Managing CFS/ME through diet

Nina Bailey
BSc (hons) MSc PhD ANutr
Managing ME/CFS symptoms
through diet

Myalgic Encephalomyelitis (ME)is a condition
that causes fatigue severe enough to interfere
with a person’s normal life
ME is also known as chronic fatigue syndrome (CFS)
According to the NHS, it’s estimated that approximately
250,000 people in the UK have ME/CFS

Suppressed immune
function
Excessive free
radicals/inflammation
Inadequate energy
(poor mitochondrial
function)
Viral infections

Treatments include
 Pain killers
 Antidepressants
 Exercise therapy/pacing
 Cognitive behavioural therapy (CBT)
 Lymphatic massage (Perrin Technique)

And yet:
 Food directly influences brain function, mood and energy
 Living with CFS can have a significant impact on our appetite and
eating habits
 Some people lose interest in cooking and don't have the energy to
prepare meals, whilst others have physical or emotional symptoms
that can be linked to either over- or under-eating
 Standard drugs, such as commonly prescribed SSRIs, (whilst
providing relief for some suffers) can also present with side effects
that affect appetite, leading to undesirable weight gain or weight
loss
GPs do not generally give advice on nutrition!

Viral infections
ME/CFS is thought to arise from a persistent viral infection
o Epstein Barr virus (glandular fever)
o Enteroviruses
o Non-specific viral infection (URI)
o SARS
o Influenza
o Borrelia (Lyme disease)
o Xenotropic murine leukaemia virus-related virus (XMRV)
‘sub-clinical infection’ - once a person is infected, viruses can
remain latent in the body for long periods of time

Cold sore
Herpes simplex virus
HSV1 HSV2
Chicken pox
Herpes varicella-zoster virus
Shingles

Two different methods exist by which the body fights
infections
 Cellular immunity (Th1) directs specialist cells (i.e. natural
killer T cells) to attack microorganisms at sites of infection
inside the cells
 Humoral immunity (Th2) results in the production
of antibodies used to neutralise foreign invaders and
substances outside the cells

 When an immature immune cell is exposed to a virus, a
Th1 response should be initiated
 Some viruses are able to deceive the immune system into
thinking that the threat is not coming from a virus
 The immune system counters with too little of a Th1
response, the virus remains concealed and the infection
becomes active or chronic

ME/CFS patients appear to
exhibit changes in the immune
system that increase their
susceptibility to viral infections
Link to stress?

Stress
Hypothalamus and pituitary
ExamsRedundancy
Bereavement
Marriage
Divorce
House move
Debt
catecholamines
Adrenal cortex
Cortisol
Suppressed
immunity
Childbirth

Acute stressors occur rapidly and
have an obvious onset and offset;
chronic stressors are ongoing and
may not have a clear endpoint
Brief, predictable stressors are
generally beneficial in terms of
enhancing cognition, emotion and
neurobiological systems such as the
immune system
Chronic, sustained stressors are
considered to be the most
deleterious, contributing to immune
and endocrine dysfunction, altered
mood, and several neurobiological
and psychological diseases

‘energy currency’
Understanding fatigue

 Mitochondria generates ATP and these molecules are the
"currency" of energy in the body
 The reserves of ATP are generally very low and have to be ‘re-
cycling’ to keep the cell constantly supplied with energy
 If the cell is not very efficient at re-cycling ATP, then the cell
runs out of energy very quickly and this causes symptoms of
weakness and poor stamina because the cell must wait until
more ATP can be produced
 When there is no ATP available, then the body will start to use
another molecule called ADP instead

 The body can create energy from ADP but the only way that
ADP can be regenerated is by making it from fresh
‘ingredients’ which is an extremely slow process
 D-ribose, CoQ10, acetyl-L-carnitine, NAD, magnesium and
vitamin B12 are ‘key ingredients’ that help support
mitochondrial function and improve energy

Managing CFS/ME symptoms
 Support immune function
 Support energy requirements (via mitochondrial function)
 Support brain function
 Reduce ‘body’ inflammation
 Support gut function

