Managing Fatigue in CIDP: How the Spoon Theory Can Help
Health ConditionsAutoimmune Diseases

The ‘Energy Budget’: Master the Spoon Theory for Chronic Fatigue in CIDP

The ‘Energy Budget’: Master the Spoon Theory for Chronic Fatigue in CIDP
Getty Images; Everyday Health
By
Published on February 5, 2026
by
Chronic inflammatory demyelinating polyneuropathy (CIDP) can cause extreme fatigue in up to 80 percent of people with this autoimmune condition.

 An invisible but often debilitating exhaustion, fatigue in CIDP can affect the body and mind, which not only leaves you physically tired but can also make you feel less alert, awake, and motivated.

But managing fatigue in CIDP is possible. Below, learn how to budget your energy for a full life.

Why CIDP Causes Fatigue

Experts don’t fully understand what causes fatigue in CIDP, but they have some theories. For example, CIDP damages the protective myelin coating around your nerves (demyelination). Once nerves get damaged, your body has to use extra energy to send signals through them, which may add to fatigue.

Nerve damage also leads to muscle weakness, so activities that were once easy can take a lot more effort, says Jeffrey Mullen, MD, a neurologist and assistant clinical professor who directs the neuromuscular diagnostics lab at the University of California in Irvine. “This increased effort over time leads to fatigue,” he says.

When you have CIDP, you may experience different types of fatigue:

  • Motor Muscle weakness
  • Sensory or Central Systemic exhaustion and lack of energy
  • Neurological Trouble with motivation and staying awake and alert

While treatment can improve your muscle strength, exhaustion can still linger. “Even if there is healing of the nerves with treatment, they often do not heal completely, so the nerves may not return to how they were prior to getting CIDP,” says Dr. Mullen.

Besides demyelination, CIDP fatigue can also arise from other causes, like taking sedating medications, says Nestor Galvez-Jimenez, MD, a neurologist with Baptist Health in Miami. Other contributing factors include depression, poor sleep quality, and difficulty taking care of yourself, Dr. Galvez-Jimenez says.

Applying the ‘Spoon Theory’ to CIDP

In 2003, Christine Miserandino developed the “spoon theory” while trying to explain her chronic fatigue to a friend.

 This energy budgeting system creates a currency value or percentage for the energy it takes to complete various daily tasks, says Kunal Desai, MD, a neurologist with Yale New Haven Health and assistant professor of neurology at Yale School of Medicine.
For example, you can assign “spoons” to activities you do frequently:

  • Taking a shower = 1 spoon
  • Making breakfast = 1 spoon
  • Commuting to work = 5 spoons
  • Having lunch with a friend = 3 spoons
  • Taking a child to soccer practice = 4 spoons
Then you can create a spoon budget that reflects the amount of energy you have available. This system can also help you identify “spoon thieves” — activities that take a lot of energy — like loud environments, long conversations, and multiple errands.

Once you know your spoon budget, you can decide how you want to spend them each day. For example, if you’re going out to eat that evening, you can skip other tasks or activities in the day to save your spoons for later. As your CIDP treatment progresses, you may find you can add more spoons to your day.

Pacing Strategies to Prevent Exhaustion

On good days with fewer symptoms, you may feel tempted to catch up or make up for lost time, but pushing yourself too hard can worsen nerve damage. This “push-and-crash” cycle can lead to more frequent relapses. So, it’s better to keep your activity slow and steady, says Mullen.

To help keep track of how fast you use your daily spoons, you can use the four P’s of energy conservation:

  • Pacing Managing how fast and hard you work to complete a task or activity
  • Prioritizing Choosing which activities to do each day and which can wait
  • Planning Building in rest time during the day and alternating between difficult and easy tasks
  • Positioning Modifying activities to make them easier, like sitting on a stool while cooking

When you have trouble taking care of daily tasks because of your CIDP symptoms, the four P’s can help you pace yourself and get the most out of your day, says Dr. Desai.

Mental Energy and the ‘Cognitive Budget’

The mental fatigue that comes with CIDP can feel just as exhausting as physical tiredness. But you can conserve your mental energy and lessen brain fog with these tips:

  • Adopt healthy sleep habits, like following a consistent sleep schedule.
  • Eat healthy, including plenty of fruits, vegetables, lean protein, and healthy fats.
  • Set alarms and reminders to help you keep track of important information.
  • Create a predictable daily routine to take pressure off your memory.
  • Take 30-minute mental breaks throughout the day.

Using these spoon-saving techniques, you can use that energy for other activities and fit more into each day.

Nutritional Tweaks to Support Nerve Health

Although no research has proven that specific nutritional changes can improve CIDP symptoms, some nutrients support peripheral nerve health and regeneration, says Galvez-Jimenez. “B vitamins, particularly thiamine (B1), B6, and B12, play essential roles in nerve function,” he says. You can find B vitamins in meat, dairy, leafy green vegetables, and beans.

According to Galvez-Jimenez, other potentially beneficial nutrients include:

  • Omega-3 fatty acids for their anti-inflammatory properties (found in fatty fish, flaxseed, and soybeans)

  • Vitamin D for neuromuscular function (found in fortified foods like milk and cereal as well as fatty fish and cheese)

  • Antioxidants (vitamins C and E) to reduce oxidative stress that causes cell damage (found in many fruits and vegetables)

  • Alpha-lipoic acid for neuroprotection (found in spinach, broccoli, tomatoes, peas, Brussels sprouts, and rice)

Because inflammation plays such a big role in CIDP, limiting inflammatory foods, like sugars and processed foods, may also be a good idea, says Mullen. An anti-inflammatory diet may include whole grains, lean protein, and colorful fruits and vegetables.

