The Fibromyalgia Diet (Part 3): Gluten Free

Mark Volmer
Jul 28, 2017 · 6 min read
gluten and fibromyalgia
gluten and fibromyalgia

Note: This is the second article in an ongoing series. Make sure to check out the other articles after finishing this one:

Could an undiagnosed gluten sensitivity be the root cause of your fibromyalgia?

Patients with fibromyalgia frequently present with similar symptoms to those with gluten-related disorders. This raises the possibility that a portion of these patients could be experiencing undiagnosed celiac disease or an underlying gluten sensitivity. (1)

Anyone familiar with my work knows that my bias is towards a gluten-free diet. In cases of fibromyalgia, a thorough inquiry into celiac disease and non-celiac gluten sensitivity should be one of the first steps in your healing journey. (2) Especially if you have a family history of autoimmune disease and/or celiac disease.

Celiac disease — a brief introduction

Celiac disease (CD) is an autoimmune disorder related to the intolerance of gluten — a protein stored in wheat, rye, barley and other grains. It affects 1% to 2% of individuals worldwide.

Those with celiac disease often carry one of two specific genes — the HLA-DQ2 or the HLA-DQ8. While these genetic markers may increase your likelihood of developing celiac disease, they are not absolute. These genes are present in more than 30% of the general population. Though only 1–2% of individuals develop celiac disease. (3)

In patients with HLA-DQ2 or 8 genotypes, gluten proteins trigger an abnormal response from the immune system. This results in the production of tTG autoantibodies and a chronic inflammation of the lining of the small intestine. Autoantibodies are proteins created by the immune system that attack our own cells.

In the case of celiac disease, the autoantibodies attack the cells of the small intestine. This attack on the small intestine is characterized by: (4)

  • Villous atrophy
  • The villi are small, finger-like projections, that extend into the small intestine. Villi increase the internal surface area of the intestinal walls. This creates a greater area for our body to absorb nutrients.
  • In celiac disease, the villi become flattened. This decreases the surface area available for our body to absorb nutrients. Eventually, this results in the malnutrition commonly found in celiac disease.
  • Intraepithelial lymphocytosis
  • This is an increase in the number of white blood cells (lymphocytes) found in the small intestine.
  • Crypt hyperplasia
  • Crypts are the grooves between the villi, which are the small fingerlike projections that line the small intestine and promote nutrient absorption. Crypt hyperplasia is when the grooves are elongated compared to a normal intestinal lining which has short crypts.

The above characteristics need to be confirmed via a biopsy. A biopsy is essential for the proper diagnosis of celiac disease.

What’s the connection between celiac disease and fibromyalgia?

Celiac disease is increasingly recognized as a condition with a wide spectrum of symptoms. Often, these symptoms overlap with the symptoms of fibromyalgia. These include chronic musculoskeletal pain, lack of energy, brain fog, and irritable bowel syndrome.

Those with fibromyalgia have rates of irritable bowel syndrome that are much more prevalent than the general population. At the time of this writing, the research is unclear whether IBS can predispose one to have fibromyalgia, or, if fibromyalgia may predispose one to have irritable bowel syndrome.

In one study, researchers found that participants with both irritable bowel syndrome and fibromyalgia were nearly 7x as likely to have undiagnosed celiac disease. (5) This result is significant enough to ensure all patients presenting with both fibromyalgia and irritable bowel syndrome are screened for celiac disease.

Another study showed that 20–32% of those with irritable bowel syndrome go on to develop fibromyalgia. (6,7) The risk of developing fibromyalgia was dependent upon the severity of the IBS. With more significant symptoms of the digestive tract leading to a greater likelihood of developing fibromyalgia. (8)

In a study of over 3300 participants, it was found that the incidence of celiac disease in those with IBS is much higher than non-diagnosed individuals. (9, 10) Remeber how celiac disease occurred in about 1–2% of the population? Well, in those with irritable bowel syndrome, 38% had celiac disease. (11)

Therefore, if you have fibromyalgia, confirming that you do (or, do not) have celiac disease is of paramount importance. Your fibromyalgia or irritable bowel symptoms may be as simple as an undiagnosed celiac disease. In a Spanish study, 6.7% of patients diagnosed with IBS and fibromyalgia had undiagnosed celiac disease. (12) The simple act of removing gluten from their diet lead to profound changes in both their digestive health and pain levels. (13)

But what if you’ve already been tested for celiac disease and it came back negative? Could gluten still be contributing to your fibromyalgia symptoms?

