ДИЕТА ПРИ ФИБРОМИАЛГИИ
Аннотация
Многие пациенты с ревматическими заболеваниями считают, что диета влияет на их симптомы и, обращаясь на прием ревматолога, рассчитывают получить подробные рекомендации по коррекции питания. При этом практикующие врачи далеко не всегда располагают достоверными данными о роли питания в возникновении и течении различных ревматических заболеваний. Рекомендации по диете при ревматоидном артрите, остеоартрите и, особенно, при подагре представлены в отечественной научной литературе достаточно хорошо, тогда как вопросы питания при фибромиалгии в русскоязычной печати практически не обсуждаются. В настоящей статье представлен обзор современных публикаций, преимущественно англоязычных, посвященных диетотерапии при фибромиалгии. Обобщен опыт применения вегетарианских диет, в том числе веганской сыроедческой диеты, лечебного голодания, исключения глутамата натрия и аспартама из рациона питания, средиземноморской, аюрведической, безглютеновой, гипоаллергенной диеты, гипокалорийных диет, в том числе кетогенной диеты, противовоспалительной диеты, диеты с низким содержанием короткоцепочечных углеводов и полиолов, а также применения пробиотиков, хорасанской пшеницы и красного вина в лечении фибромиалгии.
Литература
Воронцов И.М., Мазурин А.В. Пропедевтика детских болезней. Издание 3-е, дополненное и переработанное. СПб.: Фолиант; 2009. EDN: QLSVXZ.
Громова О.А., Калачева А.Г., Торшин И.Ю. и др. Недостаточность магния — достоверный фактор риска коморбидных состояний: результаты крупномасштабного скрининга магниевого статуса в регионах России. Фарматека. 2013;6(259):115–129. EDN: QAFYSV.
Корниенко Е.А. Современные представления о взаимосвязи ожирения и кишечной микробиоты. Педиатр. 2013;4(3):3–14. DOI: 10.17816/PED433-14.
Сантимов А.В. Структура установленных диагнозов и назначенной терапии у пациентов различных возрастных групп на амбулаторных приемах врача-ревматолога в течение двух лет. Университетский терапевтический вестник. 2024;6(1):126–138. DOI: 10.56871/UTJ.2024.69.36.012.
Теплякова О.В. Распространенность гастроэнтерологических симптомов у пациентов с фибромиалгией. Университетский терапевтический вестник. 2023;5(S):159.
Almirall M., Casellas F., Dot J. et al. Prevalence of non-coeliac gluten sensitivity and assessment of the response to gluten-free diet in a cohort of patients with fibromyalgia. Rheumatology (Oxford). 2023;62(3):1069–1077. DOI: 10.1093/rheumatology/keac434.
Azad K.A., Alam M.N., Haq S.A. et al. Vegetarian diet in the treatment of fibromyalgia. Bangladesh Med Res Counc Bull. 2000;26(2):41–7.
Baldi S., Pagliai G., Dinu M. et al. Effect of ancient Khorasan wheat on gut microbiota, inflammation, and short-chain fatty acid production in patients with fibromyalgia. World J Gastroenterol. 2022;28(18):1965–1980. DOI: 10.3748/wjg.v28.i18.1965.
Bruzzese V., Marrese C., Scolieri P., Pepe J. Efficacy of a gluten-free diet in reducing the widespread pain index and symptom severity scale in patients affected by fibromyalgia. Reumatismo. 2023;75(3). DOI: 10.4081/reumatismo.2023.1530.
Casini I., Ladisa V., Clemente L. et al. A Personalized Mediterranean Diet Improves Pain and Quality of Life in Patients with Fibromyalgia. Pain Ther. 2024;13(3):609–620. DOI: 10.1007/s40122-024-00598-2.
Ciaffi J., Lisi L., Mari A. et al. Efficacy, safety and tolerability of very low-calorie ketogenic diet in obese women with fibromyalgia: a pilot interventional study. Front Nutr. 2023;10:1219321. DOI: 10.3389/fnut.2023.1219321.
