The Right Diet for CFS and Fibromyalgia

CFS diet

As an undergraduate student studying exercise science and nutrition, popular opinion was that carbohydrates were essential for metabolism both during exercise and at rest. Textbooks, governing bodies, and medical associations continue to instill this information into dietetics students and the public today. All are taught to believe that glucose from dietary carbohydrate is THE essential fuel for the body and brain.

Boy were we wrong.

In fact there is no dietary requirement for carbohydrate at all (1)! Instead our bodies prefer fats as fuel. In a carbohydrate restricted state, high in healthy dietary fat sources, our bodies produce abundant ketones to use as fuel. Our brains, which are 90% fat and cholesterol, prefer these ketones to glucose as the blood-brain barrier contains a transporter which preferentially takes up ketones. It is no wonder then that ketone rich diets are used therapeutically to treat brain disorders like epilepsy, neurodegenerative disease, and brain cancers. The brain thrives on ketones—driving neuroplasticity and neuronal protective mechanisms (1).

I’m frequently asked what type of diet is best for CFS and fibromyalgia. The short answer is: one that does NOT rely on carbohydrate.

Here are 5 reasons why:

Simple Mathematics

I remember sitting in my AP Biology class in high school learning about metabolism for the first time. If you were there you would’ve seen a light bulb over my head as I realized that lack of cellular energy (ATP) was the reason for my unrelenting fatigue. What a simple idea that would turn out to be an extremely complex illness. It was in that moment, however, that I decided to unravel CFS for myself.

The reason why carbohydrate-rich diets are a bad choice for those with energy deficits is simple. In a healthy mitochondria, 1 primed glucose molecule can produce 36 molecules of ATP after a pass through the Kreb’s Cycle. Not too shabby. In comparison, an 18-carbon fat molecule can produce 106 ATP molecules through a process known as beta-oxidation. Looking at it another way, 100 g of glucose generates 8.7 kg of ATP whereas 100 g of hydroxybutyrate (a ketone made from dietary fat) can yield 10.5 kg of ATP (1).

You do the math.

Oxidative Stress

Glucose metabolism through breakdown of carbohydrate occurs deep within the mitochondrial matrix. To produce ATP, electrons are pumped through various complexes that churn out high energy molecules. An unfortunate consequence of this process is the creation of free radicals—highly reactive molecules with unpaired electrons. Without sufficient antioxidant protection (primarily from CoQ10) these free radicals left to their own devices damage the delicate matrix of the mitochondria. This leaves our cellular powerhouses dilapidated and unable to meet the body’s energy demands. Electrons leak out of the matrix and the mitochondrial scaffolding (cardiolipin) deteriorates leading to leaky mitochondria (2).


When blood sugar levels are high, that sugar may react with macromolecules like proteins, lipids, or nucleic acids. In a dose dependent manner, longer periods of high blood sugar can lead to creation of these sugar-coated molecules called advanced glycation end products (AGEs). This phenomenon is clinically well known in diabetic patients who frequently monitor hemoglobin A1C—a marker of hemoglobin glycation. Glycation can occur in all body tissues however, and is especially problematic in brain tissue. AGEs have been found in the deep tangles of Alzheimer’s Disease and other neurodegenerative disease (3,4). Neuronal AGEs can provoke oxidative stress in the brain which leads to microglial activation—the latest hot topic in CFS research. Activation of microglia through AGE’s is known to promote oxidative stress in the brain releasing an abundance of inflammatory cytokines that contribute to brain fog and the other neurocognitive effects seen in both CFS and fibromyalgia.

The Hormone Problem

High carbohydrate diets can wreak havoc on the body’s hormone feedback mechanisms. Not only is high carbohydrate eating associated with insulin resistance, it also disrupts satiety hormones like leptin. Leptin is a hormone released in response to elevated insulin levels, released from fat cells after carbohydrate-rich meals. The larger role of leptin is its function as a pro-oxidant. This hormone provokes the release of proinflammatory cytokines from various cell types (including again microglia!) and can lead to cytokine-induced sickness behavior as seen in CFS and fibromyalgia. A 2013 study from Dr. Montoya’s group found that elevated leptin levels were associated with worse fatigue symptoms (5).

The Microbiome

The realm of microbiome research continues to unfold but there are currently important clues emerging regarding diet and gut health. High carbohydrate diets (especially simple, refined carbohydrates) promote small intestinal bowel overgrowth and dysbiosis (6)—an all too common problem in both fibromyalgia and CFS. Diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) carbohydrates have been associated with better gut health and reduced incidence of irritable bowel. High FODMAP foods include carbohydrate rich dairy, fruits, sugar alcohols, and legumes.

With more microbiome cells in the gut than human cells, what are you feeding your gut?

Stay tuned for Part II for more on the Right Diet for CFS & fibromyalgia...


1  Manninen, AH. (2004) Metabolic Effects of a Very Low Carbohydrate Diets: Misunderstood “Villians” of Human Metabolism. Journal of the International Society of Sports Nutrition. 1(2):7-11.

2  Vasquez, A. (2014) Mitochondrial Medicine Arrives to Prime Time in Clinical Care: Nutritional Biochemistry and Mitochondrial Hyperpermeability (“Leaky Mitochondria”) Meet Disease Pathogenesis and Clinical Interventions. Altern Ther Health Med. 20(suppl 1):26-30.

3  Coker, LH & Wagenknecht, LE. (2011) Advanced Glycation End Products, Diabetes, and the Brain. Neurology. 77:1326.

4  Seneff, S, Wainwright, G, Mascitelli, L. (2010) Nutrition and Alzheimer’s Disease: The Detrimental Role of a High Carbohydrate Diet. European Journal of Internal Medicine. 22(2):134-40.

5  Stringer EA, et al. (2013) Daily cytokine fluctuations, driven by leptin, are associated with fatigue severity in chronic fatigue syndrome: evidence of inflammatory pathology. J Transl Med. 11:93.

6  Quigley, EM. (2007) Bacterial flora in irritable bowel syndrome: role in pathophysiology, implications for management. J Dig Dis. 8(1):2-7.

dietDr. Craigdiet, nutrition