Many patients with fibromyalgia ask me about supplements, vitamins, special diets
and if there are foods they should avoid. Well, I searched the scientific literature,
and I found a few studies suggesting some nutritional interventions that could be
helpful in people with fibromyalgia. So, let’s talk about nutrition and
fibromyalgia today Fibromyalgia is a
condition of diffuse pain persisting longer than 3 months associated with depression,
sleep disturbance, mental and physical fatigue. It affects more women than men, and is
present in about 1% of the general population. The pain is not directly attributable to a lesion,
disease or injury to the body, but the pain has features consistent with nociplastic pain.
The first line of treatment is includes non-drug treatments like education and self-management.
The pharmacological treatment includes pregabalin, duloxetine, milnacipran, amitriptyline,
cyclobenzaprine and possibly tramadol. When we talk about nutrition I will start
with vitamins, minerals, nutrients, and then we will talk about things to remove,
to eliminate from your diet. First, lets talk about Vitamin D
It is known that 40% of people with fibromyalgia have deficiency of Vitamin D. A natural source
of Vitamin D is our skin, which produces our own vitamin D when we are exposed to sunlight.
In Canada, where the exposure to natural sunlight is rare, almost everyone here has deficiency of
Vitamin D, so it is recommended that foods like milk, yogurt and baby formula are fortified with
Vitamin D. I tell all of my patients with chronic pain to supplement with 1,000 international units
of vitamin D per day. Doses higher than this can be toxic, as vitamin D promotes the absorption of
Calcium from the guts to the blood, it may increase the Calcium levels in the blood.
What about Vitamin C and E?
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They are both anti-oxidants, therefore they are important
to preserve the functions of neurons and muscles. However,
there are no good quality studies to show if we should recommend supplementation or not.
So, a healthy balanced diet rich in citrus fruits and vegetables should
be enough to supply all vitamin C and E that a person with fibromyalgia needs.
The daily recommended intake of Vitamin C is 90 mg for adults and 25 to 45 mg for children.
Here are the best sources of vitamin C:
Red pepper has 95 mg per ½ cup of sweet raw red pepper
1 cup of orange juice contains 93 mg 1 cup of grapefruit juice has 70 mg
½ cup of cooked broccoli has 51 mg ½ cup of cantaloup has 30 mg
If you want to download this handout, it contains all of this information. Go to my website
www . doctorandreafurlan .com /nutrition
The daily recommended intake of Vitamin E is 15 mg for adults and 6 mg for children
Here are the best sources of Vitamin E 1 tablespoon of wheat germ oil has 20 mg
1 ounce of dry roasted sunflower seeds has 7 mg 1 ounce of dry roasted almonds has 7 mg
1 tablespoon of safflower oil has 5 mg 1 ounce of hazelnuts has 4 mg
2 tablespoons of peanut butter has 2 mg ½ cup of boiled spinach has 2 mg
½ cup of boiled broccoli has 1 mg 1 medium kiwifruit has 1 mg
Please remember that this video is not intended to provide medical advice. If you have chronic pain
please ask your doctor to make a proper diagnosis. This video is for educational purposes only. If
there is an emergency please call an ambulance or go to the nearest emergency department.
What about minerals? Magnesium is associated
with muscle weakness and inflammation. There are no high quality studies of
magnesium for fibromyalgia, but it was suggested that people taking magnesium with amitriptyline
was better than amitriptyline alone. Watch my other video about magnesium
to learn about the doses and where to find this mineral in food.
Another mineral associated with muscle pain is iron. It is well known that deficiency of iron
causes anemia, and therefore fatigue and muscle pain. If the person is anemic, they need to
investigate the cause of this anemia, and if they find that it is iron deficiency, then they will
feel better with supplementation of iron. What about probiotics?
It has been suggested that people with fibromyalgia has an altered microbiota, which
basically is the composition of the bacteria in the guts. Therefore, supplementation of probiotics
was done in a study and it showed improvements in thinking and mental fatigue, but it didn’t show
any difference in pain, quality of life or mood. Extra virgin olive oil has many health benefits
to anyone, but specially in people with fibromyalgia, they may benefit from a diet
rich in EVOO compared to other kinds of oils. We talked about the nutrients to add,
but what about nutrients to eliminate? Monosodium glutamate (MSG) and aspartame may
act as excitatory neurotransmitters in the pain pathways. They activate the central sensitization
and provoke amplification of the pain signals. Therefore, limiting MSG and aspartame, which is
an artificial sweetener are recommended. Some people may notice benefits
by doing an elimination diet. They may try a period of gluten-free
diet, and observe if these symptoms improve: nausea, abdominal pain, fatigue, pain and mood
disturbance. If the symptoms do not get better after a month, they may stop the elimination diet.
Watch my other video about gluten and pain. The person may try a Low-FODMAP diet, these
are fermented oligo-di-mono-saccharides and polyols) that are poorly absorbed
short-chain carbohydrates. They include: lactose, free fructose, polyols, fructans,
and galacto-oligosaccharides. This type of diet is useful to people with
irritable bowel diseases or IBS. What about a low-calorie diet?
A low-calorie diet is the most commonly used strategie to reduce body weight. It has been
suggested that a reduction in body weight improves symptoms of pain and quality of life,
and also improved sleep quality. If the person is obese, a more aggressive low-calorie diet
for 16 weeks is recommended. What about other diets?
Vegetarian diet is rich in fiber, vitamins, minerals and anti-oxidants. There are some
studies showing 3 months of a vegetarian diet helped to reduce pain and improve sleep.
There are few studies using the mediterranean diet for people with fibromyalgia, but the conclusions
conflicting. It seems that the mediterranean diet plus supplements led to improvements in
emotional processing, fatigue and mood. In conclusion, it is very hard to conduct
high quality studies in the field of nutrition. We do not have firm conclusions about one diet,
vitamins or supplements. What we know is that a healthy diet provides all the necessary nutrients
that a person needs. If the person consumes junk food or processed food, they will not feel hungry
or motivated to seek healthy nutrition. Make a choice today to eat
healthy. You are what you eat. Answer this question in the comment below:
What nutritional change did you make that improved your pain, sleep, fatigue or mood?
Thank you for watching today. Bye