How nutrition, exercise, and lifestyle strategies can help alleviate the pain.
By Ryan Andrews, MS, MA, RD, RYT, CSC
Millions of people (including a staggering 3.4% of adult women) struggle with fibromyalgia, a pain disorder once dismissed as a made-up problem.
The good news: Doctors now treat fibromyalgia as real. We know more about it. And it’s easier than ever to feel better. The bad news: As with any fledgling market, everyone wants to sell you a quick fix.
With help from trusted trainers and coaches, you can get real answers, begin developing new lifestyle strategies today, and start feeling better tomorrow.
[Note: We’ve also prepared an audio recording of this article for you to listen to. So, if you’d rather listen to the piece, click here.]
Quick reference: What to know
Fibromyalgia (FMS) is a complex health condition. While doctors and researchers are learning more about it and taking it more seriously, there’s a lot we still don’t know.
While you may not be able to completely “cure” FMS, there are many things you can do to reduce or even alleviate some of the symptoms. This includes nutrition, exercise, mindset, and other lifestyle adjustments.
There’s a lot of information here, so don’t try to deal with it all at once. Scroll down to the end of this article for a simple “get started” plan that you can begin immediately.
Achy, tired, and sluggish… what gives?
Maybe you haven’t been sleeping so well lately. You squeeze your eyes closed and beg to drift off, but you just can’t seem to stop squirming.
The exhaustion is causing these annoying headaches, and you have to admit you’ve been kind of depressed about it for a while now.
Your body suddenly feels… old. It’s hard to make it to your workouts when you’re so tired and out of sorts.
It’s just a phase, right?
Maybe. But it could be fibromyalgia.
I know what you’re thinking:
Seriously? Come on, I don’t have some maybe-disease, I’m just a little off lately. Is fibromyalgia even real, anyway?
You’re not alone.
Since fibromyalgia is poorly understood even in the medical community, people often write it off as a fake problem that keeps doctors’ and pharmaceutical companies’ checks rolling in.
But the truth is that this disorder, characterized by persistent, all-over pain and sensitivity combined with more commonplace (but miserable) ailments like headache, anemia and arthritis, is real and quite prevalent: 5 million U.S. adults suffer from fibromyalgia according to a 2005 estimate, the most recent available.
Thankfully, we are learning more about solutions.
If you have fibromyalgia — or think you may have it, or serve as a fitness coach to someone who has it — there are lifestyle strategies you can try today to start feeling better almost immediately.
Pain with no purpose
What exactly is fibromyalgia, anyway?
“Myalgia”, from the ancient Greek roots myo, or muscle, and algos, or pain, simply refers to nonspecific muscle pain.
Fibromyalgia syndrome, or FMS, is a collection of symptoms that may or may not include:
- poor sleep
- painful menstrual periods
- overactive bladder
- irritable bowel
- restless legs
And — ugh — that’s just to name a few.
But there is one commonality among FMS sufferers, and that is pain.
The pain of FMS is widespread throughout the body, and it’s constant.
Unlike acute pain, which tells you that something needs immediate attention (like, you stepped on a nail or need your appendix removed), the chronic pain of FMS doesn’t seem to have a clear purpose. It doesn’t seem to signal any actual damage.
And though FMS has been studied for decades (in fact, similar conditions are noted in fairly old medical texts), there’s still no consensus about its cause.
Some theorize that those with FMS might have a lower threshold for pain due to certain changes in nerve cells, which would make it purely a physical problem. Others believe FMS could be a psychosomatic disorder.
In addition, pain itself is a highly subjective experience. Some folks seem to feel it more than others, or we may feel pain more in certain situations (such as when we feel emotionally stressed or socially isolated), but we’re not completely sure why.
So, yeah. We’re pretty far from fully getting it.
Unfortunately, not knowing what causes FMS means that, at this point, there’s no cure.
Pinpointing the problem
Many of the symptoms of FMS overlap with other problems and disorders, so trying to find the right diagnosis can be a confusing game of “chicken and egg”.
For example, sleep can affect pain and other things like energy levels.
If we don’t sleep well, our body chemistry changes. Inflammation can go up. Metabolism can be disrupted. Our hormones can go out of whack.
We end up feeling crummy — perhaps achey, low energy, plus other nagging complaints from the list above.
