Natural Treatment Options for Chronic Fatigue Syndrome

It's not uncommon for those with chronic fatigue syndrome (CFS) to consider natural treatments like vitamin B12, ginseng, L-carnitine when working to find a regimen that works. Chronic fatigue is a complex illness, and no one treatment plan works for everyone. Multi-faceted approaches are typically needed to help manage the syndrome's impactful symptoms, including incapacitating fatigue and pain.

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Although alternative medicine use is quite popular among people with CFS, so far, scientific support for specific treatments is lacking. Research, however, is ongoing.

That doesn't mean that natural treatments may be of no benefit in helping you manage your chronic fatigue. But it's important to consider their use in the context of a complete treatment plan and to consult your healthcare provider before attempting any new options.

Just because a treatment is natural doesn't mean that it is safe, particularly if you are taking conventional medicines, too.

Essential Fatty Acids

Research shows that people with chronic fatigue syndrome have imbalanced levels of essential fatty acids (omega-3s and omega-6s), which may contribute to symptoms such as fatigue and body aches.

The body needs to get essential fatty acids through nutrition because it cannot manufacture them on its own.

A few small studies have found that supplementing with a combination of essential fatty acids found in evening primrose oil and fish oil can lead to an improvement in symptoms. Additional research, however, failed to replicate the results.

While more studies are needed before essential fatty acids can be definitively recommended to ease symptoms of chronic fatigue syndrome, diets rich in essential fatty acids—especially omega-3s—have been shown to have many health benefits, including reducing inflammation and improving cardiovascular health.

Good dietary sources of omega-3s include fatty fish, like salmon, herring, and sardines, flaxseed, walnuts, chia, and certain oils.

Vitamin B12 and Folic Acid

Researchers have been exploring whether vitamin B12 injection or other means of supplementation, along with folic acid, can relieve CFS symptoms.

There is a biochemical theory as to how this may be of benefit: People with CFS show reduced methylation which plays a role in gene expression as well as regulation of many of the body's systems, including detoxification, cardiovascular and the neurologic system. Vitamin B12 and folic acid both promote healthy methylation pathways.

A study of B12 injections in addition to oral folic acid supplementation found that some subjects with CFS responded well, while others had only a mild response. A better response was associated with more frequent injections, lack of use of opioids, and a certain genetic phenotype.

Another study looked at using B12 nasal drops as an alternative to injections in subjects with CFS. This study also found good response in two-thirds of the participants. The researchers demonstrated that those who had a better response had a higher blood level of B12 and were more physically active (as measured with an activity monitor).

Coenzyme Q10

Coenzyme Q10 (CoQ10) is a compound found naturally in the mitochondria, the energy-producing center of our cells. CoQ10 is involved in the production of ATP, the main energy source of body cells.

An antioxidant, CoQ10 is being explored as a potential treatment for chronic fatigue syndrome. Research suggests that people with chronic fatigue syndrome may be deficient in CoQ10, and the lower its level in their system, the more debilitating the symptoms.

While additional studies are needed to determine the efficacy of CoQ10s in treating chronic fatigue, some research suggests CoQ10 may be more effective when combined with nicotinamide adenine dinucleotide (NADH).

Nicotinamide Adenine Dinucleotide (NADH)

NADH is a naturally occurring molecule formed from vitamin B3 (niacin) that plays an essential role in cellular energy production. Research suggests it may be beneficial for people with chronic fatigue syndrome.

A 2017 review of studies published in the Journal of Human Nutrition and Dietetics found that NADH may help to reduce fatigue and improve energy in patients with chronic fatigue syndrome/myalgic encephalomyelitis. 

Additional research suggests NADH may be more effective when combined with other alternative treatments, including coenzyme Q10 (CoQ10). However, larger studies are still needed.

Dehydroepiandrosterone (DHEA)

DHEA is a hormone secreted by the adrenal glands and in smaller amounts by the ovaries and testes. DHEA can be converted in the body to other steroid hormones, such as estrogen and testosterone. It is also involved in memory, mood, and sleep. Levels of DHEA in the body peak when a person is in their mid-20s and then slowly decline with age.

Studies have shown that DHEA levels are abnormal in people with chronic fatigue syndrome. More research is needed to determine if it is an effective treatment for the condition, however.

