- Vitamin A (as retinol or beta-carotene)
- Vitamin C
- Vitamin E
- Vitamin B12
- GP (Glutathione peroxidase), which can be supplemented directly via injections or liposomal products, indirectly (e.g. NAC - see below), or by supplementing its precursor selenium
- NAC (N-acetylcysteine) is not an antioxidant, but it works to restore glutathione.
- SOD (Superoxide dismutase), which can be supplemented directly (e.g. GliSODin), or by supplementing its precursors zinc, copper, iron and manganese
Non-essential anti-oxidants (beneficial extras):
- Lipoic acid, which can be supplemented directly (e.g. ALA/Alpha Lipoic Acid), or obtained from food
- Phytonutrients [phyto = from plants]
To clarify, phytonutrients are referred to in two ways, either as 1) the nutrient itself, or as 2) the natural source of the nutrient. For example, bilberries are a natural source of bioflavonoids.
1) Phytonutrients: Anthocyanidin, probably the most important. Also bioflavonoids and lycopene
2) Natural sources of phytonutrients: Ginkgo biloba, pycnogenol (pine bark), grape seed extract, turmeric, bilberries, and others. There are many natural substances which have antioxidant action.
Antioxidants can be particularly helpful for people with M.E. because they work to clear the toxins which overwhelm our bodies. M.E. involves mitochondrial dysfunction, in which impeded cell metabolism results in harmful free radicals which the body cannot clear. (Free radicals are highly unstable molecules which interfere with necessary chemical processes in the body.) Thus people with M.E. produce more free radicals than healthy people. Free radicals damage cells, cause inflammation and vascular damage (which in turn can cause brain dysfunction), muscle and joint pain, and generally poison the body. Free radicals also cause damage which is not specific to M.E., such as aging and cancer.
In addition to the fact that people with M.E. produce higher than normal levels of free radicals just by being alive, the world we live in produces free radicals in our bodies; pollution, electro-magnetic radiation and fried food produce free radicals, which is why people with M.E. are advised to avoid these threats as much as possible.
Antioxidants clear free radicals from the body, and assist with detoxification and repair.
How antioxidants work
Antioxidants work together to disarm harmful free radicals. They all work together in a chain, each one dealing with the product of the action of the previous one. Vitamin E disarms the free radical, but in the process produces a vitamin E radical, which needs to be dealt with. Vitamin C recycles vitamin E, disarming the vitamin E free radical. Glutathione recycles vitamin C. CoQ10 also recycles vitamin E. Beta-carotene and anthocyanins also recycle vitamin C, as does lipoic acid. Anthocyanins also recycle glutathione.
How B12 works (a special case)
Vitamin B12 isn't one of the conventional antioxidants, but it is very important for people with M.E. The body has lots of systems for clearing free radicals (e.g. CoQ10 and manganese-dependent SOD within the mitochondria, while outside the mitochondria there are vitamins A, C, E, zinc- and copper-dependent SOD, glutathione peroxidase, acetyl L carnitine etc.) However, when these don't work sufficiently well, Vitamin B12 takes over their functions.
As described above, normal cell metabolism results in free radicals. Cell metabolism in people with M.E. produces more free radicals than in healthy people. Nitric oxide causes brain dysfunction. The hypothesis is that these free radicals may cause some of the symptoms of M.E.
Vitamin B12 is the most powerful scavenger of nitric oxide, therefore helping the symptoms of M.E.
How to take antioxidants
Antioxidants work together, and should be taken together. Often antioxidant supplements have many of these nutrients combined.
Antioxidants can be taken as supplements. However, these can be expensive and beyond the pockets of M.E. sufferers, so it is worth noting that some antioxidants can be obtained from food (though obviously in less concentrated doses than in supplement form).
Vitamins A and E - these are fat-soluble, so it is possible to overdose on supplements, particularly vitamin A (the body will excrete excess water-soluble vitamins in urine, but cannot clear fat-soluble vitamins so easily). If taking supplements, make sure the dose is appropriate.
