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Chronic Fatigue Syndrome

By Lucy Kerrison

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What is it?

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is an umbrella condition, including a number of symptoms which can result in extreme tiredness.

What are the symptoms?

  • Extreme fatigue (ongoing even after resting or sleeping)
  • Prolonged recovery period after exercise 
  • Difficulty with memory and concentration
  • Muscle or joint pain
  • Headaches
  • Sore throat
  • Flu-like symptoms
  • Feeling dizzy or sick
  • Heart palpitations 

The symptoms vary from person to person and can include some or almost all of the above. CFS can be an incredibly debilitating and frustrating condition as there is no clear treatment route. The main focus is upon symptom management. (1)

How is it diagnosed? 

CFS is not diagnosed with a specific test or measurement, but by clinical judgement based on symptoms once all other possible causes have been ruled out. This diagnosis must be from a doctor.

Can diet help? 

We know diet can have a huge impact on our energy levels. Nutritional deficiencies such as iron, B12 and folate should be ruled out before a diagnosis of CFS is made.

We know that following a regular meal pattern and including fats, proteins and high fibre starchy carbs in each meal, will result in fewer spikes and dips in blood sugar levels. A lower level of spikes and dips in blood sugar levels will result in a lower level of dips within energy levels. Although there are not specific studies around this eating pattern in CFS, we know it to be true based on the science and so theoretically this eating pattern should reduce fatigue levels, although is unlikely to completely relieve fatigue in CFS.

Gut health and CFS

We know those with CFS include less fibre than those who don’t and so theoretically, looking to improve gut health and ensure a nutritionally optimal diet, can be helpful. We also know there can often be dysbiosis (a negative change in gut bacteria) in CFS and there are proposals that the microbiome could contribute to neurocognitive impairments, if negatively impacted. Focusing on diet and lifestyle to optimise gut health and improve bacteria diversity is likely to be beneficial in CFS: (2)

  • Aim for 30 different plant-based products/week
  • Target the gut-brain-axis daily (e.g. yoga, meditation, walking…)
  • Include time outdoors
  • Practice good sleep hygiene

Can supplements help?

There have been a few studies looking at supplements and their impact on chronic fatigue symptoms, however many of these have not provided clear results.

Vitamin D:

One study showed that serum vitamin D levels were moderately to severely suboptimal in those with CFS, as well as in comparison to the general population. This is important as we know vitamin D is key in helping cells deliver oxygen and blood to your muscles, which is key for energy levels. Despite this strong connection, supplementation did not appear to improve symptoms significantly in this study.

D-ribose:

Interestingly, there has been a small study looking at D-ribose (a naturally occurring sugar) supplementation in CFS, which did show improvements in energy levels and overall subjective feelings. 

Polynutrient supplementation:

There have been a number of studies looking at multivitamin supplementation, with some showing improvements and some showing no change in symptoms. 

Probiotics:

There have been a few trials looking at probiotics and CFS, although results are inconclusive, within studies there have been participants who reported significant improvements using probiotics and this is likely to be due to individual differences in gut bacteria. (3)

What’s the verdict?!

Diet can have a positive impact on symptoms of CFS and looking to improve your gut health can certainly be beneficial in theory. We do not have the evidence to recommend supplements for everyone, however these can be looked at on an individual basis with your specialist dietitian!

References:

  1. NHS Choices (2019). Overview – Chronic fatigue syndrome (CFS/ME). [online] NHS. Available at: https://www.nhs.uk/conditions/chronic-fatigue-syndrome-cfs/.
  2. König, R.S., Albrich, W.C., Kahlert, C.R., Bahr, L.S., Löber, U., Vernazza, P., Scheibenbogen, C. and Forslund, S.K. (2022). The Gut Microbiome in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS). Frontiers in Immunology, 12. doi:10.3389/fimmu.2021.628741.
  3. Campagnolo N, Johnston S, Collatz A, Staines D, Marshall-Gradisnik S. Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. J Hum Nutr Diet. 2017 Jun;30(3):247-259. doi: 10.1111/jhn.12435. Epub 2017 Jan 22. PMID: 28111818; PMCID: PMC5434800.

Lucy Kerrison is a gut specialist dietitian who is passionate about dietary manipulation to reduce debilitating gut symptoms such as reflux, bloating, diarrhoea, constipation and pain. Lucy understands the stresses and hectic nature of modern-day life and provides a holistic approach, which is flexible and fun.

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