Dietary Recommendations for Better Management
By Adrienne Dellwo
Table of Contents
- Benefits
- How It Works
- Considerations
- Fibromyalgia Diet vs. Other Diets
Fibromyalgia can be difficult to manage, but there is evidence that certain dietary changes can benefit people living with this chronic pain disorder. What exactly might help can differ from person to person, but some have reported improvement with increased intake of antioxidants and omega-3 fatty acids and decreased consumption of food allergens and gluten.
Although research supporting the use of diet in fibromyalgia is of low quality overall, a 2019 review published in the Annals of Medicine reported that diet rendered positive results in five of the seven studies reviewed. This included improved sleep, a reduction in depression and anxiety, and a better overall quality of life.
On the other hand, the impact of diet on fibromyalgia symptoms (such as pain, fatigue, constipation, and “mental fog”) remains unclear. Some diets appear able to alleviate pain to varying degrees, while others help reduce inflammation that complicates (rather than drives) the disease.
In the end, there is not one “fibromyalgia diet.” Instead, dietitians will typically combine key elements of different diets to tailor an effective approach for you as an individual. The process often begins with an elimination diet, which provides you a clean slate to identify which foods trigger specific fibromyalgia symptoms.
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Benefits
Diet is believed to improve fibromyalgia symptoms by removing some of the triggers that directly incite pain and ensuring adequate nutrition. Other benefits are indirect, including the alleviation of psychiatric symptoms that have physical and psychological components.
Elimination of Triggers
The exact cause of fibromyalgia is unknown, but it is likely due to more than one factor. Among them, dietary factors such as obesity or high-fat diets are known to ratchet up symptoms.
Some scientists believe that excess weight and certain fats place oxidative stress on nerve cells either directly or indirectly, causing them to fire spontaneously. By eating foods rich in antioxidants, such as vitamin C, vitamin E, beta-carotene, and resveratrol, the misfiring of motor neurons may be relieved.
There is some evidence to support the theory. A 2016 study published in the International Journal for Vitamin and Nutrition Research suggested that people with fibromyalgia who ate antioxidant-rich diets (specifically foods high in polyphenols like coffee, red fruits, pears, and dark chocolate) had fewer tender points and a better quality of life.
Another study published in Biological Research for Nursing in 2017 looked at the effects of extra virgin olive oil (EVOO) in people with fibromyalgia. According to the investigators, EVOO performed better than other types of olive oil in alleviating oxidative stress. It also improved physical and mental function scores on a self-evaluation questionnaire.
By contrast, certain foods appear to have a “pro-algesic” effect, meaning that they induce pain by sensitizing pain receptors known as nociceptors.
A 2016 study in Expert Review of Neurotherapeutics found that four pro-algesic substances were more likely to trigger fibromyalgia symptoms:
- Caffeine
- Aspartame
- Monosodium glutamate (MSG)
- Arachidonic acid (found in meat, egg yolks, and shrimp)
However, not everyone experienced improvement when these substances were removed from their diets.
Addressing Nutritional Deficiencies
In some cases, fibromyalgia may be caused by the lack of nutrients rather than the intake of certain substances. In fact, studies have long suggested that people with fibromyalgia are more likely to have vitamin and mineral deficiencies, especially vitamin D and B12.1
How these deficiencies contribute to fibromyalgia is unknown, but it has been postulated that an increased intake of these and other nutrients may reduce the incidence and/or severity of fibromyalgia symptoms.
Fibromyalgia Flares: Triggers, Symptoms, and Coping
Improving Psychiatric Symptoms
Depression, anxiety, and other mood disorders are common in people with fibromyalgia. It is unclear if these are directly spurred by the disease or simply occur as a reaction to it. Studies investigating the association suggest that foods do, in fact, play a key role.
A 2017 study published in the Journal of the Academy of Nutrition and Dietetics found that certain foods were able to influence mood in 486 women with fibromyalgia. According to the yearlong investigation, the regular consumption of fruits, vegetables, and fish were tied to better mental health status, with two to five weekly servings of fish yielding the best overall results.
