How diet may help fibromyalgia

I intended to write a post on fibromyalgia, but I found this case study by a doctor treating his fibromyalgia patient with a paleo diet (similiar to a Body Change Fat-Burner diet) and I think it highlights everything important and gives evidence. Without further ado here is the article by Dr. Robert Hansen:

The following case study describes a patient’s journey through the standard medical treatment regimen, and how prescribing the Paleo Diet, as well as a program of regular exercise and lifestyle changes, produced dramatic results for this individual.

Fibromyalgia is not an auto-immune disease but is associated with increased gut permeability. The pain of fibromyalgia is thought to be due to abnormal processing of sensory input by the nervous system. It is associated with IBS (irritable bowel syndrome) in up to 80% of patients, depending on the study. Medications produce a 50% or greater reduction in pain in only about 30% of patients. Prognosis after two years is often extremely poor relative to pain reduction. It is rare that we can get patients off of opiate medications, especially after two years.
The focus of this study is a 54-year-old Caucasian female presented at our pain clinic in June of 2010 with complaints of diffuse muscle and diffuse joint pain involving the upper and lower extremities. Associated symptoms included: sleep disorder, chronic fatigue, and symptoms of irritable bowel syndrome (frequent watery diarrhea and abdominal cramping). During the previous two years the patient had not been treated with a statin drug or any other medications known to cause myopathy (damage to muscles resulting in pain). The onset of her pain correlated with the stress of the financial market crash, having been employed as a financial consultant for her adult life. She had been seen by a rheumatologist and several other physicians, and had been diagnosed as having fibromyalgia. Testing for auto-immune arthritic disease was negative.
During her initial consultation, my patient’s pain levels were 9/10 at worst, 5/10 at the least, usually 7/10, on a scale from 1-10. Her pain was made worse by any physical activity of daily living, including walking and sitting, and she was unable to do gardening or housecleaning. The pain was interfering with her sleep, work performance, as well as her relationships with her spouse and family. Any physical activity would set her back for a week or more causing severe incapacitating pain.
At initial presentation to our pain clinic she was being treated with several medications: an antidepressant (Cymbalta), an anti-seizure medication used to treat fibromyalgia (Lyrica), another antidepressant for sleep disorder (trazodone), Lomotil to treat diarrhea, Requip for restless leg syndrome, Norco (a combination of hydrocodone, an opiate pain medication, with acetaminophen) for chronic pain, Synthroid for hypothyroidism, and estradiol for postmenopausal symptoms. She had been treated by her family physician as well as by a rheumatologist.
On physical examination the patient had less than 11 out of 18 tender points to meet American Society of Rheumatology clinical criteria for fibromyalgia. However, this examination was performed while she was under treatment with four different medications known to decrease the pain of fibromyalgia. She met all other clinical criteria for fibromyalgia, which is also referred to as diffuse chronic pain syndrome. Her weight was 165 lbs, with a body mass index of 28.3.
Clinical lab reports showed normal thyroid function tests, normal kidney function, normal liver function, normal complete blood counts and normal metabolic comprehensive panel in October of 2009. This indicated that her thyroid abnormality was adequately treated and that there was no other explanation for her pain other than a diagnosis of fibromyalgia.
I prescribed a stronger opiate pain medication (OPANA), and her Norco was refilled. I instructed her to continue on her other medications without changes and prescribed the Paleo Diet, as well as a progressive exercise program. Within four days after initial consultation she called the clinic complaining that her pain was out of control, and requested that she be allowed to increase her Norco pain medication – which was permitted.
My patient also tried an over-the-counter agent called SAMe, and developed symptoms of serotonin syndrome (tremor, headache, sweating, increased blood pressure, anxiety). She was instructed to stop the SAMe, and to withhold her anti-depressants for 24 hours and the symptoms resolved.
In addition, based on our discussion of possible food sensitivities, the patient consulted an allergy specialist. Multiple food allergy tests were positive, including wheat, corn, sesame, soy, walnuts, and scallops.
At her next visit, June 7, 2010, her pain levels were reported as 10/10 at worst, 7/10 at least, and 8/10 usual. My recommendation was to taper off of her opiate medications but she refused, stating that she knew her pain would be worse without the medication. She reported a lack of compliance with the Paleo Diet, although she had eliminated most sources of gluten and dairy from her diet.
She was again advised to follow a strict Paleo Diet, and she was prescribed a stress reduction program to be achieved through written and audio materials, including instructions for meditation and yoga. Her Opana pain medication was increased.
At her next visit on July 8, 2010 her pain levels were 10/10 at worst 4/10 at least, usually 6/10. For financial reasons she was changed from Opana to morphine, and her other medications were continued. She was again encouraged to follow the Paleo Diet and to comply with the stress reduction program previously prescribed.
At follow up visit September 1, 2010 her pain levels had decreased to 8/10 at worst, 3/10 at least, usually 4/10 – a significant improvement. She had started to swim, and was performing yoga on a regular basis. She had not started meditation, but was more compliant with the Paleo Diet.
Because of her continued improvement, she unilaterally stopped taking morphine on September 23, 2010. By that time her irritable bowel symptoms had almost completely resolved, and her pain was almost completely gone. She suffered withdrawal symptoms, but subsequently did very well, and was able to return to her gardening and other activities of daily living with minimal discomfort. She was sleeping better and had no symptoms of irritable bowel syndrome. She continued taking her non-opiate medications.
In a follow-up visit on October 8, 2010 and reported that her pain levels were decreased to 4/10 at worst, 1/10 at least, usually 2/10. This represented a dramatic improvement – particularly given the fact that she was taking no opiate pain medications, and having previously been on opiate pain medications for two years.
A follow-up phone call on November 29, 2010 revealed that she continues on the Paleo Diet and has required no opiate pain medications. This patient had suffered symptoms for over two years, and had a dramatic response to Paleo and exercise. Her irritable bowel syndrome is completely resolved, though she ate beans one day and suffered GI symptoms. As a result she has been strictly Paleo since that time.
Her diffuse joint pain is completely gone, though she does experience muscle pain ranging from 3-5 on a scale from 1-10 on an intermittent basis. The frequency and duration of these painful episodes are markedly diminished compared to their initial presentation. She is sleeping well, and is enjoying a physically active life in marked contrast to the prior two years of symptoms.
My experience with prescribing the Paleo Diet has been that when patients comply they lose weight and feel better. I have had a patient with severe Rheumatoid Arthritis who achieved dramatic improvements within one month of Paleo. He was able to cease using a medication that he had used for 10 years. Previous attempts to stop that medication resulted in a worsening of his Rheumatoid Arthritis pain and joint swelling.
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