Treatment of CFS

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.

Treatment of CFS

Many, many different treatments have been tried in an attempt to cure CFS, with little success. These treatments have included non-prescription pain medications, rest, anti-depressants, psychological counseling, cognitive behavioural therapy, genetic testing, sleeping tablets, and a whole bunch of alternative "natural" remedies, such as St John's Wort, borage seed oil, garlic, ginko, ginger, quercetin, spirulina, and shitaki mushrooms. Other remedies have tried to address various aspects of metabolic insufficiency and have included high dose folate, or more recently 5MTHF, N-acetyl-cysteine, reduced glutathione, L-carnitine, betaine, and magnesium, Despite these attempts, the majority of people do not get better rapidly. Confounding the situation is the fact that nearly all of the people who get CFS were perfectly healthy before they succumbed to the disease and were not dependent upon any of these metabolic supplements, nor were using these classical or alternative remedies.

Recently, it has been found that many people have obtained significant benefit from repeated high dose treatment with high levels of vitamin D3, plus vitamin B2, and adenosylcobalamin and methylcobalamin. It is believed that this repeated high dose supplementation is required to stock both the body's methylcobalamin levels and also the adenosylcobalamin. Over time, and with the addition of high dose vitamin D supplementation the subjects appear to slowly return to their pre-CFS status. Restoration of brain function is very slow presumably because of the time required to repair the damaged myelin basic protein and the damaged myelin sheath which surrounds the nerves. It has been found that it is almost impossible to achieve sufficient levels of adenosyl and methyl cobalamin in the serum for replenishment of vitamin B12 levels in serum, tissue and the central nervous system using high dose sub-lingual, or high dose oral tablets.

High dose supplementation has been greatly aided by topical administration of a special oil formulation containing Ado and MeCbl. Supplementation by injection of CN-Cbl or OHCbl has only been shown to be marginally effective. It is believed that the reason that supplementation with CN-Cbl or OHCbl is ineffective is because the high oxidizing environment within the cells of chronically B12 deficient individuals (such as in CFS/ME) prevents conversion of OHCbl and particularly CNCbl, to Ado or Me CBl. However, functional B2 sufficiency, as FAD is required for reduction of Co(III) which is a prerequisite for formation of Adenosyl(III) and Methyl(III)Cobalamins. For this reason it seems to be necessary to administer the two active forms of vitamin B12, namely adenosyl and methylcobalamin, and in addition vitamin B2 with Iodine, Selenium and Molybdenum, all of which are required to activate vitamin B2..

Dietary Supplementation for CFS

During the development of CFS/ME reduced methylation, due to the lack of folate and eventually vitamin B12, results in poor gastrointestinal health with the result that CFS/ME sufferers can also be low in B group vitamins. Poor GI health would also be a result of lower production of gut melatonin, an essential hormone for maintaining gut maturation and development. The absolute requirement for methylation by the body can lead eventually to changes in the levels of the essential membrane lipid, phosphorylcholine, as it is sacrificed to provide methyl groups for the body using the alternative methylation substrate, betaine, which can be derived from choline or /phosphorylcholine. Suggested dietary supplementation, to be taken in conjunction with folate or 5MTHF and Ado/Me Cbl aims to overcome these deficiencies and restock the body with phosphorylcholine, choline and acetylcholine, and to provide adequate supplies of B group vitamins. One of the best dietary sources of phosphorylcholine is lecithin, with the best source of lecithin being beef liver, eggs, toasted wheat germ, beef, brussel sprouts, broccoli, salmon, skim milk and peanut butter..

We have taken a much more pragmatic approach to treatment of CFS, which involves identifying the nutritional deficiencies in I/Se/Mo and supplementing accordingly, and then adding in extra vitamin B2 and most importantly treating with a high dose topical formulation of mixed Adenosyl/Methyl B12. Treatments with high dose oral, or sublingual B12 have not been effective - according to those that contact us. This protocol establishes active riboflavin and B12 and hence has 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).

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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