The Best Diet Plan for ME/CFS and Fibromyalgia

Diet Plan

In the third of a series of blogs examining the role that paleo / ketogenic / carbohydrate limited diets may play in treating ME/CFS/FM, Remy explores Wired to Eat, a book that provides a way for you to determine which carbs are good for you and which are not.

Given the recent metabolic findings suggesting that carbs are not being utilized properly in ME/CFS, no diet guide may be better suited to these diseases than this one. If you’re concerned about the effects your diet might have on your health, don’t miss this one.

Remy reviews Wired to Eat — a book that provides a way that people with chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM) may be able to use to create a diet that works for them.

The focus is on carbohydrates — currently an area of intense interest in ME/CFS and FM given some findings suggesting: (a) that energy production is low; (b) that the problems with energy production probably involve glucose (carbohydrates); and (c) that glucose levels may be increased in ME/CFS. My guess is that few dietary books are more pertinent to chronic fatigue syndrome (ME/CFS) and FM than this one.

Note! Unless you’re one of the lucky few, dietary interventions are not about being cured, but they can be a means to feeling significantly better.

Wired to Eat by Robb Wolf — A Review by Remy
The science of nutrition has come a long way in recent times. Robb Wolf’s new book, Wired to Eat: Turn Off Cravings, Rewire Your Appetite for Weight Loss, and Determine the Foods That Work for You, takes advantage of these scientific advances by proposing something quite revolutionary to those of us accustomed to the one-size-fits-all nutritional guidelines or pyramids put out by the federal government.

Building on the Paleo template Wolf described in his first bestselling and highly regarded book, The Paleo Solution: the Original Human Diet, Wired to Eat helps each person determine their own personal tolerance for carbohydrates, regardless of their age, weight, or health status. This allows each person to optimize their diet based on their own personal and unique biochemistry.

Your Carbohydrate Envelope
In one recent study, hundreds of people ate a wide variety of foods and had their individual blood glucose responses tracked over time. Nothing like this had been attempted before on this scale. When the data came in, it looked like chaos. To the researchers’ surprise, the data didn’t lend itself to the “types” that have been proposed in dietary plans.

Instead, the researchers found a highly variable person-to-person response to typical, everyday foods. Some “healthy” foods like hummus, for instance, were strangely problematic for many people, while others tolerated often-maligned foods like white rice or potatoes quite well.

The data gathered made it possible to create an algorithm that predicted which foods were likely to work well for a particular person. The Wired to Eat book endeavors to help you gather some of that data for yourself and create your own dietary plan based on your own physiology.

We are all familiar with working within our energy envelope. This book can be thought of as learning how to eat within our carbohydrate envelope.

Dietary approaches to manage symptoms are, of course, nothing new to ME/CFS patients. While no one is arguing that eating any one particular diet is going to cure ME/CFS, it’s an undeniable fact that the type and amounts of food that we eat can have a significant impact on our symptoms.

Mitigating symptoms is a great first step, as far as I am concerned, to improving the overall course of the disease. As a tool, however, diet seems to be woefully underused in favor of other expensive interventions and the search for a magic prescription drug.

From a personal perspective, I can say without a doubt, that dietary interventions have been among my most successful, if not the most successful, of my not inconsiderable treatment efforts. This is a refrain I often see repeated by patients on forums as well.

Of course, diet and lifestyle interventions are amongst some of the most difficult changes for anyone, healthy or ill, to make. Because the sickest people often have the least amount of metabolic flexibility, making dietary changes can be more challenging for them. That’s why the author describes Wired to Eat as a lifeline disguised as a big bag of rocks.

Carbohydrate Limiting
Some ME/CFS practitioners, like Dr. Sarah Myhill, have long recommended a ketogenic type of diet for patients. Others, like Dr. Terry Wahls, put dietary interventions that limit carbohydrates and sugar front and center in their efforts to reverse serious autoimmune disorders. These doctors are in the minority right now, but hopefully as the science progresses, more doctors will be willing to examine and recommend dietary interventions as a first line approach for not only ME/CFS, but other neurodegenerative diseases like Parkinson’s and Alzheimer’s, cardiovascular disease, and other metabolic disorders.

The results of recent metabolic studies pointing to disordered cellular metabolism at the root of ME/CFS suggests that this dietary approach might be helpful. The findings of Fluge and Mella, and Ron Davis at Stanford, and Chris Armstrong in Australia, all suggest that people with ME/CFS are not able to properly derive energy from food, specifically carbohydrates, due to a potential block in the pyruvate dehydrogenase complex preceding the initiation of the citric acid cycle.

