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 Carbohydrates, Chronic Fatigue Syndrome and Fibromyalgia

Originally developed to help diabetics control their blood sugar, the low glycemic index diet focuses on foods that keep blood sugar levels consistently low. It’s similar to other diet plans that eliminate the high carbohydrate, highly processed foods that pack the pounds on but eliminates or reduces some otherwise healthy foods. The low glycemic index diet is often used to lose weight, and it forms the basis for some popular diet plans such as the South Beach Diet and The Zone diet.

Study Evidence

But is a low glycemic index (GI) diet a good idea for people with chronic fatigue syndrome and/or fibromyalgia? Some studies and anecdotal reports suggest it might be. We’re not talking about curing ME/CFS/FM here; we’re simply talking about better health.

blood glucose control diagram

The glycemic index is all about blood sugar regulation – something that may be of concern for people with ME/CFS/FM

The low GI diet is all about blood sugar regulation—a must if you have diabetes, and possibly a plus if you have ME/CFS or FM.

Insulin removes sugar from the bloodstream when blood sugar levels get too high. Insulin resistance, which often precedes the development of type II diabetes, may be associated with metabolic syndrome. It is common in people with obesity, high blood pressure, stroke, and heart disease, and “resistance” refers to the inability of insulin to do its job. Lots of blood sugar spikes over time appear to confuse the body enough for it not to respond normally to the presence of insulin.

The study evidence for poor blood sugar regulation in ME/CFS/FM is small but positive. High rates of insulin resistance (79%) were found in FM in a recent Italian study. Higher plasma insulin, body mass index and hip to waist ratio in more memory-challenged patients suggested that insulin resistance could be contributing to cognitive issues in FM. A CDC study found increased rates of metabolic syndrome in ME/CFS in 2010 (using their random sampling approach).

Cortisol, a blood sugar regulator, is often ‘mildly low’ in ME/CFS. Some doctors believe hypocortisolism (low cortisol level) is underdiagnosed in ME/CFS. Early on, chronic fatigue syndrome was identified with hypoglycemia—a finding that didn’t seem to pan out—although Dr. Teitelbaum argues that those tests only pick up very, very severe problems. Dr. Kogelnik believes he’s finding increased rates of diabetes in his ME/CFS patients, but some other doctors don’t appear to be finding that. A small neuropathy study, however, found high rates of undiagnosed diabetes in fibromyalgia patients.

The most convincing evidence that blood sugar regulation is an issue in ME/CFS, however, is simply the fact that many people with chronic fatigue syndrome generally do not do well when they skip meals. In his new book, “The Fatigue and Fibromyalgia Solution,” Dr. Teitelbaum suggests that the easiest way to tell if your adrenal glands (producers of cortisol) are whacked is to answer the question, “Do you get irritable when you’re hungry?” If you feel shaky, nervous, dizzy, fatigued, etc., and have a craving for sugar after not eating for awhile, you’ve probably got blood sugar and adrenal problems.

cane sugar

Anything that immediately raises your blood sugar levels such as…gulp – white sugar – is high on the glycemic index

Carbohydrates, starches and blood sugar regulation have been problems for me since I had ME/CFS. (Starches are simply strings of glucose molecules put together; starches with low fiber content actually get into your system faster than some sugars.)

If I don’t eat regularly I get spacey and crave sugar. I also often crave sweets after I ‘exercise’ even when I am eating regularly. Sweet foods, though, send my system into turmoil, often leaving me feeling weak and shaky. They’re so problematic that I’ve never been able to eat sweet foods without supplementing them with protein and fat.

That yummy piece of pumpkin pie and those protein bars get slathered with a nice slab of peanut butter. Ice cream is a mixture of granola, nuts and nut butters. I crave sugar but can’t tolerate it. To be honest, my problems go way beyond sugar. Any high carbohydrate, low protein food is a problem. Eating potatoes, short-grain rice, sweet potatoes, etc., usually means it’s time for a nap.

One look at the low glycemic index diet and it all starts to makes sense. Foods with higher glycemic indexes, even if they are healthy otherwise, such as potatoes, short-grain rice, etc., are going to cause me problems.

