Fibromyalgia: What is the right diet? [Evidence-based dietary advice]

Are you affected by fibromyalgia and wondering what is the right diet for you? Research studies have shown that many people with fibromyalgia can have a very positive effect from eating the right diet adapted to them.

Here it is important to state early on that this article is based on a large overview study published in the research journal Pain management.¹ This study has definitely stood the test of time as of 2024, and was based on 29 articles that reviewed how diet and food can affect symptoms and pain in fibromyalgia. This is therefore the strongest form of research. Based on this, this article will attempt to review the recommended diet and nutrition for patients with fibromyalgia. In addition, we also go into some detail about what kind of food and ingredients you should avoid - for example those that are pro-inflammatory (inflammation-causing).

"With diet, it is important to keep your tongue straight in your mouth. Because here there are large individual differences. Some people can have a good effect from something - which others have no effect from. Therefore, it is important that you also map out yourself what works best for you."

Research Report: The Best Fibromyalgia Diet?

As is known Fibromyalgia a chronic pain diagnosis that causes significant pain in the muscles and skeleton - as well as poorer sleep and often impaired cognitive function (for example, memory and fibrous mist).

Unfortunately, there is no cure, but by making use of the research, you can become wiser about what can alleviate the diagnosis and its symptoms. What you eat and diet play a central role in suppressing inflammatory reactions in the body and in lowering pain sensitivity in painful muscle fibres.

- Learn to listen to your body to avoid triggers

Many people with fibromyalgia know how important it is to listen to the body to avoid pain peaks and "flare ups" (episodes with significantly more symptoms).

Therefore, many people are also very concerned about their diet, because they know that the right diet can reduce pain in fibromyalgia, but they also know that the wrong type of food can lead to worsening.

- We want to reduce low-grade inflammation

Very briefly, it means that you want to avoid pro-inflammatory food (inflammation-causing) and rather try to eat more anti-inflammatory food (anti-inflammatory). Especially considering that the research has also documented increased inflammatory reactions in the brain in a number of patients with fibromyalgia. This review study (Holton et al) published in Pain management concluded that deficiencies in a number of nutrients could lead to a higher incidence of symptoms and that the right diet could help reduce both pain and symptoms. See link to the study at the bottom of the article.

- In the old days, fibromyalgia was thought to be a mental illness (!)

Many years ago, doctors believed that fibromyalgia was exclusively a mental illness. Provocative, right? It wasn't until 1981 that the first study confirmed what were symptoms of fibromyalgia and in 1991 the America College of Rheumatology wrote guidelines to help diagnose fibromyalgia.

- Fortunately, research is moving forward

Research and clinical studies are constantly making progress and we can now partially alleviate fibromyalgia in many ways. Among other things, research is being carried out on biochemical markers that may indicate fibromyalgia (Also read: These two proteins can indicate fibromyalgia). A combination of self-measures, treatments and the right diet play key roles. Now we are going to take a closer look at what those with fibromyalgia should include in their diet and what kind of food they should stay away from. We start with the food that one should eat.

"Again, we remind you that these are not our personal opinions or the like, but directly based on the large overview study by Holton et al"

- Food you should eat if you have fibromyalgia

In this part of the article, we will divide food and ingredients into different categories. Next, we will look at low-FODMAP and high-FODMAP within these categories. The categories are as follows:

• Vegetables

• Fruit and berries

• Nuts and seeds

• Dairy products and cheese

• DRINKS

Vegetables (low-footmap versus high-footmap)

Conditions such as irritable bowel syndrome, indigestion and autoimmune diagnoses are common among those diagnosed with fibromyalgia. Some of the best researchers in the field agree that foods with an appropriate number of calories and moderate fiber content that also contain high levels of antioxidants and phytochemicals (health-promoting plant nutrients).

- Natural food is an important cornerstone in the diet

We find significant amounts of these in vegetables and fruit - and that is why it is recommended that such natural food should be an essential part of the diet of those with fibromyalgia. Those who are sensitive should try a low-footprint approach to exclude any vegetables and fruits they cannot tolerate. A natural anti-inflammatory diet can provide many health benefits.

What are FODMAPs?

FODMAP is actually an English word that became particularly well known when the FODMAP diet was launched by Peter Gibson and Sue Shepard in 2005. It is an acronym where each letter stands for different sugars in food. These involve:

• Fermentable oligosaccharides

• Disaccharides

• Monosaccharides

• Polyols (sorbitol, mannitol, xylitol, maltitol)

What these have in common is that it is difficult for the body to absorb these in the small intestine, and that they are therefore rather broken down in the large intestine in a fermentation process (which can be demanding on the intestinal system). The above sugars include fructose, lactose, fructans and galactans.

