Nutritional Interventions in the Management of Fibromyalgia Syndrome
Abstract
:1. Introduction
2. Nutritional Supplementation and Fibromyalgia
2.1. Vitamin D
2.2. Vitamin C and Vitamin E
2.3. Minerals
2.4. Probiotics
2.5. Other Substances
3. Dietary Interventions and Fibromyalgia
3.1. Olive Oil
3.2. Ancient Grain Products
3.3. Monosodium Glutamate and Aspartame-Free Diet
3.4. Gluten-Free Diet
3.5. Low-FODMAPs Diet
3.6. Low-Calorie Diet
3.7. Vegetarian Diet
3.8. Mediterranean Diet
4. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Author, Year | Country | Intervention, n | Control, n | Age, y | Sex | Duration | Intervention | Control | Outcomes | Findings | Efficacy * |
---|---|---|---|---|---|---|---|---|---|---|---|
Vitamin D | |||||||||||
Warner et al., 2008 [24] | US | 25 | 25 | 58.0 ± 7.3 intervention; 56.7 ± 11.3 control | F | 12 weeks | 50,000 IU of oral ergocalciferol weekly | Placebo | 25(OH)D, duration of pain, VAS, FPS | 25(OH)D increase in the intervention group; no difference in duration of pain, VAS and FPS score | = |
Arvold et al., 2009 [25] | US | 48 | 42 | 59.7 ± 14.0 intervention; 57.8 ± 15.8 control | All | 8 weeks | 50,000 IU of oral cholecalciferol weekly | Placebo | 25(OH)D, PTH, creatinine, calcium, self-reported symptoms, FIQ | 25(OH)D increase and PTH decrease in the intervention group. 5 out 20 FIQ items and total FIQ score improved after intervention. Severely deficient patients did not show symptom improvement | + |
Abokrysha et al., 2012 [26] | Saudi Arabia | 30 | NA | 34.6 ± 8.1 | F | 8 weeks | 600,000 IU of intramuscular single dose or 50,000 IU oral cholecalciferol weekly | NA | WPI, fatigue, waking unrefreshed, cognition, SS | Improvement of WPI, fatigue, waking unrefreshed and SS score after treatment | + |
Wepner et al., 2014 [27] | Austria | 15 | 15 | 48.4 ± 5.3 | All | 20 weeks | 2400 IU or 1200 IU (according to serum calcifediol levels) of cholecalciferol daily | Placebo | Calcifediol, pain severity (VAS), SF-36; HADS-D, FIQ, SCL-90-R | Severity of pain and physical role functioning scale improved after intervention | +/= |
Yilmaz et al., 2016 [28] | Turkey | 30 | NA | 36.9 ± 9.2 | All | 12 weeks | 50,000 IU of oral cholecalciferol weekly | NA | Ca, P, ALP, 25(OH) D, pain severity (VAS), asthenia (VAS), TPC, BDI, SF-36, waking unrefreshed, headache, tenderness on tibia | Marked decrease in pain, asthenia, severity of waking unrefreshed, TPC, and BDI and improvement in quality of life after treatment | + |
Dogru et al., 2017 [29] | Turkey | 42 | 28 | 38.7 ± 5.2 | F | 12 weeks | 50,000 IU of oral cholecalciferol weekly | No treatment | FIQ, SF-36, pain severity (VAS), ASEX, BDI | Improvements in physical function, physical role limitations, emotional role limitations, social function, mental health, vitality, and quality of life after treatment | + |
de Carvalho et al., 2018 [30] | Brazil | 11 | NA | 48.5 (28-67) | F | 12 weeks | 50,000 IU of oral cholecalciferol weekly | NA | 25(OH)D, pain severity (VAS), TPC | Improvements in 25(OH)D levels, pain severity and reduction in TPC | + |
Mirzaei et al., 2018 [31] | Iran | 37 | 37 | 42.1 ± 10.8 intervention; 41.0 ± 10.3 control | All | 8 weeks | Trazodone 25 mg + 50,000 IU of oral cholecalciferol weekly | Trazodone 25 mg + placebo | 25(OH)D, WPI, FIQ, PSQI, SF-36 | Improvement in 25(OH)D, WPI, FIQ, PSQI and SF-36 in the intervention group | + |
Vitamin C + E | |||||||||||