DHA
EPA
ALA
delta -6 desaturase
Viruses stop us making long
chain omega-3 fatty acids
EPA and DHA are important
regulators of:
 Brain function
 Cardiovascular function
 Immune function
 Inflammatory regulation
Plants
Fish and
seafood

DHA
EPA
ALA
delta -6 desaturase
Other factors that can reduce
EPA and DHA levels:
 Stress (cortisol)
 Alcohol
 Saturated fat
 Low vitamin and mineral
intake
 Caffeine
Plants
Fish and
seafood

Antiviral (virucidal) food?
 Garlic
 Onions
 Omega-3 (EPA)
 Grape seed extract
 Liquorice root
 Olive leaf
 Green tea polyphenols

ME/CFS and unregulated inflammation

Bosma-den Boer et al. 2012
Initiation Resolution Termination
Inflammatory
‘messengers’
derived from
omega-6 fats
Initiation requires an inflammatory ‘trigger’

Pro-inflammatory signals
from omega-6 reduce
Inflammatory switch must occur for resolution to begin
Anti-inflammatory products
produced from omega-3 are
required for resolution of the
inflammatory process
STOP!

Pro-inflammatory signals
from omega-6 reduce
Inflammatory switch must occur for resolution to begin
Anti-inflammatory products
produced from omega-3 are
required for resolution of the
inflammatory process
STOP!
CORTISOL

If the inflammatory response doesn’t reach the termination
phase we have issues with ‘silent’ inflammation
CORTISOL
STOP!

StructuralAnti-inflammatory
DHAEPA
Pro-inflammatory
AA
AA to EPA ratio
direct antagonism
The relationship between the omega-3 index and the AA to EPA ratio
Omega-3 index

Adrenal fatigue
(prolonged stress)
Depression/anxiety
Suppressed
immunity
Viral infection Low omega-3
Stress (cortisol)
Brain ‘fog’
Increased
inflammation
Brain ‘changes’
Poor sleep

“Whereas the role of diet in the prevention of other noncommunicable
diseases, such as cardiovascular disease (CVD), has been widely
investigated for the last 50 years, the relationship between diet and
depression is so far a novel and interesting field that has only emerged in
the last five to ten years”

“Long term exposure to unhealthy dietary habits
independently predisposes to depression over the life
course”
“Chronic inflammation may underlie the relationship
between diet and depression”

Understanding diet quality - what is an inflammatory diet?
Pro-inflammatory foods
Lower-quality foods include highly processed snack foods, sugar-
sweetened beverages, refined (white) grains, refined sugar, fried foods,
foods high in saturated and trans fats, and high-glycaemic foods such as
potatoes, white bread and pasta
Anti-inflammatory foods
High-quality foods include unrefined, minimally processed foods such as
vegetables and fruit, wholegrain products, healthy fats and healthy
sources of protein

Packaged and processed foods have become the norm in most industrialised
countries and increasingly throughout the world
 Since the 1950s there has been a 70% decline in the purchase of flour – directly
attributed to the availability of ready prepared foods
 There are now approximately 320,000 different packaged food and drink
products in the marketplace
 In an average supermarket, there are approximately 25,000 + different products
on the shelves - yet fresh food makes up a very small percentage
 At the end of 2004, total sales of the top products in the main processed food
categories (such as ‘bagged’ snacks and canned drinks) accounted for over £62
billion in the UK alone
Changing Diets, Changing Minds: how food affects mental well being and behaviour

The agricultural and industrial revolutions, followed by the globalisation
of world food trade, mean that most people in rich countries (and
growing proportions in poor countries) eat:
 Small amounts of a few types of vegetables and fruit
 Very few wholegrain products - our carbohydrates are mostly refined
(such as sugar and products made from white flour) - and from a very
narrow range of cereals (90% of the calories from cereals eaten in the
UK are from wheat)
 Very little oily fish, but large quantities of intensively produced meat,
meat products and dairy products

Food
MicronutrientsFatProteinCarbohydrate
How does food affect mood and cognition?