DHEA supplementation is not recommended for anyone unless lab tests indicate there is a deficiency. Treatment should be closely supervised by a qualified health practitioner, as little is known about the long-term safety of DHEA.

Known adverse effects of DHEA include high blood pressure, lowered HDL ("good") cholesterol, and liver toxicity. DHEA can also increase testosterone in women and result in male pattern baldness, weight gain, acne, deepening of the voice, and other signs of masculinization.

Because DHEA is converted in the body to estrogen and testosterone, people with hormone-sensitive cancers (such as breast, ovarian, prostate, or testicular cancer) should avoid DHEA.

DHEA can interact with certain medications as well. For example, it has been found to increase the effect of steroids, estrogen replacement therapy, the HIV medication AZT (zidovudine), barbiturates, and the cancer medication cisplatin.


Carnitine, found in nearly all body cells, is responsible for transporting long-chain fatty acids into mitochondria, the energy-producing centers of cells. It allows these fatty acids to be converted into energy.

Some studies have found that carnitine levels in the body are decreased in people with chronic fatigue syndrome, and it has been linked to muscle fatigue, pain, and impaired exercise tolerance.

However, other studies haven't found an association between carnitine deficiency and symptoms of chronic fatigue syndrome.

Supplemental L-carnitine is generally well tolerated, however, high doses of L-carnitine may cause digestive upset and diarrhea. Occasionally, increased appetite, body odor, and rash may occur.

On rare occasions, L-carnitine has been known to cause seizures in people previously undiagnosed for epilepsy or seizure disorders.


D-ribose is a type of sugar produced by your body that helps generate energy. It's also a building block of RNA genetic material.

A review of studies found that it may have positive benefits for those with chronic fatigue syndrome, but that conclusion was based on one small, older study.

The safety of supplements in pregnant women, nursing mothers, children, and those taking medications or who have medical conditions—including CFS—has not been established. And as they are largely unregulated, their contents may differ from what is specified on product labels.

Traditional Chinese Medicine

Chronic fatigue syndrome is believed to be related to the following syndromes in traditional Chinese medicine (TCM):

A review of research suggests TCM interventions such as Chinese herbal medicine, acupuncture, qigong, moxibustion, and acupoint application are beneficial for treating chronic fatigue syndrome. However, the risk of bias in the studies reviewed was high.


Ginseng is an herb that has been used in Asia for centuries to increase energy and combat fatigue. However, it has not been the focus of clinical study for chronic fatigue syndrome in more modern times.

A single study from 2004 suggested it may be beneficial for chronic fatigue patients specifically.

In looking at fatigue due to chronic illnesses in general, rather than only CFS, a systematic review of 10 studies published in the Journal of Alternative and Complementary Medicine in 2018 found modest evidence for its usefulness.

Another study of subjects with idiopathic chronic fatigue (a syndrome distinct from CFS) tested the effects of Panax ginseng. The study found an effect in relieving mental but not physical fatigue in those subjects.


While acupuncture may be one modality used in TCM treatment plans, it has been studied on its own as a treatment for CFS.

The Centers for Disease Control and Prevention (CDC) notes that acupuncture, if provided by a licensed practitioner, may be useful for pain associated with CFS.

And a 2020 review of 10 meta-analyses or systematic reviews found that acupuncture was safe and effective for these patients. However, the review also noted the overall low quality of the studies.

Mind-Body Therapies

People with CFS may have stress, anxiety, and depression, but the CDC notes that medications for these conditions can worsen the symptoms of CFS.

Therefore, they suggest trying non-drug therapies such as deep breathing with muscle relaxation, massage, yoga, tai chi, and stretching.

Rigorous studies have been few for massage, but there have been a couple that have found benefit for chronic fatigue syndrome symptoms.

A Word From Verywell

If you're considering the use of any natural remedy for chronic fatigue syndrome, talk with your primary care provider first. Self-treating a condition with alternative medicine and avoiding or delaying standard care may have serious consequences.

20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. What is ME/CFS?

