# Fibromyalgia and Diet



## Jan LEAP RD (May 19, 2002)

I'm looking for info from anybody that can tell me how diet changes have helped your fibromyalgia. (Lisa and Donna??? -HELP)I'm having a discussion with about 1000 Registered Dietitians on my ADA listserv. Some of them are claiming that diet changes don't help fibromyalgia!!! Arrrrgh. . . RDs like that give the rest of us a bad name. . . but I guess you've known a lot of clueless MDs as well. . .







So, any comments, links you'd like to help me out with? I'll sure pass them on, and who knows how many other fibromyalgia clients we can help by spreading the word to RDs.







TIA


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## ohnometo (Sep 20, 2001)

Hi JanMaybe someone on this board can help you http://www.ibsgroup.org/cgi-local/ubbcgi/u...&f=9&submit=Go..[/URL]. So far the Doctor's hasn't given me that label yet







Lisa has been missing in Action for sometime now...but I know by talking to her that working with LEAP helped her fibromyalgia ALOTand in her success story she talks about it..JanClick here http://www.ibsgroup.org/cgi-local/ubbcgi/u...c;f=17;t=000018 Maybe this will help someHappy Holidays to you and your family


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## Mike NoLomotil (Jun 6, 2000)

JANAch! I have some abstracts on the subject...at the office both hard copy and in my PC. When I am able to work my way into some time to send them to you I will. Please email me a reminder that I promised to send you some FMS papers on food and chemcial hypersensitivity so I do not forgetthanksMikePSSux, but Of course they beleive diet changes will not help FMS. If you do not have the correct tool you cannot turn the correct widget so indeed nothing happens.It is when you reject the fact that the correct tool may exist, biased-thinking, that you violate your obligations to the patient as a caregiver. That is what is inexcusable: to conclude that something which does not exist within your realm of personal experience simply does not exist. And then perpetrating the myth is simply more evidence of the existence of the human ego.


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## Susan Purry (Nov 6, 2001)

What I'd find really interesting is knowing _why_ and _how_ dietry changes may effect Fibromyalgia symptoms and symptom severity. Can anyone offer any information on this? (I understand it with IBS, not with Fibromyalgia).


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## htyson (May 23, 2002)

Hi







I couldn't understand that one either Susan, however, finally got something of an explanation from my Dr...The way he put it, is that both IBS AND Fibromalygia are Auto-Immune diseases, and can be triggered or certainley amplified by intollerance/sensitivity to certain foods...Seems to make sense in my case at least, as have been following an "elimination" programme and both seem to be improved...?Here's hoping anyway!!


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## mikeralph (Jan 27, 2003)

SUGAR and ALCOHOL are the worst triggers for most people. that is a gimme.


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## Mike NoLomotil (Jun 6, 2000)

