Vitamin D 1000 E daily in the morning eg Vigantol
Zinc, selenium, iron, magnesium, phosphate, supplement if deficient
• Zinc eg zinc aspartate capsules N2 2x20 mg for 4 weeks
• Selenium eg Selenase Tbl. N2 2x80 mg for 4 weeks
• Iron eg ferro sanol duodenal every 2 days on an empty stomach for 8 weeks
In the case of irritable bowel syndrome treatment with psyllium husks (e.g., mucofalk) 2 -3x daily, 1-2 bags or measuring spoons (dissolved in 150 ml of water).
in case of irritable bowel syndrome with diarrhea try Xifaxan (Rifaximin) 3x200 mg for 8 days
Food allergies and intolerances should be excluded or treated
Improvement of sleep quality (general sleep hygiene, tryptophan, melantonin, low Doxepin 5-10mg, diphenhydramine, if not adequate try temporarily eg 3 days a week Zolpidem / Zoplicon)
For pain, if paracetamol or ibuprofen is not sufficient, a therapy trial with Lyrica can also be useful, in low dose 100 mg initially only in the evening or Amitryptilin in low dose in the evening, with frequent increased central pain sensation, both drugs also act as a laxative. We advise you if necessary to consult a pain therapist
There are several therapies that show that NADH supplementation with 5 - 20 mg daily, alone or in combination with coenzyme Q10 leads to a symptom improvement (Santaella ML, 2004, Castro-Marrero, 2015), therapy recommendation: NADH 10 mg daily for 8 Weeks, available from various manufacturers.
There are several small studies that show that some patients benefit from a high dosage of B vitamins. Therapy recommendation Vitamin B Complex forte Hevert 50 tablets of which 2 tablets daily corresponds to 1000 μg B12 together with folic acid 10 mg daily For 8 weeks.
Omega3 fatty acids have efficacy in fatigue and concentration disorders, a controlled study also showed efficacy in CFS (Behan 1990). There are also many positive studies (Grosso G, 2014) in patients with depression and concentration disorders. Therapy recommendation Omega3 fatty acids with a high proportion of eicosapentanoic acid (EPA) of at least 500 mg daily.
Stress reduction through "mind-body therapy" such as autogenic training, yoga, meditation, breathing therapy
"Pacing" is important: observing a regular daily routine with activity adapted to the reduced resources and light physical training (for example short walking), over-exertion can increase exhaustion for long periods, good information material available from Fatigatio (German CFS Association).
Accompanying therapy for any psychological complaints (e.g., reactive depression due to disease-related complaints) by means of behavioral therapy or antidepressants
There are several therapies that show a symptom improvement with neuromodulatory drugs. We will be pleased to provide your GP with a summary of the therapies for CFS
Further information for physicians on our homepage and the US guidelines of the IOM by googling IOM CFS or http://iom.nationalacademies.org/~/media/Files/Report Files/2015/MECFS/MECFScliniciansguide.pdf
Since we are not able to offer further treatment to patients with CFS, we hope that you can implement the treatment recommendations together with your family doctor.
We are available for any questions from your family doctor.
Coming next - my trials of some of these suggestions.