Low-FODMAP versus high-FODMAP

With the knowledge of what we have just learned, we then understand that low-FODMAP involves a diet with a reduced intake of complex sugars and carbohydrates that are difficult for the intestinal system to digest.

Low-FODMAP: Examples of good vegetables

• Cucumber

• Aubergine

• Baby corn

• Cauliflower (in a boiled state)

• Broccoli beans

• broccoli (but not the stem)

• Chile

• carrots

• Green beans

• Green lentils

• Kale

• Ginger

• Chinese cabbage

• Rutabaga

• Paprika (red)

• parsnip

• Parsley

• Potato

• Leek (not the stem)

• Radish

• Brussels sprouts

• Ruccola salad

• Beetroot

• Red lenses

• salad

• Celery root

• Lemongrass

• Mushrooms (champignons, canned version)

• spinach

• Sprouts (alfalfa)

• Squash

• Tomato

All low-FODMAP vegetables are considered safe and good for those with fibromyalgia and irritable bowel syndrome. Send us a comment if you have any input.

High-FODMAP: Examples of vegetables that are not beneficial

• Asparagus

• artichoke

• Avocado (medium FODMAP)

• Cauliflower (raw)

• Broccoli stalk

• Beans

• Peas (green)

• fennel

• Jerusalem artichoke

• chickpeas

• Cabbage (savoy)

• Onion

• Corn (medium FODMAP)

• Leek (stem)

• Beetroot (medium-FODMAP at over 32 grams)

• Mushroom

• Sugar snap peas (medium FODMAP)

• Shallots

• sweet potato

• Spring onions

These are examples of vegetables that have a higher content of the aforementioned sugars and heavy carbohydrates (high-FODMAP). This means that, among other things, they can cause indigestion and irritate the intestine. Patients with fibromyalgia should therefore try to reduce their intake.

Fruit and berries

In this part of the article, we go through which types of fruit and berries are good for those with fibromyalgia (low-FODMAP) - and which it is recommended to cut out or have a reduced intake of (high-FODMAP).

We have divided it into two categories. First we go through fruit and then berries.

Low-FODMAP: Easily digestible fruit

• Pineapple

• Orange

• Dragon fruit

• Drue

• Galia

• cantaloupe

• Cantaloupe melon

• Kiwi

• clementine

• Lime

• Mandarin

• passionfruit

• Papaya

• Rhubarb

• Lemon

• Star fruit

Important to note that those with fibromyalgia seem to have a better tolerance to unripe bananas compared to more ripe bananas.

High-FODMAP: Fruit with a high content of unwanted sugars and heavy carbohydrates

• Apricot

• banana

• Apple (medium FODMAP)

• Peach

• The fig

• Mango (medium FODMAP)

• nectarines

• plums

• Pear

• Lemon

• Dried fruit (including raisins and prunes)

• Watermelon

A gradual survey is often the best when trying to find out which type of food and ingredients you react to the most.

Low-FODMAP: Berries that are best for people with fibromyalgia and irritable bowel syndrome

• Blueberry (blue core)

• Raspberries (medium-FODMAP)

• Strawberry

• Cranberries (medium FODMAP)

• Lingonberry

High-FODMAP: Berries that are difficult to digest

• Blackberry

• Cherry

• Morels

• Currant

Nuts and seeds

Nuts and seeds contain many good nutrients. Adding nuts and seeds to your diet can have major health benefits. The vast majority fall under low-FODMAP, but there are two types you should avoid that end up in high-FODMAP.

Low-FODMAP: Nutrient-rich nuts and seeds that are easy to digest

• Chia seeds

• Pumpkin seeds

• Hazelnuts (medium FODMAP)

• Linseed

• Macadamia nuts

• Almonds (medium FODMAP)

• Peanuts

• Pecans

• Pine nuts

• Sesame seeds

• Sunflower seeds

• poppy seed

• walnuts

High-FODMAP: Two nuts you should steer clear of

• cashews

• Pistachios

As you can see, you can safely eat the vast majority of nuts and seeds.

Dairy products, cheese and alternatives

Many people are surprised when they hear that there are a number of dairy products and cheeses that are categorized as low-FODMAP. At the same time, there are also a good number of dairy products that are high-FODMAP.

Low-FODMAP: Certain types of milk, dairy products and cheese

• Blue mold cheese

• Brie

• Camembert

• cheddar

• feta

• White cheese

• Kavli spread cheeses

• Manchego

• Margarine

• Dairy butter

• Mozzarella

• Lactose-free/reduced cream

• Lactose-free/reduced ice cream

• Lactose-free/reduced cottage cheese

• Lactose-free/reduced cream

• Lactose-free/reduced milk

• Lactose-free/reduced sour cream

• Lactose-free/reduced yogurt

• Parmesan cheese

• Table cheese

• ricotta cheese

• Swiss cheese

Medium-FODMAP: Milk alternatives

• Oat milk

• Coconut milk

• Almond milk

• Rice milk

High-FODMAP: Milk, cheese and alternatives

• Brown cheese

• Cream

• Ice cream

• Kefir

• Kesam

• Spicy cheese

• Milk from mammals

• prime

• Sour cream

• Soy milk

• Vanilla sauce

• yoghurt

DRINKS

Many people are relieved to hear that black coffee (without milk), wine (both white and red), as well as beer, actually fall into the low-FODMAP category. But then there was the thing about alcohol being pro-inflammatory then. Okay, let's postpone exactly that until later in the article.

