AHMF: Conf 2001: TM Emms

Food intolerance exists as a co-morbidity in Chronic Fatigue Syndrome

TM Emms 1,2, TK Roberts 1, HL Butt 1, I Buttfield 1, NR McGregor 1, RH Dunstan 1

1 Collaborative Pain Research Unit,
School of Biological and Chemical Sciences,
University of Newcastle,
Callaghan,
NSW, 2308
Australia,

2 Quality Nutrition,
NSW, Australia.

To prospectively assess the clinical efficacy of diagnosing and managing food chemical intolerance in a sub-group of Chronic Fatigue Syndrome (ME/CFS) patients reporting gastrointestinal or food induced symptoms. Reviews to date have reported retrospective analysis of patient data [1], including diagnosis of ME/CFS and advise that few patients show any benefit from dietary intervention [2], although it has been estimated that food intolerance is a significant factor in possibly 20-30% of patients [1].

Seventy six ME/CFS patients fulfilling the Fukuda diagnostic criteria were assessed for possible food chemical intolerance via an elimination diet protocol. Symptom severity was assessed both pre- and post dietary manipulation by a self-completed 86 question checklist and clinical interview. Patients reporting improvement subsequently completed open food challenges to confirm reactions. Foods and chemicals investigated for inducing symptoms were milk, wheat, commercially prepared bread, natural food chemicals and additives.

Thirty eight patients completed the elimination and 22 proceeded with all or some of the open-food challenges. Thirty four (89.5 %) reported a positive outcome from exclusion with improvements in multiple symptom severities across body systems. Fifty percent of symptoms reported showed a significant decrease in severity post-diet. This included most of the CDC diagnostic symptom criteria such as: fatigue (P<0.01), recurrent fevers (P<0.02) and sore throats (P<0.03), muscle pain (P<0.002), headaches (P<0.02), painful joints (p<0.03), difficulty concentrating (P<0.0002) and other neuropsychological symptoms and unrefreshed or prolonged sleep (P<0.03). Gastrointestinal symptoms synonymous with Irritable Bowel Syndrome (IBS) had decreased prevalence following the intervention (OR=7.3, 95%CL 2.4-22.1, P<0.0002) and therefore food intolerance may be of aetiological significance in the development of IBS symptoms in CFS.

Food intolerance may represent a co-morbidity in a CFS subgroup and could have aetiological implications for the development of gut dysfunction. The clinical investigation of intolerances shows promise for symptom management but remains mostly under-utilised.

1. Loblay RH. The role of food intolerance in chronic fatigue syndrome. In: Hyde BM, ed. The clinical and scientific basis of myalgic encephalomyelitis chronic fatigue syndrome. Ottawa: The Nightingale Research Foundation, 1992; 521-538.
2. Dietitians Association of Australia. The dietary management of food allergy and food intolerance in children and adults. Aust J Nut Diet 1996;53(3):89-98.