Fruits, Vegetables, and Fibromyalgia

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Diets rich in fruits and vegetables can benefit fibromyalgia patients in a number of ways. On a broad scale, the low-calorie nature of most fruits and vegetables is an attractive selling point due to the fact that research has shown an increased incidence of fibromyalgia among overweight and obese individuals (Ursini et al., 2011; Bennett et al., 2007). Furthermore, research has also shown that overweight and obese fibromyalgia patients tend to experience greater pain sensitivity, lower quality of life, and more severe overall symptoms (Neumann et al., 2008). Increasing consumption of low-calorie fruits and vegetables is an essential component of healthy weight-loss, which can potentially lead to overall symptom improvement in the face of fibromyalgia.fruits and vegetables for fibromyalgia

The U.S. Food and Drug Administration has a wealth of information available regarding the nutritional profile of  foods. Complete nutritional information for the most commonly consumed fruits and vegetables can be found by visiting the website listed below. You can use this information to help educate yourself about the calorie content of your favorite fruits and vegetables, as well as to assist you in your meal planning.

FDA Nutritional Information Database

Additionally, many fruits and vegetables are extremely high in fiber. To be considered a “high in fiber” food, fruits and vegetables must contain five grams or more fiber per serving. Examples of high-fiber fruits and vegetables include: apples, blackberries, lentils, lima beans, pears, pinto beans, raspberries, spinach, small white beans, and winged beans. Those considered to be “good” sources of fiber (meaning they contain 2.5 – 4.9 grams per serving) include: artichokes, bananas, blueberries, broccoli, Brussels sprouts, chickpeas, dates, figs, green beans, guava, kiwifruit, onions, oranges, split peas, plums, sweet potatoes, and white beans. The high prevalence of irritable bowel syndrome (IBS) among fibromyalgia patients makes fiber a particular topic of interest. Treatment for IBS symptoms typically includes a combination of therapies, including dietary modifications. And, one of the most effective dietary tools in the fight against IBS is fiber. Increased consumption of dietary fiber can help to relieve constipation and bloating, which are primary symptoms of IBS. Therefore, diets rich in high-fiber fruits and vegetables can potentially be of benefit to fibromyalgia patients who also suffer from the uncomfortable and burdensome symptoms of IBS.

In addition to obesity and IBS, the high-powered nutrition that fruits and vegetables bring to the table may also offer benefits to fibromyalgia patients who suffer from comorbid autoimmune illnesses, including rheumatoid arthritis, lupus, Crohn’s disease, and ulcerative colitis. Fruits and vegetables are excellent sources of vitamins, minerals, and other nutrients that are essential to healthy immune system functioning.

Oxidative Stress and Fibromyalgia

During digestion, food molecules react with oxygen in the body and form carbon dioxide and water. In the process, energy is released, which provides the body with the fuel it needs to function. This metabolic process also creates dangerous byproducts, among which include free radicals. Simply defined, free radicals are unstable atoms or molecules. To achieve stability, these free radicals strip electrons from nearby atoms or molecules, which then become unstable themselves. Those atoms or molecules strip electrons from their neighbors, and the chain-like reaction continues until it eventually slows down and stops. This process of electron removal is known as oxidation, and it can be destructive to the immediate surrounding environment. Common everyday examples of oxidation include rusting metal, or the process that causes a fresh cut apple to turn brown. Inside the body, oxidation is just as damaging. As a free radical chain-reaction occurs, it has the potential to tear through vital components of cells and cause extensive damage. The term oxidative stress refers to the total burden placed on the body by the constant production of free radicals during the normal course of metabolism, in addition to the extraneous stress placed on the body by environmental factors (such as air pollution, contaminants in food and water, and natural sources of radiation like the sun).

Fortunately, the body is well-equipped with numerous tools to defend itself against free radicals, including enzymes that neutralize highly reactive forms of oxygen, and repair mechanisms that undo oxidative damage. In the event of extreme damage, cells are programmed to kill themselves through a complex process known as apoptosis.

So what does all of this have to do with fibromyalgia? Although this particular area of research is still emerging, several studies have offered evidence to suggest that oxidative stress may be involved in the development of fibromyalgia. Studies have shown that fibromyalgia patients have increased levels of highly reactive forms of oxygen (Cordero et al., 2009) and other free radicals (Bagis et al., 2005), and that increased levels of oxidative stress are significantly associated with many clinical symptoms, including headaches (Cordero et al., 2011; Cordero et al., 2012) and fatigue (Chung et al., 2009). Additionally, studies have demonstrated a relationship between fibromyalgia and the powerful antioxidant coenzyme Q10 (or CoQ10). Some authors have noted that fibromyalgia patients have markedly decreased levels of CoQ10 and have offered research evidence to suggest that CoQ10 supplementation may be a potentially effective treatment for certain fibromyalgia-associated symptoms (Cordero et al., 2009). CoQ10 deficiency has also been linked to other conditions commonly experienced by fibromyalgia patients, including depression and fatigue (Maes et al., 2011; Maes et al., 2009). In addition, researchers have also suggested that dietary supplementation with vitamins C and E, both of which have significant antioxidant properties, may help to decrease oxidative stress in fibromyalgia patients (Naziroglu et al., 2010; Altindag & Celik, 2006).

