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CFS The Hidden illness.

A healthy diet plan is important for managing fibromyalgia (FMS) or chronic fatigue syndrome (CFS or ME/CFS). While it's not a "cure" and there is no magic diet that works wonders for everyone with these conditions, eating right can help you feel better, have more energy and support your immune system.

As important as eating right is not eating wrong -- certain foods and drinks could be worsening your symptoms. It will take some trial and error to find what works best for you, but the information here is a good place to start.


While improving your eating habits might help you lose weight, keep in mind that your first goal needs to be feeling better. FMS and ME/CFS can make it especially hard for you to lose weight, but to properly address that problem, it's important for you to first get your symptoms to a more manageable level. Once you feel better, you'll be more able to increase your activity level and to face the specific challenges that keep you from dropping extra pounds. DO NOT TRY EXTREME OR "FAD" DIETS. Make dietary changes one at a time so you can gauge their effect on your health. Sudden or extreme changes -- even beneficial ones -- can temporarily make your symptoms worse.

A lot of websites advertise "cures" or treatments in the form of diets and supplements. Some of these are reputable, while others are not, so it's important to research the claims they make. Some diets may not provide proper nutrition, while others may require you to spend a lot of money on proprietary products that might not work and could potentially damage your health.

A "Balanced Diet"

You hear it all the time -- "eat a balanced diet!" With so much contradictory information around, it's hard to know exactly what "balanced" means. According to About.com's Calorie Count page, eating a balanced diet is defined as "choosing a wide variety of foods and drinks from all the food groups," while practicing moderation when it comes to saturated or trans fat, cholesterol, refined sugar, salt, and alcohol.

The healthy food groups are:

  1. Grains
  2. Fruits
  3. Vegetables
  4. Protein (poultry, fish, lean meats or dried beans)
  5. Dairy (low-fat milk, cheese or yogurt)


Getting enough protein in your diet is especially important, because your body needs it for growth and maintenance. Protein is directly responsible for about 20% of the material in your cells and tissues, and it's also necessary for hormones, antibodies and enzymes that keep your body going. Animal-based proteins (such as milk, meat, fish, poultry and eggs) will give you the amino acids your body needs to build protein.

Things to Avoid

Some people with FMS and ME/CFS find that certain foods make their symptoms worse. To see how they effect you, try eliminating them from your diet for several days. Then reintroduce one food at a time (with a few days in between) and see how it makes you feel. The most common symptom triggers are:

  • High-calorie foods
  • Fried foods or those with high saturated fats
  • Refined sugar
  • Nutrasweet (aspartame) and monosodium glutamate (MSG)
  • Cigarettes and other tobacco products

Other factors can disturb your sleep, which will make you feel worse. You should try to avoid:

  • Caffeine
  • Alcohol
  • Drugs
  • Candy/sugary foods

A note on caffeine: While many people with these conditions believe caffeine is essential for helping them wake up and have energy, it's important for you to look at it as a possible barrier to better sleep. While you may have withdrawal symptoms and feel more tired for a little while, if eliminating caffeine helps you sleep better it will be well worth it in the long run.

You can find a lot of claims online that a gluten-free diet may alleviate symptoms. This may be true for some people, but research hasn't given us definitive answers about how effective it is (or isn't.) 

Raising Available Serotonin

Serotonin is a neurotransmitter that's involved in several processes in your brain, including pain perception, sleep regulation and feelings of well being. Abnormal serotonin levels are linked to both FMS and ME/CFS, as well as depression, which is a common result of any chronic pain condition. (Neither FMS nor ME/CFS is caused by depression.)

To raise serotonin levels through food, you can try eating:

  • Carbohydrate-rich foods, especially before bed
  • Complex carbohydrates (grains, beans and many starchy foods)
  • Dark chocolate (considered healthy only in small amounts)

As with everything else, you'll have to experiment to see what works best for you.

