Diet for Chronic Fatigue
by Sue Kira, Naturopath & Clinical Nutritionist
About chronic fatigue syndrome
– Symptoms of chronic fatigue
– Ruling out other causes for chronic fatigue
– Potential triggers for chronic fatigue syndrome
The ideal diet for managing chronic fatigue
Case study: using diet to support chronic fatigue
About chronic fatigue syndrome?
Chronic Fatigue Syndrome or CFS is a chronic (long-term) disorder which is considered to have no scientifically known cause. CFS can also be referred to as myalgic encephalomyelitis (ME) or systemic exertion intolerance disease (SEID).
No matter what you call it, CFS is a debilitating condition that family and friends of the sufferer often cannot understand, as a person with CFS looks very normal.
Symptoms of chronic fatigue
The symptoms of chronic fatigue syndrome vary from person to person, but the most common symptom is fatigue that is severe enough to interfere with daily activities.
For CFS to be diagnosed, fatigue must have been consistent for at least six months which could not be alleviated by bed rest. There will usually be at least four other symptoms, such as:
- loss of memory or concentration
- feeling unrefreshed after a night’s sleep
- chronic insomnia (and other sleep disorders)
- muscle pain
- frequent headaches
- multi-joint pain without redness or swelling
- frequent sore throat
- tender lymph nodes in the neck and armpits
Some people will come down with an illness or suffer more extreme fatigue after participating in activity. This can last for a few days after the activity.
Ruling out other causes for chronic fatigue
Ruling out other potential causes of fatigue is a key part of the diagnosis of CFS. Some conditions whose symptoms resemble those of chronic fatigue include:
- Mononucleosis (EBV)
- Lyme disease and Lyme Like Disease
- Multiple sclerosis
- Lupus (SLE)
- Hypothyroidism (underactive thyroid)
- Fibromyalgia
- Major depressive disorder
- Small Intestine Bacterial Overgrowth (SIBO)
Because the symptoms of chronic fatigue syndrome resemble those of other conditions, it’s important not to self-diagnose. With your doctor, exclude any other medical imbalances before deciding you have chronic fatigue.
Potential triggers for chronic fatigue
While there does not appear to be a single cause for chronic fatigue, there are several triggers that are considered to be potentially implicated. Some being:
- Nutrient deficiencies
- Stress (mental, physical or emotional)
- Infections and immune disorders (specifically, CFS often seems to show up following an infection, such as mononucleosis aka glandular fever, Lyme disease and Ross River Virus)
- Gut health and gut dysfunction (SIBO, Parasites, chronic constipation)
- Adrenal fatigue (see adrenal fatigue article)
- Hypotension (unusually low blood pressure)
- Hormonal imbalance can also contribute
Recent studies show that Chronic Fatigue Syndrome is potentially a mitochondrial dysfunction. Mitochondria are a part of the substances that produce energy in our cells.
Chronic fatigue and the infection connection
Though chronic fatigue can sometimes develop after a viral infection, no single type of infection has been found to be the cause of CFS.
Viruses that have been studied in relation to chronic fatigue:
- Epstein-Barr virus (EBV)
- Human herpes virus 6
- Ross River virus (RRV)
- Rubella
- Coxiella burnetti
- Mycoplasma
- Although not a virus, Mould has been found to contribute to CFS
Researchers have found that people who have been infected with three or more of the above infections have a greater chance of developing CFS. I believe that a person who has been infected by just one of those viruses can develop chronic fatigue – the evidence of which I have seen many times in clinic.
The ideal diet for managing chronic fatigue
It has been proposed that the ideal diet and caring regime for Chronic Fatigue Syndrome would:
- Be high in important nutrients, especially magnesium, and foods rich in Vitamin D and omega 3 essential fatty acids.
- Be anti-inflammatory and low in additives and chemicals.
- Be designed to support good gut health and healing
- Include autoimmune supportive foods
- Include plenty of sleep and stress management
- Include gut supportive/healing foods such as bone broth
Note: Bone broth is naturally high in histamines and a small number of people with chronic fatigue have histamine intolerance. If you feel worse after consuming bone broth, then you may be intolerant to histamine. If so, you can try a Low Histamine diet instead of a Chronic Fatigue Diet, but talk to your practitioner for advice about the diet that is the most suitable for you.
