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Nutritional Interventions in the Management of Fibromyalgia Syndrome.
Pagliai, G, Giangrandi, I, Dinu, M, Sofi, F, Colombini, B
Nutrients. 2020;12(9)
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Fibromyalgia (FM) is a chronic pain condition, often presenting with widespread body pain, joint stiffness, sleep disorders, depression, anxiety, gastrointestinal and cognitive complaints. Despite being common, the cause of FM is not well understood. In the absence of effective treatments, the current management of FM involves a multidisciplinary approach utilizing pharmacological and non-pharmacological interventions. Growing evidence suggests a role for nutrition as a complementary strategy for FM management. This brief review summarises the possible impact of nutritional supplements and dietary interventions on FM. Previous reviews concluded that vitamin and mineral deficiencies themselves are unlikely to be significant in the development of FM. Yet, a few interventional studies investigating the use of Vitamin D, magnesium, iron and probiotics showed promising results. To date, there is no or limited evidence for the use of Vitamin C, E, selected amino acids, botanical or antioxidant supplements. Food-wise the inclusion of quality olive oil and the grain Khorasan proved helpful on FM presentation, whilst findings around the role of dietary monosodium glutamate and aspartame seem mixed. Regarding diet patterns, gluten-free, low-calorie, vegetarian, vegan, raw food or Mediterranean diets were all associated with improvement of symptoms. Equally a FODMAP diet can aid FM associated digestive complaints due to the significant overlap of Irritable Bowel Syndrome with FM. The authors concluded that the clinical application of dietary supplements in the management of FM remains controversial. Yet, dietary interventions appear to be an effective tool in the management of FM. Since various diet interventions demonstrated benefits, dietary adequacy and weight loss may be most critical from a clinical perspective.
Abstract
Fibromyalgia (FM) is a multifactorial syndrome of unknown etiology, characterized by widespread chronic pain and various somatic and psychological manifestations. The management of FM requires a multidisciplinary approach combining both pharmacological and nonpharmacological strategies. Among nonpharmacological strategies, growing evidence suggests a potential beneficial role for nutrition. This review summarizes the possible relationship between FM and nutrition, exploring the available evidence on the effect of dietary supplements and dietary interventions in these patients. Analysis of the literature has shown that the role of dietary supplements remains controversial, although clinical trials with vitamin D, magnesium, iron and probiotics' supplementation show promising results. With regard to dietary interventions, the administration of olive oil, the replacement diet with ancient grains, low-calorie diets, the low FODMAPs diet, the gluten-free diet, the monosodium glutamate and aspartame-free diet, vegetarian diets as well as the Mediterranean diet all appear to be effective in reducing the FM symptoms. These results may suggest that weight loss, together with the psychosomatic component of the disease, should be taken into account. Therefore, although dietary aspects appear to be a promising complementary approach to the treatment of FM, further research is needed to provide the most effective strategies for the management of FM.
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Consumption of a Beverage Containing Aspartame and Acesulfame K for Two Weeks Does Not Adversely Influence Glucose Metabolism in Adult Males and Females: A Randomized Crossover Study.
Kim, Y, Keogh, JB, Clifton, PM
International journal of environmental research and public health. 2020;17(23)
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Artificial sweeteners gained popularity in the past decade, especially in the food industry. Up until recently, people generally considered it a better option to decrease sugar consumption and reduce obesity and Type 2 Diabetes. This randomised crossover study looked at the adverse effects of two commonly used artificial sweeteners on normal-weight subjects, overweight and obese subjects. A total of 39 healthy subjects without Type 2 Diabetes participated in this study. For two weeks, participants consumed 0.6 litres of a commercially branded soft drink containing acesulfame K and aspartame to assess the effects of the ingredients on glucose homeostasis. During the two-week treatment period, the healthy subjects did not show any significant detrimental impact of artificially sweetened beverages on glucose, insulin and insulin sensitivity. However, the study population was small, and the study was conducted only for a relatively short period. Therefore, further, longer-term robust studies are required to estimate the significance of the detrimental effect of artificially sweetened beverages on glucose homeostasis. Nevertheless, this study can help healthcare practitioners understand the short-term impact of artificial sweeteners, keeping in mind that further research is needed to investigate the effects.