Carbohydrates, the Truth About Starches and the Glycemic Index

The Glycemic Index

Glycemic index—On the glycemic index scale, each food is assigned a number from 1-100, with 100 being the highest glycemic index. (Glucose—which dumps straight into your system—get 100 points.). Usually foods are broken down in to three groups.

  • Low glycemic index—55 or less (the ‘tricklers’)
  • Moderate glycemic index—56-69
  • High glycemic index—>70 or more (the ‘gushers’)

Glycemic Load—The best way to assess a food’s impact is not by its glycemic index but by its glycemic load. Glycemic load combines both the quality and quantity of the carbohydrates in a food into one number. You will find the most fine-tuned and rigorous analysis of glycemic indexes at the University of Sydney’s glycemic index pages

FOODS

Grains

Processed grains (white flour, white rice) tend to have higher GI’s.

Rice

rice plant

GI values for rice run the gamut from moderate (basmati) to high (sweet rice). Long- grain, brown rice is better than short-grain white rice.

The GI values of rice are all over the map.

Serving rice with lower-GI foods such as beans, vegetables, or lean meats will help lower the glycemic load of your meal. Note that boiling rice (as opposed to steaming rice) increases its glycemic load substantially. Microwaving appears not to increase glycemic load values.

  • Steamed brown rice—50
  • Basmati rice (long-grain)—57
  • Microwaved medium-grain brown rice—59
  • Brown, short-grain japonica rice—62
  • Arborio or risotto rice (medium grain)—69
  • Boiled white or brown rice—72
  • Sticky or sweet rice—87
  • Jasmine (fragrant rice), white-short grain japonica—89

Oats and Oatmeal

Oats have a lower GI than other grains because of they contain both soluble and insoluble fiber. Unlike insoluble plant fiber, which does not dissolve in water, soluble fiber absorbs water and becomes viscous, coating food particles and hampering their immediate digestion. Apples and beans are also high in soluble fiber.

There are oats and there are oats, though. Instant oatmeal can have a very high GI index (66-83) since it digests so quickly. “Porridge made from rolled oats” gets anywhere from 49-63 GI, and steel-cut oats are in the mid 50’s. In general, the coarser the oats are cut the better.

Pasta—The Odd Man Out

Pasta lovers can rejoice. Despite the fact that the bran is either missing or is no longer attached to the grain, pasta has low to moderate GI values (30-60). When the starch granules in pasta become enmeshed in the gluten molecules in the pasta dough, they increase the time pasta takes to get digested.

Pasta should be cooked al dente (‘firm to the bite’) to get the full benefit of the low glycemic value of pasta. One website suggests checking pasta 2-3 minutes earlier than the package instructions suggest. They also suggest eating pasta with vegetables.

Asian noodles such as hokkein, udon, and rice vermicelli also have low to intermediate GI values.

Potatoes

potatoes

Potatoes are delicious and inexpensive but baked potatoes, in particular, are ‘gushers’ that quickly raise blood sugar levels.

Potatoes tend to have higher GI’s simply because they contain so little fiber. Cooking method makes a big difference in the glycemic index of potatoes with steamed and boiled potatoes clocking in at a medium glycemic index (61-65) and the delicious baked potato at a very high 85.

Potato salad (which still wipes me out) has a medium GI. Interestingly, a potato salad tossed with vinaigrette will have an even lower GI because cold storage increases the resistant starch content by more than 30% and the acid in the vinaigrette slows the rate at which your stomach empties.

The fats in potato chips and French fries increase digestive time, thus lowering their GI, but the saturated fats in these products may contribute to heart disease and they’re not recommended. Good fats can be found in avocados, nuts and legumes.

Fruits

blueberries

With their high fiber content, berries have a low glycemic index

Watermelon, raisans, pineapples, bananas and dried fruits are all ‘gushers’ that send your blood sugar levels up quickly.   Berries, apples, peaches, plums, etc. have low GI’s.  Note that you don’t have to eliminate all the ‘gushers’; you should use them in moderation and combine them with low GI foods. Because juicing breaks down the fiber, fruit juices have high GI’s.

Legumes and Nuts

With their low glycemic indexes, legumes and nuts get a thumbs up. Be aware of the high fat content, though.

Low-fat Dairy and Soy Drinks

Both have low glycemic indexes.

