There is a wealth of information on how to manage fibromyalgia symptoms by making choices about the foods you eat. If you investigate diets for fibromyalgia, you’ll find all kinds of advice, and some of it sounds quite authoritative. Are any of these dietary interventions truly effective? Could living better with fibro really be as simple as changing your diet? What do the scientific studies tell us?
In this article, we review the research on dietary changes and supplements to see what approaches are most likely to help with fibromyalgia symptoms. We take a deep dive into the evidence behind the impact, giving you the information you need to make an informed decision about your approach to finding the best diet for your fibromyalgia.
Why Use Diet as a Fibromyalgia Treatment?
Many people with fibro report that certain foods make their symptoms worse.¹ And the research indicates that there are indeed certain dietary approaches that can improve fibromyalgia symptoms. These findings suggest that you may be able to reduce your pain, fatigue, sleep problems, and other symptoms – at least to some degree – by changing what you eat.
Trying a balanced fibromyalgia diet plan along with your other approaches to treatment, like medication and movement, can make sense as part of a holistic treatment plan. A healthy diet will support your overall well-being, not only your experience of fibromyalgia, and it’s unlikely to have negative side effects. It’s a low-risk, high-benefit strategy.
Learn more about fibromyalgia and diet in our video with Dr. Ginevra Liptan and Dr. Andrea Chadwick.
Types of Diet Plans for Fibromyalgia
So, what is the best diet for fibromyalgia? Delving into the research, we see that there is no single fibromyalgia diet but rather several that offer potential benefits. Let’s take a look at three diets that may be helpful for fibromyalgia, according to a research review.
The Low-FODMAP Diet
The low-FODMAP diet for fibromyalgia is an approach with strong scientific support. According to a 2018 review of the seven highest-quality studies on the relationship between diet and fibromyalgia symptoms, people who followed the low-FODMAP diet had significantly less fibromyalgia pain and better mobility. Their gastrointestinal symptoms improved, as did their sleep, anxiety and depression, inflammatory biomarkers, and overall quality of life.
A low-FODMAP diet is designed to exclude certain kinds of carbohydrates that are difficult to digest. (FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.) The undigested carbohydrates feed bacteria in the small intestine, leading to a number of health problems – and, for some people, worsening symptoms of fibromyalgia.
On the low-FODMAP diet, foods to avoid include onions, garlic, cauliflower, and mushrooms; apples, cherries, nectarines, and peaches; dairy- and soy-based milk, ice cream, and yogurt; legumes (beans and lentils) and processed meats; breads and snacks containing wheat; cashews and pistachios; and high fructose corn syrup, honey, and artificial sweeteners.
Foods allowed in a low-FODMAP diet include eggplant, green beans, bell peppers, carrots, cucumbers, lettuce, potato, tomato, and zucchini; cantaloupe, grapes, oranges, strawberries, and pineapple; hard cheeses, feta cheese, brie, almond milk, and lactose-free cow milk; eggs, tofu, tempeh, meats, poultry, and seafood; corn, oats, and rice; peanuts, walnuts, and pumpkin seeds; and dark chocolate, maple syrup, rice syrup, and table sugar.
The low-FODMAP is quite restrictive and can be challenging to follow, since it takes a while to learn which foods to avoid. It’s best to consult with your doctor or a dietitian before making a major dietary change. They may recommend that you stay on the diet two to four weeks, then reintroduce other foods one at a time to see if they trigger your symptoms. If so, continue avoiding that food. If not, you can incorporate that food back into your diet.
The Mediterranean Diet
The Mediterranean diet is quite popular generally, not just among people with fibromyalgia, and with good reason. It emphasizes nutrient-rich foods and has been shown to reduce the risk of cancer² and cardiovascular disease.³
But research also suggests that it may also help improve fatigue, sleep problems, anxiety, and depression associated with fibromyalgia specifically.⁴ This study investigated the Mediterranean diet alone or combined with tryptophan and magnesium supplementation, and found that the diet plus supplementation was associated with the greatest improvements.
