WHAT IS FIBROMYALGIA?
Generalized pain condition (pain in at least 11 out of 18 tender point sites) and tenderness of which the medical treatment and etiology are not yet known, diffuse fatigue, cold hands and feet, trouble sleeping, depression, tingling in the limbs, irritable bowel syndrome, and morning stiffness for at least 3 months It is a painful syndrome.
It has been reported that 81% of fibromyalgia patients have irregular bowel problems, 63% have diarrhea and constipation, and 32% to 80% meet the criteria for Irrebital Bowel Syndrome.
FIBROMYALGIA DIAGNOSTIC CRITERIA
>7 points on the Generalized Pain Scale and >5 points on the Severity of Symptom Scale
Persistence of symptoms at similar levels for at least 3 months
It is the absence of a current disease that would explain the pain in the patient.
PREVENTION OF FIBROMYALGIA
It is 0.5-2% in the world – 2.1% in men – 3.6% in women. The reasons such as the increasing prevalence of fibromyalgia, the significant impact on the quality of life of the patients and the difficulties brought by the intensive physical therapy process have revealed the necessity of investigating the nutritional therapy, which is easy to apply in the treatment of fibromyalgia.
TREATMENT METHODS IN FIBROMYALGIA
It is known that many alternative ways are used in fibromyalgia apart from drug treatment. Some of these are: aerobic exercises, cognitive behavioral therapy, patient education, acupuncture, hypnotherapy, ozone therapy and nutritional support.
NUTRITION FROM FIBROMYALGIA TREATMENT METHODS
Nutrition; It is a part of holistic treatment in pain method. Studies have been carried out on specific diets such as gluten-free, ketogenic, vegetarian diet, Mediterranean diet, FODMAP diet on pain.
1) KETOGENIC DIET
They associated the ketogenic diet with pain through mechanisms such as ketogenic diet that mimics fasting metabolism and neuromodulation by stimulating adenosine signals. However, the ketogenic diet induces obesity due to its high fat content, and its fatty acid content can trigger inflammation. An animal study found that mice fed a high-fat diet developed obesity and an inflammatory process began in microglia, while nociceptive responses were increased in mice.
2) GLUTEN FREE DIET
Fibromyalgia patients often have gastrointestinal symptoms that significantly overlap with various gluten-related disorders, such as vomiting, nausea, abdominal pain, chronic pain, and mood disturbance, suggesting a possible coexistence of non-celiac gluten sensitivity in patients. This has led many researchers to hypothesize that a gluten-free diet may be beneficial for patients with FM. A pilot study investigating the clinical effect of a 1-year gluten-free diet in a small sample of 75 patients with celiac disease IBS and FM found overall improvement in pain symptoms, quality of life, and serum levels of tissue transglutaminase.
3) DIET WITHOUT MONOSODIUM GLUTAMATE AND NO ASPARTAME
Mono sodium glutamate and aspartame can function as excitotoxin molecules in organisms, act as excitatory neurotransmitters and cause neurotoxicity when overused. It has been reported by dietitians that the recommendation of restriction of mono sodium glutamate in the diet will be beneficial in the symptomatic treatment of fibromyalgia patients. It is also known that symptoms increase when individuals are given glutamate by injection.
Symptoms such as chronic pain, fatigue, sleep and cognitive impairment were improved after the diet application without aspartame and MSG on FM patients. Interestingly, when MSG and aspartame were reintroduced into the diet, patients’ pain and other symptoms worsened and their quality of life decreased.
4) FODMAP AND ANTI-INFLAMMATORY DIET
FODMEPs (Fermentable Mono-Di-Oligosaccharides and Polyols) are poorly absorbed short-chain carbohydrates, including lactose, free fructose, polyols, fructans, and galacto-oligasaccharides. The low-FODMAPS diet has shown significant benefits in the treatment of IBS. Since 70% of FM patients suffer from IBS, it was hypothesized that a diet of low FODMEPs could be beneficial for FM subjects. A 4-week intervention study of 38 women with FM reported a significant reduction in gastrointestinal disturbances and FM symptoms, including pain scores, as well as a reduction in body weight and waist circumference.
Another group conducted a study by dividing adult women between the ages of 18-75 into two groups. The first group was fed for 3 months without gluten, dairy products, sugar, ultra-processed foods, and high-FODMAP vegetables and fruits. The second of the groups applied the healthy diet that was approved by the World Health Organization for 3 months. At the end of this study, they reported that the hypocaloric and low-FODMAP diet was promising in complementary therapies.
