• Cristina Montoya, RD

Low FODMAP diet, Sjögren’s Syndrome and Fibromyalgia: Is there a connection?

As someone living with Sjögren's Syndrome and Fibromyalgia and as an active member of the Sjögren's Society of Canada's support groups, I can attest that digestive issues are often a common theme among us. Let's review the connection between a Low FODMAP diet, Irritable Bowel Syndrome, Fibromyalgia and Sjögren's Syndrome. At the end of this post, I will share an example of a day in the life's menu sample on the Low FODMAP Diet.

Have you ever heard of the Low FODMAP Diet?

Unless you have been diagnosed with Irritable Bowel Syndrome (IBS), or Fibromyalgia, you probably haven’t. It is a therapeutic diet designed to help ease the symptoms of IBS, and its potential effects on symptoms of Fibromyalgia are now being studied as well. This isn’t just a coincidence though, as patients can often have both diagnosed IBS and Fibromyalgia concurrently. Additionally, a 2017 study found that 39% of their study participants with Sjögren’s Syndrome also reported symptoms of IBS and Fibromyalgia! While there is not much research currently available on how the Low FODMAP Diet may ease the symptoms for those with Fibromyalgia or Sjögren’s, it is emerging as an area of interest.

* Sjögren's (SHOW-grins) Syndrome is a systematic autoimmune disease that attacks the body's moisture-producing glands causing dry eyes and dry mouth, but it can also include extreme fatigue, generalized pain and organ involvement, including the digestive system.

What is Irritable Bowel Syndrome?

Source: wix.com

IBS is one of the most common gastrointestinal conditions in North America. The Canadian Digestive Health Foundation states that IBS affects up to 18% of Canadian adults. The diagnosis is based on ruling out other potential digestive disorders first (i.e. Inflammatory Bowel Disease, Celiac Disease, diverticular disease). According to the Rome IV diagnostic criteria, a person is diagnosed with IBS if meeting a set criteria list:

  • Recurrent abdominal pain: Occurring at least one day per week, for at least three months

  • Stool symptoms: Experiencing changes in the frequency of stools or a change in the appearance of the stool – or both.

  • Persistence of symptoms: Symptoms have been experienced for the last three or more months.

The symptoms experienced by individuals can also include:

  • acute or chronic abdominal

  • irregular bowel consistency, habits and motility

  • gas and flatulence (bloating)

  • acid reflux or noncardiac chest pain

  • symptoms are usually present in the day time, especially after having a meal or snack

  • stress, anxiety, and depression

IBS is a complex condition that is not yet completely understood, however there are medical, mental health and nutritional therapy treatments available to reduce the symptoms. See also the Canadian Digestive Health Foundation for more information.

What is Fybromyalgia?

Source: wix.com

Fibromyalgia is a condition that affects the central nervous system and is characterized by enduring, persistent pain in the muscles and soft tissue around the joints. Many individuals with Fibromyalgia experience widespread pain, chronic fatigue, disturbed sleep, lack of concentration “brain fog”, mood swings, anxiety, depression, heightened sensitivity to touch and pressure.

Approximately 70% of all patients with Fibromyalgia also have diagnosed IBS, and over half of all IBS diagnosed patients have symptoms of Fibromyalgia. The link between the two conditions is not yet fully understood, but research has shown that many patients with both conditions respond well to changes in diet. Due to the close link between the two, Fibromyalgia could be responsive to the similar medical and nutritional therapy treatments as IBS. There has recently been research into the potential benefit that a Low FODMAP diet may have on Fibromyalgia patients to aid in alleviating symptoms (1).

What is a low FODMAP diet?

FODMAP is an abbreviation that stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are all carbohydrates that do not get fully digested in the intestines, but are still an important component of a healthful diet because they act as prebiotics to support the growth of beneficial gut bacteria. The types of carbohydrates (aka sugars) that are found in FODMAP foods are fructose, lactose, and sugar alcohols such as sorbitol, mannitol, and xylitol. Examples of the foods that should be restricted when undergoing a Low FODMAP Diet during the initial stage are listed below.

Source: wix.com (Mushrooms & Avocados FODMAPs)

Fruits: apples, apricots, ripe banana, currants, dates, guava, lychee, blackberries, cherries, pomegranate, nectarines, pears, peaches, plums, prunes, figs, mango, boysenberry, watermelon, tamarillo, avocados, dried fruits, and juices containing high-fructose corn syrup.

Vegetables: artichokes, asparagus, fresh beets, brussel sprouts, chipotle chilli, cauliflower, mushrooms, garlic, leeks, onion, okra, bitter melon, shallots, snow/sugar-snap peas, sun-dried tomatoes, and chicory.

Grains: wheat, barley, and rye (they are the main reason why some people think they might be sensitive to gluten as this protein is also found in these grains)