Conversely, an early study published inClinical Rheumatology concluded that processed meats and sweetened beverages were linked to high rates of depression in people with fibromyalgia. Vitamin D deficiency, common in people who consume high quantities of processed food and sugar, is believed to contribute significantly.
Despite the findings, the increased intake of fruits, vegetables, fish, and vitamin D—as well as the reduction of saturated fats and simple carbohydrates—are believed to positively influence moods in people with or without fibromyalgia.2
Whether these dietary changes offer special benefits to people with fibromyalgia has yet to be established.
Cooking When You Have Fibromyalgia
How It Works
Over time, many living with the disease start to realize that the consumption of certain foods coincides with a flare of fibromyalgia symptoms. Some make changes to their diet even before a healthcare provider suggests it.
While tinkering with your diet is usually not harmful, embarking on an elimination diet should be done under the supervision of a registered dietitian or healthcare provider. Elimination diets target specific foods suspected of triggering fibromyalgia flare-ups. The process of elimination may involve one food at a time or many all at once.
During the elimination phase, the suspected trigger foods are completely removed from your diet. This phase can last anywhere from 21 days to six weeks.
During the reintroduction phase, each food on the restricted list is added back to the diet, one at a time. A food journal can help you keep track of which foods triggered fibromyalgia symptoms.
This exercise can also help you uncover other issues that may mimic fibromyalgia, but are simply co-occurring. For example, if you notice that gastrointestinal symptoms like constipation only occur with consumption of dairy, lactose intolerance may be the cause rather than fibromyalgia. Managing that independent cause of at least one or some of your symptoms may bring you added relief.
In addition to dietary triggers, your healthcare provider will assess whether you are meeting your recommended dietary intake (RDI) of essential nutrients and adjust your diet accordingly.
Duration
Everyone with fibromyalgia will respond differently to changes in their diet. Some people may notice a difference right away; for others, improvements may occur slowly or not at all.
Once you figure out which foods make your symptoms better or worse, you can construct a diet plan to help keep your symptoms in check. You should do this with input from your healthcare provider or dietitian to ensure that the diet is healthy and balanced.
The duration of the diet should also be considered. In some cases, you may only need the diet when symptoms develop or you are at an increased risk of flares (such as when you are ill or under stress). For other people, the changes may be permanent and require strict adherence to the dietary plan.
What to Eat
The food you can eat will vary based on the results of the elimination diet, though there are some that tend to be favored and ones that are suspected to trigger fibromyalgia symptoms.
If you plan to add anything new to your diet, start with the smallest possible amount to see how you respond. In addition, always read product labels to check for hidden ingredients that may cause you symptoms.
Compliant Foods
- Fresh fruits and vegetables (organic)
- Fatty fish (salmon, tuna)
- Lean poultry (skinless)
- Nuts (walnuts, almonds, pecans)
- Flax, chia, sunflower seeds
- Extra virgin olive oil
- Beans, legumes, lentils
- Whole grains (bread, cereal, crackers, pasta)
- Nut butter (almond, cashew)
- Eggs or egg alternatives (as tolerated)
- Low-sugar, low-fat Greek yogurt, or dairy-free yogurt
- Dairy-free milk alternatives (rice, almond, oat)
- Brown rice and quinoa
- Veggie burgers/meat substitutes
- Fresh herbs and spices
- Dark chocolate (in moderation)
Non-Compliant Foods
- Refined white flour (bread, pasta, crackers)
- Sugary boxed cereals and granola
- Red meat
- Fried food and fast food
- Dairy products (milk, cheese)
- Processed meat (sausage, bacon, hot dogs, lunch meat)
- Cookies, cakes, pies, and baked goods
- Ice cream, pudding, and custard
- Frozen meals and snacks
- Packaged snack foods
- Instant noodles and pasta mixes
- Oatmeal packets with added sugar
- Dried fruit
- Vegetable oils
- Potato chips, pretzels, and microwave popcorn
- Butter, margarine, shortening, and lard
- Commercial salad dressing, marinades, and seasonings
- Doughnuts, muffins, bagels, and croissants
- Sodas and energy drinks
- Fruit juice with sugar
- Candy
- Caffeinated beverages (coffee, tea)
- Artificial sweeteners (e.g., aspartame)
- Food additives (including MSG)
Fruits and vegetables: Some people with fibromyalgia prefer organic produce to avoid exposure to chemicals, including pesticides and fertilizers. Even non-organic fruits and vegetables are a nutritious, fiber-rich addition to any diet. If you have certain gastrointestinal symptoms, like constipation, increased fiber intake can usually help.