So is it just lack of sleep? Or is it FMS? (And what if FMS is causing the poor sleep… which makes things worse… and so on?)
To address this challenge, the American College of Rheumatology recently released revised diagnostic criteria for FMS.
Whereas previously doctors diagnosed FMS based on an examination of specific (and rather limited) tender points on the body, the new set of criteria offers a broad-based severity scale: If a doc pushes on 18 of the designated points, and someone has pain in at least 11 of them, they might have FMS. The revised recommendations also account for accompanying symptoms (like fatigue).
With ever-changing diagnostic criteria, it’s hard to pin down how many people suffer from FMS.
But current data estimate that 0.7% to 3.3% of adults have FMS globally, with 2% to 7% of populations in developed countries fitting the diagnostic criteria. Adult women are affected with FMS up to seven times more than men. In children, gender distribution appears equal.
Searching for reasons
As with any health problem that’s not fully understood, there’s lots of speculation about what causes FMS.
This is a pretty complicated list, and obviously it’s still a work in progress.
In general, though, the basic idea is that there’s probably something (likely several somethings) that affects our physical and psychological perceptions of pain.
Some of these theories include:
- Bodily tissues’ inability to produce energy: Cells might be metabolically “shut down,” leading to muscle pain and symptoms of fatigue.
- Central nervous system abnormalities: Congenital malformations of the brain may disrupt the blood-brain barrier, potentially changing how the brain functions and responds to pain. In this case, viruses, stress, cell signal problems, pharmaceuticals, and nutrient deficiencies might act as triggers.
- Altered sensory response in the brain: Some brain areas that process pain may be over-active, sounding the alarm without a legitimate threat.
- Sleep deficiency: Short or poor-quality sleep can change hormone levels and immune function, increasing pain.
- Inflammatory-pathway abnormalities: Cytokines, compounds that regulate how our immune system responds to inflammation, may be out of whack, causing a trigger-happy immune response to your body’s own cells.
- Too much stress: Allostatic load, or all of the stuff in your life that causes stress (workouts, kids, relationships, job, and so forth) might increase our pain perception.
- Poor gut health: An imbalance of gastrointestinal bacteria (caused by an unhealthy diet or food intolerances) can lead to or worsen FMS symptoms including pain, fatigue and stress.
- Use of antibiotics: There has been speculation that using antibiotics (or at least certain types at certain times) might contribute to the development of FMS by throwing gut bacteria off balance.
- Hormone imbalances: Hormones — particularly from the thyroid — that are disrupted may cause hypersensitivity in the central nervous system, leading to the pain of FMS.
- Pain-perception disorder: There may be an overproduction of pain-generating substances after injury (or even intense exercise).
- Nutritional deficiency or toxicity: Pain may be triggered by deficiencies of B vitamins, vitamin C, and iron. And high levels of oxidative stress might play a role in the development of FMS (making dietary antioxidants important). Also, it might be worthwhile to check for candida overgrowth — excessive levels of yeast in the gut caused by corticosteroid use, eating too many refined carbohydrates, or taking antibiotics.
- Breathing disorders: Altered breathing (caused by problems like asthma and allergies) might cause an oxygen deficit, throwing blood gases out of balance. This could mess with the brain’s processing of messages from pain receptors, leading to an FMS flare-up.
- Infection: Getting sick (for example, with a virus) might initially trigger FMS.
- A traumatic event: Adults with FMS report higher rates of childhood distress (e.g., maltreatment and abuse). Trauma might lead to FMS by causing endocrine disturbances or changes in the inflammatory system.
- Environmental toxins: Chemicals you come into contact with can cause fatigue, headaches, chronic pain and other FMS symptoms.
- Where you live: Adults in the United States may be more than twice as likely to develop FMS compared to the global average. In China, for example, incidence of FMS is minimal, perhaps because of genetic differences or sociocultural norms that affect the perception and acceptance of pain.
Unlike, say, smallpox or lead poisoning, where we can clearly blame a specific disease on a particular, clearly recognizable pathogen or toxin, we don’t yet have a smoking gun for FMS.
FMS is probably the result of several factors, many of which are hard to measure or trace.
New ways to treat FMS
Years ago, people with FMS suffered in silence and/or shame.
