Fibromyalgia is characterized by chronic, widespread pain, with no specific cause. It is a complex condition that affects each patient differently. However, an individualized plan of simple dietary changes may help you improve your symptoms. So, what to eat and what to avoid?
Those with fibromyalgia often experience symptoms such as sleep problems, decreased attention, fatigue, depression, headache, painful menstrual periods, anemia, arthritis, or overactive bladder. Gastrointestinal problems (including abdominal pain and diarrhea) are often reported and are typical symptoms of irritable bowel syndrome, which is found in 25-81% fibromyalgia patients (1). In addition, fibromyalgia increases pain sensitivity due to changes in the way the brain processes painful stimuli.
An individualized plan of simple dietary changes may help you improve your symptoms. Click To Tweet
Data from the CDC and research studies show that fibromyalgia approximately affects 4 million people in the U.S. (2) (3). Its prevalence has been increasing over time and varies with diagnostic criteria and country (4). Women are remarkably more affected than men and residents of urban areas seem to be more susceptible than those of rural zones. (5)
Fibromyalgia significantly increases hospitalizations and decreases the quality of life, in both physical and mental health (6) (7). Hypothesized causes include certain genetic mutations, infectious diseases, obesity, and physical (a car accident) and emotional trauma (psychological stress) (8) (9) (10). A few studies even show that vaccinations may also lead to fibromyalgia (11).
How can you manage fibromyalgia?
Fibromyalgia is the second cause of a visit to rheumatologists after osteoarthritis. Therapeutic strategies typically adopted by doctors include prescription and over-the-counter pain relievers. However, pharmacological treatments are often insufficient to control pain in fibromyalgia.
Therefore, non-pharmacological approaches are also important, including exercise, education classes, and improved sleep habits. Techniques including meditation, yoga, massage therapy, and behavioral therapy to treat depression may also help you (12). Importantly, there is the concern to avoid prescribing opiates and too much medication in general, so that patients do not develop significant morbidities (13).
There are a few other approaches that can help you improve your quality of life. Regular, low-intensity, physical exercise including swimming, walking or biking is helpful (14). Experts suggest around 30 minutes per day, which can be broken in shorter 10-min periods.
If you do not feel safe with exercising by yourself, you can visit a physical therapist, enroll in physical activity programs, or join a self-management education class, which can help in understanding the disease and controlling its symptoms (15).
Perhaps the most important natural strategy for treating fibromyalgia is nutrition.
The link between nutrition and health is well-known, with several studies addressing the benefits of specific diet plans (16) (17).
Good nutritional choices can help you manage your symptoms and reduce pain, while also improving other health-related problems. However, bad choices can aggravate your fibromyalgia. So, which nutrients are good and which are bad? Keep reading to know more about nutrition in fibromyalgia.
The Role of Nutrition in Fibromyalgia
As mentioned above, obesity is considered one of the causes of fibromyalgia. When comparing to fibromyalgia patients with normal weight, those who are obese score higher in depression and disability scores. In addition, they also exercise less, take more medications and show more comorbidities (18). The link between excessive weight and fibromyalgia may also be put the other way round, i.e., obesity as a consequence of fibromyalgia (19).
A study with 60 subjects showed that the group with fibromyalgia had higher values of body mass index and weight fluctuation (20).
Regardless of what is the cause and what is the consequence, the link between weight (and a healthy diet) and fibromyalgia severity is beyond doubt (21). Inflammation is a critical factor in this association (22).
Any diet plan which is part of a treatment for fibromyalgia should be followed in the long-term and be individually tailored (21) (23).
Now, let’s take a look at which nutrients you should include in your diet:
Nutrients that Help
- Whole foods: In contrast with “processed foods” (see the What to Avoid section), whole foods are your allies to fight pain. Fruits, plants, and vegetables, as well as unprocessed meats, whole grains, and nuts and seeds, are all whole foods, grown in a natural life cycle, not manufactured or altered. Also, dairy from goats or sheep is a good choice, as they are better tolerated and raised with fewer antibiotics and hormones (24). Whole foods offer a range of benefits for fibromyalgia patients, including:
- Omega-3 fatty acids that reduce inflammation and pain associated with fibromyalgia and other chronic pain conditions, with equivalent efficacy as ibuprofen (25). These healthy fats also improve depression, quality of life, and cognitive function (26) (27). Good sources of omega-3 fats include salmon and tuna.
- Antioxidants, such as vitamins A, B12, C, D, E, and folic acid (a type of B vitamin). Fruits, vegetables, and herbs are good sources of these potent anti-inflammatory agents.
- Magnesium: this essential mineral helps fight inflammation and boosts your body’s natural defenses. Fibromyalgia patients showed abnormal levels of magnesium in the blood (28). Another study from 2013 showed that magnesium (in the form of magnesium citrate) improved pain intensity, threshold, anxiety and overall symptoms in female fibromyalgia patients (29). Foods that are rich in magnesium include green leafy vegetables, pumpkin seeds, yogurt, almonds, and avocados.
