Dr. Pellegrino’s Fibro Diet!

As you probably already know if you follow my blog, I have fibromyalgia. What is fibromyalgia?

As the Mayo Clinic describes:

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.

Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Women are much more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.

I’ve been seeing a physiatrist for 2 years now named Dr. Mark J. Pellegrino at the Ohio Pain and Rehab Clinic. He has pulled together a great diet for fibromyalgia and even explains the “science” behind it. Here it is:

Dr. Pellegrino’s Fibromyalgia Diet

by Dr. Mark J. Pellegrino, MD



People with fibromyalgia have pain as their main complaint. Additional symptoms include fatigue, weight gain, difficulty concentrating, irritability and allergies. I am asked frequently whether dietary modifications are recommended or helpful in decreasing these symptoms.


  1. Decreased metabolism. Numerous deficiencies and dysfunctions of hormones can occur in fibromyalgia and cause a decrease in the metabolism. These affected hormones include thyroid, growth hormone, cortisol. Decreased metabolism results in slowing down of the body’s machinery and making it difficult to burn calories.
  2. Dysautonomia. The small nerves that control hormones, blood flow, heart rate and blood pressure become dysfunctional and probably results in increased sensitivity to hypoglycemia and hyperinsulinism. Since insulin is the main hormone that causes fat formation, any process that increases the insulin sensitivity will increase weight gain.
  3. Medicines. Side effects of medicines used to treat fibromyalgia can cause weight gain by decreasing metabolism, altering hormones, causing fluid retention, and increasing appetite. The most common offending medicines are the anti-depressant medicines, particularly the tricyclic anti-depressants. Other medicines such as estrogen and Prednisone can cause yeast problems which can contribute to weight gain.
  4. Decreased activity due to pain. People with fibromyalgia hurt more and are not as able to be as active as they would like because activity increases pain. Thus, it is difficult to increase the energy expenditure or calorie burning related to exercise/activity.


Myth #1: Obesity is a result of eating too much fatty foods. Obesity is usually the result of eating too much carbohydrates and having metabolic changes that occur. Insulin causes sugar to turn in to fat, thus it is most important in determining weight gain especially in carbohydrate-rich diets.

Myth #2: You eat less on a low-fat diet. You actually eat less on a low-carbohydrate diet compared to a low-fat diet. This is because eating foods higher in fat and protein suppress the appetite and satisfy hunger more than eating carbohydrates. To try to maintain a low-fat diet, you eat more carbohydrates and have more hunger, and are more likely to consume more total calories overall.

Myth #3: You can’t lose weight unless you eat fewer calories. You can actually lose weight by eating a higher number of calories if you eat the right food combinations. Diets that are heavy in carbohydrates can cause weight gain but eating the same amount of calories or even higher calories on a diet heavier in proteins and fats and lower in carbohydrates can cause weight loss. The quality of food is important, not the quantity of the calories.

Myth #4: Most overweight people overeat. Actually, most overweight people do not overeat. They have a craving for carbohydrates, and the carbohydrates are easily converted to fat, especially when over secretion of insulin is occurring (hyperinsulinism).


Specific problems related to fibromyalgia that can potentially be treated by dietary modifications include: weight gain, fatigue, brain fog, hypoglycemia symptoms (i.e. irritability, anxiety, dizziness, carbohydrate craving), irritable bowel symptoms, yeast and parasite symptoms (i.e. bloating, abdominal cramping, rectal itching), food intolerances and food sensitivity.

In fibromyalgia, one of the metabolic problems may be hypersensitivity to insulin. The increased insulin causes glucose to get pushed into the cells. Glycogen, which is the form that glucose is stored in our cells, fills up the glycogen storage spaces, so the leftover glucose that is being pushed into the cells has to get converted into fat instead. The end result, sugar turns into fat. Fat doesn’t turn into fat.

The main goals of the fibromyalgia diet are to develop a diet that is a lifestyle change by changing the composition, not necessarily the quantity, of the diet. If you are overweight, the goal is to promote a steady weight loss but improve energy. If you are already at your ideal weight, the goal is to promote improved energy and feeling better all over. Appetite and hunger can be reduced naturally.