They were often dismissed by doctors. Confused by symptoms that seemed vague, inconsistent, and puzzling. Labeled crazy, hypochondriac, whiny, neurotic or “hysterical” (a very common catchall “diagnosis” for diseases that preferentially affect women).
They might have been prescribed tranquilizers and sedatives, opioid painkillers, muscle relaxants, anti-depressants, anti-inflammatories, hormonal birth control, and a host of other medications that rarely addressed the underlying problem.
Nowadays, even with modern understandings of FMS, the condition still disrupts people’s routines, wellbeing, and lives.
Many sufferers end up quitting the gym, ditching dinner plans, skipping holidays, and otherwise curtailing many of the activities that they enjoy. Now they’re not only in pain, they feel miserable and isolated too.
And health care providers are struggling to help. Given that most drugs to date have been ineffective, and the ones that were previously prescribed can have nasty side effects, doctors are increasingly recommending lifestyle solutions to help their FMS patients.
In fact, with the right holistic treatment plan, many people with FMS can reduce or eliminate their symptoms.
There is hope.
You, your support team, and life after fibromyalgia
Although there is a lot we still don’t know about FMS, there are steps that you can take — starting today — to potentially improve, or even get rid of, some FMS symptoms.
You, your doctor, your fitness trainer and nutrition coach can work together to improve your quality of life.
But first — keep it simple.
We’re giving lots of recommendations here. And we know that can be overwhelming, especially when you’re already dealing with the psychological and physical load of a chronic illness. (And since one of the symptoms of FMS can be “brain fog”.)
So take it slow. One thing at a time.
We’ll explain how, below.
And reach out for help. A coach or health care provider can help you organize your treatment steps into a clear, simple, do-able plan. You don’t have to do this all yourself — in fact, you probably shouldn’t try.
This is something you can tackle all by yourself, immediately.
Get to know your own body and the ebb and flow of your health.
Grab a notepad, or set up a little diary app on your smartphone, or use any other tool you like that will help you record your daily physical, mental, and emotional fluctuations as well as any factors that seem relevant.
Book a few minutes every day to check in.
Start to observe, like a detective or a scientist. And record.
Here are some things you can track.
Symptoms: What’s happening today? Capture as much as you notice, even stuff that might not seem relevant right away (e.g. bowel habits, skin rashes, whether your hair or nails seem brittle, etc.).
Pain: On a scale of 1-10, with 1 being no pain and 10 being the most horrible pain you can imagine, how is your pain today? Where is it? What is the quality of it — achey, burning or stinging, sharp, diffuse, etc.? Does it move around or settle in a particular area?
Sleep: How many hours? Did you have trouble drifting off, or wake up often? Etc.
Digestion: How does food feel in your body? Do you have stomach upset, digestive problems, etc.?
Mood and cognition: Are you feeling mentally sharp or dull today? How would you describe your mood or emotional state? Are you having trouble remembering things, or is recall coming easily? What’s your overall outlook on life today? Etc.
Energy levels: What’s your energy like today? Do you have bursts and then crashes over the course of the day? Or is it a more constant low or high (e.g. “good days” and “bad days”)? Do you notice yourself affected by things like the weather or light? Etc.
Food and appetite: What did you eat today? Did you notice that anything seemed to affect you? Are you hungry?
Exercise and movement: How did you move your body today? How did that feel? Did you struggle to recover or have more sustained energy afterwards? Etc.
Menstrual cycles: If you normally menstruate, how are your cycles? Where are you at in your cycle today? If you’re perimenopausal or menopausal, do you notice any hormone-like symptoms (e.g. bloating, cravings, etc.) without actually getting a period? Etc.
Other life demands and stressors: What was work like today? How are things with your family? Finances? Etc.
First, just get to know how your unique body responds, and how things might change (or not) over hours, days, weeks, and months.
Second, start to look for patterns. Can you notice regular ebbs and flows, or things that might seem to go together (e.g. “When X happens, my pain is worse” or “Eating Y seems to make it flare up”)?
Exercise is powerful medicine, but like all medicines you have to get the right type and dosage.
If you’re dealing with FMS, your recovery ability is probably lower.
That means no “beast mode”, no Ironman triathlons, no “pump till you puke” workouts. (Your body will probably kibosh that stuff pretty quickly anyway.)
