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Mitoprotective dietary approaches for Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome: Caloric restriction, fasting, and ketogenic diets by Courtney Craig

“This paper explores dietary strategies that are mitoprotective. Studied for decades, the cellular mechanisms of ketogenic diets, fasting, and caloric restriction now reveal mitochondria-specific mechanisms which could play a role in symptom reduction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.”

What is important to highlight, and a concern raised in the paper, is that we can not say categorically that mitochondrial dysfunction is a primary cause of CFS, it may come secondary to other dysfunctions. A good example given in this paper is chronic viral infections, which can be perpetrators of mitochondrial damage. Mitochondria are known to be involved in immune cell signalling by stimulating innate immunity upon detection of pathogens (disease causing bacteria for example).

Caloric Restriction & Fasting

Caloric restriction is often defined by a 20–40% reduction in caloric intake. Caloric restriction has been shown to have effects on mitochondrial functioning and redox signaling. These effects may be achieved with interventions such as carbohydrate restriction, methionine restriction, or alternate day fasting. At the level of the mitochondria, caloric restriction can lead to adaptive responses that affect inflammatory pathways, energy metabolism, mtDNA repair, and oxidative stress modulation. Mild cellular stress that occurs with energy restriction is believed to produce a hormetic effect that leads to adaptive cell responses and resistance to disease.

In regards to fasting, regimens are varied and may include intermittent fasts (alternate day or 2 days a week fasting), or periodic water-only fasts (3 days or more every 2 or more weeks). Trials in rheumatoid arthritis patients who underwent 1 to 3 week water-only fasts experienced reduced subjective pain and inflammation. This are extreme cases and we at CFS do not recommend instigating these regimes, certainly not without a clinician who is experienced in supporting their patients through the process.

Ketogenic Diets

A ketogenic diet, defined as a high fat, very low carbohydrate diet, can mimic the effects of caloric restriction or fasting.

Ketogenic diets encompass a variety of carbohydrate to fat ratios. Many studies have used a 4:1 ratio, however this ratio is difficult to sustain and can be unpalatable. Long-term ketogenic diet plans may be established by monitoring blood ketone levels in relation to blood glucose (Glucose Ketone Index Calculator) to determine an individual response to certain carbohydrate-containing foods.

We at CFS recommend working with a clinician experienced in this area before starting a ketogenic diet (see concerns with a keto diet below)

Conclusions From The Paper

“A growing body of evidence is available in the literature suggestive of a mitochondrial etiology in ME/CFS. Diets focused on mitochondria may therefore provide a safe, cost-effective intervention for ME/CFS patients who otherwise have limited treatment options.”

What the authors do say, and what we at CFS agree with whole heartedly, is that “given the high incidence of self-enforced dietary restrictions among ME/CFS patients, there is a tremendous need for validated nutritional interventions”.

Concerns With A Low-Carb/Keto Diet

We need to be mindful that some researchers have concerns over low carb ketogenic diets due to the lack of fibre content (see our article on restoring digestive health in chronic fatigue syndrome). Anecdotal evidence and our own clinical experience has shown that many of our clients coming to us on very low carb diets have an alkaline pH in the stool when we perform testing. An alkaline pH may increase the risk of dysbisois (an imbalance in bacteria) or infection. They often also have low levels of butyrate or other short-chain fatty acids which have several health benefits both from a digestive system perspective as well as systematically. Put on top of this, many find it can be challenging to actually follow a very low carb/ketogenic diet, especially when struggling with chronic fatigue. It requires sound understanding and tracking of your food which for many is not an appealing way to live.

Final Thoughts From The Team At CFS

The first step in deciding what sort of dietary approach may be best for you is to test. In certain conditions, such as small intestine bacterial overgrowth, you may find a short term application of the FODMAP diet, and reducing certain types of fibre, beneficial.

Because chronic fatigue syndrome isn’t a single disease entity, there isn’t going to be one approach for all cases. It requires understanding your current physiological state and in all likelihood will require a process of trial and error. Also, it is worth appreciating that diet is just one aspect of what needs to be considered within a programme.