In addition to eating nutritious food every day, it’s important to stay hydrated, which can lower fatigue after IVIG infusion, a common CIDP treatment.

Talking to Your Doctor About the ‘Invisible’ Symptom

You may not know how to tell your healthcare provider about fatigue, which can push you to downplay your symptoms during a neurology appointment. Fatigue can also be difficult to describe, so your provider may recommend a tool like the Fatigue Severity Scale, which asks questions about your symptoms and how they affect your life.

Your answers, plus a close assessment of your current medications and symptoms, can then give your provider clues to direct treatment.

The Takeaway

  • Up to 80 percent of people with CIDP report extreme fatigue, which can affect daily life.
  • The spoon theory can help you budget your physical and mental energy to prioritize tasks and activities for the day.
  • Be sure to tell your doctor about your fatigue symptoms. They may recommend diet changes, lifestyle hacks, and pacing strategies to help you maximize your energy with CIDP.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Steiner OL et al. Motor and Cognitive Fatigue in Chronic Inflammatory Demyelinating Polyneuropathy. European Journal of Neurology. October 28, 2025.
  2. CIDP (Chronic Inflammatory Demyelinating Polyneuropathy). Cleveland Clinic. December 4, 2023.
  3. Gerevich Z et al. Metabolic Implications of Axonal Demyelination and Its Consequences for Synchronized Network Activity: An in silico and in vitro Study. Journal of Cerebral Blood Flow & Metabolism. April 26, 2023.
  4. Gable KL et al. A Longitudinal Evaluation of Fatigue in Chronic Inflammatory Demyelinating Polyneuropathy. Brain and Behavior. July 21, 2022.
  5. Coulter J. Understanding the Spoon Theory: A Window into Chronic Illness. Case Management Society of America. May 15, 2025.
  6. Speaker Series, A Conversation With a Physical Therapist for GBS, CIDP and MMN. GBS/CIDP Foundation International. September 4, 2025.
  7. Das S. The Spoon Theory: A Journey into the World of Chronic Illness. Literary and Cultural Disability Studies: A Primer. April 2025.
  8. Quinn KL et al. Cardiovascular Considerations in the Management of People With Suspected Long COVID. The Canadian Journal of Cardiology. April 6, 2023.
  9. Brain Fog. Cleveland Clinic. May 14, 2024.
  10. Brain Fog: Simple Productivity Hacks for Clearer Thinking. Hydrocephalus Association.
  11. Hanna M et al. B Vitamins: Functions and Uses in Medicine. The Permanente Journal. June 17, 2022.
  12. Omega-3 Fatty Acids: Fact Sheet for Health Professionals. Office of Dietary Supplements. August 22, 2025.
  13. Vitamin D: Fact Sheet for Health Professionals. Office of Dietary Supplements. June 27, 2025.
  14. Antioxidants. MedlinePlus. November 18, 2025.
  15. Superti F et al. Alpha-Lipoic Acid: Biological Mechanisms and Health Benefits. Antioxidants. October 12, 2024.
  16. van Zonneveld SM et al. An Anti-Inflammatory Diet and Its Potential Benefit for Individuals with Mental Disorders and Neurodegenerative Diseases-A Narrative Review. Nutrients. August 10, 2024.
  17. Ledford DK. Post IVIG Malaise, Fatigue and Pain. American Academy of Allergy, Asthma & Immunology. February 21, 2018.
  18. Goodwin E et al. Using the Fatigue Severity Scale to Inform Healthcare Decision-Making in Multiple Sclerosis: Mapping to Three Quality-Adjusted Life-Year Measures (Eq-5D-3L, Sf-6D, Msis-8D). Health and Quality of Life Outcomes. August 5, 2019.
Meet Our Experts
See Our Editorial PolicyMeet Our Health Expert Network
jason-paul-chua-bio

Jason Paul Chua, MD, PhD

Medical Reviewer
Castle Connolly Top Doctor

Jason Chua, MD, PhD, is an assistant professor in the Department of Neurology and Division of Movement Disorders at Johns Hopkins School of Medicine. He received his training at the University of Michigan, where he obtained medical and graduate degrees, then completed a residency in neurology and a combined clinical/research fellowship in movement disorders and neurodegeneration.

Dr. Chua’s primary research interests are in neurodegenerative disease, with a special focus on the cellular housekeeping pathway of autophagy and its impact on disease development in diseases such as Parkinson disease. His work has been supported by multiple research training and career development grants from the National Institute of Neurological Disorders and Stroke and the American Academy of Neurology. He is the primary or coauthor of 14 peer-reviewed scientific publications and two peer-reviewed online learning modules from the American Academy of Neurology. He is also a contributing author to The Little Black Book of Neurology by Osama Zaldat, MD and Alan Lerner, MD, and has peer reviewed for the scientific journals Autophagy, eLife, and Neurobiology of Disease.

See full bio

Abby McCoy, RN

Author

Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.

McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.

See full bio
See Our Editorial PolicyMeet Our Health Expert Network