Dr. Pellegrino’s Fibromyalgia Diet: It’s Metabolic, My Dear


Dr. Pellegrino has seen thousands of fibromyalgia patients in his practice at Ohio Pain & Rehab Specialists, and has had fibro himself since childhood. This information is reproduced here by popular demand, with his kind permission.*


Weight Gain

A common problem observed in Fibromyalgia is weight gain. Many patients complain to me that weight gain became a major problem once Fibromyalgia established itself.

It is not unusual for a person to put on a 25- to 30- pound weight gain in the first year after Fibromyalgia was diagnosed. Various factors are involved in weight gain and include:

1. Decreased Metabolism

Various hormone changes can slow down the metabolism in Fibromyalgia. Studies have shown hormone deficiencies or imbalances (cortisol, thyroid, serotonin, growth hormone) in Fibromyalgia. Insulin and other hormones are probably affected as well.

Dr. Leslie J. Crofford** has described hormonal abnormalities in Fibromyalgia and how they interfere with physiologic communication between the brain and the body. Closely linked with hormones is the autonomic nervous system. The autonomic nerves are the small nerves vital in the coordination of the body’s hormones, and thus they play a role in the regulation and delivery of nutrients to our cells.

The hypoglycemic roller-coaster effect is a good example of the combination of hormonal endocrine imbalances and autonomic nervous system dysfunction leading to hypoglycemic symptoms. Overall, neuroendocrine abnormalities in Fibromyalgia probably interfere with the body’s metabolism (by decreasing it), and part of the treatment involves replacing or supplementing hormones to help improve the body’s metabolism.

A slower body metabolism means fewer calories are burned on a daily basis to “run” the body’s machinery. If fewer calories are burned with no change occurring in calories consumed, weight gain will result over time. Also, women in their late 30s and 40s often develop Fibromyalgia along the same time as early menopause (decreased estrogen). This can further decrease metabolism and increase the potential for weight gain.

2. Hypoglycemia (Abnormally Low Blood Sugar)

As I mentioned earlier, increased sensitivity to insulin will result in too much glucose being removed from the blood stream and pushed into the muscle. All this extra glucose pushed into the muscles has nowhere to go as the muscles have very limited ability to store glucose.

The body is forced to go into a fat-storing mode where it converts this extra glucose into fatty tissue. Contrary to the popular myth that obesity is a result of eating too much fatty foods, obesity is usually the result of eating too many carbohydrates. A carbohydrate rich diet causes weight gain by converting the extra glucose into fat and, if Fibromyalgia causes more insulin activity and sensitivity, then the weight gain can be even greater.

Another myth is that most overweight people overeat. Actually, most overweight people do not overeat. They may have a craving for carbs, and the carbs are easily converted to fat. Fibromalgia facilitates this process. A diet modified in protein and lower in carbs may help.

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 antidepressants.

Medicines such as estrogen and prednisone can also contribute to weight gain. If certain medicines are causing weight gain they may need to be stopped or adjusted depending on the individual’s medical needs.

4. Decreased Activity Due to Pain

People with Fibromyalgia hurt more and are not as active because activity increases pain. Thus, it is difficult to increase the energy expenditure or calorie burning related to exercise and activity. Less calories burned can mean weight gain. Any treatment program in Fibromyalgia must include attempts at increasing overall activity level.


We’ve discussed some of the basic problems of Fibromyalgia, the metabolism changes and the dysfunctional carbohydrate responses, especially. The problems contribute considerably to many of our most bothersome symptoms, including aching; fatigue; brain fog; irritability; anxiety; dizziness; carbohydrate craving; irritable bowel syndrome; food intolerance; and food sensitivity.

The American “diet aggravates and perpetuates our Fibromyalgia problems. We may have tolerated the higher carb, low fat diet before we got Fibromyalgia, but since we got Fibromyalgia, this diet no longer works for us and it’s probably making it worse.

• Because of our slow metabolism, it is difficult for us to eat less and notice a difference.

• Because of our pain, it is difficult for us to increase our exercise level to burn off more calories.

• Ideally, we need a diet that improves the efficiency of our calories burned by providing us with the right “quality” of food to enhance our metabolism and calorie-burning abilities.


1. Good proteins.

Meats, such as lean meats, skinless chicken, turkey and fish. Lean cuts of steaks, sausage, and bacon contain higher amounts of saturated fats so they should be kept to a minimum.