And you’ll want to avoid anything that “amps you up”, stresses you mentally, and/or activates your “fight-flight” sympathetic nervous system.
Your goal here is happy, easy, relaxed movement that gets the juices flowing, calms the stress response rather than activating it, and makes you feel good, without overly depleting your limited reserves.
- Moderate aerobic exercise has been shown to alleviate anxiety, depression, poor pain tolerance, poor sleep, elevated inflammation, and decreased mood in FMS patients.
- According to one study, progressive exercise three times per week in a support-group setting increased strength and function while decreasing pain and fatigue.
- Qigong, yoga, stretching, tai chi, and meditation appear to address FMS by promoting muscle relaxation and deep breathing.
- Start slow.
- Avoid increasing exercise volume by more than 10% in one day.
- When possible, go for lower-impact exercise (water workouts, cycling, walking, yoga, bodyweight resistance work).
- Prioritize aerobic capacity, focusing your efforts at one or two steps above “easy.”
- Take one day off for recovery between the more intense structured workouts.
- After a month of consistent aerobic work, start to build in strength training.
Here are some ideas for distributing your weekly exercise patterns.
Try this simple regimen that alternates days:
- 5-10 minutes warm-up, 20-30 minutes aerobic work, 20-30 minutes strength work.
- Normal everyday activities.
Or, mix it up a bit:
Monday: 5-10 minutes warm-up, 20-30 minutes aerobic work
Tuesday: 60 minutes gentle yoga
Wednesday: 5-10 minutes warm-up, 20-30 minutes strength work
Thursday: Normal everyday activities
Friday: 5-10 minutes warm-up, 20-30 minutes aerobic work
Saturday: 5-10 minutes warm-up, 20-30 minutes strength work
Sunday: Normal everyday activities
Be prepared to nix any part of a session if you’re having an FMS flare-up or when your stress level is unusually high. Don’t try to be a hero.
Though we don’t know exactly what causes FMS, we do know that being overweight increases your risk.
Compounds secreted by body fat may cause inflammation — a potential FMS trigger. In one study, women who were overweight or obese were up to 70% more likely to develop the disorder than those with a body mass index in the normal range.
Of course, regardless of weight, making healthy choices is always a good idea.
Start with how you eat: thoughtfully, mindfully, slowly, and in response to real physiological hunger (here’s how to distinguish between real, physical hunger and emotional hunger).
And track any ups and downs in hunger and appetite in your awareness journal.
- Prioritize whole foods: Processed ones contain too many needless sugars, fats and additives.
- Eat plenty of plants: More plants in the diet means more antioxidants. And more antioxidants might mean less pain (in fact, some research indicates that a vegan diet may offer short-term benefits to FMS victims).
- Go organic when possible: This minimizes your consumption of harmful toxins.
- Drink water and tea: Try to avoid juices and sodas, which increase your sugar intake.
- Avoid caffeine and tobacco: These are associated with sleep problems and increased pain in FMS sufferers, respectively.
- Limit alcohol: In a recent study, FMS patients who were moderate drinkers (consuming 3-7 drinks per week) experienced less pain that heavy or non-drinkers.
- Eliminate food allergens and intolerances: Obvious, right? But it might be worthwhile to get a work-up (ALCAT‘s a good one) and find out if you have sensitivities you weren’t aware of. Common culprits include wheat, dairy, sugar, caffeine, aspartame, alcohol, and chocolate.
- Beware excitotoxins: These are amino acids and brain-stimulating neurotransmitters found in MSG, aspartame and protein-dense foods that may worsen FMS pain, perhaps by increasing cerebrospinal fluid (the stuff in your brain and spine). In certain case studies, eliminating excitotoxins alleviated FMS symptoms, especially in folks who are particularly sensitive to these chemicals.
- Don’t overdo sugar: When added sugars make up more than 10% of your total calorie intake, you might experience candida overgrowth (see above).
Certain nutrients may help fight the symptoms of FMS. When possible, try getting them from food first.
If you choose to supplement:
- Pick reputable brands, and introduce supplements one at a time.
- Always check for interactions with other supplements and medications first.
Here are some options that you may consider.
- Probiotics/prebiotics: These bacteria boost the health of your gut, which can influence your whole body. Sources: sauerkraut, kimchi, miso, yogurt, kefir.
