If you have chronic fatigue syndrome, should you go paleo, keto, high carb, low carb, moderate carb, Atkins, South Beach, or follow some other nutrition plan?
What actually is the best diet for chronic fatigue syndrome?
If you’re at all familiar with my work, you’ll know that I believe individuality is key when it comes to your nutrition plan. And if you have chronic fatigue syndrome (also known as myalgic encephalomyelitis), that adage holds true – kind of. The dietary needs of those with CFS need to optimize cellular energy production.
Some diets do a better job at increasing energy within your body than others. So while individual variations will inevitably exist, there are foundational components to the chronic fatigue diet. And therefore there is a “best” diet for those with CFS.
How does your body make energy?
Inside of your cells are tiny organelles called mitochondria. Mitochondria are found inside nearly all of your body’s cells. The mitochondria are your body’s power plants. You can survive without food for weeks; without water for days; but without mitochondria, you would die in seconds.
It is thought that mitochondria used to be bacteria that through the process of evolution evolved into essential components of your cells. Today, they produce energy so that you and your body’s cells can survive.
Have you heard of a substance called ATP?
ATP stands for adenosine triphosphate. Think of ATP as the currency that your body runs on. If you have enough ATP, your body has plenty of energy. If you’re low on ATP, chronic fatigue syndrome results. (1)
Unfortunately, measuring and addressing ATP levels is not the way chronic fatigue syndrome is managed through the conventional healthcare system (though it should be!). However, just because it’s not commonly addressed in conventional medicine does not make this theory any less convincing. Mitochondrial function and the resulting production of ATP should be the focus of any treatment aimed to alleviate CFS.
The ideal diet for chronic fatigue syndrome should be one that increases ATP production.
Your mitochondria combine the food you eat with the air you breathe in order to make ATP. But the type of food you eat will have a dramatic effect on the amount of ATP your mitochondria are able to produce. And for those with chronic fatigue syndrome or myalgic encephalomyelitis, your diet should be focused around optimizing energy or ATP production.
Your body on sugar
The vast majority of you will be using sugar or glucose as your primary fuel source. When you eat carbohydrates (like grains, starches, fruits, vegetables, sugars) your body digests these into glucose molecules. Glucose is then converted into a substance called pyruvate. And pyruvate is what your mitochondria need to produce energy (ATP).
For each glucose molecule, your body is able to produce 38 molecules of ATP.
Sounds pretty good, right? But what happens when your body runs on fat?
Your body on fat
Humans are unique in that you can burn two different energy sources as fuel. Think of it like having both a gasoline and a diesel engine within your body. Most of you run on gasoline, or, glucose. While running on glucose, your diesel engine has been collecting dust.
Your diesel engine is your body burning fat (fatty acids) for fuel. When your body runs on fatty acids, each molecule of palmitate (a specific fatty acid) produces 129 molecules of ATP.
To recap: When you run on glucose, your body produces 38 molecules of ATP. But when you run on fatty acids, your body produces 129 molecules of ATP.
Now, keep in mind that these numbers are under optimal or ideal function. For those of you with CFS, the amount of ATP produced is likely much less – in both glucose and fatty acid metabolism.
But to overcome chronic fatigue syndrome, you need to optimize ATP production. This should be priority number one. In order to do this, you need to burn fatty acids as your fuel. You need to follow a ketogenic diet – it’s the best diet for overcoming fatigue.
How to structure a ketogenic diet for those with chronic fatigue syndrome
To overcome CFS, you need to get your nutrition dialed in. You need to be on a ketogenic diet. There is no way around this fact. But the way in which you get there can be done with ease – it does not have to be a struggle.
If your current diet is a standard Canadian/American/European diet, I recommend you start with our 30-day fatigue reset diet. Do this before you jump into the ketogenic diet. It will make your transition into ketosis so much easier.
If you’re already following a whole food or paleo-ish diet, you’re ready to embark on the road to ketosis. Read on to learn how.
How to keto
To get into ketosis, you will need to keep the total number of carbohydrate grams to fewer than 20 grams per day. This will involve checking the nutritional information of all the food you eat for the first few weeks. After that, you’ll know how to follow a low-carb diet. While tracking, I recommend you use an app like cronometer. It will make your life much easier.
