CFS/ME was until recently a ill defined condition, whose main symptom was
fatigue
Other associated conditions were poor sleep, depression and brain fog.
Recently it has been found that the major precipitating factor was functional
vitamin B12 deficiency. In
CFS/ME the B12 deficiency appears to be related to functional B2 deficiency Treatment of CFS must address the primary cause of vitamin B12 deficiency.
Treatment must establish whether the vitamin B12 deficiency is absolute or
paradoxical deficiency If
the cause is paradoxical B12 deficiency, then treatment must address this
Treatment involves fixing functional vitamin B2 deficiency first
Once functional B2 deficiency has been resolved then the functional B12
deficiency can be addressed.
Chronic Fatigue Syndrome (CFS) or Myalgic Encephalomyalitis
(ME) is an ill defined disease that is characterized by a post exercise
tiredness or malaise. The condition usually lasts for more than six months and
in affected individuals is very disabling. Symptoms include muscle soreness,
inability to concentrate (brain fog), headaches and severe mental and physical
fatigue. In addition these symptoms may be accompanied by sensitivity to light,
sounds and smells, digestive disturbances, depression, painful and often
slightly swollen lymph nodes, and it may also be accompanied by cardiac and
respiratory problems.
We have compared the metabolic analysis of those with CFS/ME to healthy controls
using the Organic Acids Test of urine, and a Hair Metals Test Analysis. This has
enabled to identify mineral and nutritional deficiencies in CFS/ME and have
found that Iodine/Selenium and/or Molybdenum deficiency is very common, and have
developed a protocol to treat the deficiencies and then fix the functional B2
and B12 deficiency, so enable resolution of the condition.
We have summarized the finding in the
Research section, and
have been able to identify the
Cause of the condition as well as a
Treatment strategy. In
addition, we have expanded on the concept of
Paradoxical B12
deficiency. The treatment strategy involves re-establishing active riboflavin
sufficiency and functional vitamin B12 sufficiency, which when combined with
parenteral administration of mixed Adenosyl/Methyl B12. Hence the protocol as been named the RnB protocol.
The RnB protocol has been found to be highly effective in reversing the
symptoms of CFS
(RnB protocol)
Creatine supplementation has also proven to have some success in some
individuals (Allen, 2012).
References:
Regland B, Andersson M, Abrahamsson
L, Bagby J, Dyrehag LE, Gottfries CG (1997). Increased concentrations of
homocysteine in the cerebrospinal fluid in patients with fibromyalgia and
chronic fatigue syndrome. Scand J Rheumatol. 26(4):301-7
Björkegren K. (1999) Vitamin B12,
chronic fatigue and injection treatment. Lakartidningen. 96(50):5610.
Askmark H, Haggård L, Nygren I, Punga AR. (2012) Vitamin D deficiency in
patients with myasthenia gravis and improvement of fatigue after supplementation
of vitamin D3: a pilot study. Eur J Neurol. 19(12):1554-60.
Yancey JR, Thomas SM. Chronic fatigue syndrome: diagnosis and treatment. Am Fam
Physician. 2012 Oct 15;86(8):741-6. PMID: 23062157.
Bested AC, Marshall LM. Review of Myalgic Encephalomyelitis/Chronic Fatigue
Syndrome: an evidence-based approach to diagnosis and management by clinicians.
Rev Environ Health. 2015;30(4):223-49. doi: 10.1515/reveh-2015-0026. PMID:
26613325.
Rollnik JD. Das chronische Müdigkeitssyndrom – ein kritischer Diskurs [Chronic
Fatigue Syndrome: A Critical Review]. Fortschr Neurol Psychiatr. 2017
Feb;85(2):79-85. German. doi: 10.1055/s-0042-121259. Epub 2017 Feb 24. PMID:
28235209.
Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic
fatigue syndrome: a comprehensive approach to its definition and study.
International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994 Dec
15;121(12):953-9. doi: 10.7326/0003-4819-121-12-199412150-00009. PMID: 7978722.
Blitshteyn S, Chopra P. Chronic Fatigue Syndrome: From Chronic Fatigue to More
Specific Syndromes. Eur Neurol. 2018;80(1-2):73-77. doi: 10.1159/000493531. Epub
2018 Oct 4. PMID: 30286454.
Baklund IH, Dammen T, Moum TÅ, Kristiansen W, Duarte DS, Castro-Marrero J,
Helland IB, Strand EB. Evaluating Routine Blood Tests According to Clinical
Symptoms and Diagnostic Criteria in Individuals with Myalgic
Encephalomyelitis/Chronic Fatigue Syndrome. J Clin Med. 2021 Jul 14;10(14):3105.
doi: 10.3390/jcm10143105. PMID: 34300271; PMCID: PMC8307418.