- Ribose: This simple sugar is involved in energy production, potentially improving problems related to fatigue and sleep. Sources: milk, cheese.
- Magnesium: This mineral seems to be low in some folks with FMS; getting enough might help relieve muscle spasms and cramping. Sources: almonds, spinach, cashews, peanuts, beans.
- Melatonin: It’s the hormone we produce to make us sleepy; supplementing might help promote natural sleep cycles.
- CoQ10: Coenzyme Q10 acts as an antioxidant and may offset dysfunction of mitochondria (cell parts responsible for energy production) noticed in FMS patients. Sources: fish, liver, whole grains.
- SAMe: Taking supplements of this naturally-occurring bodily chemical might help with mood and sleep.
- Quercetin: This powerful antioxidant might fight FMS symptoms by tamping down on inflammation. Sources: citrus fruits, apples, onions, parsley, tea.
- 5-HTP: The body converts this naturally-occurring neurotransmitter into serotonin, a hormone that helps regulate mood, appetite, and sleep. Supplements may improve related FMS symptoms.
- Carnosine, BCAAs, creatine: These body compounds might help with muscle energy production. Sources: beef, chicken, pork.
- Acetyl-L-carnitine: A synthesized amino acid derivative, ALCAR might assist in mitochondrial function.
- Turmeric: This delicious spice — found on its own or as an ingredient in curry — might help buffer inflammation.
- Ashwaghanda: An exotic herb available in pill form, it may help improve sleep and anxiety.
- Valerian, passionflower: These plant-based supplements might facilitate sleep.
- Capsaicin/capsicum: Ingested or used topically, this compound that gives many spicy foods their kick might help decrease pain. Sources: chili peppers.
- Iodine: Deficiency in this mineral may lead to chronic fatigue. Sources: seaweed, scallops, cod, white beans, lentils, spinach, Jerusalem artichokes, black beans, soybeans, molasses, Lima beans, tofu, liver, meats, clams.
- Zinc: Not getting enough can lead to low immunity and brain fog. Sources: mushrooms, spinach, sesame seeds, pumpkin seeds, green peas, baked beans, cashews, peas, whole grains, flounder, oats, oysters, and chicken.
- Iron: Low levels of this nutrient, necessary for delivering oxygen throughout the body, is associated with significantly elevated risk of FMS. Sources: egg yolk, liver, dried beans, dried fruit.
- Vitamin D: Low levels of D — only available via fortified foods, supplements and natural sunlight, are common in FMS patients. In a 2014 study, vitamin D supplements significantly decreased FMS pain.
- Selenium: One study noted low levels of this mineral in FMS sufferers. Sources: Brazil nuts, yellowfin tuna, orange roughy, rockfish, lobster, swordfish, oysters.
- Vitamin B1: Deficiency of this vitamin — needed for energy production and brain function — is associated with poor memory, fatigue, irritability and sleep disturbance. Sources: peas, cowpeas, navy beans, black beans, lentils, soybeans, oat bran, asparagus, sesame seeds, pork, liver.
- Essential fatty acids: Making sure you get enough, perhaps through supplements, may help with FMS-related nerve pain. Sources: flax, chia, hemp, cold-water fish, grass-fed meat, pastured eggs.
This is, obviously, a long and complex list. Consider getting guidance from a qualified naturopath or nutrition coach who can help you assess your needs, and put together an appropriate plan.
Bodywork and therapeutic touch
Whether you’re healthy or well, these therapies feel amazing, but there’s evidence they can really help FMS patients.
There’s a saying among body workers: “Mechanoreception inhibits nocioception.”
In English, it means that therapeutic touch can alleviate pain by competing for the same nerve signals, sort of like jamming up a highway with cars.
Effective bodywork may include:
- trigger point therapy
- craniosacral therapy
- foam rolling
- dry needling
Keep it gentle; if bodywork is too intense, it’ll work against your anti-pain efforts.
Again, keep track of what interventions seem to improve your symptoms.
Again, the quality of your nightly rest can influence many FMS symptoms (frankly, it affects pretty much every aspect of your health).
Check out our guide to improving sleep — and consider this nugget that I bet you’re not aware of: Every hour of sleep before midnight is worth two hours after. Wow.