Food
MicronutrientsFatProteinCarbohydrate
Vitamins &
minerals
Fatty acidsAmino acids
Complex &
simple sugars

Vitamins &
minerals
Fatty acidsAmino acids
Complex &
simple sugars
memory
concentration
learning
behaviour
attention
appetite
mood
sleep
sexual function
Chemical messengers
(neurotransmitters)
Brain
(structure and function)

The combination of nutrients most commonly associated with good
mental health and wellbeing:
 Polyunsaturated fatty acids (particularly the omega-3 types found in oily
fish)
 Quality (organic, grass fed) animal protein
 Minerals, such as zinc (in wholegrain foods, legumes, meat and milk),
magnesium (in green leafy vegetables, nuts and wholegrain) and iron (in
red meat, green leafy vegetables, eggs and some fruit)
 Vitamins, such as folate (in green leafy vegetables and fortified cereals),
a range of B vitamins (wholegrain products, yeast and dairy products),
and antioxidant vitamins such as C and E (in a wide range of fruit and
vegetables)

Eat protein-rich foods to boost alertness
Try to include a protein source in your diet several times a day, especially
when you need to clear your mind, boost your energy, lift mood, promote
relaxation and help deal with stress
 Protein is broken down into amino acids
 Amino acids provide the building blocks for the production of
neurotransmitters
Combine protein with complex carbohydrates (protein slows down the
absorption of sugars found in carbohydrates)
Vegetables (and fruit) provide vital ‘cofactors’ required to modify proteins
and amino acids into neurotransmitters

L-Tryptophan
5-HTP
Serotonin
Melatonin
Tryptophan is an
amino acid
High tryptophan foods
include nuts, seeds,
tofu, cheese, red
meat, chicken,
turkey, fish, oats,
beans, lentils and eggs
Magnesium, zinc & B6

L-Tryptophan
5-HTP
Serotonin
Melatonin
Tryptophan is an
amino acid
High tryptophan foods
include nuts, seeds,
tofu, cheese, red
meat, chicken,
turkey, fish, oats,
beans, lentils and eggs
Mood
Sleep

Choose your carbohydrates wisely!
The brain needs fuel, but at a constant rate
Glycaemic index
 GI is a measure of the effect that carbohydrates have on blood sugar
levels
 Carbohydrates that break down quickly during digestion, releasing
glucose rapidly into the bloodstream, will have a high GI
 Carbohydrates that break down more slowly, releasing glucose more
gradually into the bloodstream, will have a low GI

Sugar is inflammatory!
 The more processed and refined the carbohydrate, as a rule, the
faster it breaks down in the digestive system, and the bigger the sugar
rush it delivers
 That’s why refined flours, sugars and sugar syrups pose such a
problem for our systems
 Sugar plays a direct role in inflammatory diseases
 Poor regulation of glucose and insulin is a breeding ground for
inflammation

L-Tryptophan
5-HTP
Serotonin
Melatonin
Mood
Sleep
High levels of
Inflammatory products
(cytokines) and cortisol
(stress hormone) can
disrupt the normal
production of serotonin,
affecting both mood and
sleep

 Pro-inflammatory carbohydrates include sugar of all sorts, white rice
and refined carbohydrates made from refined or enriched flour (such as pizza
crust, bagels, most breads, crackers, most packaged cereals, biscuits, cakes,
etc.)
 Anti-inflammatory carbohydrates are the unrefined whole
carbohydrates that come packaged just the way nature designed them
including all fruits, vegetables, beans, legumes and unrefined non-flour
wholegrain products
 All anti-inflammatory carbohydrates are also brimming with nutrients,
including vitamins & minerals, phytonutrients and antioxidants

Optimise your gut health!
 Complex carbohydrates are also a good source of fibre
 Fermented foods such as fermented vegetables are also important for
optimal mental health as they are key to optimising your gut health
(prebiotics and probiotics), other natural probiotics include
 Kombucha – enzymes and bacteria
 Kefir – beneficial yeast and bacteria
 Your gut is literally your ’second brain’, and can significantly influence
your mind, mood and behaviour
 Your gut actually produces more mood-regulating serotonin than your
brain does!

