Managing Fibromyalgia: The Potential Role of a Living Foods Diet

By Anonymous

Fibromyalgia is a chronic pain disorder affecting an estimated 1.1% of Canadians, predominantly women (McNaIIy et al, 2006). It is a rheumatic disorder, diagnosed as widespread pain and at least 11 of 18 tender points defined by the American College of Rheumatology (Wolfe et al., 1990). Additional symptoms vary, but commonly include sleep difficulties, morning stiffness, irritable bowel-like symptoms, anxiety and depression (White et al, 1999; Ozgocmen et al., 2006a). Fibromyalgia often results in some degree of debilitation and symptom management is necessary to restore functioning (McNaIIy et al., 2006).

The treatment of fibromyalgia is highly individualized, based on symptoms. Drugs commonly prescribed include antidepressants, anti- inflammatories, muscle relaxants and painkillers (Rao et al., 2003). Patient dissatisfaction with drug therapy encourages many to seek alternative treatments, such as cognitive behavioural therapy, electroacupuncture, massage and cardiovascular activity (Donaldson et al., 2001; Kaartinen et al., 2000).

Dietary intervention is another potential alternative therapy. While the etiology and pathophysiology are inconclusive, fibromyalgia may be an oxidative stress disorder. In comparison to healthy control subjects, patients have higher levels of malondialdehyde, a biomarker of oxidative stress, and lower levels of Superoxide dismutase, an antioxidant enzyme (Bagis et al., 2005; Ozgocmen et al., 2006b). Some patients find a high antioxidant, “living food” diet helpful in symptom management. Living food diets are vegan diets consisting mostly of uncooked fruits, vegetables, roots, nuts, germinated seeds and cereals (Hanninen et al., 2000). Foods avoided, in addition to dairy, eggs and meat, include coffee, tea, alcohol and table salt (Hanninen et al., 2000). Overall, the diet is high in vitamin C, vitamin E and carotenoids, and long-term followers have been shown to have a better antioxidant status than do omnivorous controls (Rauma et al., 1995).

Evidence of efficacy can be seen in an observational study from North Carolina in which fibromyalgia subjects consumed a living food diet for seven months (Donaldson et al., 2001). Significant improvements were seen in physical functioning, general health, vitality, mental health and overall quality of life. The biggest impact observed was a 46% improvement in Fibromyalgia Impact Questionnaire scores, a validated survey that measures the overall impact of the disorder on a patient’s life (Donaldson et al., 2001). Additional evidence can be seen in two studies from Finland (Hanninen et al., 2000; Kaartinen et al., 2000). Compared to control groups, intervention groups reported significant improvement in joint stiffness, pain and general health after three months on the living food diet. These improvements disappeared when subjects returned to their previous diets.

A significant proportion of the fibromyalgia population is overweight or obese, perhaps partly due to reduced physical activity secondary to pain and stiffness (McNaIIy et al., 2006). Rheumatoid patients have locomotor problems, so weight loss is beneficial if the subject is overweight (Hanninen et al., 2000). Vegans tend to have lower body weights in general, and a reduction in body mass index was noted in two of the studies discussed (Hanninen et al., 2000; Kaartinen et al., 2000).

The living food diet is high in fibre, and the germinated foods included provide a source of lactobacteria. These elements have been shown to alter gut microflora positively, which may help to manage the irritable bowel-like symptoms often present (Hanninen et al., 2000; Camilleri, 2006). Since dairy and meats are excluded, certain micronutrients should be monitored. The diet is extremely low in vitamin B^sub 12^, so a supplement is necessary (Ozgocmen et al., 2006). The diet is also low in calcium and vitamin D. This is of special concern because low vitamin D levels are common in fibromyalgia, perhaps partly due to decreased mobility leading to decreased sun exposure (Huisman et al., 2001; Al-Allaf et al., 2003). Decreased physical activity may also increase the risk of osteoporosis (Hanninen et al., 2000). Supplemental calcium and vitamin D may be indicated to preserve bone health.

Despite promising results and short-term benefits, more research is necessary. By nature of the intervention, none of the studies was blinded, so psychological factors may have had a role in subjective improvements. As well, the effect of the living food diet on symptoms may not be directly attributed to antioxidants, but perhaps another factor or a synergistic effect between multiple components. Research is necessary to determine long-term effects.

The living food diet is extreme requiring high motivation. In the studies cited, despite improvement, none of the subjects continued with the diet after the intervention period, finding it too difficult to maintain (Hanninen et al., 2000; Kaartinen et al., 2000; Donaldson et al., 2001). While research is necessary to ensure efficacy, promotion of an omnivorous diet emphasizing antioxidant- rich fruits, vegetables, nuts and seeds may be a more realistic clinical approach.

References available from A. Buchholz.

Contact Information:

Amanda Beaks, BASc student

abeales@uoguelph. ca

Andrea Buchholz, PhD, RD (advisor)

Dept. of Family Relations and Applied

Nutrition

University ofGuelph

Guelph, ON

(519)824-4120(52347)

abuchhol@uoguelph. ca

Copyright Dietitians of Canada Spring 2007

(c) 2007 Canadian Journal of Dietetic Practice and Research. Provided by ProQuest Information and Learning. All rights Reserved.