Without having to post all the references, since the Merck Manual authors studied them already, the most obvious link between the two conditions is th fact that there is a subpopulation of IBS sufferers (dirraheic component) whose symptoms are provoked by food intolerance.While food allergy occurs ocassionally in IBS, it is a distinct comorbidity since the patient will show food-specific immuniglobulins in plasma for the offending foods.The majority of the reactions however are either cell-mediated (so no circulating IgE is seen for example) and begin in the small bowel, then proliferate, and/or theyalso involve mast cell activation as noted in many studies and the Merck Manual. The erarliest sign of this was the finding of elevated prostaglandin E2 levels in the stool....PGE2 of course is synthesized my mast cells, and the patients activation correlated with blind oral challenge.In later years not onlw was "mucosal" (mas cell) activatio confirmed by newer methods of jejunal isolation and challenge, and jejunal bippsy, but it was also discovered that cell-meddiated reactions also occur, resprsenting malfunction of the oral tolerance mechanisms.WHY do SOME Fibromyalgia patients respond to dietart therapy, and some do not?The one thing that has been confirmed clearly is systemic mast cell activation as a pain-pressure generating mecahnism through both PGE2 aand Leukotrines (LTB4 specifically) being found in the plasma and the muscle.The probelm with therapy is that the (2) primaery things that have to be isolated isa) are excitatory cytokines involved are other emdiators involved including prostglandins and leukotrienes and if do you must isolate what sepcifically is provoking the reactions.Causal basis for abnormal mast cell and cell-meduated reactions ar not allergy, as these patients are usually allergy-negative too...put (2) things are suspiisous just like in IBS...loss of oral tolerance (which is a bottom-up immunologic dysfunction) and direct CNS dysfunction (eithe primary or HPA dysfunction). There s work on this but so far it is oberviatory of some specific events, not linking them causally to the primary dysfunctions of mast cell acfivation in the tissue or circulating imunocyte activetion.In some patients, where there IS systemic cell mediated reaction, we can detetc this with MRT analysis just like in IBS and migraine, and assist witha diet patient specific. We can also implement diet therapy which is designed to try to isolate the MAST cell reactions within the tissue which cannot be detetcted by any known screen yet (since Ig[x] is not involved and circulating immunocytes are not needed to activate the tissue mast cells....so you have o use broad immunohistochemistry testing to look for SPECUFUC mediators presence....then try to find by orla challenge what may be provoking mediator release.No good protocol for this exists yet as it is a narrow-focus area hard to work in so far. _____________________________Acta Odontol Scand 2001 Dec;59(6):348-55 Pain mediation by prostaglandin E2 and leukotriene B4 in the human masseter muscle.Hedenberg-Agnusson B, Ernberg M, Alstergren P, Kopp S.Clinical Oral Physiology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden. The pathophysiology behind chronic pain from masticatory muscles is unclear. Our hypothesis was that this pain is of inflammatory origin and associated with release of inflammatory mediators. The aim of this study was therefore to investigate the presence of prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) in the masseter muscle and plasma and their relation to myalgia. Nineteen patients with fibromyalgia, 19 with local myalgia of the masseter muscle, and 11 healthy individuals were examined with regard to local muscular pain intensity at rest and pressure pain threshold. Inclusion criteria were masseter muscle pain for at least 3 months and masseter muscle tenderness on digital palpation. Samples were obtained from the masseter muscle by microdialysis, and the dialysates and venous blood samples were analyzed with regard to PGE2 and LTB4 concentration. Intramuscular levels were found in all groups, with significantly higher levels of LTB4 in the patients with fibromyalgia, in whom PGE2 was positively correlated to muscular pain. In the healthy individuals PGE2 was negatively correlated to pressure pain threshold. In both patient groups but not in the healthy individuals LTB4 increased during the consecutive samplings. PGE2 and LTB4 were detectable in the plasma of all groups. In conclusion, both PGE2 and LTB4 were found in the human masseter muscle. LTB4 levels are increased on needle trauma in patients with myalgia. PGE2 levels are related to muscular pain in patients with fibromyalgia. Masseter muscle pain therefore seems to be partly of peripheral inflammatory origin in fibromyalgia. ____________________________Ann Pharmacother 2001 Jun;35(6):702-6	Related Articles, Links Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins.Smith JD, Terpening CM, Schmidt SO, Gums JG.Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL, USA.BACKGROUND: Fibromyalgia is a common rheumatologic disorder that is often difficult to treat effectively. CASE SUMMARY: Four patients diagnosed with fibromyalgia syndrome for two to 17 years are described. All had undergone multiple treatment modalities with limited success. All had complete, or nearly complete, resolution of their symptoms within months after eliminating monosodium glutamate (MSG) or MSG plus aspartame from their diet. All patients were women with multiple comorbidities prior to elimination of MSG. All have had recurrence of symptoms whenever MSG is ingested. DISCUSSION: Excitotoxins are molecules, such as MSG and aspartate, that act as excitatory neurotransmitters, and can lead to neurotoxicity when used in excess. We propose that these four patients may represent a subset of fibromyalgia syndrome that is induced or exacerbated by excitotoxins or, alternatively, may comprise an excitotoxin syndrome that is similar to fibromyalgia. We suggest that identification of similar patients and research with larger numbers of patients must be performed before definitive conclusions can be made. CONCLUSIONS: The elimination of MSG and other excitotoxins from the diets of patients with fibromyalgia offers a benign treatment option that has the potential for dramatic results in a subset of patients. __________________________Since there are subsets of patients who do respond to removal of cytokine-related foods from the diet this is a simple place to start. Might be one of those and get lucky.Many patients do get assayed to see if there is any food or chemical provoked systemic inflammatory response and if so a dietary regimene based upon the offending food and chemcial removal will also help reduce symptoms. Again, loss of oral tolerance is not a physiogicx "cause" of the underlying disease, it is a characteristic of the dyndrome or disease and symptom egenrating mechanism which can be managed.perhps sharing some of this information with RD's will, if any objectivity is present, help them understand wht they have trouble with dietary therapy...and do not assume this measn that diet has naught to do wit symptom provocation.there are just few tools handy which are posessed of high specificity for provocation sources...and since the problems is dose dependent and delayed onset and the symptoms are a bit less drmatic than a severe diarrheic-expsulive event as in some IBS patients it ismore diffcult to manage. BUT it certainly is not anythjing to scoff at by any committed helathcare professional whis more concerned with the patient than in being "right".







MNL


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## Mike NoLomotil (Jun 6, 2000)

More for your skeptical colleagues...: Am J Med 1992 Apr;92(4):363-7	Comorbidity of fibromyalgia with medical and psychiatric disorders.Hudson JI, Goldenberg DL, Pope HG, Keck PE, Schlesinger LBiological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts 02178.PURPOSE: Patients with fibromyalgia have been reported to display high rates of several concomitant medical and psychiatric disorders, including migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder. To test further these and other possible associations, we assessed the personal and family histories of a broad range of medical and psychiatric disorders in patients with fibromyalgia. PATIENTS AND METHODS: Subjects were 33 women (mean age 42.1 years) who each met American College of Rheumatology criteria for fibromyalgia and presented to a rheumatologist at a tertiary referral center. They received the Structured Clinical Interview for DSM-III-R (SCID); a supplemental interview, in SCID format, for other medical and psychiatric disorders, including migraine, irritable bowel syndrome, and chronic fatigue syndrome; and an interview for family history of medical and psychiatric disorders. RESULTS: Patients with fibromyalgia displayed high lifetime rates of migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder. They also exhibited high rates of familial major mood disorder. CONCLUSIONS: The finding that migraine, irritable bowel syndrome, chronic fatigue syndrome, major depression, and panic disorder are frequently comorbid with fibromyalgia is consistent with the hypothesis that these various disorders may share a common physiologic abnormality. ____________________________MNLThere are studies which show that proinflammatory mediator release is directly associated with depression too......







people should do their homework before they give you the thumbs down, lest they appear to have their thumb conveneiently resting in a more discrete location.


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