Chronic Fatigue: D-ribose, B-vitamins, Carnitine or?

fatigue2Perhaps one of the most frustrating conditions to work with is chronic fatigue. In adults this is a relatively common symptom.  You feel run down and tired all the time, sometimes to the point of not being able to work. I am starting to see teenagers with what looks a lot like chronic fatigue.

The list of medical conditions that can cause this is long:

If you have chronic Ebstein Barr Virus (mononucleosis/mono), that can do it.  You could have other chronic infections, be they viral or bacterial. Infections like herpes, HIV, enteroviral, and others can be associated with immune suppression and fatigue. Being hypothyroid (low thyroid status) can cause fatigue. Make sure your doctor checks TSH and free T3 and free T4 and what get’s tricky now is that it may be possible to be low thyroid with normal labs.  How can this be you ask?  Receptors are sometimes resistant to the hormone as we have seen in Type-2 diabetes, where insulin levels are high due to receptor resistance.

Hypogonadism such as being low testosterone can cause fatigue (in men and women).

Depression is often associated with severe fatigue.  The lack of adequately functioning neurotransmitters (serotonin, dopamine, epinephrine) can result in fatigue. 

If you were unfortunate enough to have an undiagnosed malignancy (cancer), while extremely rare in the cause of fatigue, you don’t want to miss this.

Most of the above conditions can and should be ruled out by your physician, using a good history, physical exam, and simple labs tests.  When that fails to provide the answer, maybe we should start with nutritional causes.  It is reasonable to think that if the body is fatigued, there is a lack of energy at the cellular level.  It is the functional cells that are the basis of all life.  The energy molecule at the cellular level is ATP (adenosine triphosphate).  ATP levels have been found to be 80% higher in healthy individuals compared to those with chronic fatigue (read more here… ) The building blocks for ATP are adenine (abundant in the body), B vitamins and ribose.  It is for this reason I recommend a B-complex with methyl-B12 and methyl-folate and I am here proposing the addition of ribose for these patients.  Dr Teitelbaum published in the J. Alt. Comp. Med  2006 (read here… ) research showing promise in the use of ribose for chronic fatigue. In the latest study (which can read here… ) Teitelbaum showed that giving 5 grams three times a day of D-ribose (Corvalen) for 3 weeks resulted in 61% increase in energy, 37% increase in overall well being, 29% improved sleep, and 30% improved mental clarity.

I have also liked adding carnitine (250 mg twice a day) to the supplements given as carnitine is the shovel that gets ATP into the cell.  I find it helpful to check a Spectracell Micronutrient test (MNT) as this is a best way to find out if your cells are functionally getting enough of the key nutrients that they need. You can read more about the Spectracell Micronutrient test here…




Dr. Paul






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