Fibromyalgia and Diet
The oxidative stress hypothesis is commonly cited as contributing to the musculoskeletal dysfunction seen in patients with fibromyalgia. These individuals have been shown to have insufficient antioxidant nutrients, such as Magnesium and Selenium. Oxidative stress has been associated with cellular damage, lipidic peroxidation, and prostaglandin synthesis, all of which may directly contribute to the symptoms experienced by fibromyalgia patients.
In surveys among patients with fibromyalgia, 42% of patients report physical symptoms, such as joint pain and stiffness, after ingestion of certain foods. Furthermore, 68% report use of nutritional supplements to control their pain and fatigue. Despite the belief that diet influences fibromyalgia symptoms, the scientific basis for this is uncertain.
Results from a review of 87 scientific papers that examined the relationship between fibromyalgia and diet revealed there may be some benefit to diets rich in antioxidants, such as those based on uncooked vegan products. Individuals following this diet had higher levels of beta and alpha carotenes, lycopene, lutein, Vitamin C and Vitamin E than controls following a normal diet. Clinically, researchers noted a decrease in patients’ complaints of joint stiffness and pain, as well as an improvement in patients’ perceived well-being.
Three studies looked directly at the effect on fibromyalgia symptoms from changing from an omnivore to vegetarian or vegan diet. Two trials examined this relationship without the addition of pharmacologic therapy. The first was a non-randomized trial with 15 fibromyalgia patients following an omnivorous diet to serve as a control and 15 patients with fibromyalgia that followed a vegan diet. After three months the interventional group had significant reductions in their body mass index, total cholesterol, and urine sodium, as well as reported improvements in joint stiffness, quality of sleep, and pain compared with the control group. The second study examined 30 patients with fibromyalgia who shifted from an omnivorous diet to a raw, vegetarian diet rich in nuts, fruits, and vegetables for seven months. 19 of the 30 patients reported significant improvement in their quality of life and fibromyalgia questionnaire. The authors concluded that a mostly raw vegetarian diet may help improve fibromyalgia symptoms and produce beneficial health effects.
Previous research has shown that brain tryptophan levels are low in individuals with fibromyalgia. Diets rich in large neutral Amino Acids have been shown to lower tryptophan levels. In view of this information, a third randomized controlled trial examined fibromyalgia patients who were changed from an omnivorous diet to a vegetarian diet devoid of animal protein. These individuals were compared to patients with fibromyalgia who were treated pharmacologically with Amitriptyline. After six weeks symptoms were assessed using a tender point counter and a visual analogue scale for fatigue, insomnia, pain, and non-restorative sleep. There were significant improvements in all categories for individuals with fibromyalgia treated with Amitriptyline, but the only significant, although small, improvement seen in the vegetarian diet group was in their pain. The authors concluded that there was insufficient evidence to conclude a vegetarian diet as a treatment for fibromyalgia.
Although not studied specifically in fibromyalgia patients, the avoidance of animal fat and milk proteins have been suggested for patients with autoimmune and rheumatologic conditions. Saturated animal fats may aggregate and obstruct capillaries, decrease cell membrane fluidity, and lead to lipogenesis. Additionally, hypercaloric diets rich in saturated fats effect gene expression, cell metabolism, growth, and differentiation. Furthermore, milk proteins can possibly aggravate inflammatory conditions as the molecules of the proteins may mimic autoantigens. Previous animal studies have shown that milk proteins can induce an inflammatory response.
Polyphenols and carotenoids from vegetables, as well as polyunsaturated fatty acids from fish, have demonstrated antioxidant activity. They have been shown to have anti-inflammatory, immunomodulating, and antiviral properties.
Elimination diets have received attention in the media recently for treatment of fibromyalgia. This diet suggests eliminating all foods that may cause sub-clinical allergies for a period of time. Foods are then re-introduced, one at a time, every five days. This diet is without scientific basis; however, it is reasonable to recommend removing foods that have been identified as inducing symptoms.
In summary, vegetarian diets and diets rich in vitamins and minerals may have a positive effect on fibromyalgia symptoms. More importantly, the stress on the musculoskeletal system and negative impact on quality of life from excess body weight are undeniable. Treatment efforts should address weight loss or maintenance and nutritional requirements with all patients with a diagnosis of fibromyalgia.
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