60% of the brain is comprised of fat
 Deficiencies in specific kinds of fats can have a negative impact on
intelligence, behaviour and mood
 Omega-6 and omega-3 fats in particular are required for brain
structure and function
 Deficiencies in omega-3 are associated with a number of neurological
conditions
- Developmental disorders (i.e. ADHD)
- Depression
- Bipolar disorder
- Schizophrenia
- Dementia

Choose good fats!
Fats
Include Avoid
Coconut oil Margarine
Olive oil Sunflower oil
Rapeseed oil Canola oil
Butter (grass fed is optimal)
Flaxseed oil
Fish oil
Vegetable oil

1:1 25:1
Omega-6 to omega-3 ratio

Omega-3Omega-6
Hunter-gatherer

Omega-6 Omega-3
Westernised diet

Omega-6 Omega-3
High inflammation!!!!

Marine products offer a unique nutritional package
 Rich source of essential micronutrients acting as
cofactors for neurological processes
• Neurotransmitters
• Methylation
 Rich source of protein
• Tryptophan - serotonin
• Phenylalanine - dopamine
 Major source of EPA and DHA

Adrenal fatigue
(prolonged stress)
Improved mood
Improved
immunity
Virucidal
activity
EPA
supplements
Reduce stress
(cortisol)
Improved cognitive
function
Decrease
inflammation
Positive brain ‘changes’
Improved sleep

Neurotransmitter support (mood and cognition)
 5-HTP
 Omega-3 EPA
 St. John's Wort
 SAMe
 L-theanine

Neurotransmitter support (calming and relaxation)
 L-theanine
 Magnesium (as malate, glycinate or citrate)
 B-Complex
 Omega-3 EPA

Liver support (detoxification)
 B-Complex
 N-acetyl L-cysteine
 Glutathione
Gut function
 Pre/probiotics
 L-Glutamine

Energy (support mitochondrial function)
 L-carnitine
 CoQ10 - ubiquinol
 D-ribose
 NADH
 Vitamin B12
 Magnesium (as malate, glycinate or citrate)

Anti-oxidants (reduce free radical and lower inflammation)
 Lipoic acid
 Vitamin C
 Ubiquinol (CoQ10)
 Resveratrol
 Astaxanthin
 Carnosine

Eat well, spend less!
 Cutting down on unhealthy food items such as ready
meals, sweets, cakes, crisps and fizzy drinks will free
up more money for healthier items
 Many unhealthy food items offer little or no nutritional
benefit and can actually exacerbate feelings of
depression
“Let food be thy medicine and medicine be thy food.”
― Hippocrates c. 460 – c. 370 BC

Eat well, spend less
 Get organised and try meal planning so that when you go shopping,
you can write a list and buy only what you need
 We can spend a lot of our precious budget on ‘impulse’ purchases
because supermarkets are very clever at making us spend more than
we want!
 This also helps to avoid supermarket promotions, which are seldom
related to good foods and often only encourage spending
 Shopping with a friend can be a good idea (or buy online), if you do
want to take advantage of the healthier ‘buy one get one free’ offers!

 The nutrient content of fruit and vegetables begins to diminish as soon as
they are picked, so ideally you should try to only pick/buy the quantities you
really need for the next few days/meals
 Frozen fruit and vegetables can be much better value than buying fresh
 Frozen vegetables also tend to offer more nutrients, because they are frozen
within a very short time of being harvested
 ‘Fresh’ vegetables, on the other hand, are sometimes transported thousands
of miles, so aren’t always fresh when you finally eat them
 Local markets or greengrocers often offer better value for money and are
more likely to sell locally sourced produce
 Grow your own veg or forage for ‘free’ food!

