I have covered some diets in some prior post. Diets, like antibiotics and even supplements, are often toss at a patient without researching the potential side-effects. Having a disease model (microbiome shift) gives a measuring stick to evaluate suggestions against.

• Diet for IBS – FODMAP
  • Probably makes it worst, see this post
• Crohn’s Disease: Diets
  • Enteral Nutrition
  • Parenteral Nutrition
  • Elemental Diet
  • Gluten Free Diet
  • FODMAP Diet
  • Semi-vegetarian Diet (SVD)

PubMed in 2017

Explicit Studies

• Role of dietary modification in alleviating chronic fatigue syndrome symptoms: a systematic review[2017].
  • “Positive outcomes were highlighted in some included studies for polyphenol intakes in animal studies, D-ribose supplementation in humans and aspects of symptom alleviation for one of three polynutrient supplement studies. Omega three fatty acid blood levels and supplementation with an omega three fatty acid supplement also displayed positive outcomes in relation to chronic fatigue syndrome symptom alleviation.”
  • “Limited dietary modifications were found useful in alleviating chronic fatigue syndrome symptoms, with overall evidence narrow and inconsistent across studies.“
• Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review [2017].
  • “This review identified insufficient evidence for the use of nutritional supplements and elimination or modified diets to relieve CFS/ME symptoms.”
  • “This review identified insufficient evidence for the use of nutritional supplements and elimination or modified diets to relieve CFS/ME symptoms.
• Mitoprotective dietary approaches for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Caloric restriction, fasting, and ketogenic diets[2015].
  • “Future research should examine the physiological effects of these dietary strategies in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.” – Just a proposal of what should be tested in clinical studies.
• Vitamin D in Fibromyalgia: A Causative or Confounding Biological Interplay? [2016]
  • “Recent findings indicate that hypovitaminosis D to be highly prevalent in patients with FM. Supplementation studies are limited so far, indicating potential beneficial effects on pain and severity of the disease, however specific recommendations are lacking.” – IMHO, 15,000 IU/day of Vitamin D with regular testing every quarter until a patient is at the TOP of the normal range should be considered.
• Symptoms of Functional Intestinal Disorders Are Common in Patients with Celiac Disease Following Transition to a Gluten-Free Diet [2017].
  • “The rates of those meeting IBS (52% -> 22%) and functional dyspepsia (27% -> 8%) symptom criteria both decreased significantly on a gluten-free diet. …. Long-term follow-up of patients with celiac disease is necessary because many patients with celiac disease who are adherent to a gluten-free diet have persistent gastrointestinal symptoms.” NOTE: This is for those ‘genetically predisposed people where the ingestion of gluten leads to damage in the small intestine’ — not for those that are gluten tolerant. There is a high percentage of people with self-diagnosis as gluten intolerant which on actual testing are gluten tolerant. They may feel better — but the reason may be other ingredients being removed from their diet by that change.

So – existing literature has found little solution apart from some supplements which I have posted on earlier.

Looking at microbiome shifts

I was surprised not to find more on the various diets cited above, especially shifts in Firmicutes and Bacteroidetes. There was only a few high quality reports.

Ketogenic Diet

• Short-term impact of a classical ketogenic diet on gut microbiota in GLUT1 Deficiency Syndrome: A 3-month prospective observational study[2017].
  • “Compared with baseline, there were no statistically significant differences at 3 months in Firmicutes and Bacteroidetes. “
• Ketogenic diet modifies the gut microbiota in a murine model of autism spectrum disorder[2016].
  • “the KD counteracted the common ASD phenotype of a low Firmicutes to Bacteroidetes ratio in both sample types;” That is, it increases Firmicutes and decreased Bacteroidetes — contrary to our goal.

Mediterranean Diet (MDS)

• Mediterranean diet and faecal microbiota: a transversal study.[2016]
  • “Mediterranean Diet Score (MDS) was associated with a higher abundance of Bacteroidetes (p = 0.001), Prevotellacea (p = 0.002) and Prevotella (p = 0.003) and a lower concentration of Firmicutes (p = 0.003) and Lachnospiraceae (p = 0.045).  Also,  in subjects with MDS ≥ 4, higher concentrations of faecal propionate (p = 0.034) and butyrate (p = 0.018) were detected. ” 🙂 Perfect!

Mediterranean Diet Score

There is an interesting study looking at typical diet in 7 countries at this web site. From this 2012 study, you can evaluate where you are, and provide clues as to how to alter your general diet. My own score with below is a low 8, and I can see some changes that I can make to increase it.

Bottom Line

No diet has been shown to have health benefits for CFS/FM/IBS apart from certain specific supplements.  On the other hand, if the microbiome shift model is correct, the Mediterranean Diet is likely to result in improve symptoms that will increase the higher you get your score. How? it will counter the shift of bacteria seen in CFS.