Strict Low-Calorie Diet Reduces Fibromyalgia Symptoms

By Pat Anson, PNN Editor

Fibromyalgia patients with obesity experienced a significant reduction in pain and other symptoms after three weeks on a strict low-calorie diet, according to a new study that suggests limiting calories – not just weight loss – can have an analgesic effect.

Researchers enrolled nearly 200 patients diagnosed with fibromyalgia who were participating in a weight management program at the University of Michigan Health System. Participants had an average body mass index (BMI) of 41, which is considered severe obesity.

For 12 weeks, they were put on a very low energy diet (VLED) that limits bread, rice, potatoes and other foods that are high in carbohydrates. VLED is designed to shift the body away from using glucose in sweet or starchy foods to burning its own body fat for energy. Study participants were limited to just 800 calories a day, less than half the amount recommended for adult women and only a third of the amount recommended for men.

After just three weeks on the restricted diet, nearly three out of four participants (72%) experienced symptom reductions of 30% or more, regardless of the amount of weight lost. Patients who showed little or no improvement had a higher BMI at the start of the study and were more likely to have had a diagnosis of depression.

“Our results show, for the first time, that individuals following aggressive calorie restriction, ie, a VLED, had rapid and significant improvements in pain distribution and common pain-related comorbid symptoms and, importantly, prior to the achievement of significant weight loss,” researchers reported in the journal ACR Open Rheumatology.

“Furthermore, improvement at week 3 was strongly associated with improvement over the entire 12-week course of VLED, suggesting that patients who respond are likely to show these effects early in the process. These findings provide preliminary support for the hypothesis that calorie restriction, per se, can reduce pain and comorbid symptoms in individuals with obesity.”

Fibromyalgia is a poorly understood disorder characterized by widespread body pain, fatigue, poor sleep and depression. The FDA has approved three drugs to treat fibromyalgia -- duloxetine (Cymbalta), milnacipran (Savella) and pregabalin (Lyrica) -- but many patients say the drugs are ineffective and often have side effects.  

Previous studies have suggested that weight loss can help lower pain levels, but the improvement was thought to be caused by reduced stress on knees, hips and lower back – parts of the body that are weight-bearing.  

The new study suggests that a strict diet alone can significantly reduce fibromyalgia pain without major weight loss, but researchers caution that more studies are needed to fully understand the biological processes at work.

“The implications of this study suggest an early association between caloric restriction, through a VLED, and fibromyalgia symptoms. Although a larger study with a control group would be the next step in investigating this association, this provides important information for clinicians who counsel patients on alternatives to pharmacologic treatments for pain and other somatic symptoms,” researchers concluded.     

Many previous studies have shown that a low calorie diet can help reduce pain levels. A 2018 study at the University of Michigan found that obese patients on a low-calorie liquid diet for 12 weeks not only had lower pain levels in their knees and hips, but also in unexpected areas such as the abdomen, arm, chest and jaw. Study participants who lost 10% of their weight also reported better mental health, improved cognition and more energy.

How to Avoid the Holiday Blues

By Pat Anson, PNN Editor

For many of us, the holiday season wouldn’t be complete without Christmas cookies, jelly donuts, plum pudding, chocolate babka, or even the much-maligned fruit cake.

But if you're prone to depression or have an inflammatory condition, you might want to avoid those sweet treats. Or at least enjoy them in moderation.

New research by clinical psychologists at the University of Kansas suggests that dietary sugars found in many holiday foods can trigger metabolic, inflammatory and neurobiological processes that can lead to insomnia, digestive problems and depression – which all enhance physical pain.

"A large subset of people with depression have high levels of systemic inflammation,” said lead author Stephen Ilardi, PhD, an associate professor of clinical psychology at KU. "When we think about inflammatory disease we think about things like diabetes and rheumatoid arthritis - diseases with a high level of systemic inflammation. We don't normally think about depression being in that category, but it turns out that it really is.

