In the third of our blog series on using  supplements to treat Chronic  Fatigue Syndrome and/or Fibromyalgia, Dr. Courtney Craig talks about testing and her approach

An Interview with Dr. Courtney Craig

You noted that you’d spent thousands of dollars on supplements before you found the approach that worked for you. How long did it take you to do that? 

I first sought an integrative medicine doctor when I was 18 years old and was given high dose B-vitamins. Before that, I never considered supplementation as a viable option for symptom management because I didn’t have a clue about the illness. Over the course of the next 7 years I tried various supplements in a rather shotgun fashion that never made the slightest dent in my fatigue. This was long before I understood the importance of supplement quality and dosing. It wasn’t until I started with a doctor who used pharmaceutical-grade supplements, under the auspices of Dr. Teitelbaum’s protocol that I started to notice differences.

You graduated from the University of Bridgeport’s Human Nutrition Institute. How much time did you devote to learning about supplements and nutrition? 

My training was very different than traditional dietetics education or that of an herbalist. Instead my graduate work was heavily entrenched in biochemistry and clinical application. I had the good fortunate of learning clinical biochemistry under Richard Lord, PhD, who is the former scientific director of Genova/Metametrix labs (now retired). His seminal work Laboratory Evaluation for Integrative and Functional Medicine hones in deeply on how to adequately assess a board spectrum of biochemical pathways and focused interventions. I recommend every clinician obtain a copy.

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In general what kinds of tests do you recommend?

Most people already have a large collection of lab results, so I first look at those and try to find missing pieces. Some practitioners do not assess reliable markers (B12, iron status, etc) or miss potentially valuable tests that would rule out overlapping illnesses (Hashimoto’s, Hemochromatosis, Celiac, H. pylori, etc).

I am releasing an eBook guide in the coming weeks that explains in detail many of the laboratory tests that I think are commonly left out in basic CFS or fibromyalgia assessment. Excessive testing not only costs a lot of money but also can create unnecessary fear and uncertainty in patients. I’ve been there.

My primary approach is to create an individualized treatment plan based on the patient’s unique biochemistry and genomics so I will order specialty testing to determine what specific nutrients are needed. This may include genetic testing such as 23andMe, methylation pathway panels (Health Diagnostics), blood amino acids, or urine organic acids (Metametrix). Stool testing is also a valuable insight where indicated to detect dysbiosis, malabsorption, or parasites (Doctor’s Data).

How much do these tests cost?

Basic lab testing is covered by insurance and occasionally specialty testing from Metametrix or Doctor’s Data is reimbursable. Genetic testing from 23andMe is the most affordable option at $99, and never needs to be repeated. The raw data is easily analyzed using free tools online. Methylation pathway testing runs about $350, and testing for other markers can range anywhere from $200-500.

How long does it take to tell if supplements are making a difference?

High potency, quality supplements are very important to me. I personally use, continuously or on a trial basis, every supplement I recommend. Frequently effects are felt immediately after 1 or 2 days while other types of supplements have less dramatic effects and are only truly appreciated once stopped. Some core supplements should be taken daily indefinitely, but others are only recommended for short courses such as specialized probiotics, immunomodulators, and natural anti-microbials.

Can you say a bit more about ‘core supplements’ for ME/CFS. Recognizing that ME/CFS is a diverse disorder can you identify some of the core supplements that people with ME/CFS end up taking on your program? 

The core supplements I refer to are those that I would recommend for everyone regardless of health status. I strongly believe these nutrients are good insurance policies for overall health. Even with a “perfect” diet, it is virtually impossible to obtain all our nutrients from foods in this modern world. This notion is reaffirmed by many researchers including Bruce Ames, PhD, who I consider the modern day Linus Pauling. His decades of research support regular supplementation with a multi-vitamin / multi-mineral in order to optimize micronutrients and enzymatic pathways, thus preventing degenerative diseases of aging. Vitamin D is also an essential nutrient given the epidemic of deficiency worldwide due to reduced sun exposure. Finally, I recommend fish oils universally, as DHA/EPA are vital for cardiovascular and brain health. These core supplements are the best researched in general, and play important roles in healthy aging and many aspects of CFS pathophysiology.