Dairy: Some people with fibromyalgia need to restrict or eliminate cow’s milk and other dairy products. There are plenty of non-dairy options to choose from, including rice, soy, almond, and oat milk. You can even find yogurt and creamy desserts made with non-dairy alternatives or non-dairy “cheeses” made from cashews or tofu.
Grains: As a general rule, choose whole-grain bread, cereal, crackers, and pasta over those made with refined white flour. Instead of wheat pasta, try gluten-free pasta made with corn or veggie “noodles” made with a spiralizer. Avoid cakes, cookies, muffins, and other baked goods that are high in carbs and sugar. Baked goods made with whole grains, dairy substitutes, and nutritious seeds (like chia seeds or flax seeds) are far healthier options.
Protein: If you choose to include animal-based proteins in your diet, opt for skinless poultry or fatty fish (such as salmon or tuna). In addition to limiting red meat, avoid processed meats like hot dogs, sausage, salami, and lunchmeat. Not only are these foods high in salt and trans fat, but they are also among the most commonly cited fibromyalgia triggers. Nuts, nut butters, tofu, beans, legumes, egg whites, and vegetarian meat alternatives are excellent, non-meat sources of protein.
Desserts: Sugary foods are a common trigger for fibromyalgia flares. Even if they don’t directly cause symptoms, enjoy the treats in moderation or opt for fresh fruits instead. Even low-fat, sugar-free desserts can cause problems if they contain refined flour, butter, and sugar substitutes like aspartame.
Beverages: Caffeinated beverages like coffee, tea, and soda can be problematic for people with fibromyalgia. Herbal teas may be a better, safer option. Seltzer water, coconut water, and unsweetened fruit juices are great alternatives to soft drinks. If you consume alcohol, try reducing your intake, particularly sweet cocktails and high-carbohydrate beers.
Try Mini-Meals
Consider altering your meal times and sizes to see if your symptoms improve. Overeating places stress on the body that may trigger a flare. Instead of eating three large meals a day, try consuming four to six smaller meals spread throughout the day.
Cooking Tips
Fresh food is a staple of any healthy diet. Opt for salads and fresh fruit desserts whenever possible, and avoid deep-fat frying anything. Instead of cream sauces and mayonnaise, try seasoning your food with fresh herbs, spices, salsas, and low-fat vinaigrette. Grill meats with a minimum amount of oil (using a spray bottle to lightly coat food), and try poaching or steaming poultry or fish rather than pan-frying.
Similarly, instead of frying eggs, try microwaving, poaching, or even baking them. Egg whites and egg alternatives can be used on their own as a base for a healthy omelet.
Many fresh herbs and spices are full of antioxidants, while turmeric, garlic, cumin, and ginger are known to have anti-inflammatory properties. With that said, if you have gastrointestinal symptoms, adding spice to your meals may be irritating. Use them sparingly.
Modifications
As dietary needs change, so, too, can your sensitivity to certain foods. If you are trying to get pregnant or lose weight, additional dietary interventions may be needed. The same applies when you are pregnant or breastfeeding. Not only are your nutritional needs greater, but your body will invariably be under greater stress, increasing your risk of flares.
