Simplifying Nutritional Support in CFS & Fibromyalgia

Published: September 30, 2015

People often ask "Which vitamin or mineral do I need?" The answer, simply put, is "All of them!"

Fortunately, we do not have to become part of the "handful club," where you are taking handfuls of pills each day, to get what you need. It can be done very easily with one drink and 2 to 5 pills daily.

Let's begin with an exploration of why high-potency nutritional support is so important to optimize health in those with CFS/fibromyalgia:

  1. With half of the calories in our modern diet coming from sugar, white flour and fats—which are empty calories that have been stripped of nutrients—most Americans have lost over half of the vitamins and minerals they should be getting before they even get out of the starting gate. In fact, this is the first time in human history where a very large percentage of the population is both obese and malnourished at the same time.
  2. Fibromyalgia is associated with increased nutrient needs. This occurs for a number of reasons which we discuss below. Because of this, the RDAs (which I call the "Ridiculous Dietary Allowances") are often woefully inadequate for those with CFS and fibromyalgia.
  3. Because of gut infections, poor absorption of nutrients is also a concern.

Begin With Diet

  1. Increase salt and water intake! Especially with the adrenal fatigue and low blood pressure/dehydration issues routinely found, people who restrict their salt intake in an attempt to be healthy will crash and burn. Salt is your friend, and I would especially recommend high quality sea salts such as Celtic or Hawaiian sea salt. Mediterranean sea salt can also be found at low-cost at Costco. Increase water consumption as well.
  2. Most people with CFS/FMS do best with a high-protein diet and frequent small meals during the day. But everyone is different, so you should eat what leaves you feeling the best.
  3. Whenever conveniently possible, add in whole unprocessed foods and cut down on the junk food.
  4. Consider a 1 ounce protein snack at bedtime (e.g. a hard-boiled egg, some meat, cheese, or fish), as this may prevent some of the 2-4 AM drops in blood sugar that can wake you up. You will know if this is helpful for you in the first three days. Note that a carb snack may worsen sleep.

In a future article, we'll discuss nutrition health myths that you will be happy to see busted. For example, did you know that chocolate is a health food that helps CFS? It is!

Key Areas Where Nutritional Support to Optimize Health Is Needed

B Vitamins

These form the backbone of energy production in our body, and I recommend at least 40 mg of vitamin B1 to vitamin B6, 400 µg of folic acid (with at least half of this being in a form that is methylation friendly, called 5 MTHF), and 500 µg of vitamin B12 (as methyl or hydroxycobalmin, again to support methylation). These nutrients, especially vitamin B1 and B12, are also critical for having a clear mind. Research has shown that despite normal blood levels of vitamin B12, levels in the brain in CFS are very low or nondetectable. Because of this, very high levels of B12 are required to get optimal levels in the brain in this illness. Research suggests that very high levels of the other B vitamins may also be important.


This is another key nutrient for both energy metabolism, calming, and relief of muscle and nerve pain. The average American diet only has 275 mg of magnesium per day, whereas a healthy unprocessed diet has over 600 mg. It is likely that the vast majority of Americans suffer the effects of inadequate magnesium levels.

Vitamin C, Glutamine, Glycine and Cysteine

These four nutrients are critical for making the key human antioxidant, called glutathione. It has been suspected that glutathione deficiency is one of the most important common denominators contributing to CFS/FMS. Although we hear a lot about antioxidants, it is important to realize that humans make just two antioxidants: glutathione and SOD. This suggests that these are the two that are most important for people. Having optimal levels of these antioxidants is critical for optimizing immune function.

Zinc and Vitamin A

These are also critical for immune function, and zinc deficiency is routinely seen in people with chronic infections or inflammation. Zinc and copper are also critical for making the other key human antioxidant, super oxide dismutase (SOD). More is not better though, and I recommend 15 mg a day. Consider taking an additional 20-25 mg a day for 3 months to "fill your tank."

Vitamin D

In those with chronic pain and also those with immune dysfunction, vitamin D deficiency is routine and a significant player. Too much however can be problematic, as it can be converted to a form called calcitriol (1.25 hydroxy vitamin D) which may suppress immune function. Because of this, sometimes people have falsely low vitamin D levels on their blood testing, despite massive amounts being taken. I consider it ill advised to chase these blood levels. Instead, I recommend that people simply take 1,000 units of vitamin D daily and get sunshine.

Tryptophan, Tyrosine and Serine

These amino acids are critical for a number of functions including optimizing neurotransmitter levels (e.g., serotonin and dopamine) that are low in fibromyalgia.


This mineral is critical for immune function, but has a very narrow optimal dosing range. For most people, I recommend 55 µg daily, as higher doses can unnecessarily increase the risk of diabetes. For those with Hashimoto's thyroiditis, taking the higher dose of 200 µg a day can be helpful, with the benefits outweighing the risk of the diabetes.

To keep it simple, all of the above, and essentially all of the other key micronutrients that should be found in an optimal diet (except for calories, essential fatty acids, iron, and enzymes) can be found in a simple vitamin powder called the Energy Revitalization System by Enzymatic Therapy. This allows you to get them in one simple low-cost drink each day, instead of requiring 35 to 50 pills. Try getting what's in just one drink in less than 50 pills. Most people will not be able to! I designed the powder to be excellent for optimizing nutritional support in everyone, and it has recently been redesigned to improve methylation as well. I will note that all of my royalties for this product are donated to charity.

The other key nutrients that I recommend for everyone with CFS/FMS include:


Ribose is a special sugar produced by our body is the backbone of the energy molecules ATP, NADH, FADH, etc. We have now published two studies showing a dramatic average increase in energy of 60% after three weeks of taking 5 g three times a day.   Two thirds of the people taking it were helped. After three weeks, the dose can be dropped to 5 g a day. I personally take one scoop of the Energy Revitalization System vitamin powder plus 5 g of ribose each morning. Just add water and stir with a fork. It will be the best 30 seconds for energy production you spend each day! It also was shown to decrease muscle pain, improve cognitive function, and improve sleep. I recommend the ribose and Energy Revitalization System vitamin powder for everyone. More good news? S.H.I.N.E.® D-Ribose is now available. The same Bioenergy Ribose® used in the studies—at the lowest cost for Bioenergy ribose—anywhere!

Omega-3 Support

Fish oil support is critical for mood, balancing inflammation, and a host of other processes. Fortunately, you no longer have to take eight big fish oil pills each day, while putting up with the "fish oil burps." I recommend using a pure omega-3 with phospholipids, such as Vectomega (by EuroPharma), where one small pill replaces eight big fish oil gels.

Coenzyme Q10

I recommend taking 200 mg of coenzyme Q10 daily. Take this with a meal containing some oil to optimize absorption.

Acetyl l-Carnitine

I recommend taking 1,500 mg of acetyl l-carnitine daily for four months. Most people with CFS/FMS are carnitine deficient, but I would not bother with the muscle biopsy needed to show it. Carnitine is critical for both energy production and the ability to lose weight (a topic we will discuss at length in the future). It is also helpful for helping nerves heal. Use the acetyl l-carnitine form, as this is better able to get into the parts of the cell where it is needed.


If the ferritin blood tests is under 60, I strongly recommend supplementing with iron. Take at least 50 mg of vitamin C along with the iron to support its absorption, and do not take the iron within six hours of taking thyroid hormone.

Using the above approach, nutritional support can be done very easily. Give it six weeks to see the effects. Most people find it to be very helpful!

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. His newest book (June 10, 2024) is You Can Heal From Long COVID. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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