Low FODMAP Diet and Fibromyalgia

Fibromyalgia affects around 2-3% of the American population. Females are more likely to be affected with this long-term, painful condition. Fibromyalgia dcan reduce the quality of your life and prevent normal functioning.

In addition to medications, good sleep hygiene, and exercise, doctors often make dietary recommendations to treat the disease. In this article, we’ll look at what a low-FODMAP diet is and whether it can help treat fibromyalgia.

What is fibromyalgia?

Fibromyalgia is a long-term, functional disease characterized by widespread skin and muscle pain. Although doctors are not sure about the cause of the disease, they know it’s not caused by a physical (or structural) problem with your body. There is no inflammation in the body, which is why the condition is described as “functional”.

If you have fibromyalgia, you may experience:

• Headache
• Fatigue
• Reduced sleep quality
• Widespread pain, especially where muscles and tendons attach to the bones
• Brain fog

Some people also get dysfunction of the autonomic nervous system, which controls automatic functions of the body. This can lead to symptoms like:

• Weight changes
• Palpitations
• Sexual dysfunction
• Digestive issues

Importantly, fibromyalgia is often associated with other similar, functional disorders. These include irritable bowel syndrome (IBS), chronic fatigue syndrome, anxiety, depression, migraine as well as inflammatory conditions like rheumatoid arthritis.

What is a low-FODMAP diet?

A low-FODMAP diet aims at eliminating certain carbohydrates from your meals.

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. They are basically carbohydrates that are used as fuel by the bacteria in your gut. Bacteria munch on these sugars and produce gas, which can lead to symptoms like bloating, diarrhea, and nausea.

Some patients are particularly susceptible to FODMAPs in the diet, including IBS patients, so a low-FODMAP diet can be used to ease some of their symptoms.

When a patient starts a low-FODMAP diet, they eliminate all FODMAP-containing foods from their diet for around 4-8 weeks. Once symptoms go away completely, each FODMAP food is reintroduced one at a time. The goal is to catch the foods that trigger symptoms and then eliminate only those from the diet. This is important because if you eliminate all FODMAP-containing foods from your diet, you can develop nutritional deficiencies.

Here’s a list of FODMAP-rich foods:

• Most fruits including apples, cherries, apricots, mango, pomegranate, avocados, and pears
• Many vegetables including onion, okra, asparagus, artichokes, garlic, mushrooms, and Brussel sprouts
• Beans — kidney beans, fava beans, navy beans, baked beans
• Grains like barley and wheat
• Milk
• Nuts like pistachio
• Sweeteners ending in -ol

There are many more FODMAP-rich foods out there, and to know exactly what you should eliminate from your diet, you should work with your doctor. But how does a low-FODMAP diet help in fibromyalgia, if at all? Let’s find out.

Can a low-FODMAP diet help in fibromyalgia?

Yes, a low-FODMAP diet may help in fibromyalgia.

However, the quality of evidence for a low-FODMAP diet’s use in fibromyalgia is very poor. To date, only one study has looked at this intervention.

In this 2016 study, scientists studied patients who had fibromyalgia and IBS. Over 2 months, scientists administered these patients a low-FODMAP elimination diet, where after completely eliminating FODMAPs from the diet, they were reintroduced slowly to catch the culprits that triggered symptoms.

Scientists not only reported an improvement in IBS-related gastrointestinal symptoms, but also in the pain symptoms caused by fibromyalgia. There were two problems with this study, however, including:

• Lack of a control group
• No blinding and randomization

Without a control group (to which the findings of the experimental group could be compared), the placebo effect can’t be ruled out, making this trial low-quality. But one thing is clear, the potential of a low-FODMAP diet in treating fibromyalgia exists, and further studies could give us a better idea.

Should I use a low-FODMAP diet for fibromyalgia?

You should consider the use of a low-FODMAP diet if you have IBS and fibromyalgia together, since the only study researching the topic looked at patients who had both the conditions together.

IBS and fibromyalgia co-exist very commonly. Around 70% of all patients with fibromyalgia also have IBS. Just like fibromyalgia, IBS is a functional disorder. There is no inflammation in the gut, yet patients with IBS can experience:

• Abdominal pain
• Diarrhea
• Constipation
• Bloating
• Stress
• Anxiety
• Heartburn

IBS is diagnosed using the Rome criteria, according to which you have IBS if your symptoms have persisted for the last three months or more and all other, organic diseases have been ruled out.

If you have a diagnosis of IBS in addition to fibromyalgia, talk to your doctor about the possibility of a low-FODMAP diet. But don’t tinker with your diet without expert supervision. Your doctor will make sure you still receive enough nutrients when implementing a low-FODMAP diet. Without expert opinion, you may develop vitamin and mineral deficiencies.

What else can I do for fibromyalgia?

Doctors often stress the importance of an overall healthy lifestyle to improve fibromyalgia. So you should consider the following:

• Maintain a good sleeping schedule
• Eat healthy
• Do regular exercise
• Consider relaxation exercise to cope with stress (which can make fibromyalgia worse)

If your symptoms are still not controlled, your doctor may prescribe you with drugs like the tricyclic antidepressants, selective serotonin-norepinephrine reuptake inhibitors, or anticonvulsants. Your doctor will choose the best drug according to your overall health status.

For patients who don’t respond to drugs, physiotherapy (which includes heat application, stretching, and hydrotherapy) or psychological techniques (like the cognitive-behavioral therapy) can help. A combination of multiple drugs can also be used in these patients.

Finally, as mentioned earlier, fibromyalgia is associated with a wide range of other conditions, including psychological illnesses (like anxiety and depression) as well as inflammatory conditions (like rheumatoid arthritis). And it’s important that you seek out treatments for these conditions because untreated co-morbids will make your fibromyalgia worse.

Takeaway

A low-FODMAP diet can be used to manage fibromyalgia if you also have IBS. However, the quality of evidence for this is very poor, so make sure you talk to your doctor before making any changes to your diet!

Medically Reviewed by Onikepe Adegbola, MD PhD