On a metabolic level, the high protein, low carbohydrate diet will induce ketosis. Ketosis is the act of breaking down fat and converting it to glucose. The ease of getting into ketosis (which is also known as lipolysis) is based on the ratio of fat to carbohydrate. The more fat there is to carbohydrate, the more ketones. An overweight person is resistant to ketosis. With a decrease in dietary carbohydrates, the body will mobilize its own glucose for energy. First it uses up the stored glycogen, which takes a couple days, then the body will start burning fat which forms glucose. It is this process which puts us into ketosis or lipolysis. Once in ketosis, the appetite is actually suppressed and the carb cravings stop.


Numerous high protein/low carbohydrate diets have been described. I  have combined some of the features of different diets, especially Dr. Atkins’ Diet and the Mayo Clinic Diet, to come up with a fibromyalgia diet. There are some key goals intended with this diet:

  1. Promote steady weight loss if overweight to reach the ideal weight.
  2. Improve energy.
  3. Reduce appetite naturally and eliminate hunger.
  4. Develop a dietary lifestyle change.
  5. Consistently improve overall fibromyalgia symptoms.
  6. Change the composition, not the quantity, of the diet.
  7. Allow you to periodically go off the diet to eat your favorite foods.



  1. Refined sugars (dessert, candy, cookies, sugared drinks, crackers, potato chips even “WOW” Brand).
  2. Breads and starches (includes bagels, muffins, pancakes, waffles, noodles, pizza and pasta).
  3. Certain vegetables (potatoes, sweet potatoes, rice, corn, popcorn and cole slaw).


  1. Meats (steak, hamburger, chicken, fish, lunch meat if it does not have sugars).
  2. All red and green vegetables and beans.
  3. Fresh fruits. Limit yourself to one serving only per day of either: one cup (i.e. blueberries, strawberries, grapes); one piece (i.e. apple, pear, banana); or one 6 oz glass of juice (i.e. orange, grapefruit). Avocado, raspberries and strawberries have the least carbohydrates of fruits.
  4. Dairy products: cheese, cream, butter, skim milk, unsweetened yogurt, cottage cheese.
  5. Any salad dressing, mayonnaise or olive oil. Salad garnishes which include: nuts, olives, bacon, grated cheese, mushrooms, and allowed vegetables.
  6. Artificial sweeteners, sugar-free beverages.



6 oz. glass of skim milk

Two eggs, any style

Two slices of bacon, Canadian bacon, or two links/patties of sausage

Can have cheese melted on meat; can skip eggs from time to time and just eat the meat.


Salad (with any dressing) and salad garnishes

Meat, any style, any amount

Eat until full.


Meat, any style, any amount

Vegetables cooked in butter or any seasoning, or salad as above.

Eat until full.


Snack foods can include protein and fatty-rich foods: macadamia nuts, pecans, walnuts, Brazil nuts, cream cheese, fried pork rinds, sugar-free gelatin dessert with heavy cream.

Fruit can be eaten as snack. Can mix a cup of favorite fruit with sugar-free gelatin or heavy cream.

Cottage cheese, can mix with fruit (i.e. pineapple, peaches, etc.)


  1. Don’t skip meals and at any meal, you may eat until you are full.
  2. Don’t eat in between meals except you can have an evening snack. Can have one 6 oz. glass of skim milk per day. The combination of foods should eliminate cravings; if you get cravings, eat protein, fat-rich foods.
  3. Take nutritional supplements along with the diet. Multivitamins and mineral tablets, magnesium/malic acid supplements and colostrum are all recommended.
  4. Exercise: Stretch on a daily basis. Try to perform a light conditioning exercise at least three times a week (i.e. walking at least one mile or some type of similar exercise for 20-30 minutes at least three times a week or more if able.
  5. At first, recommend staying on the diet 12 days, stop for 2 days, and then go on again. Repeat this cycle until ideal body weight is reached, then diet can be modified to maintain stable weight. Modifications include: adding extra carbs (i.e. one potato and one bread) a day, adjusting cycle (i.e. diet during week, off on weekends). Need to experiment what works best for energy level and weight maintenance.
  6. Record initial weight and weigh once a week and keep record. Record how you feel or if you have any problems or questions. You can lose an average of 1-2 pounds every two days with this diet; usually you will not lose weight for the first four days.

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