Mediterranean Diet Improves Pain, QoL in Patients with Fibromyalgia

Ilenia Casini, PhD

Credit: LinkedIn

Patients with fibromyalgia receiving a personalized Mediterranean diet reported improvements in both pain and quality of life, according to a study published in Pain and Therapy.¹ Conversely, those who ate fewer calories but chose more inflammatory foods and/or foods with an imbalanced nutritional content did not experience these benefits.

“Diet can cause inflammation,” wrote a team of investigators led by Ilenia Casini, PhD, associated with the Department of Medicine, Surgery and Neuroscience, University of Siena, Italy. “Inflammatory conditions of the digestive system can trigger the release of cytokines, which can have effects on the central nervous system…Dietary interventions are used to treat many diseases, as a healthy diet improves physical fitness, mental health and cognitive abilities.”

The Mediterranean diet is believed to have an anti-inflammatory effect on the body. As fibromyalgia symptoms may be exacerbated by inflammation, investigators sought to evaluate the potential beneficial effects of this diet among this patient population.²

Outpatients with fibromyalgia were enrolled in the study, which included clinical, nutritional, and dietary assessments. Patients were randomized 1:1 and placed into either the personalized Mediterranean diet cohort (DIET) or the balanced diet based on the individual’s body mass index cohort (NODIET). They were evaluated at baseline, week 4, and again at week 8.

Eligible patients were aged between 18 and 65 years, met the 2016 American College of Rheumatology (ACR) criteria for fibromyalgia, and had persistent pain and symptoms despite being treated with medication in the previous 3 months. All patients received pharmacological treatment with antiepileptic drugs and antidepressants.

Participants were required to complete the following questionnaires: the eating attitude test (EAT), brief pain inventory (BPI), numeric rating scale (NRS) for pain, self-rating anxiety scale (SAS), self-rating depression scale (SDS), multidimensional assessment of fatigue (MAF), and the fibromyalgia impact questionnaire (FIQ).

The Mediterranean diet consisted of 3 meals and 2 snacks per day for 4 weeks. Patients were to receive 50% of their energy intake from complex carbohydrates with limited sugar and sweeteners; 30% from fats with an adequate intake of polyunsaturated fatty acids from foods like fish, nuts, and extra virgin olive oil; and 20% from protein. They were also required to have ≥ 20 g of fiber from fruits, vegetables, and starches. Milk and dairy products were not permitted during the study period.

A total of 100 participants were recruited, of whom 84 completed the 8-week study. Most patients exhibited incorrect habits regarding the timing of meals, composition of nutrients, and food choices.

At the end of the study, patients in the DIET group reported improvements in most fibromyalgia measures, including anxiety, fatigue, and disability scores. According to the BPI scale, patients in the DIET group reported better scores regarding disability owing to pain (P <.05), impairment of motor activity (P <.05), impairment of work activity (P <.05), and pain intensity (P <.01).

These patients also reported improvements in pain-related disability (P <.01), impairment of motor activity (P <.001), pain severity (P = .001), and the global index of severity (P <.001). The SDS scores were lower at visit 2 compared with visit 1 in the DIET cohort and were lower than the NODIET group at visit 2. Similar results were observed in terms of anxiety and fatigue.

Based on these results, investigators believe a diet program—without the use of medication—should be immediately prescribed upon the diagnosis of fibromyalgia as pharmacological interventions have a low to moderate effect.

“Although further studies are needed to support the present results in a long-term follow-up with a larger number of cases, our generally positive outcomes suggest that the dietary approach should be adopted for the treatment of fibromyalgia,” they wrote.

References

1. ^{Casini I, Ladisa V, Clemente L, et al. A Personalized Mediterranean Diet Improves Pain and Quality of Life in Patients with Fibromyalgia. Pain Ther. Published online April 29, 2024. doi:10.1007/s40122-024-00598-2}
2. ^{Descalzi G, Ikegami D, Ushijima T, Nestler EJ, Zachariou V, Narita M. Epigenetic mechanisms of chronic pain. Trends Neurosci. 2015;38:237–46}