CFS/ME have reported significant benefit from 500-1,000 mg of carnitine, even with neurological and flu-like symptoms. After taking acetyl-L-carnitine for almost four years, in 2010 I switched to L-carnitine fumarate and about a week after starting it my fatigability has been greatly reduced, I can get a lot more done. It may also have something to do with other things, like upping my DHEA dose, but I think at least some of it is from the L-carnitine fumarate.
Watch out for: L-carnitine may cause stomach upset. Large oral doses taken for long periods of time can cause problems, but this probably only applies to very high dosages. Larger doses may also increase the risk of seizures, so epileptics shouldn't take L-carnitine without discussing it with their doctor first. Carnitine may interact with a few anticonvulsants (not Lyrica or Neurontin though) and some people have reported it has caused problems with either their hypothyroidism or thyroid medication, while many hypothyroid people take it without problems.
Recommendation: Definitely.
L-glutamine
Usage: Up to 10 g a day
Supposed to help: stomach problems, ulcer preventon, fatigue, muscle endurance, immune system, brainfog, weight loss
Science: L-glutamine is an essential amino acid and thus naturally found in many foods, especially animal products. It is a popular body builder supplement, because it's supposed to aid recovery of muscles and may decrease healing times in general. It may increase secretion of growth hormone. It helps with the maintainance of gut barrier function, which may be helpful in CFS/ME since increased gut permeability may be a part of the illness. In large doses glutamine is also used to treat IBS in doses up to 30 grams a day.
Results: It seems to help slightly with muscle endurance. I don't think it has helped my stomach problems any, however.
Watch out for: There should be no side effects with normal doses of L-glutamine. However there have been some concerns from people who believe it may cause problems to those who are sensitive to MSG. People with liver problems probably shouldn't take glutamine without discussing it with their doctor first.
Recommendation: Perhaps not the first recommendation, but if you have already tried quite a few things, L-glutamine is worth a try too. If it helps you should be able to see the benefits fairly quickly and it's one of the inexpensive amino acids.
Licorice root (Glycyrrhiza glabra)
Usage: About 1-2 g of dried root brewed into tea as needed.
Supposed to help: fatigue, adrenal insufficiency, orthostatic hypotension, immune system, antiviral, antibacterial, stomach problems, ulcer prevention, aphtous ulcers, cold treatment and prevention, PMS, constipation
Science: Licorice is a broad spectrum antiviral with some antibacterial action as well. It also acts as glucocorticoid and a mineralocorticoid. It is good for preventing ulcers.
Results: It has been helpful for what I believe have been "low level adrenal crises". Sucking on licorice candy seems to be an excellent cure for mouth ulcers.
Watch out for: Excess consumption can cause hypokalemia and hypertension.
Recommendation: Yes, especially if you suspect you have adrenal insufficiency but your doctor refuses to try low dose hydrocortisone on you. It may work particularly help for viral infections when combined with undenatured whey protein.
L-lysine
Usage: 2 x 500 mg a day
Supposed to help: antiherpesviral, chelation, muscle cramps
Science: Lysine is an amino acid and a popular treatment for herpesviral infections, especially cold sores. According to studies it reduces recurrence, but there is conflicting evidence whether it relieves the symptoms or speeds up healing. Many herpesviruses have been connected with CFS/ME, which is why lysine may be worth a try for those who do not suffer from herpes simplex. Nuts contain plenty of the amino acid arginine, which "opposes" lysine and may thus reduce its efficacy.
Results: Did not notice anything.
Watch out for: Very large doses can cause stomach upset. Lysine is not recommended for those with kidney or liver problems.
Recommendation: Not sure. At least it is very safe and well-tolerated.
L-theanine
Usage: ~100-400 mg as needed
Supposed to help: anxiety, mood, sleep, cognition, stress tolerance, immune system, cancer prevention
Science: L-theanine is an amino acid found in tea, about 20-50 mg per cup. It reduces anxiety and induces relaxation without causing sedation. It can improve cognition, possibly because it increases brain levels of dopamine. It may also increase serotonin levels. L-theanine is neuroprotective and studies have found it also stimulates the immune system, which may help fighting infections, preventing cancer and even boosting the efficacy of the influenza vaccine. It may also have direct antitumor effects. Because of its pharmacological effects it could also relieve pain.
Results: Did not really notice anything. Larger doses possibly make me more calm, but I tend to be calm anyway.
Watch out for: The effects of theanine and the sensitivity to it varies widely from person to person. Some get distinct effects from 50 mg, others nothing from 1 g. 50-400 mg is a common dose. There are no known side effects even in high doses, but because L-theanine is mildly psychoactive, people who are very sensitive to psychoactive substances might have a negative reaction to it. Some people have reported headaches, others claim these are only caused by "bad" brands. Some people get a feeling of sedation, others have said they get a rebound effect which makes them wake up a few hours after going to sleep. In animal studies reduced appetite has been reported, which could obviously be either a good or a bad thing if it also applies to humans. L-theanine may reduce blood pressure, though this is only likely if you suffer from hypertension.
Recommendation: If you have anxiety or sleeping problems, it might be worth a try.
Taurine
Usage: one teaspoon (about 3 g) a day dissolved in water
Supposed to help: fatigue, brainfog, immune system, blood sugar, heart, muscle endurance, muscle tension, anxiety, mood, sleep, tolerance to stress, epilepsy
Science: Taurine is a non-essential amino acid. It is a common ingredient in energy drinks (e.g. Red Bull), but it's not really a stimulant. In fact it kind of calms the brain (without being sedative), as it is GABAergic. Additionally it may relieve the effects of stress. It is an antioxidant and supports the immune system. It is antidiabetic and good for the heart. Many people with anxiety, depression and bipolar disorder, even autism report having been helped by taurine. It also lowers cholesterol and has physiological anti-aging properties.
Results: I haven't noticed anything else, but combined with valerian it seemed to result in slightly better sleep than valerian alone (both are GABAergic). My muscles (especially my chronically very tense scalp) get a little more relaxed. A friend who suffered from depression and fatigue caused by psychiatric drugs said that he felt like taurine often gave him a bit more energy.
Watch out for: Taurine has no side effects that I'm aware of, though it may possibly lower blood pressure. Technically it can cause drowsiness due to the GABAergic component, but that's very rare - and then you can take it at bedtime.
Recommendation: Yes. It has many potential benefits, hardly ever causes side effects and is extremely cheap when bought in powder form (which has very little taste), as little as 10 euros for a 300 g jar (100-200 doses).
