Fibromyalgia is a complex syndrome characterized by debilitating symptoms of chronic pain, fatigue, and cognitive difficulties. It affects 7.7% of women and 4.9% of men in the United States. Furthermore, fibromyalgia is the most common cause of generalized musculoskeletal pain in women aged 20-55. (4)
Currently, there is no specific diagnostic test or cure for fibromyalgia, making diagnosing and treating this condition difficult. However, emerging research has shed light on the influence of inflammation, gut health, and specific nutrients on fibromyalgia etiology and the potential impact of diet on symptom management.
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Understanding Fibromyalgia
Fibromyalgia is a complex and chronic rheumatologic condition characterized by abnormal pain perception processing that leads to widespread musculoskeletal pain. Additionally, people with fibromyalgia commonly experience other symptoms, including fatigue, sleep disturbances, depression, anxiety, cognitive difficulties, headaches, and irritable bowel syndrome (IBS). The exact cause of fibromyalgia is still unknown, but it appears to be triggered or aggravated by a combination of genetic, environmental, and emotional factors.
Adults with fibromyalgia commonly experience increased rates of hospitalizations, major depression, death rates from suicide and injury, and coexisting arthritis. These complications contribute to a lower quality of life. Additionally, fibromyalgia is associated with a significant financial burden due to medical costs and reduced work productivity. A systematic literature review found that the total annual direct costs for fibromyalgia ranged from $1,750 to $35,920 annually per patient.
The Link Between Diet and Fibromyalgia
For years, fibromyalgia has been considered psychogenic in nature due to a lack of known organic pathophysiology. However, it is well-recognized that neuroinflammation is a hallmark feature of many neuropsychiatric disorders, and growing evidence suggests that the same may be true for fibromyalgia. Neuroinflammation, or inflammation within neural tissue, results from immunological alterations within the central nervous system. Literature has pointed to increased systemic levels of pro-inflammatory cytokines like IL-6 and IL-8 and microglial activation, which could be responsible for inducing the central and peripheral clinical features of fibromyalgia. (3, 25)
Additionally, several studies have shown an association between fibromyalgia and intestinal inflammation caused by an altered intestinal microbiota (33). This, along with the fact that IBS frequently coexists with fibromyalgia, supports the growing speculation that dysregulation in the gut-brain axis may play a role in the development and severity of fibromyalgia. The gut houses a large portion of the body's immune system and is home to trillions of bacteria (the microbiome). The gut microbiome plays a crucial role in shaping and modulating the immune system. It helps educate the immune system, ensuring it can distinguish between harmful pathogens and beneficial microbes, ultimately maintaining a balanced and effective immune response. Dysregulation of the gut microbiome, called dysbiosis, can lead to immune dysfunction and an increased risk of autoimmune diseases, allergies, and inflammatory conditions. Researchers have discovered distinct compositional variations in the intestinal microbiota of patients with fibromyalgia compared to healthy controls. The identified increased and decreased abundance of specific bacterial species can influence brain function and, ultimately, the perception of pain and mood.
In light of these connections, the concept of an anti-inflammatory diet has gained attention as a potential component of fibromyalgia management. A 2023 literature review concluded that adhering to plant-based and anti-inflammatory diets significantly reduces pain scores in patients with fibromyalgia. Why might this be? An inflammatory diet, characterized by high intakes of refined sugars, processed foods, and unhealthy fats, is one of the many factors known to cause dysbiosis. Conversely, an anti-inflammatory diet focuses on reducing foods that promote inflammation while emphasizing whole foods rich in fiber, antioxidants, and omega-3 fatty acids. This diet includes plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats. Such a dietary approach aims to support gut health by fostering a balanced and diverse gut microbiota, thereby mitigating inflammation.
Functional Medicine Labs That Help Assess Nutritional Status
Functional medicine labs play a vital role in assessing nutritional status and identifying underlying imbalances or deficiencies in the body. Functional medicine practitioners often use these specialized tests to gain a comprehensive understanding of a patient's health. Here are some common functional medicine labs that can help assess nutritional status:
Comprehensive Nutritional Panels
Nutritional panels use serum and urine samples to measure various vitamins, minerals, amino acids, fatty acids, and antioxidants in the body. They can provide detailed insights into deficiencies or imbalances, allowing healthcare providers to tailor nutritional interventions.
Certain blood tests, such as SpectraCell's micronutrient test, assess the intracellular micronutrient levels of white blood cells, providing a more accurate reflection of nutrient absorption and utilization at the cellular level.
Imbalances in omega-3 and omega-6 fatty acids contribute to inflammation. Testing the ratio of omega-3 to omega-6 fatty acids can guide dietary and supplemental recommendations.
