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==ME/CFS== [[Severe_and_very_severe_ME#verysevere|Very severe ME]] can cause malnutrition, for example patients who are physically unable to eat enough due to extreme exhaustion and [[post-exertional malaise]], [[:Category:Digestive signs and symptoms|gastrointestinal symptoms of ME/CFS]], or [[food intolerance]]s.<ref name="Baxter2021" /> === Diet and nutritional deficiencies === ME/CFS cannot be diagnosed until medical tests have been carried out to rule out certain nutritional deficiencies, including [[iron]], [[vitamin B12]], and [[vitamin D]], but these can occur after diagnosis.<ref name="niceng206">{{Cite web|url=https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last = NICE Guideline Development Group|first = | authorlink = |publisher=[[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref><ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10= Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf}}</ref><ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 =Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 =Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 =Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref> Nutritional deficiencies identified in people with ME/CFS include: * Lack of dietary fibre in 95% * unhealthy fat intake in 70% * inadequate fruit and vegetable intake in 70% * low intake of [[calcium]], [[iodine]], [[selenium]] and [[vitamin D]] was common * [[Vitamin D deficiency|low vitamin D]] levels in 60% of those not taking supplements was found in one study * low circulating levels of vitamin E were found in CFS patients, but only in lower quality studies<ref name="Jones2017" /><ref name="Joustra2017" /> *Deficiencies that have been found in some studies but not others include various [[B vitamin]]s, [[vitamin C]], [[magnesium]], [[sodium]], [[zinc]], [[L-tryptophan]], [[carnitine]], [[coenzyme Q10]], and [[essential fatty acid]]s.<ref name="Werbach2000">{{Cite journal | date = 2000|url=https://www.researchgate.net/profile/Mel-Werbach/publication/12548254_Nutritional_strategies_for_treating_chronic_fatigue_syndrome/links/59ea9d3eaca272cddddb8318/Nutritional-strategies-for-treating-chronic-fatigue-syndrome.pdf | title=Nutritional Strategies for Treating Chronic Fatigue Syndrome|journal=Alternative Medicine Review|first = Melvyn R. | last = Werbach|language=en|volume=5|issue=2 | pages = 93-108|quote=|via=}}</ref> A review by Jones and Probst stated that "unhealthy dietary intake [was] not significantly associated with fatigue severity or functional impairment" in chronic fatigue syndrome patients, and found that avoiding [[Dairy-free diet|dairy]] or [[Gluten-free diet|grains]] was common, and was usually not based on a diagnosed allergy or intolerance.<ref name="Jones2017" /> {{See also|Nutritional deficiencies in ME/CFS}}
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