Supplements do not have any real effect on symptoms

[leokitten]

I'm sure his father will hear about this.

(Sorry, I couldn't resist!)

This is the second time I've heard that mild/moderate cases are under-represented. I haven't counted people up, but I'm minor/moderate. Used to be more moderate, am now tending towards mild. That 'point of no return' place I keep hearing about scares the beejesus out of me, and so I take pretty careful care of myself with very mild exercise (like walking) and a variety of supplements already discussed, as well as management strategies that involve being very aware of my body and its reactions, and stopping at any early warning signs that arise. My diet is also what others would probably call "extremely fussy", but it's what makes my body respond well, so I stick to it.

In short, @leokitten, I am in the same boat as you. Even if I can't work full-time, I can work about 30 hours a week from home and still do all right. I can go out with my friends and walk around awhile (when I am feeling well, which is more and more the case). I do my own driving and grocery shopping.

But everyone here can remember when this was true of them, too. They are no longer in this position. Things have changed.

There are a few 'struck by lightning' cases of ME: 'I had the flu and next week I couldn't remember my own name' - but it seems to me that even for the 'fast onset' group, 'fast' doesn't mean 'instantly'. The illness developed rather than appeared. Every case is different, and there's no way to know if something done a bit differently could've helped. Unless there was one moment where it was obvious: a point of no return, a specific decision with disastrous consequences which, in some cases, there is. Several people here have shared their stories of this point of no return.

I quit my job before it killed me, but only just: and doing so was the opposite, my 'point of return'. Today I feel three or four times better than I did a year ago... but the intervening time. I can't even describe it. It makes me so grateful to be where I am right now, and that feeling is just as huge as spectre of my previous level of ME, in proportion to it. I am also acutely aware there are pathways I could travel that would lead me back.

Did I have a choice to quit my work? Of course. It was just the only reasonable one, given the consequences of continuing. At the time, it felt awful yet inevitable, but even in the moment I knew I'd made the right choice, and now I am proud I was brave enough to make it.

In short: this thread is emotionally charged because it talks about having to leave work (a very stressful decision that most of us have had to face), and because some of the comments here can be taken to mean that 'pushing through' until a crash occurs is a necessity for anyone who wishes to be a responsible adult. "I can't quit my job because I am responsible to others", implies that no one who is responsible to others (which is all of us!) can/should ever make the decision to quit their job (which many of us have, in fact, done). However, I don't believe the post was meant to cast doubt on others' actions in any way, shape or form, but to express the frustration we all feel when we face job-related issues.

@leokitten - your decision is yours to make. You do have the choice open to you to quit, and saying you 'can't' is a way of avoiding facing the fact that the decision is your own. Your reasoning so far seems that you will not have a point of no return because your ME is not severe enough for this to happen, but this reasoning is fallacious. The reason some of us are so ill is the point of no return, rather than points of no return only happening to very ill people. You will either make significant accommodations to your condition, or your condition will worsen: those are your two choices.

There are not two options jobwise, however: continuing to run yourself into the ground, or giving up entirely on life and sitting alone in the dark. Begin looking around for jobs that require less activity, say 'no' to things you know will cause you physical or emotional stress, and start doing so proactively rather than when you're already at wit's end. Start making plans. We're all in this for the long haul, and your health decisions now will affect you long-term.

We are all here with you, with twenty questions for every hard-won answer. Listen to the answers we give; we're not just blowing smoke.

Peace out, guys. Saying 'no' to this stressor and stepping on outta here...

- J

@JaimeS may I ask how do you afford good insurance working a part time job from home? How do you afford treatments, out-of-network doctors visits including travel, copays, etc, etc? How do you afford healthy, eg organic and gluten free foods?

I am almost certain you have family helping you, financially and otherwise. I don't have this luxury. I think it is not a good idea to assume to know the choices people have, what their life situation is, and how their particular ME/CFS might run its course.

Milder ME/CFS patients are really underrepresented here on PR, you and I are part of a handful of people on here that can still work. There are very few. The active members on PR are not at all representive of the ME/CFS population, so we are only hearing certain perspectives.

Many, many people on PR know exactly where I'm coming from and are not "emotionally charged" by this thread , they know exactly that some "choices" really aren't choices at all and could make things far worse.

What likely factored into your decision to quit your job is the fact that you know you have your family there to help you if things get bad, I know I've read your posts. I don't have any family or absolutely anyone to help me if I quit and things don't work out.

