Diet And Nutrition
The effort required to buy food and prepare nutritious meals can mean that people with ME/CFS find it difficult to maintain a healthy diet. For many it can be made harder by a loss of appetite or food intolerance (see below). However it’s important to eat a balanced and diet during your illness, to provide you with the energy and nourishment one needs for optimum health.
Although it’s better to obtain all your vitamins and minerals through your diet, intolerance towards some foods may mean that for some people supplements are advisable. It’s also important to maintain your intake of fluids. If you are experiencing significant problems with your diet and struggling to maintain an adequate food intake, discuss the possibility of a referral to a dietician with your GP specialist.
One of the common primary symptoms of ME/CFS is gut problems/dysfunction. Many people with ME/CFS have symptoms closely resembling Irritable Bowel Syndrome (IBS). As a result many will find treatments intended for IBS helpful in relieving overall illness burden. See below for the Low FODMAPs Diet – a proven treatment for alleviating the symptoms of IBS.
Supplements And ME/CFS
Many people with ME/CFS swear by their own various supplement regime. The following link at CFIDS And Fibromyalgia Self-Help site is to an article by Bruce Campbell “Dr Lapp’s Recommendations on Supplements“. Unlike many other sites advocating supplements Dr Lapp has developed three tests a supplement must pass before he recommends it: It must be safe; There must be a scientific basis for its use, and; It must produce a positive effect in at least 50% of people who use it. The 11 supplements he recommends are:
- Vitamin D3;
- Calcium and Magnesium;
- Fish Oil.
Food intolerances are not to be confused with food allergies. From the Better Health Channel Food allergy and Intolerance: “Food allergy is an immune response, while food intolerance is a chemical reaction. Food intolerance does not involve the immune system and does not cause severe allergic reactions (anaphylaxis).” It goes on to state the symptoms of food intolerance can include:
- Nervousness, tremor;
- Rapid breathing;
- Headache, migraine;
- Burning sensations on the skin;
- Tightness across the face and chest;
- Breathing problems – asthma-like symptoms, and;
- Allergy-like reactions.
The foods that tend to cause intolerance reactions in sensitive people include:
- Dairy products, including milk, cheese and yoghurt;
- Eggs, particularly egg white;
- Flavour enhancers such as MSG (monosodium glutamate);
- Food additives;
- Strawberries, citrus fruits and tomatoes;
- Wine, particularly red wine, and;
- Histamine and other amines in some foods.
It may be worth trying to avoid these foods, one at a time, for a few weeks each, to see if that makes a difference. Seek the advice of your GP or specialist and/or a dietician before excluding or eliminating any foods. Some unlucky individuals can be intolerant of a very wide range of foods indeed.
Be careful not to cut out everything you like. For example, you may still be able to enjoy some rich foods and alcohol in moderation. Even if your diet is limited, you can make food more interesting by trying out new ingredients and recipes or improving the presentation of your meals.
The following sites have more detailed information on Food Allergies and Intolerances:
- Australasian Society of Clinical Immunology and Allergy’s page on Food Intolerance;
- RPAH Allergy Unit’s page on Food Intolerance – The RPAH (Royal Prince Alfred Hospital – in Sydney) have also published the Elimination Diet Handbook with food & shopping guide – a diet you may follow under medical supervision to determine which food chemicals you react to. Also information from RPAH to be found here;
- Food Intolerance Network – They have published the “failsafe shopping list“.
This publication addresses specifically the Role Of Food Intolerance In CFS by Robert H. Loblay, MD, PhD and Anne R. Swain, PhD.
Fructose/other Sugar Malabsorption
Fructose malabsorption is found in approx 60% of those with ME/CFS. It is highly recommended that if you test positive for fructose malabsorption that you seek dietary advice form a dietician. Under the Medicare Chronic Illness/Allied Health plan if you have ME/CFS your GP can arrange 5 visits per year to a dietician, subsidised by Medicare.
There are hydrogen and methane breath tests for fructose and other sugar malabsorption see The Royal Australian College of General Practitioners, Australian Family Physician’s advice page for details. The hydrogen test works because of the fact that the only source of hydrogen gas from the human body is the bacterial metabolism of carbohydrates. The costs of these tests varies but can be expensive. For an example of pathology labs that undertake these tests, see Gastrolab for some patient information.
Low FODMAPs Diet
FODMAP is an acronym derived from “Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols” They are short chain carbohydrates and related alcohols that are poorly absorbed in the small intestine. These include short chain (oligo-) saccharide polymers of fructose (fructans) and galactose (galactans), disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols) such as sorbitol, mannitol, xylitol and maltitol.
A diet low in these carbohydrates (including fructose above) has been shown to reduce the symptoms of Irritable Bowel Syndrome and other Functional Gastrointestinal Disorders (FGID). The low FODMAPs diet was developed by Peter Gibson and Susan Shepherd at Monash University. Much of the work was based on Susan Shepherd’s PhD work.
The following sites have information and resources (some are for purchase) on the Low FODMAP Diet
- Monash University – Medicine, Nursing and Health Sciences – Low FODMAP diet for Irritable Bowel Syndrome – You can purchase The Monash University Low FODMAP Diet booklet online, and there are iPhone and Android Low FODMAP Diet Apps for purchase. From Google Play Store: The App Includes:
- Background information about FODMAPs
- A food guide detailing the FODMAP content for hundreds of foods
- A full recipe book including 79 original and nutritious recipes with professional photography
- A shopping list for organising low FODMAP purchases
- A one week challenge to trial and monitor a strict FODMAP diet, with the function to view detailed graphs of symptoms and the end of the week
- Shepherd Works – is a dietetic practice, headed by Dr Sue Shepherd, which specialises in adult and paediatric (over 3 years of age) patients;
- IBS Diets FODMAPs Food List;
- The Gastroenterological Society of Australia page on Low FODMAP Diet – includes a factsheet on Low FODMAPs.
Muir, J. G. and P. R. Gibson. “The Low FODMAP Diet for Treatment of Irritable Bowel Syndrome and Other Gastrointestinal Disorders.” Gastroenterol Hepatol (N Y), 2013, 9(7): 450-452.
Halmos, E. P., et al. “A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome.” Gastroenterology, 2014, 146(1): 67-75.e65.
Lakhan, S. E. and A. Kirchgessner. “Gut inflammation in chronic fatigue syndrome.” Nutr Metab (Lond), 2010, 7: 79.
Gibson, PR & Shepherd SJ. “Evidence-based dietary management of functional gastrointestinal symptoms: the FODMAP Approach”, Journal of Gastroenterology Hepatology, 2009, 25(2), 252-258.
Shepherd, S & Gibson, P, “Fructose Malabsorption and Symptoms of Irritable Bowel Syndrome: Guidelines for Effective Dietary Management“, Journal of the American Dietetic Association, 2006, 106(10), 1631-1639.
Barrett, J & Gibson, P, “Clinical ramifications of malabsorption of fructose and other short-chain carbohydrates“, Practical Gastroentorology, 2007, pp. 51.