New virus is not linked to Chronic Fatigue Syndrome

Jan 06, 2010
People with Chronic Fatigue Syndrome often suffer with painful joints.

(PhysOrg.com) -- New UK research, published today in PLoS ONE, has not reproduced previous findings that suggested Chronic Fatigue Syndrome may be linked to a recently discovered virus. The authors of the study, from Imperial College London and King's College London, say this means that anti-retroviral drugs may not be an effective treatment for people with the illness.

An estimated three in 1000 people have Chronic Fatigue Syndrome (CFS), or myalgic encephalomyelitis (ME), experiencing severe physical and that is not alleviated by rest, together with other symptoms such as , headache, joint pain and depression. Diagnosing CFS is difficult, as symptoms vary and there is no standard test. The fundamental cause of CFS is unknown and it is usually treated using rehabilitation techniques such as or graded .

In October 2009, a group of US scientists published research in the journal Science that suggested that a recently discovered virus called XMRV could be linked to CFS. In their study, 68 out of 101 patients with the illness and 8 out of 218 healthy controls appeared to be infected with the virus.

However, in today's study, researchers found no evidence that patients with CFS had the XMRV virus, after analysing tissue samples from 186 patients with CFS using sensitive molecular testing techniques.

This more recent analysis showed no molecular evidence for XMRV in any of the samples from CFS patients. The researchers say this means that anti-retrovirals should not be used to treat CFS, as they would be unlikely to have an effect on the symptoms. However, several labs in the US now offer CFS patients treatments based on the earlier findings that linked the condition with XMRV.

Professor Myra McClure, one of the authors of the study from the Division of Medicine at Imperial College London, said: "Our research was carried out under rigorous conditions - we looked at samples from well-studied patients, and we used very sensitive testing methods to look for the virus. If it had been there, we would have found it. The lab in which we carried out the analysis had never housed any of the murine leukaemia viruses related to XMRV, and we took great care to ensure there was no contamination.

"We are confident that our results show there is no link between XMRV and Chronic Fatigue Syndrome, at least in the UK. The US study had some dramatic results that implied people with the illness could be treated with anti-retrovirals. Our recommendation to people with Chronic Fatigue Syndrome would be not to change their treatment regime, because our results suggest that anti-retrovirals would not be an effective treatment for the condition," added Professor McClure.

After reading the US study, clinical researchers from King's College London sent blood samples from 186 CFS patients to the Imperial Retrovirology Laboratory team. King's has been running an NHS service for CFS patients for nearly twenty years, and the previously stored samples came from patients had been fully investigated and examined, meaning that CFS was the correct diagnosis.

The Imperial scientists extracted the DNA from the samples and analysed it using a sensitive technique, called Polymerase Chain Reaction (PCR), which can locate tiny fragments of virus DNA. The scientists analysed control samples of water at the same time to ensure there was no contamination. They also looked for a specific marker fragment of human DNA in the sample to make sure the technique was working.

The water controls contained no DNA, showing that the samples were not contaminated. All the test samples, from patients and healthy controls, contained the human DNA they looked for, suggesting the technique was working well.

Dr Anthony Cleare, Reader in Psychiatric Neuroendocrinology, one of the authors of the study from the Chronic Fatigue Syndrome Clinic at King's College London, said: "Chronic Fatigue Syndrome is a serious and debilitating condition. It can also be extremely frustrating for people with the illness, as we have yet to identify its fundamental cause, or come up with any definitive treatments. The recent US study generated real excitement among doctors and patients alike as it seemed to open up a new line of research. Unfortunately, we have not been able to replicate those findings."

"It is important to emphasise that today's findings do not invalidate all previous research, some of which has shown that CFS can be triggered by other infective agents, such as Epstein Barr Virus or Giardia parasites. As ever in science, no single study is conclusive and there are lots of other research groups working on this at the moment. We await their results with interest," added Professor Simon Wessely, another author of the study from the Chronic Fatigue Syndrome Clinic at King's College London.

Explore further: Experimental Ebola drug heals all monkeys in study (Update)

More information: "Failure to Detect the Novel Retrovirus XMRV in Chronic Fatigue Syndrome" PLoS ONE, Wednesday 6 January 2010.