5) VEGETARIAN DIET
Vegetarian diets are characterized by large amounts of plant foods rich in fiber, vitamins, minerals and antioxidant elements, leading to the hypothesis that the regimen of this diet may exert pain-relieving effects in FM patients with anti-inflammatory properties and absence or reduction of animal proteins. To see the effect of vegetarian diet on FM patients, they applied a strict raw vegan diet for 3 months to 18 FM patients and reported a significant reduction in joint stiffness and sleep quality as a result of pain scores. When the normal diet was returned, interestingly, an increase in the symptoms was observed again.
6) MEDITERRANEAN DIET
There is little evidence about the possible beneficial effects of the Mediterranean diet on FM. A recent cross-sectional study of 95 FM women shows that adherence to the Mediterranean diet is consistently associated with quantitative calcaneal ultrasound parameters, supporting the hypothesis that adherence to the Mediterranean diet may play a decisive role in bone health in FM women.
Given that changes in the intestinal bacterial flora are a contributing factor to many chronic inflammatory and degenerative diseases, including rheumatic diseases such as FM, Michalsen and colleagues have shown that the intestinal microbiota of interventions with the Mediterranean diet or modified intermittent 8-day fasting regimen in 35 patients affected by FM. tested its effect on Surprisingly, after 2 weeks and 3 months of follow-up, the authors found no significant changes in stool bacterial counts following the two dietary interventions within and between groups. However, they reported that it had beneficial effects on emotional processing, reducing fatigue, anxiety, and depression.
RELATIONSHIP OF FIBROMYALGIA AND NUTRIENTS
A- FIBROMYALGIA AND FAT ACIDS
Fatty acids are the building vehicles of fats and are a nutrient that has various functions in the body. The content of fatty acids has been associated with pain due to their inflammatory or anti-inflammatory role in the body. Omega-6 fatty acids are synthesized from arachidonic acid to leukotrienes, thromboxanes and prostagladins by the cyclooxygenase system; therefore, it causes an effect that supports peripheral sensitization in the pain pathway. Omega-3 fatty acids include the essential fatty acids docosahexaenoic acid and eicosapentaenoic acid and promote anti-inflammatory pathways.
According to a 3-month study investigating the frequency of omega-3 and omega-6 fatty acid consumption in FM patients receiving methotrexate therapy, dietary omega-3 intake was inversely correlated with drug-resistant and severe pain. Dietary omega-3/omega-6 ratio was also associated with severe and resistant pain.
B- FIBROMYALGIA and VITAMINS
VITAMIN D: It is a steroid that plays a role in bone growth and mineral metabolism and has hormone-like functions. It also has a direct effect on calcium and phosphorus metabolism. Vitamin D deficiency was observed in most of the patients with FM, and the treatment of vitamin D deficiency has been found to have positive effects in the treatment of chronic diseases such as FM. Low 25(OH)D levels cause widespread body pain, muscle and skeletal weakness, bone fractures and bone mineralization deficiency in patients.
Although there is no clear information on the relationship between FM and serum 25(OH)D level, there are studies showing that vitamin D levels are low in patients with FM and that adequate vitamin D replacement therapy provides serious improvements in the patient’s clinical condition. As a result of the studies, it was reported that the pain status of the patients decreased significantly.
VITAMIN C: A powerful antioxidant, vitamin C shows osteogenic and chondrogenic properties in the musculoskeletal system and its deficiency has been associated with low back, neck, extremity pain and spinal pain. In a study of 43 fibromyalgia and 44 healthy women, most subjects with fibromyalgia experienced insufficient vitamin C intake. It has been reported that the administration of vitamin C to patients with FM may provide a positive effect on pain by increasing the endogenous synthesis of neurotransmitters that will provide analgesia.
VITAMIN E: One of the other powerful antioxidant vitamins is vitamin E. It has been thought that it may play a beneficial role in the symptoms of some types of FM. Because they are beneficial for preserving cerebellar functions, memory, emotional responses, and muscle function. Studies have shown that patients with FM have lower levels of vitamin E than healthy people. However, one study did not show a significant difference in FM symptoms when boosting vitamin E.
VITAMINS B: Vitamin B12 is necessary for the normal functioning of the brain and nervous system. Its deficiency causes chronic pain symptoms and neurological dysfunctions. In many animal experiments, it has been reported that neuropathic pain and tactile allodynia can be alleviated by parenteral administration of vitamin B12 analogues, and it can be an adjunct or holistic treatment for pain conditions. It has been reported that methylcobalamin, the active form of vitamin B12, has an analgesic effect.
C- FIBROMYALGIA and MINERALS
MAGNESIUM: Magnesium is one of the essential minerals of the human body. It is found in muscle, soft tissue and body fluids. Muscle cramps, sleep problems, psychological problems, coronary spasm, etc. are seen in its deficiency, and magnesium deficiency has been described in most patients with FM.
