Keto And Fibromyalgia: Is There A Link?

The ketogenic diet is a high-fat, low-carbohydrate, and moderate-protein diet. It is known to reduce hunger and cause weight loss. While there is limited research on the effectiveness of the keto diet for people with fibromyalgia, some studies suggest that it may alleviate pain and fatigue. Fibromyalgia is a chronic disorder characterised by pain, tenderness, fatigue, sleep problems, and difficulty with memory and concentration.

Some people with fibromyalgia have reported a reduction in pain and flare-ups while on the keto diet. However, it is important to note that not everyone with fibromyalgia will respond favourably to the keto diet, and some may experience adverse effects such as electrolyte and micronutrient deficiencies, dehydration, and chemical toxicity.

It is always recommended to consult a healthcare professional or a registered dietitian-nutritionist before starting any new diet, especially when managing specific health conditions.

Keto can reduce pain and fatigue in people with fibromyalgia

Fibromyalgia is a chronic disorder defined by pain and tenderness throughout the body, fatigue, and, often, sleep problems and difficulty with memory and concentration ("fibro fog"). No single diet has been shown to improve these symptoms. However, some studies suggest that a ketogenic or low-carbohydrate diet can reduce pain and fatigue in people with fibromyalgia.

The ketogenic diet is similar to the Paleo diet, which emphasizes whole foods and the elimination of sugar, grains, and processed foods. But the ketogenic diet is extremely low in carbohydrates, moderate in protein, and high in fat. It produces a state of ketosis, in which the body's fat stores are used for energy, and which has been associated with a reduction in hunger.

John (Jack) Shelley-Tremblay, PhD, a professor of psychology and adjunct professor of neurology at the University of South Alabama, has done research on the effects of carbohydrates on fibromyalgia symptoms. While he's skeptical of diet fads, he points to research suggesting that the ketogenic diet is helpful for a number of conditions, including epilepsy and autism spectrum disorders. He also notes that some European studies have found that many people with fibromyalgia "improve dramatically" when they adopt a low-carb or ketogenic diet.

Shelley-Tremblay's research indicates that people with fibromyalgia do not metabolize sugars and other carbohydrates normally, so their cells, including their brain cells, crave energy. He describes the brain as "the most energy-craving part of the body pound for pound, and it wants sugar to run." As a result, people with fibromyalgia are in a constant state of deficit, leading to exhaustion, pain, poor sleep, and fibro fog.

A study published in the journal Orthopaedic Nursing found that high carbohydrate and sugar intake was linked to reduced quality of life in women with fibromyalgia, and increased sugar intake was associated with increased severity of pain.

A rat study published in the journal PLoS One investigated the effects of a ketogenic diet on pain and inflammation. The study authors concluded that the diet "offers new therapeutic opportunities for controlling pain and peripheral inflammation" and that such a metabolic strategy may offer significant benefits for both children and adults.

In another study published in the Journal of Musculoskeletal Pain, women with fibromyalgia who reported adhering to a low-carbohydrate diet reported less confusion, distress, and fatigue, and more vigor than those following a typical Western diet.

Parry Lama, a scientist and writer living in London, says that a low-carbohydrate diet helps her manage chronic fatigue and pain from fibromyalgia. She adheres as closely as possible to a ketogenic diet and always keeps her carb intake low.

The primary benefit of ketogenic diets, according to Shelley-Tremblay, is that they're low in the refined sugars and simple carbohydrates that are so inflammatory. He notes that it's not necessary to be in ketosis to see the health benefits of cutting back on simple starches and sugars. A low glycemic index diet can help reduce inflammation.

While a ketogenic diet may not work for everyone with fibromyalgia, it is worth considering as a potential therapeutic option. Consult a registered dietitian-nutritionist (RDN) for advice on making the switch to ensure you are getting the proper nutrients and to tailor the approach to your specific needs.

The ketogenic diet is similar to the Paleo diet

Both diets promote a high intake of dietary fats, especially mono- and polyunsaturated fatty acids from sources such as olive oil, avocado, nuts, seeds, and fish. They also discourage the consumption of highly processed and trans fats, which are detrimental to cardiovascular health when consumed regularly.

The ketogenic diet is a very low-carbohydrate diet that aims to induce ketosis, a metabolic state in which the body uses calories from fat instead of carbohydrates to create energy. The Paleo diet, on the other hand, is based on the principle of eating foods that were available to early humans, such as lean meat, fish, fruits, vegetables, seeds, and nuts. It eliminates grains, legumes, processed sugar, and most dairy.

