Many medical practitioners are still basing their knowledge around the out-dated belief that micronutrient deficiencies are rare in the Western world and play no role in contributing to common health problems such as chronic fatigue syndrome/myalgic encephalomyelitis.
However, current scientific research is now suggesting that micronutrient deficiencies such as Vitamin B12, Zinc, Magnesium and many other nutrients may be significantly more common than once suspected, especially in individuals with serious health problems such as chronic fatigue syndrome/ME, auto-immune and neurodegenerative diseases.
Many physicians and psychotherapists “try” to treat CFS/ME as if it is a disorder of psychosomatic origin i.e an illness of the mind, often treating the patient as if they are mentally ill and can be very unaccepting of the multiple physical symptoms associated with CFS. Which is something I personally find hugely disrespectful considering there is very little if any scientific research there to suggest that chronic fatigue syndrome/ME is a mental illness.
In fact there is now a growing body of scientific research, which actually confirms that individuals with CFS/ME have a number of physiological abnormalities, which are now proven to contribute to symptoms such as chronic fatigue, autonomic nervous system dysfunction(dysautonomia), neurocognitive symptoms, increased oxidative stress, mitochondrial dysfunction, immune system dysfunction and so on, as typically seen in CFS/ME.
Some other factors which can contribute to the pathophysiology of CFS/ME include vitamin/mineral deficiencies, genetic factors, viral infections, hypothalamic-pituitary-adrenal axis dysfunction/hypocortisolism, oxidative stress, hypothyroidism, heavy metal toxicity, methylation impairments, leaky gut syndrome(increased intestinal permeability) and much more.
Scientific research has now found a number of common nutrient deficiencies in individuals with CFS/ME, which we’ll come to shortly in the article.
The findings that micro-nutrient deficiencies can contribute to the pathophysiology of CFS doesn’t surprise me at all, especially when we consider just how important a role many of these nutrients play in cellular energy metabolism and ATP production such as magnesium, Vitamin B12, Co-Enzyme Q10, Zinc and so on. In other words, it’s little surprise that individuals with CFS/ME suffer from lowered energy output and a myriad of other disturbing symptoms.
Yet many doctors are still firmly stuck in the ice age when it comes to trying to treat patients with chronic fatigue syndrome. Often these root causative factors such as micronutrient deficiencies go completely unaddressed. This, in my opinion is completely unacceptable given the body of scientific evidence that is now there confirming the association between the likes of Co-Enzyme Q10 deficiency and chronic fatigue for example.
Another issue which should be highlighted is the fact that serum blood testing is notoriously inaccurate for assessing true vitamin B12 status and even minerals such as magnesium and zinc.
Red blood cell testing is thought to be much more accurate for checking mineral levels, and for assessing vitamin B12 status you will need to check homocysteine and MMA(Methylmalonic Acid) levels, which are functional markers of Vitamin B12 metabolism.
This is especially important if symptoms of pernicious anemia are present and/or spinal cord degeneration, which highly indicate Vitamin B12 deficiency. I can’t stress the importance of those with CFS/ME, having vitamin B12 status properly checked, as I suffered from undiagnosed functional Vitamin B12 deficiency for over a decade.
Anyway, let’s get onto the most common vitamin, mineral and micronutrient deficiencies associated with Chronic Fatigue Syndrome/myalgic encephalomyelitis.
Vitamin, Mineral & Micro-Nutrient Deficiencies Associated With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis
1. Magnesium Deficiency
ATP(adenosine triphosphate) is the energy-carrying molecule found in all cells and is often referenced to as the “currency of life or
Magnesium plays a pivotal role in the synthesis of ATP, so it’s not surprising that deficiencies can cause symptoms of low energy and autonomic nervous system dysfunction.
Deficiency of magnesium has been linked to a wide range of serious health problems from chronic fatigue syndrome to heart disease.
One randomized, double-blind, placebo-controlled trial showed that: 
In the case-control study, 20 patients with CFS had lower red cell magnesium concentrations than did 20 healthy control subjects matched for age, sex, and social class (difference 0.1 mmol/l, 95% confidence interval [CI] 0.05 to 0.15).
