Important notice: Please note that the information on Treatment provided here has been compiled by patients for patients, and represents a summary of what patients may have experienced in working with their individual health care providers.  The information in this website is not a substitute for professional medical advice.  Please consult with your physician or other healthcare provider in matters pertaining to your medical care.  See our full Medical Disclaimer.

Health Care Providers: Please see the information on pp. 20-22 and pp. 25-26 of ME/CFS: A Primer for Clinical Practitioners.

Nutrition

No specific diet has been devised for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) or Fibromyalgia (FM), but there are many helpful tips and suggestions. Many patients report an increased sensitivity to foods or additives in food items. Changes have been noted in metabolism, more specifically in how food is digested and converted into energy. Many patients also notice an increased craving for sweets and some may experience symptoms of reactive hypoglycemia (low blood sugar). Excessive intake of carbohydrates may lead to "insulin resistance" which is a separate, serious health problem and should receive proper medical intervention. The goal is for people to make healthier choices in the foods they consume to fuel their bodies and keep them running as well as possible—so, improved nutrition is more of a lifestyle change. 

• General recommendations are to consume less simple sugars and carbohydrates for the above reasons and to remember that brief, increased "energy" will be quickly reversed.
• Too much sugar can promote yeast overgrowth (candiasis) as well as provide a suitable breeding ground for many types of bacteria.
• Too much protein can also be harmful, as this makes the liver and kidneys work harder.
• Increase essential fatty acids, especially omega-3 rich foods such as flaxseed, walnuts, winter squash, green leafy vegetables, and cold-water fish (like salmon, tuna, or halibut).
• Reduce or avoid trans-fatty foods such as fried foods, many margarines (especially stick margarine—the worst type), dressings and dips, many baked goods (cakes with icing, creamy fillings and donuts) and snacks (chips and many crackers).
• Keep meals simple and fresh—this helps to avoid food additives, flavor enhancers and artificial coloring agents. Don't over-season dishes and try to eat fresh produce (though in what conditionsthe  produce has been grown in is another complicated issue in itself).
• Drink enough water so not to dehydrate, but some ME/CFS and FM clinicians have found some patients' bodies won't retain enough of it due to a glitch in an anti-diuretic hormone. Sometimes sodium or certain medications are prescribed— consult your doctor on this. 
• Consider finding and working with registered dietitians or healthcare practitioners to create a healthy program for specific needs and problems.
• Consider undergoing allergy testing to make sure you have no food allergies. Symptoms of food allergies do not have to be digestive symptoms or rashes. A wide variety of symptoms, including swollen Eustachean tubes, irritated eyes and neurocognitive problems can be the result of food allergies.

Exercise

Similarly, the goal is to incorporate some level of routine exercise to help maintain general muscle tone, strength and mobility, which goes hand-in-hand with more mindful eating habits. But it is very important to stay within your "energy envelope." Patients with FM but not ME/CFS tend to do reasonably well with an exercise program that approaches that for a healthy person. Patients with ME/CFS tend to relapse (often badly) by trying to follow a healthy person's exercise program.

• Start out slowly with very gentle types of exercise, increase these in small increments (even a few minutes at time) and rest in between—perhaps start with walking.
• Most useful types of exercise are those which can improve range of motion, weight bearing, strengthening, stretching, and for ME/CFS and FM patients, in particular, it is generally not recommended to increase heart rate much over 60% of maximum rate.
• Paying close attention to ergonomics and good body posture is helpful.
• Exercising in a warm water pool can be reasonably helpful for many, but those with ME/CFS might have problems (including taking hot showers and baths) because the heat could up-regulate the immune system and release cytokines (which is what causes that flu-like feeling). There might also be increased problems with neurally mediated hypotension from this type of exercise and hot showers or baths. Usually, people would be working with a physical therapist or trainer to create a suitable program for their condition. It is extremely important to work with a physical therapist or trainer who understands ME/CFS or FM, since many patients have become more ill after physical therapy by being required to do too much. Joining a standard aquatic program for arthritis might be too much, for instance. Water pressure against the body in itself is thought to help by relieving the pooling of blood in lower limbs.

More options and practices to consider are described under Alternative Therapies.

More resources

A Minimal and Achievable Exercise Program

Complementary and Mainstream Treatment Approaches by Dr. Jeanne Hubbuch

Exercise and CFIDS

Mitochondrial Dysfunction, Post-Exertional Malaise and ME/CFS

Rest, Pacing and Stress; What Every ME/CFS Patient Should Know

Review of Nutritional Supplements Used in ME/CFS/FM

Supplements