Comprehensive Gut Assessment
Gut health profoundly influences nutrient absorption, systemic inflammation, and overall well-being. A comprehensive stool analysis can reveal the state of the gut microbiome, including the presence of beneficial and harmful bacteria, parasites, and other pathogens. Other stool markers can also provide important information about gut health and function. For example, measuring fecal fat and pancreatic elastase helps identify the presence of digestive enzyme insufficiency and malabsorption, which can contribute to nutrient insufficiencies and gastrointestinal symptoms.
Organic Acid Testing (OAT)
OAT measures organic compounds in urine, providing insights into metabolic pathways, nutrient deficiencies, neurotransmitter levels, and oxidative stress. Abnormal patterns observed on the test can indicate the presence of dysbiosis, neurotransmitter imbalances, neuroinflammation, and nutritional deficiencies related to fibromyalgia.
Fibromyalgia Diet Plan
While there is no one established "right" therapeutic dietary plan for treating fibromyalgia, understanding that diet profoundly influences the gut microbiome and systemic inflammation, it is logical that nutritional interventions have been shown to help treat fibromyalgia symptoms. Based on current scientific findings, fibromyalgia patients should focus on eating a balanced, anti-inflammatory diet. A 2018 scientific review shed light on the importance of nutritional deficiencies – specifically, amino acids, antioxidants, B vitamins, and magnesium – in developing fibromyalgia symptoms. A balanced diet is one that consists of a wide variety of fresh fruits and vegetables, whole grains, lean protein, and dairy. Eating a varied, whole-foods diet prevents these deficiencies from occurring.
Furthermore, these dietary principles are shared with those that promote a healthy gut microbiome. The microbiome diet is a three-phased nutritional plan that aims to improve the microbiome and overall health. It incorporates eliminating trigger foods that contribute to dysbiosis and adding prebiotic and probiotic foods to heal the intestinal lining and reinoculate the gut with healthy microbes.
Other studies have reviewed how vegan and vegetarian diets can positively impact the course of fibromyalgia. A small 2000 study concluded that eating a raw vegan diet may relieve joint stiffness and poor sleep. Another small study in 2001 reproduced similar results; participants eating a raw vegetarian diet, including foods like salads, carrot juice, nuts, and fruits, experienced less pain and improved joint range of motion and flexibility.
A more recent 2019 literature review gives us a better idea of certain food triggers that may be worth eliminating in patients with fibromyalgia. FODMAPs (fermentable oligosaccharide, disaccharide, monosaccharide, and polyols) are carbohydrates easily fermented by gut bacteria in the digestive tract, commonly promoting digestive symptoms in some people. A low-FODMAP diet, originally developed as an effective treatment plan for IBS, has since been shown to promote healthy weight loss and improve symptoms in patients with fibromyalgia. A small study suggests that non-celiac gluten sensitivity may be an underlying cause of fibromyalgia; celiac disease-negative patients who followed a gluten-free diet reported significant improvements in pain and quality of life indicators. Eliminating food additives may also benefit patients with fibromyalgia; 57 patients with fibromyalgia and IBS eliminated monosodium glutamate (MSG) for one month. Participants not only experienced pain reduction during the one-month elimination, but symptoms returned when MSG was added back into their diets.
Supplements for Fibromyalgia
While there is limited high-quality evidence supporting the use of natural supplements in treating fibromyalgia, we can use the fact that inflammation and gut dysbiosis contribute to symptomology to recommend complementary therapies in integrative treatment plans.
Supplements with anti-inflammatory properties, such as omega-3 fatty acids, curcumin, and certain antioxidants, might help manage symptoms by targeting inflammation.
It has been suggested that vitamin D deficiency exacerbates fibromyalgia symptoms. In one study, 180 female patients with fibromyalgia and low vitamin D levels were administered oral vitamin D replacement for 12 weeks. Researchers concluded that vitamin D supplementation led to a reduction in pain in this population.
Low dietary intake of calcium and magnesium has been associated with increased pain reports in patients with fibromyalgia. Supplemental magnesium, especially when dosed with amitriptyline, has significantly reduced the number of tender points, pain severity, and depression scores in patients with fibromyalgia.
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Summary
Fibromyalgia is a multifaceted condition that challenges both patients and healthcare providers alike. While there is no one-size-fits-all solution, the growing body of evidence supporting dietary interventions offers hope and promise. Individuals with fibromyalgia can take an active role in managing their symptoms by addressing inflammation, optimizing gut health, and prioritizing nutrient-rich, anti-inflammatory foods. An integrative treatment plan that combines dietary modifications with other approaches can provide a comprehensive strategy for palliating fibromyalgia symptoms and improving overall quality of life.
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