One month trial of high protein, low carbohydrate diet for CFS

In recent years there has been some research* indicating that the cells of people with CFS may not get energy from glucose as well as regular people do, but may still be able to derive energy normally from protein.  They didn't look at processing of fat (the other main thing we get energy from), although at least one other study indicates there may be issues there, too.

* this research is explained in more lay terms here and here.

With this in mind, I decided to do a six-week trial of a very high protein, very low carbohydrate diet.  If my body was functioning like the cells in the trial, this should give me more access to energy at a cellular level, which ought to translate to more perceived energy :-)  The idea was to be as strict as I could manage with this diet then, if it proved helpful, to gradually figure out how strict was necessary.

I had put off doing such a trial for a long time as I couldn't imagine how to eat this way without significantly increasing my environmental footprint.  However, a neighbour persuaded me to figure out whether it was helpful first, and leave working out how to make it environmentally friendly until I knew that effort would be worthwhile.  That seemed like good advice, and so we went ahead!


In the end I only ran the trial for a month, as it just didn't seem to be helping and it was quite a lot of work.  Over the trial I ate as follows (the percentages are the approximate percentage of my calories from that source):

	g carb (net)	g protein	g fat	calories
week 1	24.7	118.4	94.5	1445
	6.8%	32.8%	58.9%	98.5%
week 2	23.9	115.4	86.5	1378
	6.9%	33.5%	56.5%	96.9%
week 3	20.2	118.5	88.1	1386
	5.8%	34.2%	57.2%	97.2%
week 4	18.5	126.8	62.4	1219
	6.1%	41.6%	46.1%	93.7%
week 5 (3 days)	17.7	131.1	60.1	1180
	6.0%	44.4%	45.8%	96.2%
target:	17.5	127.0	91.3	1400
	5.0%	36.3%	58.7%	100.0%

Initially I was simply trying to eat less than 25g of carbohydrate and well over 100g of protein each day.  In weeks four and five I pushed it further and came up with the targets you see at the bottom of the table.  I am 168cm tall, so the protein target was based on eating 2g of protein per kg for the mid-point of the healthy weight for my height (63.5kg - a BMI of 22.5).  I knew from past experience that I generally eat roughly 1400kCal per day (I am very inactive!), so 17.5g of carbohydrate would represent 5% of my calorie intake coming from carbs.  The fat 'target' is simply the number of grams of fat it would take to make that up to 1400kCal.

Martin mostly joined me in the experiment, although he was eating more of a classic keto/Atkins/HFLC-type diet: eating a little less protein than me and making up the extra calories he needs with a lot more fat.  He struggled with having less energy overall and his gut didn't much like it, so he didn't stick it out for the whole month.

How did it work out?
Healthwise I had two really good days in a row in the first week, which initially gave me hope the diet was working.  However that was just followed by the usual ups and downs, and overall I felt it had no impact on my energy.  It did result in 3kg of weight loss which was handy, although 1.5kg of that has returned in the three weeks since.  I had been a bit concerned I might become constipated with the drastic reduction in dietary fibre (usually we eat a lot of rice and legumes), but was fine in that department.

Most unexpectedly, we both found we'd significantly altered our microbiomes by making such a radical change to our diet.  A few weeks in, I found my teeth stopped getting a scummy film building up in the hours between brushings: as far as I could tell, they simply stayed clean.  And, after some weeks of a meat-rich diet, Martin found his gut became very gassy when he returned to eating legumes - something that had never happened before.  Presumably, both the bacteria in my mouth that gorge on carbohydrate and those in Martin's gut that do the same had simply died off from lack of food, although they seem to be repopulating now.

Whilst the diet doesn't appear to have helped with my energy, remember that CFS seems to consist of a number of subtypes so it still may help you.  It could just be that I'm not the same subtype as the people whose cells were used in the study and maybe you are!  If you'd like to learn about the logistics of trialling such a diet, please contact me or leave a note in the comments - it was tricky to figure out how to do it and I'm happy to pass on what I learned!  My first recommendation would be to use Happy Forks to track the nutritional content of what you're eating, but I can also share more details on actual recipes and strategies that helped if you would like.

There were two things I found particularly difficult in terms of getting the nutritional balance I was after.

The first was to find ways to eat a lot of protein without also eating a lot of fat.  In nature, protein seems to either come with carbohydrate (e.g. legumes, milk, most nuts) or fat (e.g. cheese, most meat, pretty much all nuts).  I got around this by consuming more and more protein shakes*, although I wasn't totally comfortable with such 'artificial' food forming such a big part of my diet.  These did help keep my carbon footprint down as they were vegan, and they were quite palatable :-)  I expect to continue to have them from time to time as a high-protein snack.  Chicken and ham also have reasonably good protein:fat ratios.

* My shakes consisted of 2T pea protein powder, 2 scoops/tablets stevia and 1/2 tsp either cocoa powder or vanilla essence, mixed with about 2 cups water.  This gave me 21.5g protein, 105kCal and either 1.0 or 1.9g carbohydrate depending on whether I used vanilla or cocoa to flavour it.

The second was to get my '5+ a day' of fruit and vegetables without exceeding my carbohydrate target.  I found I couldn't eat any fruit at all, but did manage to squeeze in a treat of 150g of truss tomatoes most mornings (4.1g carbohydrates all up).  Other than that I stuck to celery, daikon, radishes, rocket, spinach and bok choy.  This way I was able to consume at least 500g of vegies pretty much every day.  It was good we were doing this in late summer, as leafy things go up considerably in price in the winter and nice tomatoes become hard to find.

A further challenge we added to the experiment was trying to somewhat minimise its impact on our carbon footprint.  We are very concerned by the impacts the changing climate is having on our global neighbours, and it didn't seem right to try and improve my health at the expense of theirs.  Meat production has a high carbon footprint, so eating a lot more of it than usual inevitably bumped our footprint up.  We contained this somewhat by eating a lot of chicken (two whole chickens between us most weeks) as well as middling amounts of lamb, goat, pork and ham, and no beef.

If Martin and I both ate this way long-term, we estimate it would increase our per person carbon footprint by about 1Tonne CO2e/year (about 25%) and increase our food bill by nearly $200 per month (more than 50%).  So I'm kind-of pleased it didn't work out, as we'd have been faced with a lot of difficult work if it did.  But more energy would have been nice :-(