Fibromyalgia: The Diet Connection

The condition is called fibromyalgia. It consists of a complex array of symptoms that include widespread muscle and joint pain along with overwhelming fatigue. And none of it goes away, no matter how much rest you get.

Fibromyalgia affects up to 4% of the population -- mostly women. And there is still no known cause or recognized treatment that works for everyone. That's one reason, say experts, that so many people have turned to diet as a way to relieve some of the symptoms.

The fact is there's little scientific evidence to support any single eating plan as a way to deal with fibromyalgia. Nevertheless, a trip around the Internet will show that dietary approaches to fibromyalgia abound. The variety is so diverse it's hard to imagine they are all aimed at treating the same disease.

Eat more whole grains. Don't eat any whole grains. All fruit is good. Some fruit is bad. Tomatoes are healthy. Tomatoes are harmful. Sugar is bad. Sugar has no impact. Avoid meat. Eat. . . .

Confused? Don't be. Experts say diversity is another hallmark of fibromyalgia.

"This is because fibromyalgia is not a specific illness," says Michael McNett, MD. McNett directs the Fibromyalgia Treatment Centers of America, headquartered in Chicago. "Fibromyalgia is more like a symptom complex, and different people appear to have different reasons why they get this symptom complex," he says. "So what works for one person very frequently does not work for another."

And this, say experts, includes dietary measures.

Kent Holtorf, MD, is the medical director of the Holtorf Medical Group Center for Endocrine, Neurological and Infection Related Illness in Torrance, California. He says, "We're at the point now where we know diet plays a role in this disease -- it's just not the same diet for everybody. And not everybody is helped in the same way."

Fibromyalgia and diet: Can what you eat help you?

Rheumatology experts like Alex Shikhman, MD, believe the diversity of dietary approaches may have less to do with the impact on fibromyalgia, and more to do with treating a secondary, possibly undiagnosed illness. "When patients are helped by a specific dietary measure," says Shikhman, who is director and founder of the Institute for Specialized Medicine in San Diego, "it is often because of the presence of a secondary condition that does have a recognized response to diet. And when you take care of that, you do get some relief from all the symptoms. You feel better overall."

There are a number of co-existing health conditions that have a tendency to occur in people with fibromyalgia. Many of these have overlapping symptoms. These include gluten intolerance, gout (a form of arthritis), and restless legs syndrome. Some doctors believe food sensitivity itself could sometimes be responsible for some of the pain and fatigue of fibromyalgia.

Moreover, Holtorf points out that because each of these secondary conditions responds to a different dietary approach, it's not hard to understand why "different dietary recommendations are reported to work."

Shikhman believes that sometimes fibromyalgia may even be the wrong diagnosis. That's another reason, he says, we can sometimes see such dramatic and immediate response to so many different dietary measures.

"Sometimes, if you carefully note which foods a patient responds to," Shikhman says, "you can actually get a significant clue as to the true nature of their underlying health problems. And it might not always be fibromyalgia."

Fibromyalgia: Seven foods to avoid

While there may not be a single set of dietary guidelines that are right for all fibromyalgia patients, there are certain foods, or food groups, that appear to make a difference for a significant number of people. But remember, avoiding these foods is not a guarantee that your symptoms will change. Also, avoiding one group may offer benefit while another may make no difference at all. Nevertheless, the experts WebMD talked to agree that eliminating at least some of these foods is worth a try.

1. Aspartame (NutraSweet). All the experts WebMD talked to agree that for a large majority of people with fibromyalgia, foods sweetened with aspartame could exacerbate fibromyalgia symptoms.

"There is a pain receptor in the nervous system known as NMDA," says McNett. "When pain turns from acute to chronic, it involves opening the NMDA pain receptor. Aspartame, which is classified as an excitotoxin, helps to stimulate this event." He also says people with fibromyalgia appear to already have overly active NMDA pain receptors, making them more susceptible to the stimulation.

In one study published in the Journal of Rheumatology in 2006, experts found patients with fibromyalgia did have an increased expression of NMDA receptors in their skin. This indicated a general increase in activity of peripheral nerves.

Fibromyalgia: Seven foods to avoid continued...

Holtorf says aspartame may play a role in stimulating those nerve pathways. Then he adds that for some people, "cutting it out of their diet can have a dramatic impact on pain."

That appeared to be the case for patients in one small study published in the Annals of Pharmacotherapy in 2001. Researchers found that, when patients with fibromyalgia avoided aspartame as well as the flavor enhancer MSG, they felt better overall.

Other artificial sweeteners such as Splenda, saccharin, and stevia do not appear to have the same effect as aspartame.

2. Food additives including MSG (monosodium glutamine) and nitrates. MSG is an additive or flavor enhancer that's found in many processed and frozen foods and in some Asian cuisines. Experts say it can intensify pain symptoms in many individuals. Like aspartame, MSG is classified as an excitotoxin and has the same potential for affecting NMDA receptors.

The same is true, says McNett, for foods containing preservatives such as nitrates, commonly found in lunchmeats like ham or bologna or in bacon.

"A lot of people who don't have fibromyalgia can't tolerate nitrates or MSG very well. But one of the hallmarks of this condition is that it amplifies unpleasant reactions," McNett says. "So a stimulus that some people would find mildly unpleasant becomes very unpleasant in those who have fibromyalgia." Cutting these ingredients out of the diet, he adds, usually helps.