“We also know that inflammatory hormones can directly push the brain into a state of severe depression. So, an inflamed brain is typically a depressed brain. And added sugars have a pro-inflammatory effect on the body and brain."

Depression Causes Sugar Cravings

Dwindling daylight in winter can worsen depression and prompt people to consume more sweets, which provide a temporary emotional lift.

"One common characteristic of winter-onset depression is craving sugar," Ilardi said. "So, we've got up to 30% of the population suffering from at least some symptoms of winter-onset depression, causing them to crave carbs - and now they're constantly confronted with holiday sweets.

"When we consume sweets, they act like a drug. They have an immediate mood-elevating effect, but in high doses they can also have a paradoxical, pernicious longer-term consequence of making mood worse, reducing well-being, elevating inflammation and causing weight gain."

The KU research team analyzed a wide range of studies on the physiological and psychological effects of sugar, including the Women's Health Initiative study, the NIH-AARP Diet and Health Study, and studies of Australian and Chinese soda-drinkers. Their research is published in the journal of Medical Hypotheses.

Ilardi says consuming high amounts of sugar could be as physically and psychologically harmful as drinking too much liquor.

"We have pretty good evidence that one alcoholic drink a day is safe, and it might have beneficial effect for some people," Ilardi said. "Alcohol is basically pure calories, pure energy, non-nutritive and super toxic at high doses. Sugars are very similar."

The average American gets about 14% of their calories from added sugars – the equivalent of 18 teaspoons of sugar each day. Most people know a high-sugar diet can lead to diabetes, obesity and cardiovascular problems.

Another way to look at sugar is to think of it as fuel for bacteria.  

"Our bodies host over 10 trillion microbes and many of them know how to hack into the brain," Ilardi said. "The symbiotic microbial species, the beneficial microbes, basically hack the brain to enhance our well-being. They want us to thrive so they can thrive.

“But there are also some opportunistic species that can be thought of as more purely parasitic - they don't have our best interest in mind at all. Many of those parasitic microbes thrive on added sugars, and they can produce chemicals that push the brain in a state of anxiety and stress and depression. They're also highly inflammatory."

Ilardi recommends eating a minimally processed diet rich in fruits, vegetables, fish and whole grains, while avoiding red meats, refined grains, fructose and other unhealthy foods. As for sugar, the KU researcher urges moderation -- not just during the holidays, but year-round.

You're as Healthy as the Food You Eat

By Barby Ingle, PNN Columnist  

It’s important that patients with chronic pain conditions maintain a healthy lifestyle, including getting enough sleep, exercising and eating healthy foods. I know this is so much easier said than done.

You are what you eat, right? We hear this often growing up, but what does it really mean? If I have a cupcake or a slice of cheesecake, am I going to live through the night? Over course I am. But day after day of poor eating will have long-term health consequences. And when our health is poor, other aspects of life are also likely to suffer.

Patients with chronic pain and illness typically lead a more sedentary lifestyle. Because we are less active and burn off fewer calories, we are at greater risk for developing other medical problems such as cardiovascular disease, diabetes and osteoporosis. I myself have been dealing with poor posture and sudden weight gain and loss. I fall easily and have trouble gripping and holding onto things. 

One area we have more control over is what we eat and who we are eating with. When I’m at home, my spouse cooks meals for me. I used to just let him choose what he wanted to make because I was just happy to have a meal prepared for me.

I have been really working on my eating habits since being diagnosed as "skinny fat" last year. I had to change where I am eating, how I am eating and what I am eating. Although my husband doesn’t eat the same food as me most of the time, my healthier habits have rubbed off on him.

I make a grocery list for what I want to eat, instead of just eating what he prepares for himself. I also now eat about 6 times a day instead of 3 bigger meals and a snack. 

Hopefully those around you are supportive of you making changes in your diet. When they see you make a conscious effort to choose your own meal and set your own portion limits, they may be empowered to pay attention to their own habits. You don’t have to say “no” to everything, just keep indulgences under control, eat smaller portions and be mindful of what you are eating.  

