Can a Ketogenic Diet Improve Fibromyalgia Symptoms?

While there’s not an abundance of studies proving the effectiveness of the ketogenic diet for people with fibromyalgia, emerging research and anecdotal evidence suggest that it may be beneficial for some.

Fibromyalgia is a chronic disorder defined by pain and tenderness throughout the body, fatigue, and, often, sleep problems and difficulty with memory and concentration (“fibro fog”). No single diet has been shown to improve these symptoms.

The ketogenic diet is similar to the Paleo diet, which emphasizes whole foods and the elimination of sugar, grains, and processed foods. But the ketogenic diet is extremely low-carb, moderate in protein, and high in fat. It produces a state of ketosis, in which the body’s fat stores are used for energy, and which has been associated with a reduction in hunger, at least anecdotally.

John (Jack) Shelley-Tremblay, PhD, professor of psychology and adjunct professor of neurology at the University of South Alabama in Mobile, has done research on the effects of carbohydrates on fibromyalgia symptoms. And while he’s skeptical of diet fads, he points to research suggesting that the ketogenic diet is helpful for a number of conditions — including, for example, epilepsy and autism spectrum disorders. He notes that some European studies have found that many people with fibromyalgia “improve dramatically when they are on a low-carb or ketogenic diet.”;

The Brain Craves Energy to Run

“The standard American diet has a lot of sugar, refined grains, and things you wouldn’t have found in the evolutionary background of humans,” says Dr. Shelley-Tremblay. Research, he says, indicates that people with fibromyalgia do not metabolize sugars and other carbohydrates normally, so their cells, including their brain cells, crave energy.

“The brain is the most energy-craving part of the body pound for pound, and it wants sugar to run,” Shelley-Tremblay says, referring to the brain’s use of glucose as its primary fuel under normal circumstances.

People with fibromyalgia are in a constant state of deficit, he says, and have difficulty meeting the energetic needs of the brain. The result can be exhaustion, pain, poor sleep, and fibro fog, which he describes as “a condition associated with decreased cognitive capacity, specifically decreased short-term or working memory, decreased attentional resources, fatigue, and trouble concentrating.”

It’s a vicious triangle, he says. “Poor sleep, which is both caused by and exacerbates pain, leaves you with fewer cognitive resources to dampen down that pain enough to function.” On top of that, he says, are the energetic deficits associated with the metabolic conditions underlying fibromyalgia.

In Study, High Blood Sugar Leads to Lethargy

Shelley-Tremblay, along with Allen Ernst and John P. Kline, compared the effects consuming carbohydrate had on mood in a small group of women with fibromyalgia with the effects on a similar-size group of women who didn’t have fibromyalgia, in an earlier study published in the Journal of Musculoskeletal Pain.

Many of the women with fibromyalgia acknowledged that they craved carbohydrates and often used them to try to manage their moods and give themselves an energy boost. So when, after having participants fast for 8 to 12 hours, the researchers fed them a big dose of a “super-sugar Kool-Aid mixture,” according to Shelley-Tremblay, the women expected to feel better.

The researchers recorded the women’s blood glucose, assessed their mood using a Profile of Mood States scale, and recorded the electrical activity in certain areas of their brains using electroencephalography (EEG).

“What actually happened was their anger and hostility spiked, almost in sync with their elevated blood glucose,” says Shelley-Tremblay. Soon after, instead of getting an energy boost, they felt frustrated and lethargic, and many did not metabolize the sugar well.

While Shelley-Tremblay’s study looked at the effects of a single, large dose of sugar, a study published in the March-April 2013 issue of the journal Orthopaedic Nursing looked at dietary patterns in women with fibromyalgia over time. The researchers found that high carbohydrate and sugar intake was linked to reduced quality of life, and increased sugar intake was associated with increased severity of pain.

Low-Carb Diets Show More Positive Effects in Lab and in Life

The effects of a ketogenic diet on pain and inflammation were investigated in a rat study published in the journal PLoS One. Adult and juvenile rats were fed a ketogenic diet for three to four weeks, after which they were given standard tests measuring pain and inflammation. Based on their results, the study authors concluded that the diet “offers new therapeutic opportunities for controlling pain and peripheral inflammation, and that such a metabolic strategy may offer significant benefits for children and adults.”