When you have fibromyalgia (FMS) or chronic fatigue syndrome (CFS or ME/CFS), it's common for well-meaning people to tell you something like, "If you'd just exercise more, you'd feel better."

Certainly, exercise is important to anyone who wants to be healthy, but it poses special problems for anyone with these conditions. Even moderate exertion can make you feel worse, so it can be very tempting to give up exercise altogether.

The irony here is that even though exercise can make you feel worse short term, the lack of it can make your symptoms more severe long term, as well as inviting more health problems. The key is moderation and pacing. Numerous studies demonstrate that even small amounts of exercise, as little as 6 minutes per day, can lessen pain and fatigue.

Exercise is typically easier (although not easy!) for someone with FMS than it is for those with ME/CFS. That's because of one of the hallmark symptoms of ME/CFS: post-exertional malaise, which causes your body to recover much more slowly than other people's.

For example, in one Canadian study, people with ME/CFS and a healthy control group rode an exercise bike one day, then came back the next day to see if they could repeat their performance. The healthy people could, while those with ME/CFS couldn't even come close before they were exhausted. The study showed that the typical recovery period is 24-36 hours.

Another study, however, suggested that limits on how long and how hard people with ME/CFS exercise can keep them from feeling worse. Research also shows that the full effect of exercise might not be felt for up to 5 days, so you need to limit your exercise even if you feel, at the time, like you can do more. It can help to keep a log of symptoms, noting when you exercise and watching for a symptom increase within the next week.

Do back pain exercises bore you? Then play for back health now...

Some doctors recommend graded exercise therapy (GET) as part of an ME/CFS treatment regimen. Research shows that GET, when taught by a qualified therapist, can help you alleviate symptoms and regain functionality. (Note: this statement is not supporting the controversial British biopsychosocial treatment model, which uses GET as part of cognitive behavior therapy.)

Don't get the idea that people with FMS don't have any problems with exercise! Similarly to post-exertional malaise, doing too much can cause a flare-up of FMS symptoms. The difference is that people with FMS can typically handle a higher level of exertion than someone with ME/CFS, and if they don't overdo it, they can generally repeat their performance the next day.

Because of post-exertional malaise, if you have both FMS and ME/CFS, you should approach exercise more slowly.

While exercise can be an important part of your treatment, it's not a cure, and it takes time for it to work. Exercise should be considered one aspect of treatment and self-management, which may also include things such as medications, dietary changes, vitamins and supplements, alternative or complementary medicine, and good sleep hygiene.

Recommended Exercises for Fibromyalgia & Chronic Fatigue Syndrome

Once research established that exercise does benefit people with FMS, studies started focusing on what types of exercise were best, giving us solid information about specific methods.

For ME/CFS, however, most exercise-related research has focused on limits and whether setting limits allows people with it to exercise. This leaves us with little information about specific forms of exercise that could help with ME/CFS symptoms.

Because pain symptoms of FMS and ME/CFS are so similar, however, and because the exercises recommended for FMS are gentle, these forms of exercise are a good place to start for people with ME/CFS or with both conditions.

The more gentle the exercise, the better it will likely be for you. Frequently recommended exercises include:

  • Warm-water exercise
  • Yoga
  • Tai Chi
  • Pilates

When starting, be sure to stick to exercises/poses that have you lying on the floor, seated, or in a very stable standing position. Many people with FMS and ME/CFS are prone to dizziness, especially when standing up.

Other low-impact exercises include:

  • Bicycling
  • Walking
  • Step aerobics (once you're in fairly good shape)

Remember, the key is to start slowly, watch your symptoms carefully, and find the level of exertion that's right for you right now. Keep the following in mind:

  • Push yourself to get moving, but don't push yourself to do more until you know you're ready.
  • Expect some setbacks -- you'll need to experiment to find your current level of tolerance.
  • Remember that exertion comes in all forms. Don't try to exercise on a day that you're also going to the grocery store or doing something else that's strenuous.
  • Take breaks when you need them, but don't give up! The payoff could be less pain, more energy and a better quality of life.