So what does all of this have to do with fruits and vegetables? In addition to the body’s innate mechanisms to fight the damage caused by free radicals, many of the foods we eat contain substances that can essentially “quench the thirst” of these unstable molecules by donating electrons to them. The best examples of these food-borne fighters are vitamins C, E, and beta-carotene (a component of vitamin A), and they are most abundant in fruits and vegetables. Therefore, the emerging research that suggests a possible role of oxidative stress in the development of fibromyalgia offers yet another compelling reason for fibromyalgia patients to increase their consumption of fruits and vegetables.

Foods that contain the greatest content of antioxidants include the following: small red beans, blueberries, red kidney beans, pinto beans, cranberries, cooked artichokes, blackberries, prunes, raspberries, strawberries, red delicious apples, granny smith apples, pecans, sweet cherries, black plums, cooked russet potatoes, black beans, plums, and gala apples.

What Should I Eat?

As with any dietary changes, it is best to incorporate foods that you enjoy and which are readily available in your geographic area, both of which will increase the likelihood of their successful and sustained incorporation into your diet. Also remember that although fruits and vegetables are typically low in calories, fat, and carbohydrates, excessive consumption of certain fruits and vegetables can inadvertently lead to weight gain. For example, don’t let the calorie content fool you. One serving of avocado has only 50 calories, whereas apples pack 130 calories per serving. At first glance, that might make an avocado seem like the more calorie-conscious option; however, the serving sizes for each fruit are vastly different – 1/5 fruit for an avocado, versus one large apple. Therefore, if you ate an entire avocado, you would consume 250 calories in total, versus only 130 if you had chosen an apple. So, be sure to adhere to recommended portion sizes when incorporating fruits and vegetables into your diet. Finally, as with any effort to treat your fibromyalgia or control its symptoms, be sure and keep track of any new foods that you bring into your diet, paying particular attention to any symptoms that worsen or improve after doing so. This will help you in the process of elimination that is so integral to the successful management of fibromyalgia.

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References

1.        Altindag O, Celik H. Total antioxidant capacity and the severity of the pain in patients with fibromyalgia. Redox Rep. 2006;11(3):131-5.

2.        Bagis S, Tamer L, Sahin G, Bilgin R, Guler H, Ercan B, Erdogan C. Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder? Rheumatol Int. 2005;25(3):188-90.

3.        Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L. An internet survey of 2,596 people with fibromyalgia. MBC Musculoskelet Disord. 2007;8(27).

4.        Chung CP, Titova D, Oeser A, Randels M, Avalos I, Milne GL, Morrow JD, Stein CM. Oxidative stress in fibromyalgia and its relationship to symptoms. Clin Rheumatol. 2009;28(4):435-8.

5.        Cordero MD, Alcocer-Gómez E, Cano-García FJ, De Miguel M, Carrión AM, Navas P, Sánchez Alcázar JA. Clinical symptoms in fibromyalgia are better associated to lipid peroxidation levels in blood mononuclear cells rather than in plasma. PLoS One. 2011;6(10):e26915.

6.        Cordero MD, Cano-García FJ, Alcocer-Gómez E, De Miguel M, Sánchez-Alcázar JA. Oxidative stress correlates with headache symptoms in fibromyalgia: coenzyme Q₁₀ effect on clinical improvement. PLoS One. 2012;7(4):e35677.

7.        Cordero MD, Moreno-Fernández AM, deMiguel M, Bonal P, Campa F, Jiménez-Jiménez LM, Ruiz-Losada A, Sánchez-Domínguez B, Sánchez Alcázar JA, Salviati L, Navas P. Coenzyme Q10 distribution in blood is altered in patients with fibromyalgia. Clin Biochem. 2009;42(7-8):732-5.

8.        Maes M, Galecki P, Chang YS, Berk M. A review on the oxidative and nitrosative stress (O&NS) pathways in major depression and their possible contribution to the (neuro)degenerative processes in that illness. Prog Neruopsychopharmacol Biol Psychiatry. 2011;35(3):676-692.

9.        Maes M, Mihaylova I, Kubera M, Uytterhoeven M, Vrydags N, Bosmans E. Lower plasma coenzyme Q10 in depression: a marker for treatment resistance and chronic fatigue in depression and a risk factor to cardiovascular disorder in that illness. Neuro Endocrinol Lett. 2009;30(4):462-469.

10.     Nazıroğlu M, Akkuş S, Soyupek F, Yalman K, Çelik Ö, Eriş S, Uslusoy GA. Vitamins C and E treatment combined with exercise modulates oxidative stress markers in blood of patients with fibromyalgia: a controlled clinical pilot study. Stress. 2010;13(6):498-505.

11.     Neumann L, Lerner E, Glazer Y, Bolotin A, Shefer A, Buskila D. A cross-sectional study of the relationship between body mass index and clinical characteristics, tenderness measures, quality of life, and physical functioning in fibromyalgia patients. Clin Rheumatol. 2008;27(12):1543-1547.

Ursini F, Naty S, Grambiale RD. Fibromyalgia and obesity: the hidden link. Rheumatol Int. 2011;31:1403-1408.

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