I've clearly laid out the "choice" I have and many people read those bullet points and see that it's not always a smart choice to quit. If I get worse and cannot work in the future then I get long-term disability at 60% of my current salary but if I quit preemptively then I get nothing and still have to work part-time 30-hrs/week at likely 30% of what I currently make.

I completely understand that for some people continuing to work full-time then resulted in a complete crash that made them far more disabled and sick for a long time. This doesn't happen to everyone and given all the other more likely risks involved that I mentioned I'm willing to take this risk and I think a lot of other people would too.

 

[jimells]

they know exactly that some "choices" really aren't choices at all and could make things far worse.

I agree that it's not a choice when the options are A) full time work makes one sicker B) stop work and dire poverty makes one sicker. It's more like a crap shoot. Do I feel lucky?

Oh what joy to live in a society built on the concept of using up people and resources full-tilt, then throw them away.

 

[dmholmes]

Another thing I wanted to mention is when I've connected the dots and tracked posts from the same PR users over the years saying X greatly improved Y, and then A greatly improved B, and then C greatly improved D you would think that with all those testimonials and improvements to different symptoms that they would be significantly better now, but then you read more recent posts by the same user and they are in terrible shape.

What is the disconnect? Are supplements only working for a while and then nobody posts follow up negative testimonials? Or are people wrongly associating a supplement or combination of to symptom improvement when it really had nothing to do with it?

I've posted the supplements that gave me complete remission, and posted about relapse. The improvement is obvious, like a light switch turned on for me. Assuming no confounders the supplements would be:

• Biotin (1 week, no effect after)
• Super Thisilyn (relapse/remit for a couple of months, no effect after)
• Vitamin D3 (relapse/remit for 7 months at this point)
• Molybdenum (seems to be a trigger still)

I have several banker boxes full of supplements. These are the only ones that have made a difference.

 

[leokitten]

I've posted the supplements that gave me complete remission, and posted about relapse. The improvement is obvious, like a light switch turned on for me. Assuming no confounders the supplements would be:

• Biotin (1 week, no effect after)
• Super Thisilyn (relapse/remit for a couple of months, no effect after)
• Vitamin D3 (relapse/remit for 7 months at this point)
• Molybdenum (seems to be a trigger still)

I have several banker boxes full of supplements. These are the only ones that have made a difference.

Just adding my experience, I've taken all of these and for me they have made zero difference.

 

[perardua]

Dear Leokitten

The definition of stupidity is to keep doing the same thing and expect a different result.

Supplements have not helped me, although I love the Budwig mixture.

Mould avoidance (camping at the seaside and taking cholestyramine or chlorella) made me feel like a different person. However it only worked so long as I was camping.

The most important book in the last 200 years is Theory of Suppression by Prafull Vijayakar. It answers the question, what is the criterion of improvement?

I went to Mumbai to consult him. He prescribed one dose of (in my case Baryta Iod 200c). 12 hours later my mind cleared. Then it went in waves. My knee pain came back. (I had had knee pain before I started having brain fog). Now my knee pain has gone and ankle pain has come up. My brain is better and I am becoming breathless. All these statements will make sense if you read the book.

Aude sapere!

 

[Kathevans]

I don't mean to light any fires here, but @perardua, I've tried homeopathy at least twice, each time for years and had no noticeable effects (call me a fool, I'm fine with it!). Now, from a very cursory look at the contents of this book, there seems to be a reason why homeopathy doesn't work in most cases--and it has to do with not using this particular guy's approach. Oh boy. This re-stimulates so much relating to the whole mishigas of healing. If only we did this or that, it might work for us. Tweak it here or there. It's like trying to open a bank vault by listening with a stethascope for the tumblers to click into place. Yikes! I'm about to blow a fuse with methylation, working on amounts of different Bs, working on co-factors, working on sleep. I'm breathless just thinking about it...

Amazingly--or perhaps weirdly, I have experienced profound reactions to energy work. Even 'remote' energy work, which is to say done for me from a distance (when I didn't know it was being done). Well, I suppose given this, I'm willing to grant that you may well be having a powerful response to homeopathy!

P.s. How long ago did you take this supplement? Is there a point where you'll have to return for another dose?

