Fibromyalgia: Nutritional Considerations

Fibromyalgia is considered a rheumatic disease, one in which inflammatory cytokines (eg, interleukin–6) may be involved in triggering or increasing inflammation and its symptoms.⁶ Indications of increased oxidative stress (malondialdehyde, advanced glycosylation end products)⁷ and lower levels of the antioxidant enzyme superoxide dismutase have been found in patients with fibromyalgia.⁸ Dietary manipulation can reduce oxidative stress and cytokine production (see Rheumatoid Arthritis chapter), but such treatments have yet to be tested in fibromyalgia patients. Limited evidence suggests that a vegan diet may improve subjective experience of joint pain and stiffness.^9,10 However, this impression requires confirmation in additional controlled clinical trials.

Fibromyalgia patients also have disturbed sleep and may have lower nocturnal melatonin production, which can increase daytime fatigue and pain perception.¹¹ Limited evidence indicates that supplemental melatonin (3 mg at bedtime) reduces tender points, pain severity, and sleep disturbances, and results in improvement in both patient and physician assessment of global improvement.¹² Further studies are needed to assess the effects of diet changes and melatonin supplements on the condition.

Orders

See Basic Diet Orders.

Exercise prescription: Patient should be given an appropriate, sustainable, and enjoyable exercise routine.

What to Tell the Family

Fibromyalgia is a poorly understood condition that is treated symptomatically. General recommendations for a healthy exercise routine may be helpful to the patient and the entire family. Concomitant depression or other mental illness should be treated, but fibromyalgia is not an imaginary illness. Good sleep hygiene is also very important. Limited evidence suggests that some patients may respond well to a low–fat, vegan diet, and diet changes are easier to adopt when all family members make the change.