Tyrosine
Usage: 200 mg - 2 g a day taken on an empty stomach
Supposed to help: fatigue, tiredness, pain, brainfog, mood, weight loss, hypothyroidism, libido
Science: Tyrosine is an amino acid and a precursor to dopamine, which is an important neurotransmitter (for e.g. concentration, alertness, motivation, mood and libido) commonly deficient in CFS/ME. For this reason it is also used to treat e.g. ADHD and depression and many people find it helpful for fibromyalgia. Tyrosine may also increase secretion of thyroid hormones.
Results: The most noticeable benefit is that after a poor night's sleep I don't feel nearly as bad as I normally would. It has also helped some with concentration and libido, perhaps mood too. It has unfortunately not helped me with trigger points, as I was hoping for. At first I got some constipation, but it seems to have subsided. My skin also seems to have got better, not sure if this is just a coincidence.
Watch out for: Some people recommend doses as small as 200 mg while others take as much as 8 g a day. Besides the mentioned constipation, excessive doses can cause nausea, insomnia and cardiac symptoms. Probably should not be taken by those with hyperthyroidism.
Recommendation: Why not.
Herbs
Ashwagandha (Withania somnifera)
Usage: A 750 mg tablet first twice a day, then only at night.
Supposed to help: immune system, sleep, thyroid problems, adrenal insufficiency, brainfog, stress tolerance, mood, libido
Science: Ashwagandha is also known as the Indian ginseng, being a very valued adaptogen in the Ayurvedic medicine. It has nootropic and lipid-lowering effects and can improve sleep without inducing daytime drowsiness. It can also stimulate thyroid hormone production.
Results: I did not notice anything else but improved sleep (enabled me to stop taking inositol and still sleep a bit better) and possibly a more relaxed mind and clearer skin. My dreams have also got weirder, but they are not particularly disturbing.
Watch out for: Probably should not be used by those with hyperthyroidism.
Recommendation: Probably yes, especially if you have trouble sleeping.
Astragalus (Astragalus membranaceus)
Usage: Two capsules two times a day (the recommendation for this brand is actually two capsules three times a day) or one capsule two times a day (a different brand which recommends taking one to three capsules a day).
Supposed to help: fatigue, immune system, cold prevention, antiviral, stomach problems, ulcers, cardiac symptoms
Science: Astragalus is an adaptogen and has been shown to be an effective immunomodulatory and anti-inflammatory herb. It also has some antiviral (at least antiherpesviral) properties.
Results: I'm not entirely sure if it helps, I think it helped my fever some.
Watch out for: No known side effects, interactions or contraindications.
Recommendation: Probably yes. It's not my first-line suggestion, but as far as herbs go it's probably one of the best.
Chaga mushroom (Inonotus obliquus)
Usage: A few grams brewed into a tea (for 24 hours) once a day
Supposed to help: immune system, pain, ulcer prevention, cancer prevention
Science: Chaga mushroom is a medicinal mushroom that grows on birches. It has been shown to have anticancer properties in many types of cancer. It is anti-inflammatory and reduces nitric oxide levels, which should be good in CFS/ME.
Results: Did not notice anything.
Watch out for: Chaga mushroom may reduce blood levels of uric acid, which might be harmful in CFS/ME.
Recommendation: If you can find wild chaga, why not. Otherwise it's probably not worth it for CFS/ME.
Echinacea (Echinacea purpurea, Echinacea angustifolia)
Usage: 20 drops three times a day when needed
Supposed to help: bacterial, viral and fungal infections, immune system, fever, congestion, cold treatment, cold prevention, circulation, orthostatic hypotension
Science: Studies have shown that echinacea may reduce the symptoms and duration of a cold, but it doesn't seem to be helpful in preventing viral infections. It does increase the secretion of erythropoietin (EPO), which may be useful in CFS/ME.
Results: I used echinacea for a few weeks to see if it helps with CFS/ME, but I didn't notice any effects. It felt like my fever might have been a little lower than usual, but I didn't have a working thermometer at the time. Nowadays I take echinacea if I catch a cold, but I can't say if it actually helps. It seems to help congestion a bit. My SO says it shrinks his apthoid ulcers very quickly.
Watch out for: Echinacea is not recommended for people with an autoimmune illness and it's probably not a good idea for those with a very severe case of CFS/ME. There are claims that echinacea may cause liver damage. Echinacea should not be taken for more than eight weeks in a row.
Recommendation: Yes, if you have a cold/flu. Probably not too helpful otherwise.
Garlic (Allium sativum)
Usage: raw garlic, garlic powder in foods, garlic pills
Supposed to help: bacterial, viral and fungal infections, cold prevention, cardiac health
Science: Garlic may help with the complications of diabetes and cardiovascular disease. It also has some antiviral and antibacterial properties.
Results: No other effects, but seems to help the skin, perhaps due to the sulphur compounds in it?
Watch out for: Garlic can cause heartburn (and bad breath, of course).
Recommendation: I definitely recommend eating garlic in food, but the pills probably aren't needed. If your cholesterol and triglycerides are high, then it might be worth a try.
Ginger (Zingiber officinale)
Usage: a small piece of raw ginger, a small cube of candied ginger or some ginger powder in water
Supposed to help: nausea, stomach upset, anti-inflammatory, cold treatment, joint problems
Science: Ginger has been proven to help with many different kinds of nausea. It may also relieve pain in some inflammatory conditions.
Results: It greatly helps with nausea.
Watch out for: No side effects or risks that I know of.
Recommendation: If you suffer from nausea, definitely. I think candied ginger (little cubes that look like sugared jelly candies) is the most convenient form to ingest and it should be easy to find.
Ginkgo (Ginkgo biloba)
Usage: 20 drops of tincture three times a day
Supposed to help: circulation, mood, brainfog, cancer prevention
Science: Ginkgo has been shown to improve circulation. A recent study also found it prevented ovarian cancer, one of the most deadly cancers in women.
Results: Ginkgo greatly helps me with my brainfog, I've been using it since April 2004. Prednisone alone wasn't nearly as effective for my brainfog as prednisone combined with ginkgo. I had to take ginkgo for five weeks before it started working, so be patient in the beginning. But if I miss out just one dose I'll notice it, sometimes even on the next day, which is the downside of this treatment. Tablets might be more convenient and long-acting, but they're more expensive too.