 

[perardua]

Dear Kathevans, No fires ; ) I didn't believe in it myself. But it's like you say about the energy work - amazing, weird, profound. I'm not talking about the sugar pill version of the UK. Good old Hahnemann-Kent-Hering classical homeopathy practised in India.

They insist on single dose.

Or pretty much single dose. I took the remedy in January and the effects seem to be winding down only now. I am planning to go back one more time for a follow up in September.

You misunderstand if you think the book is primarily about why homeopathy doesn't work in most cases. It is primarily about what counts as working.

 

[Kathevans]

@perardua Well, as I say, who knows? My brother-in-law, whom I respect enormously, is a great believer in the single-remedy form of homeopathy. He, too, says that the reason it doesn't tend to work is because finding that 'right' remedy takes an amazing practitioner.

I hope you've found him...

 

[perardua]

Thanks Kathevans, I have. Best £50 I ever spent.

 

[redaxe]

My $0.02 on this subject I would probably start of saying that the term supplements is a very broad and generic term and can be anything from homeopathic (which mainstream science says any benefit would just be placebo) to nutritional or mineral replacements (e.g. Magnesium or Vitamin B12 or Vitamin C) to Microbiome aids (fermented foods + probiotic capultes). On the other end of the spectrum are the supplements that could also be considered as quasi-drugs like Melatonin, St Johns Wort, N-Acetyl Cysteine or Bovine colostrum). But I don't know if that is a very good way of categorising supplements.

Me personally I without a doubt had benefit from Vitamin B12 injections - not a cure but it did cause a fast and noticeable affect which long term stabilized my condition and helped me neurologically and a bit with energy. I also noticed that chemical and mold sensitivities seemed to drop a little too.

Melatonin & GABA I definately found helpful for sleep.
Been trying St Johns Wort lately for a bit of a mood lifter and possibly it is working or at least placebo.
N-Acetyl Cysteine I've used for a long time now and it largely removed long term anxiety & OCD tendencies I've had. I also take it alongside Valcyte as in theory it might help with liver function and reduce the risk of harmful side-effects of drugs.

But everybody seems to be different but I do recall someone on another thread saying that if you don't bother treating any symptom they tend to run away on you.

As for drugs I'm taking
-Valcyte for HHV6
-Doxycycline for acne but also to help clear out any intracellular bacteria
-Pyridostigmine for Orthostatic Hypotension

 

[redaxe]

On a separate note I do totally understand where the OP is coming from. Much of the push of supplements onto the CFS community has come from at least 1 doctor who has a massive vested interest in us buying supplements. And this shows as just about every supplement in existence has been advertised for use in CFS/ME by naturopaths, vitamin shops, alternative doctors and on our side virtually every patient has tried these supplements, mostly as the OP says with no or little effect. Someone is making a lot of money out of us using very dodgy science and totally corrupt ethics.

The most obvious person I'm referring to is Jacob Teitelbaum who wrote that book 'From Fatigued to Fantastic'. Sadly it is people like him who have done real patients with CFS/ME the most damage as his books and material is so widely circulated it is almost impossible for any person who has CFS/ME to avoid getting conned by him as the real science which focuses on immunological or infectious origin of the illness doesn't get the attention it deserves and ends up buried.

He is largely responsible for diluting out the CFS/ME community by mixing us in the same basket of anybody who has fatigue or energy issues and just labels it 'Chronic Fatigue' and his approach is just to push overpriced supplements onto patients. And unfortunately since people like him have been so vocal in pushing supplements and 'best-selling' books it starts to create the image in the wider community (especially amongst doctors and the media) that ours is simply an illness or state of being that can be fixed by taking a few supplements and getting some rest.... Not an illness that can totally devastate people's lives and leave them almost paralyzed. No other illness in the world that I know of has supplements pushed at it so much as ME/CFS.

 

[waiting]

This is similar to my experience as well.

I like what Chris Cairns ( author of blog "The Patient Advocate") has to say on both the relapsing/remitting nature of the disease (excerpt 1, below) AND the beneficial effect of some treatments for some patients (excerpt 2, below) in his Dec 31/14 post:

http://cfspatientadvocate.blogspot.ca/2014/12/this-time-of-year-and-severe-mecfs.html?m=1

Excerpt 1:

"It is worth noting that all ME/CFS patients are on a continuum, shifting whimsically up or down the scale over the years."

