Central sensitization syndrome (CSS) encompasses conditions like fibromyalgia (FM), chronic fatigue syndrome (CFS), and multiple chemical sensitivity (MCS). These syndromes are characterized by hyperreactivity of the central nervous system, leading to amplified pain perception and other symptoms. Since the scientific literature presents contradictory findings regarding the role of food in CSS, and evidence on the role of nutrition in MCS is particularly scarce, this article aims to gather information on dietary recommendations and discuss the scientific evidence in depth to shed light on appropriate nutritional treatment managements for CSS patients. This article explores how dietary changes can affect fibromyalgia and related conditions, offering guidelines for managing symptoms through appropriate food choices.
Understanding Central Sensitization
Central sensitization involves functional, molecular, and structural modifications in the central nervous system. Several neurobiological aspects have been postulated as the likely routes of pathological models, such as classical conditioning, biochemical disruptions, and neurogenic inflammation. Environmental factors and genetic components also play a role in the development of CSS. In fact, several single nucleotide polymorphisms related to the presence of FM, CFS, and MCS have been described.
Central sensitization can generate adverse effects even from low-level chemical exposure, such as deregulation of the intestinal passage, fatigue, or widespread musculoskeletal pain (allodynia or hyperalgesia). The complexity of diagnosing CSS stems from non-standardized diagnostic criteria and the high interindividual heterogeneity of clinical features that depend on stimulation (chemical substances, lights, pressure, sounds, temperature, etc.), the origin of the affected tissue (muscle, skin, the mucosal surface of the digestive tract, etc.) or psychobiological manifestations.
The Role of Diet in Managing Fibromyalgia
Dietary changes are not part of the standard treatment for fibromyalgia. However, favoring some foods over others may help manage the symptoms.
While doctors do not yet know what causes fibromyalgia, one theory suggests that changes in a person’s pain pathways cause them to feel pain more intensely. Some experts suggest using a multimodal approach to manage symptoms, including medication, exercise, complementary therapies, and appropriate dietary choices.
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Anti-Inflammatory Diet
There is evidence to suggest that adopting an anti-inflammatory diet can help people with chronic pain. An anti-inflammatory diet is not a specific eating plan, but its guidelines can help people make suitable choices.
- Eat plenty of fruits and vegetables: Aim for eight to nine servings of colorful fruits and vegetables per day to ensure a wide range of nutrients. Foods like broccoli and berries are particularly rich in nutrients.
- Choose whole grains: Whole-grain foods such as barley, buckwheat, oats, quinoa, brown rice, rye, wheat, and spelt provide vitamins, protein, and fiber.
- Select healthful oils: Olive oil is a good choice.
- Incorporate herbs and spices: Many herbs and spices contain antioxidants, which may help reduce inflammation. Turmeric, bay leaves, and cinnamon can offer benefits.
Plant-Based Diet
A plant-based diet may also be helpful for reducing fibromyalgia symptoms. Many plant-based foods contain antioxidants, which help the body dispose of “free radicals.” High levels of free radicals can lead to oxidative stress and inflammation.
Weight Management
Many people with fibromyalgia also have obesity. Excess weight may increase the risk of inflammation and oxidative stress. Adopting a diet that encourages a person to reach or maintain a healthy weight may help.
The DASH Diet
The DASH diet can help control blood sugar and has overall health benefits.
Foods to Include in Your Diet
Certain foods may help alleviate fibromyalgia symptoms due to their anti-inflammatory properties and nutritional benefits.
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Vitamin D-Rich Foods
Foods containing vitamin D may not reduce symptoms in everyone with fibromyalgia, but they have overall benefits, such as building healthier bones. Sources include:
- Egg yolks
- Low-fat yogurt fortified with vitamin D
- Orange juice fortified with vitamin D
- Swordfish and salmon
- Tuna, canned in water
- Whole-grain cereals fortified with vitamin D
Foods to Limit or Avoid
A number of additives and ingredients may worsen the symptoms of fibromyalgia.
Meat and Dairy Products
It may help to limit excess dairy intake because many dairy products contain saturated fat. Opt for low-fat versions or dairy alternatives such as soy milk. It may also help to limit the consumption of red meat, opting instead for turkey, fish, and vegetable-based substitutes.
Additives
Food additives called excitotoxins may worsen some of the symptoms of fibromyalgia. Examples include monosodium glutamate (MSG) and aspartame. Research has shown that people with fibromyalgia and irritable bowel syndrome (IBS) who stopped using MSG and aspartame saw a 30% reduction in symptoms. However, the symptoms returned when they started consuming these additives again.
Gluten
Recent research suggests that gluten might also affect various inflammatory conditions. A study showed that when 20 people with fibromyalgia avoided gluten for between 5 and 31 months, fifteen stopped having widespread, chronic pain, and three were able to stop using opioids altogether. Another study revealed that people with signs of both fibromyalgia and gluten sensitivity responded well to a gluten-free diet. Always speak to a doctor before eliminating a major food type, such as gluten, from your diet, as cutting out gluten can lead to a low intake of whole grains, resulting in a low intake of fiber and other nutrients.
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Other Ingredients
Other ingredients that may trigger inflammation include:
- Saturated fats and trans fats
- Refined starches
- Foods with added sugar
Keeping a food journal and recording any symptoms that occur after eating particular food items can help identify trigger foods.
