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



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


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 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.



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.


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.
5. low FODMAPS diet
6. HCG


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 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
Soya milk Low 30
Apple juice Low 41
Carrot juice Low 45
Pineapple juice Low 46
Grapefruit juice Low 48
Orange juice Low 52
Digestives Medium 58
Shortbread Medium 64
Water biscuits Medium 65
Ryvita Medium 67
Wafer biscuits High 77
**Rice cakes High 77
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
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
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
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

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