Plant-Based Diets for ME/CFS, Fibromyalgia, & Long COVID
Research articles detailing nutrition and dietary recommendations for MECFS, fibromyalgia, and long COVID are few and far between. When I do find one, I quickly look at the dietary guidance. Usually, I find the advice is too vague to be helpful. More often than not, the study designs are poorer than poor. Eat a balanced, nutrient-rich diet. What does balance mean? What nutrients should be most dense? It’s just not specific enough for these complex and nuanced conditions.
Is a Plant-based Diet best for Chronic Fatigue and Post-Viral Conditions?
Many are quick to assume that a balanced, nutrient-dense diet is plant-based. Plus, there’s a general global push towards this way of eating. Do these diets make sense for these conditions? My hot take is that the answer is no. I have strong opinions! Consider these points before switching to this popular diet:
Macronutrient Imbalance
Plant-based diets are not balanced diets. They are often low in protein. High protein diets are essential to those with chronic illness as protein balance is lost due to various factors. This includes inactivity, deconditioning, chronic inflammation, and chronic immune burden. One must also know if foods are complete proteins to ensure adequate protein intake on such a diet. Complete proteins contain all nine essential amino acids. These amino acids are crucial for various physiological functions, including muscle building, immune function, and synthesizing enzymes and hormones.
Sources of complete proteins included all animal-based foods such as meat, poultry, fish, eggs, and dairy products. Soy products and quinoa are among the few plant-based sources considered complete proteins. Incomplete proteins lack one or more of the essential amino acids. Most plant-based foods fall into this category. That includes beans, lentils, nuts, seeds, grains, and vegetables. However, combining different plant-based foods can create a complementary amino acid profile, making overall protein intake complete.
Nonetheless, the quantity of protein from animal foods versus plant foods pale in comparison. One has to consume more of these foods by comparison to reach the recommended daily protein intake. Some general knowledge of which amino acids are found in plant foods is also required.
Plant-based diets are also often high in carbohydrates. High carbohydrate diets are not something I recommend for patients or anyone. Not only can these diets promote weight gain, but they also overly tax the cell’s mitochondria. Those with ME/CFS, fibromyalgia, and long COVID have all been found to have abnormalities in carbohydrate metabolism at the level of the mitochondria. Even high-carbohydrate diets consisting of whole grains and less inflammatory foodstuffs put more strain on the mitochondria to metabolize these foods and turn them into ATP. This can result in generalized fatigue and weakness.
With over 10 years of experience creating nutrition plans for patients, I invite you to create your own personalized nutrition plan with me.
Inadequate Micronutrients
Plant-based diets are depleted in essential micronutrients. Some of the most prominent are iron, zinc, iodine, and vitamin B12. Animal foods are rich in these essential vitamins and minerals. While green leafy plants are rich in iron, this is not heme-containing iron. Non-heme iron is very poorly absorbed in the digestive tract. B12 is often found in the soil of unwashed plants. Washing our produce reduces these soil residues. Vitamin B12 is also fortified in grains (added during manufacturing), which definitely prevents deficiencies but does not necessarily ensure adequate absorption and utilization. Fermented foods can also stimulate our microbiome to make its own vitamin B12. However, again, the quantities pale compared to animal food diets. Vegans are 3 times as likely to be deficient in vitamin B12 as vegetarians and omnivores.
Other essential micronutrients that are depleted in plant-based diets are carnitine and choline. Carnitine gets its name from carnivore since it is abundant in animal foods. The body uses the carnitine in our foods, in the form of acetyl-L-carnitine (ALCAR), to move fats into the mitochondria for breakdown to cellular energy, ATP. Too little carnitine spells fatigue.
Read more about carnitine HERE.
Choline is an essential dietary nutrient for brain, heart, and liver health. Plant-based foods like pinto beans, peanuts, quinoa, and legumes do contain choline. However, animal foods, especially eggs, are the best sources of choline. Those on vegan and vegetarian diets show low levels of choline. The recommended choline intake should be at least 400mg/day for adults. Those with low estrogen, such as post-menopausal women, require more dietary choline intake since estrogen is required to activate choline.
National diet surveys from Europe, North America, and Australia indicate the average person seldom meets choline requirements. Only 11% of Americans meet adequate choline intake. Dietary choline is essential for cognitive function. There is compelling evidence of negative health outcomes associated with lower choline intake, including fatty liver disease and cognitive decline. These findings are from human studies.
Indigestion
Plant-based foods are not easy to digest. Some studies have shown that irritable bowel syndrome (IBS) is present in approximately 60% of ME/CFS patients. Similarly, small intestinal bacterial overgrowth (SIBO) is widespread. Choosing a diet high in FODMAPS will exacerbate symptoms of IBS and may also worsen SIBO.
Read more about FODMAPs HERE.
Too Much Work & Effort
Plant-based diets generally require more specialized knowledge as well as cooking. For example, many make dairy alternatives from cashews or transform mushrooms into meat lookalikes. While clever, persons with chronic health conditions need not spend extra energy preparing foods. To make plant-based foods easier to digest, legumes and grains require soaking. Again, additional time and steps that those with chronic illness cannot afford. As a result, those on plant-based diets often reach for preprepared foods laden with additives and chemicals.
References
Barrea L, Grant WB, Frias-Toral E, et al. Dietary Recommendations for Post-COVID-19 Syndrome. Nutrients. 2022;14(6):1305. Published 2022 Mar 20. doi:10.3390/nu14061305 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8954128/
Majchrzak D, Singer I, Männer M, et al. B-vitamin status and concentrations of homocysteine in Austrian omnivores, vegetarians and vegans. Ann Nutr Metab. 2006;50(6):485-491. doi:10.1159/000095828 https://pubmed.ncbi.nlm.nih.gov/16988496/
Wallace TC, Blusztajn JK, Caudill MA, et al. Choline: The Underconsumed and Underappreciated Essential Nutrient. Nutr Today. 2018;53(6):240-253. doi:10.1097/NT.0000000000000302 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259877/
Derbyshire E. Could we be overlooking a potential choline crisis in the United Kingdom?. BMJ Nutr Prev Health. 2019;2(2):86-89. Published 2019 Aug 29. doi:10.1136/bmjnph-2019-000037 https://pubmed.ncbi.nlm.nih.gov/33235962/