Take for example one ounce of almonds (source). There are 4 grams of carbohydrates and 3 grams of dietary fibre.
To get the total or net carbohydrate reading, subtract the dietary fiber from the total carbohydrates. In this case, 4 – 3 = 1. Therefore, these almonds have 1 gram of net carbs per ounce. Remember, no more than 20 grams of net carbs per day!
Keeping your diet under 20 grams of net carbs each day is essential. Your body will choose to burn glucose over fatty acids because there are fewer chemical reactions required to convert glucose to energy (even though it’s less efficient in the long term). Therefore, you have to force your body to burn fatty acids (or ketones). To do this, you restrict carbohydrate intake.
Below, I’ll give you the specifics of what foods to eat and what foods to avoid.
Keto rule #1: Eat when you are hungry.
Keto rule #2: Eat until you are full.
These are the two golden rules of ketosis. Follow them and you’re well on your way to becoming keto-adapted! Below, I’ll give you more specifics on exactly which foods to eat and which foods to avoid.
Foods to eat freely on ketogenic diet
Meat (preferably organic, pasture raised, and grass fed/finished):
- Beef (including hamburger and steak),
- Pork: ham (unglazed) and bacon,
- Check the label on processed meats like sausage, pepperoni and hot dogs. Carbohydrate count should be about 1 gram per serving and if possible the meat should be nitrate free,
- Poultry: Chicken, turkey, duck, or other fowl,
- Any fish or shellfish, including tuna, salmon, catfish, bass, trout, shrimp, scallops, crab, and lobster (no farmed seafood, there are too many toxins in them),
- Eggs: Whole eggs are permitted without restrictions,
- You do not have to avoid the fat that comes with the above foods,
- You do not have to limit quantities deliberately, but you should stop eating when you feel full.
Greens – two cups a day (preferably organic):
- Arugula, bok choy, cabbage (all varieties), chard, chives, endive, greens (all varieties, including beet, collards, mustard, and turnip), kale, lettuce (all varieties), parsley, spinach, radicchio, radishes, scallions, and watercress. If it is a leaf, you may eat it.
Veggies – one cup a day (preferably organic):
- Artichokes, asparagus, broccoli, brussels sprouts, cauliflower, celery, cucumber, eggplant, green beans (string beans), jicama, leeks, mushrooms, okra, onions, pepper pumpkin, shallots, snow peas, sprouts (bean and alfalfa) sugar snap peas, summer squash, tomatoes, rhubarb, wax beans, zucchini.
- A simple rule to follow: if the veggie grows in the dirt (like potatoes, beets, yams, carrots), don’t eat it. If the veggie grows above the dirt, eat it!
Bouillon or bone broth – two cups a day:
- Needed for sodium replenishment. Bone broth is strongly recommended unless you are on a sodium restricted diet for hypertension or heart failure.
Foods to eat in moderation on a ketogenic diet
Cheese – up to 4 ounces a day:
- Includes hard, aged cheeses such as swiss and cheddar, as well as brie, camembert blue, mozzarella, gruyere, cream cheese, goat cheeses.
- Avoid processed cheeses, such as Velveeta. Check the label; carbohydrate count should be less than 1 gram per serving.
Cream – up to 4 tablespoonfuls a day:
- Includes heavy, light, or sour cream (not half and half). Purchase grass fed/finished dairy products whenever possible.
Mayonnaise – up to 4 tablespoons a day:
- Check the labels of brands to ensure there is a low carb count. Look for paleo mayo that does not include low quality fats like canola or vegetable oils but does include avocado or olive oils.
Olives (Black or Green): up to 6 a day.
Avocado: up to 1/2 of a fruit a day.
Lemon/Lime Juice: up to 4 teaspoonfuls a day.
Soy Sauces: up to 4 tablespoons a day. Make sure you opt for a gluten-free variety like tamari.
Pickles, Dill or Sugar-Free: up to 2 a servings a day. Check the labels for carbohydrates and serving size.
- Pork rinds/skins;
- Pepperoni slices, ham, beef, turkey, and other meat roll-ups (low carb count);
- Deviled eggs.
Foods to avoid completely on a ketogenic diet
High carbohydrate containing items like
- Flavoured and low fat yogurts,
- Fruit juices,
- Coconut water,
- Tropical fruits.