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User comments : 39

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Phelankell
1 / 5 (1) Jan 06, 2010
Chronic Fatigue syndrome isn't real, fibromyalgia is. Try treating those CFS patients for depression when FM is not diagnosed. I bet you'll see great improvement.
Parsec
5 / 5 (2) Jan 06, 2010
To proclaim that CFS isn't real is saying the problem simply doesn't exist. If CFS isn't real, why would any treatment be indicated at all?

I think most (competent) authorities agree that CFS is a real description of a real problem, but the cause remains unclear. Thus the treatment is also unclear. But it is clearly different from simple depression because depression usually doesn't cause fever, muscle spasms, or clinically measurable muscle weakness.
Phelankell
1 / 5 (1) Jan 06, 2010
But it is clearly different from simple depression because depression usually doesn't cause fever, muscle spasms, or clinically measurable muscle weakness.

That is not CFS, that's fibromyalgia.

Chronic fatigue syndrome is a condition of prolonged and severe tiredness or weariness (fatigue) that is not relieved by rest and is not directly caused by other conditions. So effectively, if you're always tired you have CFS. Well there's a reason why people with depression give themselves "sheet therapy".
Phelankell
not rated yet Jan 06, 2010
From the MGH study carried out in JoM April 2009.
CFS is thought to have an incidence of 4 adults per 1,000 in the United States.
Long term clinical depression occurs in about 1 out of 250 adults in the US. Same ratio.
For unknown reasons CFS occurs most often in people in their 40s and 50s, more often in women than men, and is less prevalent among children and adolescents.
Just like clinical depression.
Full recovery from the condition occurs in only 5-10% of cases.
Just like untreated clinical depression.

The symptoms of CFS are exactly the same as depression. Post viral CFS occurs at the same rate and after the same viral illnesses as post viral depression.

The two disorders are one in the same when you remove the fibrosis-based actual diseases from under the unbrella of CFS.
Hip
not rated yet Jan 06, 2010
To try to rectify some of the misconceptions witnessed here:

First of all: Phelankell. You say "CFS are exactly the same as depression".

Well in fact, not only are you trying to amalgamate two very different things, but even just taking depression: there are many different types of depression:

(1) Some types of depression occurs due to a malfunctioning hypothalamus;

(2) Some types of depression arise due to problems in the cortex;

(3) Some types of depression are based on over activated microglia (part of the brain's immune system) secreting too much glutamate and quinolinic acid in the brain (high glutamate levels are linked to depression);

(4) Some types of depression are caused by too much interferon-alpha:
viruses can lead to raised interferon-alpha levels (interferon-alpha is secreted by cells of the the immune system as it tries to control the virus), and it is known that interferon-alpha can greatly affect the serotonin system.

You are oversimplifying things.
Hip
not rated yet Jan 06, 2010
Note that: One of the co-authors of this study, Simon Wessely, has a vested interest in the outcome of such virus studies. Simon has staked his entire academic career on the idea that diseases like chronic fatigue syndrome / myalgic encephalomyelitis are caused by purely psychological factors.

Therefore Simon Wessely would be the last person you would want in a study like this. I wonder just how hard he looked for this XMRV virus.

Ever heard of confirmation bias?
Hip
3.5 / 5 (2) Jan 06, 2010
And Phelankell, one more thing:

Check out the difference between ANHEDONIA and DEPRESSION. Very often, CFS patients experience the former much more than the later. Sometimes there is little or no depression in CFS patients, but considerable anhedonia (along, of course, with memory malfunctions, cognitive problems, extreme fatigue, gut infections, loss of visual acuity, hypersensitivity to noise and/or light, periodontal problems, joint laxity, numbness in the limbs, and so forth).

But in one respect, CFS and depression probably share one thing in common: in most cases, they may be caused by a microbial infection. To find out why, I leave this for you, as a research task.
VOR
not rated yet Jan 07, 2010
What's depressing is the endless stream of mindless fks polluting the web with thier ignorant posts. Not everyone, but I think most of us can figure out what Im talking about. Oversimplifying is indeed one of the biggest barriers to evolving as a culture. And no, CFS is of course not the same as depression. But since CFS is 'depressing' you're more likely to have some depression with it. NO amount of depression treatment can cure CFS, but it can help with the depression part of it. CFS is not literally just chronic fatigue either. Strive to be more discerning and informed about all things or just stfu. At least qualify blather with 'I think' to remind yourself that maybe you dont know wtf u r talking about and we won't think you're completely clueless. And yes I know this post will do no good. It builds up over months and every once in a while I just let it out. Its not ignorance itself, but the impact of the 'vocal ignorancia' that I grow so intolerant of.
VOR
not rated yet Jan 07, 2010
Note that: One of the co-authors of this study, Simon Wessely, has a vested interest in the outcome of such virus studies. Simon has staked his entire academic career on the idea that diseases like chronic fatigue syndrome / myalgic encephalomyelitis are caused by purely psychological factors.