Correa-Rodriguez M., Mansouri-Yachou J., Tapia-Haro R.M. et al. Mediterranean Diet, Body Composition, and Activity Associated With Bone Health in Women With Fibromyalgia Syndrome. Nurs Res. 2019;68(5):358–364. DOI: 10.1097/NNR.0000000000000361.
Correa-Rodriguez M., Casas-Barragan A., Gonzalez-Jimenez E. et al. Dietary Inflammatory Index Scores Are Associated with Pressure Pain Hypersensitivity in Women with Fibromyalgia. Pain Med. 2020;21(3):586–594. DOI: 10.1093/pm/pnz238.
Donaldson M.S., Speight N., Loomis S. Fibromyalgia syndrome improved using a mostly raw vegetarian diet: an observational study. BMC Complement Altern Med. 2001;1:7. DOI: 10.1186/1472-6882-1-7.
Gomez-Arguelles J.M., Caceres O., Blanco M. et al. Improvement of digestive symptoms in fibromyalgia patients following a diet modification according to histamine release test — an observational study. Reumatologia. 2022;60(3):209–212. DOI: 10.5114/reum.2022.117841.
Gonzalez-Lopez-Arza M.V., Trivino-Palomo J.V., Montanero-Fernandez J. et al. Benefits of the Light Consumption of Red Wine in Pain, Tender Points, and Anxiety in Women with Fibromyalgia: A Pilot Study. Nutrients. 2023;15(15):3469. DOI: 10.3390/nu15153469.
Hanninen O., Kaartinen K., Rauma A.L. et al. Antioxidants in vegan diet and rheumatic disorders. Toxicology. 2000;155(1-3):45–53. DOI: 10.1016/s0300-483x(00)00276-6.
Haugen M., Kjeldsen-Kragh J., Nordvag B.Y., Forre O. Diet and disease symptoms in rheumatic diseases — results of a questionnaire based survey. Clin Rheumatol. 1991;10(4):401–7. DOI: 10.1007/BF02206660.
Holton K.F., Taren D.L., Thomson C.A. et al. The effect of dietary glutamate on fibromyalgia and irritable bowel symptoms. Clin Exp Rheumatol. 2012;30(6 Suppl 74):10–7.
Hostmark A.T., Lystad E., Vellar O.D. et al. Reduced plasma fibrinogen, serum peroxides, lipids, and apolipoproteins after a 3-week vegetarian diet. Plant Foods Hum Nutr. 1993;43(1):55–61. DOI: 10.1007/BF01088096.
Isasi C., Colmenero I., Casco F. et al. Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. Rheumatol Int. 2014;34(11):1607–12. DOI: 10.1007/s00296-014-2990-6.
Kaartinen K., Lammi K., Hypen M. et al. Vegan diet alleviates fibromyalgia symptoms. Scand J Rheumatol. 2000;29(5):308–13. DOI: 10.1080/030097400447697.
Koppold D.A., Kandil F.I., Müller A. et al. Effects of Prolonged Medical Fasting during an Inpatient, Multimodal, Nature-Based Treatment on Pain, Physical Function, and Psychometric Parameters in Patients with Fibromyalgia: An Observational Study. Nutrients. 2024;16(7):1059. DOI: 10.3390/nu16071059.
Lamb J.J., Konda V.R., Quig D.W. et al. A program consisting of a phytonutrient-rich medical food and an elimination diet ameliorated fibromyalgia symptoms and promoted toxic-element detoxification in a pilot trial. Altern Ther Health Med. 2011;17(2):36–44.
Martinez-Rodriguez A., Leyva-Vela B., Martinez-Garcia A., Nadal-Nicolas Y. Efectos de la dieta lacto-vegetariana y ejercicios de estabilizacion del core sobre la composicion corporal y el dolor en mujeres con fibromialgia: ensayo controlado aleatorizado [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):392–399. DOI: 10.20960/nh.1341. (In Spanish).
Martinez-Rodriguez A., Rubio-Arias J.A., Ramos-Campo D.J. et al. 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. DOI: 10.3390/ijerph17072227.
Marum A.P., Moreira C., Saraiva F. et al. A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients. Scand J Pain. 2016;13:166–172. DOI: 10.1016/j.sjpain.2016.07.004.