The study didn’t only find that magnesium levels were lower in patients with CFS, but also that treatment with magnesium significantly improved symptoms of chronic fatigue syndrome.
Patients treated with magnesium claimed to have improved energy levels, better emotional state, and less pain, as judged by changes in the Nottingham health profile. 12 of the 15 treated patients said that they had benefited from treatment, and in 7 patients energy score improved from the maximum to the minimum.
By contrast, 3 of the 17 patients on placebo said that they felt better (difference 62%, 95% CI 35 to 90), and 1 patient had a better energy score.
Red cell magnesium returned to normal in all patients on magnesium but in only 1 patient on placebo. The findings show that magnesium may have a role in CFS.
2. Zinc Deficiency
Zinc is a very important nutrient for proper immune system function, hormonal and adrenal gland health, protein/DNA synthesis, healthy cell division, normal growth, promoting wound healing and helps to balance zinc/copper levels.
One study showed that not only was zinc low in individuals with CFS, but there was a significant correlation between zinc levels and the severity of the condition.
The study found that the lack of zinc was directly related to the immune system dysfunction and increased oxidative stress, both common factors in the pathophysiology of CFS. 
We found that serum zinc was significantly lower in the CFS patients than in the normal controls. There was a trend toward a significant negative correlation between serum zinc and the severity of CFS and there was a significant and negative correlation between serum zinc and the subjective experience of infection.
Zinc deficiency can cause many symptoms such as weak immune system, chronic fatigue, anxiety, anorexia, erectile dysfunction, low libido, hormonal imbalances, poor stress tolerance, adrenal gland and nervous exhaustion, autonomic dysfunction, ridges and white spots on nails, stretch marks and much more.
3. Vitamin D Deficiency
Vitamin D is another nutrient deficiency, which has been implicated in the development of many serious diseases such as auto-immune diseases(MS etc), chronic fatigue syndrome, heart disease and even cancer.
Vitamin D is a very important nutrient needed for proper cell division, bone health and for healthy function of the immune system.
Vitamin D deficiency and sub-optimal levels of this vitamin are by no means rare and scientific research is still finding that many individuals are commonly low in this vital nutrient.
Individuals with CFS(chronic fatigue syndrome) may be at an increased risk of developing Vitamin D deficiency because many are house bound and thus don’t get adequate or much exposure to sunlight daily. Some genetic mutations such as those involving the VDR(vitamin D receptor) may also contribute to low vitamin D status.
One study showed that Vitamin D levels were significantly lower in individuals with CFS. 
25-OH vitamin D levels are moderately to severely suboptimal in CFS patients, with a mean of 44.4 nmol/L (optimal levels >75 nmol/L). These levels are lower and the difference is statistically significant (p<0.0004) than those of the general British population from a recent national survey, but similar to those in patients with other chronic conditions.
Sardines are a rare dietary source of Vitamin D3 and provide a number of health supportive nutrients such as Omega-3(epa/dha) fatty acids, Vitamin B12, Bio-available Calcium and Selenium, RNA/DNA and Co-Enzyme Q10.
Sardines are one of the best “superfood” choices for individuals with CFS/ME, auto-immune/inflammatory and cardiovascular diseases.
4. Co-Enzyme Q10 Deficiency
Co-Enzyme Q10 is a vitamin-like nutrient, which is involved in the production of ATP in the mitochondria and displays significant antioxidant and anti-inflammatory properties.
It doesn’t surprise me that a nutrient so heavily involved in energy production has the possibility to be low in those with chronic fatigue syndrome and other energy/mitochondrial-related diseases.
However, Co-Enzyme Q10 is another nutrient, which is rarely ever tested by modern general practitioners, many not understanding the vital importance of Co-Enzyme Q10 deficiency as a predictor of developing congestive heart failure in at-risk groups such as CFS/ME.
One study showed that Coenzyme Q10 deficiency in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is related to fatigue, autonomic and neurocognitive symptoms and is a risk factor explaining the early mortality in ME/CFS due to cardiovascular disorder. 
