Intended for healthcare professionals

Rapid response to:

Clinical Review ABC of adolescence

Fatigue and somatic symptoms

BMJ 2005; 330 doi: (Published 28 April 2005) Cite this as: BMJ 2005;330:1012

Rapid Response:

Nutritional deficiencies found in ME/CFS patients.

Dr Charles Shepherd writes that, “The simple fact is that nobody yet
knows the underlying cause/s of ME/CFS, and while psychological and social
factors may play a role - as in any chronic medical condition - there is
compelling evidence of abnormalities in brain, muscle, endocrine and
immune system function”.

Why therefore does he not recommend therefore that patients with
myalgic encephalitis or chronic fatigue syndrome have relevant diagnostic
tests? Myalgic- about muscles- should indicate testing for correctable
magnesium deficiencies in sweat and red blood cells.1,2 Encephalitis –
about the brain- should indicate teats for sweat or white blood cell tests
for zinc deficiency and red cell superoxide dismutase tests for copper or
manganese deficiencies. These common deficiencies disrupt brain, muscle,
endocrine and immune system function.

Mervyn Werbach's detailed review of the literature suggests a number
of marginal nutritional deficiencies may have etiologic relevance. These
included deficiencies of various B vitamins, vitamin C, magnesium, sodium,
zinc, L-tryptophan, L-carnitine, coenzyme Q10, and essential fatty acids.
Objective testing, he writes, should identify them and their resolution
should be assured by repeat testing following initiation of treatment.3

Magnesium supplementation improved parameters of oxidant-antioxidant
balance in patients with chronic fatigue syndrome in a series of patients
in which 75% were females.4 In my experience ME/CFS is common with use
of hormonal contraceptives and the symptoms often signal zinc, copper,
magnesium, selenium and glutathione deficiencies. Patients can notice
immediate benefits from repletion of copper and zinc deficiencies.
Magnesium deficiencies can take longer to be repleted.

It would be useful for patients’ help groups to have advisors who are
experienced in the field of Nutritional Medicine.

1 Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and
chronic fatigue syndrome. Lancet 1991; 337: 757-60.

2 Howard JM, Davies S, Hunnisett A. Magnesium and chronic fatigue
syndrome. Lancet 1992; 340: 426.

3 Werbach MR. Nutritional strategies for treating chronic fatigue
syndrome. Altern Med Rev 2001; 6: 4-6.

4 Manuel y Keenoy B, Moorkens G, et al. Magnesium status and
parameters of the oxidant-antioxidant balance in patients with chronic
fatigue: effects of supplementation with magnesium. J Am Coll Nutr 2000;
19: 374-82.

Competing interests:
None declared

Competing interests: No competing interests

07 May 2005
Ellen C G Grant
Kingston-upon-Thames, KT2 7JU, UK