Transcript .asn.au/ - ME/CFS Australia (SA)

Dietary issues
in Chronic Fatigue Syndrome
Melanie Reid
Senior Dietitian
Southern Fleurieu Health Service
Victor Harbor, South Australia
Sept 2007
Some diet issues
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Control of blood glucose /insulin levels
Food sensitivity / allergy
Gut health
Weight management
General nutrition
- optimum levels of nutrients
Control of blood glucose/ insulin
• Symptoms may get worse when glucose
or insulin levels spike & dive
• Dietary strategies include:
– Regular meals or snacks (grazing)
– Low GI diet
– High protein intake
• Glucose is important because it is a
major fuel (energy source) for the body
• It is the main fuel for the
brain and nervous system
• It provides about half the fuel for muscles
• We need a steady supply of glucose all
day & night – don’t want drops or surges
• Glucose is released into the blood when
Carbohydrates are digested
• There are 2 main forms of carbohydrates:
Sugars:
Glucose
(blood sugar)
Starches:
Fructose
(fruit sugar)
Sucrose
(cane sugar)
Lactose
(milk sugar)
Legumes
CARBOHYDRATES
Bread
Sugar
Milk
Soft drinks
Cordial
Steady supply of glucose
• 1. Space carbohydrate foods evenly
through the day, in regular meals &
snacks
• 2. Eat moderate quantities of carbs at any
one time (avoid excessive amounts)
• 3. Include types of carbs that release
glucose slowly and steadily into the
blood (low GI foods)
Steady supply of glucose
1. Spacing:
If meals are more than 5-6 hours
apart, include a small, nourishing
snack in between e.g. raisin toast,
fruit, milk drink or yoghurt
Supper can be especially
important if you have an early
evening meal.
Steady supply of glucose
2. Moderation:
• Avoid / limit foods concentrated in sugar
• Eat only moderate amounts of bread, rice,
pasta, potatoes, fruit etc – some people do
better with the recent CSIRO-type diet
Steady supply of glucose
3. Include slow-release carbohydrates:
• GI measures how quickly carbohydrates break
down & release glucose into blood
• Low GI foods digest more gradually
– More stable blood glucose
– Less extreme insulin response
• Try to include a low GI food
in each meal
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Examples of low GI carbs:
Oats (porridge or muesli) or bran cereals
Pasta
Grainy bread
Dried beans and lentils (legumes)
Barley
Sweet potato and sweet corn
Milk, yoghurt and custard
Some fruits e.g. apples, pears, oranges,
dried apricots
High protein intake
• Many people with CFS seem to do better
with higher protein intake
• Protein may help moderate glucose/
insulin responses
• Also important building block for muscle
tissues and blood proteins
• May need more due to “hyped up” immune
response or low level muscle catabolism
High protein intake
Good sources of protein:
• Meat, chicken, fish
• Eggs
• Milk, cheese, yoghurt, soy drinks
• Legumes
Moderate sources of protein:
• Wholegrains, nuts
Food sensitivity
• Seems to be more common in CFS
• Either classic allergy, food chemical
intolerance or mal-absorption problems
• Symptoms can include headaches,
various gut symptoms (e.g. bloating, pain,
diarrhoea, constipation, nausea), skin rashes,
cognitive problems (e.g. concentration, memory),
mood changes, fatigue
Food sensitivity
Allergy-type reactions may be caused by a
range of high-protein foods e.g.:
• Wheat (maybe other gluten-containing
grains as well)
• Milk
• Soy
• Eggs
• Fish, Beef or other meats
Food sensitivity
Food chemicals that can cause intolerance
reactions:
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Salicylates
Amines
Glutamates
Preservatives
Artificial anti-oxidants
Colours (artificial and some natural)
Food sensitivity
Food chemical intolerance reactions can be
difficult to determine:
• Multiple chemicals and foods involved
• Dose-related, so seems inconsistent
• May be delayed response
• Reaction threshold can change
May need trial elimination diet to clarify,
with guidance from experienced dietitian
Gut problems
• Strong overlap between CFS and IBS