Naziroglu et al., 2010 [32] | Turkey | 21 (n = 11 vit. C + E; n = 10) vit. C+E + exercise) | 11 | 40.5 ± 4.9 vit. C + E; 37.4 ± 4.0 vit. C + E + exercise; 37.8 ± 8.7 control | F | 12 weeks | 150 mg/day of α -tocopheryl acetate and 500 mg/day ascorbic acid or 150 mg/day of α -tocopheryl acetate and 500 mg/day ascorbic acid + exercise | Exercise | Vitamin A, C and E, β-carotene, LP, GSH, GSH-Px, pain severity (VAS) | Improvement of LP, GSH, GSH- Px and plasma vitamins A, C, and E after the supplementations with or without exercise | +/= |
Magnesium | |||||||||||
Russell et al., 1995 [33] | US | 12 | 12 | 49 | F | 4 weeks | 200 mg malic acid + 50 mg magnesium, 3 tablets/day up to 6 tablets/day | Placebo | Pain severity (VAS), TPC, TPA, HAQ, CESD, Hassle, psychological response to events | Little or no effect with low doses; improvements in the severity of primary pain/tenderness measures with dose escalation and a longer duration of treatment | +/= |
Bagis et al., 2013 [34] | Turkey | 40 (n = 20 Mg citrate; n = 20 Mg citrate + amitriptyline) | 20 | 40.2 ± 5.1 Mg citrate;40.7 ± 5.2 Mg citrate + amitriptyline; 42.1 ± 6.2 control | F | 8 weeks | 300 mg/day of Mg citrate or 300 mg/day of Mg citrate + 10 mg/day amitriptyline | 10 mg/day amitriptyline | Pain severity (VAS), TPC, FIQ, BDI, BAI, self-reported symptoms | Improvement in TPC, FIQ and BDI with the Mg citrate treatment. Improvement in almost all parameters except for pain, FIQ, headache, gastric problems, IBS, cramps after amitriptyline treatment. Improvement in all parameters except numbness after the combined amitriptyline + Mg citrate treatment | + |
Iron | |||||||||||
Boomershine et al., 2018 [35] | US | 41 | 40 | 41.2 ± 11.1 intervention; 43.9 ± 10.8 control | All | 6 weeks | 15 mg/kg (up to 750 mg) of ferric carboxymaltose for 5 days | Placebo | Iron indices, hematology parameters, FIQR, BPI, MOS Sleep scale, Fatigue VNS | Improvement in FIQ, BPI, fatigue and iron indices in the treatment group. | + |
Probiotics | |||||||||||
Roman et al., 2018 [36] | Spain | 20 | 20 | 55.0 ± 8.4 intervention; 50.3 ± 7.9 control | All | 7 weeks | 4 pills/day containing Lactobacillus Rhamnosus GG®, Casei, Acidophilus, and Bifidobacterium Bifidus | Placebo | Pain severity (VAS), FIQ, SF-36, BDI, STAI, MMSE, cortisol | Improved impulsivity and decision-making after the intervention | +/= |
Author, Year | Country | Intervention, n | Control, n | Age, y | Sex | Duration | Intervention | Control | Outcomes | Findings | Efficacy * |
---|---|---|---|---|---|---|---|---|---|---|---|
Olive oil | |||||||||||
Rus et al., 2017 [51] | Spain | 11 | 12 | 53.6 ± 5.5 intervention; 48.2 ± 8.0 control | F | 3 weeks | 50 mL/die EVOO | 50 mL/die ROO | BMI, SBP, DBP, cardiac frequency, oxidative stress markers, antioxidative markers, FIQ, pain severity (VAS), PCS-12, MCS-12 | Improvement in protein carbonyls, lipid peroxidation, FIQ and mental health status after the intervention with EVOO | + |
Rus et al., 2020 [52] | Spain | 15 | 15 | 54.1 ± 5.6 intervention; 49.8 ± 5.8 control | F | 3 weeks | 50 mL/die EVOO | 50 mL/die ROO | weight, BMI, waist circumference, thrombosis-related parameters, ESR, inflammatory markers, NO, lipid profile, cortisol | EVOO declined red blood cell count and ESR. ROO increased mean platelet volume and reduced PDW, neutrophil-to-lymphocyte ratio, ESR and fibrinogen. Significant differences in pre–post change between EVOO and ROO for cortisol and PDW | + |