Watch out for: Some people are allergic to ginkgo. Ginkgo thins the blood, so watch out if you have problems with bleeding, are on blood-thinning medication or use several supplements (such as vitamin E or fish oil) that also decrease thinning.
Recommendation: Definitely.
Ginseng (Panax quinquefolium)
Usage: 2 g-4 g, brewed into a concoction, 1-2 tablets with 25 mg ginseng extract
Supposed to help: fatigue, immune system, cold prevention, tolerance to stress, cancer prevention
Science: Ginseng is classified as an adaptogen, something that increases the body's ability to adapt to stress. It has been shown to be effective in preventing viral infections.
Results: Seems to slightly alleviate fatigue, but also lowers blood sugar in larger doses, particularly if taken without food. It is actually the only stimulant that seems to have any effect on me.
Watch out for: Take with food to avoid blood sugar crashes. Be careful if you have problems with hypoglycemia or hypertension. Ginseng may cause overagitation in some people. Some sources advise it shouldn't be taken during the period.
Recommendation: I'd recommend ginseng, whether it's American ginseng or "real" (Chinese/Korean) Panax ginseng. I don't so much recommend ginseng drinks, teas and pills as most of them don't have sufficient quantities of the active ingredients.
Kava kava (Piper methysticum)
Usage: 1 teaspoon of powder brewed into tea with a bit of oil to dissolve the fat-soluble substances
Supposed to help: anxiety, depression, sleep, brainfog
Science: The kavalactones found in kava kava have anxiolytic properties. A recent study showed that kava may be an effective treatment against leukaemia and ovarian cancer.
Results: I used kava kava with great results back when I still suffered from panic disorder caused by CFS/ME. It really helped my anxiety attacks without any side effects, though once I fell asleep in the middle of the day, which is strange since the other times I used it I experienced no sedative effects of any kind. The effects can be witnessed very quickly, in a matter of minutes. There are sublingual kava sprays available in some countries and their effects should be almost instantenous.
Watch out for: Unless you're using the pills, kava numbs the mouth, but this is harmless. Kava has been associated with a few cases of liver damage, apparently due to some supplements also containing other parts of the plants besides the root. Compared to benzodiazepines kava is very safe, since it doesn't cause dependency while benzodiazepine withdrawal can be even more difficult than opiate withdrawal. Prolonged use of large doses of kava can cause skin problems.
Recommendation: I recommend kava kava to those suffering from generalized anxiety or panic attacks. Unfortunately it isn't available in all countries (I had to get mine abroad).
Maca (Lepidium meyenii)
Usage: 1-3 grams a day
Supposed to help: fatigue, libido, sexual problems, mood
Science: Maca is a so-called "superfood" touted for its "tonic" properties. It is also touted as a libido booster and a treatment for sexual dysfunction and limited research has shown its efficacy in this use (in both genders) even though the mode of action is not clear.
Results: No difference in energy levels, but it does seem to boost the libido.
Watch out for: In large doses it may be goitrogenic (bad for the thyroid).
Recommendation: If you have sexual dysfunction, it's worth a try. Probably not the most effective treatment for fatigue.
Milk thistle (Silybum marianum)
Usage: 2 x 200 mg of standardized extract a day
Supposed to help: liver, fatigue, brainfog, stomach problems
Science: Milk thistle is a herb traditionally used for "cleansing the liver" and there is a lot of scientific evidence showing that it can protect the liver. It is also a powerful antioxidant, which is why it's sometimes used in CFS/ME even in the absence of liver problems. Some people report it can help IBS and brainfog. It can also reduce cholesterol levels and reduce insulin resistance.
Results: I took it only for five days and then stopped it because I had stomach upset, nausea and poor appetite, which happen to be the only known side effects of milk thistle that I could find. I was very surprised, as I usually get no side effects from anything, certainly not from herbs and milk thistle very rarely causes any side effects. I did not notice any positive effects in the very short time I was taking it.
Watch out for: See above.
Recommendation: If you take medications that are heavy on the liver or have liver problems from CFS/ME, yes.
Oil of oregano (Origanum vulgare)
Usage: 2-4 drops 2-3 times a day orally and/or 1-2 drops 2-3 times a day externally as needed, usually mixed in canola oil
Supposed to help: bacterial, viral and fungal infections, anti-inflammatory
Science: The chemical carvacrol found in oil of oregano has been shown to have antimicrobial activity against a wide spectrum of different bacteria and Candida Albicans (yeast).
Results: I've tried oil of oregano for over 10 bacterial infections now (including stuff like infected lymph nodes, urinary tract infection, cellulitis, sinuitis, abscesses and others) and it has worked every single time. I haven't noticed it helping with any viral infections, though. It also seems to kill canker sores in less than 30 minutes, at least if the sore is only starting to form.
Watch out for: For some reason oil of oregano doesn't seem to cause the same kind of side effects (such as stomach upset) as prescription antibiotics. It appears to be extremely well tolerated even in the seriously ill.
Recommendation: If you suffer from recurrent bacterial infections, definitely. I don't know if it's harmful to take it continuously as a preventative measure or if it loses its efficacy over time.
Peppermint (Mentha x piperita)
Usage: a cup of tea as needed, or a drop or two of the essential oil mixed in shampoo/conditioner or skin lotion and used as needed, a drop mixed into a spoonful of canola oil and poured straight into the sinus cavity
Supposed to help: nausea, headache, digestive problems, antiviral, cold treatment, congestion, itching, irritated skin, menstrual problems
Science: Peppermint oil is a well-known remedy for relieving itching. It has been shown relieve digestive problems including IBS, but then it needs to be packed into an enteric-coated capsule as it irritates the stomach. It has also demonstrated antiherpesviral activity in studies and thus can help cold sores.
Results: The oil relieves the itching I have from seborrhea and urticaria (both caused by CFS) very quickly and efficiently, but the effects don't last for very long. Peppermint tea works quite well for digestive upset in most cases.
Watch out for: Peppermint relaxes the lower esophageal sphincter and thus can cause belching and isn't recommended for those with acid reflux. It should be avoided in the presence of kidney stones. Peppermint is not recommended to be used regularly in significant quantities. Some people notice that peppermint oil irritates their skin.
Recommendation: Try it if you suffer from any of the listed symptoms it may relieve.
Rhodiola/roseroot/golden root/arctic root (Rhodiola rosea)
Usage: 1-2 g a day brewed into tea
Supposed to help: fatigue, brainfog, mood, anxiety, immune system, sleep, headaches
Science: Rhodiola is a well-researched adaptogen, which has been shown to boost the immune system, enhance cognitive abilities, relieve fatigue and improve mood and libido. Note that some preparations may contain very low concentrations of the herb. You'd want to use a pure root, a tincture or a standardized product from a reliable manufacturer.
