Carbohydrates to Avoid With Chronic Fatigue and Chronic Pain
The Role of Carbohydrates in Nutrition
Carbohydrates are one of the three essential macronutrients, along with proteins and fats. They serve as the body's primary energy source, powering vital organs like the brain and muscles. However, not all carbohydrates are created equal, and for those with conditions like ME/CFS, fibromyalgia, or chronic pain, certain types of carbohydrates can exacerbate symptoms.
Types of Carbohydrates: The Good and the Bad
1. Simple Carbohydrates
What They Are:
Composed of one or two sugar molecules, these are rapidly digested, causing blood sugar spikes.Sources:
Table sugar, honey, syrups, refined grains, sugary beverages, and processed foods.Why They’re Problematic:
Quick blood sugar swings lead to fatigue, brain fog, and inflammation.
2. Complex Carbohydrates
What They Are:
Composed of multiple sugar molecules, digested more slowly for a sustained energy release.Sources:
Whole grains, legumes, fruits, and vegetables.The Fiber Factor:
Fiber, a type of carbohydrate, isn’t digested but promotes gut health, satiety, and blood sugar regulation. High-fiber foods like fruits, vegetables, nuts, and seeds are generally more beneficial.
Why Carbohydrates Can Be Problematic in Chronic Illness
While not all carbohydrates are bad, certain types can worsen symptoms for individuals with chronic conditions. Here's why:
1. Carbohydrates Can Increase Fatigue and Brain Fog
Rapid blood sugar fluctuations can lead to energy crashes and difficulty concentrating.
Low-fiber carbs, like white bread and pasta, are particularly problematic.
2. Mitochondrial Dysfunction in ME/CFS
Studies show impaired oxidative phosphorylation and glycolysis in ME/CFS, processes that convert glucose into cellular energy (ATP).
High carbohydrate intake overwhelms dysfunctional mitochondria, leading to fatigue and poor energy metabolism.
3. Microbiome Challenges in Sedentary Individuals
Chronic illness often results in reduced gut microbiome diversity, limiting the body’s ability to process carbohydrates effectively.
Sedentary individuals produce less butyrate, an anti-inflammatory byproduct of gut bacteria, contributing to a pro-inflammatory environment.
4. Fructose’s Negative Effects
Found in both fruits and processed foods, fructose from natural sources (e.g., berries) is less problematic due to their fiber content.
Processed fructose:
Increases triglycerides, raising cardiovascular risk.
Drives inflammation by elevating high-sensitivity C-reactive protein (hs-CRP).
Depletes ATP and increases waste products like uric acid, contributing to gout risk.
5. Carbohydrates and Advanced Glycation End Products (AGEs)
High sugar intake promotes the formation of AGEs, damaging proteins and lipids in the body.
AGEs activate inflammatory pathways, increasing cytokines like TNF-alpha and IL-6.
6. Age-Related Impaired Glucose Metabolism
Glucose uptake decreases with age, particularly in the brain’s hippocampus (the memory center), exacerbating cognitive issues in older individuals.
The Case for a Low-Carbohydrate, High-Fiber Diet
For individuals with chronic conditions, a diet that prioritizes high-fiber carbohydrates and minimizes simple sugars can help:
Stabilize blood sugar levels.
Reduce inflammation.
Support gut health and energy production.
Low-Fiber Carbohydrates to Avoid:
White bread, pasta, and other refined grains.
Sugary snacks and beverages.
Processed foods with added sugars.
High-Fiber Carbohydrates to Include:
Fruits: Berries, apples (with skin), and oranges.
Vegetables: Leafy greens, broccoli, cauliflower, and carrots.
Legumes: Lentils, chickpeas, and black beans.
Nuts and Seeds: Almonds, chia seeds, and flaxseeds.
National Nutritional Guidelines vs. Individual Needs
National guidelines suggest that 45–65% of daily calories come from carbohydrates, but these recommendations often overlook the needs of individuals with chronic conditions. For those with ME/CFS, fibromyalgia, or long COVID:
A high-carbohydrate diet may overwhelm energy production pathways.
Reducing net carbohydrates (total carbs minus fiber) is more effective for managing symptoms.
The Microbiome Connection
Regular cardiovascular exercise promotes a more diverse gut microbiome, increasing microbial species that help metabolize carbohydrates. However, for individuals with chronic illness who may be sedentary:
Focus on a gut-friendly diet by including high-fiber, anti-inflammatory foods.
Minimize processed carbohydrates to reduce the gut's inflammatory burden.
Bottom Line: Managing Carbohydrates for Chronic Illness
While carbohydrates are essential for energy, the type and quality of carbs matter significantly for those with chronic conditions. To reduce fatigue, brain fog, and inflammation:
Prioritize high-fiber, low-net-carb foods like fruits, vegetables, and legumes.
Limit or eliminate processed foods, sugary snacks, and refined grains.
Tailor your diet to your unique metabolic needs, focusing on what helps you feel your best.
By understanding the role carbohydrates play in chronic fatigue and pain, you can make informed dietary choices that support your health and well-being.
References
Kroemer, G., López-Otín, C., Madeo, F., & de Cabo, R. (2018). Carbotoxicity—Noxious Effects of Carbohydrates. Cell, 175(3), 605–614.
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Gao Y, et al. (2017) Dietary sugars, not lipids, drive hypothalamic inflammation. Mol Metab. 6(8):897-908.
Lynch, M. A. (2019). Can the emerging field of immunometabolism provide insights into neuroinflammation? Progress in Neurobiology, 101719.
Reis DJ et al. (2019) The depressogenic potential of added dietary sugars. Med Hypotheses. 134:109421.
Baldanzi G, Sayols-Baixeras S, Ekblom-Bak E, et al. Accelerometer-based physical activity is associated with the gut microbiota in 8416 individuals in SCAPIS. EBioMedicine. 2024;100:104989. doi:10.1016/j.ebiom.2024.104989
Clauss M, Gérard P, Mosca A, Leclerc M. Interplay Between Exercise and Gut Microbiome in the Context of Human Health and Performance. Front Nutr. 2021;8:637010. Published 2021 Jun 10. doi:10.3389/fnut.2021.637010