While the keto diet focuses on decreasing carb intake and tightly controlling macronutrient intake, the Paleo diet is more flexible and does not emphasise macronutrients. Paleo allows for more whole-food carbs and does not restrict dairy or soy products.

The ketogenic diet is extremely low-carb, moderate in protein, and high in fat

The ketogenic diet is a popular eating pattern that has been shown to offer various health benefits. This diet is characterised by its extremely low carbohydrate, moderate protein, and high-fat composition. Here is a detailed overview of the ketogenic diet, its specific guidelines, and its potential effects on individuals with fibromyalgia.

Understanding the Ketogenic Diet

The ketogenic diet, often referred to as simply "keto," is a dietary approach that involves drastically reducing carbohydrate intake and increasing fat consumption. This shift in macronutrient ratios aims to induce a metabolic state called ketosis, where the body primarily uses fat, instead of carbohydrates, as its main source of energy.

To achieve this state, the ketogenic diet typically recommends consuming less than 50 grams of carbohydrates per day. This typically equates to eliminating or strictly limiting grains, sugar, and processed foods. Protein intake is moderate, usually recommended at a level of at least 2 grams per kilogram of body weight per day. The remaining calories in the diet come from fat, with the goal of achieving 70-80% of total calories from fat sources.

Potential Benefits of the Ketogenic Diet

The ketogenic diet has gained popularity due to its purported benefits for weight loss, improved energy levels, and various health conditions.

Weight Loss

One of the most well-known benefits of the ketogenic diet is its effectiveness for weight loss. By reducing carbohydrate intake and increasing fat consumption, the body becomes more efficient at burning fat for energy. This can lead to a reduction in body fat and overall weight loss.

Improved Energy and Reduced Hunger

Ketosis has been associated with a reduction in hunger and increased energy levels. When the body uses fat for fuel, it can access a more consistent and stable source of energy, which may lead to reduced cravings and a more stable mood.

Other Health Benefits

The ketogenic diet has also been studied for its potential benefits in managing certain health conditions. For example, it has been used to help manage epilepsy and is being investigated for its potential benefits in autism spectrum disorders.

Ketogenic Diet and Fibromyalgia

Fibromyalgia is a chronic disorder characterised by widespread pain, tenderness, fatigue, sleep problems, and cognitive difficulties ("fibro fog"). While there is no single diet proven to improve all symptoms of fibromyalgia, emerging research and anecdotal evidence suggest that the ketogenic diet may provide benefits for some individuals.

Some studies and individual accounts suggest that a ketogenic or low-carbohydrate diet can help reduce pain and fatigue associated with fibromyalgia. This may be due to the anti-inflammatory effects of the diet, as well as its ability to reduce hunger and improve energy levels.

For example, in a study published in the *Journal of Musculoskeletal Pain*, women with fibromyalgia who followed a low-carbohydrate diet reported less confusion, distress, and fatigue, along with increased vigour, compared to those following a typical Western diet.

Additionally, in a pilot interventional study involving obese women with fibromyalgia, a very low-calorie ketogenic diet led to significant weight loss and improvements in various health domains, including pain, anxiety, depression, and quality of life. These improvements were maintained even after the reintroduction of carbohydrates.

Considerations and Potential Drawbacks

While the ketogenic diet may offer potential benefits, it is not without its challenges and potential drawbacks.

Initial Side Effects

During the initial stages of adopting a ketogenic diet, some individuals may experience side effects commonly referred to as the "keto flu." These side effects can include nausea, vomiting, headache, fatigue, dizziness, insomnia, and constipation. These symptoms are often transient and tend to diminish over time as the body adapts to using ketones as its primary fuel source.

Micronutrient Deficiencies

Ketogenic diets may also be lacking in certain essential nutrients, such as calcium, zinc, selenium, and copper. It is important for individuals following this diet to ensure adequate intake of micronutrients, either through diet or supplementation, to prevent potential deficiencies.

Kidney Health

There is also a potential risk for kidney stone development in individuals following a ketogenic diet, especially for those with a family or personal history of kidney stones. Therefore, it is recommended to consult with a healthcare professional before starting this diet, particularly for those with kidney health concerns.

