Pitfalls of intermittent fasting for patients diagnosed with fibromyalgia or other chronic pain conditions

Does intermittent fasting help with fibromyalgia for pain, fatigue, sleep problems, brain fog, etc.? If you have searched the Internet for intermittent fasting, you have probably found that the topic is controversial and leaves you in the dark about what to expect with intermittent fasting. Intermittent fasting can cure as well as cause fatigue, sleep problems and brain fog.

In my clinical practice, I have met people who have tried fasting to cure the above health problems and reported conflicting experiences. It seems that fasting in general and probably intermittent fasting helps some people with chronic pain more than others.

You should not consider intermittent fasting if:

1. You are younger than 18 years old
2. Have a history of an eating disorder
3. Are pregnant or breastfeeding
4. Have a complex chronic health problem and are taking a variety of medications in addition to pain medications.

There are some pitfalls to consider before you decide to try intermittent fasting for fibromyalgia or chronic pain in general:

1. obesity, chronic pain, and intermittent fasting. Obesity and chronic pain are linked. There is little scientific data on the effects of IF on chronic pain. However, if one imagines that bariatric surgery is actually a form of forced fasting, the literature on the effects of bariatric surgery actually shows significant benefits in terms of pain symptoms in fibromyalgia, back pain, and osteoarthritis. The only potential danger is that bariatric surgery has negative effects on bone and is associated with an increased risk of fracture. This may not be the case with intermittent fasting.

In a minority of patients (about 13-18% in some studies), pain worsens after bariatric surgery. At present, there are insufficient data, and we can only speculate about possible mechanisms underlying the worsening in this patient subgroup.

From the perspective of my clinical experience, there are two potential issues to consider.

First, after bariatric surgery, patients also suffer from muscle wasting and associated physical fatigue. In the case of sarcopenia before surgery (i.e., muscle atrophy due to inactivity), the situation can worsen to extreme mobility problems, which can aggravate pain when resuming normal daily activities. So pay attention to your muscle mass before you start fasting, or get professional help to prevent muscle loss during the process.

Second, food deprivation can act as an emotional trigger, which is especially important in patients with complex PTSD or CPTSD (not uncommon in fibromyalgia patients). CPTSD is more difficult to identify and is related to early childhood adversity. It would not be surprising if this is the first thing that comes to mind when you scrutinise your relationship with food - more on this in the next section.

2. Mental health and intermittent fasting

Food is an important part of our lives. We eat for a variety of reasons and not just to provide our bodies with necessary nutrients. Food and eating habits are an expression of culture and deeply rooted in society and human relationships. We eat to celebrate and to comfort ourselves. The food choices we make are part of our autopilot behavior. We usually do not feel comfortable when we are forced to think about what we eat and what we do not eat. Such behavior, which is increasingly common these days, could even lead to orthorexia nervosa ("preoccupation with the quality of the food people put into their bodies, refining and restricting their diets according to their personal view of what foods are truly 'pure'").

From my clinical perspective, there are two important things to know about mental health before intermittent fasting when struggling with fibromyalgia or chronic pain in general.

First, you need to realise what function food has in your life. If it is an important emotional regulator, you need support or some kind of coaching from an experienced clinician. It is not recommended to begin a fast of more than 24 hours without first addressing the issue of emotion regulation. In the case of CPTSD, food can be an important emotional regulator, with fasting being a possible emotional trigger that can exacerbate mood swings, fatigue, or pain episodes.

Second, you may be one of those people who forgets to eat when they are busy. Perhaps fasting is easy for you because you are used to going 12 hours or more without eating. In such a situation, it is more important to realize what happens when you stop being busy and forget to eat, for example, by eating more comfort foods like chocolate or french fries. For IF to have a positive effect on pain, sleep or energy, what we eat after fasting is of utmost importance.

And again, it is very important to know that you should not experiment with foods if you have an eating disorder in your personal history, regardless of all the benefits of intermittent fasting, which you may have read about here or elsewhere. If your diet needs to be corrected, please consult a nutritionist who has experience in caring for people with microbiota problems resulting from eating disorders.

3. Sleep and intermittent fasting

Adequate sleep is a prerequisite for healing chronic pain.

Fasting may seem controversial, especially when you think of low blood sugar as a trigger for waking. People with fibromyalgia often have prediabetes, a state of insulin resistance in the body. Intermittent fasting seems to be a good way to improve insulin sensitivity. In such a case, intermittent fasting may not lead to waking because it makes blood glucose levels more stable and corrects insulin resistance.

Fluctuations in blood glucose levels may be associated with chronic pain leading to hunger and eating at night, which is very problematic in many ways. Intermittent fasting may not be the right place to start. The physical discomfort caused by nighttime blood sugar fluctuations is difficult to remedy if problematic habits persist during the day (regular consumption of foods or beverages with a high glycemic index - GI -, alcohol, lots of coffee, sedentary lifestyle). A stressful phase of life also contributes to glucose fluctuations and leads to cortisol problems or a lack of parasympathetic tone.

Nonetheless, in theory, there are definite benefits of fasting that can make you feel better and function better. Intermittent fasting affects your microbiota, metabolism, and inflammation, all of which play an important role when disrupted in any type of chronic pain.