Vitamin C - this is an important vitamin to supplement, as it has so many roles (immune system, etc.), and it is very difficult to obtain enough from food (food loses vitamin C rapidly during storage).
Vitamin B12 - there are issues about absorption, so B12 should be taken as a supplement sublingually (under the tongue). Some doctors recommend injections.
Glutathione - supplementing glutathione directly is not recommended unless it is in the injectable or liposomal form.
Selenium (precursor to glutathione peroxidise) - from brazil nuts or supplements.
Lipoic acid - from liver and yeast or supplements. Lipoic acid is a versatile antioxidant as it is both water- and fat-soluble, so it can protect against free radicals from many foods.
Phytonutrients - lycopene from tomatoes, bioflavonoids from berries. Fruit and vegetables generally are full of phytonutrients. Although some fruits and vegetables are high in particular phytonutrients, beware of so-called 'superfoods.' These are often no higher in phytonutrients than other fruits and vegetables, but are extremely expensive because of the 'superfood' label. Eating many different types of fruits and vegetables and many different coloured fruits and vegetables is far preferable to eating large amounts of a small number of so-called 'superfoods.'
The detoxifying effect of antioxidants releases toxins into the body. This can cause a Herxheimer reaction, in which the person feels extremely sick (both body and brain can be affected). People with M.E. are particularly vulnerable to this, as their livers, which should clear toxins, may not be working efficiently and also because their bodies are already so dysfunctional (e.g. central nervous system, brain and cardiac dysfunction).
People with M.E. should be cautious in taking some antioxidants, and start with small doses. This seems particularly true of ALA and NAC. Many M.E. patients may find they have to avoid cysteine altogether.
Most of the above was taken from:
Patrick Holford's 'New Optimum Nutrition Bible 2004' (Holford is the founder of the Institute of Optimum Nutrition in London, and he works with Higher Nature company on formulating supplements).
Dr. Sarah Myhill, 'Diagnosing and Treating Chronic Fatigue Syndrome' a book which is available from her website www.drmyhill.co.uk (Unfortunately Dr. Myhill does not focus on M.E., - and makes little if any distinction between genuine neurological M.E. and 'CFS' or even various types of 'chronic fatigue' unbelievably, and again, unfortunately - which means that some of her advice is not right for our illness, but she provides useful information on treatment (but NOT diagnosis), to a certain extent).
Part 2: RNase L, cancer risk, antioxidants and M.E. by Lesley Ben
The immune system has two types of cells, T helper cells 1 and 2. Th1 works inside the cell against intra-cellular pathogens such as viruses, cancer, yeast and intra-cellular bacteria like mycoplasma and chlamydia pneumonia. Th2 works outside the cell against extra-cellular pathogens in blood and other fluid, such as allergens, toxins, parasites and bacteria (i.e. normal extra-cellular bacteria).
M.E. causes a switch in the immune system, away from Th1. Th1 cells are suppressed and Th2 cells are activated. M.E. patients have more Th2 cells than Th1 cells. They also typically have low natural killer (NK) cells which are the weapons of the Th1 system, and high white cells and antibodies, the weapons of the Th2 system.
Thus the anti-viral immune system is suppressed, while the antibody-mediated anti-bacteria, anti-allergen etc. system is activated. So M.E. patients over-respond to allergens and toxins etc. They are under-defended against viruses and yeasts etc, and may be unable to keep viruses from past exposure suppressed, so may get viral re-activation.
In a nutshell:
Th1 = inside cell, protection from viruses etc
Th2 = outside cell, protection from allergens, toxins, bacteria etc
M.E. causes a switch from Th1 to Th2
M.E. patients are Th1 suppressed and Th2 activated
This is why:
- M.E. patients are particularly vulnerable to viruses, yeasts etc. and viral re-activation
- M.E. patients over-respond to allergens, toxins etc, i.e. allergic reactions, MCS etc
The role of RNaseL in immune response
RNaseL is like a footsoldier with limited powers, trying to hold the line against the enemy while waiting for the cavalry to arrive. RNaseL prevents pathogens from reproducing, waiting for Th1 to come and kill them. The problem is that in Th1-suppressed M.E. sufferers, Th1 never comes to the rescue. RNaseL gets worn out. It eventually shifts into exhausted mode, the more deadly and toxic Low Molecular Weight form (discovered by Suhadonlik). Eventually RNaseL disappears altogether.