As a former athlete, I know nutrition is crucial for good performance outcomes. But when I got sick, I let all of that go. I had more important challenges to focus on, or so I thought.

Nutrition plays a role in chronic pain and how we prepare our bodies to cope with the stress.  Make sure your doctor is doing frequent blood testing to check for any deficiencies you may develop. A friend of mine developed Hypokalemia, a potassium deficiency that led to a psychological breakdown and two mental hospital stays.

Medications can also affect your liver, kidneys and digestive system. Blood testing can help prevent this from getting out of control and let you know if dietary supplements are needed to counter poor vitamin absorption.  

Maintaining good nutrition and hygiene may be difficult, but are very important. My new reality is that I am disabled and need to ask for help. I have to pay attention to what I eat, my hormones, my vitamins and everything I put on and in my body.

Eating is an important part of our lives and healing is a process. I have to control the parts of my life that I can to be able to live the life that I want.  

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website.  

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Can a Junk Food Diet Cause Osteoarthritis?

By Steve Weakley

Does what’s in your gut influence the pain in your knees? New research on mice at the University of Rochester Medical School suggests that it might, but the results are far from conclusive.

Researchers fed one group of laboratory mice a high fat diet that included red meat and milkshakes, and another group of mice a healthier low-fat diet. Both groups of mice had their knees surgically damaged to mimic the effects of osteoarthritis -- “wear and tear” arthritis that is often associated with age, obesity or injury.

Twelve weeks of the high fat diet made the mice obese and diabetic and led to more seriously damaged joints. It also created an imbalance of harmful bacteria in their digestive tracts. 

One group of the fat mice were then given a supplement containing the prebiotic fiber oligofructose (also available as an over-the-counter probiotic).  The researchers said the supplement did not cause the mice to lose weight, but it did greatly improve their blood sugar levels and the balance of healthy bacteria in their gut.  More importantly, the study concludes, the mice that were given the supplement also had healthier joints than the control group.

The University of Rochester study concluded that prebiotics and the correction of gut bacteria might help protect against osteoarthritis caused by obesity. And one of the researchers, Dr. Robert Mooney, told Forbes that the study suggests osteoarthritis may be accelerated or even caused by inflammation.

"That reinforces the idea that osteoarthritis is another secondary complication of obesity--just like diabetes, heart disease, and stroke, which all have inflammation as part of their cause," said Mooney. "Perhaps, they all share a similar root, and the microbiome (digestive bacteria) might be that common root."

However a critique by Britain’s National Health Service (NHS) said that conclusion might be premature.

“It's presumptuous to conclude that an imbalance of gut bacteria could be directly linked to risk of osteoarthritis in humans from the results of a study in mice with artificially induced knee damage. As such, there's no compelling evidence that prebiotics would prevent or reverse osteoarthritis,” the NHS said.

“Aiming for a healthy weight through a good diet combined with physical activity is a better strategy for reducing the risk of osteoarthritis (as well as many other long-term conditions) than taking prebiotics to try to combat the effects of a poor diet. “

Osteoarthritis is a joint disorder that leads to progressive joint damage. It can affect any joint in the body but is most commonly felt in weight bearing joints such as the knees and hips. Nearly 40 percent of Americans over the age of 45 have some degree of knee osteoarthritis.

Previous studies have also found a link between a high fat diet and osteoarthritis.  Australian researchers reported last year that a diet rich in animal fats, butter and palm oil weakens cartilage and produces osteoarthritis-like changes in the knee.

"We also found changes in the bone under the cartilage on a diet rich in saturated fat," said Professor Yin Xiao of Queensland University of Technology’s Institute of Health and Biomedical Innovation. "Our findings suggest that it's not wear and tear but diet that has a lot to do with the onset of osteoarthritis.”

The University of Rochester researchers hope to include humans in future studies on the effects of diet on osteoarthritis.

