Fatigue

[Loriyas]

Hi all. Haven't been here for a while. Quick question:I am experiencing fatigue to a degree I never have before. I am wondering what anyone else who deals with it does to alleviate it? I have tried everything I know and am still having difficulty. Neurologist, of course, is no help. Provigil, B12, vitamin D, rest, exercise, eating right, and a few other things I can't think of right now because I'm too tired!! What am I missing?

[jimmylegs]

HEY first thing i thought was, there's a familiar name how much d3 on a daily basis? any cofactors with it? and how much b12, what times of day? any b complex with? anything else in the nutritional regimen? do you have a serum ferritin test on file?

[Loriyas]

Hi Jimmy
50,000 iu vit D/week per Vanderbilt neurologist
B12 injection every 2 weeks/General Practioner. I have to go to his office to get it. I don't know dosage
3000 mcg sublingual B12 daily
no feritan test that I know of

Light bulb moment-it is D2 not D3. I have gone around w neuro about this. Do you think I could add D3 to regimen as well?

[Loriyas]

I do get 400 iu/day of D3 in multivitamin. So there is that...

[Quest56]

I take 500mg acetyl l-carnitine 3-4 times daily on an empty stomach to help reduce physical fatigue.

[jimmylegs]

hi you're right d3 is better than d2. so some cofactors are going in via the multivit. i did ask about the d3 not directly for energy per se but in case your d3 intake might be driving down tissue cofactor levels of nutrients required for energy.

i used to take 4000 IU d3 daily (so under 30K per week) with a little bit of daily mag, but the mag i did take was not enough. after a couple of years i personally ended up with breathing and swallowing difficulties. but mag has hundreds of things to do in the body so a deficit can manifest differently in different individuals. one of those hundreds of things is to cart ATP (aka Mg-ATP aka your 'energy currency') around your body.

when i was suffering the most, a pharmacist told me to take more mag and to time it better if i was going to stick with high dosing vit d. he said to ensure half the daily supplemental magnesium went in *with* d3, with the other half taken at a diff time of day, to allow for magnesium absorption for other purposes. it took me months before i didn't feel magnesium actually 'kick in' in my throat each time i took it, and years to restore depleted tissue mag to the point where i could go a day without a supplement, and not immediately feel increased muscle spasticity.

so that's my own scenario, but how each person's body uses mag depends on so many different interconnected factors that in your specific case, low mag could readily be affecting energy levels. not to mention that everyone is pretty much guaranteed to be low in mag without even adding d3 into the mix.

i'm surprised you need b12 injections every other week in addition to 3000 mcg sublingual b12 daily. what is the form of sublingual cobalamin? side question - any trouble sleeping at night with that intake? b12 and b6 work together on mood so it could be an idea to work in a b50 complex here and there, to keep natural ratios in line. i haven't seen any studies on whether loading b12 disturbs b vitamin ratios in the body and whether that can influence function, but i definitely *have* seen that when researchers are looking at the vitamin e complex. my fave ms diet/nutrient protocol (klenner - decades old and in need of an update) advocates for the entire b complex.

serum ferritin is an indicator of iron status, related to your blood's ability to deliver oxygen to cells. most common nutrition issue in general, even more so for premeno ladies whose daily iron requirements are more than double an adult man's. my daily high quality multi for some reason has no iron. last time (ie within last 6 months or so i would say) i went a bit overboard on vegetarian diet i started to feel pretty off and had to have someone bring me some floravit liquid iron supplement. i dislike it so much i just made sure to boost the iron density in the diet with more lentils, spinach and vit C, plus more servings here and there of things like clam chowder, ensure a serving of high quality red meat once a week (even if i sort of spread it out over more than one meal), etc. have been fine ever since on the iron/energy front.

[Loriyas]

Ok I am going to up the D3.

I hadn't thought about mag so will add it

I will continue with what I was doing, plus add the above. I will give it some time to see how well it works and if I need to adjust anything.

I did have bronchitis then walking pneumonia and although I am better from that perhaps it is taking me longer to get energy back. I was already low on energy before getting sick so I guess it is just going to take me longer.

Thanks for your insight!

[Scott1]

Hi

As part of something else, I wrote a little bit on fatigue and what i do about here- http://www.mstranslate.com.au/ms-many-s ... e-fatigue/ .

It may be of use to you.

Regards,

[jimmylegs]

hi sry i was unclear. i meant the magnesium was not enough cofactor to deal with my high vit d intake (even though it was lower than yours probably even after you adjust for the d2 d3 issue) and i paid the price. if your d3 is driving mag down, it will be the mag you need more of. if your mag status is indeed low, improving that should improve your d3 absorption and serum levels as well.

if you're dealing with infections, look at antibacterial / antiviral nutrients like zinc and selenium in diet and in any supplements. good zinc will help you absorb the vit b12 as well (i *will* find the study for that again :S not today tho)

that just bounced my brain over to one memory: for virus fighting i like the combo vit A C E plus zinc and selenium. these come in a single combo supplement but i don't particularly like their ratio so i often have all the ingredients separately so i can build my own. once i had been out of vit A thinking meh, how much difference can it make. then i got some and added it in and WOW it was like night and day. you could still tell you were fighting something off, but didn't 'feel sick' any more. zinc helps the body utilize vit A, so it makes sense that the wonder powers were activated once all the players finally showed up lol

[NHE]

Light bulb moment-it is D2 not D3. I have gone around w neuro about this. Do you think I could add D3 to regimen as well?