Sugar Substitutes

Stevia, an herbal sweetener, contributes zero carbohydrates. In fact according to one expert Stevia helps to regulate the blood sugar levels.

Celiac Disease and Gluten Sensitivity

With the low glycemic diet knocking out some foods that gluten sensitive people may be eating, let’s see what a low glycemic, gluten-free diet looks like.

Recommended Foods

  • Fruits—apples, citrus, peaches, plums, apricots, pears
  • Leafy green and salad veggies—all
  • Starches—Be careful of potatoes, sweet potatoes, taro and yams.
  • Reduce potato intake by replacing with yams, taro, legumes, sweet corn, peas, carrots, and pumpkins.
  • Make breads with chickpea or legume-based flours.
  • Gluten-free pastas based on rice or corn tend to have moderate to high GI values. Try buckwheat and bean noodles.
  • Try buckwheat, quinoa, and basmati rice for grains. Stay away from millet.

Fiber

Since the goal is to keep blood sugar levels from spiking, anything that impedes the digestion can be helpful.

Fiber types that inhibit enzymes from getting a food (soluble fibers found in apples, oats, beans) therefore reduce a foods GI value. Because the insoluble fiber in grains only impedes enzymes when it’s still attached to the grain, whole grain breads have GI values similar to white breads.

Other Foods

Foods such as beef, chicken, fish, eggs, tofu, avocados, nuts, seeds, many fruits (including berries) and vegetables, beer and wine and liquor have such low GI indexes that they often don’t appear on GI tables.

 

GI Diet Books from Health Rising’s Amazon.com Bookstore

Glycemic Index ME/CFS/FM Survey

Here are the results from the survey thus far:

Skipping meals often makes me feel irritable, spacey or weak

Response Chart Percentage Count
Agree completely 67% 34
Mostly agree 20% 10
Somewhat agree 10% 5
Don’t agree 4% 2
Total Responses 51

Eating starchy or sweet foods by themselves makes me feel tired and weak

Response Chart Percentage Count
Agree completely 35% 18
Mostly agree 25% 13
Agree somewhat 20% 10
Don’t agree 20% 10
Total Responses 51

When I eat sweet or starchy foods by themselves I add protein or fat to them so I don’t feel bad

Response Chart Percentage Count
Agree completely 28% 14
Agree mostly 18% 9
Agree somewhat 28% 14
Don’t agree 26% 13
Total Responses 50

I’ve tried a glycemic index diet before. It was

Response Chart Percentage Count
Very effective 31% 9
Somewhat effective 59% 17
Not effective 10% 3
Total Responses 29

I’m interested information on

Response Chart Percentage Count

Paleo diet 50% 18
Anti-inflammatory diet 72% 26
Ketogenic diet 28% 10
Elimination diet 17% 6
Anti-histamine diet 39% 14
Other, please specify… 17% 6
Total Responses 36

I’m interested information on (Other, please specify…)

# Response
1. reference for food diary ap that focuses on GI and gluten, not calories
2. I stay away from ALL carbs
3. Balanced, healthy diet that’s right for you and your metabolic, genetic type. Eliminate only if it really helps as it’s a pin and could result in a deficiency.
4.
5. low FODMAPS diet
6. HCG

Conclusions

The low glycemic index diet isn’t the complete answer for me. Some low-glycemic foods such as soy can wipe me out. Eating  foods from the nightshade family causes an old knee injury to flare up and I’m experimenting with a gluten-free diet. It may be that all diet plans need to be individualized to be completely effective. The glycemic index does, however, explain some of my negative reactions to foods that were unexplained before.

With some studies and a lot of anecdotal evidence that sugar (and probably blood sugar regulation) is a problem in ME/CFS/FM, the glycemic index is something many people might want to check out.

