Can food cause physical pain? Should people with fibromyalgia follow a certain diet?

Of the five million people affected by Fibromyalgia (FM) in the United States, 80% are women.  FM is a long-term condition characterized by widespread musculoskeletal pain, fatigue, and mood disorders. Fibromyalgia syndrome is often accompanied by other issues, such as migraine headaches, increased pain sensitivity, allodynia, hyperalgesia, IBS and sleep impairments. Needless to say, people with this condition often face lower quality of life. With no medical cure presently available, most treatments focus on pain management and symptom reduction based on the trial and error of a multitude of modalities, including, but not limited to:

•      Nonsteroidal anti-inflammatory drugs (NSAIDS)
•      Acupuncture
•      Antidepressants
•      Chiropractic care
•      Massage therapy

Focusing the Lens on Food

Medical research has started exploring the impact of nutrition on chronic pain conditions like fibromyalgia, yielding several interesting and optimistic reports. An increasing number of scientific studies are showing that dietary choices can reduce both the intensity of pain and the likelihood of flare-ups. Some evidence has shown that “dietary habits in women with FM can fundamentally affect the clinical course of the disease” and that patients who consume a plant-based diet rich in antioxidants show clinical improvement in their symptoms. (1, 2, 3)

Fast Facts for Fibro Patients

•      Patients show lower levels of magnesium.
•      B12 supplementation can help lessen symptoms.
•      Tomatoes or citrus foods are reported to exacerbate pain.
•      A plant-based diet can reduce pain.  
•      Magnesium supplementation can alleviate neuropathic pain.
•      Vitamin D deficiency is associated with anxiety and depression.
•      Sleep impairment is common.
•      Magnesium deficiency can impair sleep and supplementation has improved it.
•      Selenium deficiency has been linked to skeletal muscle disorders.

5 Dietary Deficiencies in Fibromyalgia

1- Vitamin D

A strong association between FM symptoms and hypovitaminosis D has been made, with some studies reporting a deficiency in up to 40% of FM patients. (4, 5, 6) There have been cases where an extreme lack of vitamin D has caused muscle weakness, cramps, stiffness, or spasm—symptoms familiar to many patients with fibromyalgia. (7) One of the primary reasons vitamin D is so important is the role it plays in the absorption of magnesium (the relevance of which is noted below). Vitamin D deficiency has also been correlated with depression and anxiety, which are common mood disorders among people with fibromyalgia.

2- Magnesium

Magnesium is a nutrient that is critical to the metabolism of carbohydrates and glucose, muscle function and growth, the transmission of nerve impulses, and hundreds of other vital enzymatic roles within the body. This is especially relevant to FM patients, as subjects have shown impaired glucose metabolism (often leading to obesity). Magnesium deficiency has been said to accompany low-grade chronic systemic inflammation, leading to elevated pain levels. Learn more about the association between inflammation and pain here. (8)

3- Omega-3 Fatty Acids

Omega-3s are “good” fats, found in cold water fish like salmon, tuna, mackerel, and herring, and also in walnuts and avocados. These fats protect the body by inhibiting prostaglandins—molecules that trigger inflammation. A higher intake of omega-3 fatty acids is associated with lower levels of CRP, TNF-alpha, and IL-6. They also increase central serotonergic activity which helps to alleviate pain. Omega-3 supplementation has been shown effective for treating migraines, low back and joint pain, rheumatoid arthritis, and other autoimmune conditions. (9)

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4- Selenium

Selenium is an essential mineral found in a wide variety of foods, including Brazil nuts, fish, brown rice, and more. A study conducted in Germany showed significantly reduced levels of selenium in fibromyalgia subjects compared to the control group. Musculoskeletal disorders characterized by FB-like symptoms, including fatigue and muscle pain, have also been recognized in patients with SE deficiency. (10) A selenium deficiency has been cited as a possible cause for the muscle pain associated with FM. (11)

5- Vitamin B12

Low levels of B12 found in the brains of patients with fibromyalgia have been associated with musculoskeletal pain and patients have reported that their symptoms were “much improved” following B12 supplementation. (12, 13, 14)

Why One Size Won’t Fit All

This is hardly an exhaustive list of associations between food and the chronic pain experienced by patients with fibromyalgia. The complexity of the condition means that a “one-size-fits-all” approach is not likely to yield reliable results and that the best treatment approach would be an individualized and holistic one, whereby all areas of a person’s life are taken into consideration, including their dietary habits.

What correlations have you found between food and pain, either personally, or among your clients?

Click here to learn how to use nutrition to treat chronic pain!

REFERENCES:

1. Ruiz-Cabello P, Soriano-Maldonado A, Delgado-Fernandez M, et al. Association of dietary habits with psychosocial outcomes in women with fibromyalgia: The al-Ándalus Project. J Acad Nutr Diet 2017;117:422-32.
2. Strain GW. Dietary habits and psychosocial outcomes in women with fibromyalgia. J Acad Nutr Diet 2017;117:1175-76.
3. Ross A, Di Lollo AC, Guzzo MP, et al. Fibromyalgia and nutrition: what news? Clin Exp Rheumatol 2015;33(1 Suppl 88):S117-S125.
4. Mateos F, Valero C, Olmos J, et al. Bone mass and vitamin D levels in women with a diagnosis of fibromyalgia. Osteoporosis Int 2014;25:525-33.
5. Al-Allaf A, Mole P, Paterson, et al. Bone health in patients with fibromyalgia. Rheumatology 2003;42:1202-6.
6. Huisman AM, White KP, Algra A, et al. Vitamin D levels in women with systemic lupus erythematosus and fibromyalgia. J Rheumatol 2001;28:2535-9.
7. Finbraten AK, Syverson U, Skranes J, et al. Bone mineral density and vitamin D status in ambulatory and non-ambulatory children with cerebral palsy. Osteoporos Int 2015;26:141-50.
8. Simental-Mendia LE, Sahebkar A, Rodriguez-Moran M, et al. Effect of magnesium supplementation on plasma C-reactive protein concentrations: a systematic review and meta-analysis of randomized controlled trials. Curr Pharm Des 2017;23:4678-4686.
9. National Center for Complementary Integrative Therapy. Omega-3 supplements: in depth. Available from: https://nccih.nih.gov/health/omega3/introduction.htm#hed5. Accessed Sept 19, 2018.
10. Reinhard P, Schweinsberg F, Wernet D, et al. Selenium status in fibromyalgia. Toxicol 1998;96:177-80.
11. Bjorklund G, Dadar M, Chirumbolo S, et al. Fibromyalgia and nutrition: therapeutic possibilities? Biomedicine & Pharmacotherapy 2018;103:531-8.
12. Regland B, Forsmark S, Halaouate L, et al. Response to vitamin B12 and folic acid in myalgic encephalomyelitis and fibromyalgia. PloS One 2015;10:e0124648.
13. Chen H, Liu S, Ji L, et al. Associations between alzheimer’s disease and blood homocysteine, vitamin B12, and folate: a case-control study. Curr Alzheimer Res 2015;12:88-94.
14. Ma F, Wu T, Zhao J, et al. Plasma homocysteine and serum folate and vitamin B12 levels in mild cognitive impairment and alzheimer’s disease: a case-control study. Nutrients 2017;9:725.