10 Diet Commandments for Pain Patients
What is the fibromyalgia-food connection?
By Mara Betsch, Health.com
Fibromyalgia is a chronic condition whose symptoms include muscle and tissue pain, fatigue, depression, and sleep disturbances; it often mimics or appears together with other chronic conditions such as irritable bowel syndrome (IBS), lupus, and arthritis. "There are usually other things that are triggering it, so you have to individualize treatment for each patient," says Daniel Arkfeld, MD, an associate professor of clinical medicine at the Keck School of Medicine at the University of Southern California.
Because it is such a complex condition, fibromyalgia is difficult to treat. Medication tends to reduce symptoms only by about 30% to 50%. Many patients seek diet and lifestyle changes as treatment; in one survey, 42% of patients reported that certain foods aggravated their symptoms.
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How Does Food Affect Pain?
Recent data suggests that central sensitization, in which neurons in the spinal cord become sensitized by inflammation or cell damage, may be involved in the way fibromyalgia patients process pain. Certain chemicals in the foods patients eat may trigger the release of neurotransmitters that heighten this sensitivity, Dr. Arkfeld explains. Because of this, fibromyalgia patients often have food sensitivities that may not show up in food allergy tests.
Although there have only been a handful of studies on diet and fibromyalgia—with no definitive links found—experts suggest that the following 10 healthy eating rules can’t hurt, and may help, people dealing with chronic pain.
Fresh Foods, Mostly Plants
Because many fibromyalgia patients have food sensitivities, eating a diet of fresh foods, devoid of preservatives and additives, may ease symptoms triggered by coexisting conditions such as IBS, according to Dr. Arkfeld. Several studies have shown improvement of symptoms in fibromyalgia patients who followed vegan and vegetarian diets, although most of the patients in those studies chose to discontinue the diets after the study. Simply cutting back on the amount of red meat in your diet may help as well.
It’s also a good idea to buy organic food when possible, says Dr. Arkfeld. “Some patients do better avoiding pesticides and chemicals.”
Lay off the Caffeine
Fibromyalgia is believed to be linked to an imbalance of brain chemicals that control mood, and it is often linked with unrestful sleep and fatigue. Fibro patients may try to ease fatigue with stimulants like caffeine, but they may end up doing more harm than good in the long run.
“Caffeine is a loan shark for energy. We recommend not using a lot,” says Kent Holtorf, MD, the founding medical director of the Fibromyalgia and Fatigue Centers, which are located across the country. He explains that though caffeine provides an initial boost of energy, it is no substitute for sleep; in fact, it can stay in your system for several hours and keep you awake long after you’ve finished a cup of joe.
The Veggie Paradox
"For joint pains, a lot of people say avoid nightshade vegetables," says Dr. Arkfeld. Normally veggies are low-cal, healthy options, but the nightshade variety—including tomatoes, potatoes, and eggplant—are suspected to trigger arthritis and pain conditions in some people. "The thought is that they have components that are neurotoxins. For a small percentage of patients, cutting them out makes a dramatic difference," says Dr. Holtorf. Though there is anecdotal evidence of these foods exacerbating symptoms, research hasn't proven these plants to be harmful.
Omega-3 fatty acids, found in salmon and a variety of fish, have been touted as a heart-healthy food, but they may help with pain, as well. "The fatty acids are great," says Dr. Holtorf. "They reduce the inflammation and help brain function." A 2006 survey of arthritis patients found that daily fish oil supplements reduced pain symptoms in 60% of the patients. Omega-3s have not, however, been tested on fibromyalgia patients specifically.
Beware Yeast and Gluten
Yeast, along with its partner in crime, gluten, can be found in a variety of baked goods. Consuming yeast may also contribute to the growth of yeast fungus in the body, says Dr. Holtorf, which can contribute to pain. Fibromyalgia patients may also be more prone to gluten sensitivities. "Celiac disease is seen in a subset of patients. Avoiding [yeast and gluten] can help some patients improve," says Dr. Arkfeld.
Easy on the Milk
Some degree of lactose intolerance affects about 70% of adults worldwide, so it's not surprising that many fibromyalgia patients have trouble digesting milk and dairy products as well. In a 1998 study, researchers tested whether blood samples taken from 40 fibromyalgia patients reacted to substances found in various foods; the blood of 25% of the subjects demonstrated an immune response to cow dairy products. Patients on vegan diets have also been shown to improve symptoms.
The patients in the 1998 study, who were given a personalized diet based on their blood samples, reported that their overall health was about twice as good after six months on the diet, but since other foods (such as shrimp and chocolate) were avoided, and because dietary supplements were also used, the exact link between dairy and fibromyalgia was unclear.
Prevent Carbo Crash
“If I had to choose one particular diet for fibromyalgia patients, I would choose a low-carb, low-sugar diet," says Dr. Holtorf. "About 90% of fibromyalgia patients have low adrenal functioning," he adds, which affects the metabolism of carbohydrates and may lead to hypoglycemia. These people crave sugar, but they also experience the crash that follows the initial energy high. "If you're hypoglycemic, you want to keep that sugar level as stable as possible. Try carbs with a mix of protein and fat," says Dr. Arkfeld.
"Getting off of [aspartame] can make some pain patients feel much better," says Dr. Holtorf. The artificial sweetener found in diet sodas and many sugar-free sweets is part of a chemical group called excitotoxins, which activate neurons that can increase sensitivity to pain. Though aspartame isn’t dangerous to healthy people when consumed in moderation, fibromyalgia patients are already sensitive to pain, and aspartame may heighten their sensitivity.
Some artificial sweeteners, most notably sorbitol and xylitol, can trigger IBS as well. Since about half of fibromyalgia patients suffer from IBS, "foods that irritate your bowel will trigger the body to send a message to the brain that signals fibromyalgia symptoms," Dr. Arkfeld adds.