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.
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.
Dig Deeper: See Hypocortisolism in Chronic Fatigue Syndrome by Cort Johnson (unattributed)
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.
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
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 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
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
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Amazon.com Widgets
Glycemic Index ME/CFS/FM Survey
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.
More on Diets and Chronic Fatigue Syndrome – The Best Diet for Chronic Fatigue Syndrome?
Next up – Anti-inflammatory Diets
Appendix: A Glycemic Index Chart
Food List
Rating
Food Glycemic Index
Bakery Products
*Pound cake
Low
54
Danish pastry
Medium
59
Muffin (unsweetened)
Medium
62
Cake , tart
Medium
65
Cake, angel
Medium
67
Croissant
Medium
67
Waffles
High
76
Doughnut
High
76
Beverages
Soya milk
Low
30
Apple juice
Low
41
Carrot juice
Low
45
Pineapple juice
Low
46
Grapefruit juice
Low
48
Orange juice
Low
52
Biscuits
Digestives
Medium
58
Shortbread
Medium
64
Water biscuits
Medium
65
Ryvita
Medium
67
Wafer biscuits
High
77
**Rice cakes
High
77
Breads
Multi grain bread
Low
48
Whole grain
Low
50
Pita bread, white
Medium
57
Pizza, cheese
Medium
60
Hamburger bun
Medium
61
Rye-flour bread
Medium
64
Whole meal bread
Medium
69
White bread
High
71
White rolls
High
73
Baguette
High
95
Breakfast Cereals
All-Bran
Low
42
Porridge, non instant
Low
49
Oat bran
Medium
55
Muesli
Medium
56
Mini Wheats (wholemeal)
Medium
57
Shredded Wheat
Medium
69
Golden Grahams
High
71
Puffed wheat
High
74
Weetabix
High
77
Rice Krispies
High
82
Cornflakes
High
83
Cereal Grains
Pearl barley
Low
25
Rye
Low
34
Wheat kernels
Low
41
Rice, instant
Low
46
Rice, parboiled
Low
48
Barley, cracked
Low
50
Rice, brown
Medium
55
Rice, wild
Medium
57
Rice, white
Medium
58
Barley, flakes
Medium
66
Taco Shell
Medium
68
Millet
High
71
Dairy Foods
Yogurt low- fat (sweetened)
Low
14
Milk, chocolate
Low
24
Milk, whole
Low
27
Milk, Fat-free
Low
32
Milk ,skimmed
Low
32
Milk, semi-skimmed
Low
34
*Ice-cream (low- fat)
Low
50
*Ice-cream
Medium
61
Fruits
Cherries
Low
22
Grapefruit
Low
25
Apricots (dried)
Low
31
Apples
Low
38
Pears
Low
38
Plums
Low
39
Peaches
Low
42
Oranges
Low
44
Grapes
Low
46
Kiwi fruit
Low
53
Bananas
Low
54
Fruit cocktail
Medium
55
Mangoes
Medium
56
Apricots
Medium
57
Apricots (tinned in syrup)
Medium
64
Raisins
Medium
64
Pineapple
Medium
66
**Watermelon
High
72
Pasta
Spaghetti, protein enriched
Low
27
Fettuccine
Low
32
Vermicelli
Low
35
Spaghetti, whole wheat
Low
37
Ravioli, meat filled
Low
39
Spaghetti, white
Low
41
Macaroni
Low
45
Spaghetti, durum wheat
Medium
55
Macaroni cheese
Medium
64
Rice pasta, brown
High
92
Root Crop
Carrots, cooked
Low
39
Yam
Low
51
Sweet potato
Low
54
Potato, boiled
Medium
56
Potato, new
Medium
57
Potato, tinned
Medium
61
Beetroot
Medium
64
Potato, steamed
Medium
65
Potato, mashed
Medium
70
Chips
High
75
Potato, micro waved
High
82
Potato, instant
High
83
**Potato, baked
High
85
Parsnips
High
97
Snack Food and Sweets
Peanuts
Low
15
*M&Ms (peanut)
Low
32
*Snickers bar
Low
40
*Chocolate bar; 30g
Low
49
Jams and marmalades
Low
49
*Crisps
Low
54
Popcorn
Medium
55
Mars bar
Medium
64
*Table sugar (sucrose)
Medium
65
Corn chips
High
74
Jelly beans
High
80
Pretzels
High
81
Dates
High
103
Soups
Tomato soup, tinned
Low
38
Lentil soup, tinned
Low
44
Black bean soup, tinned
Medium
64
Green pea soup, tinned
Medium
66
Vegetables and Beans
Artichoke
Low
15
Asparagus
Low
15
Broccoli
Low
15
Cauliflower
Low
15
Celery
Low
15
Cucumber
Low
15
Eggplant
Low
15
Green beans
Low
15
Lettuce, all varieties
Low
15
Low-fat yogurt, artificially sweetened
Low
15
Peppers, all varieties
Low
15
Snow peas
Low
15
Spinach
Low
15
Young summer squash
Low
15
Tomatoes
Low
15
Zucchini
Low
15
Soya beans, boiled
Low
16
Peas, dried
Low
22
Kidney beans, boiled
Low
29
Lentils green, boiled
Low
29
Chickpeas
Low
33
Haricot beans, boiled
Low
38
Black-eyed beans
Low
41
Chickpeas, tinned
Low
42
Baked beans, tinned
Low
48
Kidney beans, tinned
Low
52
Lentils green, tinned
Low
52
Broad beans
High
79
Notes: *high in empty calories **low-calorie and nutritious foods
From the South Beach Diet
The post Is the Glycemic Index Diet Right for Chronic Fatigue Syndrome and Fibromyalgia? appeared first on Health Rising.