FİBROMİYALJİDE BESLENME YAKLAŞIMLARININ DEĞERLENDİRİLMESİ

Yıl 2025, Cilt: 5 Sayı: 3, 326 - 341, 30.09.2025

Nisa Nur Ayhanci , Zeynep Parlak Özer

https://doi.org/10.52369/togusagbilderg.1595349

Öz

Fibromiyalji, yaygın kronik ağrı ve yorgunluk ve çeşitli somatik ve psikolojik belirtiler ile karakterize edilen karmaşık, çok faktörlü bir sendromdur. Fibromiyaljinin etiyolojisi ve patofizyolojisi hala belirsizdir. Fibromiyaljinin yönetimi, farmakolojik ve farmakolojik olmayan stratejileri birleştiren multidisipliner bir yaklaşımı gerektirir. Kanıtlar, düşük dereceli sistemik inflamasyonun, baskın prooksidatif durumun ve yetersiz antioksidan kapasitenin hastalığın gelişimine katkıda bulunabileceğini göstermektedir. Bu bilgi beslenmenin Fibromiyalji yönetiminde potansiyel yararlı etkileri olabileceği fikrini gündeme getirmiştir. Bu derlemede Fibromiyalji ile bireyin beslenme durumu, beslenme alışkanlıkları, diyet örüntüsü ve beden kütle indeksi arasındaki çeşitli ilişkiler tartışılmaktadır. Kanıtlar uygun vücut bileşimine sahip olmanın, yüksek antioksidan ve anti-inflamatuar beslenme modelinin, serum eser element ve antioksidan vitaminlerin optimal düzeyde olmasının, gıda katkı maddelerinin minimum düzeyde tüketildiği beslenme modelinin Fibromiyalji patofizyolojisi ve/veya klinik belirtilerinde olumlu rol oynayabileceğini göstermektedir.

