Chronic Fatigue Syndrome and Diet
Myalgic encephalomyelitis/encephalopathy (ME), post viral fatigue syndrome, and chronic
fatigue immune dysfunction syndrome are all used to describe a condition commonly called
chronic fatigue syndrome (CFS). Some people believe that there are two separate conditions:
CFS and ME. Other people believe that the two conditions are the same, but symptoms can
vary. Until these issues are resolved, many people now use the umbrella term of CFS/ME.
There is no test for CFS/ME; diagnosis is based on symptoms. The medical definition of CFS/ME
states that symptoms should have lasted for at least four months in adults and three months in
children and young adults. People with CFS/ME describe overwhelming fatigue, sleep
disturbances, muscle pain and/or weakness, headaches, poor concentration, poor memory,
nausea, irritable bowel syndrome (IBS), and increased sensitivity to food, drugs, household
chemicals, and alcohol. People with severe CFS/ME will be extremely sensitive to noise and
light, and may become bedbound.
It seems likely that altered autonomic function might play a lead role in the symptoms of
CFS/ME. Patients with CFS/ME are hyper-responsive to challenges arising both from within the
body and from the environment. In fact, even while sleeping it appears that the stressresponsive neural systems of people with CFS/ME remain on high alert.
Recently, evidence for interactions between the intestinal microbiota, mucosal barrier function,
and the immune system has been shown to play a role in the disorder's pathogenesis.
Moreover, patients with both IBS and CFS/ME were found to have increased levels of two other
pro-inflammatory cytokines. Probiotic lactic acid-producing bacteria have been shown to
prevent and alleviate gastrointestinal (GI) disturbances and to normalize the cytokine profile
which might be of an advantage for patients suffering from CFS.
The following have been hypothesized to lead to the development of CFS/ME:
 Genetic predisposition
 Viral infections
 Mental stress and/or depression
 A traumatic event
The latest results from the PACE trial show that cognitive behavior therapy (CBT) and graded
exercise therapy (GET), as supplements to specialist medical care, increase the likelihood of
recovery from CFS/ME three-fold compared to other treatments studied.
There is no specific diet for CFS/ME. The following tips may help:
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If you suspect that you have a food allergy or food intolerance, work with a registered
dietitian nutritionist (RDN) to develop an elimination diet.
Keep a food journal to detect any patterns between what you are eating and your
symptoms.
Keep your kitchen stocked with non-perishable, healthful foods in case you are too tired
to go to the store or prepare an extensive meal. Good examples include canned tuna,
dried fruits, nuts, seeds, unsweetened applesauce cups, skim milk powder, canned
beans, nut butter, brown or whole grain rice, quinoa, couscous, whole wheat pasta,
whole grain cereal, oats, etc.
If you do have the energy to cook or bake, prepare extra and freeze some for when you
have less energy.
Get kitchen tools such as food processors, stand mixers, pressure cookers, or slow
cookers that will make your food preparation easier.
Some people with CFS/ME have to grind their meats, because chewing meat can take a
good bit of energy.
Avoid high sugar foods which can cause fluctuations in blood glucose leading to lethargy
and fatigue.
Omega-3 fatty acids found in fish such as tuna, salmon, or mackerel, as well as flaxseeds,
hemp seeds, and walnuts, may decrease inflammation and improve mood.
Consider taking probiotic supplements, drinking kefir, eating yogurt, or finding other
food sources of probiotics that you enjoy to help with gastrointestinal wellness and to
possibly improve immunity.
Although nicotinamide adenine dinucleotide (NADH) has been proposed to be helpful
for people with CFS (among other conditions), there has been no meaningful scientific
evidence behind it.
Some research has shown that magnesium may improve fatigue, but not all research
has agreed. In 1991, a case-control study and a randomized double-blind, placebocontrolled trial published in the Lancet concluded that patients treated with magnesium
claimed to have improved energy levels, a better emotional state, and less pain. In the
clinical trial, 32 patients with CFS were randomly allocated either to intramuscular
magnesium sulfate every week for six weeks, or a placebo. Twelve of the 15 treated
patients said they had benefitted from treatment, and in seven patients, the energy
score improved from the minimum to the maximum. Three of the 17 patients who
received a placebo also said that they felt better, and one placebo patient had a better
energy score. In the case-control study, 20 patients with CFS had lower red cell
magnesium concentrations than did 20 healthy control subjects matched for age, sex,
and social class.