Kaslow JE, Rucker L, Onishi R. Liver extract-folic acid-cyanocobalamin vs
placebo for chronic fatigue syndrome. Arch Intern Med. 1989 Nov;149(11):2501-3.
PMID: 2684076.
Wiebe E. N of 1 trials. Managing patients with chronic fatigue syndrome: two
case reports. Can Fam Physician. 1996 Nov;42:2214-7. PMID: 8939323; PMCID:
PMC2146911.
Regland B, Forsmark S, Halaouate L, Matousek M, Peilot B, Zachrisson O,
Gottfries CG. Response to vitamin B12 and folic acid in myalgic
encephalomyelitis and fibromyalgia. PLoS One. 2015 Apr 22;10(4):e0124648. doi:
10.1371/journal.pone.0124648. PMID: 25902009; PMCID: PMC4406448.
Regland B. Vitamin B12/B9 – möjlig behandling vid mental trötthet [Vitamin
B12/B9 – possible treatment for mental fatigue]. Lakartidningen. 2017 Jul
11;114:ERZ3. Swedish. PMID: 28696491.
Blankfield A. Kynurenine Pathway Pathologies: do Nicotinamide and Other Pathway
Co-Factors have a Therapeutic Role in Reduction of Symptom Severity, Including
Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM). Int J Tryptophan Res. 2013
Jul 21;6(Suppl 1):39-45. doi: 10.4137/IJTR.S11193. PMID: 23922501; PMCID:
PMC3729338.
Blankfield A. A Brief Historic Overview of Clinical Disorders Associated with
Tryptophan: The Relevance to Chronic Fatigue Syndrome (CFS) and Fibromyalgia
(FM). Int J Tryptophan Res. 2012;5:27-32. doi: 10.4137/IJTR.S10085. Epub 2012
Sep 17. PMID: 23032646; PMCID: PMC3460668.
ABDULLA J, Torpy BDJ. Chronic Fatigue Syndrome. 2017 Apr 20. In: Feingold KR,
Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Hershman JM,
Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung
W, Laferrère B, Levy M, McGee EA, McLachlan R, Morley JE, New M, Purnell J,
Sahay R, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors.
Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID:
25905324.
Rossi L, Nardecchia F, Pierigè F, Ventura R, Carducci C, Leuzzi V, Magnani M,
Cabib S, Pascucci T. Intellectual Disability and Brain Creatine Deficit:
Phenotyping of the Genetic Mouse Model for GAMT Deficiency. Genes (Basel). 2021
Aug 2;12(8):1201. doi: 10.3390/genes12081201. PMID: 34440375; PMCID: PMC8391
Modi BP, Khan HN, van der Lee R, Wasim M, Haaxma CA, Richmond PA, Drögemöller B,
Shah S, Salomons G, van der Kloet FM, Vaz FM, van der Crabben SN, Ross CJ,
Wasserman WW, van Karnebeek CDM, Awan FR. Adult GAMT deficiency: A literature
review and report of two siblings. Mol Genet Metab Rep. 2021 Apr 26;27:100761.
doi: 10.1016/j.ymgmr.2021.100761. PMID: 33996490; PMCID: PMC8093930.
Joncquel-Chevalier Curt M, Voicu PM, Fontaine M, Dessein AF, Porchet N, Mention-Mulliez
K, Dobbelaere D, Soto-Ares G, Cheillan D, Vamecq J. Creatine biosynthesis and
transport in health and disease. Biochimie. 2015 Dec;119:146-65. doi:
10.1016/j.biochi.2015.10.022. Epub 2015 Nov 2. PMID: 26542286.
Mercimek-Mahmutoglu S, Stoeckler-Ipsiroglu S, Adami A, Appleton R, Araújo HC,
Duran M, Ensenauer R, Fernandez-Alvarez E, Garcia P, Grolik C, Item CB, Leuzzi
V, Marquardt I, Mühl A, Saelke-Kellermann RA, Salomons GS, Schulze A, Surtees R,
van der Knaap MS, Vasconcelos R, Verhoeven NM, Vilarinho L, Wilichowski E,
Jakobs C. GAMT deficiency: features, treatment, and outcome in an inborn error
of creatine synthesis. Neurology. 2006 Aug 8;67(3):480-4. doi:
10.1212/01.wnl.0000234852.43688.bf. Epub 2006 Jul 19. PMID: 16855203.