- Melatonin-Rich Foods: magnesium, B vitamins, zinc and polyunsaturated fatty acids were suggested to drive melatonin synthesis in animal studies. Conversely, their deficiency was linked with lower melatonin levels (30). Melatonin is a key hormone in sleep (31). As sleep problems are one of the most common complications of fibromyalgia, strategies to increase your melatonin levels are highly recommended. Among the natural sources of melatonin are walnuts, asparagus, bananas, fresh mint, tomatoes, ginger, mustard seed, rice, and red wine (which is also a source of antioxidants).
- Ginger: this flowering plant, which is popularly used as a spice, has proven anti-inflammatory properties that relieve pain. In a 2001 study enrolling 247 patients with osteoarthritis, six-week consumption of ginger reduced pain symptoms with a good safety profile (32). Benefits were also found in patients with chronic low back pain (33).
- Foods rich in tryptophan: Tryptophan is an essential amino acid and a precursor of the neurotransmitter serotonin and of melatonin, therefore a sleep promoter. Foods rich in tryptophan include organic dairy products, potatoes, bananas, sesame seeds, cashews, walnuts, and wild-caught fish (such as cod and salmon). A 90-day study in 50 fibromyalgia patients showed that 5-hydroxy-L-tryptophan (produced from tryptophan) induced clinical improvements in nearly 50% of patients (34). Clinical variables were the number of tender points, anxiety, pain intensity, quality of sleep, and fatigue. A study from 1990 also showed that 5-hydroxytryptophan improved all clinical parameters (pain intensity, sleep quality, the degree of morning stiffness, fatigue and anxiety) in a group of 50 fibromyalgia patients, with only mild and transient side effects (35).
- Organic foods: Organic food is a healthier, more nutritious option than food grown conventionally. How do you know of a product is really organic? Look for the label “USDA Certified Organic” (36). It means that the plants have not been exposed to synthetic pesticides and fertilizers, sewage sludge or irradiation, seeds are not genetically engineered (GMO), there are no artificial flavors, colors or preservatives, and in the case of animal products, there were no antibiotics and hormones involved, neither animal by-products in the animal feed. For a look at an updated list of healthy sources of fruits and vegetables, you can trust, check the website of the Environmental Working Group (EWG). An extensive 2014 study found that organic crops have higher concentrations of antioxidants and lower incidence of pesticide residues (37). So besides boosting your self-defense, organic foods won’t be a source of toxins that damage your health.
Now that you have information on what to include, which nutrients should you avoid?
Nutrients to Avoid
- Processed foods: When we mention “processed foods” we mean an altered product from its natural state. As opposed to real, whole foods (see above), processed foods are way too common in American households. Unfortunately, the alterations in natural products normally mean that the benefits we take from eating are not as much. Specifically, some processed foods lack crucial nutrients like vitamins, minerals, and fibers. Processed foods are not merely microwaved or other ready meals. They include any food that was altered in its preparation, including freezing, canning, drying or baking. Besides high levels of salt, sugar and fat, processed foods may contain artificial colors, flavors, and sweeteners, preservatives, hormones and antibiotics, which can all be harmful and result in increased weight, inflammation, and oxidative stress. So, if you want to add flavor and color to your meals, why not choosing natural herbs and spices? They not only save you from increased pain but contain plenty of antioxidants and nutrients that are healthy!
- Gluten: Gluten-related disorders have an estimated global prevalence of 5% (38). Although cereal consumption has been a vital part of human diet, the increasing knowledge of what causes disease has led to reports on the link between gluten and celiac disease, wheat allergy, and non-celiac gluten sensitivity (39). In fibromyalgia, elimination of gluten can improve disease severity. A pilot study with 97 female patients with fibromyalgia and irritable bowel syndrome found that a one-year gluten-free diet improved physical and mental symptoms in a subgroup of patients. Amelioration in scores of quality of life was also observed (40). Similar results were found in an earlier study from the same team in 7 female patients with celiac disease and associated severe fibromyalgia or irritable bowel syndrome (41). The prevalence of fibromyalgia among patients with celiac disease further suggests improved symptoms with a gluten-free diet (42). A different study was carried in 20 fibromyalgia patients without celiac disease and taking a gluten-free diet for over one year. Although the timing of the symptoms’ improvement was variable (from only a few too many months), patients exhibited a vast array of benefits, including remission of pain, return to work and normal life, and discontinuation of opioids (43). Therefore, although more studies are warranted and contradictory findings were reported, the present knowledge suggests that eliminating gluten is helpful to decrease your symptoms (44).
