An elimination diet for fibromyalgia
In the April 2006 Townsend Letter, along with David Fairbrook, MD, I reviewed the science linking fibromyalgia (FM) to immune injury or hypersensitivity. This sequel is meant to offer practical advice based on clinical experience rather than the literature. Since 1985, we have run over 10,000 patients through elimination diets. In 1999, we noted that FM patients were benefiting the most from these diets, and since then, we have focused exclusively on those patients. Although FM patients have taught us that elimination diets have great potential for treating FM, these patients have a variety of special needs that must be addressed before an elimination diet will help the majority of them. The following considerations should provide 80% or better reduction in patient symptom ratings, on a sustained basis for at least 60% of those patients who complete the three-week regimen.
Patient Selection Criteria
Many FM treatment candidates present on a dozen medications with some prescriptions for the purpose of treating the side effects of other medications. These present a great challenge. FM patients are so hyper-allergic, they often suffer especially severe drug side effects, and their FM symptoms are also triggered by many supplements. By the time they are deep into polypharmacy, drug reactions can block the benefits of allergen elimination, and alternatively, drug withdrawal effects can render them unwilling to continue treatment before they can benefit. On the other hand, successful FM patients usually present on Selective Serotonin Reuptake Inhibitors (SSRIs), narcotics, migraine and GI tract remedies, handfuls of supplements, and other potential FM triggers. They are encouraged to temporarily discontinue any supplements that they don't absolutely need to avoid suffering in the short term and to stay on their medications, slowly discontinuing each one as they experience remission of each symptom set. Patients are warned to avoid narcotic rebound pain and withdrawal by tapering down the dose long after the pain is gone.
SSRI withdrawal is a challenge for clinician and patient alike. We wait until the patient has long stabilized in symptom remission and only attempt the withdrawal after educating and preparing the patient through helpful books and web sites. The "bolts of lightning in the brain" reported by patients trying to gradually taper off SSRI medication (Zoloft comes to mind here, especially) seem to be largely ignored by the literature and pretreatment PCP warnings, but this phenomenon is very real, day to day, as we attempt to help people discontinue these perhaps underestimated medications.
Prednisone has shown the ability to entirely sabotage the benefits of allergen elimination in about 30% of cases. It is a risk factor worth sharing with patients who might elect to try the treatment anyway and, if unsuccessful, come back to the treatment at a later date when they have discontinued prednisone.
Patients with childhood trauma and chaotic lives of anxiety and compulsive smoking, eating, drinking, or drugging, are usually going to be overwhelmed and drop out of treatment in the first week. They should not attempt elimination dieting without a support...
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