Results: I have only used rhodiola occasionally as a "booster" on bad days, but it has worked well in most cases. It alleviates fatigue and brainfog, let's me "go on for longer" without nasty after effects and seems to have helped headaches in a few cases too. Taking a bit too big a dose has caused short-lived nausea in some cases, but I haven't noticed any other negative effects. A friend who suffers from chronic non-CFS/ME lassitude has improved a lot on rhodiola.
Watch out for: It may interact with antidepressants, so be careful if you're using them. Taken too late in the day it can cause insomnia. Larger doses can cause nausea and restlessness. Probably not recommended for people suffering from bipolar disorder. It should never be combined with MAOIs. Combining it with SSRIs is not recommended, though many people do it without problems. If you're taking a SSRI start out with a very low dose, just in case.
Recommendation: Definitely. It might be one of the best herbs for CFS/ME, as long as you can acquire a decent product. If you can find the dried root, it should also be extremely cheap (and isn't all that expensive in either case).
Siberian ginseng/eleuthero (Eleutherococcus senticosus)
Usage: 2-3 grams brewed into concoction or one pill a day containing 1000/1500 mg of extracted Siberian ginseng
Supposed to help: fatigue, brainfog, immune system, cold prevention, vision, tolerance to stress, anti-inflammatory, cancer prevention, PMS
Science: Siberian ginseng (eleuthero) is not a true ginseng, but it has similar adaptogenic and antiviral properties to the plants in the ginseng family. It can prevent viral infections and some cancers and make antibiotics more effective. It also improves the vision, color vision in particular.
Results: Siberian ginseng doesn't seem to have the stimulant effects of real ginseng. In fact I can take it just before going to bed and it doesn't hinder my sleep in any way. It doesn't seem to lower my blood sugar like ginseng does. It appears to be effective against colds. When I've taken Siberian ginseng I haven't caught any colds despite certain exposure. It also noticeably improves color vision.
Watch out for: No known side effects, interactions or contraindications.
Recommendation: Not one of my first recommendations, but adaptogens tend to be benign and well-tolerated herbs so it's unlikely to do any harm.
Valerian (Valeriana officinalis)
Usage: 1-2 300 mg tablets as needed (almost every night)
Supposed to help: sleep, anxiety, pain, migraine prevention, epilepsy
Science: Valerian is GABAergic just like most sedative drugs and some anticonvulsants. It has been shown to be fairly effective as a sleep aid in many studies.
Results: It did somewhat help with sleep as long as I didn't have too much stress. Combining it with taurine seemed to make it a bit more effective, though the effects were mild compared to some other sleep aids I've tried. No daytime sleepiness or other adverse effects.
Watch out for: Valerian is touted as free of side effects, but of course it is not. It can cause morning drowsiness in some people. Someone I know who has severe CFS/ME got a nasty reaction to valerian, even though she can tolerate benzos without problems. It may cause mild discontinuation syndrome if long-term use is abruptly stopped. But in general most people handle valerian just fine. Just don't abuse it (e.g. combine it with alcohol or go driving when you have taken it).
Recommendation: For sleeping problems and anxiety it's a rather good choice, though if melatonin is OTC in your country (it isn't here) it's probably better to try it as the first sleep aid. Pay attention to the valerian content of the pills - some of them are more like homeopathic preparations with next to no active ingredient. Even with the strongest pills you may have to take 2-3 to get decent effects.
Vitamins, minerals and similar
Betacarotene
Usage: Five 6 mg tablets a day for three weeks, taken with fat-containing food (as it is fat soluble).
Supposed to help: fatigue, immune system, vision, skin
Science: Betacarotene is a precursor to vitamin A and has immunomodulating properties. Some doctors have suggested that taking a three-week course of 50,000 IU (30 mg) of betacarotene daily helps some people with CFS/ME. After three weeks it is discontinued whether it helped or not. The possible benefit should continue for some time. Another course can be taken after six months.
Results: It didn't seem to do anything at all.
Watch out for: Even though vitamin A is toxic in overdoses the body will never convert too much of betacarotene to vitamin A. Betacarotene is considered to be safe and doesn't cause any harmful side effects, but it is not recommended for smokers as there is some evidence it might increase their cancer risk. Large doses of betacarotene can cause carotenemia (skin turning orange, which is completely harmless), but it's not supposed to happen during this short course and it didn't happen to me.
Recommendation: It didn't help me, but it's very safe and very cheap, so it's worth a try.
Brazil nuts (for selenium)
Usage: 1-2 nuts a day
Supposed to help: immune system, cancer prevention, thyroid function, mercury chelation
Science: Brazil nuts are very high in selenium and just a few nuts contain the recommended daily dose of selenium, which has been shown to help the immune system and even prevent cancer.
Results: I haven't really noticed anything, but it's clear that most effects of selenium aren't easily perceived.
Watch out for: Be careful not to eat too many of the nuts as selenium is toxic in overdoses. A few nuts a day is probably the biggest safe dose. If you live in an area where the soil is high in selenium, it's probably not a good idea to supplement with selenium or Brazil nuts.
Recommendation: Yes, unless you live in an area with high selenium content in the soil.
Calcium
Usage: 400-800 mg a day in different forms
Supposed to help: bones, muscle aches and tension, PMS, sleep
Science: Calcium was thought to improve bone health, but research has since found that exercise and vitamin D intake are much more important than your calcium intake - not to mention that calcium can't be absorbed without the help of many vitamins and minerals. But it also has many other functions in the body.
Results: No positive effects. I've noticed that doses of 800 mg a day cause muscle aches almost invariably, even if I take magnesium with them. Doses of 400 or 500 mg seem to cause no problems.
Watch out for: Some people with CFS/ME say that calcium citrate has made them feel worse, but calcium carbonate has improved their condition. However calcium carbonate can cause constipation for some. Don't waste your money on coral calcium, it's not in any way better than other forms of calcium.
Recommendation: Probably not, though I guess it's worth a try due to the cheap price and low risk. If you want to improve your bone density, vitamin D is a better bet.
Chromium
Usage: 100-200 ug a day
Supposed to help: blood sugar, fatigue, mood, weight loss
Science: Chromium is essential in the sugar metabolism. It's believed to stabilize blood sugar and reduce carbohydrate cravings, even help with weight loss and fatigue, but there's no clear evidence of this.