Anahtar Kelimeler

fibromiyalji , beslenme durumu , besin takviyesi , modifiye diyetler

Kaynakça

• Bellato E, Marini E, Castoldi F, Barbasetti N, Mattei L, Bonasia DE, et al. Fibromyalgia syndrome: etiology, pathogenesis, diagnosis, and treatment. Pain Res Treat. 2012;2012(1):426130.
• Pagliai G, Giangrandi I, Dinu M, Sofi F, Colombini B. Nutritional interventions in the management of fibromyalgia syndrome. Nutrients. 2020;12(9):2525.
• Wolfe F, Clauw DJ, Fitzcharles M-A, Goldenberg DL, Häuser W, Katz RL, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. In: Seminars in arthritis and rheumatism. Elsevier; 2016. p. 319–29.
• Clauw DJ. Fibromyalgia: a clinical review. Jama. 2014;311(15):1547–55.
• Jones GT, Atzeni F, Beasley M, Flüß E, Sarzi‐Puttini P, Macfarlane GJ. The prevalence of fibromyalgia in the general population: a comparison of the American College of Rheumatology 1990, 2010, and modified 2010 classification criteria. Arthritis Rheumatol. 2015;67(2):568–75.
• Borchers AT, Gershwin ME. Fibromyalgia: a critical and comprehensive review. Clin Rev Allergy Immunol. 2015;49:100–51.
• Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 2016;338:114–29.
• García JJ, Carvajal-Gil J, Herrero-Olea A, Gómez-Galán R. Altered inflammatory mediators in fibromyalgia. Rheumatology. 2017;7:215–25.
• Assavarittirong C, Samborski W, Grygiel-Górniak B. Oxidative stress in fibromyalgia: from pathology to treatment. Oxid Med Cell Longev. 2022;2022(1):1582432.
• Tomaino L, Serra-Majem L, Martini S, Ingenito MR, Rossi P, La Vecchia C, et al. Fibromyalgia and nutrition: an updated review. J Am Coll Nutr. 2021;40(7):665–78.
• Organization WH. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. World Health Organization; 2013.
• Elma Ö, Yilmaz ST, Deliens T, Coppieters I, Clarys P, Nijs J, et al. Do nutritional factors interact with chronic musculoskeletal pain? A systematic review. J Clin Med. 2020;9(3):702.
• Boros S. The role of nutrition in the treatment of chronic musculoskeletal diseases. Nutr J. 2013;12(146):10–15226.
• Speciani AF, Piuri G. Measuring biomarkers for an innovative personal food profile. J Am Coll Nutr. 2015;34(sup1):34–8.
• Casini I, Ladisa V, Clemente L, Delussi M, Rostanzo E, Peparini S, et al. A personalized Mediterranean diet improves pain and quality of life in patients with fibromyalgia. Pain Ther. 2024;13(3):609–20.
• Maddox EK, Massoni SC, Hoffart CM, Takata Y. Dietary effects on pain symptoms in patients with fibromyalgia syndrome: systematic review and future directions. Nutrients. 2023;15(3):716.
• Arranz L-I, Canela M-Á, Rafecas M. Dietary aspects in fibromyalgia patients: results of a survey on food awareness, allergies, and nutritional supplementation. Rheumatol Int. 2012;32:2615–21.
• Arranz L-I, Canela M-Á, Rafecas M. Fibromyalgia and nutrition, what do we know? Rheumatol Int. 2010;30:1417–27.
• Mader R, Koton Y, Buskila D, Herer P, Elias M. Serum iron and iron stores in non-anemic patients with fibromyalgia. Clin Rheumatol. 2012 Apr;31(4):595–9.
• Abeles AM, Pillinger MH, Solitar BM, Abeles M. Narrative review: the pathophysiology of fibromyalgia. Ann Intern Med. 2007;146(10):726–34.
• Günther K. Biochemistry of Iron. In: Diet for Iron Deficiency: Metabolism-Bioavailability-Diagnostics. Springer; 2023. p. 7–27.
• Ortancil O, Sanli A, Eryuksel R, Basaran A, Ankarali H. Association between serum ferritin level and fibromyalgia syndrome. Eur J Clin Nutr. 2010;64(3):308–12.
• Hsiao M-Y, Chen-Yu H, Chang K-V, Der-Sheng H, Wang T-G. Is serum hypovitaminosis D associated with chronic widespread pain including fibromyalgia? A meta-analysis of observational studies. Pain Physician. 2015;18(5):E877.
• Kasapoğlu Aksoy M, Altan L, Ökmen Metin B. The relationship between balance and vitamin 25 (OH) D in fibromyalgia patients. Mod Rheumatol. 2017;27(5):868–74.
• Okyay R, Kocyigit B, Gursoy S. Vitamin D levels in women with fibromyalgia and relationship between pain, tender point count and disease activity. Acta Med Mediterr. 2016;32:243–7.
• Wepner F, Scheuer R, Schuetz-Wieser B, Machacek P, Pieler-Bruha E, Cross HS, et al. Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. PAIN®. 2014;155(2):261–8.
• Sakarya ST, Akyol Y, Bedir A, Canturk F. The relationship between serum antioxidant vitamins, magnesium levels, and clinical parameters in patients with primary fibromyalgia syndrome. Clin Rheumatol. 2011;30:1039–43.