  2. Castro-Marrero J, Zaragozá MC, Domingo JC, Martinez-Martinez A, Alegre J, von Schacky C. Low omega-3 index and polyunsaturated fatty acid status in patients with chronic fatigue syndrome/myalgic encephalomyelitis. Prostaglandins Leukot Essent Fatty Acids. 2018;139:20-24. doi:10.1016/j.plefa.2018.11.006

  3. Bjørklund G, Dadar M, Pen JJ, Chirumbolo S, Aaseth J. Chronic fatigue syndrome (CFS): Suggestions for a nutritional treatment in the therapeutic approach. Biomed Pharmacother. 2019;109:1000-1007. doi:10.1016/j.biopha.2018.10.076

  4. Linus Pauling Institute. Essential fatty acids.

  5. Regland B, Forsmark S, Halaouate L, et al. Response to vitamin B12 and folic acid in myalgic encephalomyelitis and fibromyalgiaPLoS One. 2015;10(4):e0124648. doi:10.1371/journal.pone.0124648

  6. van Campen CLM, Riepma K, Visser FC. Open trial of vitamin B12 nasal drops in adults with myalgic encephalomyelitis/chronic fatigue syndrome: Comparison of responders and non-respondersFront Pharmacol. 2019;10:1102. doi:10.3389/fphar.2019.01102

  7. Morris G, Puri BK, Walker AJ, et al. Myalgic encephalomyelitis/chronic fatigue syndrome: From pathophysiological insights to novel therapeutic opportunities. Pharmacol Res. 2019;148:104450. doi:10.1016/j.phrs.2019.104450.

  8. Maes M, Mihaylova I, Kubera M, Uytterhoeven M, Vrydags N, Bosmans E. Coenzyme Q10 deficiency in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is related to fatigue, autonomic and neurocognitive symptoms and is another risk factor explaining the early mortality in ME/CFS due to cardiovascular disorder. Neuro Endocrinol Lett.

  9. Castro-Marrero J, Cordero MD, Segundo MJ, et al. Does oral coenzyme Q10 plus NADH supplementation improve fatigue and biochemical parameters in chronic fatigue syndrome? Antioxid Redox Signal. 2015;22(8):679-85. doi:10.1089/ars.2014.6181.

  10. Alraek T, Lee MS, Choi TY, Cao H, Liu J. Complementary and alternative medicine for patients with chronic fatigue syndrome: a systematic review. BMC Complement Altern Med. 2011;11:87. doi:10.1186/1472-6882-11-87

  11. Campagnolo N, Johnston S, Collatz A, Staines D, Marshall-Gradisnik S. Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. J Hum Nutr Diet. 2017;30(3):247-259. doi:10.1111/jhn.12435.

  12. Tomas C, Newton J, Watson S. A review of hypothalamic-pituitary-adrenal axis function in chronic fatigue syndromeISRN Neurosci. 2013;2013:784520. doi:10.1155/2013/784520

  13. U.S. National Library of Medicine: MedlinePlus. DHEA.

  14. Nicolson GL. Mitochondrial dysfunction and chronic disease: treatment with natural supplements. Altern Ther Health Med.

  15. Jones K, Probst Y. Role of dietary modification in alleviating chronic fatigue syndrome symptoms: a systematic review. Aust N Z J Public Health. 2017;41(4):338-344. doi:10.1111/1753-6405.12670

  16. Wang YY, Li XX, Liu JP, Luo H, Ma LX, Alraek T. Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials. Complement Ther Med. 2014;22(4):826-33. doi:10.1016/j.ctim.2014.06.004

  17. Arring NM, Millstine D, Marks LA, Nail LM. Ginseng as a treatment for fatigue: A systematic review. J Altern Complement Med. 2018;24(7):624-633. doi:10.1089/acm.2017.0361.

  18. Kim HG, Cho JH, Yoo SR, et al. Antifatigue effects of Panax ginseng C.A. Meyer: a randomised, double-blind, placebo-controlled trial. PLoS One. 2013;8(4):e61271. doi:10.1371/journal.pone.0061271

  19. Centers for Disease Control and Prevention. Treatment of ME/CFS.

  20. Yin ZH, Wang LJ, Cheng Y, et al. Acupuncture for chronic fatigue syndrome: An overview of systematic reviews. Chin J Integr Med. 2020. doi:10.1007/s11655-020-3195-3

Additional Reading

By Cathy Wong
Cathy Wong is a nutritionist and wellness expert. Her work is regularly featured in media such as First For Women, Woman's World, and Natural Health.