Fibromyalgia and non-celiac gluten sensitivity

Non-celiac gluten sensitivity (NCGS) is increasingly recognized as a legitimate medical condition. In non-celiac gluten sensitivity, patients present with symptoms nearly identical to celiac disease. Yet their lab results indicate they do not have celiac disease. (14)

More information regarding the symptoms of both celiac disease and NCGS is being released each year. We often think of symptoms relating primarily to the digestive tract. However, new research is showing that symptoms are not focused solely on one’s gut. Instead, symptoms include muscle and joint pain, fatigue, and neurological and psychological symptoms. (15, 16)

These symptoms sound a lot more like the symptoms commonly experienced by those with fibromyalgia.

In a 2014 study, 20 participants who were diagnosed with fibromyalgia and negative for celiac disease were placed on a gluten-free diet. The results of this small study were startling: (17)

  • All patients had a decrease in pain levels.
  • 15 of the 20 participants no longer had chronic, widespread pain.
  • 15 patients were able to return to work and normal life.
  • 3 patients who were dependent on opioid pain killers were able to completely come off their medications.
  • 2 patients who entered the study with psoriatic arthritis went into complete remission.

For some of the study’s participants, improvement in symptoms occurred within a month after gluten was removed from their diet. For others, the results were more gradual and occurred after many months of a gluten-free diet.

While more studies like this are required for us to know the true connection between gluten and fibromyalgia, the initial results are promising. There does seem to be a link between the health of one’s gut and fibromyalgia.

Tying it all together

If you’ve been following this series of posts, you now know that the ideal diet for someone with fibromyalgia consists of three, equally important parts:

  1. The diet allows the individual to maintain an ideal body weight.
  2. The diet is low in inflammatory foods.
  3. The diet is (likely) gluten-free.

By now, you’ve likely realized that this is not a quick fix diet. It’s not 30-days to cure fibromyalgia. Instead, this is a gradual lifestyle shift. To better make these changes sustainable, tackle them one at a time.

To better make these changes sustainable, tackle them one at a time. I recommend starting by ruling in (or out) celiac disease and gluten sensitivity.

Testing for gluten allergies needs to be performed while you’re consuming wheat products. Therefore, don’t perform lab testing after a 30-day reset diet or a gluten-free nutrition plan. Ensure that you look to test for both celiac disease and non-celiac gluten sensitivity.

For a deeper look into where gluten may be hiding in your diet, please see this post.

After you’ve identified your body’s reaction to gluten, move on to slowly removing inflammatory foods. By reducing or removing wheat products, you’ll likely have already decreased your intake of foods with a high GI index. The next step involves decreasing refined and artificial sugars.

Start by first eliminating all forms of artificial sweeteners. These can be replaced with natural sweeteners like maple syrup and honey. Next, read labels on the packaged foods you purchase to begin decreasing refined sugar in your diet. If you see words like corn syrup, sugar, dextrose, fructose, fruit juice, maltose, or, high-fructose corn syrup, look for a different product.

If your fibromyalgia symptoms remain unchanged after eliminating gluten, sugars, and artificial sweeteners, try removing nightshades from your diet for a period of 30 days. After the 30 days, re-introduce them (gradually) 1-by-1. Pay close attention to any changes in your symptoms.

By following the above recommendations, weight loss is likely to occur naturally and without much effort on your part. Don’t stress about going on intense calorie restriction diets in order to lose weight. Sustained, gradual weight loss is ideal. This ensures that the modifications you’re making are lifestyle changes and not unsustainable fad diets.

Ok, now you have all the information needed to begin your own fibromyalgia diet!

I’d love to hear about your successes and challenges in the comments section below.


Originally published at Flourish Clinic.

Mark Volmer

Written by

I help those with fatigue naturally reclaim their energy and share their gifts with the world.

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