What is the Best Diet for Chronic Fatigue Syndrome?
Chronic Fatigue Syndrome is a debilitating and often devastating illness for many people. As a nutritional therapist, people expect me to recommend a magical diet that will alleviate their symptoms. But is there really a ‘best diet’ for chronic fatigue syndrome?
In this article, I’m going to explain what the research tells us about the effects of diet on CFS (spoiler alert! not a lot!) and share my thoughts on the ‘best diet’ for chronic fatigue syndrome.
First The ‘Take Home’ Message
I’m going to begin this article a bit differently by giving you the ‘take home’ message first.
People with Chronic Fatigue Syndrome come to see me, in the hope a magical diet will improve their symptoms. They are then surprised when I tell them ‘it’s extremely unlikely they will be able to diet themselves out of CFS’.
There is no doubt that people with a variety of issues such as overweight, metabolic syndrome, PCOS, and even HPA-axis can achieve tremendous effects from dietary change, but CFS is not one of them (in my experience of helping a number of people with CFS) (1, 2, 3, 4) .
Diet certainly plays an important foundation, which can palliate symptoms, but it’s a stretch to say (in my experience) diet is the defining factor. I will explain later.
So what does the research say about the effects of Diet on Chronic Fatigue Syndrome?
Well, surprisingly little at this time (2021). Dietary intervention studies are difficult to perform because we don’t yet understand all the mechanisms of the condition.
(And I think we’ll be waiting a very long time, as CFS is just a set of symptoms driven by a number of different causes. But you can read about this in my previous article on CFS.)
As a result, the majority of research studies have focused on specific nutrients in the form of supplements which I will write about soon.
In the meantime, let me briefly outline what nutrients have shown significant benefit i.e. improvements in physical fatigue:
- 10mg of NADH (Niacin) per day (4 weeks) (5)
- A cocktail of 200mg of NADH with 20mg of CoQ10 (for 8 weeks) (6)
- Polyphenol rich 85% cocoa liquor (15g bar three times daily for 8 weeks) (7)
- A mix of 2 grams of Acetyl-L-Carnitine with Propionyl-L-Carnitine (24 weeks) (8). Acetyl-L-Carnitine alone (2g) improved mental fatigue.
- 15 grams of D-Ribose for 3 weeks (9).
- Weekly B12 injections (1mg) and oral folate (5mg) (10).
- There is also some extremely limited evidence of Magnesium and Calcium supplementation with unknown dose (11).
There’s more than one type of fatigue!
Although general fatigue was not improved, mental fatigue, activity and motivation was observed when taking Guanidinoacetic Acid (GAA) (2.4g per day for 3 months) (12).
Additionally, improved neurocognitive function was observed using Lactobacillus F19, Lactobacillus Acidophilus and Bifidobacterium Lactis (200 grams of yoghurt per day) (13, 14).
And surprisingly, a combination of pollen and pistil (7 tablets of Polbax per day) was found to improve ‘overall wellbeing’ in CFS patients versus placebo (15).
It’s important to note, that researchers would call these studies ‘low-quality’ due to small sample sizes, no long term follow-up and featured different inclusion/exclusion criteria and subject characteristics.
This is ‘sciency’ jargon for:
1) We don’t know if these findings are applicable to the wider population of CFS sufferers, because there were not enough people in the studies.
2) They didn’t check how patients felt several months later.
3) It’s not entirely clear if the subjects even had CFS.
Furthermore, a recent meta-analysis (think about a rating on Tripadvisor based on hundreds of individual reviews) concluded that there does not seem to be a correlation between nutrient deficiency, supplementation and improvement in symptoms (15).
But remember just because a person with a condition, has deficiencies , does not mean the deficienies caused the disease.
Moreover, addressing the deficiency does not necessarily mean the disease will improve. More often than not, the deficiency or insufficiency is a result of a downstream event such as increased oxidative stress (16).
What about Diet?
Some limited observational studies have tried to identify links between between dietary intake and blood nutrient status with the hope of improving symptoms through diet.
