Condition
Myalgic Encephalomyelitis (Chronic Fatigue Syndrome)
ME/CFS is a long-term illness in which deep exhaustion does not ease with rest and often flares after exertion, possibly tied to disrupted cellular energy and immune signaling. Among supplements, L-carnitine and D-ribose drew the most interest, and small studies found attention improved with carnitine and fatigue eased with D-ribose. The evidence is limited, though, since those studies were small, with 90 and 36 people.
Sources: PMID 15039515; PMID 17109576
- Supplements studied
- 7
- Graded outcomes
- 6
- Trials
- 9
- People studied
- 463
Evidence by supplement
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Depression Symptoms Moderate Improvement | Improves (the measure goes down) | Moderate effect | 14 studies | 50 people | ||
Studies that measured depression symptoms
| ||||||
| Fatigue Symptoms | Improves (the measure goes down) | 50 people | ||||
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Depression Symptoms Moderate Improvement | Improves (the measure goes down) | Moderate effect | 2 studies | 48 people | ||
Studies that measured depression symptoms | ||||||
| Fatigue Symptoms | Improves (the measure goes down) | 3 studies | 48 people | |||
Studies that measured fatigue symptoms
| ||||||
L-Carnitine
- Attention: improves
- Fatigue Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Attention Small Improvement | Improves (the measure goes up) | Small effect | 1 study | 90 people | ||
Studies that measured attention | ||||||
| Fatigue Symptoms | Improves (the measure goes down) | 174 people | ||||
Panax Ginseng (Korean Ginseng)
- Depression Symptoms: improves
- Insomnia Signs and Symptoms: improves
- Fatigue Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Depression Symptoms Small Improvement | Improves (the measure goes down) | Small effect | 1 study | 50 people | ||
| Insomnia Signs and Symptoms | Improves (the measure goes down) | 1 study | 50 people | |||
Studies that measured insomnia signs and symptoms | ||||||
| Fatigue Symptoms | Improves (the measure goes down) | 50 people | ||||
D-Ribose
- Fatigue Symptoms: improves
- Subjective Well-Being: improves
- Fibromyalgia Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Fatigue Symptoms Small Improvement | Improves (the measure goes down) | Small effect | 36 people | |||
| Subjective Well-Being | Improves (the measure goes up) | 1 study | 36 people | |||
Studies that measured subjective well-being | ||||||
| Fibromyalgia Symptoms | Improves (the measure goes down) | 36 people | ||||
Rhodiola Rosea
- Fatigue Symptoms: improves
- Social Functioning: improves
- Stress Signs and Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Fatigue Symptoms Moderate Improvement | Improves (the measure goes down) | Moderate effect | 101 people | |||
| Social Functioning | Improves (the measure goes up) | 1 study | 101 people | |||
Studies that measured social functioning | ||||||
| Stress Signs and Symptoms | Improves (the measure goes down) | 1 study | 101 people | |||
Studies that measured stress signs and symptoms | ||||||
Spirulina
- Fatigue Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Fatigue Symptoms | Improves (the measure goes down) | 4 people |
Key findings
- Depression SymptomsImproves (the measure goes down)
- AttentionImproves (the measure goes up)
- Fatigue SymptomsImproves (the measure goes down)
The Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) protocol
2 primary supplements · 7 supporting supplements
- L-Carnitine / Acetyl-L-Carnitine1–2 g L-carnitine or 500–2,000 mg acetyl-L-carnitine daily
- Coenzyme Q10 (CoQ10)100–300 mg daily (ubiquinol form preferred)
Studies cited
100 studies from PubMed
- Effects of Coenzyme Q10 Supplementation on Depressive Symptoms and Fatigue: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
- Exercise Performance and Rhodiola rosea: A Meta-Analysis
- Safety and Tolerability of Rhodiola rosea: A Review of Clinical Evidence
- Rhodiola rosea in Depression: A Systematic Review
- Rhodiola rosea L. as a Putative Botanical Adaptogen: An Overview on Its Beneficial Effects
- The Adaptogenic Effects of Rhodiola rosea: A Systematic Review and Meta-Analysis
- Effects of spirulina and wakame consumption on intestinal cholesterol absorption and serum lipid concentrations in non-hypercholesterolemic adult men and women