 Whilst organic, grass-fed animal products (meat & dairy) are the healthiest
option when choosing a protein source, pulses and soy products can be
much cheaper than meat, and offer additional nutrients not found in meat
 Cuts of meat such as skirt, flank and shin (and offal) are cheap and nutritious
 Tinned sardines, mackerel, pilchards etc offer very good value for money and
are packed with omega-3!
 Try cooking in bulk and freezing portions for when you don’t feel like cooking
 Remember – it doesn’t have to be expensive to eat well in order to look after
not only your brain, but your whole body
 Eating the right foods can improve memory, mood and energy levels as well
as improve sleep patterns

“But I don’t feel like eating”
What about
High nutrient rich soups
Raw smoothies (vegetables/fruit)
Add coconut oil (MCTs) for an energy ‘hit’
Add protein powder
Try to eat little and often

Top tips
 Adopt an anti-inflammatory diet
 Eat at least 5 portions of fruit and vegetables a day (4 veg and 1 fruit)
(raw fruit and vegetables provide the biggest nutrient hit)
 Choose whole foods, not refined foods (and anti-nutrients i.e. sugar)
 Choose good fats (limit omega-6 and increase omega-3)
 Choose quality protein
 Eat small portions regularly
 Use supplements where appropriate

Contact details
ninab@igennus.com

 SAMe – metabolism of neurotransmitters
serotonin, melatonin and dopamine
 cysteine and glutathione – vital for antioxidant
protection and detoxification processes
 DNA – cell cycle, genetic replication, growth
and development
 carnitine, choline and CoQ10 – energy
metabolism and mitochondrial function
 myelin proteins – nerve transmission and CNS
communication
A healthy methylation cycle – necessary for the production of:

 Highly bioavailable (‘body-ready’) micronutrient
actives
 Formulated at proven dosages for enhanced
efficacy
 Strong benefits supported with strong health
claims
 Offers benefits for cardiovascular health, brain
function and mood balance
 Synergistic benefits alongside the Igennus clinical
omega-3 range
 Small, easy-to-swallow tablets optimised for split-
dosing
 Split-dosing overcomes bioavailability issues
related to vitamin B12 intake and maintains
optimal blood levels of key B-vitamins
 Suitable for vegetarians & vegans
 Suitable for adults and children aged 7+
Nutritional information Per dose % RI*
Vitamin C (ascorbic acid) 160 mg 200
Vitamin B3 (niacin) 48 mg 300
Vitamin B5 (pantothenic acid) 36 mg 600
Vitamin B1 (thiamine ) 20 mg 1818
Vitamin B6 (pyridoxal-5-phosphate) 20 mg 1429
Vitamin B2 (riboflavin-5-phosphate 14 mg 1000
Vitamin B12 (methylcobalamin) 900 mg 36000
Folate ([6S]-5-methyltetrahydrofolate) 400 mg 200
Vitamin B7 (biotin) 300 mg 600
Super B-Complex

Igennus MindCare® is the first comprehensive range of targeted brain
nutrition supplements based on four identified consumer need-states.
EPA & DHA +
vitamins E & D
EPA & DHA +
vitamins E & D
EPA & DHA +
vitamins E & D
EPA & DHA +
vitamins E & D
Magnesium glycinate,
L-Theanine &
micronutrients
Acetyl-l-Carnitine,
L-Theanine, taurine,
caffeine &
micronutrients
5-HTP, Magnesium
glycinate &
micronutrients
N-Acetyl L-Cysteine,
alpha-lipoic acid,
resveratrol &
micronutrients

S-adenosylmethionine (SAMe)
 SAMe is an important co-factor involved in the biosynthesis of several
hormones and neurotransmitters, such as dopamine and serotonin,
which affect mood
 Supplementing the diet with SAMe increases levels of serotonin and
dopamine
 Usual dose is 100-200mg daily
 Cannot be taken alongside standard antidepressants

Neurotransmitter precursors - tryptophan and 5-HTP
 Serotonin is made in the body and brain from the amino acid 5-HTP
which is derived from tryptophan
 Both can be found in the diet; tryptophan is found in many protein-rich
foods such as meat, fish, beans and eggs
 Tryptophan supplements are available as 500mg to 1000mg
 The highest immediate form of 5-HTP is the African Griffonia bean
(100mg-200mg dose)
 Not advised to take alongside SSRIs

Managing CFS/ME through diet

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