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A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients

Marum AP, et al. Scand J Pain (2016)

Reduction of FODMAPs has been shown to have significant benefits in the treatment of irritable bowel syndrome (IBS). It is reported that 70% of patients with fibromyalgia (FM) suffer from IBS and FM patients report exacerbation of symptoms with certain foods, with a proportion attempting to control symptoms via dietary restriction.
It was therefore hypothesised that a LFD may be an effective treatment of FM, not only for the gastrointestinal (GI) symptoms but that some benefit for somatic pain and impact on daily life might also be derived.

The aim of this pilot longitudinal study was to examine the effects of a LFD on the symptoms of FM, especially with regard to pain, quality of life (QOL) and GI symptoms. 38 adult female participants, aged 51 ± 10 years, with a mean duration of 10 years of FM diagnosis, met the inclusion criteria and underwent a four-week, repeated assessment programme. Assessments at baseline, four weeks after LFD introduction (the point at which FODMAPs were reintroduced) and four weeks later were undertaken where clinical and nutritional data were collected. Satisfaction and adherence to diet were also assessed.

This study showed a LFD had a positive effect for the spectrum of symptoms associated with FM including improvements in somatic pain and GI symptoms as well as impact on daily life and improved wellbeing. The improvement in IBS symptoms was found to be in agreement with results from other studies with the high prevalence of functional GI symptoms in the study cohort being similar to previously recorded prevalence of IBS in FM patients. Significant reductions in a variety of FM scores following four weeks on a LFD were observed. The variation of parameters related to FM varied according to FODMAP intake, with a significant difference after the LFD period and no significant difference after the reintroduction of FODMAPs. The subgroup of participants found to have the most significant response to a LFD were those classified with a moderate impact score for FM.

Following the reintroduction of FODMAPs to the diet, whilst FM morbidity scores remained fairly stable, IBS symptom scores worsened. This difference in response between GI and systemic symptoms may be explained by the fact that the GI tract is more quickly exposed, and perhaps more sensitive to FODMAP activation of symptoms. The overall QOL score showed a non-significant trend towards improvement with significant improvements in ‘pain/discomfort’ and ‘mobility’ domains seeming to be related with FM. Adherence to the diet (85%), satisfaction with symptomatic improvement (76%) and ease of diet (75%) were similar to the findings of other studies looking at these.

This study showed that a LFD may have potential as a treatment option for FM, particularly in those with moderate severity FM. Further research in this area is required to verify the use of a LFD for treatment of FM.

Link to original paper: https://dx.doi.org/10.1016/j.sjpain.2016.07.004
 
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