Ancient grain | |||||||||||
Pagliai et al., 2020 [53] | Italy | 10 | 10 | 46.2 ± 11.5 intervention; 51.7 ± 12.9 control | All | 8 weeks | Pasta, bread, cracker, biscuits made with ancient grain Khorasan | Pasta, bread, cracker, biscuits made with modern grain Palesio | WPI, SS, FIQ, FSS, TSS, SRSBQ, RSQD, FOSQ | Improvement in WPI + SS, FIQ and FOSQ after the intervention | + |
MSG and aspartame-free diet | |||||||||||
Holton et al., 2012 [54] | US | 46 | NA | 53.0 ± 13.0 | All | 4 weeks | MSG and aspartame-free diet | NA | 28-symptom checklist, pain severity (VAS), FIQR, IBS QOL | Improvement in all the tested outcomes after the intervention | + |
Vellisca et al., 2014 [55] | Spain | 36 | 36 | 42.3 ± 8.4 intervention; 39.6 ± 8.2 control | F | 12 weeks | MSG and aspartame-free diet | Free diet | Pain severity (VAS) | No significant differences in pain referred after the intervention | = |
Gluten-free diet | |||||||||||
Rodrigo et al., 2013 [56] | Spain | 7 | NA | 49.0 ± 12.0 | F | 1 year | Gluten-free diet | NA | TPC, FIQ, HAQ, SF-36, gastrointestinal complaints (VAS), pain severity (VAS), fatigue (VAS), tTG | Improvement of all the tested outcomes after the intervention | + |
Rodrigo et al., 2014 [57] | Spain | 97 | NA | 50.0 ± 8.0 | All | 1 year | Gluten-free diet | NA | TPC, FIQ, HAQ, SF-36, gastrointestinal complaints (VAS), pain severity (VAS), fatigue (VAS) | Improvement of all the tested outcomes after the intervention only in the lymphocytic enteritis subgroup | + |
Isasi et al., 2014 [58] | Spain | 20 | NA | 46 (25–73) | F | 16 months | Gluten-free diet | NA | Widespread pain, return to work, return to normal life | Improvement of all the tested outcomes after the intervention | + |
Slim et al., 2017 [59] | Spain | 35 | 40 | 52 (36–66) intervention; 53 (32–65) control | F | 24 weeks | Gluten-free diet | Hypocaloric diet | NCGS symptoms, BMI, waist circumference, FIQR, PSQI, BPI-SF, BDI, STAI, SF-12, PGI-S | No statistically significant difference in the tested outcomes between intervention and control treatment | = |
Low-FODMAPs diet | |||||||||||
Marum et al., 2016 [60] | Portugal | 38 | NA | 38.5 ± 10.0 | F | 4 weeks | Low-FODMAPs diet | NA | FSQ, FIQR, IBS-SSS, EQ-5D, abdominal and somatic pain (VAS), satisfaction | Improvements in VAS, FSQ, FIQR and GI symptom | + |
Marum et al., 2017 [61] | Portugal | 38 | NA | 38.5 ± 10.0 | F | 4 weeks | Low-FODMAPs diet | NA | Body weight, BMI, body composition, waist circumference | Weight, BMI and waist circumference decreased after the intervention, but no significant effect on body composition | + |
Low-calorie diet | |||||||||||
Shapiro et al., 2005 [62] | US | 42 | NA | 54.5 ± 8.1 | F | 5 months | Hypocaloric diet (1200–1500 kcal/die) | NA | Body weight, BMI, waist circumference, FIQ, HAQ, MPI, BDI-II, STAI, QOL, BSQ | Improvement in pain, body image, anxiety, quality of life and depression after the intervention | + |
Senna et al., 2012 [63] | Egypt | 43 | 43 | 44.8 ± 13.6 intervention; 46.3 ± 14.4 control | All | 6 months | Hypocaloric diet (1200 kcal/die: 50% CHO, 30% Fat, 20% Protein) | Isocaloric diet | FIQ, TPC, BDI-II, PSQI, Body weight, BMI, waist circumference, IL-6, CRP | Improvements in pain, fatigue, depression, IL-6, CRP | + |
Schrepf et al., 2017 [64] | US | 123 | NA | 50.7 (23–69) | All | 12 weeks | Hypocaloric diet (800 kcal/die) | NA | Body weight, WPI, SS IDS, inflammatory markers | Improvements in pain, symptom severity, depression, FM scores, IL-10 after weight loss | + |
