Can diet help chronic fatigue syndrome?

What is M.E/CFS?

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (M.E/CFS) is a complex condition that leads to severe fatigue after normal daily activities. But it extends far beyond fatigue: other debilitating symptoms include pain, neurological and sensory issues. 

It is understandable to search for answers in food when support is limited. Lots of people with M.E/CFS look to diet to help manage symptoms like fatigue and gut issues. They might also be looking to diet to help with managing co-existing conditions such as irritable bowel syndrome (IBS), food intolerances and dysautonomia (conditions which affect the autonomic nervous system). 

As a Dietitian specialising in supporting adults with complex chronic conditions including M.E/CFS, here's what I want you to know.

Is there a diet for M.E/CFS? 

Some people report that certain foods worsen symptoms for them as individuals. But M.E/CFS itself does not have one evidence-based diet that works for everyone. 

In practice, nutrition is usually less about finding one perfect way of eating and more about:

• aiming to meet nutritional needs consistently
• reducing your personal symptom triggers
• making food manageable within the reality of limited energy levels

Could something else be worsening fatigue? 

It is important not to miss preventable contributors to fatigue and to think about whether there are other factors making symptoms worse. This can include:

• undereating
• not drinking enough
• nutritional deficiencies.  

Where should I start? 

When fatigue is severe keeping things simple can help to ensure your nutritional needs are met. Your body still needs a regular supply of energy and nutrients even when activity is limited. In practice I usually start by exploring these three things: 

• Are you eating enough and regularly enough?  Undereating can worsen fatigue, dizziness and brain fog and reduce the diversity of the gut microbiome. As a guide it can help to have something to eat every 3-4 hours when you are awake. If meals are difficult this can be snacks or nutritious drinks. Try to have a mix of snacks with protein (like eggs, tofu, beans or chicken), carbohydrate (like pasta or crackers), fat and vegetable/fruit choices so that you get a range of nutrients. 

• Are you drinking enough?  Dehydration can worsen fatigue and autonomic symptoms like dizziness and brain fog. Aiming to drink 1.5-2 litres of fluid per day is a good starting point, although individual needs may vary. If nausea makes drinking hard, take sips through the day and remember liquid foods like soups, sauces, ice lollies, jelly, cucumber and juicy fruits count too. 

• Do you have any deficiencies?  Iron, B12, folate and vitamin D deficiencies are common and can overlap with M.E./CFS symptoms of fatigue, muscle weakness, low appetite, changes in mood, bone or muscle pain. These are worth checking and correcting where possible. You can ask your G.P. for a blood test to check your levels.

Should I take supplements? 

There is limited evidence for the benefit of supplements in M.E/CFS beyond preventing and correcting deficiencies. Small studies have shown modest benefits with Coenzyme Q10, NADH (Nicotinamide adenine dinucleotide + hydrogen), probiotics and yeast beta glucan but more research is needed. 

If you do want to trial supplements it is important to introduce them one at a time to monitor side effects and benefits. In my practice I see large numbers of supplements being taken and this can worsen symptoms and risks interactions with each other and prescribed medications. 

What about elimination diets?

People with M.E/CFS are often vulnerable to trying multiple restrictive diets, sometimes stacked one after another in search of relief. For someone with M.E/CFS, these can come with hidden costs. I often see people who are following multiple restrictive diets for many years, and this often leads to overwhelm and malnutrition. This means they are not getting enough of the nutrients their bodies need to function.

The main problems that can happen with restrictive diets include:

• Using extra valuable energy for shopping, cooking and planning
• Reduced food intake if suitable foods are not easy to prepare  
• Eating becomes stressful and confusing 
• Feeling guilty when the plan cannot be followed consistently 
• Malnutrition and worsening of symptoms if followed for a long time

When your energy is very limited, a diet that only works on a good day is often not the right plan. Advice needs to work on your difficult days too. 

Questions to ask before following a diet plan 

Before starting any new diet plan, especially one that restricts your food intake, it can help to pause and ask these things first: 

• What is this diet meant to help with and is there a clear reason for me to follow it? 
• Will it make eating harder or more stressful? 
• Can I manage it with my current health?  
• Am I likely to eat enough while following it? 
• Is this intended to be short term, and do I know how to review it? 

These questions can help you to step back and think about whether a change is likely to be useful for you as an individual, or whether it will just add restriction and burden. 

But what if I think food is causing symptoms? 

It is very understandable to wonder if certain foods are making symptoms worse. For some people this is part of the picture, but it is not always straightforward.  

Rather than starting a restrictive diet, try to note eating and symptoms and look for patterns.  

If this takes too much energy, experiment with one food at a time. You could remove a single food for a short period, then reintroduce it and see if anything changes. This can give you clearer information without adding unnecessary restriction. 

What helps on low energy days? 

Food needs to be realistic. On very fatigued days, the priority is eating something, rather than preparing an ideal meal each time. Here's what can help:

• Having a plan for low energy days in advance 
• Keep easy meals at home such as soup, beans on toast, frozen meals or sandwiches 
• Use convenience foods to reduce effort, such as pre-chopped fruit, microwave rice, ready-cooked meat, pre grated cheese or frozen vegetables 
• Have a few repeat meals that are familiar and easy to assemble 
• Keep drinks and snacks within easy reach if you struggle with mobility 
• Use prescribed or over the counter meal replacement drinks if food is too difficult 

If you are noticing ongoing reactions, you are struggling to eat, or losing weight, find support from a registered dietitian experienced with M.E/CFS (this directory can help you find one). They can help you to safely work through this in a way that feels manageable. 

Take home message...  

There is no single best diet for M.E/CFS. Nutrition advice should reduce pressure, not add to it. For most people, the priority is not finding the perfect diet plan but building a way of eating that supports energy, reduces individual symptoms and feels manageable within the limits of their condition. 

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