Additional Dietary Considerations
Elimination Diets
Elimination diets involve a rotation sequence of food components to identify which cause the exacerbation of symptoms and omit them. One by one, food components must be introduced into the diet every 4-5 days. Avoiding foods causing aggravating symptoms and controlling the environment might be sufficient to achieve normal immune system function in MCS patients. The recommendation in MCS patients to avoid foods through elimination diets should be adequately designed to provide variety and a correct nutritional profile.
Food Additives
Food additives, including food coloring, monosodium glutamate (MSG), and aspartate, are the primary triggers in FM and MCS. Some authors point to MSG and aspartame as excitatory neurotransmitters and, consequently, central nervous system stimuli.
Oligoantigenic Diet
Another diet considered in CSS patients is the oligoantigenic diet, which consists in disregarding processed foods and replacing them with the paleolithic equivalents. Many studies have emphasized the positive repercussion of following a healthy diet enriched in vegetables on alleviating symptoms of FM.
Vegan and Vegetarian Diets
The effects of vegan and vegetarian diets have been praised due to their antioxidant power. The living foods diet (LFD) is a raw vegan diet that contains a high quantity of antioxidants, including berries, cereal, fruits, germinated seeds, nuts, roots, sprouts, and vegetables. In addition, it is free of alcohol, coffee, table salt, and tea.
Low-FODMAP Diet
The concurrence of FM and IBS is estimated to be high. Several recent meta-analyses concluded that dietary modifications through the short-term restriction of foods rich in fermentable, oligo-, di- and monosaccharides and polyols (FODMAP) show benefits in IBS patients. The overlap of both diseases may be linked with the perception that lactose is a frequent trigger in FM patients.
Supplements and Complementary Methods
While more research is needed, some researchers have looked at whether the following may help manage the symptoms of fibromyalgia:
- Soy
- S-adenosyl-L-methionine
- Creatine
It is important to talk to a doctor before starting to take any supplements, as some can have adverse effects or interact with medications.
There is some evidence to suggest that other complementary methods help with fibromyalgia. These include:
- Exercise: Engaging in aerobic exercise for 20-30 minutes per day on 2-3 days per week may help reduce symptoms and fatigue. Other physical activities that may help include tai chi, weightlifting, and yoga.
- Sleep hygiene: Getting regular, quality sleep can also help manage symptoms. This includes waking up and going to sleep at the same time each day, building a relaxing bedtime routine, maintaining a cool, dark, and comfortable sleep environment, and leaving cell phones and other devices outside the bedroom.
- Alternative therapies: Stress-relieving activities that may help relieve fibromyalgia symptoms include acupuncture, massage therapy, meditation, relaxation training, balneotherapy, homeopathy, magnetic therapies, Reiki, and counseling or therapy.
The Gut-Brain Connection
The enteric nervous system (ENS), often referred to as the "second brain," stores and produces neurotransmitters, serving as a crucial link between the ENS, the sympathetic nervous system (SNS), and the central nervous system (CNS). Microbial factors, cytokines, and gut hormones can impact cognition by reaching the brain through the gut mucosal system and its local immune system. This affects not only cognition but also emotion, mood, stress resilience, recovery, appetite, metabolic balance, interoception, and pain.
Expert Opinions and Innovations
Poor nutrition leads to oxidative stress, necrotic cells, or tissue damage. This can activate toll-like receptors on immune cells, leading to the production of proteins that activate glial cells in the central nervous system, resulting in central nervous system sensitization. A diet high in saturated fat, carbohydrates, and energy can also activate the vagus nerve in the gut, leading to inflammation that travels to the brain. Additionally, poor nutrition can change the gut microbiome, causing inflammation both in the gut and peripherally, further activating the vagus nerve and passing through the blood-brain barrier.
Opioids, poor sleep, and stress can also directly impact toll-like receptors and glial cells, contributing to central nervous system sensitization.
Modulating Neuroimmune Mechanisms
Nutrition can be used to modulate neuroimmune mechanisms for the modulation of central nervous system sensitization and chronic pain. Animal studies show that a standard American diet results in microglial activation of the central nervous system in pain, and inadequate nutrition contributes to neuroinflammation. Metabolic ketosis has been found to favorably impact oxidative stress and neuronal excitability in mice.
Human studies, with level 1A evidence, show that altered dietary patterns and specific nutrients promote analgesia. An anti-inflammatory diet intervention focusing on the elimination of common food intolerances and inflammation-inducing foods, along with the introduction of anti-inflammatory foods and supplements, can be beneficial.
Practical Steps for Dietary Changes
- Limit Sugar: Increased insulin levels can worsen pain. Limit all sugars, including fresh fruit juices.
- Eat Fresh Foods: Buy organic food when possible to avoid pesticides and chemicals.
- Avoid Caffeine: It is believed to be linked to an imbalance of brain chemicals that control mood, and it is often linked with inadequate sleep and fatigue.
- Try Avoiding Nightshade Vegetables.
- Be Careful with Your Fats: Animal-based omega-3 fats like DHA and EPA may help with pain by reducing inflammation and improving brain function.
- Use Yeast Sparingly.
- Avoid Pasteurized Dairy: Many fibromyalgia sufferers have trouble digesting milk and dairy products.
- Cut Down on Carbs.
- Avoid Aspartame.
- Avoid Additives: Food additives such as monosodium glutamate (MSG) often cause trouble for pain patients.
- Stay Away from Junk Food: Limit or eliminate fast food, candy, and vending-machine products.
- Choose Whole Foods Instead of Processed Ones: Steer clear of processed foods, and choose more whole foods instead.
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