Conventional medicine offers only symptomatic treatment for fibromyalgia with very limited benefit. Patients who come to us have often been unsuccessfully treated for years on a variety of regimens, including opioid pain killers which inevitably fog the mind further.
There are several things going on here that it took us a while to work out. But I was hesitant to write about them in the absence of controlled trials. The necessary research has just been published, and it supports our ideas that sort out fibromyalgia, celiac disease and gluten.
Conventional medicine teaches that gluten sensitivity is linked to celiac disease, and that one symptom of celiac disease is weight loss. This is often correct. Because of malabsorption of nutrients caused by their irritable gut, celiac patients tend to be thin. We were puzzled because about half the people we saw, who had been previously diagnosed with “celiac disease”, were overweight. So were about 60% of patients presenting with fibromyalgia.
So we began to routinely to run an antibody test on all patients presenting with fibromyalgia or “celiac disease”, called the anti-transglutaminase test. A positive score on this test is considered a strong marker of celiac disease. Surprisingly, most of the overweight patients presenting either with fibromyalgia or “celiac disease”, had a negative test result, meaning that they were very unlikely to have celiac disease.
So, were their often debilitating symptoms simply gluten sensitivity? Removing gluten from their food constituted a fairly simple treatment that certainly could do no harm. It was very successful. Simple removal of most of the gluten from their diets reduced symptoms dramatically in most patients. The improvement has now continued in some we have tracked for up to 8 years. Some also gradually lost considerable body fat without reducing their food intake, though that was not a major aim of the treatment.
These cases convinced us that gluten sensitivity can cause almost all the symptoms of celiac disease in folk who do not have it. Except, most of those we saw were overweight, not a marker of celiac. But, even though other researchers had reached similar conclusions (1), there was no controlled evidence either way. Now we have some. The first controlled trial was published last November (2). Gluten sensitivity without celiac disease, can cause fibromyalgia, and removal of gluten from the diet is a potent strategy to treat it.
Here is the Mayo Clinic Gluten-Free Diet we use.
Beans, seeds and nuts in their natural, unprocessed form
Fresh meats, fish and poultry (not breaded, batter-coated or marinated)
Fruits and vegetables
Most dairy products
It's important to make sure that they are not processed or mixed with gluten-containing grains, additives or preservatives. Many grains and starches can be part of a gluten-free diet, such as:
Corn and cornmeal
Gluten-free flours (rice, soy, corn, potato, bean)
FOODS TO AVOID
Avoid all food and drinks containing:
Barley (malt, malt flavoring and malt vinegar are usually made from barley)
Triticale (a cross between wheat and rye)
Avoiding wheat can be challenging because wheat products go by numerous names. Consider the many types of wheat flour on supermarket shelves — bromated, enriched, phosphated, plain and self-rising. Here are other wheat products to avoid:
Avoid unless labeled 'gluten-free'
In general, avoid the following foods unless they're labeled as gluten-free or made with corn, rice, soy or other gluten-free grain:
Cakes and pies
Cookies and crackers
Imitation meat or seafood
Processed luncheon meats
Sauces, including soy sauce
Seasoned rice mixes
Seasoned snack foods, such as potato and tortilla chips
Soups and soup bases
Vegetables in sauce
Certain grains, such as oats, can be contaminated with wheat during growing and processing stages of production. For this reason, doctors and dietitians generally recommend avoiding oats unless they are specifically labeled gluten-free.
Food additives, such as malt flavoring, modified food starch and others.
Sapone A, Bai JC, Ciacci C, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012;7(10):13. doi: 10.1186/1741-7015-10-13.
Isasi C, et al. Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. Rheumatol Int. 2014 Nov;34(11):1607-12. doi: 10.1007/s00296-014-2990-6.