Another factor in the decrease of RNaseL is that it is a protein and requires growth hormone. Human growth hormone (HGH) is suppressed in this illness. In a 2008 lecture, Byron Hyde discussed growth hormone manufacture in stage 4 sleep, of which M.E. sufferers get little or none. Lack of growth hormone wipes out RNaseL.
Thus RNaseL status changes over time, a process which may take many years. There may initially be high levels as RNaseL is activated in response to pathogens, then it diminishes, changes to LMW form, and disappears. Tests of RNaseL status can be used to chart the progression of disease.
Despite many claims to the contrary, abnormal RNaseL is not specific to M.E.
Abnormal RNaseL levels are not specific to M.E. RNaseL activation giving raised levels is common to immune response to viruses and infection.
However, the Low Molecular Weight form of RNaseL, the exhausted 'after-burner' form, was discovered in `CFS' patients by Suhadolnik. The molecular weight of RNaseL is normally 80 kDa, but Suhadolnik discovered RNaseL in `CFS' patients of 37 kDa. The presence of this Low Molecular Weight form has been seen as specific to the illness, but this assumes that 'CFS' is a distinct disease or a distinct patient group which is clearly not at all the case.
My thoughts on LMW form:
1) Suhadolnik was looking at `CFS' patients, not M.E., and I don't know by what criteria his patients were selected.
2) The LMW form certainly indicates that something is very wrong with immune function. It hasn't been discovered in patient groups other than `CFS' ones, but as 'CFS refers to a very large and mixed patient group it cannot be said to be unique to any patient group, and certainly not to M.E.
In M.E. the immune system is both down regulated AND upregulated at the same time
This puzzled me for a long time, and I couldn't make any sense of different studies which talked about up- and down-regulation.
Things fell into place for me when I understood that the immune system normally acts in two different ways, depending on the type of pathogen it encounters - but that in M.E., one response is suppressed and the other is activated.
As described, Th1 cells respond to intra-cellular pathogens: viruses, cancer, yeast, mycoplasma & CPN. Th2 cells respond to extra-cellular pathogens: allergens, toxins, bacteria & parasites. In M.E., Th1 is suppressed & Th2 activated - for me, this was helpful to understand, because it explains why we are often vulnerable to viruses, but at the same time, develop allergies when we over-respond to allergens.
May I add a bit more to the story? This next bit amazed me, with the low-down cunning of biological organisms:
It's not quite that there are two different systems, the Th1 & Th2 system, but rather that at first, Th cells are neither one nor the other - they start as Th0 cells, what Cheney calls 'naive or unformed cells.' When an invading pathogen comes along, they convert to either Th1 or Th2, depending which type the pathogen is.
It's so clever, how 'naive' Th0 converts to the appropriate defence, depending on the type of threat - if it encounters virus, cancer etc, a cytokine called Interleukin-12 is produced, which causes the Th0 cell to turn into a Th1 cell, all ready to fight. If the Th0 cell encounters allergen, toxin etc, another cytokine called Interleukin-10 is produced, which turns the Th0 cell into the appropriate Th2 fighter. (I had read about cytokines and Interleukin, and never really understood it - now I picture the different kinds of Interleukin as chemical messengers, running from the invading army to the waiting defenders, telling them what kind of fighters to turn into, to best fight off the approaching threat.)
As the 'naive' Th0 cells grow up into the appropriate type of fighter, depending on the threat, they develop the appropriate type of weapons. (I picture a young child, responding to the messenger by suddenly growing up into a fighter, taking up the right kind of weapons.) The weapons developed if the cell becomes a Th1 cell are cytotoxic T cells and Natural Killer cells. In other words, these are the weapons that fight viruses, cancer etc. The Th2 cell has different weapons, including antibodies.