Hypomagnesemia mostly affects the neuromuscular system. Muscle weakness and cramps are common in patients. In addition, decreased synthesis of vitamin D may cause hypocalcemia and cause muscle pain. And hypomagnesemia is more common in patients with fibromyalgia, so magnesium deficiency should be considered immediately in individuals diagnosed with FM.
Iodine: Prevention of iodine deficiency in patients with FM is extremely important in terms of thyroid functions. Because; It has been reported that the symptoms are more pronounced when hypothyroidism is detected in patients with FM.
SELENIUM: It has also been shown that selenium intake plays a protective role against damage caused by ischemia and subsequent reperfusion. Similar protection has been reported for other antioxidants such as carnosine, taurine and melatonin. Moreover, it has been suggested that an increased load of toxic substances such as cadmium and mercury will worsen muscle soreness.
D- FIBROMYALGIA AND CUCUMER/CUCUMIN
It has been stated that when turmeric is taken 1000 mg per day, the curcumin molecule, which has biological activity, can provide analgesia due to its anti-inflammatory properties or show an antinociceptive effect. It has been reported that curcumin, on the other hand, reduces hypersensitivity and pain intensity by adding topical application instead of oral intake.
E- FIBROMYALGIA AND GINGER
Ginger is another herb that has been researched in the treatment of chronic inflammatory and pain relief. It is an anti-inflammatory herb due to its ginger content. A placebo case-control study comparing the analgesic and anti-inflammatory effects of ginger powder and ibuprofen in a post-operative pain model concluded that ginger was as effective as ibuprofen in controlling pain, but its analgesic effect was delayed compared to ibuprofen.
G- FIBROMYALGIA AND Caffeine
Caffeine increases the stomach acid level and increases the absorption of analgesic drugs and is used as an adjuvant with these drugs in the treatment of pain.
H- FIBROMYALGIA CHLORELLA
Chlorella is one of the green aquatic green algae. Chlorella is rich in non-essential amino acids as well as containing all 9 essential amino acids. It is also rich in vitamins and minerals. Due to the abundant protein and nutritional balance it contains, it has recently entered the field of research in the scientific world. One of these studies was on 18 patients with FM. It has been reported that when 10 kg/g/day Chlorella is added to the diet of FM patients, their pain is reduced by at least 25%, their quality of life is increased, and other symptoms of fibromyalgia are improved.
I- FIBROMYALGIA AND PROBIOTICS
It has been shown that cognitive and neurological deficits in fibromyalgia may be associated with decreased Bifidobacterium levels and increased Enterecoccus levels. Probiotics, on the other hand, are microorganisms that, when taken in adequate amounts, have health benefits for the host. Some probiotics have been shown to cause an increase in tryptophan levels, a precursor to serotonin. Serotonin; It is involved in neuroendocrine functions such as emotional processes, cognition and motor function, pain and reproductive activity.
Therefore, studies have concluded that probiotics are effective in intestinal regulation in patients with FM.
I- FIBROMYALGIA AND OLIVE OIL
Extra virgin olive oil is characterized by a high concentration of phenolic compounds, and its numerous health benefits are due to its antioxidant activity, which is linked to its ability to protect FM patients from damage caused by increased exposure to reactive oxygen species. A clinical study investigated the effects of olive oil in 50 female subjects with FM. They reported a statistically significant improvement in protein carbonylation, lipid peroxidation, and mental health status at the end of the 3-week intervention. And the same research group recently concluded with a new study that extra virgin olive oil can protect against cardiovascular diseases in patients with FM.
CONCLUSION
In studies conducted under FM and nutrition; Although clinical trials with vitamin D, magnesium, iron, and probiotic supplementation have shown promising results, the role of dietary supplements in FM remains controversial.
In terms of dietary interventions, the administration of olive oil, low-calorie diets, vegetarian diets, low-FODMAPs diet, gluten-free diet, monosodium glutamate and aspartame-free diet, and Mediterranean diet all appear effective in reducing FM symptoms.
The majority of included studies showed significant improvement in chronic pain, anxiety, depression, cognitive function, sleep patterns, and gastrointestinal symptoms. In addition, weight loss appears to be associated with both reduced inflammation and improved quality of life in FM subjects, suggesting that body weight may have a functional repercussion in these patients. Additionally, all of these diets are generally considered models of healthy diets rich in plant foods, antioxidants or fiber, so the fact that people have experienced an improvement in symptoms after almost all dietary interventions suggests that an adequate diet may play a crucial role in FM management.
