Fatigue

Summary
Improving your diet could particularly help to build up your energies if you are depleted and fatigued. Of course you may also be too exhausted to prepare proper food and may be reliant on someone else to make sure you eat properly. However it is done it is as important as in any other health problem to make sure the right nutrients are available.

The NHS Eatwell Guide shows that to have a healthy, balanced diet, people should try to:

• eat at least 5 portions of a variety of fruit and vegetables every day (see 5 A Day)
• base meals on higher fibre starchy foods like potatoes, bread, rice or pasta
• have some dairy or dairy alternatives (such as soya drinks)
• eat some beans, pulses, fish, eggs, meat and other protein
• choose unsaturated oils and spreads, and eat them in small amounts
• drink plenty of fluids (at least 6 to 8 glasses a day)

If you’re having foods and drinks that are high in fat, salt and sugar, have these less often and in small amounts.

Try to choose a variety of different foods from the 5 main food groups to get a wide range of nutrients.

In traditional regimes for building up energy there was a focus on foods that were easily assimilated, that did not cause more trouble then necessary. This included most of the list above with an emphasis the second and fourth bullet points.

Summary
Being active and getting gradually fitter can boost your energy levels. But if you have chronic fatigue syndrome, simply going to the gym or exercising more, without expert help, may make you feel worse. You will need to increase your physical exercise slowly and gradually. Research has shown that regular weekly exercise sessions for people with CFS can reduce fatigue and improve quality of life.

The important thing is to pace yourself. Know when to stop and rest by paying attention to the body’s signals, and do not overdo it. On the other hand, it is very important to avoid resting too much, as this can reduce your fitness. You should also try not to get isolated. If you find you aren’t managing to do all this, you should definitely get some medical advice.

Avoid exercising immediately before going to bed because it stimulates your heart, brain and muscles, and this is likely to make it harder to get to sleep.

Find out more
Click on the Go See Someone tab for some of the types of exercise you can learn at classes.

Summary
Some people who feel stressed or fatigued tend to over-breathe (irregular, shallow, fast breathing, using the upper chest). Breathing like this can increase anxiety, fatigue, lack of stamina and muscle pain. Learning breath-awareness and how to breathe from the diaphragm can help prevent over-breathing. What’s more, gentle, slow rhythmic breathing can help trigger the relaxation response. The ‘relaxation response’ happens when the body and mind do the opposite of what they do when you feel stressed. Breathing exercises and techniques have been used for thousands of years in Eastern health practices and are part of many complementary therapies.

Some things to try include slow diaphragmatic breathing (using the diaphragm to breathe, rather than the rib-cage) and 7/11 breathing (inhaling to a count of 7 and exhaling to a count of 11).

Evidence
Two small studies of people with chronic fatigue found different results when people with CFS were taught better breathing. More research is needed before we can be sure about its effectiveness.

Safety
Breathing exercises are safe, although some people actually ‘over-breathe’ when they try this approach. This can make you feel dizzy or tingly when you try to use rhythmic breathing to relax. Not breathing so deeply and breathing more slowly should help. In any breathing exercise you try, aim to breathe out fully and let the in-breath happen naturally.

Cost
There are no costs.

Further information
See our section on STRESS AND ANXIETY.

Summary
When you feel tired it’s tempting to reach for stimulating drinks such as tea, coffee, colas or so-called ‘energy drinks’. They can give you a quick lift, but if you rely on them they will only keep you going until your energy stores run down further. They will also stop you sleeping well (and many people with CFS have sleep problems). Generally speaking, when you are ‘running on empty’, stimulants will only drain your energy further.

Evidence
There is very little research on the effects of limiting caffeine on people with fatigue. But too much caffeine during the day or late at night can affect sleep. And lack of sleep increases tiredness and fatigue.

Safety
If you are cutting down on large amounts of caffeine, headaches might be a problem for two or three days. It is better to reduce the amount of caffeine slowly over a few days.

Cost
There are no costs. In fact you will save money.

Summary
Whatever the causes of CFS, it makes good sense to use your body’s own healing resources. In fact your recovery depends on them. Since smoking and excessive drinking undermine your overall health (and can affect how tired you feel), there is every reason to cut down on them or, better still, cut them out completely.