Shelley-Tremblay and Ernst compared the effects of different types of diets in humans with fibromyalgia in a study published in November 2013 in the Journal of Musculoskeletal Pain. The participants, all of whom were women, completed a questionnaire on mood, energy level, and fibromyalgia symptoms. Those who reported adhering to a low-carbohydrate diet reported less confusion, distress, and fatigue, and more vigor than those who reported following a typical Western diet.

Parry Lama, a scientist and writer living in London, says that a low-carbohydrate diet helps her tamp down chronic fatigue and pain from fibromyalgia. She adheres as closely as possible to a ketogenic diet, but otherwise always keeps the carbs low. She recently discovered a Mediterranean version of the diet that mirrors what she’d already adopted.

“I almost exclusively eat coconut milk, red meat, and salmon when I need to work an 18-hour day, as I know my body will crash otherwise. However, working an 18-hour day was unheard of for me before I started this diet,” the 27-year-old says.

Though some may find it difficult to follow a low-carb diet, Lama, while she admits to missing the crunchy foods that are hard to come by when eschewing carbs, says, “I can feel the difference so quickly that I’m not inspired to cheat. The impact on pain is so strong that I can feel the difference after more than one carb-heavy meal.”

The Key May Be Reducing Inflammation

The primary benefit of ketogenic diets, says Shelley-Tremblay, is that they’re low in the refined sugars and simple carbs that are so inflammatory.

“Some people can go into ketogenesis with a low-fat, low-sugar diet, while some need to lay on the fats,” he says. But it’s not necessary to be in ketosis to see the health benefits of cutting back on simple starches and sugars.

It’s essentially a low glycemic index–type diet that helps, “because that has the biggest correlation with reducing inflammation.” (More information about the glycemic index is available from the Glycemic Index Foundation.)

For Some, Low-Carb Makes Symptoms Worse

But just as the symptoms of fibromyalgia are variable, so is response to diet. Not everyone will thrive on a low-carb diet. Annie Sisk, 52, of upstate New York, found that her symptoms worsened when she adopted a low-carb diet.

“My pain levels began soaring almost immediately. I felt so much worse. Nothing helped. I missed days from work,” Sisk says.

It took some time for her to realize that cycles of constipation and loose stools tracked with her pain cycles. “Since low-carb diets create or exacerbate constipation, it makes sense my symptoms got worse. ” She tried stool softeners and fiber additives to no effect.

Sisk has settled on a mostly vegetarian, low-fat diet that she says keeps her pain at manageable levels. Her diet includes lean, grass-fed beef, free-range chicken, and wild fish, along with occasional servings of fruits that have a low glycemic index.

RELATED: All About Fiber: Food Sources and Supplements

Consult an Expert When Changing Your Diet

Whether you’re considering trying a ketogenic diet, another type of low-carb diet, or any nutritional approach that’s different from what you now eat, it’s best to consult a registered dietitian-nutritionist (RDN) for advice on making the switch.

RDNs can help you tailor the approach to your specific needs and help you overcome side effects, such as constipation. In addition, they can help with weight management which, says Shelley-Tremblay, is crucial for those living with fibromyalgia. A healthy weight, he says, is essential, since excess weight can contribute to pain, poor sleep, sleep apnea, and wear and tear on joints.

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Effects of a Low-Carbohydrate Ketogenic Diet on Reported Pain, Blood Biomarkers and Quality of Life in Patients with Chronic Pain: A Pilot Randomized Clinical Trial

Randomized Controlled Trial

. 2022 Feb 1;23(2):326-338.

doi: 10.1093/pm/pnab278.

Rowena Field 
¹
, Fereshteh Pourkazemi 
¹
, Kieron Rooney 
¹

Affiliations

Affiliation

• ¹ Sydney School of Health Sciences, The University of Sydney, Faculty of Medicine and Health, NSW, Australia.

• PMID:

  34534353

• DOI:

  10. 1093/pm/pnab278

Randomized Controlled Trial

Rowena Field et al.

Pain Med.

2022.

. 2022 Feb 1;23(2):326-338.

doi: 10.1093/pm/pnab278.

Authors

Rowena Field 
¹
, Fereshteh Pourkazemi 
¹
, Kieron Rooney 
¹

Affiliation

• ¹ Sydney School of Health Sciences, The University of Sydney, Faculty of Medicine and Health, NSW, Australia.