In the same way that illness can trigger symptoms, the failure to control high blood pressure and diabetes can directly influence your risk of fibromyalgia flares. Until you are better able to get these conditions under control, you may need to be extra careful about what you eat.
If faced with any significant change in your health or health practices (including a new exercise or weight-loss program), let your healthcare provider know. Even positive changes can exert stresses that trigger fibromyalgia symptoms.
If needed, adjustments to your treatment plan can be made.
Considerations
The choices you make about your diet are impacted by—and can have an effect on—all different aspects of your life. Food is an integral part of your family, work, and social life and directly influences your physical and emotional well-being.
Change can be hard but, rather than focusing on what you can’t eat, think about how the changes will benefit all of the different facets of your life.
General Nutrition
A diet that focuses on whole foods and avoids processed food will generally be healthy. But that doesn’t mean that the diet will necessarily be balanced.
A balanced diet is one that gives your body all of the nutrients it needs to function correctly. Each meal should combine protein, fat, carbohydrates, fruits and/or vegetables, and dairy in specific proportions.
In most Western diets, too much protein and carbohydrates are consumed while fruits and vegetables are treated more like an afterthought. In a balanced diet, the opposite is true.
According to the USDA, a healthy, balanced meal should consist of the following proportions:
- Protein: one-quarter of your plate
- Carbohydrates: one-quarter of your plate
- Vegetables and/or fruits: half of your plate
Keep most of your fats unsaturated, using them sparingly when needed.
Safety
Your healthcare provider may prescribe medications to help control your fibromyalgia symptoms. These may include analgesics and gabapentin, sedatives, and selective serotonin reuptake inhibitors (SSRIs).
Foods can affect how many of these drugs work. For example:
- Certain types of gabapentin (Gralise and Horizant) should be taken with food, while others (like Neurontin) can be taken with or without food.
- SSRIs should also be taken with food but can cause jitteriness if combined with caffeine.
- Sedatives like Halcion (triazolam) can interact with grapefruit, increasing the risk of side effects.
- Tylenol (acetaminophen) combined with alcohol may cause liver damage.
Herbal remedies can also interact with fibromyalgia medications. Examples include kava kava and sedatives like Xanax (alprazolam) and St. John’s wort and SSRIs like Prozac (fluoxetine) and Zoloft (sertraline).
Knowing how foods affect fibromyalgia medications can help prevent interactions while ensuring the optimal response to treatment.
Herbal Supplements for Fibromyalgia
Flexibility
Certain ways of eating are less healthy whether you have fibromyalgia or not. Chief among them are fast food and family chain restaurants that are more likely than not to trip up your diet.
Wherever you dine out, check the restaurant menu online and pre-select the foods you can eat, if possible. You can also opt to visit restaurants that cook to order and will leave off any ingredients you find problematic.
To avoid frustration, call the restaurant in advance and let them know about your dietary concerns. In many cases, they will offer suggestions or even prepare a special order if you call early enough.
Support and Community
Living with fibromyalgia is as much an emotional journey as a physical one. Even though your healthcare provider and nutritionist can answer many of your questions and concerns, you may feel the need to talk to others who know first-hand what you are going through.
You can often find fibromyalgia support groups through your healthcare provider or non-profit organizations like the National Fibromyalgia and Chronic Pain Association (NFMCPA). There are also online community support groups on Facebook and live informal groups organized on Meetup and other social platforms.
Support from family and friends is equally important. The more that they understand about fibromyalgia and why your dietary restrictions are essential, the easier daily meals and outings become.
Fibromyalgia Support Groups
Side Effects
When making significant changes to your diet, it is not uncommon to experience bowel problems. Most of these are short-lived and tend to resolve once your body adjusts to the new routine. While constipation is common, an increased intake of dietary fiber can also cause runny stools, bloating, and gas.
Don’t give on the diet if you happen to feel uncomfortable for a few days or weeks. Instead, find ways to manage your symptoms. This may involve a fiber supplement and drinking extra fluids if you have constipation or eating a BRAT diet to help bind runny stool.
