Dietary interventions in fibromyalgia: a systematic review

Abstract

Fibromyalgia (FM) is a chronic non-degenerative disease, whose nutritional therapy seems controversial. This systematic review aimed to synthesize the knowledge about the effect of dietary interventions on patient-reported outcomes (PRO) and inflammation in patients with FM. Six electronic databases -PubMed, BioMed Central, Cochrane library, EMBASE, LILACS and ISIwere searched for clinical trials, in which a dietary intervention in patients with FM diagnosed was conducted. Quality of evidence assessment was measured in accordance with GRADE methodology. Seven clinical trials -3 randomized controlled trials, 1 unrandomized clinical trial and 3 uncontrolled clinical trials were identified. Dietary approaches included gluten-free diet (n ¼ 1), raw vegetarian diet (n ¼ 2), low Fermentable oligo-, di-and monossacharides, alcohols and polyols (FODMAPs) diet (n ¼ 1), hypocaloric diet (n ¼ 2) and monosodium glutamate-and aspartamefree diet interventions (n ¼ 1). The major PRO were pain and functional repercussion, with 5 out of 7 studies reporting an improvement. The progress in secondary outcomes was reported for fatigue (2/5 studies), sleep quality (2/3 studies), depression and anxiety (3/6 studies), quality of life (4/5 studies), gastrointestinal symptoms (1/2 studies) and inflammatory biomarkers (1/1 study). However, according to Cochrane Risk of Bias, these studies had poor statistical quality. Well-designed studies should be performed to investigate the dietary interventions effect on FM. KEY MESSAGESFibromyalgia (FM) is a chronic non-degenerative disease, whose nutritional therapy seems controversial but promising. Pain and functional repercussion in FM patients seem to improve with a hypocaloric diet, a raw vegetarian diet or a low FODMAPs diet, as much as quality of life, quality of sleep, anxiety and depression and inflammatory biomarkers. Existing studies in this subject are scarce and low quality, which does not allow conclusions to be drawn.

A systematic review of the association between fibromyalgia and functional gastrointestinal disorders

“…While a low FODMAP diet may improve IBS symptoms (73), associated with changes to the gut microbiome (46) and intestinal gas production (74), the effect on fibromyalgia symptoms had not been previously investigated. However, some dietary interventions that have been studied in fibromyalgia are associated with clinical improvements (75). Our review also concludes a high prevalence of functional bloating and/or gas (65.4%), similar to Zanetti et al's reported prevalence of 56.5% in women with fibromyalgia (54), although in their report a "functional" classification was not specified.…”

A high fat anti-inflammatory diet improves widespread allodynia despite worsening metabolic outcomes in adult mice exposed to neonatal maternal separation

“…Ginseng is a root that contains pharmacological compounds called ginsenosides (25) and prevented pain-like behaviors following capsaicin injection into the hindpaw (26). There is growing evidence that these individual anti-inflammatory compounds can improve aspects of chronic pain, however, these studies are limited (16,19,21,23,24,26,27) and additional studies using a combination of these compounds at physiologically relevant doses are warranted (28).…”

Clinical Pharmacists in Chronic Care

“…A nearly 70% German FM patients used thermal baths, 35.2% use alternative therapeutics such as homeopathy, dietary supplements, and 18.4% use introspectiveor meditation-based exercises such as yoga or Tai chi [275]. Low FODMAP was found be compellingin QOL, quality of sleep, anxiety and depression and inflammatory biomarkers in FM patients [276][277][278][279][280][281]. Cognitive behavioral therapy (CBT) interventions may slow or reverse cortical gray matter atrophy, diminishescirculating proinflammatory cytokines (IL-6, IL-8, and TNF-α level) of FM patients, pain symptoms and pain perceptions, helps FM patient having fear of pain, anxiety, depression and sleep disturbances [282][283][284][285][286][287].…”