Losing Weight Helps Lower Pain Levels

By Pat Anson, Editor

Those of us who made a New Year’s resolution to lose weight have a little more incentive to keep our pledge – thanks to new research showing that even a small weight loss reduces overall body pain, as well as fatigue and depression.

The University of Michigan study, published in The Journal of Pain, involved 123 obese participants who were put on a low-calorie liquid diet for 12 weeks and asked to gradually increase their physical activity. The goal was to lose at least 10 percent of their body weight.

“It’s been known for some time that people who are obese tend to have higher levels of pain, generally speaking,” says Andrew Schrepf, PhD, a research investigator at Michigan Medicine’s Chronic Pain and Fatigue Research Center. “But the assumption has always been the pain is going to be in the knees, hips and lower back — parts of the body that are weight-bearing.”

Schrepf and his colleagues found that losing weight not only lowered pain levels in the knees and hips, but in unexpected areas such as the abdomen, arm, chest and jaw. Study participants who could reach the goal of losing 10% of their weight also reported better mental health, improved cognition and more energy. Men in particular showed improvements in their energy levels.

The results are significant because previous research hasn’t shown how weight loss affects widespread pain throughout the body.

“We know when people lose a lot of weight they tend to feel better,” Schrepf says. “But astonishingly, no one ever looked at where in the body the pain gets better.”

Researchers surveyed participants about their pain and other symptoms before and after the 12 week diet, using fibromyalgia assessment criteria to make their determinations. Participants were also evaluated and counseled by physicians and dietitians who specialize in endocrinology and obesity medicine.

Of the 123 participants, 99 were able to lose 10 percent or more of their body weight.

“The focus in the program is on calorie restriction and long-term weight loss, although all patients are encouraged to get more physically active for the other health benefits that exercise provides,” says Amy Rothberg, MD, an associate professor of endocrinology nutritional sciences at U-M. “The truth is people are, paradoxically, far more energetic on a low-energy diet and find after they begin losing weight that they can do more and are more physically active.”

Participants who met the weight loss goal reported widespread improvement in pain compared to those who did not. Their blood samples also showed a spike in anti-inflammatory molecules — a key weapon in fighting many types of pain. Researchers say the widespread improvement in body pain suggests that joints aren’t the only conduit of chronic pain.

“What we think that means is this process of losing weight may be affecting the central mechanisms of pain control related to the brain and spinal cord,” said Schrepf.

In future research, the team hopes to better understand why losing 10% of body weight was the dividing line for reduced pain.

“Some of your earliest weight loss isn’t all fat; it could be water,” Schrepf says. “Somewhere around 10 percent we’re reaching some kind of critical mass, but it’s hard to know exactly what that means.”

Does Changing Your Diet Help With Fibromyalgia?

By Lana Barhum, Columnist

Having lived with fibromyalgia most of my adult life, I know my diet may worsen or improve my pain and other fibromyalgia symptoms. I am not alone in this belief, but the research disagrees. 

Most studies have not shown any specific evidence that fibromyalgia patients should avoid certain foods or add any to their diets to manage symptoms.  Nonetheless, it is still a good idea to take a look at how some foods influence how you feel.

MSG, Gluten and Vitamin D

At least 42% of fibromyalgia patients have reported worsening symptoms after eating certain foods, according to a study in Clinical Rheumatology.  Other studies on fibromyalgia and diet have focused on food additives, gluten, and vitamin D, and found some evidence that they may affect fibromyalgia pain.  

A 2012 study published in Clinical Experimental Rheumatology, assessed fibromyalgia and irritable bowel syndrome (IBS) patients who had excluded monosodium glutamate (MSG) and aspartame from their diets.  After four weeks, 84% of the study participants reported their symptoms had improved by about a third.  Adding MSG back into their diets resulted in a return of symptoms.

The researchers concluded that MSG did, in fact, have an adverse effect on some fibromyalgia patients and removing it from their diets was an easy solution.

"This novel research implicates glutamate as a major adverse excitotoxin in some FM (fibromyalgia) patients. Dietary manipulation is a relatively simple and low cost non-pharmacological intervention that warrants further exploration," reported lead author Kathleen  Holton, PhD.