- White sugar,
- Brown sugar,
- Maple syrup,
- Coconut sugar,
- Raw or Cane sugar,
- Corn syrup.
- Grains (even whole grains),
- Vegetables grown in the dirt (beans, carrots, parsnips, potatoes, yams).
On this diet, no sugars (simple carbohydrates) and no starches (complex carbohydrates) are eaten. The only carbohydrates encouraged are the nutritionally dense, fiber‐rich vegetables listed.
More keto diet tips for those with chronic fatigue
Eat fat (but only the right kinds)
Fat is where it’s at on the keto diet. All fats and oils, even butter, are allowed (and encouraged!). Olive oil and coconut oil are especially healthy oils and are encouraged in cooking. Even though industrial seed oils (canola, safflower, soybean, corn, and vegetable oils) are technically keto friendly, they’re known to cause inflammatory signals within your body. Please ensure you avoid all industrial seed oils.
Fats, in general, are important to include, because they taste good and make you feel full. All that information you were fed about how fats cause heart disease and early death… Turns out they’re not so true after all. (3, 4) A well-formulated ketogenic diet will not increase your risk of heart disease. In fact, it could actually improve your heart and cholesterol health! (5)
How to satiate your sweet tooth on a keto diet
On a ketogenic diet, you cannot reach for the sugar like you once did. Even a small amount of refined sugar is enough to kick your body out of a ketogenic state. To stay in ketosis, you’ll need to change the way you sweeten foods. Opt for sweeteners like stevia, erythritol, and/or xylitol.
Other low-calorie sweeteners like Splenda, aspartame, and saccharin are best avoided. These sweeteners have been linked to IBS and other gut-related symptoms. And since the connection between IBS and chronic fatigue is firmly established, it is best to avoid any foods that may contribute to gut issues.
There are no restrictions on beverages – as long as your drink of choice does not contain carbohydrates. My number one recommendation for beverages is water (no surprise there). Spring water, mineral water, and club sodas are also ok to drink. There are “keto pops” on the market; while these will keep you in ketosis, I still recommend minimizing their consumption.
Caffeinated beverages are welcome on the ketogenic diet, though the refined sugar you add to your coffee will have to go. For those of you with CFS and adrenal fatigue, high caffeine intake is not recommended. For some of you, coffee will help increase your energy; in others, it will make it worse. Not everyone with chronic fatigue syndrome should drink coffee.
Alcohol and the ketogenic diet
For those of you with chronic fatigue syndrome, I’d strongly encourage you to minimize your alcohol consumption. Alcohol and your mitochondria do not get along well. In fact, alcohol is shown to damage mitochondrial DNA. This will decrease your body’s ability to produce energy (ATP) and most certainly contribute to your fatigue. (6)
As your energy levels increase, you can (slowly) look at adding back small amounts of low carbohydrate alcohol. Please do not rush this process. The negative effects of alcohol consumption on CFS far outweigh any benefits.
What does a day of keto look like?
When you’re just starting out on a ketogenic diet, I always recommend you opt for simple dishes first. The amount of fat used on a daily basis is not an intuitive amount. It is way beyond what you think is “normal”. This is why tracking your macros can be so helpful for the first couple of weeks.
Once you get comfortable with the high levels of fat in your life, you can start experimenting with more creative recipes. But don’t think your food will be bland or unappetizing. The high levels of fat found in the keto diet make the majority of meals incredibly satisfying – even without fancy preparation techniques. Below, I give you a simple example of a ketogenic dieters meal plan.
- Bacon or sausage
- Grilled chicken on top of salad greens and other vegetables, with bacon, chopped eggs,
and olive oil/balsamic vinegar dressing.
- Pepperoni slices and a cheese stick.
- Burger patty or steak
- Green salad with other acceptable vegetables and salad dressing
- Green beans with butter
A day in the life of your keto diet can look as simple as the above, or, you can get all kinds of fancy with your cooking. When starting out, I recommend keeping it simple. That will make for easier tracking. Once you’ve figured out how much fat you need to consume on a typical day, you can start experimenting with more complex recipes.
Learn about what foods increase energy and which foods take it away.
Also published on Medium.