New Evidence or a Rediscovery
by Dr Alan Stewart
Two recent publications have established a link between several of the B group vitamins and Chronic Fatigue Syndrome (CFS) also known as ME myalgic encephalomyelitis
Chronic Fatigue syndrome is viewed by many as a state of easy fatiguability that has persisted for over six months and is not due to another identifiable illness. It may have followed an acute or repeated infection such as ‘flu¹, viral sore throat or, sometimes, a tropical illness.
Disruption of daily routine is expected as even modest physical activity results in marked physical or mental fatigue from which the patient may take several hours or days to recover. There are also many associated and diverse symptoms including muscle pains (which may worsen after exercise), enlarged and sometimes painful neck glands, depression, sleep disturbance, mood change, poor concentration or poor memory, headaches and mild fever or sweats.
Attempts to explain the cause of these symptoms have led to the discovery that some, but not all, sufferers have subtle changes in the function of the immune system, the central nervous system and muscle function. Unfortunately such minor abnormalities are not unique to this condition and can also be found in a small percentage of the normal population. Which is why the argument continues to rage over the nature of the disease and the best way to treat it.
A leading group of researchers into CFS from King’s College Hospital in South London recently found that mild B vitamin deficiencies were commonplace in a small group of patients with this condition. Vitamin B6 (pyridoxine) was particularly low and there were lesser deficiencies of Vitamin B1 (thiamin) and B2 (riboflavin). These deficiencies were only detected by a series of blood tests and were not obvious from examination. Mild deficiencies of these and other B vitamins can all cause fatigue as an early symptom and many will go on to influence the immune, neurological and muscle function. Thus they could also explain some aspects of CFS.
The B group of vitamins discovered in the first third of this century has long been regarded as a tonic for the ill. In fact the first report linking vitamin B6 deficiency and fatigue known to the author was from 1939. Dr. Tom Spies and colleagues from the University of Cincinnati described four malnourished patients in whom symptoms of extreme nervousness, insomnia, irritability, abdominal pain, weakness and difficulty in walking had persisted despite treatment with vitamins B1,B2 and B3. These symptoms improved dramatically and within hours of the administration of synthetic pyridoxine.
Subsequent studies have confirmed that deficiencies in Vitamin B6 together with Vitamins B1 & B12, Vitamin C (ascorbic acid) and, to a lesser extent, the other B vitamins can all cause fatigue as an early feature of a deficiency state.Furthermore they all influence some aspects of immune system, muscle and neurological function and thus could be important in Chronic Fatigue Syndrome.
These early papers do not come up on computerized literature searches and may only be found in older reference texts.
Another recent paper reported on the effectiveness of a multi-dimensional treatment plan in 81 patients with CFS who were attending the Glasgow Homeopathic Hospital. After fulfilling certain criteria a composite treatment program involving dietary change, supplements of vitamin B, Magnesium, Evening Primrose Oil and Coenzyme Q10 was instituted. This was followed by use of Homeopathic remedies and psychotherapy. An overall crude success rate of 70% was reported after six months and there were significant reductions in the scores from various standard questionnaires used to assess ill health.
Doctors Sheila and Robin Gibson are to be congratulated on this work though it does little to tell us which aspects of their approach are actually effective. What is striking though, is the gap in time between the first reports from the 1930s and now. You might well wonder what has been going on in nutrition and in particular with the B vitamins in the interim.
Maybe it is time some of my medical colleagues looked again at the nutritional state of their patients and, when appropriate, used nutritional supplements in well defined conditions.
1 Spies TD., Bean WB, Ashe WF. A note on the use of vitamin B6 in Human Nutrition. Journal of the American Medical Association. 1939, Vol 112 : number 23:2414-5.
2 Gibson SLM, Gibson RG A Multidimensional Treatment Plan for Chronic Fatigue Syndrome. Journal of Nutritional and Environmental Medicine 1999, 9:47-54