3. Sugar, fructose, and simple carbohydrates. There is no clear evidence that cutting out simple carbohydrates -- like sugar, cake, or white bread -- will have an impact on fibromyalgia. What it can do, though, is reduce symptoms of chronic yeast infection -- a fungus that thrives on sugars and may be a secondary condition contributing to the pain of fibromyalgia. This theory, however, is still being debated by experts.

"Cutting out sugary foods, particularly high fructose corn syrup, can make a difference in these patients," says Holtorf. "And that's independent of any weight loss that might occur when they stop eating these foods."

Shikhman adds that cutting out carbonated beverages sweetened with fructose may yield even more noticeable results. That's because the carbonation, he says, causes a metabolic reaction. This reaction results in much more sugar pouring into the blood much more quickly.

"It's this quick rise in blood sugar," Shikhman says, "followed by the subsequent fall that exacerbates the fatigue element of fibromyalgia. That, in turn, creates more cravings for sugar, followed by still more fatigue -- allowing a vicious cycle to develop." Cutting out the sugar, he says, particularly soda, can result in better, more even control of blood sugar. Better control will help reduce fatigue and at least some of the related pain.

4. Caffeine -- including coffee, tea, colas, and chocolate. Because it is considered a stimulant, many fibromyalgia patients turn to caffeine-rich beverages as a source of energy. But McNett says the boost you get is false -- and can quickly exacerbate fatigue.

Fibromyalgia: Seven foods to avoid continued...

"The problem with caffeine is that the 'up' is relatively brief and transient," he says. "And it's followed by substantially longer and deeper sedative effect."

Because people with fibromyalgia are already tired, McNett cautions, those sedative effects can be much more powerful. "They are starting off from a point of fatigue, so the sedative qualities are amplified -- leading to a much deeper and long lasting sense of fatigue."

The good news is that cutting out caffeine can make a difference within less than a week. "Most patients begin to see a difference in their fatigue level almost right away," he says.

5. Yeast and gluten. Although these are two separate food substances, they frequently appear together -- particularly in baked goods like cake, donuts, and bread. For this reason, cutting out one, usually means you are cutting out both. That can actually yield two separate benefits for people with fibromyalgia.

In the case of yeast, some doctors say it fosters the overgrowth of the yeast fungus in the body. This overgrowth may cause or exacerbate much of the joint and muscle pain experienced by people with fibromyalgia. Research, though, has yet to confirm this link.

Gluten can exacerbate a condition known as gluten intolerance. Gluten intolerance, Shikhman says, frequently results in a variety of stomach ailments and other digestive problems. It also is associated with fatigue in patients with fibromyalgia.

"I have seen people with and without fibromyalgia experience enormous positive changes in their health by simply cutting out gluten products," Shikhman says.

6. Dairy. Be they low fat or high fat, some experts say, dairy products -- particularly, milk -- have been known to drive the symptoms of fibromyalgia. Avoiding these products may help some people turn their health around.

On the other hand, if you feel as if milk is doing your body some good, keep chugging a glass or two of skim milk a day. It's got calcium to build bones and protein to build muscle, and it's fat free.

7. Nightshade Plants: Tomatoes, chili and bell peppers, potatoes, and eggplant. There are over 2,000 species of plants that that can be listed under the category of "nightshade." Those which are edible comprise a group that some say can trigger flares of various types of arthritis, including fibromyalgia.

"I have seen patients who do much better when they cut these foods out of their diet," says Holtorf. We're not sure why, but it seems to work in a significant percentage of fibromyalgia patients." At the same time, these vegetables are among the most nutritious. So if they don't trigger your fibro pain, don't ban them from your fridge.

A final word - Nutrients and the power of a healthy diet

Avoiding certain foods may help individual patients better cope with their disease. Nutritionist Samantha Heller, MS, RD, says, however, that most can also benefit from an overall heart-healthy approach to good eating.

A final word - Nutrients and the power of a healthy diet continued...

"When you are eating a heart-healthy diet - one low in saturated fat, lean meats, and poultry and high in the fresh fruits and vegetables that don't cause you problems, your body is going to work in a more healthful way, " Heller says.

And while, she says, this won't necessarily reduce your fibromyalgia symptoms, it can help to reduce the risk of other ailments that can only compound your health issues.

"When your body is healthier overall," says Heller, "you may be better able to cope with any disease, and better able to respond to even small changes you make."

One small study published in the journal Complementary and Alternative Medicine in 2001 found that patients who ate a vegetarian diet consisting of mostly raw whole foods did see a reduction in their fibromyalgia symptoms.

Holtorf also believes that sticking to a heart-healthy diet may yield some specific helpful effects. "Patients with fibromyalgia have documented mitochondria dysfunction," he says. "This is the area of the cell where energy is made. Consequently, it's necessary to have high levels of nutrients to get the mitochondria to work and for energy to be produced." So, Holtorf adds, the higher your level of dietary nutrients, at least theoretically, the better off you might be.

What can also help, he says, is a high potency vitamin supplement as well as supplements containing omega 3 fatty acids. Omega 3 fatty acids -- which are also found in foods such as fish oil, flax seed, walnuts, some fortified cereals, and eggs -- are the "good fats" that have been shown to have an impact on inflammation.

Hi Shirley,

Your advice about a sensible diet is right on the mark. I wish I could avoid the desserts and other simple carbohydrates, but that is so difficult to do.

DonnaZ