Fibromyalgia Syndrome: A Case Report on Controlled Remission of Symptoms by a Dietary Strategy.

[Murph]

Fibromyalgia Syndrome: A Case Report on Controlled Remission of Symptoms by a Dietary Strategy.
Lattanzio SM1, Imbesi F2.
Author information
Abstract
A 34-year-old woman suffered from significant chronic pain, depression, non-restorative sleep, chronic fatigue, severe morning stiffness, leg cramps, irritable bowel syndrome, hypersensitivity to cold, concentration difficulties, and forgetfulness. Blood tests were negative for rheumatic disorders. The patient was diagnosed with Fibromyalgia syndrome (FMS). Due to the lack of effectiveness of pharmacological therapies in FMS, she approached a novel metabolic proposal for the symptomatic remission.

Its core idea is supporting serotonin synthesis by allowing a proper absorption of tryptophan assumed with food, while avoiding, or at least minimizing the presence of interfering non-absorbed molecules, such as fructose and sorbitol. Such a strategy resulted in a rapid improvement of symptoms after only few days on diet, up to the remission of most symptoms in 2 months. Depression, widespread chronic pain, chronic fatigue, non-restorative sleep, morning stiffness, and the majority of the comorbidities remitted.

Energy and vitality were recovered by the patient as prior to the onset of the disease, reverting the occupational and social disabilities. The patient episodically challenged herself breaking the dietary protocol leading to its negative test and to the evaluation of its benefit. These breaks correlated with the recurrence of the symptoms, supporting the correctness of the biochemical hypothesis underlying the diet design toward remission of symptoms, but not as a final cure. We propose this as a low risk and accessible therapeutic protocol for the symptomatic remission in FMS with virtually no costs other than those related to vitamin and mineral salt supplements in case of deficiencies. A pilot study is required to further ground this metabolic approach, and to finally evaluate its inclusion in the guidelines for clinical management of FMS.

 

[Lisa108]

Maybe she had a missed diagnosis of fructose and/or sorbitol intolerance instead of Fibromyalgia... it's quite common to lack nutrients like tryptophan (and zinc and folic acid) when your intestines are damaged from untreated fructose and/or sorbitol intolerance.

 

[Lisa108]

Here is the link to the full-text

 

[ChrisD]

https://www.frontiersin.org/articles/10.3389/fmed.2017.00198/full

Fibromyalgia Syndrome: A Metabolic Approach Grounded in Biochemistry for the Remission of Symptoms
The presence of non-absorbed molecules in the gut, primarily fructose, reduces tryptophan absorption. Low tryptophan absorption leads to low serotonin synthesis that triggers FMS symptoms.

I had ME and Fibro, quit eating fruit and the Fibro went - I still have ME though.

 

[Murph]

"
The patient’s diet includes eggs, meat, fish, clams, potatoes, carrots, celery, spinaches, beets, chards, dark chocolates (at least 70 + % cacao), rice, millet, carob powder, walnuts, extra virgin oil, grape seed oil, thyme, sage, rosemary, coffee, green tea, and small amount of almonds. Almonds, despite containing fructose, still belong to the patient’s diet, as they are well tolerated in small amount, suggested to be consumed together with a glucose source, typically rice or potatoes to activate GLUT2 transporter as remarked in Ref. (11).

Any food, beverage, or herb not in the previous list and not according to treatment guidelines is excluded from the diet protocol. Particularly, processed food containing artificial sweeteners, high fructose corn syrup, sorbitol, glutamate, and aspartame must be excluded: among others soft drinks, fruit juices and the majority of confectionery (11). Food containing free fructose, such as honey and fruits, must be removed from patient’s diet. Most legumes, wheat and most cereals, and many vegetables that contain fructans and inulins (15) must also be removed (11). Attention must also be paid to the excipients in pharmacological preparations, pills, syrups, and solutions (16).

Compared with the previous patient’s diet, the one proposed here does not affect the total daily energy intake (2,200–2,400 kcal/day), but the nutritional profile concerning a reduction in carbohydrates, fibers, and an increase in protein and fat intake. The patient’s diet is thus composed of 31–36% carbohydrates, 30–32% fats, 25–27% proteins, and 9–10% fibers. The previous diet was mainly a Mediterranean diet. It was rich in vegetables, fresh fruits, dried fruit, cereals, and legumes. It contained a moderate amount of fish, meat, dairy products, eggs, nuts, and sweets. Its proportion of nutrients was: 55–56% carbohydrates, 30–32% fats, 17–18% proteins, and 16–18% fibers.