A study in the UK found that CFS patients consumed lower levels (RNI) of B12, Calcium, Iodine, Selenium and Vitamin D. But Poor dietary intake did not correlate with low blood levels and increasing intake did not improve symptoms (17).
Another study from the Brits observed that patients with severe CFS restricted dairy and grains due to gut issues and food sensitivities and had low vegetable intakes. None of these findings were found to have causality or benefit symptoms (18).
A larger scale study out of The Netherlands with 247 CFS patients, found that by government standards, 70% of patients consumed high amounts of saturated and ‘trans’ fats and consumed on average 2 portions of fruits or vegetables per day. However, unhealthy lifestyle factors were not associated with fatigue severity! (19)
The first randomised Control Trial
During a time when Candida infections were ‘all the rage’ and everyone with an unexplained health problem had Candida (fungal overgrowth), a group of researchers wanted to test the theory with CFS.
In the first randomized control study, researchers examined the effects of a low sugar and low yeast diet for 24 weeks (11). The Low sugar diet was compared to a group consuming a diet based on the UK eat based on the ‘eat well plate’ (12). Unsurprisingly, 25% of participants dropped out (it’s a hard thing to do), and patients with CFS didn’t feel much better compared to the eat well group.
Finally, three of the most recent systematic reviews (think Tripadvisor again) have concluded that due to extremely sparse and poor quality evidence, it is very difficult to recommend dietary changes to improve symptoms (13, 14, 15).
If you’re feeling a bit discouraged, or confused because a diet helped your CFS, remember, although things have not been studied yet, it does not mean we don’t have tools in our arsenal!
My Experience using Diet for Chronic Fatigue Syndrome
I’m going to try to keep this as simple as possible. I sometimes forget what it was like to have CFS, and that you may be dealing with brain fog!
Before we dive in, I think it’s important to understand some of the drivers of Chronic Fatigue Syndrome, and why we may need to do certain things.
From what we know about the aetiology or mechanisms of the condition, CFS can be considered an immune function syndrome possibly triggered by a viral or bacterial infection (20, 21, 23).
Whatever the trigger, it’s becoming widely accepted that multiple system dysfunction from autoimmunity (20), dysbiosis (24, 25, 26), altered gut-brain axis, hpa-axis hypofunction (27) and ultimately increased levels of inflammation drive CFS (21).
So in other words, if you have Chronic Fatigue Syndrome, you may likely have:
- Imbalances in your gut bacteria.
- Issues with communication between your gut and brain (gut-brain axis)
- A weaker hormonal and stress response system
- Increased levels of inflammation
- Autoimmune issues from thyroid to skin to gut to neurological illness (27, 28, 29).
All driven by a multitude of different things!
Note: The processes I’ve outlined are extremely vague and cited by many people in the functional medicine world. The truth is most don’t know what they really mean. I will be diving deep into what we know about the autoimmune and inflammatory processes soon.
Let’s get on with it!
The ‘IDEAL’ Diet for Chronic Fatigue Syndrome
In my experience of helping many people with CFS, I’ve found the most effective diet to minimise and manage symptoms is an autoimmune paleo style diet (AIP).
Recently, there has been some encouraging research from the field of Gastroenterology evaluating the effectiveness of removing ‘immunogenic’ foods that can drive the processes outlined above using an AIP style diet (30, 31, 32).
You’re probably thinking ‘I don’t have stomach problems!’ And that’s great, but remember CFS is a condition driven by inflammation (like many gut diseases).
Using an AIP style diet helps by:
1. Remove ‘Irritating’ foods
Foods such as nightshade vegetables, nuts, seeds and sometimes dairy and gluten may drive the inflammatory process (33, 34). In nightshades, very limited evdence suggests Glycoalkaloids, Solanine and Chaconine may increase intestinal permeability (leaky gut) (35). But a small clinical trial, suggests levels of inflammation improve consuming an AIP style diet (36).
Although, the evidence is limited, I’ve found that nightshades and even nuts and seeds are very overrated foods, and clients report improvement when they remove them.
2. Removes processed junk foods like crisps, cakes and sweets and replaces with whole foods like sweet potatoes, fish and vegetables.