Plasma CoQ10 was significantly (p=0.00001) lower in ME/CFS patients than in normal controls. Up to 44.8% of patients with ME/CFS had values beneath the lowest plasma CoQ10 value detected in the normal controls, i.e. 490 microg/L. In ME/CFS, there were significant and inverse relationships between CoQ10 and the total score on the FF scale, fatigue and autonomic symptoms.
Patients with very low CoQ10 (<390 microg/L) suffered significantly more from concentration and memory disturbances.
The results show that lowered levels of CoQ10 play a role in the pathophysiology of ME/CFS and that symptoms, such as fatigue, and autonomic and neurocognitive symptoms may be caused by CoQ10 depletion.
Ubiquinol is the reduced form of Co-Enzyme Q10, which studies have found to be around 8 times better absorbed compared to other Co-Enzyme Q10 supplements.
There is also a double-blind placebo-controlled study, which found clinical improvement and reduction of symptoms in individuals with CFS being treated with ubiquinol supplementation. 
As a result, depression symptoms, sleep duration and the performance in the arithmetic task were improved after the supplementation with Ubiquinol, and these improvements were dependent on increases in plasma coenzyme Q10 levels. And the increases in plasma coenzyme Q10 levels correlated with decreases in plasma oxidative stress. It is noteworthy that decreases in oxidative stress and in energy production are related to the mechanism of chronic heart failure syndrome.
5. Miscellaneous Nutrient Deficiencies Associated With Chronic Fatigue Syndrome/ME
Other nutrients that can be low in individuals with CFS(Chronic fatigue syndrome) include B-complex vitamins such as pantothenic acid(Vitamin B5), Pyridoxine(Vitamin B6) and Vitamin B12, Selenium, Omega-3 fatty acids(epa/dha), taurine, Vitamin C and many other nutrients.
Regular serum blood testing as mentioned above is often inaccurate and unreliable
Advanced testing such as Spectra-cell may be beneficial for checking intracellular and functional levels of vitamins, minerals, and antioxidants such as coenzyme q10 and alpha lipoic acid.
As always I recommend seeking the advice and guidance of a qualified practitioner, before attempting to address any of the above micro-nutrient deficiencies.
Here is an infographic of five of the most common nutrient deficiencies seen in ME/CFS patients from the research.
Individuals can test their blood levels of nutrients easily now thanks to Forth with Life’s home “finger prick” blood test kits.
The Home Nutri-Check tests for many nutrients including Vitamin D, Active Vitamin B12, Zinc, Magnesium, Iron, Folate, Calcium and much more.
The Home Nutri-Check test is perfect for individuals with ME/CFS to identify key micro-nutrient deficiencies that may be playing a role. Another benefit is that they have included the Active Vitamin B12 test also, which is a significantly better marker for assessing Vitamin B12 status than serum tests.
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 Red blood cell magnesium and chronic fatigue syndrome. – Medical School, University of Southampton, UK.
 Lower serum zinc in Chronic Fatigue Syndrome (CFS): relationships
to immune dysfunctions and relevance for the oxidative stress status in
CFS. – M-Care4U Outpatient Clinics, Olmenlaan 9, 2610 Antwerp-Wilrijk,
 Serum 25-hydroxy vitamin D levels in chronic fatigue syndrome: a
retrospective survey. – Royal London Homeopathic Hospital, University
College London Hospitals NHS Trust, London, UK http://www.ncbi.nlm.nih.gov/pubmed/20209476
 Coenzyme Q10 deficiency in myalgic encephalomyelitis/chronic
fatigue syndrome (ME/CFS) is related to fatigue, autonomic and
neurocognitive symptoms and is another risk factor explaining the early
mortality in ME/CFS due to cardiovascular disorder. – Maes Clinics,
 Effect of Ubiquinol (reduced form of Coenzyme Q10) on Chronic
Fatigue Syndrome (CFS) in double-blind placebo controlled
study—Collaborative research with Osaka City University—
The information in this article has not been evaluated by the FDA and should not be used to diagnose, cure or treat any disease, implied or otherwise.