Abstract
There is an association between the consumption of artificial sweeteners and Type 2 diabetes in cohort studies, but intervention studies do not show a clear elevation of blood glucose after the use of artificial sweeteners. The objective of this study was to examine whether two commonly used artificial sweeteners had an adverse effect on glucose control in normal-weight subjects, and in overweight and obese subjects when consumed for 2 weeks. In the study, 39 healthy subjects (body-mass index, kg/m2) (18-45) without Type 2 diabetes with an age of 18-75 years were randomly assigned to 0.6 L/day of an artificially sweetened soft drink containing acesulfame K (950) and aspartame (951) or 0.6 L/day of mineral water for 2 weeks each in a crossover study. There was a 4 week washout period with no drinks consumed. Glucose levels were read by a continuous glucose monitor (CGM) during each 2 week period. A 75 g oral glucose-tolerance test (OGTT) was performed at the beginning and end of each intervention period. Blood samples were collected at baseline, and 1 and 2 h for glucose and insulin. A 2 week intake of artificially sweetened beverage (ASB) did not alter concentrations of fasting glucose and fasting insulin, the area under the curve (AUC) for OGTT glucose and insulin, the incremental area under the curve (iAUC) for OGTT glucose and insulin, the homeostatic model assessment for insulin resistance (HOMA-IR), and the Matsuda index compared with the baseline and with the changes after a 2 week intake of mineral water. Continuous 2 week glucose concentrations were not significantly different after a 2 week intake of ASB compared with a 2 week intake of mineral water. This study found no harmful effect of the artificially sweetened soft drink containing acesulfame K (950) and aspartame (951) on glucose control when consumed for 2 weeks by people without Type 2 diabetes.
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Dietary interventions in fibromyalgia: a systematic review.
Silva, AR, Bernardo, A, Costa, J, Cardoso, A, Santos, P, de Mesquita, MF, Vaz Patto, J, Moreira, P, Silva, ML, Padrão, P
Annals of medicine. 2019;51(sup1):2-14
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Fibromyalgia is a long-term health condition causing widespread pain and is often accompanied by other symptoms such as extreme tiredness, headaches and irritable bowel syndrome (IBS). Several different dietary approaches have shown some potential in reducing the symptoms of fibromyalgia. In this meta-analysis, researchers looked at seven previous trials that examined five different dietary approaches: low-calorie; low FODMAPs (fermentable oligo-, di-, monosaccharides and polyols); gluten-free; vegan; and a monosodium glutamate (MSG) and aspartame-free diet. Pain and function improved with the low calorie diet, a raw vegan diet and the low FODMAPs diet. Other outcomes, such as quality of life, quality of sleep, anxiety and depression and inflammation also showed a significant improvement with these interventions. However, all of the studies were of low quality, and whilst there were some promising results, there is not currently enough evidence to recommend any of these dietary approaches. More well-designed clinical trials are needed on the effects of dietary approaches on fibromyalgia symptoms.