- Too much caffeine: Caffeine is found not only in coffee, tea and soft drinks (including non-cola sodas), but also in energy drinks, and over-the-counter medications. Chocolate bars, diet pills, and some processed foods can also have caffeine. Studies show that the top countries in caffeine consumption are European (and Scandinavian in particular), with the U.S. falling just outside the top 20 (data from Euromonitor International). A very recent study in the Journal of Pain Research showed that caffeine consumption improved pain, pain catastrophizing (magnifying the threat and feeling helpless with pain), depression, and physical parameters in fibromyalgia patients taking opioids, but not in non-opioid users. This finding indicates that caffeine may have an analgesic effect when combined with opioids (45). This is illustrated in a study with children and adolescents with very frequent headaches. Moderate daily doses of caffeine did not result in negative effects on health, nor did they increase pain severity. However, higher doses were associated with caffeine-induced headaches (46). A study published in the journal Physiology & Behavior found that consumption of a caffeinated chewing gum did not reduce the increase in muscle pain in comparison with placebo. However, the authors reported a potential association between greater severity of fibromyalgia and greater benefit with caffeinated chewing gum in reducing exercise-induced pain (47). The current consensus is that consumption of 200 mg daily (around 2 cups of coffee) is not harmful (48). However, high doses of caffeine may lead to depression, anxiety, disturbed sleep, insomnia, and muscle tremors, which are all observed in fibromyalgia (49). So, enjoy your cup of joe, but be wary of the dose!
- Carbohydrates: Although the evidence that sugars are linked to fibromyalgia is not as overwhelming as that of other nutrients, a diet with a low glycemic index is effective in reducing body weight, a common problem in fibromyalgia patients (50). Furthermore, diets with a low amount of carbohydrates effectively reduced the blood levels of inflammation markers in overweight men and women (51). As discussed above, inflammation is a well-known hallmark of fibromyalgia.
- Excitotoxins: Excitotoxins include a number of compounds, such as monosodium glutamate (MSG) – used in the food industry as a flavor enhancer and common in Asian cuisine, packaged foods, and fast foods – and the artificial sweetener aspartame. These compounds can cause toxicity in the brain, thereby killing neurons and causing inflammation and pain. A 2012 study published in the journal Clinical and Experimental Rheumatology showed that a 4-week elimination of MSG and aspartame from the diet led to a decrease in disease symptoms of over 30% in 37 patients with fibromyalgia and irritable bowel syndrome. Re-introduction of MSG worsened fibromyalgia severity and quality of life (52). The same outcome – remission with elimination followed by worsening with re-introduction – was observed in 4 female fibromyalgia patients (53). Of note, not all studies point to a connection between a diet with MSG and aspartame and clinical symptoms of fibromyalgia (54). You should be particularly rigorous with avoiding artificial sweeteners. These products can impact not only fibromyalgia but also chronic pain and headache (55) (56). Artificial sweeteners may sabotage our weight-loss effort, by “telling” the brain to eat more and making us crave for more unhealthy foods and drinks. Besides aspartame, other common names are sucralose, high fructose corn syrup, and saccharin. Trade names include Equal, Nutrasweet, Splenda, and Sweet N’ Low.
- Excessive alcohol: Alcohol dependence is linked with comorbid conditions, such as anxiety, depression and chronic pain. Research shows that some brain areas involved in alcohol dependence are also important in pain control. Upon episodes of alcohol consumption or periods of alcohol intoxication and withdrawal, these areas may become permanently altered and lead to chronic pain (57). Interestingly, a 2013 study published in the journal Arthritis Research & Therapy, showed that low or moderate alcohol consumption reduced the severity of fibromyalgia symptoms in comparison with no alcohol consumption (58). Another study supports this finding, by showing that low-to-moderate alcohol consumption reduced pain intensity, improved sleep quality, and increased the volume of the hippocampus, a crucial region in pain control, memory and learning (59). The authors of both these studies suggest that this effect may be due to alcohol’s agonism (binding that leads to downstream effects) of the receptor of the neurotransmitter gamma-aminobutyric acid (GABA), which has low levels in chronic pain (60).
Nutrition can have a deep impact in fibromyalgia. While you should bear in mind that your case is unique and, unfortunately, what may help one patient may not necessarily have the same benefit in a different person, there is a number of important considerations when it comes to nutrition that may help you deal better with your condition. You should monitor your weight regularly and avoid any food that increases your chance of becoming overweight or obese.
Opt for whole, organic foods, rather than processed foods! Avoid food additives or artificial sweeteners; there are plenty of natural sources to add flavor to your meals that will also benefit your health! And, of course, it is ok to have coffee and alcohol in moderation or a but don’t forget that a lot of anything is normally too much!
Remember, reversing pain requires an integrated approach.
If you need help to better understand what to eat, how to move, or how your thoughts and emotions affect your pain, I hope you’ll consider attending my Free Webinar on Healing Pain Naturally. You’ll learn how to use the power of your mind to heal; as well how nutrition and gentle movement can reverse your pain. Does this sound like something you need?
This webinar will provide you with the info to change your life, almost immediately.
Sign-up for the free webinar here (I’ll email you a recording, too!).