A friend of mine has recently been diagnosed with fibromyalgia (FM)—after lots of misdiagnosis and silent pain, she came with this news, and a new road in front of her for learning, discovering, and adopting a new lifestyle for such a condition. But FM is still widely misunderstood, and there is not a unique stand-alone treatment for everyone; therefore, guidance in an adequate diet and exercise should also be considered part of this journey. And this article wants to help in that process with the latest nutritional recommendations and bits of advice!
First, what is actually fibromyalgia?
FM is related to the central nervous system; it affects the person’s sensory processing system with the effect of amplifying painful sensations, or in other words, the way the brain processes pain signals. The main symptoms are widespread body pain, together with chronic fatigue, sleep, mood, and possible memory problems. The patient doesn’t always experience symptoms; when it happens, it is called a flare and can last from days to weeks. There are many different reasons that can trigger those flares, but stress is very common! So the first piece of advice is to pay attention to your emotional life and stress levels, learn how to cope with them, and get them all in balance!
So, when flares happen, can they be reduced or controlled?
Yes, but solutions are not as simple as a single medicament prescription, and they often imply regular exercise, pain management techniques like mindfulness and visualisations, diet guidelines, possibly water therapies, and approaches to cope with the psychological challenge of dealing with chronic pain and the changes that come with it all levels [1][2][3]. Patients following holistic approaches do experience prolonged periods with no symptoms, and there is accumulating evidence that diet can lead to real improvement, .and it is something directly in everyone’s control! [1] Good news, right?!
And these are some of the principles regarding diet that can benefit patients with FM [1][2]:
1. Reduce or eliminate food additives
Food additives (like MSG, some processed foods, and sauces with artificial ingredients), aspartame (often added as a sweetener in soda, drinks, and dairy), protein isolates, yeast extract, and aged cheeses. In general terms, it consists in eating a whole food diet limiting the consumption of processed foods with additives and choosing products which ingredient lists on their food labels that are short, easy to read, and with understandable names.
The reason for this is that these foods are related to glutamate and aspartate, two neurotransmitters linked to pain occurrence. Concretely, there have been studies where higher brain glutamate levels have been reported in FM patients compared to healthy controls.
2. More magnesium, zinc, and vitamin B6.
Micronutrients are very important in supporting optimal brain health and the neurotransmitters (or messengers) in them, and concretely magnesium, zinc, and B6 are related to glutamate's levels and optimal functioning.
Magnesium: whole grains, pumpkin seeds, almonds, cashews, peanuts, sesame seeds, beans, spinach, milk, figs, cocoa, okra, bananas, avocados, molasses, and salmon)
Zinc: Whole grains, baked beans, chickpeas, nuts (cashews and almonds), dairy, oysters, shellfish, red meat, and poultry.
3. More omega-3 fatty acids
Omega 3: Oily fish (salmon, sardines, mackerel, and tuna), flaxseeds, walnuts, and chia seeds.
Deficiency in omega-3 fatty acids has been shown to increase the process in which nerve cells are damaged by excessive stimulation by neurotransmitters like glutamate.
4. More antioxidants
Vitamin C: citrus, guava, broccoli and spinach
Vitamin E: olive oil, nuts, avocados, carrots, spinach and grains
Others: Green tea, grapes, and in general, more fruits and vegetables!
5. Reduce gluten
Gluten sources: wheat, rye, barley and malt
Gluten-free sources: rice, cassava, corn, potatoes, tapioca, beans, quinoa, millet, amaranth, flax, chia, yucca, gluten-free oats, and nut flours
The spectrum of gluten-related disorders has acquired a new syndrome, defined as non-celiac gluten sensitivity, and fibromyalgia is one of them. FM patients' understudies have shown improvement in their symptoms and manifestations resembling the clinical picture of non-celiac gluten sensitivity, such as skin rash, cognitive dysfunction, headache, anxiety, and depression. There is still more to be researched in this field, but it seems that reducing gluten in diets could help with some of those symptoms!
And now, how to put it in practice?
You can consider the following approaches:
Small changes: you only need to do some to see improvements; it is better to make one change at a time but keep it constant and persistent over time. There is always room for improvement, no matter how small the change is. Do what you can, depending on your situation, and keep in mind that you can always do something.
An elimination diet: if your circumstances are good for it, you can adopt an elimination diet to observe the effect of each food and changes in your symptoms. You would need to apply it for long enough to see the real impact, and it would require persistence and commitment from your side and some time to prepare your meals and menus.
Whatever the way you choose, be patient and consistent with it because it is usually in the long term when you see the benefits of them!
For more information about FM, you can check the following link here.
References
[1] Kathleen Holton, “The role of diet in the treatment of fibromyalgia”, Future Medicine, 2016
[2] Umberto Volta, “Gluten-free diet in the management of patients with irritable bowel syndrome, fibromyalgia and lymphocytic enteritis”, Arthritis Research & Therapy, 2014, DOI 10.1186/s13075-014-0505-1
[3] Rita Chiaramonte, “Multidisciplinary protocol for the management of fibromyalgia associated with imbalance”, Department of Physical Medicine and Rehabilitation, University of Catania, Italy, 2019