This approach to eating is based on traditional diets of people in the Mediterranean region. It includes plenty of vegetables and fruit; whole grains rather than refined flour, such as that in white bread and pasta; beans, low-fat dairy, cold-water fish (which is high in beneficial omega-3 fatty acids and vitamin D), and poultry as protein sources, with minimal red meat; and olive oil as the main source of fat. It’s naturally low in cholesterol and high in antioxidants, which help reduce inflammation. This may explain why it seems to be protective against cancer and ease fibromyalgia symptoms.
The Anti-Inflammatory Diet
Although the biological processes behind the connection are not fully understood, a range of studies have suggested that fibromyalgia might be linked in some way to inflammatory processes in the body. For this reason, anti-inflammatory diets are often recommended to people with fibro and other kinds of chronic pain, and research suggests they may be effective.⁵
Typically, an anti-inflammatory diet is defined as one that includes eight to nine servings of vegetables per day (two of which could be fruit), minimal or no dairy products, whole grains instead of refined flours, and no red meat. It is quite similar to the Mediterranean diet for fibromyalgia. The main difference is that the anti-inflammatory diet excludes dairy, while the Mediterranean diet allows it in moderation as long as it is low-fat.
As you compare these diets for fibromyalgia, you’ll notice that there is quite a bit of overlap. All of them emphasize vegetables and fruits, which are naturally high in inflammation-calming antioxidants. They all feature plant-based protein sources along with lean meats such as fish and poultry. And they all encourage whole grains and deemphasize refined flour. These similarities offer a simple way to think about what foods to focus on when you have fibromyalgia.
Other Foods to Avoid
When adjusting your diet to improve health, there are two categories to consider: foods to eat more of because they contain beneficial nutrients, like antioxidants, and foods to eat less of because they contain substances that trigger symptoms. With fibromyalgia, there are certain foods you may wish to avoid.
According to recent studies, the worst culprits are foods that contain excitotoxins. These are substances that strongly irritate the nervous system, to the point of toxicity if they are ingested in large quantities. Preliminary research has suggested that people with fibromyalgia may be able to reduce their symptoms by avoiding excitotoxins.⁶
One common class of excitotoxins is the flavor enhancers often found in processed foods. Check ingredient lists for monosodium glutamate (MSG) and also for the words “hydrolyzed,” “autolyzed,” “protein concentrate,” or “protein isolate,” which may signal other ingredients containing glutamate. Artificial sweeteners such as aspartame are also excitotoxins. More research is needed about how these substances relate to fibromyalgia symptoms, but foods containing them tend to be highly processed and low in nutritional value, so there isn’t much harm in avoiding them, and you may feel a lot better.
You might also consider avoiding meat. Several rigorous studies of diet and fibromyalgia symptoms have suggested that a vegetarian or vegan diet can be beneficial. The Mediterranean and anti-inflammatory diets exclude red meat, which may partly explain their effectiveness. Regardless, it’s best to avoid cured meats and those labeled “natural flavor added,” since they may contain naturally occurring monosodium glutamate.
A handful of research studies have suggested that a gluten-free diet can also be helpful for people with fibromyalgia.⁷ Participants in these studies experienced less pain, improved cognitive function and gastrointestinal symptoms, and better overall quality of life. More research is needed, but in the meantime, you can try this out for yourself by eliminating gluten for a period of time, tracking your symptoms, and noticing how you feel.
Supplements for Fibromyalgia
So far, we’ve focused on foods to eat and foods to avoid. But with some nutrients, it’s difficult to get enough simply from food. Extra intake of some vitamins and minerals can be helpful for certain health conditions. Are there supplements that can help with fibromyalgia? Research suggests that vitamin D and magnesium citrate are two with the most promise.
A randomized controlled trial found that supplementation with vitamin D significantly reduced pain in people with fibromyalgia, so this is one supplement you may wish to try.⁸ Vitamin D can also be found naturally in cold-water fish, but it can be difficult to get your daily recommended value from food alone; 35% of American adults have a vitamin D deficiency.
Magnesium can help reduce the body’s response to excitotoxins, and, according to one study, supplementation with magnesium citrate may help improve fibromyalgia symptoms.⁹ Leafy greens, beans and lentils, nuts, seeds, and bananas all contain magnesium.