Therefore Simon Wessely would be the last person you would want in a study like this. I wonder just how hard he looked for this XMRV virus.

Ever heard of confirmation bias?

I'd like to know more about his interests. While it seems unlikely in this case, of course bias can wreck things. But its more likely for example when you have big drug develepment involved. Thats a nice pile of conflict of interest. But can't dismiss ego or reputation either. I'd like to hope its flawed. I want XMRV to be the cause because I want the cause(s), to be found. This certainly isn't encouraging.
Nik_2213
not rated yet Jan 07, 2010
Perhaps if you find patient is positive for XMVR, a course of targetted anti-virals may help. Plus, there's a zoo of 'weakly identified' viruses in the community: There may be multiple viral candidates for this condition...

( Isn't it still unclear which virus triggers auti-immune 'juvenile diabetes' ?? )

Plus, post-viral recovery may cast a long, long shadow. I've twice spent best part of six months struggling after severe 'flu. Everything ached, every-where was up-hill. I was lucky. And, yes, I did and do have 'flu vaccinations when available...
Hip
not rated yet Jan 07, 2010
Hi VOR

About Simon Wessely: if you Google search for "Wessely School", you will find there there is a whole scam going on. In essence, many health insurance companies around the world are frightened of chronic fatigue syndrome: it affects around 0.2% to 2% of the population (estimates vary), and is a lifelong, incurable neurological condition, often so debilitating, CFS suffers have to say goodbye to their life, and are often unable to work. Typically, CFS is caused by a chronic, but low-level viral infection of the central nervous system, particularly the hypothalamus - which is a central hub of the the entire endocrine system, and a key organ in the brain (the hypothalamus has been called the brain's brain).

So the insurance payouts costs are very high for this CFS group. To try to save money, insurance companies stick with the idea that CFS is only a a psychological condition that you sort of accidentally fell into, and can just snap out of. In this way, these .. [continued below]
Hip
not rated yet Jan 07, 2010
[continued] .. insurance companies can avoid payout to chronically ill people with CFS. They do not have to pay if CFS is categorized as psychological condition. Therefore these insurance companies need people like Simon Wessely, as a sort of "rent-an-expert", who will say that in their opinion, CFS is all in the mInd.

Many from the Wessely School have these "rent-an-expert" roles. The Wessely School comprise high-ranking people, all with the appropriate academic credentials to their names. Simon Wessely and his colleagues often work directly for these insurance companies, or are regularly brought in as well-paid consultants for these companies.

We are talking about saving billions of insurance company dollars here, so you realize that scientific truth has very little to do with the Wessely School's doctrine on CFS.

Wessely is also known for his "expert opinion" (cough) on Gulf War Syndrome - which of course he said was all in the mind, again saving compensation payouts.
Phelankell
not rated yet Jan 07, 2010
Wessely is also known for his "expert opinion" (cough) on Gulf War Syndrome - which of course he said was all in the mind, again saving compensation payouts.
Yes but Gulf War Syndrome wasn't successfully treatable with anti-depressants. CFS, in non-myaligic cases, is fully treatable with anti-depressants.
Hip
not rated yet Jan 07, 2010
PhelankelL, I think you may have been fooled by the Wessely School, just like many people.

Simon Wessely and company often use a different set of criteria to select the patients for their "CFS" studies (such as the Oxford Criteria). These selection criteria are set up so as to include lots of people that are just depressed, and do not have CFS at all !!

As a consequence, it is not surprising many studies, based on the Oxford Criteria or similar, find that patients do not have XMRV, or can be cured by antidepressants: they studied the wrong people!!

When Simon Wessely talks about "CFS" patients, he is, in reality, referring to people with depression. Wessely loves to play language games, and often bends the definition of terms. You would be surprised how easily this fools people.

The original XMRV research at the Whittemore Peterson Institute used the Canadian Consensus definition of CFS/ME. The advantage of these inclusion criteria is that they actually do select CFS patients !!
Phelankell
not rated yet Jan 08, 2010
PhelankelL, I think you may have been fooled by the Wessely School, just like many people.

