Nutrition And Lifestyle For Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (also referred to as Myalgic Encephalomyelitis) first attracted attention in the mid 1980s with patients describing persistent debilitating fatigue and symptoms such as sore throat, headache, muscle pain, joint pain, and difficulty sleeping. Initially, as there was no recognisable cause for the symptoms, chronic fatigue was referred to as a psychiatric disorder, a 20th century illness, and even as a “yuppie flu”. Although there is still no explanation why chronic fatigue syndrome develops, it is now recognised as a serious condition that can cause long-term illness and disability.

Predisposing factors for chronic fatigue

It has been suggested that a person is born with a predisposition for the syndrome (genetics), which can then be triggered by other factors.

Possible triggering factors

• Personality - people who are overanxious are presumed to be more vulnerable to Chronic Fatigue.
• Lifestyle – inactivity in childhood may increase the risk of chronic fatigue in adults.
• Viral infections - some people develop chronic fatigue syndrome after having a viral infection such as cold and flu or glandular fever.
• Psychological stress - serious stressful situation, such as the loss of a loved one or a job have been found to trigger chronic fatigue.
• Hormonal imbalances, immune system problems, toxic exposure, food intolerance and physical trauma such as serious injuries, surgery, pregnancy, or even labour have been suggested as a triggering cause for chronic fatigue.

Diagnosing Chronic Fatigue Syndrome

There are no specific laboratory tests to diagnose chronic fatigue syndrome. Your doctor will carefully evaluate your symptoms and medical history, and may order further tests to rule out other possible explanations. According to Emerge Australia, to be diagnosed with chronic fatigue syndrome, a patient should have symptoms that have persisted for more than 4-6 months in an adult and 3 months in a child.

Nutrition Intervention for Chronic Fatigue Syndrome

Because the cause of chronic fatigue syndrome is still a mystery, there is no known cure and research is ongoing. However, some nutritional strategies may assist in relieving the symptoms. They include:

Correcting nutritional deficiencies

Some patients with chronic fatigue syndrome appear to be deficient in certain vitamins, minerals, and essential fatty acids. Correcting these deficiencies may improve fatigue and contribute to the healing process.

Specific deficiencies include:

• Folic acid
• Vitamin B12
• Vitamin C
• Vitamin D
• Magnesium
• Sodium
• Zinc
• L-tryptophan
• l-carnitine
• coenzyme Q10
• Essential fatty acids.

Elimination diets

Many patients with chronic fatigue syndrome have been found to have allergies or food sensitivities. Many eliminate gluten and/or dairy, sometimes unnecessary, in the hope it would relieve their symptoms. If you suspect that certain foods in your diet are causing some of the symptoms of chronic fatigue, an elimination diet may help to determine if you are sensitive to anything in your diet. This should only be done in consultation with a qualified dietitian,  nutritionist or naturopath.

Polyphenols

Polyphenols are naturally occurring compounds in plants that provide powerful benefits to our health. They help the body get rid of toxins, boost the immune system, improve heart health, stimulate the death of cancer cells and involved in energy metabolism. There are thousands of polyphenols in fruits and vegetables. 

Studies in animals (mice and rats) found that polyphenols reduce fatigue. One study in patients with chronic fatigue syndrome demonstrated that a daily consumption of dark chocolate (containing 85% cocoa solids) considerably reduced their fatigue. Chocolate contains cocoa, which is a potent polyphenol. Other foods that are high in polyphenols include blueberries and red grapes, apples, oranges, onion, broccoli, kale, turmeric and tea.

Diet restriction  

In the absence of a proven food allergy or intolerance, it is not recommended to follow dietary restriction. However, one study found that 95% of patients with Chronic Fatigue Syndrome had poor fibre intake and 70% had unhealthy fat, fruit, and vegetable intake. Improving the quality of the diet may help reduce fatigue and increase energy levels.