Those findings, while still preliminary at this point, suggest that figuring out your own personal carbohydrate tolerance and degree of insulin resistance could be crucial.

Ultimately, the goal of healthy metabolic functioning isn’t to emphasize one particular fuel source over another, but to provide a personalized approach to diet. It’s in that personal approach where Wolf’s book goes a step further than the average “diet” book. In Wired to Eat, Wolf provides a plan, divided into two phases, to reset and measure your own individual response to carbohydrates. This plan, which uses an inexpensive blood glucose meter, allows each person to determine their own personal tolerance for different kinds of carbohydrates.

The Hyper-Palatable Food Hijack!
The first section of Wired to Eat focuses on the neuro-regulation of appetite and how modern hyper-palatable foods hijack our biology. Wolf makes the case that genetic and environmental factors such as sleep, stress, and community participation affect our appetites and govern our metabolism. Our genes are not our destiny, however. While they provide a template, our individual control regarding what Wolf calls the “Four Pillars” (food, sleep, movement, and social connections) can help us to create as healthy a life as possible.

Wolf also makes a solid argument against moralizing food and eating that I found quite refreshing. There are no inherently good and bad (whole) foods; there are only choices and consequences. You cannot cheat on a diet because there is no unfair advantage to be had, especially against yourself. Again, there are only choices and consequences.

Food manufacturers and their labs do have an advantage over us. Their labs’ ability to determine which ingredients and artificial colors and flavors will be the most pleasing to the human palate has resulted in the advent of hyper-palatable processed foods chemically designed to turn us on. It isn’t an accident that “no one can eat just one” potato chip. This book gives us the knowledge we can use to make choices that support our long-term health and wellness goals.

Wolf also reviews basic principles of digestion simply and succinctly in the gut section of the book. It turns out that changing what you eat may be one of the fastest and easiest ways to change the composition of your gut microbiome, without any expensive probiotics or fecal transplants required.

The Costs of a Wrong Diet
Following that discussion comes a simple review of the hormones most important for digestion. Wolf discusses the impact of insulin, glucagon, ghrelin, and leptin along with cortisol and adrenaline. It turns out that when we chronically eat the wrong types of food for our physiology, the brain becomes leptin resistant and the muscles become insulin resistant. So, despite having plenty of calories around, the body acts much like it is starving. This produces muscle and bone wasting and a host of other detrimental effects.

Mitochondria are also damaged by chronic over-consumption of problematic foods. Damaged mitochondria do not produce energy well and ketogenic diets have been scientifically proven to increase mitochondrial functioning. Eating within the limits of carbohydrate tolerance can only improve energetic functioning. However, the reverse is also true and often results in a vicious cycle of carbohydrate intolerance as the mitochondria become less and less flexible.

Another detrimental effect that relates to ME/CFS concerns the development of senescent cells — cells that are still alive, but do not behave as they should. Typically, these cells should die (apoptosis) and be recycled by the body, but in some diseases this does not happen. The presence of senescent cells causes low grade chronic inflammation and the secretion of inflammatory cytokines. (The Solve ME/CFS Initiative is currently funding a study on cell senescence in ME/CFS.) A proper diet can increase apoptosis and reduce the negative effects of this inflammatory process.

Sepsis is another infectious, inflammatory process that should sound familiar to those with ME/CFS. Dr. David Bell has described ME/CFS as a state of “slow sepsis.” His book, Cellular Hypoxia and Neuro-Immune Fatigue, describes a cascade of events that gradually leads to a state of septic shock.

While acute sepsis is likely to kill you, a low-grade smoldering infection can produce a sepsis-like state with all the associated inflammation and symptoms. In fact, sepsis looks very similar to poorly controlled Type 2 diabetes. Sepsis is typically a response to lipo poly saccharide (LPS) caused by the same gut dysbiosis that this type of diet aims to address.

Wolf also discusses food allergies, lectins and other inflammatory components of common foods that may contribute to both changes in the gut microbiome as well as inflammatory symptoms.

We seem to be “wired” for an expectation of variable food intake, not the steady state of food availability we experience now. This “feast or famine” physiology is evolutionarily driven and perfectly healthy. Wired to Eat helps teach how to return to that state and all the associated health benefits.

The preceding sections of the book have indicated ‘the Why’ of the importance of a personalized approach to your diet. The next section helps people get started by focusing on ‘the How’.

Resetting Your Diet — The 30-day Eating Plan
It’s important to understand that there is no such thing as a one-size-fits all “good diet.” There is a diet that fits your physiology and there’s everything else. You can have a diet which, by most peoples’ standards, seems very good but which is still harming you, or is not optimal for you.