 

[Runner5]

I do tend to have to take L-Tryptophan directly at night if I want to sleep properly and I have trouble with digesting FODMAPS. Interesting stuff!

 

[Lisa108]

Yes, interesting indeed. For me it seems as if a lot of people weren't checked for food intolerances before diagnosis of Fibromyalgia. But were they checked for small fiber neuropathy/damage? Maybe different causes leading to same dx, just like in ME?
I am intolerant to sorbit (which means that I have to cut short fructose, too), but there is no difference in my ME symptoms, just better for my gut.

 

[ljimbo423]

The patient’s diet includes eggs, meat, fish, clams, potatoes, carrots, celery, spinaches, beets, chards, dark chocolates (at least 70 + % cacao), rice, millet, carob powder, walnuts, extra virgin oil, grape seed oil, thyme, sage, rosemary, coffee, green tea, and small amount of almonds. Almonds, despite containing fructose, still belong to the patient’s diet, as they are well tolerated in small amount, suggested to be consumed together with a glucose source, typically rice or potatoes to activate GLUT2 transporter as remarked in Ref.

That's basically the same diet I am on for dysbiosis and increased intestinal permeability. With only small amounts of potatoes and rice for starchy carbs.

I wonder how much of her improvement had to do with modifying the gut microbiota rather than serotonin.

Jim

 

[Wonkmonk]

This reminds me of Jordan Peterson saying all his autoimmune diseases went into remission with a strict diet of only meat and greens.

His daughter also reports a complete remission of severe depression with similar dietary adjustments.

Diet definitely is important for some patients.

Btw, the diet of the patients above also appears to happen to be gluten-free. I assume any gluten-associated disease has been ruled out?

 

[Gondwanaland]

https://www.frontiersin.org/articles/10.3389/fmed.2017.00198/full

Fibromyalgia Syndrome: A Metabolic Approach Grounded in Biochemistry for the Remission of Symptoms
The presence of non-absorbed molecules in the gut, primarily fructose, reduces tryptophan absorption. Low tryptophan absorption leads to low serotonin synthesis that triggers FMS symptoms.

I had ME and Fibro, quit eating fruit and the Fibro went - I still have ME though.

According to this paper, the FMS symptoms are

The constellation of symptoms that characterize this condition comprises lower pain threshold to normally non-painful stimuli (allodynia), greater sensitivity to pain stimuli (hyperalgesia), stiffness, fatigue, psychological distress (depression), cognitive impairment, such as problems with short-term memory, impaired speed of information processing, limited multi-tasking performance, and reduced attention span (1–3). Moreover, the majority of patients has one or more pain co-morbidities or associated disorders: among them lower back pain, specific regions of localized tenderness, non-restorative sleep and sleep disturbances, irritable bowel syndrome (IBS), restless leg syndrome and leg cramps, headache, migraine, visceral pain, temporomandibular disorder (TMD), anxiety, palpitation, chest pain and muscle twitching (2–7).

How to tell FMS and Hashi's symptoms apart ? I have read before that taking thyroid hormone would help with FMS symptoms. There is also a small study about a similar diet putting Hashi's into remission:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028075/pdf/dddt-10-2939.pdf

Drug Des Devel Ther. 2016 Sep 14;10:2939-2946. eCollection 2016.
Effects of low-carbohydrate diet therapy in overweight subjects with autoimmune thyroiditis: possible synergism with ChREBP.
Esposito T1, Lobaccaro JM2, Esposito MG3, Monda V4, Messina A4, Paolisso G5, Varriale B6, Monda M4, Messina G7.
Author information

