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Fibromyalgia is a common disorder whose cardinal manifestation is chronic, widespread pain. Well, not so common, affecting 2 to 4 percent of the population, though probably more like 2 percent, and especially women. For decades, some medical professionals dismissed fibromyalgia as all in people’s heads, but this outdated view has been refuted by more recent research characterizing it as a disorder of pain regulation and sensitization. Brain imaging studies have shown several perturbations of pain processing and regulation that amplify pain in people with the condition.
Twin studies have shown that about half of fibromyalgia is genetic, but the other half we can do something about. There are lots of drugs with lots of side effects to help with some of the symptoms, but what about lifestyle approaches? Engagement in regular physical activity is considered imperative for effective management of ﬁbromyalgia.
A systematic review and meta-analysis of randomized clinical trials on the effectiveness of therapeutic exercise in fibromyalgia found that both aerobic and resistance exercises are effective ways of reducing pain and improving global well-being in people with fibromyalgia. Patients may worry, and perceive that exercise will worsen their pain and fatigue, and so you have to start slow and work your way up as tolerated, with the goal of eventually achieving daily 30 to 60 minutes of moderate intensity aerobic exercise in addition to muscle-strengthening exercises (1 to 3 sets of 8–11 exercises; 8–10 repetitions with a load of about 7 pounds, or 45 percent of the max you can lift). But what about dietary interventions in terms of dialing down the pain sensitivity?
Well, what causes it in the first place? Inflammation. During the inﬂammatory response, pain receptors are activated. And chronic inflammation can cause chronic activation, which may cause chronic pain due to this prolonged hypersensitization of pain pathways.
No wonder, then, that a pro-inﬂammatory diet was found to be associated with pain hypersensitivity in patients with fibromyalgia syndrome. Exactly which foods are pro-inflammatory and which foods are anti-inflammatory? Check out those twin videos: Foods That Cause Inflammation and Which Foods are Anti-Inflammatory? But broadly speaking, components of processed foods and animal products, such as saturated fat, trans fat, and cholesterol, were found to be pro-inflammatory, while constituents of whole plant foods, such as fiber and phytonutrients, were strongly anti-inflammatory.
The intake of dietary fiber found concentrated in only one place—whole plant foods—is fundamental to reducing not only the risk of abdominal pain, but also muscle and joint pain. We think it’s because of these short-chain fatty acids that our good gut bugs produce when we eat fiber. These short-chain fatty acids are important mediators of pain, fundamentally because they modulate inﬂammation. So, having lots of fiber-feeding bugs in your colon is like carrying around your own anti-inflammatory compound factory. But to cultivate them, you actually have to eat the foods that feed them.
In terms of phytonutrients, plant-derived polyphenols are widely acknowledged to also act as anti-inﬂammatory substances. Here are some foods packed with anti-pain pathway nutrients: berries, greens, citrus, nuts, spices like turmeric and ginger, edamame, and green tea. That’s why you can do a randomized, double-blind crossover trial showing that about three cups worth of strawberries a day can significantly improve pain and inflammation. If that’s what a single plant can do, what about a diet chock full of plant foods?
Put people on a strictly plant-based diet rich in fresh fruits and vegetables, whole grains, and various legumes, which are beans, split peas, chickpeas, and lentils, as well as nuts and seeds, and you can drop C-reactive protein levels (a leading blood marker of systemic inflammation) 33 percent in three weeks. But does that translate into less pain?
The answer is yes, when it comes to migraine headaches. Yes, when it comes to painful periods. A signiﬁcant reduction in menstrual pain duration and pain intensity, in addition to premenstrual symptoms. In fact, even just a single plant, cinnamon, about a third of a teaspoon three times a day during your period can help, though it doesn’t work as well as ibuprofen. Ginger powder—ground ginger—on the other hand, has been found to be comparable to ibuprofen in relieving pain in women with painful cramps. You can learn more in my video on the topic: Benefits of Ginger for Menstrual Cramps.
Whole food plant-based diets also alleviate the symptoms of osteoarthritis. Several studies have shown improvements in rheumatoid arthritis symptoms with diets excluding animal products, though it may be just as much a function of increasing the quantity of healthy plant foods. But it’s not just because plant-based diets are so effective in causing weight loss. Even at the same weight, there’s an improvement in rheumatoid arthritis from more plant-based diets. And plant-based diets can also alleviate fibromyalgia symptoms.
This is the latest study, which enrolled anyone with chronic musculoskeletal pain, fibromyalgia or not. Yes, diets high in animal proteins and fats have been linked to chronic pain and inﬂammation, while plant-based diets produce anti-inﬂammatory responses. Did it actually work when put to the test for pain? Yes. Consumption of a plant-based diet produced positive improvements in chronic pain and function. How much? A minimally clinically important diﬀerence in chronic musculoskeletal pain is 1 point on the Numeric Pain Rating Scale, which is just a scale from 1 to 10 on how much pain you’re feeling. On the plant-based diet, perceived pain decreased an average of 3 points on a 10-point scale, from an average of 5 or 6 out of 10 down to 2. Now, unlike most prior studies, there was no control group. But what’s the downside of giving healthier eating a try? In fact, those with chronic pain are more likely to be overweight, and have nutrition-related maladies such as high blood pressure, diabetes, and heart disease––all of which can be prevented, arrested, and in some cases even reversed with a healthy enough plant-based diet. So, any pain benefit is just icing on the cake of health.
Uh, scratch that. How about the dollop of guacamole on your bean burrito.
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