Most women have difficulty getting their nutrient intake up to the levels needed for optimal healing using diet alone. The use of supplements can help make up this deficiency so you can heal as rapidly and completely as possible. I do want to emphasize the importance of a good diet along with the use of supplements. Supplements should never be used as an excuse to continue poor dietary habits. I have found that my patients heal most effec-tively when they combine a nutrient rich diet with the right mix of supplements.

This chapter is divided into four sections. The first discusses the role of vitamins and minerals; the second section explains the beneficial effects of fatty acids. The third section tells which herbs help relieve chronic fatigue. I end the chapter with specific recom-mendations on how to make and use your own supplements, along with a series of charts that list major food sources for each essential nutrient.

Vitamins and Minerals for Chronic Fatigue
Many vitamins and minerals are useful in the treatment and pre-vention of fatigue. While a high nutrient diet plays an important role in combating fatigue, you may get the best therapeutic results by adding supplements to boost the level of these nutrients. However, I must caution you to use supplements very carefully. This chapter includes formulas with specific dosage recommendations for supplements, but I suggest that you start slowly. You may want to begin with as little as one-fourth of the listed dose, to see how you tolerate the supplements. You can then increase your dose gradually until you find the level that works best for you. Very rarely, women experience nausea or diarrhea when begin-ning a supplement program. If this happens, your body is having difficulty tolerating a particular supplement. In this case, stop all supplements. After a week you may want to begin your supple-ment intake again. Start with one supplement at a time until you discover which one gives you trouble. You should probably eliminate that supplement from your program. Before taking any supplements, consult your physician or a nutritionist with specific questions about their use or possible side effects.

Vitamin A
This nutrient helps protect the body against invasion by pathogens such as viruses (which might trigger chronic fatigue syndrome) and by bacteria, fungi, and allergies. It does this in several ways. Vitamin A supports the production and maintenance of healthy skin, as well as the mucous membranes that line the mouth, lungs, digestive tract, bladder, and cervix. When these tissues are healthy, invaders have difficulty penetrating the mem-branes, the body's first line of defense. Vitamin A also enhances the immune system by increasing T-cell activity (these are impor-tant cells that help to fight infectious disease). Vitamin A also contributes to the health of the thymus, a gland located in the chest that plays an important role in maintaining healthy immune function.

Because Vitamin A is needed for normal production of red blood cells, it helps prevent fatigue caused by anemia. It also helps control the tiredness caused by anemia that occurs with heavy menstrual bleeding.

Vitamin A should be used carefully. It is a fat-soluble vitamin that is stored in the body. You should not take more than 20,000 I.U. (international units) per day without being monitored by a physician. An overdose of vitamin A can cause headaches and stress the liver.

Beta carotene, called provitamin A, is a precursor of vitamin A found in fruits and vegetables. Beta carotene is water soluble and, unlike vitamin A, does not accumulate in the body. As a result, it can be used safely in high doses. Certain foods, such as sweet potatoes and carrots, contain large amounts of beta carotene. A single sweet potato or a cup of fresh carrot juice contains 25,000 I.U. of beta carotene.

Provitamin A also enhances immune function. It stimulates immune cells called macrophages and helps trigger increased immune activity against certain bacteria as well as candida. Beta carotene is also a powerful antioxidant that helps to protect the body from damage by free radicals. Free radicals are chemicals that occur as by-products of oxygen use in the body, exposure to ultraviolet light, and other natural processes; they can damage the cell membranes as well as other parts of the cell. Antioxidants like beta carotene neutralize free radicals.

Vitamin B Complex
This complex consists of 11 vitamin B factors. The whole complex works together to perform important metabolic functions, including glucose metabolism, stabilization of brain chemistry, and inactivation of estrogen. These processes regulate the body's level of energy and vitality. Because B vitamins are water soluble and are not stored in the body, they are easily lost when a woman is under stress or is eating unhealthy food, including coffee, cola drinks, and other caffeine containing beverages. Fatigue and depression can result from the depletion of B vitamins.

Many women with anemia are deficient in three B-complex vitamins: folic acid, pyridoxine (vitamin B6), and vitamin B12. All three are needed for normal growth and maturation of red blood cells. Their deficiency leads to anemia and fatigue. Supplemental vitamin B12 is necessary for women on a vegetarian diet. It is usually given by injection.

Vitamin B6 is extremely important in relieving and preventing fatigue. In women who are prone to fatigue caused by bacteria, viruses, candida, or allergies, B6 supports a healthy immune response. Vitamin B6 is needed for both the production of antibodies by white blood cells and the production of T-cell lymphocytes by the thymus. This vitamin also appears to help enhance the activity of the T-cells, making them more effective in destroying infectious agents.