Excerpt 2:

"In the meantime, I have five or six ME/CFS friends who have made substantial improvement in the last few years. Most had the illness at a moderate to serious level and were disabled in one way or another, suffering serious consequences to their lives. Each of them pursued various avenues to betterment and there was no commonality to what brought them to some betterment - and a couple to substantial betterment. No commonality, and yet they have the same illness. Their diverse treatments included antibiotics, acupuncture, Valtrex, methylation supplements, uv light therapy, thyroid regulation, dietary changes, Chinese herbs, jin shin jyutsu, ozone therapy - and cannabis.Each had to find their own path through trial and error. This is an important bit of information."

[I think Chris is a member of PR and I'd tag him on this if I could find his PR name!]

 

[MikeV]

Hello All

I read at this site often the last two years. I have suffered for 20 years with this illness --came down with a horrible viral flu in November 1994 and was still in bed all day 8 months later. My HMO finally threw his hands up in the air and reffered me to a psychiatrist. Lost everything. I have been homeless. Now I support myself by working two weekends a month as a home health aid --praise God-- because being in a homeless shelter with CFS/ME is hard to endure.

Have embarked on so many supplement protocols in 20 years! Nothing made a difference that I could feel. Some things, like Methylation and SamE made ME feel worse, and unbalanced. SamE makes me angry --weird but true-- I temporarily got fired from my job while taking it. Had to go crawling back and apologize. Most things, highly recommended things like chlorella, ingestible aloe vera, "super foods", did nothing that made a difference that I could feel or measure.

Recently, however, something has made a huge difference to me: It is simply taking lots and lots of B-12 sublinguals every day. I am talking about the very common little 500 mcg sublinguals (yes, cyanocobalamin) you can get anywhere inexpensively. I started taking them every night about four months ago because they calmed me and helped me get a good night's sleep. I started noticing I was able to work longer hours and even do some weightlifting. Usually weightlifting puts me into a crash for one to four days, but I started being able to (carefully) complete an every-other-day weightlifting routine, working one body part per session. (I also take several grams of Vitamin C, Omega 3, and glucosamine for their anti-inflammatory effects. I also take Vitamin E with Selenium.) My calendar for April 2015 shows that I worked out 18 out of 31 days --for me this is absolutely incredible.

I did not fully understand at the time that it was the B-12 helping me. I just thought it was some kind of miracle --some wonderful, beautiful upswing. But when I discontinued the B-12 (because I did not want the added Sucralose in my diet) I found myself in the worst relapse I have ever experienced in 20 years of having CFS/ME: bed-bound for over a week, and unable to work all last month (June 2015). I added the b-12 back in small doses, and started to feel a little better. Last week, when I ran out of B-12 for about three days I found myself feeling terrible. So this time the light bulb finally clicked on and I went to Wal-Mart and got a cart-load of these cheap B-12 sublinguals. It is working. For me, it really seems like the more I take the better I feel. So now I probably ingest about 60 to 70 of these little micro-lozenges per day. Yea this is probably unwise --please do not take this as a recommendation-- but for me, today, it seems to be the thing that is making my life livable again. By livable I mean I can go out and earn a decent living.

Two days ago, after a lot of reading here at PR, I found some Jarrow Methyl B-12 at Pharmica and started using that, as well. Another step up on the upswing. I rode my bike almost 15 miles yesterday (slow pace).

I don't know why this is working. I don't know if it will help anyone else. I don't know if it is the cyanocobalamin or the methyl or some kind of combination. All I know is that two weeks ago I could not remain out of bed for very long. Now I am getting ready to go out and ride my bike through beautiful Napa Valley.

This website has great information --thanks so much for all the good reading

 

[Ruthie24]

For me, I have found some supplements to be a huge help (seemingly) although I am also on antivirals and now SubQ IG infusions. I tried some of these same supplements at other times without success so I don't know if it's just the timing of when I added them in again, or if it was that I needed to add other supplements for them to work in a synergistic manner. It could also all just be a matter of timing and that I'm now in a remitting phase. I do know that when I miss a day or two of the supplements, I feel like a battery that runs out very quickly.

I have definitely made myself worse with supplements as well. As much as I don't want to believe that it works, I have found that self muscle testing has helped me figure out what to take on which day. Since I started doing that, I have (overall) enjoyed improvement in many symptoms. Whereas I had been ill for 5 years with a constant downward trend in my health, I am finally feeling like I'm slowly showing improvement over the past 10-11 months.

