A low fermentable oligo-di-mono-saccharides and polyols (FODMAP) diet is a balanced therapy for fibromyalgia with nutritional and symptomatic benefits

Ana Paula Marum, Cátia Moreira, Pablo Tomas Carus, Fernando Saraiva, Catarina Sousa Guerreiro


Introduction: Fibromyalgia is a chronic rheumatic disease producing widespread pain, associated to a major comorbidity -irritable bowel syndrome. Low FODMAPS diet (low fermentable oligo-di-mono-saccharides and polyols diet) has been effective in controlling irritable bowel syndrome symptoms. Overweight is an aggravating factor for fibromyalgia. We studied effects of low fermentable oligo-di-mono-saccharides and polyols diets on fibromyalgia symptoms and weight status.

Methods: A longitudinal study was performed on 38 fibromyalgia patients using a four-week, repeated assessment as follow: M1 = first assessments/presentation of individual low fermentable oligo-di-mono-saccharides and polyols diet; M2 = second assessments/reintroduction of FODMAPs; M3 = final assessments/nutritional counselling. The assessment instruments applied were: Fibromyalgia Survey Questionnaire (FSQ); Severity Score System (IBS-SSS); visual analogic scale (VAS). Body mass-index/composition and waist circumference (WC) were also measured. Daily macro-micronutrients and FODMAP intake were quantified at each moment of the study.

Results: The studied cohort was 37% overweight, 34% obese (average body mass-index 27.4 ± 4.6; excess fat mass 39.4 ± 7%). Weight, body mass-index and waist circumference decreased significantly (p < 0.01) with low fermentable oligo-di-mono-saccharides and polyols diet, but no significant effect on body composition was observed. All fibromyalgiasymptoms, including somatic pain, declined significantly post-LFD (p < 0.01); as well for severity of fibromyalgia [Fibromyalgia survey questionnaire: M1 = 21.8; M2 = 16.9; M3 = 17.0 (p < 0.01)]. The intake of essential nutrients (fiber, calcium, magnesium and vitamin D) showed no significant difference. The significant reduction in FODMAP intake (M1 = 24.4 g; M2 = 2.6g; p < 0.01) reflected the “Diet adherence” (85%). “Satisfaction with improvement of symptoms” (76%), showed correlating
with “diet adherence” (r = 0.65; p < 0.01).

Conclusions: Results are highly encouraging, showing low fermentable oligo-di-mono-saccharides and polyols diets as a nutritionally balanced approach, contributing to weight loss and reducing the severity of FM fibromyalgiasymptoms.


Palabras clave

FODMAP. Fibromyalgia. Irritable bowel syndrome. Pain. Diet. Shortchain. Carbohydrates.

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Borchers AT, Gershwin ME. Fibromyalgia: A Critical and Comprehensive Review. Clin Rev Allergy Immunol. 2015 Oct 7;49(2):100–51. doi:10.1007/s12016-015-8509-4

Branco JC, Bannwarth B, Failde I, Abello Carbonell J, Blotman F, Spaeth M, et al. Prevalence of Fibromyalgia: a survey in five european countries. Semin Arthritis Rheum. 2010 Jun;39(6):448–53..doi.org/10.1016/j.semarthrit.2008.12.003

Laroche F, Guérin J. Fibromyalgie : où en est-on en 2015 ? Douleur et Analgésie. 2015;28(1):31–9. doi:10.1007/s11724-015-0407-2

Nishida C, Uauy R, Kumanyika S, Shetty P. The joint WHO/FAO expert consultation on diet, nutrition and the prevention of chronic diseases: process, product and policy implications. Public Health Nutr. 2004;7(1A):245–50. doi:10.1079/PHN2003592

Ángel García D, Martínez Nicolás I, Saturno Hernández P. Clinical approach to fibromyalgia: synthesis of evidence-based recommendations, a systematic review. Reumatol Clínica. 2015;803:4–7. doi: 10.1016/j.anpedi.2012.06.005

Rossi A, Lollo AC, Guzzo MP, Giacomelli C, Atzeni F, Bazzichi L et al. Fibromyalgia and nutrition : what news ? Clin Exp Rheumatol. 2015;33(Suppl.88):S117–25.

Arranz LI, Canela MA, Rafecas M. Relationship between body mass index, fat mass and lean mass with SF-36 quality of life scores in a group of fibromyalgia patients. Rheumatol Int. 2012 Nov;32(11):3605–11.

Fava A, Plastino M, Cristiano D, Spanò A, Cristofaro S, Opipari C, et al. Insulin resistance possible risk factor for cognitive impairment in fibromialgic patients. Metab Brain Dis. 2013;28(4):619–27.

Alcocer-Gómez E, Garrido-Maraver J, Bullón P, Marín-Aguilar F, Cotán D, Carrión AM, et al. Metformin and caloric restriction induce an AMPK-dependent restoration of mitochondrial dysfunction in fibroblasts from Fibromyalgia patients. Biochim Biophys Acta. 2015;1852(7):1257–67.

Holton KF, Kindler LL, Jones KD. Potential dietary links to central sensitization in fibromyalgia: past reports and future directions. Rheum Dis Clin North Am. 2009;35(2):409–20.

Arranz LI, Canela MÁ, Rafecas M. Dietary aspects in fibromyalgia patients: results of a survey on food awareness, allergies, and nutritional supplementation. Rheumatol Int. 2012;32(9):2615–21.