But another study, published in Rheumatology International, found no relationship between MSG and fibromyalgia pain and symptoms.  The researchers reported no symptom improvement in the group that removed MSG and aspartame from their diets and the group that did not.

While there has been little specific evidence pointing to gluten as a fibromyalgia trigger, some research shows patients respond well when they avoid eating gluten.  Spanish researchers reported in Rheumatology International that fibromyalgia patients who removed gluten from their diets showed notable improvements in pain and symptoms.                                                           

There may also be a link between fibromyalgia pain and low levels of vitamin D, according to a 2014 study out of Austria. That research, reported in the journal Pain, found that study participants who took vitamin D supplements experienced less pain and morning fatigue.   

A 2015 report from the journal Pain and Therapy, also makes a case for a link between Vitamin D deficiency and pain. "Significant improvements in assessment of sleep, mood, pain levels, well-being, and various aspects of quality of life with vitamin D supplementation have been shown,” said researchers Elspeth and Edward Shipton.

More research is needed to further determine if diet and fibromyalgia are actually related.  But doctors do agree eating healthy foods can help patients to feel better and tweaking your diet may improve symptoms.

Making Diet Changes

Here are some ways to help you figure out which foods help and which ones hurt.

Keep a Food Journal.  Many people with fibromyalgia have food sensitivities, but specific “trigger” foods will vary from person to person.  A good way to identify which foods worsen fibromyalgia symptoms and pain is to keep a food journal.  If you find your symptoms consistently worsen after eating certain foods, try eliminating those foods from your diet and see if your symptoms improve.

Eat Healthy. It makes sense for everyone to eat healthy, not just people with fibromyalgia.  Eat a diet that is rich in fruits and vegetables, whole grains, and lean proteins. 

A balanced diet will also give you more energy and improve overall health.

Pick the Right Foods. There are certain foods that may help improve fibromyalgia symptoms and minimize flares.  Vitamin D is one, as studies show deficiency can cause joint and muscle pain.

Vitamin D is one, as studies show deficiency can cause joint and muscle pain. Foods rich in vitamin D include fatty fish (tuna and salmon), dairy products fortified with vitamin D (orange juice, milk, and cereal), beef liver, and egg yolks. Foods containing omega 3 fatty acids, which are found in fatty fish, walnuts and flax seed, may also ease fibromyalgia symptoms by reducing soreness and inflammation.  

My Take

I am strong believer in taking your health into your own hands and experimenting with alternative treatments, including a healthy diet.  Through trial and error, I have figured out which foods help and which foods hurt as I continue to learn how to successfully cope with fibromyalgia. 

Aspartame (Nutrasweet), food additives (especially MSG), sugar, fructose, simple carbohydrates, caffeine, gluten, fried and junk food, dairy and nightshades (tomatoes, peppers, and potatoes) are all foods that I have either eliminated or minimized from my diet.  Cutting them out of my diet has made fibromyalgia flares less frequent. 

In addition, I take vitamin D supplements, since my levels are often low, and eat foods rich in omega 3 fatty acids, such as fish, walnuts, and eggs, to manage inflammation, as I also suffer from rheumatoid arthritis.

While I don’t know for certain if my diet is the reason for fewer flare-ups, I do know that avoiding certain foods and eating healthy ones benefits my overall health.  And when my body feels healthier, I am better able to cope with fibromyalgia pain and symptoms.

The specific foods that help and hurt will be different for you, but a healthy diet can help you manage fibromyalgia symptoms and pain and improve your health overall.  And, it is definitely worth a try to find out. 

Lana Barhum is a freelance medical writer, patient advocate, legal assistant and mother. Having lived with rheumatoid arthritis and fibromyalgia since 2008, Lana uses her experiences to share expert advice on living successfully with chronic illness. She has written for several online health communities, including Alliance Health, Upwell, Mango Health, and The Mighty.