Individual Variability

It is important to note that not everyone with fibromyalgia will experience the same benefits from the ketogenic diet. Individual responses to the diet can vary, and some may find that their symptoms worsen or remain unchanged.

The ketogenic diet, with its extremely low-carbohydrate, moderate-protein, and high-fat composition, has been suggested as a potential dietary approach for individuals with fibromyalgia. While some studies and anecdotal reports indicate improvements in pain and other symptoms, more comprehensive research is needed to fully understand the effectiveness of this diet for fibromyalgia. As with any dietary intervention, it is essential to consult with a healthcare professional or registered dietitian to ensure a safe and individualised approach.

The diet may cause electrolyte and micronutrient deficiencies

The keto diet is a high-fat, moderate-protein, and low-carb diet. While it has been shown to reduce pain and fatigue in people with fibromyalgia, it may also cause electrolyte and micronutrient deficiencies. This is because many micronutrient-rich foods like fruits, vegetables, grains, and legumes are restricted on a keto diet.

Electrolyte Deficiencies

Electrolytes are minerals that carry an electric charge and are vital for the proper functioning of the body. Common electrolytes include sodium, potassium, magnesium, chloride, calcium, phosphate, and bicarbonate. When starting a keto diet, people often get low on electrolytes due to carb restriction leading to lower insulin levels. This can result in symptoms such as muscle cramps, headaches, fatigue, brain fog, and increased cravings, commonly known as the "keto flu."

To prevent electrolyte deficiencies on a keto diet, it is recommended to eat whole foods that are high in electrolytes, such as coconut water, avocados, beef, chicken, eggs, spinach, clams, salmon, lettuce, tomatoes, yogurt, and almonds. Drinking electrolyte-infused water and taking keto-friendly electrolyte supplements can also help.

Micronutrient Deficiencies

Micronutrients, including vitamins and minerals, play crucial roles in the body's daily functions. A keto diet may lead to deficiencies in certain micronutrients, especially those found in high-carbohydrate foods. These include:

• Thiamin (B1)
• Folate (B9)
• Pantothenic Acid (B5)
• Calcium
• Copper
• Iron
• Magnesium
• Manganese
• Molybdenum
• Selenium
• Zinc
• Biotin (B7)
• Vitamin D
• Vitamin E
• Chromium
• Iodine
• Potassium
• Sodium

To avoid micronutrient deficiencies on a keto diet, it is recommended to focus on specific vitamin-rich foods or take supplements. Some keto-friendly food sources of these micronutrients include:

• Salmon
• Liver
• Beef
• Mussels
• Nutritional yeast
• Pork
• Trout
• Eggs
• Chicken
• Turkey
• Sunflower seeds
• Liver capsules
• Spinach
• Broccoli
• Avocados
• Nuts

The diet may be beneficial for people with fibromyalgia who are also obese

Obesity can worsen fibromyalgia, and a very low-calorie ketogenic diet (VLCKD) may be a potential treatment option for obese people with fibromyalgia. A pilot interventional study investigated the effects of VLCKD in obese women with fibromyalgia. The results suggest that ketosis may have beneficial effects beyond rapid weight loss.

The Study

The study included 20 obese women with fibromyalgia who followed a VLCKD for 20 weeks. The ketogenic phase was followed by a progressive reintroduction of carbohydrates. The women's body mass index (BMI), Fibromyalgia Impact Questionnaire (FIQ) scores, Hospital Anxiety and Depression Scale (HADS) scores, EuroQol 5D (EQ-5D) scores, and 36-item Short Form Health Survey (SF-36) scores were evaluated.

Results

All 20 women lost weight during the first period of VLCKD, and this weight loss was maintained at the end of the study. The mean BMI decreased significantly from 37.2 kg/m^2 at the beginning of the study to 32.1 kg/m^2 at the end. A significant reduction in mean FIQ scores was also observed, indicating an improvement in different domains of the disease. Similar results were obtained for HADS, EQ-5D, and SF-36 scores.

Adverse Effects

Adverse effects of the diet were mild and transient, with constipation and fatigue being the most common. No major safety concerns were reported.

The study suggests that VLCKD may be beneficial for obese women with fibromyalgia, leading to weight loss and improvements in various aspects of the disease. However, further research is needed to confirm these findings and determine the potential applications of VLCKD in tailoring treatment approaches for individual patients with fibromyalgia.

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