Abstract
The thyroid is one of the metabolism regulating glands. Its function is to determine the amount of calories that the body has to burn to maintain normal weight. Thyroiditides are inflammatory processes that mainly result in autoimmune diseases. We have conducted the present study in order to have a clear picture of both autoimmune status and the control of body weight. We have evaluated the amount of either thyroid hormones, or antithyroid, or anti-microsomal, or anti-peroxidase antibodies (Abs) in patients with high amounts of Abs. In a diet devoid of carbohydrates (bread, pasta, fruit, and rice), free from goitrogenic food, and based on body mass index, the distribution of body mass and intracellular and extracellular water conducted for 3 weeks gives the following results: patients treated as above showed a significant reduction of antithyroid (-40%, P<0.013), anti-microsomal (-57%, P<0.003), and anti-peroxidase (-44%, P<0,029) Abs. Untreated patients had a significant increase in antithyroid (+9%, P<0.017) and anti-microsomal (+30%, P<0.028) Abs. Even the level of anti-peroxidase Abs increased without reaching statistical significance (+16%, P>0064). With regard to the body parameters measured in patients who followed this diet, reduction in body weight (-5%, P<0.000) and body mass index (-4%, P<0.000) were observed. Since 83% of patients with high levels of autoantibodies are breath test positive to lactase with a lactase deficit higher than 50%, this fact led us to hypothesize a correlation with carbohydrate-responsive element-binding protein and therefore a possible role of carbohydrate metabolism in the development and maintenance of autoimmune thyroiditis associated with body weight increase and slower basic metabolism.

unfortunately I am already underweight and food intolerances and poor digestion only allow me to eat about 1,800 calories daily. I also must be careful about a high protein diet because my BUN and serum uric acid are very high.

My BUN would make Shawn Baker (the carnivore MD) blush.

 

[Eiren]

Interesting.

My primary diagnosis is FMS.

Though I seem to be sensitive to serotonin. Last year I was prescribed both amipitryptiline and tramadol and after a few days I got nasty serotonin syndrome side effects. Not life-threatening bad, but bad. I stopped the tramadol and have kept the amipitryptiline, but on 25mg/day.

I've trialed other SSRI's, small dose of escatipralom for example, and that also makes me feel weird, buzzing in head and shaky and so on. So I've had the theory that my serotonin is off somehow, and started looking at dopamine recently. But I haven't figured anything out about that yet.

But maybe the tryptophan route would work better for my serotonin than SSRI's?

I had (have?) Lyme, but only took a (too) low dose of Doxy for (too) short a time, for a few times. But I found Doxy really hard on my stomach. Bloating, cramps, and general indigestion followed it. I'm allergic to sulfas, so I've kinda given up on the antibiotic route and have been using herbs. But maybe the bit of Doxy was enough to throw it all off-kilter?

Oh, and I've been screened for neuropathy and SFN with the skin wrinkle test. It all turned out fine.

Anyway, I'm thinking about this. And I'm pretty willing to change my diet drastically. It's family members that are the drag. I need to figure that out somehow.

 

[Gondwanaland]

But maybe the tryptophan route would work better for my serotonin than SSRI's?

In the papers they advise against taking Trp because one can easily get serotonin syndrome from it.

It's family members that are the drag.

Precisely. I am already underweight, how am I going to explain that I need to decrease the diversity of food I eat?

 

[Eiren]

In the papers they advise against taking Trp QUOTE]

Yes, I didn't mean supplement with trp. I've just been totally avoiding anything to do with serotonin. Including natural routes.

Now I'm wondering if it's possible that my serotonin sickness could be because the natural route in my intestines is messed up somehow.

 

[Gondwanaland]

@Murph thank you so much for this thread! I just fixed my insomnia! @Mary
Just by removing the piece of fruit I used to eat with dinner and adding Dijon mustard I can sleep the whole night again.

Last year I hacked my dinner with dijon mustard (with whole seeds) + parsley which are high in Trp and it worked, until I just couldn't take the pain caused by my corneal herpes. Now I know to balance it with Lysine and vitamin A. Let's see how long it lasts.

 

[Murph]

@Murph thank you so much for this thread! I just fixed my insomnia!

For a moment there I thought you were saying this thread was so soporifically boring you nodded off!

 

[Eastman]

Last year I hacked my dinner with dijon mustard (with whole seeds) + parsley which are high in Trp and it worked, until I just couldn't take the pain caused by my corneal herpes. Now I know to balance it with Lysine and vitamin A. Let's see how long it lasts.

Do you take the lysine at dinner with the dijon mustard + parsley?

 

[Gondwanaland]

Do you take the lysine at dinner with the dijon mustard + parsley?

