Fibromyalgia diet: what to eat and what may help

What is fibromyalgia, and what can nutrition do?

Fibromyalgia is chronic, widespread pain that does not damage or deform the joints. It rarely occurs on its own. It is accompanied by fatigue, unrefreshing sleep, difficulty concentrating, and digestive discomfort. According to EULAR, the European rheumatology society, it affects around 2% of the population [2] and is more common in women.

Management is multidisciplinary and brings together medical care, physiotherapy, psychology, exercise, and nutrition. Nutrition does not treat fibromyalgia or relieve the pain. What it can do is help you feel better the next day by supporting your energy, weight, and muscle, without adding another battle in the kitchen. When fatigue is the hardest part, that matters a lot.

Is there a diet for fibromyalgia?

No, although many diets are promoted. A review of twenty-two studies concludes that there is not enough evidence to recommend any specific nutritional intervention [1]. Another, more recent review of twelve studies reaches the same conclusion [3]. The most promising results are from plant-based diets, but they come from small, short studies [1] [3]. Both reviews point to the same limitations: small samples, studies that differ greatly from one another, and a high risk of bias.

The fact that there is no specific diet does not mean that what you eat makes no difference. What may work for you is a pattern you can sustain: a Mediterranean-style way of eating, with vegetables, fruit, pulses, fish, eggs, nuts, and extra-virgin olive oil. This is the same pattern described in the anti-inflammatory eating guide. It is suggested because it supports overall health and is the pattern most people manage to maintain. No single food treats inflammation. Exercise and weight management matter more than avoiding nightshades. As a house guideline, try it for three months and see how you feel.

What might you eat in a day with fibromyalgia?

There is no fibromyalgia menu, but there is a way to spread meals across the day that can hold up when fatigue takes over. At Alimmenta, we recommend having breakfast at whatever time suits you. If it does not agree with you or fit your lifestyle, adapt your meals to your day and your appetite. An ordinary day could look like this:

• Breakfast: wholemeal bread with tomato and extra-virgin olive oil, plus an egg or plain yoghurt. Coffee or herbal tea.
• Mid-morning: a piece of fruit and a handful of nuts.
• Lunch: salad or raw vegetables to start, lentils with vegetables, and fruit.
• Afternoon snack: plain yoghurt, or toast with cheese.
• Dinner: vegetable soup and oven-baked fish with potato.

Choose simple meals that are easy to digest, because cooking can be tiring too. A forty-minute recipe is not going to get made on a bad Tuesday. If dinner is the hardest meal, these nine quick dinner ideas work just as well here.

Does fibromyalgia cause weight gain? Can you lose weight?

Fibromyalgia does not cause weight gain by itself, but weight can go up easily. Pain and fatigue reduce how much you move, and poor sleep can disrupt appetite. In addition, some of the medicines used can contribute to weight gain. If you think this may be happening to you, discuss it with your doctor and do not change your medication on your own. It deserves attention for your health: with more weight, movement becomes harder and pain often increases.

To lose weight with fibromyalgia, the same approach applies, but at a slower pace and with greater care for muscle. That means a moderate deficit, protein at every meal, and strength training two or more days a week [4]. Very restrictive diets and prolonged fasting are not a good fit. With too little energy available, fatigue and pain worsen, and muscle is the first thing you lose. If this is your goal, the approach is set out in the guide to losing body fat and keeping it off, at a slower pace.

Should you cut out gluten, dairy, or nightshades?

Without a diagnosis that calls for it, there is no basis for cutting them out. Gluten-free and elimination diets have been studied in fibromyalgia, but the evidence is not sufficient to recommend them [1][3]. Their cost, however, is clear. Each food group removed makes the diet less varied, more expensive, and harder to sustain, and eating with others can become a problem.

If you suspect that a food does not agree with you, seek a diagnosis before removing anything: coeliac disease, lactose intolerance, or irritable bowel syndrome. If bloating and digestive discomfort are your main issues, which are common in fibromyalgia, you can find specific guidance in the guide to bloating.

When migraines or rheumatoid arthritis coexist with fibromyalgia, each has its own guide: the migraine diet and the rheumatoid arthritis diet.

What about supplements?

This is where people spend the most money and know the least. The review of twenty-two studies includes trials of various supplements. Its authors consider them small, very different from one another, and at high risk of bias. They conclude that there is not enough evidence to recommend any of them [1].

Our position is the same as always. A supplement is occasional support, never the foundation. If you need one, your doctor or dietitian-nutritionist prescribes it. If a blood test shows a deficiency, it should be addressed for that reason, whether or not you have fibromyalgia.

How to start moving when everything hurts

According to the European recommendations for managing fibromyalgia, exercise is the only therapy with a strong recommendation in its favour, including aerobic and strength exercise, on land or in water [2]. It has the strongest support of any part of treatment.

The general reference for adults, including people with a chronic condition, is 150 to 300 minutes of moderate activity a week [4], plus strength work for all muscle groups on two or more days [4]. The same guideline adds what matters most here: people who cannot reach those amounts should move according to what their abilities allow [4]. With fibromyalgia, that means starting below what you think you can manage and increasing very gradually. It may hurt a little more at first, and that does not mean things are going wrong [2].

What mistakes do we see most often in consultations?

Starting with a list of foods to cut out. This is the approach most people give up on. First, add vegetables, pulses, fish, and fruit. Once that is in place, look at what might be unnecessary, if anything.

Changing everything on a good day. A plan designed during a good week is made for someone who does not exist for the rest of the month. A fibromyalgia eating plan should be designed for a bad day. If it works then, it can work any day.

Looking to food for the cause of the pain. This leads to trying diet after diet, blaming yourself when none works, and narrowing what you eat more and more. Food does not cause the pain and will not take it away. But it is one of the few parts of this condition you can influence.