Fibromyalgia is chronic arthritis-related condition with symptoms that may include widespread musculoskeletal pain, fatigue, depression, headaches, mental fogginess, and bowel and bladder problems. A type of central sensitization or central pain syndrome, fibromyalgia is believed to result from a problem in the way the brain processes pain signals.
Although the cause of fibromyalgia is not well understood, scientists are finding that certain nutrients or food additives may worsen symptoms for some people. Similarly, consuming or eliminating particular nutrients may lessen symptom severity.
Here are three nutrients that may play a role in fibromyalgia and what researchers are learning about them.
Food Additives & Fibromyalgia Symptoms
For years, researchers have suspected that food additives called excitotoxins may worsen fibromyalgia symptoms for some people. Excitotoxins include three amino acids – glutamate, aspartate and L-cysteine – that are commonly found in many grocery store staples as flavor enhancers and sugar substitutes.
Some of the earliest evidence of a fibromyalgia-excitotoxin connection was seen in 2001 in a small case study published in Annals of Pharmacotherapy. Four people with fibromyalgia who had not responded well to other treatments became totally or mostly symptom-free within months of removing monosodium glutamate (MSG) or aspartame from their diets. All had symptoms return when MSG was reintroduced.
More recent and slightly larger studies have had conflicting results. In a study published in 2012 in Clinical and Experimental Rheumatology, 57 patients with fibromyalgia and irritable bowel syndrome (IBS) symptoms were put on a diet that excluded MSG and aspartame. After four weeks on the elimination diet, 84% of those completing the diet reported their symptoms improved by more than 30%. Adding MSG back into the diet resulted in a significant return of symptoms.
A 2014 study published in Rheumatology International, however, showed no relationship. In this study of 72 women with fibromyalgia, half of them stopped eating monosodium glutamate (MSG) and aspartame, while the other half continued their regular diets. There were no significant differences between the groups on pain ratings before or after the elimination diet. The researchers concluded that discontinuing the additives did not improve fibromyalgia symptoms.
Researchers say larger studies are needed to better understand the potential role of excitotoxins on fibromyalgia symptoms and whether some patients may benefit from eliminating them.
You need vitamin D to absorb calcium. Your body makes it when your skin is directly exposed to the sun. Vitamin D is also found in fatty fish, beef liver, egg yolks, mushrooms, and fortified milk and cereal products.
Research has shown a connection between low blood levels of vitamin D and several chronic health problems including osteoporosis, high blood pressure, autoimmune diseases and chronic widespread musculoskeletal pain.
It’s not known whether supplementing vitamin D in people who are deficient will help pain or other symptoms of fibromyalgia. A small Austrian study published in 2014 in the journal Pain suggests it might. In the study, 30 women with fibromyalgia and low blood levels of vitamin D received either a vitamin D supplement or placebo. The treatment group experienced improvement in physical functioning, morning fatigue and pain, while the placebo group was unchanged.
While the data presented in the study are promising, study author Florian Wepner, MD, an orthopaedist at Vienna’s Orthopaedic Hospital Speising, notes that the study was small and larger studies are needed to better determine the potential role of vitamin D in fibromyalgia treatment. He believes, however, that vitamin D is a safe supplement that can be used along with medication and other non-medication treatments for fibromyalgia.
Gluten & Inflammation
Shop the aisles of almost any supermarket and you’ll find a wide array of gluten-free products. Gluten – a protein found in wheat, rye and barley – triggers damaging inflammation in the small intestines of people with celiac disease. More recently gluten intolerance has been suspected to play a part in a host of other ailments including digestive problems, fatigue, headache, skin rash and possibly fibromyalgia.
Spanish researchers wondering whether gluten contributed to fibromyalgia sought the answer in a study published in 2014 in Rheumatology International.
The study examined 20 patients who had fibromyalgia and a suspected gluten sensitivity while not fully meeting the criteria for celiac disease. After transitioning to a gluten-free diet for 16 months, all patients reported improvement in the level of widespread chronic pain. Fatigue, gastrointestinal symptoms, migraine and depression also improved.
“This report shows that remarkable clinical improvement can be achieved with a gluten-free diet in patients with [fibromyalgia], even if celiac disease has been ruled out,” the authors wrote.
Another 2014 study published in Arthritis Research and Therapy evaluated the one-year effect of a gluten-free diet in 97 women with both fibromyalgia and irritable bowel syndrome. None of the women met criteria for a celiac diagnosis. However, 58 tested positive for lymphocytic enteritis (LE), an inflammation of the small intestine found in people with food allergy, autoimmune disorders, bacterial infection and those taking nonsteroidal anti-inflammatory drugs.
The gluten-free diet produced slight improvement in symptoms of both IBS and fibromyalgia in the LE group, but not the group without LE. This suggests that LE might be useful for identifying patients who are most likely to benefit from eliminating gluten, the authors said. One important limitation of this study is the lack of a control group.
Despite the research on nutrition and fibromyalgia, there is no conclusive evidence that the addition – or elimination – of any nutrient or set of nutrients will help everyone with the condition. Any dietary changes you might like to try should be tailored to you in consultation with your doctor.
Fibromyalgia expert Daniel Clauw, MD, professor of anesthesiology, rheumatology and psychiatry at the University of Michigan in Ann Arbor, says the data supporting vitamin D as a reliever of fibromyalgia pain is inconsistent, but its other benefits are a good enough reason to try it. “It helps strengthen bones and has a host of other benefits.”
While more research is needed to determine how different elements of our diets affect fibromyalgia, experts agree that eating a diet of healthy whole foods is certainly a step in the right direction.
Authors: Kerry Ludlam and Mary Anne Dunkin for the Arthritis Foundation