To the Editor.
—Dr Bou-Holaigah and colleagues1 report an association between chronic fatigue syndrome (CFS) and neurally mediated hypotension (NMH). Their preliminary report recommends that patients with CFS adhere to the usual Western high sodium intake, without providing any baseline or follow-up data on sodium excretion.Their next report must answer the following questions: At what sodium excretion rates were symptoms of CFS observed? At what sodium excretion rates can symptoms be relieved? Does salt relieve symptoms when given without fludrocortisone acetate? Does a double-blind randomized trial confirm that coated sodium chloride tablets have a greater effect than placebo?Double-blind evidence that salt is beneficial without steroids would show that CFS is one more disease that can be treated with a nutrient at a dose exceeding the physiological requirement. For example, hyperlipidemia responds to high doses of niacin. This does not necessarily mean that hyperlipidemia is due to niacin
Beard TC. Chronic Fatigue Syndrome and Neurally Mediated Hypotension. JAMA. 1996;275(5):359. doi:10.1001/jama.1996.03530290029021