• PMID:

  34534353

• DOI:

  10. 1093/pm/pnab278

Abstract

Background:

A low-carbohydrate ketogenic diet has been reported to improve chronic pain by reducing inflammation, oxidative stress, and sensitivity within the nervous system. The main aim of this trial is to evaluate the effects of a ketogenic diet on reported pain, blood biomarkers and quality of life in patients with chronic pain.

Methods:

Participants with chronic musculoskeletal pain were recruited for a 12-week diet intervention that commenced with a 3-week run-in diet removing ultra-processed foods, followed by randomization to either a whole-food/well-formulated ketogenic diet (WFKD) or to continue with the minimally processed whole-food diet (WFD). Outcome measures included: average pain (visual analogue scale VAS), blood biomarkers, anthropometrics, adherence, depression, anxiety, sleep, ketones, quality of life, diet satisfaction, and macronutrient intake.

Results:

Average weekly pain improved for both groups. WFKD group VAS reduced by 17.9 ± 5.2 mm (P = .004) and the WFD group VAS reduced 11.0 ± 9.0 mm (P = .006). Both groups also reported improved quality of life (WFKD = 11.5 ± 2.8%, P = .001 and WFD = 11.0 ± 3.5%, P = .014). The WFKD group also demonstrated significant improvements in pain interference (P = 0.013), weight (P < .005), depression (P = .015), anxiety (P = .013), and inflammation (hsCRP) (P = .009). Significant average pain reduction remained at three-month follow-up for both groups (WFKD P = .031, WFD P = .011).

Conclusions:

The implementation of a whole-food diet that restricts ultra-processed foods is a valid pain management tool; however, a low-carbohydrate ketogenic diets may have potentially greater pain reduction, weight loss and mood improvements.

Keywords:

Chronic Pain; Human; Inflammation; Ketogenic Diet; Low-Carbohydrate; Nutritional Ketosis; Quality of Life; Randomized Clinical Trial; Whole-Food Diet.

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected].

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Fibromyalgia, chronic fatigue syndrome and chronic pain

When I started my medical practice 30 years ago, fibromyalgia could not be accurately diagnosed, so a person had to go to the doctor for 9-10 years before the disease could finally be diagnosed. The situation has changed dramatically, and today a wide variety of symptoms are attributed to fibromyalgia. However, there is no doubt that this disease really exists, is painful and sometimes detrimental to health.

An estimated 5 million people in the United States suffer from fibromyalgia. 9 out of 10 of all cases are women (29). Unfortunately, there is still no special diagnostic analysis for the detection of this pathological condition. There are clinical diagnostic criteria, and the most common of these is the presence of hypersensitivity to pain in certain areas of the body, including:

• elbows;

• clavicle;

• knees;

• thighs.

Patients often complain of pain throughout the body, such as in muscles, ligaments and tendons, which is accompanied by a strong feeling of fatigue. That is why in this section I am talking about fibromyalgia with reference to chronic fatigue syndrome and chronic pain.

Painkillers and, in some cases, psychotropic drugs such as antidepressants, are the traditional treatments prescribed by doctors. I do not advise taking these medicines because they do not address the root cause of the disease.

Recent evidence suggests that central sensitization, where neurons in the spinal cord are sensitized by inflammation or cell damage, may be associated with pain in people with fibromyalgia (30).

The problem is that fibromyalgia has a very wide range of symptoms, including extensive pain and weakness, and many causative factors. No treatment can eliminate them all at once.

If you suffer from fibromyalgia, chronic fatigue syndrome, or chronic pain, you know how difficult it can be to manage these conditions and navigate the many conflicting dietary recommendations. In fact, there is very little scientific evidence in favor of any particular nutrition program that can be classified as effective.

But I am sure that a high-fat diet can significantly alleviate unpleasant symptoms and change the quality of life of patients. This is primarily due to the fact that by improving the functioning of mitochondria, you improve the body’s ability to produce energy.

