What is fibromyalgia and how does it affect patients?
Fibromyalgia (FM) is a disease with an unknown origin that is characterized by generalized chronic pain, of non-joint origin, that the patient localizes in the locomotor system. In addition to pain, other symptoms such as intense fatigue, sleep disturbances, cognitive disorders, numbness in extremities, digestive disorders, genitourinary problems, dizziness , allergic symptoms, depression, anxiety, joint stiffness (especially in the morning) and headaches are among the most common clinical manifestations.
Patients with FM often have a hypersensitivity to pain that is manifested by the appearance of a painful sensation to pressure in multiple sites of the locomotor system, trigger points , which is not observed in healthy subjects.
Currently, it reduces the quality of life of approximately 4% of the European population and involves a considerable economic expense in European health systems and society in general. It has been estimated that FM affects about 12 million Europeans (Rivera et al., 2006).
How is it diagnosed? Are there new methods?
The diagnosis of FM is eminently clinical, it can not be diagnosed by laboratory tests and complementary studies; For example, blood tests and muscle biopsies present normal results in these patients. During the general physical examination, joint mobility, muscle balance and neurological examination are normal, and there are no inflammatory signs (Rivera et al., 2006).
FM is still a very unknown disease , which is usually diagnosed according to the criteria of the American College of Rheumatology , which include generalized chronic pain for at least 3 months, period of time in which, in addition, there must be pain to the palpation in at least 11 of the 18 sensitive points described by the same scientific society. This criteria developed in 1990 is not valid today, since it was focused only on the perception of pain and excluded 46% of people with FM. In 2010/2011, this society eliminated the sensitive points of the diagnosis and included fatigue, pain perception and other somatic symptoms. Finally, these criteria have been modified in 2016: generalized pain in 4 out of 5 body regions for 3 months is an essential inclusion criteria, in addition to the critical assessment of fatigue, tiredness and other similar symptoms. On the other hand, due to the large number of symptoms that these people may suffer, it is common for fibromyalgia to be confused with other diseases, such as hypothyroidism, polymyalgia rheumatica, rheumatoid arthritis and lupus (Rheumatology.org, 2018).
Up to 60 % of professional doctors and 45 % of medical specialists in different countries admit that FM is a difficult disease to diagnose. Further, two out of three people with FM also admit that this disease shows certain difficulties to be diagnosed. All this has as a consequence a late diagnosis or lack thereof (Harris Interactive, 2008).
Why is an early diagnosis important? What does it mean to be sick with FM?
Fibromyalgia causes people suffering from it to wander between clinics without conclusive results, undergoing multiple diagnostic tests that are based on ruling out other pathologies, a period of time that can reach up to 3 and 4 years. During these years, due to the complications presented, one in four FM patients end up losing their job and dedicate up to 35% of their income to personalized attention. The patient with FM must learn to live with persistent symptoms, such as a generalized pain from head to toe, whose severity varies from day to day; exhaustion, which can vary from a feeling of slight tiredness to severe exhaustion. They must strive to manage their condition, being patient and maintaining hope. Therefore, the early diagnosis of this disease would provide solutions to many of these problems that fibromyalgia patients have to deal with throughout their clinical history, managing to treat the disease as soon as possible and improve the quality of life (Harris Interactive, 2008).
It is also important that they know how their body responds to fibromyalgia to know which treatment is the most appropriate. Although each and every person with FM has common symptoms, the number of areas of the body with pain, the intensity of the pain and the frequency of time in which they are incapacitated are factors that allow us to distinguish the intensity of the disease. Due to this, we can distinguish between different degrees of affection, which suggests that each of these people should have a unique, personalized and high quality treatment.
Treatments used and why
Since there are no curative treatments for fibromyalgia, current treatments are palliative and focus on the management of FM symptoms to the greatest extent possible. In the same way that the manifestations of fibromyalgia vary from patient to patient, so do the treatment approaches that are successful. What works for one patient may not work for another.
In addition, medical professionals often have their own preferences regarding treatment. Since the successful treatment of fibromyalgia may involve the combination of a variety of health professionals, patients usually benefit from an approach to the treatment of coordinated and multidisciplinary teams (Harris Interactive, 2008).
Typical treatments for FM are focused mainly at the symptomatic level and are based on the use of analgesics, antidepressants, sleeping pills and a broad spectrum of “alternative therapies” that are not very efficient (Rheumatology.org, 2018).
FibroCure is a family of tools made up of three diagnostic kits: FibroKit (molecular diagnostic kit), FibroGen (kit for the genetic study and its hereditary risk) and FibroMap (classification kit based on the transcriptomic signature).
As a whole, they aim to minimize the waiting time necessary to obtain a diagnosis, to check whether a treatment is appropriate for each patient, to improve the diagnosis of FM, classifying patients according to their degree of affection, and allowing a personalized follow-up.
FibroKit is a molecular tool for clinical help, that is used to describe and diagnose fibromyalgia. From a blood sample, FibroKit is able to assess the energy status of each patient at the time of analysis and, in addition, has a predictive component when diagnosing patients. With this tool we are not only able to diagnose fibromyalgia early, but it also provides us information to evaluate individually who suffer from this disease.