 

[Stretched]

<<With all the testimonials I constantly read on PR about supplement X completely improving symptom Y, or e.g. combination of supplement A,B,C totally improving symptom D, I tend to feel that gosh even though I have ICC/CCC ME/CFS that something is different with my disease than others?

In the almost 2.5 years I've had this disease I've been taking all sorts of different supplements and combinations based on what research I read and testimonials here on PR, which I do appreciate so much because we are all helping each other with our experiences.>>

Edited (numbers, to pick up more studies) and reduce wordy previously posted rough draft; 'sorry about that:&

This introspective questioning struck a personal note with my own existential interests and prompted me to share at least one tentative answer from my experience with this very frustrating plight of CFS/ME, more specifically related to supplement efficacy.

This is a great thread with lots of valuable hands on experience as well as other considerations for variations from ingesting biochemical substances. There's a vast amount of insights in the above prose both in black and white AND those not-so-obvious encoded implications between the lines, hinting at reasons results vary on an individual basis.

In recent years old and new studies of natural substances are re-emerging - particularly on those substances that work, scientifically validated or not - and patients are wandering into this now emergent new field of naturopathy, neutragenics, or more likely Integrative Medicine, and rightfully leaving their 'old model' GP's to learn the new stuff (along with us) or face extinction.

Over years of frustrations of hit and miss symptom relief I had similar questions with supplements working as intended (or not)... . I found the short answer is to learn how these substances work. That detail is readily accessible by reasonably intelligent people - no whiz bangs required, though the texts can get expensive, especially when you buy an original and one for online use. ...

These easily accessible resources (relatively) offer alternatives and/or explanations of WHY some substance works or don't and in many instances lead to plausible alternatives.

This ongoing process has not led to a panacea for any particular condition. Obviously, it's open ended but learning what to look for can yield small successes where heretofore we were at an impasse, dependent on some GP's lack of knowledge or big pharma substitution. For example, I cured my own IBS when even specialist MD's could not offer relief.

If I can point out one tangible hint at finding the effectiveness in using supplements or achieving expected results from claims of a 'proven' OTC substance it is this: carefully check the QUANTITY of the substance tested that ended up yielding the results claimed: the original research often shows it took 3 to 10+ times the amount labeled as a for-sale recommended dosage, which in many cases does little. It's akin to sellers proffering 'little truths' to erroneously imply the validity of (a) bigger truth(s).

FWIW, before arbitrarily raising or switching doses to get 'better results' - when in doubt get competent professional advice in advance of upping or changing the 'healing quantities.'

Note: The above is my opinion, offered without recourse based on benefits gained from personal experience. In that regard, and since the field is open ended, I wish to defer on fielding specific questions, i.e. relative to what works, or doesn't, etc.

 

[Snowdrop]

What is the disconnect? Are supplements only working for a while and then nobody posts follow up negative testimonials? Or are people wrongly associating a supplement or combination of to symptom improvement when it really had nothing to do with it?

Yes, good observation and questions.
It's difficult not to be crazy optimistic when desperate for relief.
It's normal to hope but you are right there is a disconnect here.
Maybe we need a guide on how to approach supplement use along with assess and report on symptom improvement that would help make the information more uniform. It's something I've thought about.

Having said that, there are no supplements that have helped with pain, fatigue, sleep, sensitivities or hormonal issues for me.
I've tried the B12 protocol (no success) and am going to try again (with a different approach).
I suppose it's possible that some lucky few have managed to find the right combination that works for them.

But I have had some marginal but noticable success with my cognitive fog.
This is measured objectively by my posts. In June 34 (most 4-6 lines)
At the beginning of July I acquired a few supplements. My posts for July were all mostly longer and there were 86 posts.
I would have been posting more in June but I was unable to. The short posts I did took quite some time to compose.
Will this last? I hope so but who knows. And of course if it doesn't will I be in a position to relate that.

Just FYI:
The supplements I've been taking:

• CoQ10 (SISU 100mg) 1xday
• Omega 3 fish oil (Nordic Natural ~600mg/cap) 2xday. Stopped suppl at this level--now 2 0r 3 times a week (thought it might be contributing to increased pain)
• Magnesium 150mg of malate and glycinated forms 1 each per day.
• Vitamin C powder Because it's powder I've been titrating it up.
• drinking water and the occasional Emergen-C electrolyte mix.

Which of these was what made the difference I can't say. Certainly CoQ10 has been implicated in science papers. But I just don't know.
I continue to be loosing ground physically.

