Multi-Vitamins for Chronic Fatigue Syndrome & Fibromyalgia
Nutrition plays a crucial role in managing chronic fatigue syndrome, fibromyalgia, and post-viral conditions. Getting all the essential vitamins and minerals from the foods we eat should be a top priority. For those with a well-balanced diet, multivitamins and a multimineral supplement are not generally recommended. This is absolutely the case! For those with chronic illness, a quality multivitamin with adequate minerals on top of a nutrient-dense diet is essential. Let’s see why…
No Nutrient Deficiencies on Blood Testing
What if you don’t have any vitamin or mineral deficiencies on your blood tests? Should you still take a supplement? Well, it depends. For some vitamins, like vitamin D, standard blood testing accurately measures status. Those who have normal or high-normal vitamin D levels should not supplement. The same applies for iron. Supplementing with iron is not recommended in the absence of a clear deficiency.
However, standard blood tests for B vitamins, vitamin C, and minerals are not as accurate. These are the main ingredients in a multivitamin supplement. Often, these nutrient tests are not representative of overall nutrient status. Frankly, a nutrient like vitamin C is exceptionally difficult to measure accurately.
Some doctors may include special testing like hair mineral analysis or organic acids in urine to get a better idea if vitamins and minerals are depleted. These tests are more accurate than some standard blood tests for nutritional status. However, like most diagnostic tests, they provide only a snapshot in time—not necessarily a complete overview of nutrient status over an entire day or longer periods.
I believe a multivitamin with adequate minerals is essential for those with chronic conditions like ME/CFS, fibromyalgia, or long-haul COVID, regardless of what nutrient testing may show. Hear me out.
Chronic Illness Increases Demand for Vitamins & Minerals
In general, chronic illness places extra demands on metabolic processes that require vitamin and mineral co-factors. This includes immune cell function, metabolism (mitochondria function), hormone regulation, and more. Micronutrients, like vitamins and minerals, also help mitigate the effects of daily oxidative stress, which is a hallmark of these conditions.
Vitamins and minerals play a key role in the following processes that are vital in the context of fibromyalgia and post-viral conditions:
Energy Production: B vitamins, like B12 and folate, play a key role in energy production within the body. They help convert food into energy (ATP). A deficiency in these vitamins can contribute to feelings of fatigue.
Immune Support: Vitamin C, zinc, and selenium are essential for maintaining a healthy immune system response.
Improved Mental Clarity: Certain vitamins and minerals, such as vitamin D and magnesium, play a role in brain function and mood regulation.
Enhanced Nutrient Absorption: Digestive issues can impair nutrient absorption. Multivitamin-multimineral supplements provide a convenient way to ensure your body receives essential nutrients, even if digestive issues are present.
Hormone Function & Regulation: Deficiencies in essential nutrients like magnesium, zinc, selenium, and B vitamins can disrupt hormone synthesis, regulation, and action.
Musculoskeletal Health: Proper muscle function is influenced by various vitamins and minerals, like zinc and vitamin C, to assist in muscle protein synthesis, collagen formation, and tissue repair.
Studies Show Vitamin & Mineral Deficiencies in Chronic Fatigue Syndrome & Fibromyalgia
Numerous studies have shown deficiencies in key vitamins and minerals for those with ME/CFS. Not surprisingly, those with the most severe cases show the most severe deficiencies. Studies have shown insufficient levels of vitamin C, vitamin B complex, sodium, magnesium, zinc, and folic acid.
Muscle pain, common to fibromyalgia, has been associated with deficiencies in magnesium, selenium, and vitamins B and D. Some studies in fibromyalgia show mild deficiencies in these nutrients.
Drug-Induced Nutrient Depletion
The long-term use of common medications depletes essential vitamins and minerals. This may also be the reason why some medications cause side effects. It’s important to continue to take these medications unless otherwise advised by your doctor. However, keep in mind which medications can drain vitamins and minerals. Opt for a general multivitamin to cover your bases. Ask your doctor. Drug and vitamin/mineral interactions and deficiencies are found in the Physician’s Desk Reference, which I hope is on every medical doctor’s bookshelf!
