Special Dietary Considerations for Severe ME/CFS Patients: Protein

Dietary protein requirements for the average person are about 0.8g/per kg body weight/day per the U.S. and European standards. That equates to about 67-114g per day for men, and between 59-102g per day for women. Adequate dietary protein allows for:

• Repair of tissues and cellular proteins: a daily necessity for normal physiology

• Synthesis of important proteins by the liver: including transport proteins, which move hormones, minerals, and other important components through the blood

• Immune cell regeneration: synthesis of new immunoglobulins and antibodies

• Blood: generation of the blood protein hemoglobin which carries oxygen in the blood

In chronic illness, protein demands increase due to the body being under constant physiological stress. Stress hormones such as epinephrine and norepinephrine, degrade existing proteins and inhibit the creation of new ones. Chronic inflammation and oxidative stress can inhibit the activity of important enzymes involved in protein synthesis. Degradation of existing proteins and inhibition of new protein creation can detrimentally affect every system of the body, worsening the chronic illness.

Within days of disuse, as occurs with bed rest, this imbalance between protein synthesis and breakdown occurs resulting in muscle loss, weakness, and lowered insulin response. With successive short periods of muscle disuse over time, a cumulative effect can be seen that increases the risk of future age-related muscle loss, also known as sarcopenia. Longer periods can weaken the immune system, slow tissue healing, and reduce blood flow and oxygenation.

Even short periods of bed rest, 5-6 days, can result in up to 1kg of muscle loss. Several studies of those with longer duration bed rest between 10 and 42 days, average a rate of muscle loss of approximately 0.5–0.6% of total muscle mass per day. This can be as much as 100-200 grams/week of lean mass loss. These losses are greatest in advanced age. For the bed-bound ME/CFS patient confined for months or years, this loss is substantial!

To maintain daily protein balance, intake must exceed those losses.

In general, it is customary to recommend exercise for bed-bound patients to preserve muscle mass. This is not an option for those with ME/CFS. So, severe, bed-bound patients must then increase dietary protein at every meal. Synthesis of protein relies on dietary sources of complete protein—that is foods that contain all of the essential amino acids. Most important of these is the amino acid leucine, which is essential for the synthesis of muscle protein. Foods high in leucine include beef, chicken, pork, fish, octopus, hard cheeses, pumpkin seeds, pistachios, and white beans. Supplemental whey protein is also rich in leucine and has been shown to increase muscle protein in elderly subjects who supplement with 15g per day.

A diet of at least 25% of calories coming from protein is recommended to maintain muscle tissue and support protein utilization in every organ system. Aim for 1.5-2g/kg body weight/day. Multiply your body weight (kg) by 1.5-2g protein. For example, a 59kg female would require 89-118g of dietary protein per day. These same recommendations can be made for less severe patients. Even the less ill will have muscle loss due to a lack of physical activity. Increased dietary protein is not known to cause detrimental effects or long-term risks. Several studies have shown protein intake 3x the daily recommendations have no detrimental effect to the kidney, bone, or any organ.

In addition to higher dietary protein intake, severely ill, bed-bound patients may also consider supplements that preserve muscle tissue. In addition to added leucine, creatine is well known to preserve muscle mass in the elderly. Exogenous ketone powders are also promising in preventing lean muscle loss.

What does this look like on the plate? Four hard-boiled eggs contain 20g of complete dietary protein. Visit Diet Doctor for examples of meals containing 40-130g of protein.

References

1  English, KL and Paddon-Jones, D. (2010) Protecting muscle mass and function in older adults during bed rest. Curr Opin Clin Nutr Metab Care. 13(1): 34–39.

2 Wall BT, Dirks ML, & van Loon LJ (2013) Skeletal muscle atrophy during short-term disuse: implications for age-related sarcopenia. Ageing Research Reviews 12(4):898-906.

3 Cholewa JM et al. (2017) Dietary proteins and amino acids in the control of the muscle mass during immobilization and aging: role of the MPS response. Amino Acids, 49(5), 811–820.

4 Candow DG, Chilibeck PD, Forbes SC. (2014) Creatine supplementation and aging musculoskeletal health. Endocrine. 45(3):354-61.

5  Deutz NE, et al. (2013) Effect of β-hydroxy-β-methylbutyrate (HMB) on lean body mass during 10 days of bed rest in older adults. Clin Nutr. 32(5):704-12.