Here are two relevant papers on D3. The first compares D3 to D2. D2 can lower your D3 levels. The second showed a 32% increase in absorption of D3 by taking it with a meal that includes fat. In light of this second paper, I've switched to taking my D3 with dinner.


Vitamin D2 is much less effective than vitamin D3 in humans.
J Clin Endocrinol Metab. 2004 Nov;89(11):5387-91.

Vitamins D(2) and D(3) are generally considered to be equivalent in humans. Nevertheless, physicians commonly report equivocal responses to seemingly large doses of the only high-dose calciferol (vitamin D(2)) available in the U.S. market. The relative potencies of vitamins D(2) and D(3) were evaluated by administering single doses of 50,000 IU of the respective calciferols to 20 healthy male volunteers, following the time course of serum vitamin D and 25-hydroxyvitamin D (25OHD) over a period of 28 d and measuring the area under the curve of the rise in 25OHD above baseline. The two calciferols produced similar rises in serum concentration of the administered vitamin, indicating equivalent absorption. Both produced similar initial rises in serum 25OHD over the first 3 d, but 25OHD continued to rise in the D(3)-treated subjects, peaking at 14 d, whereas serum 25OHD fell rapidly in the D(2)-treated subjects and was not different from baseline at 14 d. Area under the curve (AUC) to d 28 was 60.2 ng.d/ml (150.5 nmol.d/liter) for vitamin D(2) and 204.7 (511.8) for vitamin D(3) (P < 0.002). Calculated AUC(infinity) indicated an even greater differential, with the relative potencies for D(3):D(2) being 9.5:1. Vitamin D(2) potency is less than one third that of vitamin D(3). Physicians resorting to use of vitamin D(2) should be aware of its markedly lower potency and shorter duration of action relative to vitamin D(3).






Dietary fat increases vitamin D-3 absorption.
J Acad Nutr Diet. 2015 Feb;115(2):225-30.

BACKGROUND: The plasma 25-hydroxyvitamin D response to supplementation with vitamin D varies widely, but vitamin D absorption differences based on diet composition is poorly understood.

OBJECTIVES: We tested the hypotheses that absorption of vitamin D-3 is greater when the supplement is taken with a meal containing fat than with a fat-free meal and that absorption is greater when the fat in the meal has a higher monounsaturated-to-polyunsaturated fatty acid ratio (MUFA:PUFA).

DESIGN: Open, three-group, single-dose vitamin D-3 comparative absorption experiment.

PARTICIPANTS/SETTING: Our 1-day study was conducted in 50 healthy older men and women who were randomly assigned to one of three meal groups: fat-free meal, and a meal with 30% of calories as fat with a low (1:4) and one with a high (4:1) MUFA:PUFA. After a 12-hour fast, all subjects took a single 50,000 IU vitamin D-3 supplement with their test breakfast meal.

MAIN OUTCOME MEASURES: Plasma vitamin D-3 was measured by liquid chromatography-mass spectrometry before and 10, 12 (the expected peak), and 14 hours after the dose.

STATISTICAL ANALYSES PERFORMED: Means were compared with two-tailed t tests for independent samples. Group differences in vitamin D-3 absorption across the measurement time points were examined by analysis of variance with the repeated measures subcommand of the general linear models procedure.

RESULTS: The mean peak (12-hour) plasma vitamin D-3 level after the dose was 32% (95% CI 11% to 52%) greater in subjects consuming fat-containing compared with fat-free meals (P=0.003). Absorption did not differ significantly at any time point in the high and low MUFA and PUFA groups.

CONCLUSIONS: The presence of fat in a meal with which a vitamin D-3 supplement is taken significantly enhances absorption of the supplement, but the MUFA:PUFA of the fat in that meal does not influence its absorption.

[jimmylegs]

smart move NHE we need dietary fat for absorption/utilization of any of the fat soluble essential nutrients including vits A D E and K.

eg: Effect of dietary fat on absorption of β carotene from green leafy vegetables in children.
http://bit.ly/2ktxGHV

[ElliotB]

Fat is a fuel that supplies the body with a good and natural energy source. Good fats (such as Omega 3 fats) are indeed good for you and may help with fatigue. Saturated and trans fats should be avoided.

Good sources of Omega 3 fats aside from supplements include wild caught fatty fish like salmon and tuna as well as grass fed meats.

[Loriyas]

Thank you all for your replies. Lots of information to go over. I'm glad I brought this topic up as there is a lot of new information since this was discussed some time ago.
Lori

[jimmylegs]

sounds good once you've absorbed the above (haha no pun intended), say so and then we can dig in on best magnesium sources in diet and from supplements (which are NOT all created equal). fun fun fun ;)

[Loriyas]

Ok will do JL! Thanks!