Quite false. I won't acknowledge CFS as a "disease" until they can show non-myalgic symptoms that do not share a depression vector.

Until then, it's depression, plain and simple. There will be people who have myalgia of some form which will exhibit the symptoms of their specific myalgia, however, the majority of CFS cases are misdiagnosed depression.

The most successful treatment for CFS is daily anti-depressant use.

I understand the pain of those who are suffering from one of the various forms of myalgia, and the vector is understood in those cases, meaning there is a legit disease. CFS as an "umbrella syndrome" is a nothing more than a mechanism for bad doctors to continue prescribing unnecessary treatments.

Wessely is easily included in the list of bad doctors with poor scientific reasoning skills regardless of his affiliations. He's sold himself like many others.
arisoned
not rated yet Jan 08, 2010
Phelankell

Please share your research as to how CFS is treated with anti-depressants?

I have had aforementioned disease for 10 years. I take anti-depressants daily for pain relief and associated sleep disorder caused by M.E and I am not by any means well. Please enlighten me as it seems I am wasting my time visiting specialist Dr's with years of experience in M.E in light of your startling evidence?

Thank you to HIP, NIK and VOR for your helpful comments and information.

I don't know if you are sufferers or have an interest in the disease but it's refreshing to see informed arguments.
Hip
not rated yet Jan 08, 2010
Phelankell

The funny thing is, the are so many people just like you, Phelankell, (including laymen, researchers and doctors) that do not believe that CFS exists - but when suddenly they get CFS themselves, surprise, surprise, they totally reverse their belief. This happens time after time.

And the more arrogantly someone initially denies the reality CFS, the more vociferous they finally become, if they unfortunately catch this viral disease, in shouting out from the rooftops the reverse belief.

Therefore, I think the only way to convince most people is for them to catch CFS themselves.

As much as 2% of the population have CFS, so you never know, Phelankell, you might just get it on day. And then it will be you, now a CFS believer, typing these words, to another "know-it-all" CFS non-believer.
Phelankell
not rated yet Jan 08, 2010
Arisoned

I have had aforementioned disease for 10 years. I take anti-depressants daily for pain relief and associated sleep disorder caused by M.E and I am not by any means well.

And right there you discount yourself from what I said. You have Myalgic Encephalomyelitis. Key word, "Myalgic", that is the vector for your disease. I don't discount your symptoms. I discount non-vectored CFS.

Hip,

I was diagnosed with CFS and I think it's bunk. So feel free to continue the commentary as to "I hope you get it" because if it's legit, I have it. I also recognize depression, which many people in my family have been diagnosed with. CFS is an umbrella of Myalgia (real disease vector) and common depression (mental vector). The majority of CFS is treated with antidepressants. Meaning the "surge in CFS diagnoses" is a surge in poor diagnostics. As I said, I do not discount myalgic diseases and their symptoms. So before you go after someone's statements, you might want to read them
Hip
not rated yet Jan 08, 2010
I actually suffered two years of clinical depression (about 20 years ago), so I know what that is like, and I have the greatest of sympathies for anyone going though this. But that experience was distinctly different from CFS, which I acquired 5 years ago. Yet I have no muscle pain (though I think I do have nerve damage, as my muscles are getting weaker)

I think all that has happened is that you got a wrong diagnosis, when you were told you have CFS. Doctors are far from perfect, and often make wrong diagnoses.

You may want to take a new home test for CFS, called the neurotoxic metabolite test (available here: http://www.protea...tics.php ).

I took it and got a result that was HIGH POSITIVE. It costs 15 Euros or something like that - cheap.

Are the anti-depressant drugs you are taking working? Have you also tried herbal and vitamin supplements as well. I found the latter invaluable when I had depression.

Hip
not rated yet Jan 08, 2010
By the way, if you truly want to get a feel for what CFS is like, have a look at this excellent list of CFS/ME symptoms:

http://www.borgof...i_03.htm

I am experiencing about 70% of these symptoms on this CFS list.
Phelankell
not rated yet Jan 08, 2010
Are the anti-depressant drugs you are taking working? Have you also tried herbal and vitamin supplements as well. I found the latter invaluable when I had depression.
I don't take any. Clinical depression can be controlled through focus and other activity as an alternate treatment. I prefer to avoid the haze that anti-depressants would bring, as well as the overly caffinated feeling and slow mental response I experienced as side effects.