 

[Stretched]

<<Science is the belief in the ignorance of experts. -- Richard Feynman>>

I really like your tag line, and certainly recall studying Feynman in Physics back in the dark ages.

Regarding the current topic of frustration with supplements (me, too). I have DEFINITELY seen the science of many experts fail, repeatedly, and in pursuing tangents of the original premise; but every now and then one (or another) hits! For example, just today a preventative protocol hit to wipe out Ebola, 100%! Again, an offshoot of a 1000+/- efforts of near hits. What a boon for humanity!

If you haven't tried the 'Synergy Trial' supplements from kpaxpharmaceuticals.com, along with a stimulant kicker,
it might be the one more effort that makes a difference. FWIW, they have some scientific results from that trial to scrutinize.

BTW, aren't ethical pharmaceuticals really supplements, just more 'likely to be effective,' based on current science? (But then again, so is eating a Snickers Bar - with predictable outcomes=&

 

[leokitten]

If you haven't tried the 'Synergy Trial' supplements from kpaxpharmaceuticals.com, along with a stimulant kicker,
it might be the one more effort that makes a difference. FWIW, they have some scientific results from that trial to scrutinize.

From what I've read the Synergy trial was a failure. It's just doesn't work in most PWME which honestly I think most here on PR expected. The use of Ritalin (or other stimulant) along with supplements (antioxidants, amino acids, and mitochondrial factors such as NAC, acetyl-l-carnitine, alpha lipoic acid) is nothing new and so many PWME have already tried this type of protocol without any success, even many years before this trial was ever envisioned.

I think a lot of other people here would agree with me, but using stimulants to counteract symptoms of this disease actually makes you worse. My experience was that I would get a short-term gain in energy for a couple days followed by a very severe crash and increase in symptoms. The stimulants did not improve any ME symptoms whatsoever they only masked some symptoms and taking all of the above supplements (and more) along with it had no synergistic effect.

To me the use of stimulants has the same effect as exercising beyond your anaerobic threshold in PWME. It's physically pushes your body into a state where you crash and have a huge increase in symptoms and PEM.

 

[Mij]

Coffee does this to me too. I get a PEM like feeling. I try to limit to 2 cups per week (sometimes skip a week) when I'm not planning anything for that day.

 

[Stretched]

From what I've read the Synergy trial was a failure. It's just doesn't work in most PWME which honestly I think most here on PR expected...
To me the use of stimulants has the same effect as exercising beyond your anaerobic threshold in PWME. It's physically pushes your body into a state where you crash and have a huge increase in symptoms and PEM.

Other than the slight concerns you mention, Mrs. Smith, how would you like to buy some heroin? ,)...

Your case is well stated in concept but I have a bit of a problem with the formal logic ('...most...'). Otherwise, it's hard to argue against in the main, especially when considering PWCs at different progression levels of health.

May I share an alternative afterthought from personal experience? I have been using low dose Add'l for ~20 years. With it and with additional supplements (sans 'Snickers') I am able to function at level of ~5-6 (of 10, best) versus a 2-3 level without the home brew (not unlike the ingredients to which you refer and more, like mega D-3 saturation, but not methylization).

I had studied upon them along the way - before the Synergy Trials. Now, aware of the ingredients from the Trials I'm cutting way back on the pill load hoping to maintain the perceived benefits (of which one never really knows, IMHO).

'Bottom line for me as a pragmatist, with the ball of string getting shorter, if this sort of 'synergy protocol' gets the job done today then why choose the purity path and suffer for uncertain better health in the future, when I have experienced a downward functional health progression, beginning ~30 years ago - after a vacation at Lake Tahoe? For me, perhaps others it is an additive protocol not a diminishing one. In the end every day is today... .

PS . Let me emphasize that I believe my decision to be judicious, by a responsible, mature adult aware of the related ramifications in dealing with a very debilitating illness; and there are side effects with which to contend. It is not one of recommending stimulants willy nilly. (FWIW, I do without them periodically just for discipline and to avoid being a junkie in my own mind, which matters less as the years roll by.)

Lastly, more remote, IMO, by adding a stimulant to the Trials perhaps its formulators intended an ulterior message - to the medical treatment community giving credence to such reasoning - to get otherwise debilitated folk up and running, but not as in 'I'm Dancing As Fast As I Can'.)