Results: I've noticed no effects.
Watch out for: Chromium picolinate, one of the most common forms of chromium in supplements, may be carcinogenic.
Recommendation: Not particularly, but since it's fairly cheap you could try it if you have problems with sugar cravings or if your blood sugar levels fluctuate too much.
Inositol
Usage: 500/650/750 mg at bedtime
Supposed to help: sleep, depression, anxiety, muscle endurance, neuropathy, liver, PMS, weight loss, hyperlipidemia, skin, hair, keeping other treatments effective
Science: Inositol is a kind of sugar that acts a secondary messenger in many human metabolic processes. It is sometimes counted as a B group vitamin. It has been shown to be effective in many psychiatric conditions, such as depression, panic disorder, bipolar disorder and OCD, but the mode of action in these uses is not known. While this use has not been studied many people claim inositol helps them stay asleep at night. In the use of most psychiatric disorders the doses are usually very large, up to 20 g or more, but as a sleep aid much smaller doses (often 500 mg) appear to be sufficient. Inositol may also be helpful in polycystic ovary syndrome. According to CFS/ME expert Jay Goldstein inositol can be helpful if treatments help your CFS/ME at first but then cease working, he uses 1 g a day to keep the treatments effective.
Results: I tried melatonin and found that it puts me to sleep, but I stay up at night even more than before. I had heard that inositol might be helpful for this so I tried it - and as a really nice surprise I found it really works. So now I sleep better than in well over a decade - not great by any means, I still have e.g. nightmares and nocturia, but very well for my standards. Sadly it has not improved my daytime functionality much, but at least I no longer have the horrible days caused by very bad sleep, and in general my quality of life is better, of course. Perhaps I wouldn't even need the melatonin now, but I want to keep taking it for its beneficial effects. I haven't noticed anything negative. Some people say inositol makes their hair and skin better and it may relieve hair loss, but I haven't noticed anything to that effect.
Watch out for: Inositol is very low on side effects. Most people never experience any. Some people have reported possible reduced libido and some bipolar disorder sufferers have reported induction of mania, which may suggest that inositol acts at least in part by serotonergic mechanisms. I have not seen reports of daytime drowsiness or any parasomnias.
Recommendation: Definitely, if you have any of the problems mentioned here. I wouldn't deny the possibility that inositol could even work for fatigue or brainfog because it's such an important substance for the body. Inositol is often recommended to take together with choline.
Magnesium
Usage: 200-350 mg a day (I've tried many different forms of magnesium)
Supposed to help: bones, muscle aches and tension, arrhythmias, migraine prevention, PMS, sleep, constipation, night sweats, epilepsy, allergies, anxiety, mood, Raynaud's phenomenon
Results: Sometimes I get a feeling which I believe is due to a slight magnesium deficiency, which manifests itself as muscle aches, increased palpitations and sometimes even a migraine. Taking magnesium relieves these symptoms, but it doesn't seem to help them in other cases. Magnesium also alleviates my night sweats, which I already noticed years ago, but only recently found out why it works. If I've taken large doses of magnesium (400-500 mg a day) I've felt that the vasodilatatory effect can cause flushing of the face and my urinary frequency is increased (because sodium doesn't cause so much water retention then?)
Watch out for: Large doses of magnesium may cause diarrhea and upset the balance of other electrolytes.
Recommendation: Definitely, it's inexpensive and helps a lot of people with CFS/ME. Magnesium citrate, magnesium malate and the amino acid chelates are supposed to be the best forms in terms of absorption. Malate is the form usually recommended for CFS/ME.
Multivitamin
Usage: one pill a day
Supposed to help: immune system, general well-being
Science: Vitamins and minerals are essential for life and one might not get sufficient amounts of them from the diet, especially when sick. Many people with CFS/ME also suffer from malabsorption. Many vitamins and minerals can be beneficial even when doses exceed the required daily amount.
Results: I haven't noticed anything special, but it seems like I'm less suspectible to viral infections. Also, once I was without a multivitamin for several weeks and seemed to be more achy during this time.
Watch out for: Multivitamins differ widely in their ingredients. Usually they should be safe, but watch out for the vitamin A content, as vitamin A can decrease bone mass. Preferably take a multivitamin without any vitamin A (beta carotene should be safe, despite the study with a positive link to lung cancer in smokers). This is also the reason why you should take fish oils instead of fish liver oil. Other vitamins shouldn't cause problems even if you're taking a separate, stronger supplement. Some people claim to get headaches from multivitamins.
Recommendation: Multivitamins are generally inexpensive and I recommend them for everyone with CFS/ME.
Vitamin B complex (mega strength)
Usage: At first one pill a day, then half a pill a day.
Supposed to help: fatigue, brainfog, tiredness, immune system, mood, allergies, asthma, nausea, migraine prevention, skin
Science: The B group contains a number of different water-soluble vitamins (even though B12 is stored in the body) that have numerous important functions in the body. Deficiencies can cause all kinds of issues from anaemia to neurological problems. The requirements of these vitamins may be larger in people with CFS/ME due to increased usage and decreased absorption. Riboflavin can help in migraine prevention.
Results: I haven't noticed any benefit for my CFS/ME symptoms nor any other things the B group vitamins are supposed to help, including the skin. The only thing I have noticed is that I have more vivid dreams and I can always remember them with plenty of detail, which is due to pyridoxine (vitamin B6) - kind of cool, but not very helpful.
Watch out for: Niacin can cause a harmless but unpleasant flush reaction in some people. Riboflavine can color the urine, which is also harmless. Pyridoxine can cause insomnia for some people and also neuropathy in very large doses.
Recommendation: Hard to say, it hasn't helped me, but they're cheap and many people feel they are helped. It's probably worth a try at least since some people have observed effects after just one pill.
Vitamin B12
Usage: one 1,000 mcg (1 mg) sublingual lozenge a day (some 200-500x the RDA)
Supposed to help: immune system, fatigue, brainfog, tiredness, neuropathic pain, circulation, mood
Science: B12 is a vitamin mostly (but not exclusively, unlike many people think!) available in animal based food. However, even if you eat meat every day, you can be deficient in B12. In general it's all about the absorption. Additionally high doses of B12 in injection form (up to 20 mg a day, some 10,000 times the normally recommended dose!) are often used to treat CFS/ME with great results, apparently because it scavenges peroxynitrite, which can cause brainfog and other nasty symptoms. Sublingual tablets are a good alternative, as they're much cheaper and bypass the gastrointestinal system similar to injections. Even many healthy people notice an energizing and cognition enhancing effect when consuming large doses of B12.
