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Elimination diet for someone with ME/CFS or FM?

  [ 21 votes ]   [ 1 Comment ]
By Blake Graham, Clinical Nutritionist* • • August 28, 2010

Elimination diet for someone with ME/CFS or FM?

Q: I have ME/CFS and FM, and increasingly have digestion problems & itchiness that I suspect could be food related. Can you recommend an elimination diet I can try to see if I have some food sensitivity?

A: ME/CFS specialist Dr. Paul Cheney reports he has documented food sensitivities in roughly 50% of cases of CFS, and a large proportion of fibromyalgia patients suffer from food intolerances, though many do not know it. I believe an elimination diet is the best method of assessing food sensitivities, and have developed a protocol for patients with chronic illnesses that includes a preliminary step for CFS (and fibromyalgia) patients specifically.

Elimination Diet for Those with ME/CFS (or Fibromyalgia)

There are many reasons why individuals react negatively to foods, and an elimination diet is the best method of assessing food sensitivities. It encompasses all food reactions and is not reliant on a particular mechanism (such as lab tests that test for IgG antibodies** and exclude others).

The elimination diet described below is:

•  Limited to unrefined/whole/fresh foods

•  Devoid of food additives/colorings/artificial sugars

•  Gluten free, casein free, and lactose free

•  Very low in salicylates

•  Very low in dietary yeasts

•  Very low in dietary glutamates

•  Very low in dietary biogenic amines

•  Very low in dietary solanines

•  Generally hypoallergenic

•  Devoid of caffeine and alcohol.

Adhering to the following diet for a period of time enables a person to determine if any of these key, and common, food sensitivities are present. Observing benefits in any aspect of health while on this diet indicates one or more of the points listed above are significantly related to your symptoms.

This diet provides a snapshot in time of what you may feel like while taking into consideration all the factors listed above.


CFS/FM Patients – First, Go Gluten & Casein Free For 30 Days

In the weeks before an elimination diet…

•  Eat a nutrient-rich, unrefined and varied diet.

•  In the case of Chronic Fatigue Syndrome or fibromyalgia, this diet trial should come after a gluten/casein-free diet trial of 30 days or more. Sensitivity to gluten and casein, two dietary proteins [defined below], can sometimes take a more extended time period to become evident than a standard elimination diet allows.

To attempt this diet…

You must carefully read the ingredients list of every food you eat, and truly do it 100 percent, to see real results.

No lab test negates the need for this trial. Most people who react negatively to gluten do not have true celiac disease (and therefore test negative to celiac blood tests), but rather another form of gluten sensitivity.

Sources of gluten include:

•  Anything containing wheat, barley, rye, oats & spelt [a species of wheat grown in parts of Europe since ancient times, and now often a ‘health food’].

•  Anything that contains the words gluten, gliadin & glutenin.

•  Foods which state they may contain traces of wheat/gluten.

•  Maltodextrin/malt (unless it states it is derived from rice or corn).

•  Soy sauce (unless or states it is gluten free).

•  Bran (unless it states it is gluten free and/or derived from rice or corn).

•  Hydrolyzed vegetable protein (HVP).

•  Bulgar, couscous, durum, dinkle, kamut, semolina & triticale [all aka “wheat”].

Sources of casein include:

• Anything containing milk, yoghurt, cheese, butter, cream, ice cream, goat’s milk derived products, etc.

•  Milk solids.

•  Anything that says casein or caseinate.

Choose the most convenient time to try this diet.

For example not when relatives are staying over or when traveling. Ask for the support of your family.

First 7 to 10 Days Very Limited

For 7 to 10 days, consume nothing but the foods listed below.

If there are any foods on this list you know or suspect you may be sensitive to, eliminate those foods also. (Aspirin should also be avoided during this period, due to its high salicylate content.)

Consume a varied diet, eating some [of these] fruits, vegetables, meats, and grains daily.

•  GRAINS - Whole grain rice (rinse before cooking).

•  MEAT - All unrefined (non aged/processed/smoked/seasoned) fresh meats, except beef.

•  VEGETABLES - Cabbage, celery, green beans, iceberg lettuce, & swedes [rutabagas].

•  FRUITS - Peeled pears.

•  OILS/SEASONINGS - Olive oil & sea salt.

•  DRINKS - Water (filtered).

Keep a diary of symptoms [see list of “Common food allergy and intolerance symptoms/signs” below] and note any changes.

•  If symptoms worsen (or new symptoms appear) in the first 2 to 4 days, this may indicate withdrawal from food allergy or addiction.

•  If after 7 to 10 days symptoms have improved, this may indicate food sensitivities of some kind.