Marum A.P., Moreira C., Tomas-Carus P. et al. 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):667–674. DOI: 10.20960/nh.703.
Michalsen A., Riegert M., Ludtke R. 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;5:22. DOI: 10.1186/1472-6882-5-22.
Pagliai G., Colombini B., Dinu M. et al. Effectiveness of a Khorasan Wheat-Based Replacement on Pain Symptoms and Quality of Life in Patients with Fibromyalgia. Pain Med. 2020;21(10):2366–2372. DOI: 10.1093/pm/pnaa134.
Proietti E., Rapallo F., Molinari E. et al. Online Questionnaire with Fibromyalgia Patients Shows Negative Correlations between Disease Severity and Adherence to Mediterranean Diet. Nutrients. 2024;16(7):1078. DOI: 10.3390/nu16071078.
Rasmussen L.B., Mikkelsen K., Haugen M. et al. Treatment of fibromyalgia at the Maharishi Ayurveda Health Centre in Norway. A six-month follow-up study. Clin Exp Rheumatol. 2009;27(5 Suppl 56):S46–50.
Rasmussen L.B., Mikkelsen K., Haugen M. et al. Treatment of fibromyalgia at the Maharishi Ayurveda Health Centre in Norway II — a 24-month follow-up pilot study. Clin Rheumatol. 2012;31(5):821–7. DOI: 10.1007/s10067-011-1907-y.
Rodrigo L., Blanco I., Bobes J., de Serres F.J. Remarkable prevalence of coeliac disease in patients with irritable bowel syndrome plus fibromyalgia in comparison with those with isolated irritable bowel syndrome: a case-finding study. Arthritis Res Ther. 2013;15(6):R201. DOI: 10.1186/ar4391.
Rodrigo L., Blanco I., Bobes J., de Serres F.J. 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;13:157. DOI: 10.1186/1471-230X-13-157.
Rodrigo L., Blanco I., Bobes J., de Serres F.J. 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):421. DOI: 10.1186/s13075-014-0421-4.
Roman P., Estevez A.F., Miras A. et al. A Pilot Randomized Controlled Trial to Explore Cognitive and Emotional Effects of Probiotics in Fibromyalgia. Sci Rep. 2018;8(1):10965. DOI: 10.1038/s41598-018-29388-5.
Schrepf A., Harte S.E. Miller N. et al. Improvement in the Spatial Distribution of Pain, Somatic Symptoms, and Depression After a Weight Loss Intervention. J Pain. 2017;18(12):1542–1550. DOI: 10.1016/j.jpain.2017.08.004.
Senna M.K., Sallam R.A., Ashour H.S., 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(11):1591–7. DOI: 10.1007/s10067-012-2053-x.
Silva A.R., Bernardo A., de Mesquita M.F. 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. DOI: 10.3389/fnut.2022.856216.
Slim M., Calandre E.P., Garcia-Leiva J.M. et al. The Effects of a Gluten-free Diet Versus a Hypocaloric Diet Among Patients With Fibromyalgia Experiencing Gluten Sensitivity-like Symptoms: A Pilot, Open-Label Randomized Clinical Trial. J Clin Gastroenterol. 2017;51(6):500–507. DOI: 10.1097/MCG.0000000000000651.
Smith J.D., Terpening C.M., Schmidt S.O., Gums J.G. Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins. Ann Pharmacother. 2001;35(6):702–6. DOI: 10.1345/aph.10254.
Stubbs A., Harte S., Clauw D.J. et al. Early Relationships of a Low-Energy Diet With Symptoms of Fibromyalgia. ACR Open Rheumatol. 2022;4(5):464–469. DOI: 10.1002/acr2.11418.
Taubman B., Mamula P., Sherry D.D. Prevalence of asymptomatic celiac disease in children with fibromyalgia: a pilot study. Pediatr Rheumatol Online J. 2011;9:11. DOI: 10.1186/1546-0096-9-11.
Vellisca M.Y., Latorre J.I. Monosodium glutamate and aspartame in perceived pain in fibromyalgia. Rheumatol Int. 2014;34(7):1011–3. DOI: 10.1007/s00296-013-2801-5.