Vegetarian diet | |||||||||||
Hostmark et al., 1993 [65] | Norway | 10 | NA | 49.9 ± 4.1 | All | 3 weeks | Vegetarian diet | NA | Peroxides, lipid profile, apolipoproteins, fibrinogen | Improvements in serum peroxide concentration, fibrinogen, total cholesterol, apolipoprotein-B and -A | + |
Azad et al., 2000 [66] | Bangladesh | 37 | 41 | NA | All | 6 weeks | Vegetarian diet | Amitriptyline | Fatigue, insomnia, non-restorative sleep, pain severity (VAS), TPC | No statistically significant difference in the tested outcomes between intervention and control treatment | = |
Kaartinen et al., 2000 [67] | Finland | 18 | 15 | 51 (34–62) intervention; 52 (37–59) control | F | 12 weeks | Raw vegan diet | Omnivorous diet | BMI, HAQ, TPC, pain severity (VAS), BDI, sleep, haematocrit, ESR, total cholesterol, urinary Na, GHQ, physical activity | Improvements in pain, autonomy, sleep quality, morning stiffness, total cholesterol and urinary Na after the intervention | + |
Hänninen et al., 2000 [68] | Finland | 33 | 20 | NA | 12 weeks | Raw vegan diet | Omnivorous diet | Antioxidants, lignan, carotenoids, vitamins, morning stiffness, pain severity (VAS) | Improvements of carotenoids, phenolic compounds, vitamin C and E, joint stiffness, pain, general well-being after the intervention | + | |
Donaldson et al., 2001 [69] | US | 30 | NA | NA | All | 7 months | Raw vegan diet | NA | FIQ, SF-36, QOL, physical performance | Improvement in pain, vitality, mobility, general well-being after the intervention | + |
Martínez-Rodríguez et al., 2018 [70] | Spain | 14 (n = 7 LOV; n = 7 LOV + exercise) | 7 | 34.0 ± 2.0 LOV + exercise; 34.0 ± 2.0 LOV; 33.0 ± 3.0 control | F | 4 weeks | LOV or LOV + exercise | Free diet and no exercise | Pain severity (VAS), body composition | Improvement in body composition and pain severity after the intervention with diet and exercise | + |
Mediterranean diet | |||||||||||
Michalsen et al., 2005 [71] | Germany | 14 | 21 | 51.6 ± 13.3 intervention; 52.0 ± 10.0 control | All | 8 weeks | Mediterranean diet | 8-days fasting | Gut microbiota composition, stool pH, IgA, pain severity (VAS) | No statistically significant difference in the tested outcomes between intervention and control treatment | = |
Martínez-Rodríguez et al., 2020 [72] | Spain | 11 | 11 | 48.0 ± 4.0 intervention; 50.0 ± 5.0 control | F | 16 weeks | Mediterranean diet + 60 mg of tryptophan and 60 mg of Mg | Mediterranean diet | PSQI, BSQ, STAI, POMS-29, EAT-26 | Improvements in anxiety, mood disturbance, eating disorders, dissatisfaction with body image after tryptophan and Mg-enriched Mediterranean diet | + |
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Pagliai, G.; Giangrandi, I.; Dinu, M.; Sofi, F.; Colombini, B. Nutritional Interventions in the Management of Fibromyalgia Syndrome. Nutrients 2020, 12, 2525. https://doi.org/10.3390/nu12092525
Pagliai G, Giangrandi I, Dinu M, Sofi F, Colombini B. Nutritional Interventions in the Management of Fibromyalgia Syndrome. Nutrients. 2020; 12(9):2525. https://doi.org/10.3390/nu12092525
Chicago/Turabian StylePagliai, Giuditta, Ilaria Giangrandi, Monica Dinu, Francesco Sofi, and Barbara Colombini. 2020. "Nutritional Interventions in the Management of Fibromyalgia Syndrome" Nutrients 12, no. 9: 2525. https://doi.org/10.3390/nu12092525