A significant percentage of EU citizens (and around the world) are currently suffering from FM while facing inadequate treatment strategies. Current data show that in Spain about 1.5 million inhabitants and 400,000 inhabitants in Andalusia could benefit from FibroKit.
Complementary treatment of fibromyalgia through nutritional interventions
Currently, it has been shown that there is a relationship between nutritional interventions and nutritional supplementation and improvement of the symptoms of fibromyalgia. Fibromyalgia is characterized by the presence of high oxidative stress (Arranz et al., 2010). There are studies that show that following a diet rich in antioxidants (such as a vegetarian diet), composed mainly of plant-based products rich in antioxidants and micronutrients (vitamins and minerals), has a good impact on the improvement of symptoms (Cordero, 2011; Ozgocmen et al, 2006). That is why the need arises to investigate the relationship that exists between fibromyalgia and nutrition, establishing nutrition as a method of palliative and personalized medicine. These methods are based on the elimination of factors that may alter the patient’s symptoms, such as pharmacology and changes in lifestyle and eating habits. The treatment of fibromyalgia must be multidisciplinary, covering molecular aspects, nutritional interventions and through physical exercise. It has been observed that the combination of aerobic and anaerobic exercises, about 2 or 3 times a week for 30-45 minutes (Sosa-Reina et al., 2017), with a balanced diet normocaloric and preferably vegetarian, produces a muscular strengthening that decreases pain and depression symptoms, increases muscle mass and improves body composition in general, and this also produces an improvement in the quality of life of these patients (Martínez-Rodríguez et al., 2018).
What to eat
A balanced diet provides the nutrients necessary for the proper functioning of the body. Foods are classified into the following groups:
– Cereals and legumes: rice, corn, bread, pasta, etc. They contain carbohydrates, fibers and vegetable proteins. The recommended consumption is 4-6 servings of cereals and derivatives per day.
– Vegetables: contain minerals, vitamins and fibers. They can be used to accompany fish or meat. It is not recommended to eat fries in excess because they absorb a lot of fat. A minimum consumption of two servings per day is recommended.
– Fruits: they contain minerals, fibers, vitamins and healthy sugars. 3 or more pieces of fruit are recommended per day, preferably fresh.
– Dairy products: milk, cheese, yoghurts, etc. Neither butter nor cream are included. They are rich in calcium, magnesium and good quality proteins. If they cost to assimilate, you can opt for skimmers. It is recommended to consume 2 to 4 servings of dairy per day, depending on age and physiological situation.
– Meat, egg and fish: they are rich in proteins, fats and minerals. You should preferably consume lean meat, blue fish, and avoid fried foods, choosing to cook them roasted or steamed. Recommended consumption is 3 to 4 servings / eggs per week.
– Fats: use olive oil mainly because it contains monounsaturated and polyunsaturated fatty acids. The nuts also contain fat, fiber and proteins of vegetable origin.
The food pyramid represents these groups ordered by Ingest recommended.
In fibromyalgia there is oxidative stress, so it is important to consume the following antioxidants:
|Vitamin C (200 mg / day)||Fresh fruit such as citrus, strawberries, cherries, plums, kiwi, dark green leafy vegetables such as Swiss chard, peppers and spinach, tomatoes, broccoli, etc.|
|Vitamin E (10 mg / day)||Nuts such as hazelnuts and almonds, olive oil, avocado, cereals, etc.|
|Vitamin A (600-700 μ g / day)||Orange foods such as carrots, sweet potatoes, squash, citrus fruits, eggs, etc.|
|Selenium (50-100 μ g / day)||Kidneys, fish such as tuna, sole, sole, nuts, onion, garlic, etc.|
An adequate consumption of the following nutrients is also important:
|Calcium (1000-1200 mg / day)||Dairy products such as milk and cheese, legumes such as chickpeas and lentils, nuts, green leafy vegetables, etc.|
|Magnesium (100-500 mg / day)||Nuts such as almonds, lupine, pine nuts, peanuts, etc.|
|Zinc (10 mg / day)||Pork, brown rice, egg, etc.|
By carrying out an adequate and balanced diet you can cover the daily needs of these nutrients.
– It is important to use fresh foods, avoiding prepared meals and pre-cooked or ultra- processed dishes.
– It is necessary to avoid alcohol.
– Salt consumption must be reduced, taking into account that processed foods are also rich in sodium, such as canned meats, sausage soups, pot tomatos, etc.
– It is important to read the labeling of all the foods that are consumed and to choose those with less quantity of these.
– You should take time to eat, not do it in an accelerated way, chewing slowly and in a relaxed atmosphere.
– It is important to plan meals and avoid making purchases hungry.
– Water should be consumed during meals and also outside them, around 2 liters a day.
– The culinary techniques used should be those that do not include much fat, opting for boiling, griddle, roast, oven, microwave, sauteed.
– You should not take nutritional supplementation on your own. With a balanced diet based on natural products you can cover all the nutrient requirements. In case of any deficiency, consult a doctor.