• Sendur OF, Tastaban E, Turan Y, Ulman C. The relationship between serum trace element levels and clinical parameters in patients with fibromyalgia. Rheumatol Int. 2008;28:1117–21.
• Andretta A, Batista ED, Schieferdecker MEM, Petterle RR, Boguszewski CL, Paiva E dos S. Relation between magnesium and calcium and parameters of pain, quality of life and depression in women with fibromyalgia. Adv Rheumatol. 2019;59.
• Bagis S, Karabiber M, As I, Tamer L, Erdogan C, Atalay A. Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia? Rheumatol Int. 2013;33:167–72.
• Brouwers FM, Van Der Werf S, Bleijenberg G, Van Der Zee L, Van Der Meer JWM. The effect of a polynutrient supplement on fatigue and physical activity of patients with chronic fatigue syndrome: a double‐blind randomized controlled trial. Qjm. 2002;95(10):677–83.
• Nazıroğlu M, Akkuş S, Soyupek F, Yalman K, Çelik Ö, Eriş S, et al. Vitamins C and E treatment combined with exercise modulates oxidative stress markers in blood of patients with fibromyalgia: a controlled clinical pilot study. Stress. 2010;13(6):498–505.
• Witham MD, Adams F, McSwiggan S, Kennedy G, Kabir G, Belch JJF, et al. Effect of intermittent vitamin D3 on vascular function and symptoms in chronic fatigue syndrome–a randomised controlled trial. Nutr Metab Cardiovasc Dis. 2015;25(3):287–94.
• Joustra ML, Minovic I, Janssens KAM, Bakker SJL, Rosmalen JGM. Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis. PLoS One. 2017;12(4):e0176631.
• Cordero MD, Alcocer-Gómez E, de Miguel M, Culic O, Carrión AM, Alvarez-Suarez JM, et al. Can coenzyme q10 improve clinical and molecular parameters in fibromyalgia? Mary Ann Liebert, Inc. 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA; 2013.
• Cordero MD, Cotán D, del-Pozo-Martín Y, Carrión AM, de Miguel M, Bullón P, et al. Oral coenzyme Q10 supplementation improves clinical symptoms and recovers pathologic alterations in blood mononuclear cells in a fibromyalgia patient. Nutrition. 2012;28(11–12):1200–3.
• Miyamae T, Seki M, Naga T, Uchino S, Asazuma H, Yoshida T, et al. Increased oxidative stress and coenzyme Q10 deficiency in juvenile fibromyalgia: amelioration of hypercholesterolemia and fatigue by ubiquinol-10 supplementation. Redox Rep. 2013;18(1):12–9.
• Alves CRR, Santiago BM, Lima FR, Otaduy MCG, Calich AL, Tritto ACC, et al. Creatine supplementation in fibromyalgia: a randomized, double‐blind, placebo‐controlled trial. Arthritis Care Res (Hoboken). 2013;65(9):1449–59.
• de Araújo TA, Mota MC, Crispim CA. Obesity and sleepiness in women with fibromyalgia. Rheumatol Int. 2015;35:281–7.
• Bond DS, Roth J, Nash JM, Wing RR. Migraine and obesity: epidemiology, possible mechanisms and the potential role of weight loss treatment. Obes Rev. 2011;12(5):e362–71.
• Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res. 2015;399–408.
• D’Onghia M, Ciaffi J, Lisi L, Mancarella L, Ricci S, Stefanelli N, et al. Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis. In: Seminars in Arthritis and Rheumatism. Elsevier; 2021. p. 409–24.
• Kawasaki Y, Zhang L, Cheng J-K, Ji R-R. Cytokine mechanisms of central sensitization: distinct and overlapping role of interleukin-1β, interleukin-6, and tumor necrosis factor-α in regulating synaptic and neuronal activity in the superficial spinal cord. J Neurosci. 2008;28(20):5189–94.
• Okifuji A, Bradshaw DH, Olson C. Evaluating obesity in fibromyalgia: neuroendocrine biomarkers, symptoms, and functions. Clin Rheumatol. 2009;28:475–8.
• Neumann L, Lerner E, Glazer Y, Bolotin A, Shefer A, Buskila D. A cross-sectional study of the relationship between body mass index and clinical characteristics, tenderness measures, quality of life, and physical functioning in fibromyalgia patients. Clin Rheumatol. 2008;27:1543–7.
• Senna MK, Sallam RA-ER, Ashour HS, Elarman M. Effect of weight reduction on the quality of life in obese patients with fibromyalgia syndrome: a randomized controlled trial. Clin Rheumatol. 2012;31:1591–7.
• Rodrigo L, Blanco I, Bobes J, de Serres FJ. Clinical impact of a gluten-free diet on health-related quality of life in seven fibromyalgia syndrome patients with associated celiac disease. BMC Gastroenterol. 2013;13:1–8.
• Rodrigo L, Blanco I, Bobes J, de Serres FJ. Effect of one year of a gluten-free diet on the clinical evolution of irritable bowel syndrome plus fibromyalgia in patients with associated lymphocytic enteritis: a case-control study. Arthritis Res Ther. 2014;16(4):1–11.
