Posted by MERM on 6/24/2008, 10:32 am
Fibromyalgia: The Diet Connection
Find out what experts say really matters about the foods you eat -- and why staying away from certain foods might help your fibromyalgia symptoms.
The condition is called fibromyalgia. It consists of a complex array of symptoms that include widespread muscle and joint pain along with overwhelming fatigue. And none of it goes away, no matter how much rest you get.
Fibromyalgia affects up to 4% of the population -- mostly women. And there is still no known cause or recognized treatment that works for everyone. That's one reason, say experts, that so many people have turned to diet as a way to relieve some of the symptoms.
The fact is there's little scientific evidence to support any single eating plan as a way to deal with fibromyalgia. Nevertheless, a trip around the Internet will show that dietary approaches to fibromyalgia abound. The variety is so diverse it's hard to imagine they are all aimed at treating the same disease.
Eat more whole grains. Don't eat any whole grains. All fruit is good. Some fruit is bad. Tomatoes are healthy. Tomatoes are harmful. Sugar is bad. Sugar has no impact. Avoid meat. Eat. . . .
Confused? Don't be.
Experts say diversity is another hallmark of fibromyalgia.
"This is because fibromyalgia is not a specific illness," says Michael McNett, MD. McNett directs the Fibromyalgia Treatment Centers of America, headquartered in Chicago.
"Fibromyalgia is more like a symptom complex, and different people appear to have different reasons why they get this symptom complex," he says.
dietary measures.
Kent Holtorf, MD, is the medical director of the Holtorf Medical Group Center for Endocrine, Neurological and Infection Related Illness in Torrance, California.
He says, "We're at the point now where we know diet plays a role in this disease -- it's just not the same diet for everybody. And not everybody is helped in the same way."
Rheumatology experts like Alex Shikhman, MD, believe the diversity of dietary approaches may have less to do with the impact on fibromyalgia, and more to do with treating a secondary, possibly undiagnosed illness.
"When patients are helped by a specific dietary measure," says Shikhman, who is director and founder of the Institute for Specialized Medicine in San Diego, "it is often because of the presence of a secondary condition that does have a recognized response to diet. And when you take care of that, you do get some relief from all the symptoms. You feel better overall."
There are a number of co-existing health conditions that have a tendency to occur in people with fibromyalgia. Many of these have overlapping symptoms.
These include
gluten intolerance
, gout (a form of arthritis),
and restless legs syndrome.
Some doctors believe food sensitivity itself could sometimes be responsible for some of the pain and fatigue of fibromyalgia.
Moreover, Holtorf points out that because each of these secondary conditions responds to a different dietary approach, it's not hard to understand why "different dietary recommendations are reported to work."
Shikhman believes that sometimes fibromyalgia may even be the wrong diagnosis. That's another reason, he says, we can sometimes see such dramatic and immediate response to so many different dietary measures.
"Sometimes, if you carefully note which foods a patient responds to," Shikhman says, "you can actually get a significant clue as to the true nature of their underlying health problems.
And it might not always be fibromyalgia."
Fibromyalgia: Seven foods to avoid
While there may not be a single set of dietary guidelines that are right for all fibromyalgia patients, there are certain foods, or food groups, that appear to make a difference for a significant number of people.
But remember, avoiding these foods is not a guarantee that your symptoms will change. Also, avoiding one group may offer benefit while another may make no difference at all.
Nevertheless, the experts WebMD talked to agree that eliminating at least some of these foods is worth a try.
1. Aspartame (NutraSweet). All the experts WebMD talked to agree that for a large majority of people with fibromyalgia, foods sweetened with aspartame could exacerbate fibromyalgia symptoms.
"There is a pain receptor in the nervous system known as NMDA," says McNett. "When pain turns from acute to chronic, it involves opening the NMDA pain receptor. Aspartame, which is classified as an excitotoxin, helps to stimulate this event."
He also says people with fibromyalgia appear to already have overly active NMDA pain receptors, making them more susceptible to the stimulation.
In one study published in the Journal of Rheumatology in 2006, experts found patients with fibromyalgia did have an increased expression of NMDA receptors in their skin. This indicated a general increase in activity of peripheral nerves.
Holtorf says aspartame may play a role in stimulating those nerve pathways. Then he adds that for some people, "cutting it out of their diet can have a dramatic impact on pain."
That appeared to be the case for patients in one small study published in the Annals of Pharmacotherapy in 2001. Researchers found that, when patients with fibromyalgia avoided aspartame as well as the flavor enhancer MSG, they felt better overall.
Other artificial sweeteners such as
Splenda,
saccharin,
and stevia do not appear to have the same effect as aspartame.
2. Food additives including MSG (monosodium glutamine) and nitrates. MSG is an additive or flavor enhancer that's found in many processed and frozen foods and in some Asian cuisines. Experts say it can intensify pain symptoms in many individuals.
Like aspartame, MSG is classified as an excitotoxin and has the same potential for affecting NMDA receptors.
The same is true, says McNett, for foods containing preservatives such as nitrates, commonly found in lunchmeats like ham or bologna or in bacon.
"A lot of people who don't have fibromyalgia can't tolerate nitrates or MSG very well. But one of the hallmarks of this condition is that it amplifies unpleasant reactions," McNett says.
"So a stimulus that some people would find mildly unpleasant becomes very unpleasant in those who have fibromyalgia."
Cutting these ingredients out of the diet, he adds, usually helps.
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