Though it’s currently a trendy health topic, fibromyalgia was first recognized in the 1800s, when it was termed rheumatism, says Elisabeth Deffner of the National Fibromyalgia Association (NFA). Today, almost 10 million people in the US have the condition, and of those, between 75 percent and 90 percent are women, according to the NFA. Women’s propensity for developing fibromyalgia may be because they experience more hormonal fluctuations—believed by doctors to play a role in the condition—than men or simply because men are less likely to seek medical attention for vague, flu-like feelings and thereby go underdiagnosed, Deffner says.
Despite the disorder’s prevalence, its causes remain unknown. “Certain people may be genetically predisposed to developing fibromyalgia, which can also be triggered by extreme stress, emotional trauma, or even another health condition,” Deffner says. New research suggests that a defect in the central nervous system can lead to abnormal sensory and pain processing.
But because no one is absolutely certain what causes it, fibromyalgia is difficult to diagnose. There’s no standard blood test or X-ray used to identify the condition, says Kent Holtorf, MD, a fibromyalgia specialist in Torrance, California. Fibromyalgia’s characteristic symptoms—muscle pain, fatigue, sleep disturbances—are common, and many people with the condition have concurrent illnesses like arthritis or chronic fatigue, further confounding doctors. So, generally, fibromyalgia is diagnosed by symptoms, patient history, and by looking at criteria set by the American College of Rheumatology.
After a fibromyalgia diagnosis, treatment is usually symptomatic—that is, there’s no “cure.” As a result, many people turn to complementary therapies, including hydrotherapy, massage, homeopathy, mindfulness meditation, acupuncture, and osteopathy, all of which have been shown to help alleviate pain in people with fibromyalgia, according to the NFA. But diet is also crucial.
“Dietary changes, especially when they involve eliminating foods that trigger inflammation and emphasizing certain nutrients, can be very effective in reducing the symptoms of fibromyalgia,” says Dean Raffelock, DC, LAc, an acupuncturist, chiropractor, and clinical nutritionist in Boulder, Colorado.
In most cases, finding a specific eating plan is as baffling as diagnosing the disease itself, because no single diet is effective for everyone. For example, some people can’t touch fruit or grains, while others do just fine with them. “We know diet may help relieve symptoms of fibromyalgia,” says Ellie Krieger, RD, author of So Easy: Luscious, Healthy Recipes for Every Meal of the Week (Wiley, 2009). “We just don’t know what that diet is.”
Most experts recommend eliminating trigger foods shown to aggravate fibromyalgia symptoms. “Aspartame (an artificial sweetener found in sugar-free products) stimulates pain receptors in the brain,” Holtorf says. “So does monosodium glutamate (MSG). Sugar and white flour can upset blood sugar, increase fatigue, and lead to weight gain. Caffeine exacerbates sleep disturbances and stresses the adrenal glands.”
The best approach for fibromyalgia patients is to learn how their bodies respond to suspicious foods, says Susan Levin, RD, director of nutrition education at the Physicians Committee for Responsible Medicine. “They should eliminate potential triggers,” she says, “then reintroduce them one at a time to see if they provoke a reaction.” (See “Pulling the Triggers” below.)
Though triggers vary from person to person, some foods and nutrients may help lessen symptoms in almost all fibromyalgia sufferers. “People with fibromyalgia almost always have inflammation, so it’s crucial to include anti-inflammatory foods like most fresh vegetables and fruits, as well as spices such as ginger and turmeric,” Krieger says. Same goes for protein-rich foods, like beans, fish, and lean meats, which help keep blood sugar steady, says Jacob Teitelbaum, MD, fibromyalgia expert and author ofBeat Sugar Addiction Now! (Fairwinds Press, 2010). For some, adding foods containing these nutrients will improve symptoms; in other cases, you may need to take supplements. Start by eating more of the following nutrients, says Levin, then add supplements if your symptoms don’t improve after a month.
Omega-3 fatty acids reduce inflammation, improve brain and joint function, and may help relieve pain, Teitelbaum says. In one study, people with back and neck pain took 1,200 mg of fish oil per day for an average of 75 days. At the end of the study, 60 percent of participants reported reduced pain with the omega-3 supplements, while 59 percent of those were able to stop using nonsteroidal anti-inflammatory drugs altogether. Although study participants suffered from pain not associated with fibromyalgia, the research helps confirm that omega-3s inhibit inflammation, central to treating the condition.