• Slim M, Calandre EP, Garcia-Leiva JM, Rico-Villademoros F, Molina-Barea R, Rodriguez-Lopez CM, et al. The Effects of a gluten-free diet versus a hypocaloric diet among patients with fibromyalgia experiencing gluten sensitivity–like symptoms. J Clin Gastroenterol. 2017;51(6):500–7.
• Martinez-Rodriguez A, Leyva-Vela B, Martinez-Garcia A, Nadal-Nicolas Y. Effects of lacto-vegetarian diet and stabilization core exercises on body composition and pain in women with fibromyalgia: Randomized controlled trial. Nutr Hosp. 2018;35(2):392–9.
• Nadal-Nicolás Y, Miralles-Amorós L, Martínez-Olcina M, Sánchez-Ortega M, Mora J, Martínez-Rodríguez A. Vegetarian and vegan diet in fibromyalgia: a systematic review. Int J Environ Res Public Health. 2021;18(9):4955.
• Bonaccio M, Di Castelnuovo A, De Curtis A, Costanzo S, Persichillo M, Donati MB, et al. Adherence to the Mediterranean diet is associated with lower platelet and leukocyte counts: results from the Moli-sani study. Blood, J Am Soc Hematol. 2014;123(19):3037–44.
• Tsigalou C, Konstantinidis T, Paraschaki A, Stavropoulou E, Voidarou C, Bezirtzoglou E. Mediterranean diet as a tool to combat inflammation and chronic diseases. An overview. Biomedicines. 2020;8(7):201.
• Correa-Rodríguez M, El Mansouri-Yachou J, Tapia-Haro RM, Molina F, Rus A, Rueda-Medina B, et al. Mediterranean diet, body composition, and activity associated with bone health in women with fibromyalgia syndrome. Nurs Res. 2019;68(5):358–64.
• Michalsen A, Riegert M, Lüdtke R, Bäcker M, Langhorst J, Schwickert M, et al. Mediterranean diet or extended fasting’s influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study. BMC Complement Altern Med. 2005;5:1–9.
• Martínez-Rodríguez A, Rubio-Arias JÁ, Ramos-Campo DJ, Reche-García C, Leyva-Vela B, Nadal-Nicolás Y. Psychological and sleep effects of tryptophan and magnesium-enriched mediterranean diet in women with fibromyalgia. Int J Environ Res Public Health. 2020;17(7):2227.
• Hausteiner-Wiehle C, Henningsen P. Irritable bowel syndrome: relations with functional, mental, and somatoform disorders. World J Gastroenterol WJG. 2014;20(20):6024.
• Garofalo C, Cristiani CM, Ilari S, Passacatini LC, Malafoglia V, Viglietto G, et al. Fibromyalgia and irritable bowel syndrome interaction: a possible role for gut microbiota and gut-brain axis. Biomedicines. 2023;11(6):1701.
• Hayes PA, Fraher MH, Quigley EMM. Irritable bowel syndrome: the role of food in pathogenesis and management. Gastroenterol Hepatol (N Y). 2014;10(3):164.
• Bellini M, Tonarelli S, Nagy AG, Pancetti A, Costa F, Ricchiuti A, et al. Low FODMAP diet: evidence, doubts, and hopes. Nutrients. 2020;12(1):148.
• Vasant DH, Paine PA, Black CJ, Houghton LA, Everitt HA, Corsetti M, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021;70(7):1214–40.
• Silva AR, Bernardo A, de Mesquita MF, Vaz-Patto J, Moreira P, Silva ML, et al. An anti-inflammatory and low fermentable oligo, di, and monosaccharides and polyols diet improved patient reported outcomes in fibromyalgia: A randomized controlled trial. Front Nutr. 2022;9:856216.
• Marum AP, Moreira C, Saraiva F, Tomas-Carus P, Sousa-Guerreiro C. A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improve ddaily life in fibromyalgia patients. Scand J pain. 2016;13(1):166–72.
• Marum AP, Moreira C, Tomas-Carus P, Saraiva F, Guerreiro CS. A low fermentable oligo-di-mono-saccharides and polyols (FODMAP) diet is a balanced therapy for fibromyalgia with nutritional and symptomatic benefits. Nutr Hosp. 2017;34(3):667–74.
• Roman‐Ramos R, Almanza‐Perez JC, Garcia‐Macedo R, Blancas‐Flores G, Fortis‐Barrera A, Jasso EI, et al. Monosodium glutamate neonatal intoxication associated with obesity in adult stage is characterized by chronic inflammation and increased mrna expression of peroxisome proliferator‐activated receptors in mice. Basic Clin Pharmacol Toxicol. 2011;108(6):406–13.
• Choudhary AK, Pretorius E. Revisiting the safety of aspartame. Nutr Rev. 2017;75(9):718–30.
• Abdel-Salam OME, Salem NA, Hussein JS. Effect of aspartame on oxidative stress and monoamine neurotransmitter levels in lipopolysaccharide-treated mice. Neurotox Res. 2012;21:245–55.
• Holton KF, Taren DL, Thomson CA, Bennett RM, Jones KD. The effect of dietary glutamate on fibromyalgia and irritable bowel symptoms. Clin Exp Rheumatol. 2012;30(6 Suppl 74):10–7.
• Vellisca MY, Latorre JI. Monosodium glutamate and aspartame in perceived pain in fibromyalgia. Rheumatol Int. 2014;34:1011–3.