Lysine supplementation gives me neck tension, which I haven't ruled out if it is from interaction with Trp, arginine, ammonia or some viral issue... So I try to balance it with food... When adding mustard, I also add more cheese - far from ideal considering that dairy can revv up autoimunity... but it's working. Additionally, my dinner always contains meat, chicken or fish. I haven't reintroduced the parsley in this round yet.

 

[mrquasar]

This reminds me of Jordan Peterson saying all his autoimmune diseases went into remission with a strict diet of only meat and greens.

His daughter also reports a complete remission of severe depression with similar dietary adjustments.

Diet definitely is important for some patients.

Btw, the diet of the patients above also appears to happen to be gluten-free. I assume any gluten-associated disease has been ruled out?

I'm starting to come around to the dietary route for treating or reversing many chronic illnesses (maybe not ME but who knows). I will begin a low-sugar, low-carb diet in the coming weeks for suspected D-lactic acidosis / bacterial overgrowth. From talks and documentaries I've watched, it's becoming readily apparent that the current Western diet really is toxic to our bodies. As another poster mentioned, changing your diet actually alters your gut microbial composition. And this is crucial as different gut microbes produce different chemicals that interact with our bodies in ways that our just now being elucidated and which are being shown to be linked to various autoimmune diseases.

I wouldn't try to sell as a paleo-keto style diet as a cure-all, but it does seem to be an important tool in supporting your body's optimal health.

I will see in the coming weeks how I respond to the dietary change.

 

[Eiren]

"
The patient’s diet includes eggs, meat, fish, clams, potatoes, carrots, celery, spinaches, beets, chards, dark chocolates (at least 70 + % cacao), rice, millet, carob powder, walnuts, extra virgin oil, grape seed oil, thyme, sage, rosemary, coffee, green tea, and small amount of almonds. Almonds, despite containing fructose, still belong to the patient’s diet, as they are well tolerated in small amount, suggested to be consumed together with a glucose source, typically rice or potatoes to activate GLUT2 transporter as remarked in Ref. (11).

Any food, beverage, or herb not in the previous list and not according to treatment guidelines is excluded from the diet protocol. Particularly, processed food containing artificial sweeteners, high fructose corn syrup, sorbitol, glutamate, and aspartame must be excluded: among others soft drinks, fruit juices and the majority of confectionery (11). Food containing free fructose, such as honey and fruits, must be removed from patient’s diet. Most legumes, wheat and most cereals, and many vegetables that contain fructans and inulins (15) must also be removed (11). Attention must also be paid to the excipients in pharmacological preparations, pills, syrups, and solutions (16).

Compared with the previous patient’s diet, the one proposed here does not affect the total daily energy intake (2,200–2,400 kcal/day), but the nutritional profile concerning a reduction in carbohydrates, fibers, and an increase in protein and fat intake. The patient’s diet is thus composed of 31–36% carbohydrates, 30–32% fats, 25–27% proteins, and 9–10% fibers. The previous diet was mainly a Mediterranean diet. It was rich in vegetables, fresh fruits, dried fruit, cereals, and legumes. It contained a moderate amount of fish, meat, dairy products, eggs, nuts, and sweets. Its proportion of nutrients was: 55–56% carbohydrates, 30–32% fats, 17–18% proteins, and 16–18% fibers.

Hmm...having a flare right now, and trying this is appealing to me.

Wondering about the food list though. Plain Greek yogurt? Coffee? Butter? Coconut oil? I found this list of fructose foods https://www.healthhype.com/nutrition-guide-for-fructose-malabsorption.html. All those things seem okay, unless there's another reason to exclude them that I'm missing? Maybe the diet in the study was based on what the lady was already eating?

 

[Eiren]

https://www.frontiersin.org/articles/10.3389/fmed.2017.00198/full

Fibromyalgia Syndrome: A Metabolic Approach Grounded in Biochemistry for the Remission of Symptoms
The presence of non-absorbed molecules in the gut, primarily fructose, reduces tryptophan absorption. Low tryptophan absorption leads to low serotonin synthesis that triggers FMS symptoms.

I had ME and Fibro, quit eating fruit and the Fibro went - I still have ME though.

Oh, right. They also exclude lactose because.....it might be like fructose? Okay. Hmm....



so quitting fruit caused remission or your muscle pain et. al. Interesting. Did you trial cutting out all fructans?