Fibromyalgia (FM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. Managing fibromyalgia can be challenging, and many individuals seek alternative or complementary therapies to alleviate their symptoms. One such approach is the ketogenic diet, a high-fat, very low-carbohydrate diet that has gained popularity for its potential health benefits. This article explores the relationship between the ketogenic diet and fibromyalgia, examining the potential benefits, risks, and considerations for individuals with FM who are considering this dietary approach.
Understanding the Ketogenic Diet
A ketogenic diet is composed of high dietary fat that is the main source of daily calories, and also severely restricts carbohydrates. This equates to a total carbohydrate intake of less than 50 g/day and a protein intake of at least 2 g/day/per kg of body weight. The remaining caloric intake comes from fats and should be around >80% of total calories. The body’s metabolism is highly flexible. With a ketogenic diet as described above, metabolism shifts to fat-burning and stimulates the liver to produce ketones. These ketones have various effects on the brain, gut, and mitochondrial function as described elsewhere.
The ketogenic diet is a high-fat, very low-carbohydrate diet that forces the body to switch from using glucose (derived from carbohydrates) to ketones (derived from fat) as its primary fuel source. This metabolic shift, known as ketosis, can have various effects on the body, including weight loss, improved blood sugar control, and reduced inflammation.
Potential Benefits of the Ketogenic Diet for Fibromyalgia
Weight Management
Obesity can worsen fibromyalgia (FM). Studies have shown a strong association between obesity and FM, with a significant percentage of FM patients being obese. The ketogenic diet has been shown to be effective in achieving rapid weight loss in obese subjects who failed other dietetic interventions and it was included as a therapeutic option in the guidelines for the management of obesity. For those with FM, losing weight through a ketogenic diet may lead to reduced pain and improved function.
Reduced Inflammation
Most diets strive to reduce your body’s level of inflammation because it’s tied to enhanced pain perception and greater fatigue. Ketogenic diets may help reduce inflammation by altering metabolic pathways and reducing the production of inflammatory molecules.
Read also: Easy Low-Carb Cheese Crackers
Potential Impact on Metabolic Dysfunction
Fibromyalgia (FM) seems to have possible links with systemic metabolic dysfunctions with a common inflammatory root. Diet therapies employed particularly for metabolic syndromes proved recently to be efficacious for correcting systemic dysmetabolism and a high number of chronic inflammation conditions. In particular, the very-low-calorie ketogenic diet (VLCKD) demonstrated therapeutic benefits in many disorders. Nutritional approaches based on VLCKD proved effective in treating obesity, metabolic syndrome (diabetes), neurological and autoimmune diseases, acne, polycystic ovary syndrome, and cancer. In recent years, the fascinating realm of metabolomics has played a pivotal role in unraveling the mysteries behind various health conditions, shedding light on the intricate biochemical pathways at play.
Improvement in Clinical Parameters
A study aimed to evaluate how a nutritional regimen based on a ketogenic diet protocol named the oloproteic diet influenced the clinical parameters and the metabolic profiles of patients with a diagnosis of fibromyalgia. Our findings revealed a remarkable improvement in various clinical parameters across both dietary protocols. However, the oloproteic diet stood out, demonstrating a significant impact on FM symptoms that was possibly related to a rebalancing of the biochemical pathways associated with pain perception, as revealed by metabolomic data from all biological fluids.
Positive Effects on Mood, Cognitive Functions, Nociception and Sleep Quality
Accumulating evidence suggests positive effects on mood, cognitive functions, nociception and sleep quality.
Improvement in Disease Burden
All patients achieved improvement in different domains of the disease, which was maintained also after carbohydrate reintroduction.
Risks and Considerations
However, not everyone with ME/CFS or fibromyalgia has responded favorably to a ketogenic diet. Some report worsening symptoms. Let’s look at some common reasons why it may not be working for you, or why the diet makes you feel worse.
Read also: Keto Calorie Counting: A Detailed Guide
"Keto Flu" and Initial Side Effects
Adverse effects as these are sometimes referred to as the keto flu. Nausea, vomiting, headache, fatigue, dizziness, insomnia, constipation. All of these effects may be explained by losses of potassium. During the initial stages of ketosis, the body rapidly breaks down stored glucose which is formed as glycogen. The glycogen molecule is stored in a hydrated form within skeletal muscle and liver. The quick breakdown of glycogen therefore also results in rapid water loss in the urine. This is commonly known as loss of “water weight.” These rapid losses of water can predispose to dehydration. Increasing your water intake substantially during the first few weeks of a ketogenic diet is imperative. Because water always follows salt in the body due to osmosis, salt will also spill into the urine during these losses. The rapid water and salt loss can result in light-headedness and dizziness upon standing. Drink more water and add more salt to meals. In addition to water, stored glycogen also comprises a large surplus of potassium. Potassium is therefore also lost through the urine as glycogen is depleted. Consider a supplemental electrolyte drink in the initial weeks of trying this diet. Continue to eat non-starchy fruits and vegetables as these are excellent sources of potassium.
