Tired as they may be, people with CFS often have trouble sleeping, To help improve sleep, Dr. Hubbuch recommends 5-hydroxytryptophan (5-HTP) and melatonin.

In your body, 5-HTP increases levels of serotonin, a chemical that helps regulate sleep patterns. Studies show that 5-HTP can shorten the time it takes to fall asleep and make you less likely to waken during the night. When Dr. Hubbuch prescribes this supplement, she instructs people to take 50 milligrams one hour before bedtime. You can increase the dosage up to 150 milligrams at night if necessary, but don’t go any higher than 200 milligrams, advises Dr. Lombard, since higher doses can cause disturbing dreams.

You should not take 5-HTP if you are currently taking antidepressant medication or have taken it recently, as the combined effects could cause a possibly fatal condition called serotonin syndrome. Otherwise, you can use 5-HTP safely for long periods of time, Dr. Hubbuch says. Decrease the dose if you are sleeping well, she advises. Along with the 5-HTP, she suggests taking 50 milligrams of vitamin B₆. In addition to 5-HTP, some people may need to take melatonin, which can also be a sleep aid, Dr. Hubbuch says. She recommends two milligrams of timed-release melatonin at bedtime. For those who need still more help falling asleep, she suggests valerian, a calming herb that can help hasten sleep, improve the quality of sleep, and reduce nighttime awakenings.

In his book The Green Pharmacy, James A. Duke, Ph.D., a botanical consultant and former ethnobotanist with the U.S. Department of Agriculture who specializes in medicinal plants, says that some naturopaths whom he respects suggest drinking valerian root tea about 30 minutes before retiring. Others suggest taking 150 to 300 milligrams of a standardized extract (0.8 percent valeric acid). Do not use valerian with sleep-enhancing or mood-regulating medications such as diazepam (Valium) or amitriptyline (Elavil), however. If stimulant actions such as nervousness or heart palpitations occur, discontinue use.

Try one of these sleep remedies at a time and see if it works for you, Dr. Hubbuch says. If you don’t notice results after one to two weeks of using one product, try another. "Sometimes, you do use all of them," she says. "It depends on how bad your sleep problem is." It is safe to use all three, according to Dr. Hubbuch.

People with CFS may also have impaired energy metabolism within the mitochondria, the energy producing areas of the muscle cells, Dr. Lombard says. The cells just don’t make or use energy as well as they should, for unknown reasons. To improve this situation, he recommends coenzyme Q₁₀ (coQ₁₀). This substance helps charge up the mitochondria. Both he and Dr. Hubbuch recommend taking 200 milligrams a day. Dr. Hubbuch suggests taking a type of coQ₁₀ that is placed under the tongue (sublingual), where it dissolves and is absorbed through the mucous membranes, rather than the kind you swallow. "It is helpful in quite a few people," she says. "It’s better absorbed and seems to work better." If you start taking coQ₁₀ and it helps, the results usually show up in about a month, says Dr. Hubbuch. "Try it for a month and see if it is worth it for you. If it’s not doing anything, then just stop." You can take it at any time of day, she says.

Many of the B vitamins as well as the amino acid l-carnitine are also essential for energy production. They’re important because they all appear to work together to boost muscle energy levels. You can make sure that you’re getting all of the B vitamins by taking a high-potency B-complex supplement, Dr. Lombard says. Look for one that includes about 50 milligrams of most of the B’s. Since you should get more folic acid and vitamin B₁₂ than what’s provided by a B-complex supplement, you’ll probably need to take additional supplements, says Dr. Lombardo. He recommends a total of 1,000 micrograms of folic acid and 1,000 micrograms of B₁₂ a day. In addition, he suggests supplementing with 500 milligrams of l-carnitine daily. But don’t take extra B-complex vitamins if you are already taking them to boost immunity, he cautions.

An essential mineral, magnesium, is also necessary for energy metabolism. Doctors have found that many people with CFS have low levels of magnesium in their red blood cells, and several studies have shown some improvement in energy levels with magnesium supplementation. Typically, magnesium comes as magnesium oxide or carbonate, but other forms may be better absorbed orally and utilized in the body. These include magnesium lactate, orotate, glycinate, and gluconate.

 

People with CFS may need to reduce the amount of stress on their adrenal glands. That means limiting sugar and caffeine and taking vitamins, minerals, and herbs that help the glands function properly, Dr. Lombard says.

"The adrenal glands contain the highest concentration of vitamin C in the body," he says. Vitamin C helps influence neurotransmitters, the essential messenger chemicals that carry signals from one part of the body to another. Dr. Lombard recommends 4,000 milligrams of vitamin C a day, taken in divided doses. If you are already taking this amount to boost immunity, however, you don’t need to take more.

He also suggests 50 milligrams of pantothenic acid, 30 milligrams of zinc, and 600 milligrams of magnesium in divided doses. "These nutrients all play necessary roles in the manufacture of hormones by the adrenal glands," Dr. Lombard says. If you are already taking these nutrients for other reasons, though, there’s no need to add more. Siberian and Asian ginseng can also help support the adrenal glands, increase resistance to stress, and exert a number of beneficial effects on immune functions that may be useful in the treatment of CFS, Dr. Lombard says. In one study, people who took 10 milliliters a day of a liquid extract of Siberian ginseng had a significant increase in T-helper cells and in natural killer cell activity, both of which are of value in treating CFS. Dr. Lombard recommends 500 milligrams a day of standardized extract of Siberian or Asian ginseng.

Licorice is also helpful in supporting the adrenal glands and increasing the production of cortisol, an important hormone, by this gland, Dr. Hubbuch says. Low amounts of cortisol or other adrenal hormones in the body can lower blood pressure. "Some people with CFS have problems with low blood pressure. As a result, they may feel dizzy and light-headed, especially when they are changing positions," she says. If you notice that you become dizzy when you stand up suddenly, low blood pressure may be the reason. Licorice can help relieve this symptom.

How much licorice you need to take depends on your symptoms and the type you use. A standard dose is 1,000 to 2,000 milligrams of powdered root or two to four milliliters (roughly 1¼3 to 2¼3 teaspoon) of liquid extract. Alternatively, you can take 250 to 500 milligrams of dry, powdered extract.

Be careful not to overdo it, though. You should talk to a doctor if you’re taking these amounts, since high daily doses for more than four to six weeks can cause symptoms such as headache and lethargy and may even lead to impaired heart or kidney function. Research

Dr. Hubbuch will also sometimes recommend dehydroepiandrosterone (DHEA), an adrenal hormone that the body can convert to various other hormones, including testosterone. People with CFS may produce inadequate amounts of it. She recommends that you have your doctor check your level of DHEA with a simple blood or saliva test before you supplement with it.

"I would try it only if other treatments aren’t helping enough and if DHEA levels are low," she says. In men, low DHEA levels are often associated with low sex drive. In women, often the only symptom is fatigue, Dr. Hubbuch says.

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