Diet is without doubt, if not a causal effect, at least a contributing one to a whole raft of diseases. Remember the acronym: GIGO, garbage in=garbage out. The following is an excerpt from a study, which demonstrated an improvement in fibromyalgia syndrome, in subjects who followed a mostly raw vegetarian diet.
Fibromyalgia syndrome improved using a mostly raw vegetarian diet: An observational study
Michael S Donaldson1 email, Neal Speight2 email and Stephen Loomis3 email
1Hallelujah Acres Foundation, Shelby, NC USA
2Center for Wellness, Charlotte, NC USA
3Cleveland Physical Therapy Associates, Shelby, NC USA
BMC Complementary and Alternative Medicine 2001, 1:7doi:10.1186/1472-6882-1-7
Discussion
The connection between dietary and lifestyle habits with chronic diseases has become increasingly strong in the past several years. Most of the research has been towards the prevention of chronic disease rather than toward its treatment.
The natural course of fibromyalgia shows that symptoms are generally the same over at least 7 years [3]. A stable, sharp reduction in symptoms in seven months, as we have reported here, is a definite alteration of the natural history of fibromyalgia.
Group treatment of fibromyalgia patients using a multi-faceted approach resulted in a 25% improvement in overall FIQ score and a 5.2 cm increase in sit and reach flexibility . This study resulted in even greater improvements with a 46% improvement in overall FIQ score and a 6.1 cm increase in sit-and-reach flexibility. A six-week exercise and education program produced a total drop in 8 FIQ subscales of 2.4 points ; these same subscales in this study decreased by 23.9 points after the dietary intervention reported here. This comparison shows that education and exercise are not as an effective intervention as this dietary intervention.
As mentioned, vegetarian dietary intervention of fibromyalgia has been tested by two investigators. In a small study of 10 patients, Hostmark et al found a 3-week vegetarian diet produced an improvement in subjective well-being. Increase in well-being, as seen in the improvement in quality of life, FIQ, and SF-36 scores, was also seen in our study. In a recent study Kaartinen et al used a strict “living-foods” pure vegetarian diet in 3-month non-randomized, controlled study of FMS. Investigators saw significant improvements in pain scores and significantly less morning stiffness, similar to our results. Apparently the diet was difficult to implement and no subjects continued with the “living-foods” diet. Symptoms returned upon reverting back to a more standard diet, showing even more clearly the association of diet and FMS. Maintenance of diets requiring more food preparation time and uncommon foods is difficult. Since the diet used here is mainly based on common foods the long-term adherence to the program is likely to be higher. Subjects learned which foods caused them the most symptoms so that they avoided these foods on a long-term basis.
Initial scores using the SF-36 health survey, compared to population norms, were very similar to those reported elsewhere . This indicates that our fibromyalgia subjects were very similar to other surveyed groups in terms of their health status. Initial FIQ scores are also in line with other studies . After 7 months, the 19 subjects that responded to the diet were no longer statistically different from the general population of women aged 45–54, except for bodily pain. This indicates a remarkable recovery of function in a short period of time.
Self-reported pain was significantly reduced as measured by the FIQ and by the physical performance measurements, but not as measured by the SF-36 questionnaire. Both the FIQ and physical performance measure used a visual analog scale from 0–10 to measure pain, whereas the SF-36 only used 2 questions with a total range of 10 points to measure bodily pain. This may have made the SF-36 a less sensitive measure of bodily pain than the other two measures.
It was unclear whether or not closer adherence to the diet by the non-responders would have resulted in better success. Without rapid improvements a few subjects lost motivation and adhered less to the diet, while others saw positive results within a couple of weeks, thus encouraging them to continue faithfully. The basis for not responding to the diet may have been physiological rather than motivational. Further research will help answer this question.
What caused the significant improvements seen in this intervention study? There is likely a synergy of both physiological and psychological factors. The change in diet gave the subjects motivation to take control of their symptoms, to overcome their disabilities and inactivity. People that believed that a change in their diet would improve their symptoms were attracted to this study. The effect of expecting a positive result was not measured, but it certainly was beneficial to the subjects.
Some aspects of the new diet also improve fatigue and sleep patterns, so that overwhelming fatigue did not squelch subjects’ newfound motivation. Subjects could begin an upward cycle out of their FMS symptoms, rather continuing the downward trend toward further disability, chronic pain, and depression.
Intakes of fats, protein, fiber, several vitamins, including the antioxidants vitamin C, vitamin E, and beta-carotene, and minerals (especially magnesium, potassium, and zinc) are significantly different from the general population’s dietary intake , so it is difficult to single out which factors were most important in producing the dramatic improvements seen in this study. The improvement is likely the synergistic result of several factors. It is unlikely that a single factor or a dietary supplement will be able to reproduce the results generated by an overall dietary change.
Though the FFQ used in this study has not been validated rigorously, a comparison to 7-day semi-quantitative dietary intake of people following the same Hallelujah Diet showed that, on an energy basis, the only significant differences between nutrient intakes reported here and in that survey were for fiber and vitamin A. So, it appears that the FFQ captured nutrient intakes satisfactorily.
Our study had several limitations. First, because all of the subjects did not currently meet the diagnosis criteria of FMS, the results cannot be compared directly with other studies. It’s possible, but cannot be proven here, that greater improvement would have been seen with people who were experiencing more pain. It’s also possible that subjects with less severe pain were able to improve quicker. Equal percentages of subjects with more than 11 painful tender points were found among responders and non-responders.
Second, as an unblinded observational study there was no direct comparison with a control group. Many historical controls were available and the natural, chronic course of FMS is well described. However, the results would certainly be stronger if an active control group was included. Another limitation was the size of the treatment group. Though the subjects here seemed to be representative of people with FMS, it is not certain that the same results would be seen in a large study. These results should be reproduced and extended in a larger, controlled trial.
Conclusions
In summary, a diet intervention using a mostly raw, pure vegetarian diet produced dramatic improvements in FMS symptoms. 19 of 30 participants responded very favorably to the intervention, seeing marked improvement in all FMS symptoms. This dietary intervention shows that many fibromyalgia subjects can be helped even without understanding the full cause of their symptoms. Further controlled studies are needed to reproduce and extend the results obtained here to see if this dietary intervention is a viable adjunctive therapy for managing fibromyalgia in a clinical setting.