Healthy, balanced diet

A healthy and balanced diet is the recommendation for all people. It should include a wide variety of whole unprocessed foods such as fruits and vegetables in different colours, legumes, nuts, and whole grains, in their most natural forms. Chia seeds, sunflower seeds and pepitas are healthy choices. Include oils such as fish, olive, and avocado, and lean quality protein.

Lifestyle Intervention for Chronic Fatigue Syndrome

Cognitive behaviour therapy

This therapy is a general form of psychotherapy, teaching patients how to gain control over their symptoms. Although the exact way in which it works is not known, studies found that cognitive behaviour therapy greatly improves fatigue in adults with Chronic Fatigue Syndrome.

Graded exercise

Graded exercise therapy has been found to be a very effective and safe treatment for chronic fatigue syndrome, improving symptoms of fatigue and overall health in most participants. 

The therapy is delivered in six stages:

1. Estabilising a daily routine 

2. Starting regular stretching 

3. Deciding on a physical activity goal and choosing a type of activity with which to start (such as walking)

4. Setting an achievable physical activity baseline

5. Increasing the duration of physical activity 

6. Increasing intensity

The Bottom Line

Chronic fatigue syndrome is a complicated disease that can last for months and even years. If you have been diagnosed, it is important that you slow down and minimise physical and psychological stress, optimise your diet, and when you are ready, begin a slow graded exercise program with the help of a qualified therapist.

References

1. Campagnolo, N. et al., 2017. Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. Journal of human nutrition and dietetics : the official journal of the British Dietetic Association, 30(3), pp.247–259. Available at: http://www.ncbi.nlm.nih.gov/pubmed/28111818
2. Clark, L. V et al., 2017. Guided graded exercise self-help plus specialist medical care versus specialist medical care alone for chronic fatigue syndrome (GETSET): a pragmatic randomised controlled trial. Lancet (London, England), 390(10092), pp.363–373. Available at: http://www.ncbi.nlm.nih.gov/pubmed/28648402
3. Emerge Australia 2017. Think you might have ME/CFS? -. Available at: https://emerge.org.au/
4. Institute of Medicine. 2015. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: The National Academies Press. https://doi.org/10.17226/19012
5. Jones, K. & Probst, Y., 2017. Role of dietary modification in alleviating chronic fatigue syndrome symptoms: a systematic review. Australian and New Zealand Journal of Public Health, 41(4), pp.338–344. Available at: http://doi.wiley.com/10.1111/1753-6405.12670
6. Joustra, M.L. et al., 2017. Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis. PloS one, 12(4), p.e0176631. Available at: http://www.ncbi.nlm.nih.gov/pubmed/28453534
7. Mayo Clinic 2017. Chronic fatigue syndrome. Available at: https://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome
8. Price, J.R. et al., 2008. Cognitive behaviour therapy for chronic fatigue syndrome in adults. In J. R. Price, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd. Available at: http://doi.wiley.com/10.1002/14651858.CD001027.pub2
9. Prins, J.B., van der Meer, J.W.M. & Bleijenberg, G., 2006. Chronic fatigue syndrome. Lancet (London, England), 367(9507), pp.346–55. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16443043
10. Royal Australian College of General Practitioners, 2015. Graded exercise therapy for chronic fatigue syndrome, Available at: http://doi.wiley.com/10.1002/14651858.CD003200.pub3
11. Sathyapalan, T. et al., 2010. High cocoa polyphenol rich chocolate may reduce the burden of the symptoms in chronic fatigue syndrome. Nutrition journal, 9, p.55. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21092175
12. The Association of UK Dietitians 2016. Food Fact Sheet - Chronic Fatigue Syndrome, Available at: https://www.bda.uk.com/foodfacts/cfs-meanddiet.pdf
13. Werbach, M.R., Werbach, M. & Clinical Professor, A., 2000. Nutritional Strategies for Treating Chronic Fatigue Syndrome. Altern Med Rev, 55(22), pp.93–108. Available at: http://www.altmedrev.com/publications/5/2/93.pdf