Add Back Food Categories One at a Time

Add back foods one at a time and in a pure form (fresh corn, for example), or with a non-eliminated food, taking note of symptoms changes.

Consume plenty of the foods you are testing. (Corn at lunch and dinner, for example.)

The following order is recommended:

1. Dairy (in the form of whole cream or plain yogurt)

2. Eggs

3. Yeast [see below]

4. Citrus

5. Corn

6. Cocoa.

Allow about 48 hours between adding new foods.

•  Note changes in symptoms upon adding back foods [see symptoms/signs list].

•  Any foods you react to should be eliminated, as you go on to test others.

•  If you react to specific foods wait until the resulting symptoms have cleared before adding new foods.

Patterns to Look Out For

Some people are sensitive to dietary salicylates. [Found in many fruits and vegetables, often concentrated just under their skin and in the outer leaves of vegetables, such as cabbage and lettuce. Levels decrease as fruit/vegetable ripens. Discard outer leaves; peel thickly; go for ripe. For information on the relative salicylate levels of scores of fruits and vegetables, nuts and snacks, sweets, herbs/spices/condiments, coffees/teas, alcoholic beverages, and fats & oils, go to]

Some people are sensitive to dietary yeasts. [Found in many foods including yeast raised breads; fermented beverages; vinegar; fruits eaten with skin, from berries, cherries, and grapes to prunes and raisins; olives; peanut butter. To print out a small chart of “permitted” and “not permitted” foods in a yeast-free diet, go to]

Some people are sensitive to dietary glutamates. Glutamates are contained in MSG, hydrolyzed vegetable protein, anything that contains the word glutamic or glutamate, and foods including roquefort cheese, parmesan cheese, soy sauce, walnuts, fresh tomato juice, grape juice, peas, etc. [For a more complete food list with relative glutamate levels, go to]

Some people are sensitive to dietary amines. Amines are contained in chocolate, cheese, fish, aged/processed meats, bananas, oranges, avocados, tomatoes, wine/beer, etc. [For a more complete food list with relative amine content levels, go to]

Some people are sensitive to solanine containing foods. Solanines are contained in tomatoes, potatoes, peppers, eggplant. [They function as the plant’s natural defense against pests and fungus.]


Common Food Allergy & Intolerance Symptoms/Signs

•  Hives

•  Increased mucus production in throat, regularly clearing throat, coughing

•  Irregular flattened patches on tongue or mottled tongue

•  Dark areas and/or blue, black or pink circles around eyes

•  Nose rubbing/Itchy nose

•  Nasal/sinus congestion or postnasal drip

•  Puffy eyes, nose, face

•  Abnormally red cheeks/nose and/or flushed appearance

•  Ears turn red for no apparent reason

•  Inner corners of eyes itch

•  Skin problems (eczema, rash or pale ring around mouth, dermatitis, itching, ‘burning’ feeling of skin, ‘creepy crawlies’ under skin feeling, numb skin, etc.)

•  Diarrhea or loose stools or constipation

•  Abdominal pains, bloating or nausea after meals

•  Increased frequency of stools

•  Feel/act best when don’t eat

•  Strong particular food likes (cravings) and dislikes

•  Unexplained intermittent +/- sudden irritability, depression, hyperactivity, anxiety, anger, crying, giggling, hiding in dark places, rage, vulgarity, not wanting to be touched

•  Unexplained intermittent +/- sudden changes in walking, reading, writing, speaking

•  Fatigue/lethargic.


* Blake Graham specializes in nutritional and environmental treatments for patients with CFS, FM, and other chronic conditions. He is an associate of the Australasian College of Nutritional and Environmental Medicine in Perth, Western Australia (AACNEM), and lectures widely. This information is excerpted with kind permission from his educational website

** [For example, IgG-specific antibody tests look for the immunoglobulin G antibodies associated with non-atopic or ‘delayed’ food reactions to specific foods that can worsen or contribute to many different health problems. These tend to be frequently eaten foods that are hard to avoid, including milk, corn, and wheat. Another type of test – the IgE antibody assay – addresses less frequent but more immediate, high-profile atopic food sensitivities, such as those to peanuts or shellfish.]

Note: This information has not been evaluated by the FDA. It is not intended to diagnose, cure, treat, or prevent any illness, disease, or condition. Importantly, you should never make any change in your health care plan or health support regimen without researching and discussing it in consultation with your professional healthcare team.

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Article Comments Post a Comment

Or try this
Posted by: biomedmama
Sep 27, 2010
Get and IgG food pannel blood test. It will tell you your food sensitivities. Many labs who do the testing will even give you a rotation or elimination diet plan with your results. One such lab is Alatess Laboritories.
Reply Reply
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