I don't believe my case is particularly severe, but it is continuous. I just don't think about it and engross myself with other pursuits. High stress can be detrimental to it, but aside from that, I cope sans intoxicants.
windhill
not rated yet Jan 09, 2010
Patients with CFS will tell you that they are frustrated that they cannot achieve their goals, but many chip away regardless.
Depressed patients exhibit a pervasive air of hopelessness and any goals they may have once had are gone while the disease is active.
Pretty big difference,IMO.
windhill
not rated yet Jan 09, 2010
Hmmm-the Protea people market supplements to treat people who test positive on their urine test for "neurotoxic metabolites"... does that sound even a little bit suspicious? CFS /FM treatment is a goldmine for snake oil peddlers- people who have it are desperate and traditional medicine has little to offer.
StarDust21
not rated yet Jan 09, 2010
Chronic Fatigue syndrome isn't real, fibromyalgia is. Try treating those CFS patients for depression when FM is not diagnosed. I bet you'll see great improvement.

I'm assuming you either are a CFS specialist or have/had CFS? How otherwise could someone possibly make such a statement..
Phelankell
not rated yet Jan 09, 2010

I'm assuming you either are a CFS specialist or have/had CFS? How otherwise could someone possibly make such a statement..

Read above. I was diagnosed with it years ago.
Hip
not rated yet Jan 11, 2010
"CFS /FM treatment is a goldmine for snake oil peddlers".

Not at all, windhill - in general, the dietary supplements (usually herbs and vitamins) that people with CFS/ME take do provide small improvements in health. Most people find the ones that work for them by trial and error. If you consistently feel better on a given supplement(s), then that is the one(s) for you.

I don't know of any major snake oil supplements in this CFS/ME field (apart from CBT/GET).

The interesting thing about the neurotoxic metabolite test (which is still in a research stage), is that it might become one of the first recognized metabolic tests for CFS. As I am sure you know, CFS has been plagued by the lack of biological markers to confirm this condition. So while it is early days yet for this test, at least there is some progress. So few scientists have done research on CFS (it is often not a good field to make your career in) that when you do get some progress like this new NMT, it is always good news.
Phelankell
not rated yet Jan 11, 2010
Most people find the ones that work for them by trial and error. If you consistently feel better on a given supplement(s), then that is the one(s) for you.

Ever heard of the placebo effect?
Hip
not rated yet Jan 11, 2010
Phelankell, instead of being passive in this situation, why don't you do something positive for yourself. Taking the NTM might help determine whether is is CFS you have, or just plain depression, or some other condition.

Furthermore, I assume your doctors tested your for the viruses that are commonly connected to CFS, namely: the Epstein-Barr virus, HHV-6, parvovirus B19, cytomegalovirus and enterovirus. If not, then why not get tested.

If you discover that you have one of these viruses as an active infection, then this gives you the necessary info for a battle plan to fight the infection, and the CFS it is thought to create.

For example, if your CFS symptoms are a result of Epstein-Barr virus, this particular viral infection can be quelled quite effectively, believe it not, with an alkalinizing or raw food diet (look up pH-dependant fusion of EBV for an explanation).

Of course, if you are suffering from depression, then as windhill points out above, .. [continued]
Hip
not rated yet Jan 11, 2010
[continued], the difference between depression and CFS is that:

"Patients with CFS will tell you that they are frustrated that they
cannot achieve their goals, but many chip away regardless.

Depressed patients exhibit a pervasive air of hopelessness and
any goals they may have once had are gone while the disease
is active."

In other words, people with CFS, when told than there may be some way to improve their plight, will be active and wanting to pursing it, but the depressed person will not.

Your comments suggest perhaps it may well be that you have depression, not CFS.

In fact, there are lots of safe dietary supplements that can help with depression.

Start with trying 10 mg of NADH daily, available in most good health stores (NADH is a special form of vitamin B). NADH is often very effective for depression, as it boosts levels of three very important brain neurotransmitters: dopamine, norepinephrine, and serotonin. Yet this is a safe as any vitamin.

Phelankell
not rated yet Jan 11, 2010
Hip, if I hadn't already done so and received confirmation of CFS I wouldn't be saying anything.
Hip
not rated yet Jan 11, 2010
Phelankell: This confirmation of CFS, do you mean by a doctor's diagnosis (purely via your symptoms), and/or also by the NMT?