Vitamin B6 helps reduce PMS related mood swings, fatigue, food cravings, and fluid retention through its effect on glucose metabolism and its participation in prostaglandin synthesis. Prostaglandins hormones that regulate many important physiological functions are formed in the body from certain essential vegetable and fish oils. The essential fats can only be converted to prostaglandins in the presence of B6 and other essential nutrients. Prostaglandin deficiency adversely affects brain chemistry and mood and can worsen fatigue.

Women using birth control pills and menopausal women on hormonal replacement therapy can be prone to fatigue because the use of hormones causes vitamin B6 deficiency. Finally, B6 deficiency has been found in fatigued women who suffer from depression. Vitamin B6 can be taken safely by most women in doses up to 250 milligrams. Doses above this level should be avoided because B6 can cause toxic symptoms in the nervous system in susceptible women.

The B-complex vitamins are usually found together in beans and whole grains. These foods should be part of the diet of women with chronic fatigue, who would also probably benefit from the use of supplemental vitamin B.

Vitamin C
This an extremely important nutrient for fatigue. In one research study done on 411 dentists and their spouses, scientists found a clear relationship between the presence of fatigue and lack of vitamin C. By supporting the immune func-tion, vitamin C helps prevent fatigue caused by infections. It stimulates the production of interferon, a chemical found to prevent the spread of viruses in the body. Necessary for healthy white blood cells and their antibody production, vitamin C also helps the body fight bacterial and fungal infections. Women with low vitamin-C intake tend to have elevated levels of histamine, a chemical that triggers allergy symptoms. Vitamin C is an important antistress vitamin, needed for the production of sufficient adrenal gland hormones. Healthy adrenal function helps prevent fatigue and exhaustion in women who are under physical or emotional stress.

In women with iron deficiency anemia, vitamin C increases the absorption of iron from the digestive tract. Vitamin C has also been tested, along with bioflavonoids, as a treatment for anemia caused by heavy menstrual bleeding a common cause of fatigue in teenagers and premenopausal women in their forties. Vitamin C reduces bleeding by helping to strengthen capillaries and prevent capillary fragility. One clinical study of vitamin C showed a reduction in bleeding in 87 percent of women taking supplemental amounts of this essential nutrient. The best sources of vitamin C in nature are fruits and vegeta-bles. It is a water soluble vitamin, so it is not stored in the body. Thus, women with chronic fatigue should replenish their vitamin C supply daily through a healthy diet and the use of supplements.

Bioflavonoids
These nutrients are found abundantly in flowers and in fruits, particularly oranges, grapefruits, cherries, huckleberries, blackberries, and grape skins. Besides giving pigmentation to plants, they have a number of beneficial physiological effects that can help decrease fatigue symptoms. Bioflavonoids are powerful antioxidants that help protect cells against damage by free radicals. They help protect us from fatigue caused by allergic reac-tions, because their anti-inflammatory properties help prevent the production and release of compounds such as histamine and leukotrienes that promote inflammation. Bioflavonoids such as quercetin have powerful antiviral properties that protect us from infections. Quercetin also inhibits the release of allergic compounds from mast cells the cells in the digestive and respiratory tract that release histamine.

Bioflavonoids are among the most important nutrients for mid-life women suffering from menopausal symptoms. Bioflavonoids produce chemical activity similar to estrogen and can be used as an estrogen substitute. Clinical studies have shown that bioflavonoids can help control hot flashes and the psychological symptoms of menopause, including fatigue, irritability, and mood swings. Interestingly, bioflavonoids contain a very low potency of estrogen, much lower than that used in hormonal replacement therapy. As a result, no harmful side effects have been noted with bioflavonoid therapy.

Because of their ability to strengthen capillary walls, bioflavonoids have also shown dramatic results in reducing the anemia caused by heavy menstrual bleeding. They have been used in women with bleeding caused by hormonal imbalance and have even been tested in women who have lost multiple pregnancies because of bleeding. They were used in conjunction with vitamin C In these studies. Bioflavonoids are often found with vitamin C in fruits and vegetables.

Vitamin E
This vitamin can enhance immune antibody response at high levels and has a significant immune stimulation effect. Vitamin E has antihistamine properties and should be used by women who suffer from allergies. One group of volunteers who were injected with histamine showed far less allergic swelling around the injection site when they were pretreated with vitamin E.

Like vitamin C and beta carotene, vitamin E is an important antioxidant. It protects the cells from the destructive effects of environmental pollutants that can react with the cell membrane. Because it has been found to increase red blood cell survival, it is an important nutrient for the prevention of anemia.