- Rhodiola rosea for Mental and Physical Fatigue: A Systematic Review
- Effects of Adaptogens on the Central Nervous System: Rhodiola rosea
- Spirulina in Health and Disease Prevention: A Comprehensive Review
- Stress Management and the Role of Rhodiola rosea: A Review
- Spirulina Supplementation and Metabolic Syndrome: A Meta-Analysis
- Spirulina and Allergic Rhinitis: A Systematic Review
- Spirulina (Arthrospira): Nutritional Value and Health Effects
- Spirulina and Immune Function: A Systematic Review
- Safety Assessment of Spirulina (Arthrospira) as a Dietary Supplement
- Rhodiola rosea in Stress-Induced Fatigue: A Double-Blind Cross-Over Study
- A Systematic Review of the Effects of Spirulina on Cardiovascular Risk Factors
- Effects of Spirulina on Lipid Profile: A Systematic Review and Meta-Analysis
- Rhodiola rosea for Physical and Cognitive Performance: Clinical Evidence
- Antioxidant and Anti-Inflammatory Effects of Spirulina: Evidence from Clinical Studies
- Effects of Spirulina on Body Weight and Blood Glucose: A Meta-Analysis
- Understanding Adaptogens: Rhodiola rosea and Human Performance
- Effect of Spirulina maxima on postprandial lipemia in young runners: a preliminary report
- Wheat grass supplementation decreases oxidative stress in healthy subjects: a comparative study with spirulina
- Lack of effect of Rhodiola or oxygenated water supplementation on hypoxemia and oxidative stress
- No effects of oral ribose supplementation on repeated maximal exercise and de novo ATP resynthesis
- L-carnitine ameliorated fasting-induced fatigue, hunger, and metabolic abnormalities in patients with metabolic syndrome: a randomized controlled study
- L-Carnitine's Effect on the Biomarkers of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- Ameliorating hypertension and insulin resistance in subjects at increased cardiovascular risk: effects of acetyl-L-carnitine therapy
- Comparative study to evaluate the effect of l-carnitine plus glimepiride versus glimepiride alone on insulin resistance in type 2 diabetic patients
- Effects of simvastatin and carnitine versus simvastatin on lipoprotein(a) and apoprotein(a) in type 2 diabetes mellitus
- Comparison between orlistat plus l-carnitine and orlistat alone on inflammation parameters in obese diabetic patients
- Effects of combination of sibutramine and L-carnitine compared with sibutramine monotherapy on inflammatory parameters in diabetic patients
- L-Carnitine supplementation reduces oxidized LDL cholesterol in patients with diabetes
- Effect of L-carnitine on plasma glycemic and lipidemic profile in patients with type II diabetes mellitus
- Effect of carnitine-orotate complex on glucose metabolism and fatty liver: a double-blind, placebo-controlled study
- Efficacy and tolerability of combined treatment with L-carnitine and simvastatin in lowering lipoprotein(a) serum levels in patients with type 2 diabetes mellitus
- Blood Pressure and Metabolic Effects of Acetyl-l-Carnitine in Type 2 Diabetes: DIABASI Randomized Controlled Trial
- The effects of oral L-carnitine treatment on blood lipid metabolism and the body fat content in the diabetic patient
- The effect of L-carnitine on plasma lipoprotein(a) levels in hypercholesterolemic patients with type 2 diabetes mellitus
- The effects of L-carnitine supplementation on cardiovascular risk factors in participants with impaired glucose tolerance and diabetes: a systematic review and dose-response meta-analysis.
- Effects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trial
- Effect of oral L-carnitine administration on insulin sensitivity and lipid profile in type 2 diabetes mellitus patients
- The effects of L-carnitine supplementation on glycemic markers in adults: A systematic review and dose-response meta-analysis.
- L-carnitine improves glucose disposal in type 2 diabetic patients
- Caloric restriction and L-carnitine administration improves insulin sensitivity in patients with impaired glucose metabolism
- Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes
- Acetyl-l-carnitine versus placebo for migraine prophylaxis: A randomized, triple-blind, crossover study
- The effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation in migraine prophylaxis
- Effects of carnitine on glucose and lipid metabolic profiles and fertility outcomes in women with polycystic ovary syndrome: A systematic review and meta-analysis.
