Diet in patients with fibromyalgia

Over time, specialists in the Pain Unit are giving greater importance to the influence of diet on the medium-term development of the disease in patients affected by fibromyalgia. Highlights include glutamate and aspartate , vitamin B6 , deficiency of omega-3 fatty acids and vitamin antioxidants . 

• Glutamate and aspartate are excitatory neurotransmitters with proven relationship in patients with chronic pain who have also been found in higher concentrations in the cerebrospinal fluid of patients with fibromyalgia and migraine compared to healthy controls. From the dietary point of view, glutamate is one of the two negatively charged non-essential amino acids of the diet. Aspartate acts on the NMDA receptor, neuronal receptor involved in pain and depression. These amino acids are found in the diet as food additives as well as in foods such as soy sauce, fish sauces, mixed spice jars and flavorings in cheddar or parmesan cheese. There is scientific evidence describing improvement of fibromyalgia symptoms by suspending these amino acids from the diet and returning symptoms by re-taking them. However, there are cases in which patients do not improve, so it is not a measure that works in all patients with fibromyalgia. To test its effectiveness it would be necessary to completely eliminate its exposure in the diet, so special care should be taken in the selection of foods such as yogurt, cereals, bread, sauces, sweeteners ... The trial period of one month would be adequate, although most patients begin to notice improvements around the end of the first week. 
• In addition, there are two minerals that play a key role in regulating the NMDA receptor. Magnesium and zinc negatively influence excitotoxicity by blocking this receptor, so that at low levels of magnesium and zinc could support excitotoxicity. 
• Vitamin B6 is another important component in glutaminergic neurotransmission. Vitamin B6 deficiency can lead to increased levels of glutamate and reduced levels of GABA, thus facilitating excitotoxicity in the central nervous system. 
• Deficiency of omega-3 fatty acids has also been shown to increase excitotoxicity. This effect is thought to be mediated by the ability of omega-3 fatty acids to increase fluidity in the cell membrane, which could modulate excess glutamate at the synaptic level, thereby preventing excitotoxicity.

What is oxidative stress in fibromyalgia?

In addition to the above nutrients, exitotoxicity can cause oxidative stress through increased production of oxygen reactants in the nervous system. However, oxidative stress can be combative with antioxidants, and the main ones are vitamin C and vitamin E, although other substances found in vegetables and fruits have proven to be efficient, such as resveratol in grapes and polyphenols in green tea.

In conclusion, there is evidence that certain dietary excitotoxins may play an important role in patients with fibromyalgia. Low consumption of omega-3 fatty acids, vitamin B6, magnesium, zinc and antioxidants may also influence the onset of symptoms.