If gastrointestinal symptoms fail to resolve, speak with your healthcare provider. Unless there is some other explanation for your symptoms, they are more likely caused by an imbalance in your adjusted diet.
Cost
From a practical standpoint, eating well with fibromyalgia can sometimes be costly, particularly where fresh fish and lean meats are concerned. To help constrain costs, add canned tuna or sardines to your weekly menu, and buy beef or chicken in bulk to store in the freezer. Frozen peas, corn, peaches, and mixed berries are also great cost-savers.
Fibromyalgia Diet vs. Other Diets
Since there is no set fibromyalgia diet, many people will combine elements from several different plans to manage their symptoms. The most popular plans for people with fibromyalgia are low-FODMAP, gluten-free, and plant-based diets.
Low-FODMAP Diet
A 2017 study in the Portuguese journal Nutricion Hospitalaria investigated the benefits of a low-FODMAP diet for people with fibromyalgia. FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are the types of sugar or sugar alcohols that are broken down by bacteria in the colon. FODMAPs are naturally found in certain foods and commonly used as food additives.
According to the researchers, 38 adults with fibromyalgia experienced significant reductions in pain after eating a low-FODMAP diet for four weeks. In addition, there were decreases in weight and body mass index (BMI) in some of the study participants.
If considering a low-FODMAP diet, let your healthcare provider or dietitian know. As beneficial as the approach may be, it is often harder to achieve a balanced diet given the high nutritional value of high-FODMAP foods.
Low-FODMAP Foods
- Bananas
- Blueberries
- Grapes
- Brown sugar
- Table sugar
- Butter
- Almond milk
- Broccoli
- Carrots
- Potatoes
- Brown rice
- Oats
- Sunflower seeds
High-FODMAP Foods
- Apples
- Peaches
- Barley
- Wheat
- Ice cream
- Margarine
- Milk
- Soy
- High-fructose corn syrup
- Honey
- Cauliflower
- Celery
- Artificial sweeteners ending in –ol (like sorbitol)
Gluten-Free Diet
According to a 2015 study in Rheumatology International, there are similarities between the gastrointestinal symptoms of fibromyalgia and those of celiac disease. Both involve abnormal physiological responses to trigger foods. With celiac disease, the culprit is gluten found in wheat and other cereal grains.
There is evidence, albeit scant, that some people with fibromyalgia have an underlying gluten sensitivity. It is unclear at this stage if fibromyalgia is an extension of celiac disease in these individuals or if the two diseases are independent and simply share a common trigger.
Given the similarities between fibromyalgia and gluten intolerance, it may be reasonable to add gluten to the list of possible triggers in an elimination diet.
Gluten Intolerance in Fibromyalgia & Chronic Fatigue Syndrome
Plant-Based Diets
An early study published in BMC Complementary and Alternative Medicine suggested that a vegan or vegetarian diet may help reduce fibromyalgia pain by as much as 46%.
The two-month study involved the balanced intake of protein, carbohydrates, fats, and nutrients using raw fruits, salads, carrot juice, tubers, whole grains, nuts, seeds, and dehydrated barley grass juice. Of the 20 participants who made it to the trial’s end, 19 achieved a positive result.
There are several vegan, vegetarian, and semi-vegetarian diets to consider, including:
- Mediterranean Diet
- Flexitarian Diet
- Macrobiotic Diet
- Engine-2 Diet
- Ornish Diet
A Word From Verywell
Treating fibromyalgia is challenging and it typically involves many strategies that work together to help you feel your best. If you haven’t tried changes to your diet, consider working with a healthcare provider or dietician to undergo a three- to six-week elimination diet. It requires commitment and focus on your part, with no “cheating” or sudden introductions of new foods into your plan, but it could help. Though your symptoms may or may not improve on a fibromyalgia diet, your efforts to follow its eat-well strategies can only benefit your overall health.
Reference<https://www.verywellhealth.com/fibromyalgia-diet-good-and-bad-foods-4144693
