Believe it or not, fibromyalgia is a fairly new diagnosis. The American Medical Association (AMA) first defined it as a disease in 1987; however, it’s diagnosis has been controversial over the years with many physicians believing it is more of a psychiatric illness related to stress and other mental factors. (3) For individuals suffering from fibromyalgia, the associated pain and disability are very real. A comprehensive, integrative approach that includes diet, lifestyle, and supplement interventions may be beneficial in managing the condition.

Fibromyalgia definition

The ICD-10 diagnosis code describes fibromyalgia as a chronic musculoskeletal and connective tissue disorder, leading to inflammation and fibrous degeneration of muscles. The condition is characterized by pain, stiffness, and tenderness in the muscles of the neck, shoulders, back, arms, hips, and legs. Individuals may also report experiencing sleep disturbances, headache, fatigue, and painful menstruation. To date, the etiology of fibromyalgia remains unknown.

The Centers for Disease Control and Prevention (CDC) reports that conventional medicine utilizes pharmaceuticals, including prescription medications and over-the-counter drugs to manage pain symptoms.

In addition to widespread pain and fatigue, the CDC states that cognitive difficulties, including inability to focus, pay attention, and concentrate, are also hallmark symptoms of fibromyalgia. (6)

Fibromyalgia is not an autoimmune condition, however, comorbidity of autoimmune diseases such as rheumatoid arthritis and lupus can occur. (20)

Fibromyalgia causes and diagnosis

While the exact cause of fibromyalgia remains unclear and is likely highly individualized, researchers have found that patients with this condition experience changes in the way the brain processes pain signals, causing painful sensations to become amplified. (11)

Because pain is present in all cases of fibromyalgia, analyzing pain is a key diagnostic goal. There are two types of fibromyalgia pain evaluated when diagnosing this condition:

  1. Widespread pain, which indicates that pain is on both sides of the body, above and below the waist.
  2. Tender points, which occur in 18 different sites of the body and are painful upon digital palpation. A minimum of 11 painful tender points is required to diagnose fibromyalgia. (2)

Treatment and natural remedies for fibromyalgia

There are several approved pharmaceuticals for fibromyalgia treatment with the most common being pregabalin (Lyrica). Due to the potential of side effects, a non-pharmaceutical approach to treatment may be preferable. This includes modifying diet and lifestyle habits, as well as evaluating nutrient deficiencies and considering nutrient interventions.

Fibromyalgia diet

According to a 2019 systematic review, diets that can improve pain and quality of life for people with fibromyalgia include a hypocaloric (or low calorie) diet, the low-FODMAP diet, and a raw vegetarian diet. (18) In that review, these three diets reduced markers of inflammation, improved sleep quality, and reduced anxiety and depression. Other research shows that a raw vegetarian diet can also significantly improve pain in patients with fibromyalgia. (9)

Image of extra virgin olive oil

Research has shown extra virgin olive oil may improve the physical and mental health of individuals with fibromyalgia.

In addition, research has highlighted the potential benefits of certain foods and components of food. For example, a 2016 study featuring women with fibromyalgia found that the women who consumed extra virgin olive oil (EVOO) had better physical and mental health compared to those who ate other refined oils, which do not have the anti-oxidants found in EVOO. (16)

Another 2016 study found that women with fibromyalgia who ate foods high in anti-oxidants had better pain management and improved quality of life compared to the control group. (6)

Proactive symptom management

In addition to dietary recommendations, there are other proactive steps patients can take to better manage the symptoms associated with fibromyalgia.

Acupuncture for fibromyalgia

Acupuncture has been shown to help patients cope with various fibromyalgia symptoms, including pain, fatigue, sleep issues, and quality of life. According to a 2013 Cochrane review, acupuncture with electrical stimulation was better at reducing fibromyalgia symptoms compared to needling alone. (7)

Yoga for fibromyalgia

Several studies have shown that yoga can help improve pain, fatigue, and mood in patients with fibromyalgia. (5) Research has also shown that when yoga is combined with other mindfulness activities such as meditation, patients are better able to cope with their symptoms, experience less anxiety, and have better overall mental health. (4)

Correcting nutrient deficiencies

Individuals with fibromyalgia may have nutrient deficiencies that can exacerbate their symptoms including:

Calcium and magnesium may also be a factor. While deficiencies in these two minerals have not been specifically linked to fibromyalgia, low dietary intake of these important minerals is correlated with increased pain. (1)

Nutrient interventions to consider

While correcting nutrient deficiencies is important, additional nutrient interventions may be worth considering for people who have been diagnosed with fibromyalgia.

5-HTP

5-Hydroxytryptophan (5-HTP) is an amino acid that is naturally produced in the human body from the amino acid tryptophan and is a precursor of the neurotransmitter serotonin. A short-term open trial demonstrated that 5-HTP improved pain intensity, the number of tender points, sleep, fatigue, anxiety, and overall quality of life in patients with fibromyalgia. (17)

Acetyl-L-carnitine

In the human body, acetyl-L-carnitine is derived from the amino acid L-carnitine. A double-blind, placebo-controlled multi-center trial showed that acetyl-L-carnitine provided pain improvement and mental health benefits to fibromyalgia patients. (15)

Coenzyme Q10

Studies indicate that coenzyme Q10 (CoQ10) can help support optimal energy in individuals with fibromyalgia. A review of intervention studies demonstrated that CoQ10 improved symptoms of fatigue in patients diagnosed with fibromyalgia. (12)

Ribose

Produced in the body, ribose is a simple carbohydrate involved in energy production. A pilot study showed that ribose improved fibromyalgia pain intensity, sleep disturbances, energy levels, mental clarity, and overall well-being. (19)

The bottom line

Fibromyalgia is a complex condition and we continue to learn more about its etiology, useful diagnostic methods, and effective treatments. The best approach to managing symptoms should include a comprehensive examination of diet, movement, mindfulness, and certain nutrient interventions.