Find them in: Salmon, tuna, sardines, anchovies, mackerel, herring, flax, walnuts, hempseed, and eggs fortified with DHA
Magnesium strengthens bones, relaxes nerves and muscles, and aids sleep. But people with fibromyalgia have low levels of magnesium, in part because stress, hormonal disruptions, and sleep disturbances deplete the nutrient, Levin says. Magnesium deficiency is also associated with inflammation and increased levels of substance P, a neurotransmitter produced by the body in response to stress that makes us susceptible to pain. “Lack of magnesium may be the single biggest factor in exacerbating symptoms of fibromyalgia,” says Holtorf. Aim to get 400 to 1,000 mg of magnesium per day.
Find it in: Halibut, pumpkinseeds, white and black beans, brown rice, lima beans, cashews, almonds, and kale
Vitamin D deficiency has been linked to fibromyalgia and other immune-system disorders, including lupus, multiple sclerosis, and chronic fatigue syndrome. “About 90 percent of people with fibromyalgia have low vitamin D levels,” Holtorf says. “We don’t know if it’s a cause of the condition or a result, but vitamin D prevents the immune system from becoming overactive and attacking other cells, which can improve symptoms.” In any case, vitamin D is crucial for treating lowered immunity and osteoarthritis, characteristic of fibromyalgia, in addition to improving overall health. Raffelock recommends people with fibromyalgia take 5,000 IU of vitamin D daily, which is difficult to do through food alone (you’d have to drink 40 cups of low-fat milk daily).
Find it in: Salmon, tuna, sardines, fortified cereals and juices, fortified milk alternatives like rice milk
Low levels of Vitamin B12 have been shown to worsen pain in fibromyalgia patients, Levin says. For this reason—and also because low levels of vitamin B12 can lead to fatigue and diminished cognitive function—adequate intake of the nutrient is crucial. Vitamin B12 also decreases levels of homocysteine, an inflammatory amino acid found in elevated amounts in people with fibromyalgia. Shoot for 1,000 mcg of B12 a day.
Find it in: Clams, oysters, sardines, trout, beef, turkey, eggs, and dairy
Antioxidants fight oxidative stress and can help reduce inflammation. People with fibromyalgia often have reduced levels of the antioxidant vitamins C and E. “Eating foods high in antioxidants is like pouring water on the inflammatory fires that can cause pain,” Raffelock says. In one study, cherries, packed with antioxidants called anthocyanins, lowered inflammation blood markers by 18 percent to 25 percent.
Find them in: Dark leafy greens, beets, sweet potatoes, cherries, berries, walnuts, dark chocolate, and green tea
Flu or fibro?
The flu and fibromyalgia share many similar symptoms, but you should get over the flu in three days, while fibromalgia symptoms can last for years. The most common parameters for identifying fibromyalgia come from the American College of Rheumatology. First, you have pain in all four physical quadrants of your body or deep pain to the bone in your head, neck, chest, or spine that’s been present on a more-or-less continuous basis for at least three months. Second, 11 out of 18 precise, localized points on the body—particularly the neck, spine, and hips—are tender when pressed. Other telltale signs include:
Vague, flu-like symptoms, including low-grade fever, sore throat, and muscle aches
Sleep disturbances and insomnia
Lack of focus, fuzzy thinking, or brain fog
Chronic migraine and tension headaches
Heat and cold intolerance
Restless legs syndrome
Anxiety or depression
Pulling the Triggers
Trigger foods can worsen fibromyalgia symptoms, but what causes your pain may be different than what instigates someone else’s. The best way to identify your triggers? Eliminate the following suspicious foods for 10 days to two weeks to see how your symptoms respond. If you’re sleeping better and have less pain within a week, you’ve likely eliminated one or several trigger foods, says Ellie Krieger, RD, author of So Easy: Luscious, Healthy Recipes for Every Meal of the Week (Wiley, 2009). To find the specific culprit, reintroduce one food at a time for several days to see if your symptoms return. (For more tips on how to do an elimination diet, enter “Elimination Diet” into the search box at nsnew.wpengine.com.)
Red meat * Dairy products * Fried foods * Nightshade vegetables (tomatoes, potatoes, peppers, and eggplant) * Raw crucifers (broccoli, cabbage, and kale) * Citrus * Sulfites (found in wine, dried fruit, and some preserved meats) * Additives, including sugar, artificial sweeteners, and MSG * Coffee and caffeine * White flour and processed foods * Wheat, corn, soy, and other common allergens, such as peanuts and eggs
Additional source: Susan Levin, RD, director of nutrition education at the Physicians Committee for Responsible Medicine.