Results: I noticed decreased tiredness and increased mental clarity from the first lozenge. I had slept very poorly and felt like a zombie, but it all went away with the B12. In daily use this effect lasted for several months, but after that it seems to have had no effect, even if I have kept a break of several weaks.
Watch out for: B12 doesn't really have any side effects, in fact it doesn't even have LD50. Taking thousands of times the daily dose appears to be entirely safe even in the long term. Still, some people can be sensitive to the effects, but it is very rare (it made my severely ill friend more anxious for some reason).
Recommendation: Definitely. One of the cheapest supplements and the effects are often noticeable right away.
Vitamin C
Usage: usually 2 x 500 mg a day, more if I either have a cold or consider myself particularly likely to catch a cold (e.g. after social gatherings)
Supposed to help: immune system, brainfog, cold treatment, cold prevention, urinary tract infections, allergies, pain
Science: Vitamin C is essential for humans, with the recommended daily allowance being about 60 mg. However much larger doses up to tens of grams a day have been claimed to have benefits. Vitamin C also improves the absorption of iron. It can prevent urinary tract infections and is often used for treating them.
Results: Vitamin C really seems to decrease the incidence of viral infections for me. Many people say it helps them with brainfog, but I haven't noticed any effect even when taking several grams a day.
Watch out for: Some people take very large doses of vitamin C, up to tens of grams a day, sometimes intravenously. Large doses can irritate the stomach and cause diarrhea. Vitamin C may also irritate the bladder, especially if you're prone to bladder problems. There are non-acidic forms of vitamin C available in many countries.
Recommendation: Definitely, probably in the range of 500 mg to 2 g a day, perhaps up to 5 g in case of an acute infection.
Vitamin D
Usage: 100-150 mcg (4,000-6,000 IU) a day
Supposed to help: bones, aches, immune system, cold prevention, cancer prevention, mood
Science: Vitamin D was thought to be important only for bone health, but recent studies have shown it benefits the immune system as well. It appears to effectively prevent diabetes, autoimmune illnesses and cancer. The recommended daily allowances are likely way too small. Many leading scientists recommend amounts of 100-150 mcg a day.
Results: I haven't noticed anything special. When I increased the dose from 50 mcg to 100 mcg and soon afterwards 150 mcg I felt more feverish (and actually had a little more fever) for about a week, but it could have been a coincidence.
Watch out for:
Recommendation: Most people living in higher latitudes are deficient in vitamin D in the darker time of the year and people with CFS/ME may not go out often even in the summer. I definitely recommend vitamin D and particularly the D3 form, which is more effective. Vitamin D intake is much more important for your bone health than calcium intake. Everyone should take vitamin D to prevent chronic illnesses.
Zinc
Usage: 60 mg a day (+ 15 mg in multivitamin)
Supposed to help: immune system, fatigue, cold treatment and prevention, brainfog, antiherpesviral, libido, high cholesterol, hair loss, neuropathic pain, tinnitus, skin
Science: Zinc has been used to treat numerous different conditions involving the immune system, from the flu to rheumatoid arthritis and leukemia. It is helpful for many different kinds of skin problems and may also help neuropathic pain. In some studies it has been helpful for suppressing Herpes simplex infection, but it is not known whether it works similarly for other herpesviruses. Zinc raises the blood levels of testosterone, which may be beneficial for libido (and sexuality in general) and may also explain some of the immunomodulatory effects.
Results: I haven't noticed anything at all, not even an improvement skin which I expected.
Watch out for: Large doses of zinc impair copper absorption, if using large doses for a longer while, you should also supplement with copper (many multivitamins and zinc supplements also contain copper). Very large doses can also hinder the absorption of iron, which may be of concern if you tend towards anemia.
Recommendation: It is worth a try.
Other supplements and non-pharmaceutical treatments
Bio-Strath yeast extract
Usage: 30 drops three times a day
Supposed to help: fatigue, immune system
Science: ?
Results: I bought this supplement just because I got it for practically free of cost and it's supposed to help with chronic fatigue. It didn't seem to do anything.
Watch out for: Considering that this is yeast extract it can probably cause problems if you are sensitive to yeast, even though the package says the product contains no live yeast cells.
Recommendation: No, though I don't deny the possibility that it may help some people.
Coenzyme Q10 (ubiquinone) and ubiquinol
Usage: one 100 mg capsule a day (at one point one 400 mg capsule every other day)
Supposed to help: fatigue, brainfog, muscle endurance, blood sugar, immune system, heart symptoms, migraine prevention
Science: Coenzyme Q10 is a vitamin-like substance that can be produced by the body, but not necessarily always in sufficient quantities. It is used as an "anti-aging" supplement and to treat mitochondrial diseases. It's one of the most widely recommended supplements for CFS/ME, some doctors think it helps almost everyone and a small study also showed very promising results.
Results: I was expecting a lot from this since so many people say Q10 helps them and so many doctors recommend it (my friend's neurologist even recommended it even though she didn't know anything about CFS). Sadly during the first months I was on it my CFS/ME worsened considerably and instead of improved exercise tolerance I lost most of the mobility I had. Of course it's possible that I'd be worse off without it, as I haven't really had much fatigue, just tiredness and muscle weakness. The only result I can confirm is that I hardly ever get tachycardia or other bothersome heart symptoms any more, which is of course great, but not nearly what I was hoping for. I have also tried ubiquinol, the more active form of Q10, for three weeks (100 mg a day), but I'm not sure if it made a difference. I felt better after the first 7-10 days or so, but it could have been something else.
Watch out for: Q10 is very safe. For some illnesses people may take up to several grams a day without any side effects. Still some sources report possible nausea, insomnia, rashes, dizziness, fatigue and abdominal pain as possible side effects, but I have not heard of anyone actually experiencing these symptoms. Diabetics should discuss the supplementation with their doctors, as Q10 can reduce the need for insulin.
Recommendation: Definitely, despite my less than impressive experience with it. And everyone who's taking statins (a class of cholesterol lowering drugs) should definitely take it, CFS/ME or not, as statins can greatly lower the amount of Q10 produced in the body.
D-ribose
Usage: 8-10 g a day
Supposed to help: fatigue, muscle endurance, heart
Science: D-ribose is a mitochondrial nutrient. It should work particularly well together with carnitine and creatine. There is a study which showed it was helpful in reducing fatigue in CFS/ME (in a large dose of 15 grams a day).