Moderate drinking means no more than two drinks a day for men and one drink a day for women. A unit of alcohol is half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). A small (125ml) glass of basic wine is 1 and a 1/2 units.

Evidence
There is little research on the effects of limiting alcohol on fatigue.

Safety
Cutting down on smoking and alcohol is safe, but if you are cutting down from heavy use, there can be side effects including loss of appetite and difficulty sleeping. There are unlikely to be side effects if you are cutting down a moderate alcohol intake but if you are a very heavy drinker, it is better to get help with cutting down.

Cost
No costs are involved and think of the money you will save!

Further information
For more information, see the NHS information sensible drinking.

If you are giving up or cutting down on smoking you can order a Quit Kit from SmokefreeNHS. You can also phone the NHS Free Smoking Helpline on 0800 022 4332.

Summary
While there is no ‘magic diet’ that works for everyone with CFS, certain diets may help some people feel better and more energetic. Cutting out particular foods has not been found to be generally helpful for people with CFS, but keeping a food diary might help you find out whether certain foods seem to make you feel more tired, or upset your digestion. Write down what you eat and make a note of how you feel a couple of hours afterwards, bearing in mind that you might feel the effects of certain foods some time after you have eaten them.

Evidence
Some people find that certain foods don’t agree with them and try to cut out foods to see if they have an allergy or intolerance. This is called an ‘exclusion diet’. This sort of diet may help with irritable bowel symptoms such as diarrhoea, constipation or bloating. But there is very little research evidence as to how these diets affect people with fatigue. Some people say that a low-sugar, low-yeast diet helps them, so it may be worth trying this type of diet for two or three weeks.

Safety
It can be quite difficult to exclude certain foods and still have a balanced diet. If you want to make big changes to what you eat, it is a good idea to see a dietician or qualified nutrional therapist. They can help you make sure you are still eating a healthy diet and getting all the nutrients you need.

Cost
Eating a healthy diet and excluding some foods need not cost you anything. But if you consult a dietician there will be a charge, unless this is a service provided by your GP’s practice.

Summary
Meditation is a state of mind, not a religion, though it features in most major religions, especially Eastern ones. Meditation seems to harmonise the activity between the two sides of the frontal brain, and encourages a ‘relaxation response’. The relaxation response happens when the body and mind do the opposite of what they do when you feel stressed. In meditation the body is relaxed while the mind is alert. You don’t need an experienced teacher or a spiritual faith in order to take up meditation. You can learn the basics from a book or a podcast. Meditation is easily accessible, and it is remarkably effective, both for rapid stress reduction and as a way of promoting long-term health.

Evidence
Few studies have looked at whether meditation helps with chronic fatigue. Several studies of mindfulness meditation training suggest that mindfulness meditation might be helpful for CFS.

Safety
There are generally no safety problems with meditation unless you have a severe or long-standing mental health problem.

Cost
Meditation involves certain (simple) techniques that can be easily practised at home. There are many books and audio aids available and some people find it useful to join a class initially.

Summary
Many people who feel fatigued say they get tense and have problems sleeping. Relaxation skills can help with this. This technique teaches you to notice muscular tension and learn to relax your muscles to release the tension. Progressive relaxation works by tensing and relaxing various muscle groups in your body, starting from your feet and working your way up. At each level, try to notice how it feels when your muscles are tense, and how it feels when you let go and relax. Gradually you will get used to the feeling of relaxation and learn how to make it happen at will. As with most relaxation methods, you need to start by finding a quiet, relaxing place to practise. Put yourself in a comfortable position, whether standing, sitting or lying, and start by allowing your out-breath to get softer, longer and deeper.

Evidence
Research shows that these techniques have some effect on fatigue itself, but not as much as cognitive behavioural therapy (see Psychological therapies covered in other conditions).

Safety
These techniques are generally safe unless you have a severe or long-standing mental health problem.

Cost
Once you have learned the relaxation techniques, there are no costs. There are many books and audio aids available and some people find it useful to join a class initially.