The following bit amazed me: even though the defenders are so clever, turning into the appropriate type of cell with the appropriate type of weapons to fight off whatever the threat is - the attackers can be even cleverer!
Some cunning viruses MIMIC the other sort of threat! (I laughed in amazement when I understood this.) Some viruses like CMV & HHV6 give off a chemical messenger similar to the one that indicates they are the other sort of threat, i.e not a virus but an allergen, toxin etc. (i.e. a peptide similar to Interleukin-10). They pretend! They disguise themselves!
(Although do note that we know for a fact that herpes viruses do NOT cause M.E., and that this has been scientifically proven for decades.)
The defenders are deceived, and the Th0 cells turn into the wrong sort of fighters, Th2 cells. The poor body is defenceless against the real threat, having no Th1 cells, and instead has useless Th2 cells running around, causing other problems like allergies etc.
From the virus's point of view, it wins its survival by deceiving the body into thinking it isn't a virus but something else, so that the body's defences are mobilised to fight off another kind of threat, and don't kill off the virus.
Not only that, but the virus also helps his friends - other viruses that might want to invade in future. The body gets stuck switched to Th2 mode, so that it's permanently Th1-suppressed and Th2-activated.
M.E. increases our susceptibility to cancer, particularly Non-Hodgkins Lymphoma. I don't mean to be alarmist, and there are things we can and should do to protect ourselves. I've only recently understood the mechanics of the cancer connection in simple terms, and even though I find it frightening, I was glad to feel at least I understood it a bit.
Our vulnerability to cancer is due to the decrease in RNaseL, as described previously. RNaseL provides cancer protection. Lack of RNaseL leaves the person susceptible to cancer.
This is why some M.E. patients develop cancer (particularly Non-Hodgkin's Lymphoma), typically some years after the onset of M.E. As described above, as the disease wears on, RNaseL diminishes, changes to the LMW form, and then is gone. This process, which leaves the patient vulnerable to cancer, may happen over many years. Some M.E. patients develop cancer 10, 15 years or more after they developed M.E.
I believe that the fact that an occurrence of cancer was caused by M.E. is often lost, and the cancer is seen as separate misfortune, because the above is not widely-enough understood. Such deaths are deaths attributable to M.E. - this is yet another way in which M.E. may be a fatal disease.
It is good to know about this possible susceptibility to cancer, I believe, so that we are motivated to protect ourselves. We should avoid known carcinogens such as pollution, electro-magnetic frequencies, deep-fried or burnt food, chemicals in food, etc. We should take anti-oxidants. We should investigate substances which may have anti-cancer properties.
Unfortunately Dr. Paul Cheney in the U.S. talks about 'CFS' and 'CFIDS' and does not distinguish fully between M.E. and 'CFS' but I feel that his work can be illuminating, as explained in the comments in Question: Is Cheney talking about M.E. or 'CFS'? on HFME. For a more detailed explanation of the above see: Balance the Immune System (Th1/Th2) by Dr. Cheney and other articles and lectures by Dr. Cheney.
Part 3: Liposomal glutathione and M.E. by Jodi Bassett
As Lesley Ben explains in her HFME paper on antioxidants, direct oral glutathione supplementation is not recommended. This is because the supplement breaks down into its different parts in the stomach; glutamate, l-cysteine and glycine.
Recently, however, a new delivery system for glutathione has become available and is thought to be far more effective than glutathione given by injection (which while effective to some extent, only has a half life of 2 minutes in the body) and it is certainly more practical. It utilises nanotechnology to deliver glutathione to the bloodstream and the cells of the body in a way that protects it from degradation by the stomach.
As LivOn labs explain, there are 3 main functions of glutathione (Glutathione Sulfhydryl or GSH):
GSH is the cell's master antioxidant. Not only does GSH function very well as an intracellular antioxidant, but it also recycles Vitamin C, Vitamin E, lipoic acid and peroxide, the cell's other vital antioxidants.