Abstract
Fibromyalgia (FM) is a chronic non-degenerative disease, whose nutritional therapy seems controversial. This systematic review aimed to synthesize the knowledge about the effect of dietary interventions on patient-reported outcomes (PRO) and inflammation in patients with FM. Six electronic databases - PubMed, BioMed Central, Cochrane library, EMBASE, LILACS and ISI - were searched for clinical trials, in which a dietary intervention in patients with FM diagnosed was conducted. Quality of evidence assessment was measured in accordance with GRADE methodology. Seven clinical trials - 3 randomized controlled trials, 1 unrandomized clinical trial and 3 uncontrolled clinical trials were identified. Dietary approaches included gluten-free diet (n = 1), raw vegetarian diet (n = 2), low Fermentable oligo-, di- and monossacharides, alcohols and polyols (FODMAPs) diet (n = 1), hypocaloric diet (n = 2) and monosodium glutamate- and aspartame-free diet interventions (n = 1). The major PRO were pain and functional repercussion, with 5 out of 7 studies reporting an improvement. The progress in secondary outcomes was reported for fatigue (2/5 studies), sleep quality (2/3 studies), depression and anxiety (3/6 studies), quality of life (4/5 studies), gastrointestinal symptoms (1/2 studies) and inflammatory biomarkers (1/1 study). However, according to Cochrane Risk of Bias, these studies had poor statistical quality. Well-designed studies should be performed to investigate the dietary interventions effect on FM. Key messages Fibromyalgia (FM) is a chronic non-degenerative disease, whose nutritional therapy seems controversial but promising. Pain and functional repercussion in FM patients seem to improve with a hypocaloric diet, a raw vegetarian diet or a low FODMAPs diet, as much as quality of life, quality of sleep, anxiety and depression and inflammatory biomarkers. Existing studies in this subject are scarce and low quality, which does not allow conclusions to be drawn.
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Excessive Sugar Consumption May Be a Difficult Habit to Break: A View From the Brain and Body.
Tryon, MS, Stanhope, KL, Epel, ES, Mason, AE, Brown, R, Medici, V, Havel, PJ, Laugero, KD
The Journal of clinical endocrinology and metabolism. 2015;100(6):2239-47
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It is widely known that people eat to relieve stress. Rodent studies have shown that sugar consumption switches off activity in the networks that mediate the stress induced hypothalamic-pituitary-adrenal (HPA) autonomic nervous system. This study aimed to compare the effects of consuming drinks, sweetened with either sucrose or aspartame, on cortisol responses induced by stress. The researchers found that sucrose consumption was associated reduced stress induced cortisol, and a trend towards lower cortisol. Aspartame did not have the same effect. The Montreal Imaging Stress Task (MIST) was used to map areas of the brain associated with stress. It was found that sugar consumption caused a diminished response to MIST after two weeks of sucrose consumption, and cortisol was elevated after two weeks of aspartame. The study concluded that brain negative feedback pathways are affected by sugar, and consequently may make stressed individuals more reliant or addicted to sugar. In turn, this increases the likelihood of obesity and its associated chronic diseases.
Abstract
CONTEXT Sugar overconsumption and chronic stress are growing health concerns because they both may increase the risk for obesity and its related diseases. Rodent studies suggest that sugar consumption may activate a glucocorticoid-metabolic-brain-negative feedback pathway, which may turn off the stress response and thereby reinforce habitual sugar overconsumption. OBJECTIVE The objective of the study was to test our hypothesized glucocorticoid-metabolic-brain model in women consuming beverages sweetened with either aspartame of sucrose. DESIGN This was a parallel-arm, double-masked diet intervention study. SETTING The study was conducted at the University of California, Davis, Clinical and Translational Science Center's Clinical Research Center and the University of California, Davis, Medical Center Imaging Research Center. PARTICIPANTS Nineteen women (age range 18-40 y) with a body mass index (range 20-34 kg/m(2)) who were a subgroup from a National Institutes of Health-funded investigation of 188 participants assigned to eight experimental groups. INTERVENTION The intervention consisted of sucrose- or aspartame-sweetened beverage consumption three times per day for 2 weeks. MAIN OUTCOME MEASURES Salivary cortisol and regional brain responses to the Montreal Imaging Stress Task were measured. RESULTS Compared with aspartame, sucrose consumption was associated with significantly higher activity in the left hippocampus (P = .001). Sucrose, but not aspartame, consumption associated with reduced (P = .024) stress-induced cortisol. The sucrose group also had a lower reactivity to naltrexone, significantly (P = .041) lower nausea, and a trend (P = .080) toward lower cortisol. CONCLUSION These experimental findings support a metabolic-brain-negative feedback pathway that is affected by sugar and may make some people under stress more hooked on sugar and possibly more vulnerable to obesity and its related conditions.