- Oral carnitine supplementation reduces body weight and insulin resistance in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial
- Effects of Carnitine Administration on Carotid Intima-media Thickness and Inflammatory Factors in Patients with Polycystic Ovary Syndrome: A Randomized, Double-blind, Placebo-controlled Trial
- Effects of L-carnitine supplementation for women with polycystic ovary syndrome: a systematic review and meta-analysis
- Effect of glycine propionyl-L-carnitine on aerobic and anaerobic exercise performance
- Influence of L-carnitine administration on maximal physical exercise
- Effects of nine weeks L-Carnitine supplementation on exercise performance, anaerobic power, and exercise-induced oxidative stress in resistance-trained males
- l-Carnitine l-tartrate supplementation favorably affects biochemical markers of recovery from physical exertion in middle-aged men and women
- Glycine propionyl-L-carnitine produces enhanced anaerobic work capacity with reduced lactate accumulation in resistance trained males
- Chronic oral ingestion of L-carnitine and carbohydrate increases muscle carnitine content and alters muscle fuel metabolism during exercise in humans
- The effect of oral supplementation with L-carnitine on maximum and submaximum exercise capacity
- Effect of intravenous L-carnitine on carnitine homeostasis and fuel metabolism during exercise in humans
- Effects of prolonged L-carnitine administration on delayed muscle pain and CK release after eccentric effort
- l-Carnitine Supplementation in Older Women. A Pilot Study on Aging Skeletal Muscle Mass and Function
- Effects of L-carnitine L-tartrate supplementation on muscle oxygenation responses to resistance exercise
- The effects of L-carnitine L-tartrate supplementation on hormonal responses to resistance exercise and recovery
- Levocarnitine administration in elderly subjects with rapid muscle fatigue: effect on body composition, lipid profile and fatigue
- Oxidative stress in response to aerobic and anaerobic power testing: influence of exercise training and carnitine supplementation
- Effect of L-carnitine on submaximal exercise metabolism after depletion of muscle glycogen
- Androgenic responses to resistance exercise: effects of feeding and L-carnitine
- Carbohydrate, protein, and fat metabolism during exercise after oral carnitine supplementation in humans
- Effects of four weeks L-carnitine L-tartrate ingestion on substrate utilization during prolonged exercise
- L -Carnitine and the recovery from exhaustive endurance exercise: a randomised, double-blind, placebo-controlled trial
- Effects of carnitine coingested caffeine on carnitine metabolism and endurance capacity in athletes
- Effects of L-carnitine supplementation on physical performance and energy metabolism of endurance-trained athletes: a double-blind crossover field study
- Clinical Effects of L-Carnitine Supplementation on Physical Performance in Healthy Subjects, the Key to Success in Rehabilitation: A Systematic Review and Meta-Analysis from the Rehabilitation Point of View.
- L-Carnitine/Simvastatin Reduces Lipoprotein (a) Levels Compared with Simvastatin Monotherapy: A Randomized Double-Blind Placebo-Controlled Study
- Effect of lysine, vitamin B(6), and carnitine supplementation on the lipid profile of male patients with hypertriglyceridemia: a 12-week, open-label, randomized, placebo-controlled trial
- L-carnitine infusion does not alleviate lipid-induced insulin resistance and metabolic inflexibility
- Effects of acute versus chronic L-carnitine L-tartrate supplementation on metabolic responses to steady state exercise in males and females
- Liver-Oriented Acute Metabolic Effects of A Low Dose of L-Carnitine under Fat-Mobilizing Conditions: Pilot Human Clinical Trial
- The effects of L-carnitine supplementation on glycemic control: a systematic review and meta-analysis of randomized controlled trials
- The effect of L-carnitine on inflammatory mediators: a systematic review and meta-analysis of randomized clinical trials
- Single dose administration of L-carnitine improves antioxidant activities in healthy subjects
- Comparison of pre-workout nitric oxide stimulating dietary supplements on skeletal muscle oxygen saturation, blood nitrate/nitrite, lipid peroxidation, and upper body exercise performance in resistance trained men
- Glycine propionyl-L-carnitine modulates lipid peroxidation and nitric oxide in human subjects
- L-carnitine supplementation to diet: a new tool in treatment of nonalcoholic steatohepatitis--a randomized and controlled clinical trial
- Effects of carnitine supplementation on flow-mediated dilation and vascular inflammatory responses to a high-fat meal in healthy young adults
- The effect of l-carnitine on fat oxidation, protein turnover, and body composition in slightly overweight subjects
- Effects of exercise intensity and altered substrate availability on cardiovascular and metabolic responses to exercise after oral carnitine supplementation in athletes
- Safety measures of L-carnitine L-tartrate supplementation in healthy men
- Effects of oral L-carnitine supplementation on insulin sensitivity indices in response to glucose feeding in lean and overweight/obese males
- Glycine propionyl-L-carnitine increases plasma nitrate/nitrite in resistance trained men
- Effects of L-carnitine on oxidative stress responses in patients with renal disease
- Effects of L-carnitine supplementation on blood pressure: a systematic review and meta-analysis of randomized controlled trials.
- Effects of combined treatment with simvastatin and L-carnitine on triglyceride levels in diabetic patients with hyperlipidaemia
- Effects of L-carnitine supplementation on lipid profiles in patients with coronary artery disease
- Effects of carnitine on thyroid hormone action
- L-carnitine improves the asthma control in children with moderate persistent asthma
- Carnitine supplementation improves metabolic flexibility and skeletal muscle acetylcarnitine formation in volunteers with impaired glucose tolerance: A randomised controlled trial