Low-FODMAP: These beverages are easier to digest

• Farris

• Cocoa (without milk or with lactose-free milk)

• Lactose-free milk

• Powdered coffee

• Juice from low-FODMAP berries and fruit

• Juice (light)

• Black coffee (without milk or with lactose-free milk)

• Tea (chai, green, white, peppermint and rooibos)

• tomato Juice

• Cranberry juice

• Wine (both white and red)

• Beer

High-FODMAP: Drinks you should avoid

• Soft drink with fruit concentrate

• Cider

• Dessert wine

• Juice from concentrate

• Juice from high-FODMAP fruit and berries

• Coffee with cow's milk

• Cocoa with cow's milk

• Liqueur

• Tropical juice

• Soda

• Strong tea (fennel, chai, chamomile and herbal tea)

- Food rich in omega-3 is important

Omega-3 is an essential fatty acid. This is a nutrient that your body needs to, among other things, fight inflammatory reactions, but which it cannot make on its own. Therefore, you must get omega-3 through the diet you eat.

- The very best sources

Fatty cold-water fish, walnuts, flaxseed and tofu are considered the best sources of omega-3. Mackerel has the highest content of omega-3, so for example eating mackerel in tomato on bread (preferably yeast-free) can be a good idea to cover this need. Salmon, trout, herring and sardines are other very good sources of omega-3.

Examples of foods high in omega-3 for people with fibromyalgia:

• Avocado (medium FODMAP)

• Cauliflower (low-FODMAP)

• Blueberries (low-FODMAP)

• Raspberries (medium-FODMAP)

• Broccoli (low-FODMAP)

• Broccoli sprouts (low-FODMAP)

• Beans (low-FODMAP)

• Chia seeds (low-FODMAP)

• Fish caviar (low-FODMAP)

• vegetable Oil

• Salmon (low-FODMAP)

• Flaxseed (low-FODMAP)

• Mackerel (low-FODMAP)

• Brussel sprouts (low-FODMAP)

• Sardines (low-FODMAP)

• Herring (low-FODmap)

• Spinach (low-FODMAP)

• Cod (low-FODMAP)

• Tuna (low-FODMAP)

• Walnuts (low-FODMAP)

• Trout (low-FODMAP)

High content of lean proteins

Fatigue, reduced energy levels and fatigue are common symptoms among those affected by fibromyalgia. Therefore, it is very important to limit the intake of carbohydrates and increase the proportion of protein in the diet.

- Proteins regulate blood sugar

The reason why you want to eat food with a lot of lean protein if you have fibromyalgia is that this helps the body to regulate blood sugar and keep it steady throughout the day. As is known, uneven blood sugar can lead to more fatigue and a strong desire for sugary foods.

Examples of food with a high content of lean protein

• Bean sprouts (low-FODMAP)

• Cashews (high-FODMAP)

• Cottage cheese (though made from skimmed milk, so if you react to dairy products you should steer clear)

• Eggs (low-FODMAP)

• Peas (high-FODMAP)

• Fish (low-FODMAP)

• Greek yogurt (lactose-free is low-FODMAP)

• Lean meat (low-FODMAP)

• Turkey (low-FODMAP)

• Chicken (low-FODMAP)

• Salmon (low-FODMAP)

• Lentils (low-FODMAP)

• Almonds (medium FODMAP)

• Quinoa (low-FODMAP)

• Sardines (low-FODMAP)

• Low fat soy milk

• Tofu (high-FODMAP)

• Tuna (low-FODMAP)

Some recommended light meals based on what we have learned so far

Based on the knowledge we have learned so far, we have some suggestions for some light meals you can try to get into during the day.

Avocado with berry smoothie

As mentioned, avocados contain healthy fats that provide the right energy for those affected by fibromyalgia. They also contain vitamin E, which can help with muscle pain, as well as vitamins B, C and K - together with the important minerals iron and manganese. Therefore, we recommend that you try a smoothie consisting of avocado in combination with berries full of antioxidants. Avocado is rated as medium-FODMAP, but due to the content of nutrients it is still recommended. You can read more about the health benefits of eating avocados here .