Slim M, Calandre EP, Rico-Villademoros F. An insight into the gastrointestinal component of fibromyalgia: clinical manifestations and potential underlying mechanisms. Rheumatol Int. 2014 Aug 14;35(3):433–44. doi:10.1007/s00296-014-3109-9.

Slim M, Molina-Barea R, Garcia-Leiva JM, Rodríguez-Lopez CM, Morillas-Arques P, Rico-Villademoros F, et al. The effects of gluten-free diet versus hypocaloric diet among patients with fibromyalgia experiencing gluten sensitivity symptoms: protocol for a pilot, open-label, randomized clinical trial. Contemp Clin Trials. 2015 Jan;40:193–8. doi:10.1016/j.cct.2014.11.019

Slim M, Calandre EP, Garcia-Leiva JM, Rico-Villademoros F, Molina-Barea R, Rodriguez-Lopez CM, et al. The Effects of a Gluten-free Diet Versus a Hypocaloric Diet Among Patients With Fibromyalgia Experiencing Gluten Sensitivity–like Symptoms. J Clin Gastroenterol. 2016 Aug 19. doi: 10.1097/MCG.0000000000000651

Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology.2013 Aug; 145(2):320–8. doi:10.1053/j.gastro.2013.04.051.

Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. doi:10.1007/s00394-015-0922-1.

Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals? Therap Adv Gastroenterol. 2012;5(4):261–8. doi:10.1177/1756283X11436241

Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010 Feb;25(2):252–8. doi:10.1111/j.1440-1746.2009.06149.x;

Helfenstein M, Heymann R, Feldman D. Prevalence of irritable bowel syndrome in patients with fibromyalgia. Rev Bras Reum. 2006;46(11):16–23. doi.org/10.1590/S0482-50042006000100005

Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RS, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol. 2011;38(6):1113–22. doi:10.3899/jrheum.100594

Biesiekierski JR, Rosella O, Rose R, Liels K, Barrett JS, Shepherd SJ, et al. Quantification of fructans, galacto-oligosacharides and other short-chain carbohydrates in processed grains and cereals. J Hum Nutr Diet. 2011;24(2):154–76.

Muir JG, Rose R, Rosella O, Liels K, Barrett JS, Shepherd SJ, et al. Measurement of short-chain carbohydrates in common Australian vegetables and fruits by high-performance liquid chromatography (HPLC). J Agric Food Chem. 2009;57(2):554–65.

Almansa C, Sánchez RG, Barceló M, Díaz-rubio M, Rey E. Traducción , adaptación cultural y validación al español del cuestionario de gravedad del síndrome de intestino irritable ( Irritable Bowel Syndrome Severity Score ). Rev Esp Enfermedades Dig. 2011;103(12):612–8.

Sales CMD, Moleiro CM, Evans C, Alves PCG. Versão Portuguesa do CORE-OM: tradução, adaptação e estudo preliminar das suas propriedades psicométricas. Rev Psiquiatr Clínica; 2012;39(2):54–9.

Marum AP, Moreira C, Saraiva F, Tomas-Carus P, Sousa-Guerreiro C.

A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients. Scand J Pain. Scandinavian Association for the Study of Pain; 2016;1–7.

Rao SSC, Yu S, Fedewa A. Systematic review: dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome. Aliment Pharmacol Ther. 2015;41(12):1256–70.doi.wiley.com/10.1111/apt.13167

Lobo MT, Paiva E, Andretta A, Schieferdecker ME. Composição corporal por absorciometria radiológica de dupla energia de mulheres com fibromialgia. Rev Bras Reumatol. 2014;54(4):273–8.

Aparicio VA, Ortega FB, Carbonell-Baeza A, Gatto-Cardia C, Sjöström M, Ruiz JR, et al. Fibromyalgia’s key symptoms in normal-weight, overweight, and obese female patients. Pain Manag Nurs. 2013;14(4):268–76.

Senna MK, Sallam RA-ER, Ashour HS, Elarman M. Effect of weight reduction on the quality of life in obese patients with fibromyalgia syndrome: a randomized controlled trial. Clin Rheumatol. 2012;31(11):1591–7.

Sendur OF, Tastaban E, Turan Y, Ulman C. The relationship between serum trace element levels and clinical parameters in patients with fibromyalgia. Rheumatol Int..2008;28(11):1117–21.

Wepner F, Scheuer R, Schuetz-Wieser B, Machacek P, Pieler-Bruha E, Cross HS, et al. Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. Pain. ; 2014;155(2):261-8

Pérez y López N, Torres-López E, Zamarripa-Dorsey F. Respuesta clínica en pacientes mexicanos con síndrome de intestino irritable tratados con dieta baja en carbohidratos fermentables (FODMAP). Rev Gastroenterol México. 2015;80(3):180–5. doi:10.1016/j.rgmx.2015.06.008

Schmulson M, Vargas JA, López-Colombo A, Remes-Troche JM, López-Alvarenga JC. Prevalence and clinical characteristics of the IBS subtypes according to the Rome III criteria in patients from a clinical, multicentric trial. Rev Gastroenterol México. 2010;75(4):427–38.

Staudacher HM, Lomer MCE, Anderson JL, Barrett JS, Muir JG, Irving PM, et al. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr. 2012;142(8):1510–8.

Halmos EP, Christophersen CT, Bird AR, Shepherd SJ, Gibson PR, Muir JG. Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut. 2015;64(1):93–100.

DOI: http://dx.doi.org/10.20960/nh.703

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