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  1. Andretta, A., Batista, E., Schieferdecker, M.E., Petterle, R., Boguszewski, C.L., & dos Santos Paiva, E. (2019). Relation between magnesium and calcium and parameters of pain, quality of life and depression in women with fibromyalgia. Advances in Rheumatology, 59(55). https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-019-0095-3
  2. Bellato, E., Marini, E., Castoldi, F., Barbasetti, N., Mattei, L., Bonasia, D.E., & Blonna, D. (2012). Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment. Pain Research and Treatment, 2012. https://doi.org/10.1155/2012/426130
  3. Bennett, R. M. (1987). Fibromyalgia. JAMA, 257(20), 2802-2803. https://jamanetwork.com/journals/jama/article-abstract/366274
  4. Carson, J. W., Carson, K. M., Jones, K. D., Mist, S. D., & Bennett, R. M. (2012). Follow-up of yoga of awareness for fibromyalgia: results at 3 months and replication in the wait-list group. The Clinical Journal of Pain, 28(9), 804–813. https://doi.org/10.1097/AJP.0b013e31824549b5
  5. Carson, J. W., Carson, K. M., Jones, K. D., Bennett, R. M., Wright, C. L., & Mist, S. D. (2010). A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain, 151(2), 530–539. https://doi.org/10.1016/j.pain.2010.08.020
  6. Centers for Disease Control and Prevention. (2020, Jan 6). Fibromyalgia. https://www.cdc.gov/arthritis/basics/fibromyalgia.htm
  7. Deare, J. C., Zheng, Z., Xue, C. C., Liu, J. P., Shang, J., Scott, S. W., & Littlejohn, G. (2013). Acupuncture for treating fibromyalgia. The Cochrane database of systematic reviews, 2013(5), CD007070. https://doi.org/10.1002/14651858.CD007070.pub2
  8. de Miranda, R., Paiva, E.S., Cadena, S.M., Brandt, A.P., & Vilela, R.M. (2017). Polyphenol-rich foods alleviate pain and ameliorate quality of life in fibromyalgic women. International Journal for Vitamin and Nutrition Research, 87:66-74. https://doi.org/10.1024/0300-9831/a000253
  9. Donaldson, M.S., Speight, N., & Loomis, S. (2001). Fibromyalgia syndrome improved using a mostly raw vegetarian diet: an observational study. BMC Complementary and Alternative Medicine, 1, 7. https://doi.org/10.1186/1472-6882-1-7
  10. Ellis, S.D., Kelly, S.T., Shurlock, J.H., & Hepburn, A. (2018). The role of vitamin D testing and replacement in fibromyalgia: a systematic literature review. BMC Rheumatology, 2(28). https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-018-0035-6
  11. Jahan, F., Nanji, K., Qidwai, W., & Qasim, R. (2012). Fibromyalgia syndrome: an overview of pathophysiology, diagnosis and management. Oman Medical Journal, 27(3), 192–195. https://doi.org/10.5001/omj.2012.44
  12. Mehrabani, S., Askari, G., Miraghajani, M., Tavakoly, R., & Arab, A. (2019). Effect of coenzyme Q10 supplementation on fatigue: a systematic review of interventional studies. Complement Ther Med, 43, 181-187. https://www.ncbi.nlm.nih.gov/pubmed/30935528
  13. Ortancil, O., Sanli, A., Eryuksel, R., Basaran, A., & Ankarali, H. (2010). Association between serum ferritin level and fibromyalgia syndrome. Eur J Clin Nutr, 64(3), 308-12. https://www.ncbi.nlm.nih.gov/pubmed/20087382
  14. Regland, B., Forsmark, S., Halaouate, L., Matousek, M., Peilot, B., Zachrisson, O., & Gottfries, C. G. (2015). Response to vitamin B12 and folic acid in myalgic encephalomyelitis and fibromyalgia. PloS One, 10(4), e0124648. https://doi.org/10.1371/journal.pone.0124648
  15. Rossini, M., Di Munno, O., Valentini, G., Bianchi, G., Biasi, G., Cacace, E., Malesci, D., La Montagna, G., Viapiana, O., & Adami, S. (2007). Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients. Clin Exp Rheumatol, 25(2), 182-8. https://www.ncbi.nlm.nih.gov/pubmed/17543140
  16. Russ, A., Molina, F., Ramos, M., Martinez-Ramirez, M.J., & del Moral, M.L. (2016). Extra virgin olive oil improves oxidative stress, functional capacity, and health-related psychological status in patients with fibromyalgia: a preliminary study. Biological Research For Nursing, 19(1), 106-115. https://doi.org/10.1177/1099800416659370
  17. Saarzi Puttini, P., & Caruso, I. (1992). Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90-day open study. J Int Medicine, 20(2), 182-9. https://www.ncbi.nlm.nih.gov/pubmed/1521674
  18. Silva, A.R., Bernardo, A., Costa, J., Cardoso, A., Santos, P., de Mesquita, M.F., Vaz Patto, J., Moreira, P., Silva, M.L., & Padrao, P. (2019). Dietary interventions in fibromyalgia: a systematic review. Annals of Medicine, 51(S1), S2-S14. https://doi.org/10.1080/07853890.2018.1564360
  19. Teitelbaum, J.E., Johnson, C., & St. Cyr, J. (2006). The use of d-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study. The Journal of Alternative and Complementary Medicine, 12(9), 857-862. https://pubmed.ncbi.nlm.nih.gov/17109576/
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