If you decide to try new supplements or make changes to your diet, it’s best to consult with your doctor. You may also wish to consult with a dietitian who is familiar with fibromyalgia. Not all diets that are free of problematic foods or additives are nutritionally balanced or benefit your overall health. You’ll want to be sure you’re getting the right proportions of macronutrients (such as protein, carbohydrates, and fiber), as well as all the micronutrients your body needs.
Food is the fuel for everything you do, and it provides the building blocks for your body, so it’s not surprising that diet can make such a big difference in how you feel, including your experience of fibromyalgia. By adjusting what you eat, you may be able to reduce some of your symptoms and find more freedom to do the things you love. Everyone is different, so take some time to experiment with your food choices, keep notes, and discover what works for you.
Finding Experts in Fibromyalgia and Diet
If you or someone you know has fibromyalgia, you can access fibromyalgia specialists in several states through virtual visits with Swing Care, with services covered by major insurance plans. Visit www.swing.care to learn more or to check your insurance benefits.
If you are experiencing symptoms of fibromyalgia, this fibromyalgia self-test based on a standardized diagnostic tool may help you determine whether you may need professional evaluation for fibromyalgia from a physician. However, this is not a diagnosis, and Swing Care clinicians are available for a consultation to discuss your symptoms and history, as well as other potential diagnoses.
Medically reviewed by Dr. Andrea Chadwick
Sources
¹ Silva, A. R., Bernardo, A., Costa, J., Cardoso, A., Santos, P., de Mesquita, M. F., Patto, J. V., Moreira, P., Silva, M. L., & Padrão, P. (2019). Dietary interventions in fibromyalgia: a systematic review, Annals of Medicine 51:sup1, 2-14, DOI: 10.1080/07853890.2018.1564360.
² Mentella, M. C., Scaldaferri, F., Ricci, C., Gasbarrini, A., & Miggiano, G. A. D. (2019). Cancer and Mediterranean Diet: A Review. Nutrients 11(9), 2059. https://doi.org/10.3390/nu11092059.
³ Widmer, R. J., Flammer, A. J., Lerman, L. O., & Lerman, A. (2015). The Mediterranean diet, its components, and cardiovascular disease. The American journal of medicine, 128(3): 229–238. https://doi.org/10.1016/j.amjmed.2014.10.014.
⁴ Martínez-Rodríguez, A., Rubio-Arias, J.Á., Ramos-Campo, D.J., Reche-García, C., Leyva-Vela, B., Nadal-Nicolás, Y. (2020). Psychological and sleep effects of tryptophan and magnesium-enriched mediterranean diet in women with fibromyalgia. Int. J. Environ. Res. Public Health 17, 2227.
⁵ Rondanelli, M., Faliva, M., Miccono, A., Naso, M., Nichetti, M., Riva, A., Guerriero, F., De Grrgori, M., Peroni, G., & Perna, S. (2018). Food pyramid for subjects with chronic pain: Foods and dietary constituents as anti-inflammatory and antioxidant agents. Nutrition Research Reviews, 31(1), 131-151. doi:10.1017/S0954422417000270.
⁶ Smith, J. D., Terpening, C. M., Schmidt, S. O., & Gums, J. G. (2001). Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins. The Annals of pharmacotherapy 35(6), 702–706. https://doi.org/10.1345/aph.10254.
⁷ Pagliai, G., Giangrandi, I., Dinu, M., Sofi, F., & Colombini, B. (2020). Nutritional interventions in the management of fibromyalgia syndrome. Nutrients 12(9): 2525. https://doi.org/10.3390/nu12092525.
⁸ Wepner, F., Scheuer, R., Schuetz-Wieser, B., Machacek, P., Pieler-Bruha, E., Cross, H. S., Hahne, J., & Friedrich, M. (2014). Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. Pain 155(2): 261–268. https://doi.org/10.1016/j.pain.2013.10.002.
⁹ Bagis, S., Karabiber, M., As, I., Tamer, L., Erdogan, C., & Atalay, A. (2013). Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia? Rheumatology international 33(1), 167–172. https://doi.org/10.1007/s00296-011-2334-8.
