Nutrición Hospitalaria 00703 / http://dx.doi.org/10.20960/nh.703
Resumen| PDF (ENGLISH)

Trabajo Original

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

Logo Descargas   Número de descargas: 6020      Logo Visitas   Número de visitas: 21096      Citas   Citas: 23

Compártelo:


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.



Kadayifci, Fatma Z, Bradley, Madelyn J, Onat, Ahmet M, Shi, Hai Ning, Zheng, Shasha (2022) Review of nutritional approaches to fibromyalgia. Nutrition Reviews
Wang, Claire, Erridge, Simon, Holvey, Carl, Coomber, Ross, Usmani, Azfer, Sajad, Mohammed, Guru, Rahul, Holden, Wendy, Rucker, James J., Platt, Michael W., Sodergren, Mikael H. (2023) Assessment of clinical outcomes in patients with fibromyalgia: Analysis from the UK Medical Cannabis Registry. Brain and Behavior
Haddad, Hannah Waleed, Mallepalli, Nikita Reddy, Scheinuk, John Emerson, Bhargava, Pranav, Cornett, Elyse M., Urits, Ivan, Kaye, Alan David (2021) The Role of Nutrient Supplementation in the Management of Chronic Pain in Fibromyalgia: A Narrative Review. Pain and Therapy
Brain, K., Burrows, T. L., Rollo, M. E., Chai, L. K., Clarke, E. D., Hayes, C., Hodson, F. J., Collins, C. E. (2019) A systematic review and meta‐analysis of nutrition interventions for chronic noncancer pain. Journal of Human Nutrition and Dietetics
Shiha, Mohamed G., Aziz, Imran (2021) Review article: Physical and psychological comorbidities associated with irritable bowel syndrome. Alimentary Pharmacology & Therapeutics
Campolina, Ana Carolina Garcia de las Ballonas, Resende, Cristina Maria Mendes, Leocádio, Paola Caroline Lacerda, Freire, Rachel Horta, Silva, Melissa Tainan, Fonseca, Luana Moreira, Andrade, Karine Silva de, Rodrigo, Luis, Ribeiro, Aloisio Joaquim F., Cara, Denise Carmona, Alvarez-Leite, Jacqueline Isaura, Mowafy, Mohey (2020) Pilot Study: Impact of a Gluten-Free Diet on Symptoms and Severity of Fibromyalgia. International Journal of Nutrition
Elma, Ömer, Yilmaz, Sevilay Tümkaya, Deliens, Tom, Coppieters, Iris, Clarys, Peter, Nijs, Jo, Malfliet, Anneleen (2020) Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review. Journal of Clinical Medicine
Aman, Mansoor M., Jason Yong, R., Kaye, Alan David, Urman, Richard D. (2018) Evidence-Based Non-Pharmacological Therapies for Fibromyalgia. Current Pain and Headache Reports
Bjørklund, Geir, Dadar, Maryam, Chirumbolo, Salvatore, Aaseth, Jan (2018) Fibromyalgia and nutrition: Therapeutic possibilities?. Biomedicine & Pharmacotherapy
Tomaino, Laura, Serra-Majem, Lluís, Martini, Stefania, Ingenito, Maria Rosaria, Rossi, Paola, La Vecchia, Carlo, Bamonti, Fabrizia, Vigna, Luisella (2021) Fibromyalgia and Nutrition: An Updated Review. Journal of the American College of Nutrition
Bellini, Massimo, Tonarelli, Sara, Nagy, Attila, Pancetti, Andrea, Costa, Francesco, Ricchiuti, Angelo, de Bortoli, Nicola, Mosca, Marta, Marchi, Santino, Rossi, Alessandra (2020) Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients
Venkatesan, Nanditha, Gyawali, Mallika, Botleroo, Rinky A., Ahmed, Rowan, Kareem, Roaa, Ogeyingbo, Opemipo D., Bhandari, Renu, Elshaikh, Abeer O. (2022) Efficacy of Vitamin D Supplementation in the Improvement of Clinical Status in Patients Diagnosed with Fibromyalgia Syndrome: A Systematic Review. Current Rheumatology Reviews
Erdrich, Sharon, Hawrelak, Jason A., Myers, Stephen P., Harnett, Joanna E. (2020) A systematic review of the association between fibromyalgia and functional gastrointestinal disorders. Therapeutic Advances in Gastroenterology
Pagliai, Giuditta, Colombini, Barbara, Dinu, Monica, Whittaker, Anne, Masoni, Alberto, Danza, Giovanna, Amedei, Amedeo, Ballerini, Giovanna, Benedettelli, Stefano, Sofi, Francesco (2020) Effectiveness of a Khorasan Wheat–Based Replacement on Pain Symptoms and Quality of Life in Patients with Fibromyalgia. Pain Medicine
Pagliai, Giuditta, Giangrandi, Ilaria, Dinu, Monica, Sofi, Francesco, Colombini, Barbara (2020) Nutritional Interventions in the Management of Fibromyalgia Syndrome. Nutrients
Maddox, Emma K., Massoni, Shawn C., Hoffart, Cara M., Takata, Yumie (2023) Dietary Effects on Pain Symptoms in Patients with Fibromyalgia Syndrome: Systematic Review and Future Directions. Nutrients
Arora, Richa, Chandel, Anuj K. (2023) Unlocking the potential of low FODMAPs sourdough technology for management of irritable bowel syndrome. Food Research International
Lim, Kia Teng, Lim, Kia Hui, Zhou, Xuan, Yang, Juan, Shin, Kyung-Min, Mohabbat, Arya B., Baude, Wyatt W., Nanda, Sanjeev, Bauer, David, Theberath, Monique, Theberath, Nicole, Bauer, Brent A., Ganesh, Ravindra (2022) Dietary Supplements for Pain Relief in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The American Journal of Chinese Medicine
Carrasco-Querol, Noèlia, Cabricano-Canga, Lorena, Bueno Hernández, Nerea, Gonçalves, Alessandra Queiroga, Caballol Angelats, Rosa, Pozo Ariza, Macarena, Martín-Borràs, Carme, Montesó-Curto, Pilar, Castro Blanco, Elisabet, Dalmau Llorca, Maria Rosa, Aguilar Martín, Carina (2024) Nutrition and Chronobiology as Key Components of Multidisciplinary Therapeutic Interventions for Fibromyalgia and Associated Chronic Fatigue Syndrome: A Narrative and Critical Review. Nutrients
Mendonça, Carolina, Noll, Matias, Castro, Maria, Silveira, Erika (2020) Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review. Nutrients
Sala-Climent, Marta, López de Coca, Teresa, Guerrero, María Dolores, Muñoz, Francisco Javier, López-Ruíz, María Amparo, Moreno, Lucrecia, Alacreu, Mónica, Dea-Ayuela, María Auxiliadora (2023) The effect of an anti-inflammatory diet on chronic pain: a pilot study. Frontiers in Nutrition
San Mauro Martin, Ismael, López Oliva, Sara, Collado Yurrita, Luis, Sanz Rojo, Sara, Garicano Vilar, Elena (2019) Anti-inflammatory and antioxidant feeding and supplementation may serve as adjuvants in women with fibromyalgia. Journal of Nutrition & Intermediary Metabolism
Ratajczak, Alicja Ewa, Szymczak-Tomczak, Aleksandra, Skrzypczak-Zielińska, Marzena, Rychter, Anna Maria, Zawada, Agnieszka, Dobrowolska, Agnieszka, Krela-Kaźmierczak, Iwona (2020) Vitamin C Deficiency and the Risk of Osteoporosis in Patients with an Inflammatory Bowel Disease. Nutrients
Borchers AT, Gershwin ME. Fibromyalgia: A Critical and Comprehensive Review. Clin Rev Allergy Immunol. 2015 Oct 7;49(2):100–51.
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.
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.
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.
DOI: 10.1007/s11011-013-9421-3
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.
DOI: 10.1016/j.bbadis.2015.03.005
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.
DOI: 10.1016/j.rdc.2009.06.003
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.
DOI: 10.1007/s00296-011-2010-z
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.
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.
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.
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.
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.
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.
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.
DOI: 10.1111/j.1365-277X.2010.01139.x
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.
DOI: 10.1021/jf802700e
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.
DOI: 10.4321/S1130-01082011001200002
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.
DOI: 10.1590/S0101-60832012000200003
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.
DOI: 10.1016/j.rbr.2014.03.024
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.
DOI: 10.1016/j.pmn.2011.06.002
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.
DOI: 10.1007/s10067-012-2053-x
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.
DOI: 10.3945/jn.112.159285
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: 10.1136/gutjnl-2014-307264