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The National Institute for Health and Care Excellence (NICE) guidelines recommend that
all patients with moderate to severe CFS should be encouraged to obtain adequate sun
exposure and eat foods high in vitamin D. Oral or intramuscular vitamin D
supplementation should be considered for those whose levels remain suboptimal.
There is little available information about the use of vitamin B12 to treat fatigue in
patients without vitamin B12 deficiency. Dosing regimens have been inconsistent among
published studies. The results of the few and very small clinical trials evaluating vitamin
B12 for fatigue do not support the claim that it will improve fatigue symptoms. If you are
concerned about your vitamin B12 status, talk to your doctor about getting a blood test.
If you are deficient, B12 injections are more effective than oral supplements.
Drink plenty of water as dehydration can worsen fatigue.
If you are too tired to eat large meals, try to eat six small meals each day.
If your appetite is much diminished, ask your doctor if you might benefit from an
appetite stimulant.
Anecdotal reports and books have been published linking an overgrowth of Candida
albicans with CFS, suggesting dietary change as a treatment option. A 24-week randomized
intervention study was conducted with 52 individuals diagnosed with CFS. Patients were
randomized to either low-sugar low-yeast (LSLY) or healthy eating (HE) dietary
interventions. Primary outcome measures were fatigue as measured by the Chalder Fatigue
Score and quality of life measured by Medical Outcomes Survey Short Form-36. Intentionto-treat (ITT) analysis showed no statistically significant differences in primary outcome
measurements. I n this randomized control trial, an LSLY diet appeared to be no more
efficacious on levels of fatigue or quality of life compared to HE. Given the difficulty with
dietary compliance experienced by participants, especially in the LSLY group, it would
appear HE guidance is a more pragmatic approach than advocating a complicated dietary
regime.
References and Recommended Readings
Chronic fatigue syndrome/ME. Nutritionist Resource website. http://www.nutritionistresource.org.uk/articles/chronic-fatigue-syndrome.html. Accessed May 12, 2015.
Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and
management of CFS/ME in adults and children. National Institute for Health and Care
Excellence website. http://www.nice.org.uk/guidance/cg53. Published August 2007.
Accessed May 5, 2015.
Chronic fatigue syndrome: system under stress. ScienceDaily website.
http://www.sciencedaily.com/releases/2012/11/121115133806.htm Published November
15, 2012. Accessed May 12, 2015.
Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic fatigue syndrome.
The Lancet. 1991;337(8744):757-760. doi:http://dx.doi.org/10.1016/0140-6736(91)91371-Z.
Ehrlich SD. Chronic fatigue syndrome. University of Maryland Medical Center website.
http://umm.edu/health/medical/altmed/condition/chronic-fatigue-syndrome. Updated
May 31, 2013. Accessed May 12, 2015.
Hobday RA, Thomas S, O'Donovan A, Murphy M, Pinching AJ. Dietary intervention in chronic
fatigue syndrome. J Hum Nutr Diet. 2008;21(2):141-9. doi:10.1111/j.1365277X.2008.00857.x.
Kenny T. Chronic fatigue syndrome/ME. http://www.patient.co.uk/health/chronic-fatiguesyndromeme. Reviewed April 17, 2014. Accessed May 12, 2015.
Nicotinamide adenine dinucleotide (NADH). Rose Medical Center website.
http://rosemed.com/hl/?/21810/NADH. Updated September 18, 2014. Accessed May 12,
2015.
Rehabilitation therapies can lead to recovery from chronic fatigue syndrome. ScienceDaily
website. http://www.sciencedaily.com/releases/2013/01/130131120851.htm Published
January 31, 2013. Accessed May 5, 2015.
Shaheen E Lakhan SE, Kirchgessner A. Gut inflammation in chronic fatigue syndrome.
Nutrition & Metabolism 2010;7:79. doi:10.1186/1743-7075-7-79.
Contributing Author: Elaine M. Hinzey, RD, LDN
Review Date: 5/5/15