To learn more about Lana, visit her website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Would This Meal Give You a Migraine?

By Pat Anson, Editor

The dinner on the right looks inviting – but to some people prone to migraines it could leave them with a bad headache.

Many migraine sufferers have learned to avoid or limit their consumption of foods and beverages that can cause a migraine attack. Wine, chocolate, coffee, nuts, and milk are often named as likely triggers, but did you know that some diets can actually help prevent migraines?

The role of diet in the treatment and prevention of migraine is poorly understood and somewhat controversial in the field of headache medicine because few rigorous studies have been performed.

In an effort to bring some clarity to the issue, two professors at the University of Cincinnati College of Medicine performed a comprehensive review of over 180 research studies on the subject of migraine and diet. Their two-part review, "Diet and Headache" is being published online in Headache: The Journal of Head and Face Pain. You can also see it by clicking here and here.

"One of the most important triggers for headache is the withdrawal of caffeine," says Vincent Martin, MD, a professor in the Department of Internal Medicine at the University of Cincinnati (UC) College of Medicine. “Let's say you regularly pound down three or four cups of coffee every morning and you decide to skip your morning routine one day, you will likely have full-fledged caffeine withdrawal headache that day."

Martin and co-author Brinder Vij, MD, an associate professor in the UC Department of Neurology and Rehabilitation Medicine, say there are two different approaches to preventing headaches with diet. The first is an elimination diet that avoids foods and beverages known to trigger headaches. The second approach is to adopt low fat and low carbohydrate diets that may actually help prevent headaches.

"The beauty of these diets is that they not only reduce headaches, but may produce weight loss and prevent heart disease," says Vij.

One of the most promising diets for those with frequent migraine attacks is one that boosts omega-3 fats while reducing omega-6 fatty acids. That means avoiding polyunsaturated vegetable oils (corn, sunflower, safflower, canola and soy) in favor of flaxseed oil. Foods that are rich in omega-3 fats include flaxseed, salmon, halibut, cod and scallops, while foods to avoid would be peanuts and cashews.

Martin and Vij say gluten-free diets are only helpful in lessening headaches if someone suffers from celiac disease, which can be established through a blood test or intestinal biopsy.

Other foods to avoid include anything with monosodium glutamate (MSG), a flavor enhancer used in many processed foods, including frozen or canned foods, soups, snack foods, salad dressing, seasoning salt, ketchup, barbecue sauce, and in some Chinese cooking.

"You eliminate it by eating fewer processed foods," explains Martin. "You eat more natural things such as fresh vegetables, fresh fruits and fresh meats. MSG is most provocative when consumed in liquids such as soups."

About 5 percent migraine suffers are likely to have an attack on days they consume nitrites, a preservative often used in processed meats such as bacon, sausage, ham and lunch meat. The use of both nitrites and MSG has declined, but Martin says checking food labels is a good idea.

Alcohol is another headache trigger for about a third of migraine sufferers, and studies suggest that red wines, especially those with high histamine content, are the worst. Interestingly, one study found that beer was associated with fewer headaches and migraines.

"Persons with headache and migraine have more dietary options than ever. Ultimately a healthy headache diet excludes processed foods, minimizes caffeine and includes a lot of fruits, vegetables, fish and lean meats,” Martin says.

Martin and Vij say identifying dietary triggers is challenging because there are so many different foods and ingredients that migraine sufferers are exposed to. They recommend keeping a food diary to help determine which foods to eliminate.

“It is not reasonable for persons with headache to avoid all know dietary triggers, as individuals may only be susceptible to a small number of foods or beverages,” they wrote. “The triggers could be identified by simple observation if the association is strong or through the use of a food diary if it is less obvious. The ideal would be to use a food diary as part of an app that would then determine statistically if a given food or beverage was associated with headache.”

Migraine affects about three times as many women as men. In addition to headache pain and nausea, migraine can cause vomiting, blurriness or visual disturbances, and sensitivity to light and sound. About half of people living with migraine are undiagnosed.