The following medications, commonly prescribed to those with fibromyalgia and post-viral conditions, have been shown to deplete key vitamins and nutrients with prolonged use:
Antidepressants (SSRIs): sertraline, escitalopram, fluoxetine
Antidepressants (TCAs): amitriptyline
Anti-epileptic drugs (AEDs): pregabalin, gabapentin
Proton-pump inhibitors: omeprazole
Sleep aids: trazodone
Pain relievers: salicylate (aspirin), opioids
The following medications have been shown to deplete vitamin C, vitamin D, iron, magnesium, zinc, and all B vitamins with the side effect of fatigue and weakness:
Aspirin
Cholesterol-lowering drugs
Acid-suppressants
Antibiotics
Oral contraceptives
Corticosteroids
Digoxin
Hormone replacement therapy
Diuretics/ACE inhibitors
Dr. Craig’s Multivitamin/Multimineral Picks
Don’t be tempted to take individual vitamins and minerals. This may be appropriate for certain patients but, in general, a good quality multivitamin will have an adequate combination. Taking individual nutrients is not only more expensive but can also lead to toxicity and imbalances. For example, taking too much zinc can throw off the body’s balance of copper. Too much vitamin D can disrupt calcium balance.
Here are the products I take myself:
· Pure Longevity Nutrients (US only)
· Pure All-in-One Plus (without iron, copper, or iodine) (EU only)
· Researched Nutritionals Core Minerals Multi-Mineral (US only)
**Caution: Not Everyone Should Take a Multivitamin
Those at Risk of Toxicity: Certain vitamins and minerals, such as vitamin A and iron, can be toxic in high doses. Individuals at risk of toxicity due to excessive supplementation should avoid multivitamins or opt for formulations with lower doses of these nutrients. Better yet, avoid a multivitamin with iron altogether. Iron should not be supplemented unless there is a clearly defined iron deficiency seen in blood testing. Supplementing with iron can increase oxidative stress and inflammation.
Individuals with a History of Kidney Stones: Some multivitamins contain high doses of certain minerals, such as calcium and vitamin D, which may increase the risk of kidney stone formation in susceptible individuals. Those with a history of kidney stones should be careful about choosing a multivitamin.
Those who Smoke: There are serious risks when taking multivitamins due to specific interactions between the nutrients and tobacco smoke components. For example, vitamin E and tobacco smoke may even increase cancer risks. Quit smoking before considering taking any nutritional supplement!
Bottom Line
A diet rich in nutrient-dense foods can help ensure adequate intake of these essential nutrients. Chronic oxidative stress, and the immune, hormone, and metabolic abnormalities of ME/CFS necessitate getting additional vitamins and minerals from a supplement. The musculoskeletal abnormalities found in fibromyalgia and the effects of common medications prescribed for fibromyalgia necessitate the addition of a multivitamin. Those with long-haul COVID should also consider a multivitamin to combat the chronic inflammatory processes of this condition.
References
Bjørklund G, Dadar M, Pen JJ, Chirumbolo S, Aaseth J. Chronic fatigue syndrome (CFS): Suggestions for a nutritional treatment in the therapeutic approach. Biomed Pharmacother. 2019;109:1000-1007. doi:10.1016/j.biopha.2018.10.076
Pagliai G, Giangrandi I, Dinu M, Sofi F, Colombini B. Nutritional Interventions in the Management of Fibromyalgia Syndrome. Nutrients. 2020;12(9):2525. Published 2020 Aug 20. doi:10.3390/nu12092525
Mohn ES, Kern HJ, Saltzman E, Mitmesser SH, McKay DL. Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. Pharmaceutics. 2018;10(1):36. Published 2018 Mar 20. doi:10.3390/pharmaceutics10010036
Jung JW, Park SY, Kim H. Drug-Induced Vitamin Deficiency. Ann Clin Nutr Metab 2022;14:20-31. https://doi.org/10.15747/ACNM.2022.14.1.20
Laight, D. (2023), Raising awareness of drug-micronutrient interactions. Prescriber, 34: 28-34. https://doi.org/10.1002/psb.2097
Lewis SL, Chizmar LR, Liotta S. COVID-19 and micronutrient deficiency symptoms - is there some overlap?. Clin Nutr ESPEN. 2022;48:275-281. doi:10.1016/j.clnesp.2022.01.036
