As a professional nutritionist, I often come across cases where seemingly healthy patients suffer from chronic conditions, sometimes even without knowing the seriousness of these conditions.
From my several years of practice, the one thing I have learnt is that people’s perception of “being healthy” is often incorrect. For instance, in the United States, “thin is in.” And so, if you look skinny with restricted flab, then you are considered “healthy”, which is not always the right assessment.
Then there are the ‘Diet Extremists’ – people who consciously avoid eating junk and choose to eat nutritious food instead, yet miss out on foods from different food groups (carbohydrates, proteins, fats, etc.) that are necessary for long-term health. I had one such patient who was suffering from chronic fatigue. I’d like to to share her case study to demonstrate how a chronic fatigue syndrome diet looks like.
The Patient: A Stay-at-Home with Chronic Fatigue and Wrong Notions about Diet
The patient is a stay-at-home mom in her late 40s. Her chief complaints were long-term fatigue, which did not improve after resting or even bed rest. This chronic fatigue interfered with her ability to perform day-to-day activities, such as cleaning and cooking. Loss of appetite and poor digestion was also reported.
In my first interaction with the patient, I realized the patient had incorrect notions about what constitutes a healthy diet. The patient was convinced she ate the healthiest of diets. She was also content with the fact that she maintained her ideal weight, despite having two grown up kids.
Yet, she was experiencing chronic exhaustion, which seemed to worsen as the days progressed. On same days, she even found it difficult to get out of her bed. This had been going on for almost a year now.
Her other symptoms included weakness, poor concentration and impaired memory, sore throat, unrefreshing sleep, insomnia, aching joints and muscle pain, occasional headaches and fatigue, following exertion that lasted for a long time. She also had occasional bouts of depression, while at other times she appeared cheerful. She did go for walks 2-3 times a week, though this was more out of compulsion rather than joy.
Clinical Assessment: Low Calcium Levels and Deficiency of Vitamin D
A closer look at her blood reports revealed no thyroid disease, no diabetes or pre-diabetes, and no hypertension. Her body mass index (BMI) revealed the patient’s weight was ideal; she was neither overweight nor underweight. Her body measurements and reports showed a reduced risk for obesity-related lifestyle diseases, such as hypertension, diabetes, heart disease, and so on.
Conditions that may lead to symptoms similar to chronic fatigue were ruled out – namely hypothyroidism, obesity, alcohol or substance abuse, hormonal disorders, sleep apnea, major depressive disorders, such as schizophrenia or bipolar disorders, cancer, reaction to medications, and eating disorders.
However, her emotional health still needed to be evaluated. There was also a need to identify any immunity-related risk factors, based on her dietary assessment.Her blood reports showed low levels of calcium and a deficiency in vitamin D. Clinical examination revealed distinct sores with reddish and white spots on the lower lip. Apparently, her doctor had recently diagnosed her with herpes (a viral skin infection.) Herpes is an auto-immune disorder, which is present in a latent form in a lot of people and is manifested due to a lowered immunity. Fortunately, the sores on her lip did not interfere with her ability to consume food.
So, in a nutshell, along with her primary complaint of chronic fatigue, other things that needed to be dealt with included a loss of appetite, deficiency of vitamin D, and herpes.
“Aren’t Fruits And Vegetables The Healthiest of Foods?”
Her dietary assessment showed that she was a vegetarian and did not consume alcohol. Her food intake revealed small, yet frequent consumption of fruits & vegetables and all sorts of detoxifying juices made from them. Sprouts and nuts were consumed occasionally in a very small quantity. She did not consume any dairy foods or other vegetarian protein-rich foods.
Because she perceived her diet to be very healthy, she was naturally very concerned about the causes of her health issues. Some of her questions were, “Aren’t fruits and vegetables the best and healthiest foods?” or “I am drinking so many glasses of detoxifying juices, then why am I facing these health complications?”
Nutrition Advice: Increase the Intake of Proteins, Fats and Carbs
My nutrition advice to her involved eating a balanced diet that included foods from various food groups, as planned for her specific health needs. I pointed out to her that although fruits and vegetables are a rich source of nutrients and antioxidants, they are not a good source of protein. Her intake of nuts and sprouts was not sufficient to meet her daily protein needs.
I asked her to include adequate carbs, protein-rich foods and sufficient fats in her diet to ensure she gets the desired amount of nutrients. These foods also help in improving immunity, which was crucial for her. As noted above, she was diagnosed with herpes, which is an auto-immune disorder arising out of a lowered immunity. Improving the immunity would help in long term management of herpes as well.
Water intake was calculated for her health needs. Her dietary assessment showed a big gap between her current and ideal water intake. Low water intake can be correlated to frequent headaches. Improving hydration by correcting fluid and water intake can possibly avoid dehydration-related headaches.
Furthermore, inclusion of whole grains, beans, pulses, nuts, dairy, soy and curd along with additional probiotics was recommended for easy digestibility. Good fats in the form of omega-3 fatty acids were prescribed in ideal quantities needed for her health. She was also advised to have more of iron-rich and vitamin C-rich foods.
Based on my experience, I felt her low hemoglobin was most likely due to a protein-deficient diet. She was counselled to include whole foods rather than drinking detoxifying juices. I pointed out to her that juicing eliminates fiber and reduces nutrient contents of the fruits considerably.
Along with modifications to diet, such as including plenty of fluids and intake of Vitamin D supplements, I gave her tips on stress management. I also prescribed some easily-doable aerobic exercises, which are essential for patients of chronic fatigue.
By following the suggested changes in diet and lifestyle, the patient experienced an improvement in their health within a month. Along with an improvement in the symptoms of chronic fatigue, she had little or no digestive complaints. Correcting her diet also helped in managing the symptoms of herpes.
Chronic Fatigue Can Be Reversed with the Right Diet & Nutrition
Chronic Fatigue Syndrome (CFS) is a chronic disorder characterized by several conditions, including severe fatigue and weakness. The causes of CFS are unknown, and there are no specific tests to diagnose the condition. The only way CFS can be diagnosed is through exclusion, that is, by ruling out other illnesses with similar symptoms. To complicate matters, just like the case above, often patients may appear healthy from outside, yet suffer from chronic fatigue. Then, there’s also a risk of the condition going into remission and then relapse.
Given the complications involved, Chronic Fatigue Syndrome cannot be reversed overnight. A major component in reversing chronic fatigue is correcting the patient’s diet. A balanced diet with a precisely calculated intake of protein and fat along with necessary vitamins and minerals, such as calcium, iron, vitamin C, vitamin D, essential fats and probiotics can help the patient considerably. Benefits of daily exercise need to be emphasized as regular exercise helps in release of endorphins or feel-good hormones.
And finally, it should be noted that chronic fatigue also has an emotional component, and can sometimes be traumatizing for patients. Therefore, reversing chronic fatigue also involves support from family and close friends.