Gordon N. Guanidinoacetate methyltransferase deficiency (GAMT). Brain Dev. 2010
Feb;32(2):79-81. doi: 10.1016/j.braindev.2009.01.008. Epub 2009 Mar 16. PMID:
19289269.
Nasrallah F, Kraoua I, Joncquel-Chevalier Curt M, Bout MA, Taieb SH, Feki M,
Khouja N, Briand G, Kaabachi N. Guanidinoacetate methyltransferase (GAMT)
deficiency in two Tunisian siblings: clinical and biochemical features. Clin
Lab. 2012;58(5-6):427-32. PMID: 22783571.
Pérez B, Medrano C, Ecay MJ, Ruiz-Sala P, Martínez-Pardo M, Ugarte M,
Pérez-Cerdá C. A novel congenital disorder of glycosylation type without central
nervous system involvement caused by mutations in the phosphoglucomutase 1 gene.
J Inherit Metab Dis. 2013 May;36(3):535-42. doi: 10.1007/s10545-012-9525-7. Epub
2012 Sep 14. PMID: 22976764.
Sahlin K, Tonkonogi M, Söderlund K. Energy supply and muscle fatigue in humans.
Acta Physiol Scand. 1998 Mar;162(3):261-6. doi:
10.1046/j.1365-201X.1998.0298f.x. PMID: 9578371.
Clark JB, Hayes DJ, Morgan-Hughes JA, Byrne E. Mitochondrial myopathies:
disorders of the respiratory chain and oxidative phosphorylation. J Inherit
Metab Dis. 1984;7 Suppl 1:62-8. doi: 10.1007/BF03047377. PMID: 6434847.
Sobreira C, Hirano M, Shanske S, Keller RK, Haller RG, Davidson E, Santorelli
FM, Miranda AF, Bonilla E, Mojon DS, Barreira AA, King MP, DiMauro S.
Mitochondrial encephalomyopathy with coenzyme Q10 deficiency. Neurology. 1997
May;48(5):1238-43. doi: 10.1212/wnl.48.5.1238. PMID: 9153450.
Kan, HE, Buse-Pot TE, Peco R, Isbrandt D, Heerschap A, de Haan A. Lower force
and impaired performance during high-intensity electrical stimulation in
skeletal muscle of GAMT-deficient knockout mice. Am J Physiol Cell Physiol. 2005
Jul;289(1):C113-9. doi: 10.1152/ajpcell.00040.2005. Epub 2005 Mar 2. PMID:
15743892.
Mercimek-Mahmutoglu S, Stoeckler-Ipsiroglu S, Adami A, Appleton R, Araújo HC,
Duran M, Ensenauer R, Fernandez-Alvarez E, Garcia P, Grolik C, Item CB, Leuzzi
V, Marquardt I, Mühl A, Saelke-Kellermann RA, Salomons GS, Schulze A, Surtees R,
van der Knaap MS, Vasconcelos R, Verhoeven NM, Vilarinho L, Wilichowski E,
Jakobs C. GAMT deficiency: features, treatment, and outcome in an inborn error
of creatine synthesis. Neurology. 2006 Aug 8;67(3):480-4. doi:
10.1212/01.wnl.0000234852.43688.bf. Epub 2006 Jul 19. PMID: 16855203.
Strahler J, Fischer S, Nater UM, Ehlert U, Gaab J. Norepinephrine and
epinephrine responses to physiological and pharmacological stimulation in
chronic fatigue syndrome. Biol Psychol. 2013 Sep;94(1):160-6. doi:
10.1016/j.biopsycho.2013.06.002. Epub 2013 Jun 13. PMID: 23770415.
Morriss R. Insomnia in the chronic fatigue syndrome. BMJ. 1993 Jul
24;307(6898):264. doi: 10.1136/bmj.307.6898.264. PMID: 8369716; PMCID:
PMC1678179.
Galvez-Sánchez CM, Duschek S, Reyes Del Paso GA. Psychological impact of
fibromyalgia: current perspectives. Psychol Res Behav Manag. 2019 Feb
13;12:117-127. doi: 10.2147/PRBM.S178240. PMID: 30858740; PMCID: PMC6386210.
Welsch P, Üçeyler N, Klose P, Walitt B, Häuser W. Serotonin and noradrenaline
reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst Rev. 2018
Feb 28;2(2):CD010292. doi: 10.1002/14651858.CD010292.pub2. PMID: 29489029; PMCID:
PMC5846183.