Appendix: A Glycemic Index Chart

Food ListRatingFood Glycemic Index
Bakery Products
*Pound cakeLow54
Danish pastryMedium59
Muffin (unsweetened)Medium62
Cake , tartMedium65
Cake, angelMedium67
CroissantMedium67
WafflesHigh76
DoughnutHigh76
Beverages
Soya milkLow30
Apple juiceLow41
Carrot juiceLow45
Pineapple juiceLow46
Grapefruit juiceLow48
Orange juiceLow52
Biscuits
DigestivesMedium58
ShortbreadMedium64
Water biscuitsMedium65
RyvitaMedium67
Wafer biscuitsHigh77
**Rice cakesHigh77
Breads
Multi grain breadLow48
Whole grainLow50
Pita bread, whiteMedium57
Pizza, cheeseMedium60
Hamburger bunMedium61
Rye-flour breadMedium64
Whole meal breadMedium69
White breadHigh71
White rollsHigh73
BaguetteHigh95
Breakfast Cereals
All-BranLow42
Porridge, non instantLow49
Oat branMedium55
MuesliMedium56
Mini Wheats (wholemeal)Medium57
Shredded  WheatMedium69
Golden GrahamsHigh71
Puffed wheatHigh74
WeetabixHigh77
Rice KrispiesHigh82
CornflakesHigh83
Cereal Grains
Pearl barleyLow25
RyeLow34
Wheat kernelsLow41
Rice, instantLow46
Rice, parboiledLow48
Barley, crackedLow50
Rice, brownMedium55
Rice, wildMedium57
Rice, whiteMedium58
Barley, flakesMedium66
Taco ShellMedium68
MilletHigh71
Dairy Foods
Yogurt low- fat (sweetened)Low14
Milk, chocolateLow24
Milk, wholeLow27
Milk, Fat-freeLow32
Milk ,skimmedLow32
Milk, semi-skimmedLow34
*Ice-cream (low- fat)Low50
*Ice-creamMedium61
Fruits
CherriesLow22
GrapefruitLow25
Apricots  (dried)Low31
ApplesLow38
PearsLow38
PlumsLow39
PeachesLow42
OrangesLow44
GrapesLow46
Kiwi fruitLow53
BananasLow54
Fruit cocktailMedium55
MangoesMedium56
ApricotsMedium57
Apricots  (tinned in syrup)Medium64
RaisinsMedium64
PineappleMedium66
**WatermelonHigh72
Pasta
Spaghetti, protein enrichedLow27
FettuccineLow32
VermicelliLow35
Spaghetti, whole wheatLow37
Ravioli, meat filledLow39
Spaghetti, whiteLow41
MacaroniLow45
Spaghetti, durum wheatMedium55
Macaroni cheeseMedium64
Rice pasta, brownHigh92
Root Crop
Carrots, cookedLow39
YamLow51
Sweet potatoLow54
Potato, boiledMedium56
Potato, newMedium57
Potato, tinnedMedium61
BeetrootMedium64
Potato, steamedMedium65
Potato, mashedMedium70
ChipsHigh75
Potato, micro wavedHigh82
Potato, instantHigh83
**Potato, bakedHigh85
ParsnipsHigh97
Snack Food and Sweets
PeanutsLow15
*M&Ms (peanut)Low32
*Snickers barLow40
*Chocolate bar; 30gLow49
Jams and marmaladesLow49
*CrispsLow54
PopcornMedium55
Mars barMedium64
*Table sugar (sucrose)Medium65
Corn chipsHigh74
Jelly beansHigh80
PretzelsHigh81
DatesHigh103
Soups
Tomato soup, tinnedLow38
Lentil soup, tinnedLow44
Black bean soup, tinnedMedium64
Green pea soup, tinnedMedium66
Vegetables and Beans
ArtichokeLow15
AsparagusLow15
BroccoliLow15
CauliflowerLow15
CeleryLow15
CucumberLow15
EggplantLow15
Green beansLow15
Lettuce, all varietiesLow15
Low-fat yogurt, artificially sweetenedLow15
Peppers, all varietiesLow15
Snow peasLow15
SpinachLow15
Young summer squashLow15
TomatoesLow15
ZucchiniLow15
Soya beans, boiledLow16
Peas, driedLow22
Kidney beans, boiledLow29
Lentils green, boiledLow29
ChickpeasLow33
Haricot beans, boiledLow38
Black-eyed beansLow41
Chickpeas, tinnedLow42
Baked beans, tinnedLow48
Kidney beans, tinnedLow52
Lentils green, tinnedLow52
Broad beansHigh79

Notes: *high in empty calories **low-calorie and nutritious foods

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