Artículos más populares

Revisión: Ayuno intermitente: efectos en diversos escenarios clínicos

Introducción: los esquemas de ayuno intermitente (...

Publicado: 2023-05-24

Trabajo Original: Body mass index and risk of inflammatory breast disease: a Mendelian randomization study

Introduction: in previous studies, obesity was ide...

Publicado: 2023-04-22

Revisión: Relación entre la dieta, aspectos nutricionales y la calidad del sueño en población pediátrica

.La relación entre la dieta y el sueño ha sido esc...

Publicado: 2023-06-08

Una cookie o galleta informática es un pequeño archivo de información que se guarda en su navegador cada vez que visita nuestra página web. La utilidad de las cookies es guardar el historial de su actividad en nuestra página web, de manera que, cuando la visite nuevamente, ésta pueda identificarle y configurar el contenido de la misma en base a sus hábitos de navegación, identidad y preferencias. Las cookies pueden ser aceptadas, rechazadas, bloqueadas y borradas, según desee. Ello podrá hacerlo mediante las opciones disponibles en la presente ventana o a través de la configuración de su navegador, según el caso. En caso de que rechace las cookies no podremos asegurarle el correcto funcionamiento de las distintas funcionalidades de nuestra página web. Más información en el apartado “POLÍTICA DE COOKIES” de nuestra página web.