Pejovic S, Natelson BH, Basta M, Fernandez-Mendoza J, Mahr F, Vgontzas AN.
Chronic fatigue syndrome and fibromyalgia in diagnosed sleep disorders: a
further test of the 'unitary' hypothesis. BMC Neurol. 2015 Apr 12;15:53. doi:
10.1186/s12883-015-0308-2. PMID: 25884538; PMCID: PMC4405866.
Campbell R, Vansteenkiste M, Delesie L, Tobback E, Mariman A, Vogelaers D,
Mouratidis A. Reciprocal associations between daily need-based experiences,
energy, and sleep in chronic fatigue syndrome. Health Psychol. 2018
Dec;37(12):1168-1178. doi: 10.1037/hea0000621. Epub 2018 Oct 15. PMID: 30321019.
Tobback E, Desmet O, Hanoulle I, Delesie L, Pevernagie D, Vogelaers D, Mariman
A. Retrospective Analysis of Risk Factors for Periodic Limb Movements in a Large
Cohort of Insomnia and Chronic Fatigue Patients. Pharmacopsychiatry. 2020
Mar;53(2):71-77. doi: 10.1055/a-0991-0498. Epub 2019 Aug 27. PMID: 31454848.
Wright A, Fisher PL, Baker N, O'Rourke L, Cherry MG. Perfectionism, depression
and anxiety in chronic fatigue syndrome: A systematic review. J Psychosom Res.
2021 Jan;140:110322. doi: 10.1016/j.jpsychores.2020.110322. Epub 2020 Dec 1.
PMID: 33278659.
Loades ME, Read R, Smith L, Higson-Sweeney NT, Laffan A, Stallard P, Kessler D,
Crawley E. How common are depression and anxiety in adolescents with chronic
fatigue syndrome (CFS) and how should we screen for these mental health
co-morbidities? A clinical cohort study. Eur Child Adolesc Psychiatry. 2021
Nov;30(11):1733-1743. doi: 10.1007/s00787-020-01646-w. Epub 2020 Sep 22. PMID:
32964335; PMCID: PMC8558286.
Groven N, Reitan SK, Fors EA, Guzey IC. Kynurenine metabolites and ratios differ
between Chronic Fatigue Syndrome, Fibromyalgia, and healthy controls.
Psychoneuroendocrinology. 2021 Sep;131:105287. doi:
10.1016/j.psyneuen.2021.105287. Epub 2021 May 27. PMID: 34090138.
Daniels J, Brigden A, Kacorova A. Anxiety and depression in chronic fatigue
syndrome/myalgic encephalomyelitis (CFS/ME): Examining the incidence of health
anxiety in CFS/ME. Psychol Psychother. 2017 Sep;90(3):502-509. doi:
10.1111/papt.12118. Epub 2017 Feb 28. PMID: 28244209.
Stoll SVE, Crawley E, Richards V, Lal N, Brigden A, Loades ME. What treatments
work for anxiety in children with chronic fatigue syndrome/myalgic
encephalomyelitis (CFS/ME)? Systematic review. BMJ Open. 2017 Sep
5;7(9):e015481. doi: 10.1136/bmjopen-2016-015481. PMID: 28877941; PMCID:
PMC5588976.
Allen PJ. Creatine metabolism and psychiatric disorders: Does
creatine supplementation have therapeutic value? Neurosci Biobehav Rev. 2012
May;36(5):1442-62. doi: 10.1016/j.neubiorev.2012.03.005. Epub 2012 Mar 24. PMID:
22465051; PMCID: PMC3340488.
Ensenauer R, Thiel T, Schwab KO, Tacke U, Stöckler-Ipsiroglu S, Schulze A,
Hennig J, Lehnert W. Guanidinoacetate methyltransferase deficiency: differences
of creatine uptake in human brain and muscle. Mol Genet Metab. 2004
Jul;82(3):208-13. doi: 10.1016/j.ymgme.2004.04.005. PMID: 15234333.
Russell-Jones, GJ 2022 Functional vitamin B12 deficiency in CFS. Int J.
Psychiatry 27 Jul 2022
PDF
Russell-Jones, GJ 2022 Paradoxical vitamin B12 deficiency
PDF
Copyright © 2021 B12 Oils. All Rights Reserved.
CFS/ME
Chronic Fatigue Syndrome
(CFS) or Myalgic Encephalomyelitis (ME)
Research CFS/ME
Reproduction in whole or in part in any form or medium without express written
permission is prohibited