“Let food be thy medicine and medicine be thy food.”
― Hippocrates, 400 B.C.
In the fist part I discussed the evidence about metabolic differences, nutritional deficiencies and hence supplements for Fibromyalgia (FMS). This article covers dietary interventions. But first I want to emphasize that studies on nutrition always remain somewhat controversial. The reason is that too many factors come into play, such as different individual metabolism, lifestyle, baseline nutrients, plus it's necessary to keep study participants adherent to a diet for a long period of time which is challenging. So there is no one-size-fits-all solution but still valuable lessons to learn. Diet should always be tailored individually and consider lifestyle, body mass and tolerance.
Diet and Fibromyalgia
Several studies have showed symptom improvement in FMS patients after a shift to a vegan or vegetarian diet for at least 6 weeks of diet adherence (1). The effect is most likely due to the increased intake of antioxidants. The role of meat is not yet clear but meat consumption is generally too high in western countries. The brain needs antioxidants to properly function and an imbalance of radicals/antioxidants seems to play a role FMS. This is especially important for stressed individuals who usually tend to crave more sweets and carbohydrates. With increasing age the body's defense mechanisms against metabolic stress decrease so the older we get the less we are able to handle bad nutrition. Also, depending on the foods we eat we create different metabolic states in the body, also the brain, which over long term can be detrimental or supportive for health and vitality. A good trick to increase antioxidant intake is juicing vegetables and fruits, especially if appetite is not high and nutrient content of many industrially grown vegetables and fruits is low.
Other studies have showed signigicant improvements and even remissions of FMS after a so called excitotoxin elimination diet. Excitotoxins are substances that excite nerve cells in an abnormal and harmful manner. Examples are glutamate (MSG), aspartame and cysteine. Several authors have hypothesized that excitotoxins affect central sensitization which is the hallmark of FMS. But the evidence is controversial. One study showed a symptom reduction >30% in FMS patients after 4 weeks and a return of symptoms with reintroduction of MSG. Another controlled study showed no effect on symptoms. On the other side there are several case reports of patients with symptom improvements after elimination of MSG and aspartame, even two cases of aspartame-induced FMS were reported (1).
This is a quite new and interesting research field. In celiac disease (CD), which is an auto-immmune disorder of the intestine due to gluten proteins, a gluten free diet also lead to improvement of FMS symptoms in one study.
Apart from coeliac disease, "non-coeliac gluten sensitivity" is increasingly recognised as a frequent condition with similar manifestations and overlap with FMS. The elimination of gluten from the diet of FMS patients is recently becoming a potential dietary intervention for clinical improvement. In a recent spanish study (2) 20 patients with longstanding FMS and no CD were placed on a gluten-free diet for one year and showed remission of pain, return to work and opioid discontinuation. The level of widespread chronic pain improved dramatically for all patients, in 15 patients it was no longer present. But the improvement took a couple of months to take place. This is a remarkable result and here we should take into consideration the nature of this protein gluten. Nowadays it's abundant in foods, but before agriculture took place, people actually ate gluten-free. Only 2000 years ago wheat came to europe and it increasingly gained importance over other grains. In the past 60 years wheat production has increased nine-fold (on the same surface) with an increase in gluten content due to cross breading. This type of modern wheat and gluten abundance is indeed unknown in mankinds history and may indeed cause health issues.
Unfortunately the relevance and knowledge of nutrition is often neglected by physicians. So you need to do your own work, but there is plenty of information out there.
Feel free to ask questions, give feedback and share you experiences about this important topic!
Marc Fouradoulas, MD
1 Rossi, A., et al. "Fibromyalgia and nutrition: what news?." Clinical and experimental rheumatology 33.1 (2014): 117-125.
2 Isasi, Carlos, et al. "Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia." Rheumatology international 34.11 (2014): 1607-1612.