The next section of Wired to Eat focuses on the 30-day eating plan Wolf recommends to reset your diet so that it fits your physiology. He helps you to articulate your own personal needs and goals, determine insulin sensitivity using common lab tests, and determine an initial carbohydrate intake that best reflects the results of those measures.

He also provides a simple food preparation matrix to use during the 30-Day Reset. This plan provides an excellent template for everyone to create variety in a basic diet without complicated cooking or recipes to follow (though there are many simple recipes in the final part of the book as well). The 81,000 potential meal possibilities the book presents neatly eliminate the idea that a lower carbohydrate diet is, by default, a boring diet.

At the end of that 30-day reset, Wolf recommends that everyone go deeper by investing in a cheap blood glucose meter. Called the 7-Day Carb Test, the meter will help you figure out the foods that work best for your own physiology…and the ones that don’t work well for you at all.

Conventional wisdom says that a calorie is a calorie whether it comes from a sweet potato or from a steak. Modern science knows that is not accurate at all. The source of the calories you eat affects your hormonal response which, in turn, produces metabolic changes. (Does anyone really still believe a 2,000 calorie diet of vegetables, lean protein and good fats would produce the same results as 2,000 calories of Snickers bars? Yet that is exactly what most registered dieticians would have you believe.)

REALLY Resetting Your Diet — the 7-Day Glucometer/Carb Test
The 7-Day Carb Test helps you determine your response to a standardized, measured amount of carbohydrates by testing your blood sugar before and 2 hours after eating. Wolf’s charts contain the appropriate measurements for a great variety of commonly consumed carbs to make this process simple and easy.

Trying to keep as many factors the same, one eats the measured amount of the selected carb in the morning and then measures the blood glucose response 2 hours later. Typically, Wolf suggests eating 50g of the targeted carbohydrate source as the sole component of the meal. Ideally, the blood glucose level will be between 90-115 mg/dl at the 2-hour mark.

If the blood glucose is above 115 mg/dl, the same test can be repeated the next day using only 25g of the targeted carbohydrate source. If the blood glucose level at the 2-hour mark falls into the target range, the implication is that small amounts of that carb may be okay as an occasional treat but that large amounts should best be avoided. If the glycemic response is still over 115 mg/dl that carb should probably not be consumed with any regularity.

It’s worth noting that while Wolf’s optimal range is more stringent than conventional medical recommendations, it still does not approximate a normal glycemic response from a truly healthy, insulin-sensitive, metabolically flexible person. This example, data taken from a recent issue of The Townsend Letter, shows at the 2-hour mark, blood glucose levels are essentially back to fasting levels — in the mid-70s.

Table 4. Example of Insulin and Glucose Profile
in Exceptional Insulin Homeostasis Category*
Fasting Hr 1/2 1 Hr 2 Hr 3 Hr
Insulin
uIU/mL
<2 18 14 4 <2
Glucose
mg/dL
(mmol/L)
77 (4.27) 168 (9.33) 109 (6.05) 74 (4.11) 59 (2.88
*The patient, a 60-yr-ol 5’7″ man weighing 138 pounds, presented for a wellness assessment. He was in excellent health by clinical and laboratory evaluation criteria.


I bet most of us with ME/CFS will find ourselves far from that ideal – even if a doctor has told us our lab tests are “normal.” The thing about Type 2 diabetes is that you can see it coming, for years, if not decades, ahead of time. The medical profession, unfortunately, is doing absolutely nothing to warn most people of the train wreck headed for them. Given the extraordinary cost of ill health, it seems imperative for people to have information they can use to ward off future illnesses.

To take it a step further than the book, my suggestion would be to buy a blood meter that will accept both glucose and ketone strips. The Precision Xtra glucose and ketone meter is typically the most popular and is the meter I use personally. My suspicion is that many with ME/CFS will find themselves in a situation where a ketogenic diet will produce the best results and having a blood ketone meter is by far the best way to track progress, especially during the transition.

So why not stop guessing and do this test to figure out exactly where you stand on the metabolic spectrum?

Best case scenario? You figure out that you have perfect metabolic flexibility and are able to turn both glucose and fat into energy to be used by your cells to fuel your activities of daily life.

Worst case scenario? You figure out that glucose is not your friend and that a ketogenic type of diet holds promise for mitigating the worst of the symptoms caused by poor glycemic control.


For the rest of us, the answer is probably somewhere in between. By doing the steps in this book, you will be able to identify your personal trigger foods and your carbohydrate tolerance level — and be able to maximize your dietary energy production based on your own personal physiology. That really is the best of all worlds! It’s amazing that a few simple tools and strategies could positively benefit your energy levels and the overall level of functioning.

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