While a Diet for Chronic Fatigue is not considered to be a cure, the premise is to include foods that support the body, and eliminate foods considered detrimental, to help your body to do its natural job of healing. For this reason, it is recommended the diet is gluten, dairy and additives free and low in sugar – apart from the more obvious such as no alcohol, caffeine or nicotine.
Important: Before you commence a new diet, see your medical or health care professional for qualified guidance about what foods and supplements are best for your body. While on the diet do not stop any medications or supplements previously prescribed unless advised otherwise by your medical or health care professional.
Note: During the early stages of a new diet, you may experience symptoms such as fatigue, headaches or body aches, which may occur because your body is detoxifying. However, if you are unsure about a symptom at any time, check immediately with your medical or health care professional.
Case study: using diet to support chronic fatigue
Client name and identifying information changed
Jason came to me with a 10yr history of chronic fatigue. It appeared to have started after he contracted an infection in Bali. The infection seemed to have cleared up but he had terrible fatigue that continued to get worse as the years went by.
His girlfriend suggested he visit me, but he was initially reluctant because he said he had done all the tests and resolved himself to this way of life. I find this happens a lot when clients say they have had all the tests, when in fact often all they have had is a full blood count arranged by their GP and some standard screening tests.
The word ‘full’ conjures up the notion that every test has been done, especially when a doctor tells their patient that, ‘I can’t find anything wrong, so maybe you’re just stressed’, or ‘Try this anti-depressant and see if that helps’.
Jason had tried anti-depressants which made things worse because he didn’t have depression, just a constant state of fatigue. While that is depressing, to say the least, it was not true depression.
After a discussion and some in-clinic testing, I organised bowel screenings for Jason (to check for good and bad bacteria levels, bowel function, leaky gut and food intolerances) plus a hair mineral and heavy metal screening.
Jason’s results showed marked inflammation in the gut, an array of pathogenic bacteria with very little good bacteria, plus some candida species (fungal). His hair mineral analysis showed very low levels of magnesium, potassium, calcium and sodium. He was also intolerant to over 20 foods which I felt was due to his overactive immune system because of the bug (bacteria) situation.
All his energy was going into keeping the pathogens at bay, but because of his intestinal permeability he couldn’t absorb nutrients properly and consequently his energy decreased. The low minerals also reflected adrenal exhaustion which is common with chronic fatigue.
As Jason had to give up work because of his low energy, he couldn’t afford much in the way of supplements, so we focused on some bug killing herbs and used diet to do the rest of the job.
Initially he had to stop eating foods he was sensitive to and he was placed on a SIBO diet (small intestine bacterial overgrowth) where sugars and certain fibres in his foods were restricted. As the bug killers started to do their job, he could then transition to the second phase of the SIBO diet where he could re-introduce some foods, apart from foods he was sensitive to (for a while).
After six weeks on the phase one SIBO diet and six weeks on phase two, Jason’s energy was 6/10 compared to 2/10 when he first came to see me. He was so excited about the shift in his energy and was committed to the plan. He was prepared to spend a little more on his health and borrowed some money to buy some multi-strain probiotics to support the species that he tested low in.
He only needed to do this for about a month because he was then into phase three of the diet, from which he benefited from more diversity in fibres and nutrients. This meant he didn’t need any further supplementation and his mineral levels reflected better on his next test.
With his energy levels now 8/10 he went to a mate’s party one weekend and ate pizza (gluten), with cheese (was sensitive to casein) and drank beer (gluten and sugar). His energy crashed big time, but it showed him to not take things for granted and to respect to his body.
From then on, he committed to the phase three diet, but occasionally would test himself with small amounts of the foods he was sensitive to. He found that he could tolerate everything on his list of 20, except gluten and dairy products. He avoided sugar, particularly in alcoholic drinks and chocolate, apart from a raw cacao treat occasionally which seemed to be fine.
Not everyone’s chronic fatigue is due to an imbalance in gut bacteria and subsequent mineral deficiencies. It is best to visit a good health practitioner who can run as many tests as needed to find out why you have chronic fatigue. Then follow their advice, along with the foods suitable for a chronic fatigue diet, plus any additional diet parameters relating to your condition.