Results: From the very first time I took it I've noticed a marked improvement in fatigue and tiredness. However, after some weeks of use the effects seemed to disappear, which is weird since usually drugs and supplements do not lose their efficacy for me.
Watch out for: Can keep you up at night if you take it too late in the day. It is a sugar, so keep that in mind if you are a diabetic or on a hypoglycemia diet or something.
Recommendation: It is quite expensive, but if you can afford it, it could be well worth the price.
Inosine
Usage: 3 x 500 mg on Monday, Wednesday and Friday, 500 mg on other days
Supposed to help: fatigue, muscle endurance, immune system, antiviral
Science: Inosine is a purine derivative that turns into the antioxidant uric acid in the body. It also has antiviral and immunostimulatory properties. Inosine has been used in the treatment of multiple sclerosis. The related molecule inosine pranobex (isoprinosine) is thought to be one of the best medications for CFS/ME.
Results: About five days since starting inosine I started noticing improvement in fatigue, being able to do more (especially general stuff that wasn't physically or mentally very demanding) yet suffering less afterwards. The dosing protocol I use has been modeled after the inosine pranobex protocols, though they usually have breaks of taking zero tablets (but people have complained they then have too many bad days). Varying the dose is said to keep it more effective. Using this protocol I don't notice any difference whether I take one or three capsules that day.
Watch out for: Inosine should not be used by people with a history of gout or kidney stones. It could theoretically worsen allergic symptoms like chronic urticaria, but I didn't notice anything like that (and I get urticaria very easily).
Recommendation: Definitely, at least if you cannot afford inosine pranobex or it is not available in your country.
MSM (methylsulphonylmethone)
Usage: up to 4 x 1,500 mg a day
Supposed to help: aches, fatigue, detoxification, chelation, fungal infections, osteoarthritis, allergies, asthma, snoring
Science: MSM is a popular over-the-counter anti-inflammatory, though there isn't that much scientific evidence about its properties. Paul Cheney and some other CFS/ME doctors recommend MSM started at very low doses and increased up to 9-12 grams a day.
Results: I did not really notice anything. Some possible "detox"/"die-off" reactions, which could have been entirely coincidental, and perhaps a slight relief in fatigue.
Watch out for: MSM is very safe, as long as it's pharmaceutical grade. Cheney warns that starting with a high dose could really intensify the symptoms for a while due to detox/die-off reactions.
Recommendation: Probably. It's quite cheap and safe. If Cheney is right, taking high doses for a while could even provide permanent relief.
Omega-3 fatty acids (flax seed oil)
Usage: 1 tablespoon a day
Supposed to help: fatigue, mood, immune system, brainfog, arrhythmias, hair, skin, anti-inflammatory
Science: Omega-3 fatty acids are polyunsaturated fatty acids essential for the human body. It has anti-inflammatory effects and it has been shown to help in some cognitive and psychiatric conditions (including depression and bipolar disorder).
Results: I didn't perceive any effects.
Watch out for: Flax seed oil goes rancid very quickly. Omega-3 fatty acids thin the blood, so watch out if you have problems with bleeding, are on blood-thinning medication or use several supplements (such as vitamin E or ginkgo) that also decrease thinning. Fish oil supplements can contain traces of heavy metals.
Recommendation: Yes. Fish oil is probably more effective than flax seed oil.
Picamilone
Usage: 2 x 50 mg a day (if I remember correctly)
Supposed to help: brainfog, mood, fatigue, sleep, neurological symptoms, anxiety, migraine, other headaches, orthostatic hypotension
Science: Picamilone is a nootropic (cognition enhancing drug). The molecule combines GABA, an inhibitory neurotransmitter, with niacin, orv vitamin B3 that acts as a vasodilator, improving cerebral circulation. Despite the addition of GABA it is not thought to be sedative, but more like a mild stimulant. It also has anxiolytic effects.
Results: I didn't notice anything, but I was already taking piracetam and other nootropics at the time.
Watch out for: Cerebral vasodilators can cause headaches. Picamilone may be a mild MAO-A inhibitor, so it should not be combined with antidepressants or serotonergic supplements (like St. John's wort).
Recommendation: Maybe, but try other nootropics first, if possible.
Probiotics
Usage: one capsule a day with a small meal
Supposed to help: stomach problems, fatigue, immune system, anti-inflammatory, cancer prevention, cold treatment and prevention, skin, allergies
Science: Probiotics usually refers to lactic acid bacteria, but it can also mean other types of bacteria and even some types of yeast. There is no evidence that probiotics will be able to provide lasting help if the original gut flora has been damaged, but they can offer at least temporary relief by forming colonies in the gut. Long-term use may also prevent colon cancer. Lactic acid bacteria may also help with lowering cholesterol. In one study people with CFS/ME were found to have too little bifidobacteria in their intestine.
Results: It has definitely helped my IBS like symptoms quite a bit, no other benefit that I'm aware of.
Watch out for: Many cheap probiotics may contain totally ineffective strains, so it's probably worth it to stick with a product from a known manufacturer - even though that doesn't guarantee the efficacy. Just the species of the bacteria isn't a guarantee of anything, the specific strain is what matters. Instead you can use probiotic yoghurts or other similar products. Normal yoghurt doesn't contain beneficial bacteria. Sauerkraut and kombucha tea are other sources of probiotic bacteria.
Recommendation: Yes, especially if you have stomach problems (primarily in the gut instead of heartburn-like symptoms) or are taking antibiotics (don't take them at the same time of the day, of course). You can often notice a difference in a matter of a few days. If it doesn't help, try a different brand. I've tried three brands, two of them helped but one didn't seem to be effective at all.
Quercetin & bromelain
Usage: 3-6 capsules a day (each containing 125 mg of bromelain and 250 mg of quercetin)
Supposed to help: immune system, pain, sinusitis, asthma, cold prevention, cancer prevention, urinary tract problems, prostatitis, allergies, osteoarthritis, depression, anxiety (quercetin) diarrhea, weight loss, osteoarthritis, sinusitis, circulation, digestion, muscle aches, increased efficacy of antibiotics, cancer prevention, candida (bromelain)
Science: Bromelain is not a single substance, but a combination of protein digesting enzymes that comes from pineapple. It can be used as a digestive enzyme, but if used for the anti-inflammatory effects it should be taken on an empty stomach so that it isn't "used up" digesting your food. It also destroys fibrinogen, a substance which may be implicated in a subset of CFS/ME caused by chronic hypercoagulation. Quercetin is a flavonoid found in many foods, but supplements can provide much larger doses. It has antioxidant, anti-inflammatory, neuroprotective and antihistamine-like effects and has been shown to lower the risk of getting a viral infection.