Micronutrient Deficiencies
Ketogenic diets are not always nutrient-dense. While they should still include non-starchy vegetables, they may still be inadequate in the essential nutrients of a standard diet. The literature shows that ketogenic diets are low in calcium, zinc, selenium, and copper. A general multivitamin, or multimineral supplement is suggested as long as one is on a ketogenic diet to cover these inadequacies. If possible, consume adequate amounts of seafood and shellfish as they are the richest food sources of these nutrients.
Kidney Stones
If there is a family history or a past history of kidney stones, caution is suggested before starting a ketogenic diet. It has been reported that up to 6% of those who try a ketogenic diet develop kidney stones. Those with hereditary risk factors may consider adding supplemental citrate to reduce the risk of kidney stone development. However, careful monitoring with a nutritionist is suggested.
Chemical Toxicity
Several environmental pollutants are preferentially stored in fat tissue and released into the circulation during rapid weight loss. During the early stages of a ketogenic diet when weight loss is also experienced, there may be a steady release of these pollutants which can have various ill effects. For example, polychlorinated biphenyls (PCBs) as well organochlorine pesticides are well studied to be released during weight loss. These chemicals are implicated as potential endocrine disruptors and obesity stimulants. In some studies, the elevated organic pollutants are still in circulation up to 12 months following the initial weight loss. Supporting liver detoxification pathways with sulforaphane is one of many possible approaches in these cases.
Restrictive Nature and Potential for Disordered Eating
The ketogenic diet is highly restrictive, which can make it difficult to adhere to long-term. Women with fibromyalgia have been found in some studies to be at higher risk of eating disorders than the general population. While changing your diet can have health benefits, there are serious risks to going on restrictive diets as they can lead to food obsession, nutrient deficiencies, bingeing, increased stress, and for some people, eating disorders.
Read also: Magnesium Supplements for Keto
Practical Tips for Implementing a Ketogenic Diet for Fibromyalgia
Consult with a Healthcare Professional
Before starting a ketogenic diet, it is essential to consult with a healthcare professional, such as a doctor or registered dietitian. They can assess your individual needs, medical history, and potential risks, and help you determine if the ketogenic diet is appropriate for you.
Gradual Transition
To minimize the risk of side effects, it is recommended to gradually transition into a ketogenic diet over several weeks. This allows your body to adapt to using ketones as its primary fuel source.
Focus on Nutrient-Dense Foods
Choose whole, unprocessed foods that are rich in nutrients, such as non-starchy vegetables, healthy fats (e.g., avocados, olive oil, nuts, and seeds), and moderate amounts of protein.
Monitor Electrolyte Levels
Electrolyte imbalances are common during the initial stages of a ketogenic diet. Ensure adequate intake of electrolytes, such as sodium, potassium, and magnesium, through diet or supplementation.
Stay Hydrated
Drink plenty of water throughout the day to prevent dehydration, which can exacerbate fibromyalgia symptoms.
Monitor Symptoms and Adjust as Needed
Pay close attention to your fibromyalgia symptoms and overall well-being while on the ketogenic diet. If you experience any adverse effects, such as increased pain, fatigue, or digestive issues, adjust your diet accordingly or discontinue it altogether.
Other Dietary Considerations for Fibromyalgia
In addition to the ketogenic diet, several other dietary approaches may be beneficial for individuals with fibromyalgia. These include:
Anti-Inflammatory Diet
An anti-inflammatory diet focuses on consuming foods that reduce inflammation in the body, such as fruits, vegetables, whole grains, lean protein, and healthy fats.
Low-FODMAP Diet
A low-FODMAP diet restricts certain types of carbohydrates that can cause digestive issues, such as gas, bloating, and abdominal pain, which are common in individuals with fibromyalgia and irritable bowel syndrome (IBS).
Gluten-Free Diet
A gluten-free diet eliminates gluten, a protein found in wheat, barley, and rye. Some individuals with fibromyalgia may experience symptom improvement on a gluten-free diet, even if they do not have celiac disease.
Avoiding Excitatory Amino Acids
Research shows excessive amounts of glutamate throughout the body in people with fibromyalgia. A four-week trial shows that avoiding foods with glutamate cuts fibromyalgia symptoms by more than a third.
tags: #keto #diet #and #fibromyalgia