There is evidence that people with fibromyalgia experience fewer symptoms when they eliminate one or more foods that cause food allergies or sensitivities from their diet. Common foods include corn, wheat, soy, dairy products (which are likely high in glyphosate), citrus fruits, and sugar. The top 3 are pasteurized milk, soy, and gluten (wheat and similar grains). A study in 17 patients with fibromyalgia found that after cutting out corn, wheat, dairy, citrus and sugar, almost half experienced a “significant reduction in pain” (31).

Scientists are only just beginning to recognize the link between oxidative stress, mitochondrial dysfunction, and health problems such as chronic fatigue and fibromyalgia (32), two conditions that a high-fat diet can help restore balance to your body.

While there has been very little research on the effects of a high-fat diet on chronic fatigue syndrome, fibromyalgia, and chronic pain, there is one study worth noting, published in 2013 in the December 9 issue. 0031 Journal of Musculoskeletal Pain (33). The diet used in this study was unequivocally non-ketogenic (i.e., its goal was not to force the body to actively produce ketones through high fat or intermittent fasting), but it was low-carbohydrate. The researchers noted that 33 middle-aged women who followed this diet experienced increased energy, decreased pain, and improved scores on the Fibromyalgia Impact Questionnaire.

If you suffer from one of these pervasive and difficult-to-treat disorders, you will be glad to know that you can dramatically improve your health and quality of life. Just rethink your diet and ditch carbs in favor of high quality fats.

Plant-based nutrition and the ketogenic diet for cancer. What’s better?

You can lower your risk of developing cancer!

The incidence of cancer and metabolic disorders is steadily increasing. Against this background, scientists decided to evaluate the impact of nutrients and diet on the development of cancer. It turns out that a healthy diet can prevent the development of cancer.

A recent review of evidence found that, compared to the keto diet, a plant-based diet is more effective in reducing the chance of developing cancer.

Findings from the Plant-Based Nutrition and Ketogenic Diet for Cancer Study

In July 2020, a review published in JAMA Oncology assessed the impact of a ketogenic diet and a plant-based diet on cancer risk. Despite their differences, both eating styles are associated with weight loss, reduced inflammation, and reduced insulin levels, scientists say.

A plant-based diet has also been associated with increased intake of fiber and phytochemicals, while a ketogenic diet has anti-cancer effects due to beta-hydroxybutyrate, a ketone known to have an effect on cancer cells.

An analysis of the data from both diets showed that a predominantly plant-based diet reduced the risk of cancer. However, the researchers note that there are currently no well-studied approaches that support the use of any particular diet for cancer treatment.

What does it mean

Scientists have found that when comparing a plant-based diet and a keto diet in terms of reducing the risk of cancer and combating metabolic disorders, the resulting collective evidence speaks in favor of the former.

The keto (or ketogenic) diet involves drastically reducing carbohydrate intake while increasing fat intake. This puts the body into ketosis, a metabolic state that allows the body to burn fat instead of carbohydrates for energy. The ketogenic diet has been proven to have an antitumor effect and is believed to create a hostile environment for cancer cells.

A plant-based diet includes fruits, vegetables, beans, beans, nuts, seeds, grains, and healthy fats. Cancer prevention intervention studies have found that increasing the amount of fruits and vegetables consumed while reducing fat reduces common cancer risk factors such as inflammation, excess body fat, and insulin resistance.

Studies have shown that a plant-based diet contributes to both the treatment and prevention of breast cancer. A meta-analysis based on over 3 million subjects found that plant-based diets reduce the risk of developing digestive system cancer.

There is evidence that both a plant-based diet and a ketogenic diet reduce cancer risk, with a diet high in whole foods and low in fat generally more effective.

Cancer Prevention

Since cancer is not a single disease, but a group of related diseases, there are many risk factors that affect the occurrence of this disease, including diet, lifestyle, environment and genetics.

But you can reduce your risk of developing cancer by:

• Eat cancer-fighting foods, including fruits, vegetables, healthy fats, nuts, and seeds
• Maintain a healthy weight
• Avoid processed foods
• Avoid foods with added sugar and artificial sweeteners
• Do sports
• get enough sleep
• Avoid stress
• Quit smoking and limit alcohol consumption
• Drink enough water
• Reduce exposure to chemicals both at home and outside
• Maintain optimal vitamin D levels

Conclusion

• A recent review published in JAMA Oncology found that a plant-based diet was more effective than a ketogenic diet in reducing the risk of cancer.