Unfortunately, many processed foods contain ‘immunogenic foods’ prepared in vegetable oils (PUFAs) which can help drive the inflammatory process (37). In fact, a link has been observed between a low Omega 3 (EPA) and Omega 6 (AA) and severity of CFS symptoms (38, 39, 40). In other words, CFS patients with higher levels of Omega 6 (cooked processed foods) and lower levels of Omega 3s (fish, eggs and meat) had worse symptoms.
3. Vegetable intake and Antioxidant Status
If I had to choose one tip for a person with CFS who is at their ‘witts end’ and cannot cope with another diet or too many recommendations, this is the one!
In a previous article, I talk about the likely role of a dysregulated peroxynitrite/nitric oxide cycle in CFS (41, 42). To summarise, this cycle plays an essential role in our energy and immune systems. Some researchers believe too much oxidative and nitrosative stress helps drive inflammation and depletes energy stores.
In fact, I don’t believe it is a coincidence that 80% of the nutrients mentioned above are antioxidants and contribute to a healthy NO/NOO cycle. In fact, during crashes, CFS patients have been shown to have lower levels of antioxidants such as Vitamin E (43).
Besides the high micronutrient content, compounds rich in these vegetables such as flavonoids, stilbenes, carotenoids, indoles and aryl hydrocarbon ligands provide antioxidants, support mucosal immunity and help activate important genes in the liver (essential player in energy production) (44, 45).
And it’s no coincidence that researchers are finding people who consume upwards of 8 portions of vegetables per day have lower rates of heart disease, cancer and all cause mortality (46).
4. Red meat consumption
Controversial I know in times when the vegans are invading, but hear me out. I don’t hold any militant beliefs either way. I do believe, however, our requirements for meat is highly individual, depending on our health and disease status. Dr Nick Gonzalez used raw vegan all the way to ketogenic, for cancers of all types. It is totally dependent on the person.
When it comes to the early stages of CFS, I can confidently say for the vast majority of my clients with CFS, they need a few portions of fatty red meat, at least in the first few months.
The fatty red meat provides a combination of the B vitamins, minerals such as Zinc but also sulphates, phosphates and amino acids such as tyrosine and phenylalanine which supports the adrenal hormones and autonomic nervous system. Fats from red meat are also strong sympathetic stimulants (which is what you need when you have CFS).
So what does this look like in Practice?
About 8-9 cups of green leafy, colourful and sulphur rich vegetables per day (always well cooked, not raw).
Vegetables such as:
Broccoli, Cauliflower, Cabbages, Brussel Sprouts, Leeks, Shallots, Onions, Parsnips, Turnips, Mooli, Swedes, Celeriac, Sweet Potatoes.
Red meat (especially lamb) twice per week. Other meats include: Beef, chicken, venison, rabbit, chicken, duck once per week.
Avoiding or minimising Nightshade family, Dairy and/or Gluten (for a few weeks).
There are many cookbooks which use this AIP ethos such as Mickey Trescott’s autoimmune paleo cookbook and Mellisa Hartwig’s Whole 30 cookbook. I even love Dr Lawrence Wilson’s Nutritional Balancing diet guidelines.
Supporting Symptoms v.s. Root Cause
As I said at the beginning of this article, this diet is unlikely to make you feel 100% better, but in my experience it can certainly help symptoms and make life more manageable. The priority is try to identify the root cause and remove your personal barriers to health.
If you are struggling with CFS, and have not tried increasing your intake of vegetables and removing certain foods, then this is certainly a good place to start on your journey to health.
Wishing you well on your path to health,
Annemarie Foller · May 10, 2021 at 4:57 am
Pretty nice post. I just stumbled upon your blog and wished to
say that I have really enjoyed surfing around
your blog posts. In any case I’ll be subscribing to your rss feed and
I hope you write again very soon!
Inder Singh Virdi BA (Hons) mBANT · August 11, 2021 at 2:48 pm
Hi Annemarie, thank you for your very kind message. I have been busy with clinics but hope to be posting once per week from now. Best wishes. Inder