GSH is a powerful detoxifier. The liver, as the body's primary filter, contains more GSH than any other organ or tissue in the body. Not only does GSH neutralize many toxins, but it is also key in their elimination from individual cells and the body. This means GSH is a powerful chelator.
GSH is "super food" for T-killer cells, T-helper cells, basophils, phagocytes, microphages, and leucocytes, greatly empowering these first line defenders in the human immune system.
Glutathione gets to the mitochondria in the cell more effectively than vitamin C can. Overall immune status is inextricably linked with glutathione levels and brain injuries of all kinds are known to cause lowered glutathione levels.
The phosphidatylcholine (PPC) contained in liposomal products also has health benefits as it contains omega 3 and 6 fatty acids and choline, a B vitamin. Liposomal delivery of nutrients represents is 98% absorbed and is an energy sparing delivery system, it doesn’t requite the body to use up electrons to use the supplements as other forms do. Considering that oxidative stress is an extensively documented cause of symptomatology and worsening of all diseases, this is a very important advantage.
As vitamin C experts Dr Levy explains, Vitamin C is the premier extracellular antioxidant and glutathione is the premier intracellular antioxidant. Vitamin C and glutathione are powerful and important antioxidants taken alone and have an even more powerful synergistic effect when they are taken together. They both give the body the ‘rapid and profound influx of electrons’ needed to fight disease and to support heart, lung and brain health and immunity says Dr Levy, who also adds that ‘Virtually all diseases and toxins/poisons cause sickness and death through their electron stealing activity.’
In the book GSH: Master Defender Against Disease, Toxins and Ageing’ Dr Levy continues,
Since no one has ever seen an electron, for most people it remains a theoretical entity. It is this invisibility that makes it so difficult to accept them as real entities that reliably treat diseases more effectively than antibiotics or prescription drugs. Yet this is precisely the case.
Even though it is not possible to give a teaspoon of electrons to a sick child, one can administer medications and/or nutrients that are extremely rich in their electron content. Once a sufficient quantity of electrons is delivered to the body, it brings what can only be described as fantastic clinical results when compared to traditional medical therapies. And, this has already been shown to be true for a wide variety of medical conditions.
Glutathione and vitamin C and other antioxidants are not cure-alls, particularly when it comes to the treatment of long-term diseases. It is also true that prevention is far easier with these treatments than cure. But Dr Levy does explain that even where the disease is too far advanced to be reversed the administration of reduced glutathione and vitamin C can at least provide reliable symptomatic relief.
Glutathione levels can also be boosted indirectly through taking ALA, methionine, sesame oil, garlic, whey, carnitine, vitamin C and selenium. Carnitine and ALA taken together are particularly effective at raising GSH levels, according to Dr Levy.
For more information on liposomal glutathione see Dr Levy’s excellent short book on glutathione ‘GSH: Master Defender Against Disease, Toxins and Ageing’ and the LivOn labs website.
To buy liposomal glutathione or vitamin C see the List of international suppliers of liposomal vitamin C sachets from Livon labs. Liposomal vitamin C from LivOn Labs is the form recommended and used by Dr Levy. Some brands of liposomal vitamin C may not be reputable and may not be selling the same quality product.
Glutathione is also available from some compound pharmacies in a nasal spray form.
Note that the aim of this site is to provide a starting point for health and healing research for ill people; especially very overwhelmed and disabled ill people. This site provides recommendations, summaries and reviews of books but is not meant to be a replacement for actually reading some of these wonderful health books if the reader is at all well enough to do so. (Plus getting individualised advice from a doctor that is also an orthomolecular medicine expert if possible). There is no substitute for reading as many of these books as you can. The HHH site can only really hint at their full brilliance. The amount of insight, scientific references, logic, intelligence, compassion and experience in the recommended books will most likely amaze you. HHH aims to encourage people to do their own reading and learning, and to always make up their own minds. All content copyright Jodi Bassett 2006 - 2014.