Salmon with walnuts and broccoli

Fish for dinner. We strongly recommend that you eat fatty fish, preferably salmon, at least 3 times a week if you are affected by fibromyalgia. We are of the opinion that you should actually try to eat it up to 4-5 times a week if you have this chronic pain diagnosis.

- The Norwegian salmon has a lot of lean protein

Salmon contains high levels of anti-inflammatory omega-3, as well as lean protein that provides the right kind of energy. Feel free to combine it with broccoli, which is full of antioxidants, and walnuts on top. Both healthy and incredibly good.

Lemon juice with chia seeds

Another good suggestion in the fibromyalgia diet. Lemon juice contains vitamins and minerals that can act as anti-inflammatory and therefore pain-reducing. Chia seeds contain high levels of protein, fibre, omega-3 and minerals, making the latter among the best forms of nutrition you can get.

Food that should be avoided if you have fibromyalgia

Sugar

Sugar is pro-inflammatory - which means that it promotes and creates inflammatory reactions. Thus, having a high sugar intake is just not the smartest thing to do when you have fibromyalgia. In addition, it is the case that high sugar content often leads to weight gain, which in turn can put more strain on the body's joints and muscles. Here are some examples of foods and beverages with surprisingly high sugar content:

• cereals

• vitamin Water

• Brus

• Frozen pizza

• Ketchup

• BBQ sauce

• Done Soups

• Dried fruit

• Bread

• Cakes, cookies and cookies

• Bagels and churros

• Ice tea

• Sauce on can

Alcohol

Many people with fibromyalgia report worsening symptoms when they drink alcohol. It is also the case that a number of anti-inflammatory and analgesic drugs do not react particularly well with alcohol - and that one can thus have side reactions or reduced effect. Alcohol also contains a high level of calories and often sugar - which thus helps to give more inflammatory reactions and pain sensitivity in the body.

Food with a high content of heavy carbohydrates

Cookies, cookies, white rice and white bread can cause blood sugar levels to skyrocket and then rage. Such uneven levels can lead to fatigue and worsening pain levels for those with fibromyalgia. Over time, such unevenness can cause damage to the insulin receptors and the body's difficulty in controlling blood sugar and thus energy levels.

Be aware of these carbohydrate bombs:

• Brus

• French fries

• Muffins

• Cranberry sauce

• Father

• smoothie

• Dates

• Pizza

• energy Bars

• Candy and sweets

Unhealthy fat and deep fried foods

When you fry oil, it creates inflammatory properties - which thus also applies to fried food. Studies have shown that such foods (such as french fries, chicken nuggets and spring rolls) can aggravate the symptoms of fibromyalgia. This also applies to processed foods, such as donuts, many types of biscuits and pizza.

But what about gluten?

You're absolutely right. One of the weaknesses of FODMAP is that it does not address gluten. But it is well documented that many people with fibromyalgia react negatively to gluten. You can read more about that here .

Other dietary advice for those with fibromyalgia

Vegetarian diet for fibromyalgia

A number of research studies (including Clinton et al., 2015 and Kaartinen et al., 2001) have shown that eating a vegetarian diet, which contains a high natural content of antioxidants, can help reduce fibromyalgia pain, as well as symptoms due to osteoarthritis.

- Not always as easy to deal with

The vegan diet is not for everyone and can be difficult to stick to, but trying to include a high content of vegetables in the diet is highly recommended anyway. This will also help you to reduce your intake of calories and thus unnecessary weight gain. Due to the pain associated with fibromyalgia, it often becomes very difficult to move, and thus the extra kilos come. Working actively with weight reduction, if desired, can result in major health benefits and positive results - such as less pain in everyday life, better sleep and less depression.

Drink plenty of good Norwegian water

In Norway, we have perhaps the world's best water straight from the tap. A good piece of advice that nutritionists often give to those with proven fibromyalgia or other chronic pain diagnoses is to drink a lot of water and make sure you stay hydrated throughout the day. It is the case that a lack of hydration can hit those with fibromyalgia extra hard due to the fact that energy levels are often lower than in others.

- We are all different

Living with fibromyalgia is about making adjustments – just like those around you have to pay attention to you (which we talk about in the article we've linked to below). The right diet can work well for some, but not be as effective for others - we are all different, even if we have the same diagnosis. It is also important to remember that progress is constantly being made within research on fibromyalgia and bowel.

Also read: 7 tips to persevere with fibromyalgia

More information? Join this group!

Feel free to join the Facebook group «Rheumatism and Chronic Pain - Norway: Research and news"(Press here) for the latest updates on research and publications on chronic disorders. Here, members can also get help and support - at all times of the day - through the exchange of their own experiences and advice.

Sources and research

1. Holton et al, 2016. The role of diet in the treatment of fibromyalgia. Pain Management. Volume 6.

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Article: What is the right diet for people with fibromyalgia?

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