Fibromyalgia is a complex chronic condition characterized by widespread pain, fatigue, sleep disturbances and other symptoms. One common comorbidity is weight gain or difficulty losing excess weight.
A combination of disease factors, medications, and inactivity contributes to this problem. Losing weight with fibromyalgia requires an integrative approach tailored to each person.
Lifestyle Modifications for Weight Management
Making sustainable lifestyle changes can help fibromyalgia patients improve diet quality, increase activity, and promote weight loss without worsening symptoms:
- Follow a balanced, nutrient-dense diet – boost intake of fruits, vegetables, lean proteins while limiting sugar, unhealthy fats, and processed foods.
- Engage in low-impact aerobic exercise like walking, swimming or cycling to avoid flaring joint pain.
- Improve sleep quality and duration through sleep hygiene techniques to reduce fatigue and allow for daytime activity.
- Employ stress management skills such as meditation, yoga, deep breathing exercises to decrease cortisol levels.
- Use journals and logs to track progress, symptoms, and motivation around nutrition and physical activity goals.
Medical and Professional Interventions
Consulting healthcare providers and specialists can provide expertise on safe, effective weight loss strategies:
- Work with your doctor to adjust any medications that may be contributing to weight gain.
- Meet with a dietitian to create a personalized healthy meal plan based on your needs and limitations.
- Start physical therapy tailored to improve strength, mobility, and aerobic capacity within your limits.
- Seek counseling or CBT for emotional support, motivation, and help changing eating behaviors.
Dietary Approaches
- Low-calorie diets: Reducing caloric intake to 1200-1500 calories per day promotes gradual weight loss. This approach has been shown to reduce symptoms like pain, fatigue, and depression in fibromyalgia patients. Caloric restriction activates neuroendocrine adaptations that may improve fibromyalgia symptoms beyond just weight loss.
- Low-FODMAP diet: Restricting fermentable carbohydrates that exacerbate IBS symptoms also facilitates weight loss and reduces gastrointestinal symptoms in fibromyalgia patients. The diet eliminates fructans, galactooligosaccharides, lactose, fructose and polyols. This improves abdominal pain, bloating, and diarrhea.
- Gluten-free diet: Eliminating gluten sources may alleviate gastrointestinal and musculoskeletal symptoms in some fibromyalgia patients with gluten sensitivity. This restrictive diet promotes weight loss by reducing overall carbohydrate intake. However, benefits are likely not superior to simple caloric reduction.
- Vegetarian diets: Plant-based vegetarian or vegan diets are lower in inflammatory animal proteins. They provide antioxidants and fiber that reduce pain and stiffness. These diets have shown weight loss and symptom improvement but require strict adherence.
- Mediterranean diet: Anti-inflammatory effects of omega-3 fats, fruits/vegetables, and olive oil may benefit fibromyalgia. Limited evidence supports improved pain, mood, and quality of life. Weight loss occurs due to increased intake of vegetables, fiber and fish.
Low Calorie Diets
Several studies have explored using caloric restriction between 1200-1500 calories per day to promote gradual weight loss in fibromyalgia patients. Key findings on low calorie diets in fibromyalgia include:
- A 5 month trial of a 1200-1500 cal/day diet in 42 fibromyalgia patients resulted in 4.4% weight loss and reduced pain, improved body image, anxiety, depression, and quality of life.
- An 18-week 1200 cal/day hypocaloric diet in 83 fibromyalgia patients led to lower inflammation (IL-6, CRP) and improved pain, sleep, fatigue, and quality of life.
- A 12-16 week very low calorie diet of 800 calories per day in 123 obese fibromyalgia patients improved pain, sleep, depression, and fibromyalgia severity scores.
Potential mechanisms for benefit include neuroendocrine adaptations to caloric restriction that reduce pain amplification, lowered inflammation, and psychosocial effects of weight loss. Gradual caloric reduction tailored to the individual avoids nutritional deficiencies.
Low FODMAP Diet
| FODMAP Group | Components | High FODMAP Food Sources |
|---|---|---|
| Fructans | Fructooligosaccharides | Wheat, garlic, onion |
| GOS | Galactooligosaccharides | Legumes, pulses |
| Lactose | Disaccharide sugar | Dairy products |
| Fructose | Monosaccharide sugar | Honey, high-fructose corn syrup, fruits |
| Polyols | Sugar alcohols | Sweeteners like sorbitol, mannitol |
The low FODMAP diet eliminates foods high in fermentable carbohydrates that can exacerbate IBS symptoms. Studies in fibromyalgia patients show reduced abdominal pain, bloating, and diarrhea on the diet along with weight loss.
Nutritional Supplements
- Vitamin D: Supplementing vitamin D up to 50,000 IU weekly has reduced pain, fatigue, depression and improved quality of life in fibromyalgia patients deficient in vitamin D. This may be attributed to the immunomodulatory effects of vitamin D.
- Magnesium: Increasing magnesium intake through diet or supplements alleviates muscle pain, spasms, and tenderness associated with magnesium deficiency seen in some fibromyalgia patients. Magnesium regulates neurotransmitters involved in pain processing.
- Probiotics: Correcting microbial dysbiosis with probiotic strains like Lactobacillus and Bifidobacterium has shown early promise in modifying gut-brain interactions and improving neurocognitive symptoms for fibromyalgia patients. More research is needed on weight loss effects.
- Iron: Addressing iron deficiency with oral iron supplementation has been shown to reduce fibromyalgia symptoms and fatigue. Iron is essential for proper muscular, neurological and immune function relevant to fibromyalgia pathophysiology.
Complementary and Alternative Options
Certain complementary modalities and supplements may also provide adjuvant support for weight loss:
- Practice mind-body therapies like yoga, tai chi which can improve flexibility, strength, and mindfulness around food.
- Try specialized anti-inflammatory diets or exclusion diets that may reduce inflammation and symptoms.
- Use assistive equipment such as recumbent bikes, aquatic exercise tools to enable activity with less pain.
Realistic Goal Setting and Monitoring
Creating realistic weight loss goals and monitoring progress is key for fibromyalgia patients:
- Focus on gradual, sustainable changes in eating and exercise rather than extensive dieting.
- Set specific but achievable goals for nutrition, physical activity, sleep, reducing stressors.
- Track progress through a journal or app to log weight, diet, symptoms, energy levels.
- Adjust approach by reducing activity or intensity if symptoms flare up.
Having realistic expectations and making incremental changes can promote steady, maintainable weight loss over time.
Conclusion
Losing weight with fibromyalgia requires a multifaceted strategy tailored to each individual. Lifestyle modifications, medical and professional input, complementary approaches and realistic goal-setting all play an important role.
The focus should be on safe, gradual weight loss through controlled diet changes and gentle increases in physical activity. Pacing activity to avoid overexertion is key. With an integrated, personalized plan, fibromyalgia patients can successfully achieve weight loss and better health.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.