In either case, remember that the NMT, which provides an indication of the levels of hydrogen sulfide (H2S) in your body, is still in the research stage. The significance of the result is not fully understood as yet.

The theory of it is that high H2S may put the human body into a low-energy state. If you expose mice even to very small quantities of H2S, they actually go into a weird type of suspended animation, where all their vital systems and organs are shut down to a quarter of their normal capacity, as if in hibernation. This is provably the case with mice, and thus is it considered that H2S may have similar energy-reducing effects on humans, and may thus be behind the energy deficit of CFS. And many with CFS do test +ve for H2S.

A lot of people with CFS do follow the latest research, as they typically like trying everything they can to get better.
iggy00
not rated yet Jan 16, 2010
From the MGH study carried out in JoM April 2009.
CFS is thought to have an incidence of 4 adults per 1,000 in the United States.
Long term clinical depression occurs in about 1 out of 250 adults in the US. Same ratio.

It's really poor reasoning to conclude that just because two disorders have the same incidence they are therefore the same disorder. Schizophrenia for example affects roughly 1-2 percent of the population. According to your faulty reasoning, that would mean that every other disease that had an incidence of 1-2 percent of the population was schizophrenia (or vice versa).

Obviously that makes absolutely no sense whatsoever.
iggy00
not rated yet Jan 16, 2010
Until then, it's depression, plain and simple. There will be people who have myalgia of some form which will exhibit the symptoms of their specific myalgia, however, the majority of CFS cases are misdiagnosed depression.

The most successful treatment for CFS is daily anti-depressant use.


All that is totally false. There are thousands of studies documenting physiological differences in chronic fatigue syndrome patients that don't occur in normal adults or depressed adults. I don't know where you're getting your information, but it's completely wrong.
iggy00
not rated yet Jan 16, 2010
Chronic Fatigue syndrome isn't real, fibromyalgia is. Try treating those CFS patients for depression when FM is not diagnosed. I bet you'll see great improvement.


Chronic fatigue syndrome is absolutely real. Researchers just don't know the exact cause or causes yet.

CFS is not depression. There are different and non-overlapping symptoms in CFS that don't exist in depression. There are also physiological differences in CFS that don't exist in depressed patients.

You are seriously misinformed - you really ought to do more research before making such blatantly incorrect statements as you have been making here.
iggy00
not rated yet Jan 16, 2010
Most people find the ones that work for them by trial and error. If you consistently feel better on a given supplement(s), then that is the one(s) for you.

Ever heard of the placebo effect?


The placebo effect typically is short-lived and does not last long-term. It would be extremely unusual if not unheard of for a placebo effect to last more than a couple of weeks at most.
iggy00
not rated yet Jan 16, 2010
This study is junk science. By what criteria were these study subjects diagnosed with Chronic Fatigue Syndrome?

The conflict of interest of the study designers is also well known.

Next!
windhill
not rated yet Jan 19, 2010
There must be 100+ "supplements" that are hawked for CFS- where does one start? How long do you take something before you find that "it's not right for you"? Do you keep taking supplement #1, and add supplement #2? Then # 3 and so on? Almost no one has the luxury of changing a single thing in their lives and sitting back and waiting for the results. People are very complex. Patients who are suffering may take a shot in the dark, but anyone who suggests at this point in time that they know the answer is likely a charlatan and derives income from the supplement industry in some way shape or form
Phelankell
not rated yet Jan 20, 2010
The placebo effect typically is short-lived and does not last long-term. It would be extremely unusual if not unheard of for a placebo effect to last more than a couple of weeks at most.

The placebo effect can work indefinitely. Haven't you ever heard of religion? That's one of the prime indicators of the placebo effect's strength.
Hip
not rated yet Feb 01, 2010
windhill asked "There must be 100+ "supplements" that are hawked for CFS- where does one start?"

Answer: There are also probably a 100+ different symptoms found in CFS.
The choice of supplements depends on what particular CFS symptom you are trying to improve.

For example, for aphasia (loss of some vocabulary, and/or loss of some ability to select the right word), a supplement like ALC (acetyl-l-carnitine) may be beneficial.

For improving the general brain fog, try Piracetam.

For energy increase, try NADH, co-enzyme Q10 and L-carnitine.