–Pain, bloating, diarrhoea, constipation
–Nausea, fullness, indigestion
• May be caused by :
–food chemical intolerance
–changes in bowel bacteria
–poor stomach emptying / gut motility
–impaired digestion (stomach acidity,
digestive enzymes)
Gut problems
• Bowel bacteria
– May have overgrowth of unfriendly bacteria,
lack of friendly bacteria e.g. lactobacilli,
bifido species, and strains of E. coli
• Probiotic supplements may help
e.g. VSL#3, Symbiotic, Mutaflor, Lactobac
• Prebiotic supplements can also help
e.g. Benefiber, FOS, foods rich in galactose
(milk, legumes)
Gut problems
Mal-absorption syndromes
Undigested sugars can be fermented in the
large bowel e.g.:
• lactose (milk, yoghurt)
• fructose and fructans (some fruit &
vegetables, honey, wheat)
• polyols such as sorbitol (some fruits,
sugar-free products)
Fructose malabsorption
• Fructose mal-absorption → gas, pain,
osmotic diarrhoea (possibly also fatigue and
effects on mood)
• Quite common cause of IBS
• Can be tested by Breath Hydrogen Test
• Treated by reduced fructose diet – level of
restriction depends on each individual
Fructose malabsorption
Problem foods include:
• those with high fructose to glucose ratio
(glucose assists absorption of fructose)
e.g. apples, pears, melons, mango, honey
• foods with high total sugar load
(overwhelms absorptive capacity
e.g. dried fruit, juice, confectionary, sweet drinks
• foods high in fructans/inulins
(long-chain fructose)
e.g. wheat, onion, leek, asparagus, artichokes
Gut problems
“One person’s meat is another’s poison”
Fructans & inulin can be useful
prebiotics that encourage the
growth of friendly bowel bacteria
(that’s why inulin is added to some yoghurts)
but they can cause problems for others
e.g. fructose malabsorbers
Gut problems
• Some people find digestive enzyme
supplements helpful e.g. Creon
• Some people need
medication to improve
gut motility e.g. Maxalon,
Motilium
Weight management
Some gain weight:
• Less activity, metabolic changes?
• Need to reduce non-nutritious, high fat/ high
sugar foods
• Low GI / high protein diet can help control
hunger
• Find alternative strategies to reduce “comfort”
or non-hungry eating
Weight management
Some lose weight:
• Problems with meal preparation, poor appetite,
digestive problems etc.
• Encourage nutritious snacks and drinks
• May require nutrition supplement drinks e.g.
Ensure, Sustagen, Resource (if tolerating milk)
or whey-based, soy or rice-based alternatives
“ Balanced diet”
2-3 serves fruit
3 or more serves
bread/ cereal group
At least 4-5 serves
colourful vegetables
2 or more serves
meat or alternative
2-3 serves low fat
dairy or alternative
“ Balanced diet”
However, this advice needs to take account
of individual sensitivities!!
- May need alternative sources of protein
& calcium if milk isn’t tolerated
- May need alternative sources of protein,
iron & zinc if meat isn’t tolerated
- May need alternative sources of fibre &
carbohydrate if wheat isn’t tolerated
Nutrient Supplements
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People with CFS may have higher
requirements for some nutrients, and may
need supplementation. For example:
Magnesium
Protein / amino acids
Omega 3 fats (fish oil)
Nutrients for energy pathway support
e.g. Co Q10, Vitamins B3, B12, acetyl-carnitine
• Anti-oxidants e.g. ά-lipoic acid, curcumin
Vitamin D
The “Sunshine” vitamin
• Many people with CFS are low in Vitamin D
• Important for bone health, muscle strength,
immune function, ↓ risk of cancer etc. etc.
• Simple blood test to check level
• Supplement may be required
- at least 1,000 IU/day
- 5,000 – 6,000 IU/day if deficient
Other factors for bone health:
• Adequate calcium
- Low calcium intake is quite common
• Weight bearing exercise
- Often limited in people with CFS
Orthostatic Intolerance
• Neurally-mediated hypotension (NMH) &
postural orthostatic tachycardia syndrome
(POTS) → dizziness, rapid heart-beat
• High salt intake may be part of treatment
(not if person has high BP)
e.g. 3 gm salt per day