Keeping stress to a minimum can go a long way toward reducing FMS hell by helping improve your mood and sleep habits. Decreasing stress and developing effective ways of coping may help build resilience in the body.
A couple tips:
- When you rest, really rest: Hint! TV and books require energy. That’s work, not resting.
- Try yoga and breathing: These can take FMS sufferers to a tranquil state, perhaps by delivering oxygen to the tissues and relieving fatigue.
That’s the warmup. Here’s the real game: Chronic illness often forces us to re-evaluate our relationship to stress and life demands.
Obviously, life happens. We can’t control all of our circumstances or stressors — a sick child, a nasty boss, etc.
However, we do have control over many other stressors, and we also have control over how we respond.
- We may take an unflinching assessment of all our expectations, commitments, and responsibilities, and decide to let go of some of them.
- We may opt for work, family, and/or school arrangements that help us get more recovery time or assistance with daily-life tasks.
- We may choose to be compassionate rather than critical with ourselves.
- We may practice mindfulness and relaxation techniques to help regulate and calm ourselves when the poop hits the fan.
We’re social beings. And pain isn’t just an individual experience; it’s a social one too.
Social isolation and loneliness can make us sicker, feel more stressed, and die sooner. This is especially poignant for chronic illness sufferers, who may already feel alone or unsupported (or have trouble asking for help).
Conversely, there’s evidence that when we have a happy, healthy and thriving social support network and relationships, it can help decrease pain, inflammation, and stress. And of course, this can also cut down our isolation.
Research on emotional attunement shows that when someone we love and feel connected to is close to us or touching us (such as holding our hand), it can actually decrease our perception of pain. (Apparently kissing the boo-boo really does work.)
And luckily, even if you don’t have close friends and family nearby, the same holds true for regularly being around animals. Consider Fido or Fluffy part of your health care plan.
What you can do
There’s a lot of information here. This can seem pretty overwhelming, especially if you’re already dealing with the mental, emotional, physical, and other demands of a chronic health problem.
So take a deep breath.
And start slowly and simply.
What you can do right now
- Start to build awareness. Take notes on how you feel and what you notice, every day. Learn how FMS lives in your body, and over time, look for patterns.
- Think about who you can recruit for your health care and support team. Whether it’s your doctor, a naturopath, your personal trainer or nutrition coach, family members, friends, etc. — look for allies, supporters, and helpers. Don’t suffer alone.
- Ask for help. Even if it’s something small and simple, like someone else picking up a few groceries for you, or letting you have some quiet time for a nap.
- Decide to be kind to yourself. Illness is not a moral failure or a sign of weakness. Choose to be gentle and compassionate with yourself.
What you can work towards, gradually
- Go see your doctor: If you suspect FMS, or have already been diagnosed but want to explore some new treatment options, go see your doc and ask tons of questions. Your M.D. is doubtless a skilled, experienced, caring professional, but no one can advocate for your best interest better than you.
- Talk to your coaches: Complex health problems like FMS require extreme care, and what you eat and how you move your body are at the front lines of your battle against the pain. Enlist your personal trainer and nutrition coach to help you develop an anti-FMS plan that works for you, then revise together as you go. And if you don’t have these coaches yet, consider hiring some! Life’s too short to feel terrible.
- Start a simple workout routine: Getting back into an exercise groove can seem daunting when you’re feeling gross, and especially if you’ve been sedentary of late. Start slow with an easy alternating-days regimen of light cardio (see above for a sample schedule).
- Cut down foods that actively subtract health: I know I offered a lot of tips for proper diet, but one tip rises above the rest for me: eliminating toxins. Putting unhealthy “food” in your body can have countless negative consequences– both known and unknown. Clean up your plate, prioritize whole foods, and the rest will fall into place a lot easier than you think.
- Get serious about recovery and replenishment: Don’t try to muscle through or be a martyr. Recognize that this health condition requires you to actively “fill your tank”. That may mean offloading some responsibilities, commitments, or life demands. Or purposely scheduling additional recovery activities rather than waiting to someday “have the time” for them.
- Go get a massage: Hey, you deserve it. We all do.
- Do more of the good stuff: Use your awareness journal to look for “bright spots” as well as problems. Notice especially what seems to make you feel better, even just a little bit, and build a bank of “success strategies”.
Eat, move, and live…better.©
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