Do you incorporate any so-called brain stimulants or Nootropics such as bacopa, piracetam or gingko biloba into your treatment protocols? 

Nootropics certainly play a key role in brain function and I do recommend them to improve persistent cognitive fog. They are thought to work in a similar fashion as drugs such as Modafinil or LDN, which some CFS patients are prescribed. Piracetams and others of the –acetam class are difficult to obtain due in part to the risk of hepatotoxicity.

I like to use a product from Designs for Health called Brain Vitale that contains a combination of safer nootropics including glycerophosphocholine (GPC), gingko, phosphoditylserine (PS) and acetyl-L-carnitine. Nootropics such as these have erased my aphasia (inability to form words) completely.

Do you use D-Ribose much?  Do you find it effective? 

I first tried D-Ribose when I started Dr. Teitelbaum’s protocol but I don’t use it on a regular basis now. I know many people experience great benefit with D-ribose, and there is no doubt that it is a vital energy source for the mitochondria. From my experience, I prefer instead a different approach to mitochondrial support with intermittent fasting, a high fat diet, and lipid replacement therapy.

In one of your blogs you talk about Lithium’s possible role in the methylation cycle and ME/CFS. I have never heard of Lithium mentioned in connection with ME/CFS before. Can you give us another example of something else that might help in ME/CFS that most people have never heard of?

I’m currently looking into bacteriophage therapy for treatment resistant dysbiosis. Bacteriophages make up the human virome as innocuous viruses that feed on bacteria. Phage therapy has been used for decades but was displaced when penicillin was discovered. Now there is renewed interest in phage therapy due to the rise in antibiotic resistance. I think this may be a valuable new intervention for those who continue to struggle with chronic infections in the gut that do not resolve with pharmaceutical or nutraceutical interventions. The research, however, is still several years off.

• Check out “Getting to Know Bacteriophages“

It seems like new nutrients and new supplement possibilities turn up all the time.  Recently I’ve been in touch with two people who benefited greatly from Moringa oleifera and Empower Plus Q96 –  two things I’d never heard of. How do you keep up with them? 

There are many new and exciting products coming on the market thanks to advances in technology. I stay abreast of new products through communication with several companies that I follow closely and interact with at seminars/webinars. An added benefit of being a healthcare provider is getting to try many sample products. Over the years I’ve noticed a vast improvement in the quality of supplements with added attention to purity, labeling, and sourcing due to concerns over GMO’s, among other things. There is also a new focus on delivery–with acid-resistant probiotics and liposomal formulations that dramatically improve bioavailability. Both patients and doctors are putting pressure on supplement companies to manufacture the highest quality products possible and produce research to back them up.

Besides supplements what other treatment approaches do you use?

I start with dietary recommendations; since nutrients obtained from food are better utilized by our cells than supplements. I recommend a nutrient-dense diet that could be called a modified Paleo diet—no grains, no dairy, no sugar. In general, I universally recommend low carbohydrate eating that is high in vegetables and quality fats and moderate in protein. In certain individuals I will recommend intermittent fasting or periods of ketogenic eating—both of which have direct effects on the immune system, the gut, and inflammatory markers. I wrote more about the physiological effects of this type of diet in a 2-part blog post found here

Health Rising’s Supplements in ME/CFS and FM Series

• Pt. I: Five Supplement Mistakes You Don’t Want to Make with Fibromyalgia or Chronic Fatigue Syndrome
• Pt. II: Creating a Supplement Program for Fibromyalgia and ME/CFS That Works

Health Rising is not affiliated with Dr. Craig in any manner 

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Dr. Courtney Craig was first diagnosed with CFS as a teen in 1998, and recovered in 2010 utilizing both conventional and integrative medicine. Trained as a doctor of chiropractic and nutritionist, she now provides nutrition consulting and blogs about what she’s learned on her website.

Check out her Health Rising  blogs here.

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