Diet and Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS)

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1 All Party Parliamentary Food and Health Forum 15 December 2015 Diet and Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) Professor Neil I. Ward FRSC Chemistry FEPS University of Surrey

2 MS/CFS characterised by profound sensation of fatigue (physical and mental) unrefreshing sleep post-exertional malaise with recovery delayed more than 24 hr worsening of symptoms with effort and non-restorative sleep widespread diffuse pain cognitive impairment

3 MS/CFS Common dietary issues put on too much weight due to less exercise (muscle pain) food cravings, comfort eating, medication effects, need to boost energy levels, less energy to prepare foods IBS-type symptoms wind/bloating, abdominal pain and diarrhoea or constipation problems

4 Common dietary recommendations* eat little and often (3-4 hours) low glycaemic index (GI) goods (wholegrains, pasta, porridge..) to slowly release energy avoid high sugar food and drinks (high GI) balanced healthy diet (oats, wholegrains, fruit and vegetables, meat, fish, eggs, nuts, beans, pulses, Ca-enriched and soya based ) *BDA Association of UK Dietitians

5 ME/CGS Food allergies? many reported food allergy problems need to identify not IBS or other medical condition to identify problem foods need elimination or exclusion diet tests Caution* must maintain a balanced diet *BDA Association of UK Dietitians

6 Dietary intake CFS food allergy history 16 patients (Colorado, USA) CFS, 90-item food freq. questionnaire, 7-day diet consect. Record 56% fast foods, 25% skipped meals 31% wheat/flour; 25% dairy allergies all intake of calories, vit E, Cu, Zn significantly lower than US National Health and Nutrition Examination Survey III levels Smith & Cohen J Amer Dietetic Assoc. A-87, Oct 21 st

7 Elemental deficiency in CFS Mg, Fe, Cu and Zn reported lower in blood serum and RBCs of CFS patients Mg deficiency may cause CFS-like symptoms (memory difficulties, depression, myalgias, fatigue) low Mg and Zn RBC levels reported in CFS but not linked to dietary intake most studies small sample sizes, non-fasting Cox et al., Lancet 337, , 1992 Grant et al., J Amer Dietetic Assoc, 96, 383-6, 1996

8 Toxic metals and CFS/ME Al, Hg (dental amalgams), Cd triggers of CFS/ME might be responsible for inflammatory processes trigger multiple non-specific symptoms Cd exposure associated with reduced cerebral blood flow in cortex of patients Pacini et al., Med Hypothesis 79, 403-7, 2012

9 ME/CGS supplements vitamins, minerals, essential fatty acids (omega 3), co-enzymes vit A, C, D, E, B 6 limited control, randomised studies on use of vitamin and mineral supplement effects to manage ME/CFS BDA The Association of UK Dietitians

10 Essential fatty acids in CFS abnormalities of EFAs incorporated into phospholipids found in chronic diseases EFA metabolites can influence immune system and hypo-response immune function in CFS dietary EFA modulation has resulted in 90% CFS gaining improvement within 3 months Gray & Martinovic, Med Hypoth. 43, 31-42, 1994

11 Dietary interventions limited randomised, controlled trials examining treatment interventions many patient formulated dietary schemes to provide symptom relief: (i) caloric restriction (ii) fasting diets (iii) ketogenic diets (high fat/low carbs) (iv) avoidance of diary, sugars, alcohol, gluten-containing grains, vegetable or fibre intake

12 Caloric restriction and fasting diets focus on mitochondrial functioning (oxidative stress, decreased membrane electron transport coenzyme Q10, increased fatigue, modified energy metabolism): carbohydrate restriction methionine restriction alternate day fasting (Craig, Med Hypothesis, 85, 690-3, 2015)

13 Caloric restriction Affects: inflammatory effects energy metabolism mtdna repair oxidative stress modulation

14 Zinc and ME/CFS (1) considerable evidence of link between Zn and depression Zn plays a critical role in memory, learning and neurogenesis decreased dietary Zn during early development produces an irreversible impairment of learning and memory Zn plays an essential role in modulating adult hippocampal neurogenesis and synaptogenesis

15 Zinc and ME/CFS (2) Zn supplementation enhances antidepressant therapy in unipolar depression hippocampus is the most responsive to Zndeficiency lower serum Zn found in CFS significantly related to markers of inflammation and immune system evidence that the hippocampus plays a key role in pathogenesis of MS/CFS

16 Zinc and ME/CFS (3) Saury J-M, The role of the hippocampus in the pathogensis of ME/CFS, Med Hypothesis 86, (2016) Maes et al., Lower serum Zn in CFS: relationships to immune dysfunctions and relevance for oxidative stress status in CFS, J Affect Disorders 90, (2006) Takeda A, Zn signaling in the hippocampus and its relation to pathogenesis of depression, J Trace Elements in Med Biology 26, 80-4 (2012)

17 Summary ME/CFS are complex disorders with extensive literature limited details on diet and ME/CFS Cause and Effect? limited control, randomised studies increasing areas on vitamins, essential free fatty acids and zinc (hippocampus)