Results: I mostly tried this product for my chronic post-nasal drip, in combination of twice daily nasal irrigation and topical echinacea and oil of oregano. Unfortunatelyt I didn't get any relief. I'd have also liked to get some relief for my urinary frequency, but there was no effect. The only effect I noticed at the time was improved digestion, even though I took the capsules on an empty stomach. Later I took the capsules when I injured my foot and it seemed to heal extremely quickly (bromelain is recommended for sports injuries). It also seems to prevent muscle aches caused by excessive activity very well.
Watch out for: Quercetin doesn't have known side effects, but bromelain can cause nausea, diarrhea, heavy periods and stomach upset. Very large doses of bromelain (e.g. well over 1 gram a day) appear to increase the heart rate. Bromelain may interact with blood thinning medications.
Recommendation: Bromelain is well worth a try for muscle aches. Quercetin is perhaps more of a general "tonic" and "life extension drug" than something that helps specific symptoms.
R lipoic acid (the active isomer of alpha lipoic acid)
Usage: one 100 mg capsule a day (corresponds to a much larger amount of ALA)
Supposed to help: fatigue, brainfog, immune system, blood sugar, liver, heart, muscle endurance, neuropathy, detoxification, cancer prevention
Science: Lipoic acid has many important functions in the body. It is a very strong antioxidant and improves glucose tolerance. It has been shown to be helpful in the treatment of neuropathies and liver problems. Many people with MS swear by it, especially in combination with ALC, for its ability to relieve fatigue. Many bodybuilders use it in large doses. The R lipoic acid is the active isomer of alpha lipoic acid and it appears that the S isomer actually decreases the efficacy of the R isomer, which is why it's more effective to take R lipoic acid than alpha lipoic acid.
Results: I had suddenly lost a lot of the use of my legs and a bit later I developed very uncomfortable "gnawing" feelings in my legs at night, which could have been neuropathic pain. When I started taking RLA the pain went away very quickly and hasn't come back. I've also regained most of my previous function. Sadly my brainfog still seems very bad.
Watch out for: Some people don't recommend ALA/RLA for those with amalgam fillings. Diabetics may need to adjust their medication due to improved blood sugar control. High doses can cause insomnia, nausea, stomach upset or hypoglycemia. Lipoic acid may deplete the body of biotin, which may cause hair loss unless you're supplementing with it (found in most multivitamins and B complex vitamins).
Recommendation: Definitely. It has many different beneficial functions. Even if you don't notice a benefit it's probably still a good idea to take it.
Undenatured whey protein
Usage: 20-25 g a day mixed into water, taken on an empty stomach
Supposed to help: immune system, stomach problems, muscle endurance, headaches, antiviral, antibacterial, antifungal
Science: Undenatured whey protein is used in CFS/ME for its immunomodulatory and antimicrobial properties. Besides containing some directly antimicrobial substances it also increases the amount of glutathione in the body, which may be decreased in CFS/ME and adversely affecti the immune system. In a small study conducted by Paul Cheney all patients improved on undenatured whey protein and most (formerly positive) even tested negative for chronic bacterial and viral infections at the end of the study.
Results: I have noticed a moderate benefit in my overall feeling. I have less "off" days (days when I can't really do anything at all). It only seems to help my stomach problems (slightly) when I take it, but not later in the day. However I am fairly sure I have got some kind of a "die-off" reaction (joint pain, muscle pain, feverishness, swollen lymph nodes, night sweats etc - normally I don't have these symptoms since I've been on LDN), which has never happened to me with any other antimicrobial substance. For several months these symptoms returned every time I drink licorice tea (according to one study licorice and whey protein may have synergistic antiviral effects).
Watch out for: Not suitable for those allergic to milk. Large doses may also cause problems to people with lactose intolerance. Can cause "die-off" reactions. Someone I know experienced tingling and burning in palms a few days after starting to take whey, and it hasn't gone away. I don't know what mechanism could be this or whether it's just a coincidence.
Recommendation: Yes, especially if you know/suspect that you have a chronic viral infection and cannot get/afford antiviral medication.
Other treatments
Gluten-free diet
Usage: only gluten-free food for six weeks
Supposed to help: fatigue, brainfog, allergies, congestion, stomach problems, skin
Science: Gluten is a mixture of the proteins gliadin and glutenin, found in wheat (including spelt), rye and barley. A very similar protein is also contained in oats. Gluten-free diet is required for people with coeliac disease, which isn't allergy but an autoimmune disease. It is also possible to be intolerant to gluten without having coeliac disease. Many people with CFS/ME report that a gluten-free diet relieves their symptoms, especially brainfog, congestion and stomach problems. Effects are often noticed after a week or two, but doctor Sarah Myhill recommends trying the diet for six weeks to assess the benefits.
Results: I noticed nothing at all, except for a urinary tract infection I got which I believe may have been related (e.g. due to changed pH of urine). My fatigue, brainfog, congestion, stomach problems and skin stayed just the same. When I reintroduced gluten back to my diet there was no change either-
Watch out for: Many gluten-free baked products are made out of fairly low nutrition ingredients such as corn, potato, rice and tapioca. Try to eat things like buckwheat, quinoa and amaranth, which are gluten-free and extremely nutritious. In some countries you can find buckwheat cakes which are like rice cakes, but made out of 100% buckwheat. They have a pleasant, roasted taste somewhat reminiscent of popcorn.
Recommendation: If you have a significant amount of allergies/intolerances, congestion and stomach problems, it may be worth a try. If you are very sensitive to medications and supplements this is a good candidate to try, as it should not cause any side effects.
Tiger balm
Usage: Spread on the affected part of the skin as needed or exhaling vapours from the jar
Supposed to help: muscle pain and tension, headaches, congestion
Science: ?
Results: I've used tiger balm successfully for sore and tense muscles. Even in case when muscle relaxants haven't worked, tiger balm has noticeably relaxed the muscles in just a few hours.
Watch out for: Tiger balm contains many types of essential oils, so it may cause problems for people with allergies or chemical sensitivities.
Recommendation: Yes. You should be able to find it for just a few euros/dollars for a jar, which lasts for quite a while.