Eggs. This breakfast staple is a great source of protein; egg whites are healthier.


Soy meat substitutes.

Dairy products. These include cheese, cream, butter, skim milk, cottage cheese and unsweetened yogurt. Try for low fat dairy products.

Legumes. This class includes beans, peas, peanuts, lentils, and soybeans.

2. Good carbohydrates

All vegetables. Vegetables are a source of carbs that are highest in fiber and lowest in sugar. Some vegetables such as corn have more carbs than others.

Fresh fruits. Avocado, raspberries and strawberries have the least carbohydrates of fruits. Avoid dried fruits.

3. Good fats

Plant oils, especially olive and coconut oil. Other vegetable oils are acceptable including soy, corn, sunflower and peanut.

Fish oils (rich in Omega-3)



4. Others

Salad garnishes which include nuts, olives, bacon, grated cheese, mushrooms and other vegetables are allowed.

Flaxseed oil. A healthy supplement which contains essential fats.

Artificial sweeteners and sugar-free beverages are allowed in moderation. If you feel you are sensitive to aspartame, avoid products that contain it (NutraSweet) or substitute a different artificial sweetener, such as sucralose (Slenda) or saccharin (Sweet’n Low). Stevia is a sweet supplement alternative to sugar. Xylitol is another one of nature’s sweeteners like Stevia that won’t raise blood sugar levels and can substitute for sugar.

[Note: Dr. Pellegrino’s detailed list of FOODS TO AVOID includes what you don’t see here, such as sweets; breads & pastas, especially white-flour based; rice, especially white; potatoes; partially hydrogenated oils (trans fats); carbonated drinks; alcohol except in moderation. See also his review of the hormonal and nutrient deficiencies commonly found in fibromyalgia patients – "Nutritional Approaches in FM – Deficiencies, Symptoms, and Supplement Strategies"]


1. Think Protein Always

A key with this diet is not to eat any carbohydrate foods by themselves, even if they are considered good carbs. “Orphaned” carbs will increase the risk of hypoglycemia/insulin hypersensitivity in someone with Fibromyalgia, so foods that have some protein in them should be consumed every time we eat. Therefore:

• We shouldn’t eat pancakes and syrup for breakfast because it doesn’t contain any protein. Insulin is controlled by the balance of protein and carbs each time we eat.

• If we want a salad for lunch, we should not just eat plain lettuce and vegetables. We need to have a protein source in our salad as well, such as chicken, tuna, turkey, eggs, cheese and more.

• We should not eat a plain spaghetti supper. We should have spaghetti and meatballs (made with lean ground chuck meat) or lean sausage.

• If we crave a snack, we shouldn’t eat a sugar cookie. A small bag of cashews would be a better protein-laden choice for a snack.

Once you are trained to think about protein every time you put something in your mouth, it becomes easier to stay within the framework of the Fibromyalgia diet.

2. Avoid The Rush

Hypoglycemia is often the result of a sudden surge of glucose in our bloodstream after eating a carbohydrate-rich food. The Glycemic Index of foods is a measure of how fast the carbohydrate triggers the rise in circulating blood sugars. A GI over 70 is high. Examples of food with high GI are: Rice Crispies – GI 80; corn muffin – GI 95; mashed potatoes – GI 88.

To avoid a carbohydrate surge, take a few bites from proteins first whenever you eat. Even if you are eating good carbs, if you take the first few bites from protein, you can minimize the carbohydrate “rush”:

• Eating proteins first activates the protein digesting enzymes and slows the absorption of carbohydrates.

• Plus, proteins require hydrochloric acid for proper digestion, carbohydrates don’t. If we eat carbohydrates first, hydrochloric acid may not be activated and subsequent proteins eaten may not be properly digested.

Foods rich in fiber and fats also slow the absorption of carbohydrates.

3. Eat Until Full

Try to eat at least 3 meals a day and have 1-2 snacks. At meals, eat until you are comfortably full but not stuffed. Some people with Fibromyalgia actually do better by eating 5 to 6 smaller meals a day or by eating 3 smaller meals and 2 larger snacks.

Those who are bothered by irritable bowel syndrome sometimes can do better by eating smaller portions more frequently.

Eat slowly and take your time to chew food well.

4. Weekdays: Behave!

I recommend that the Fibromyalgia diet be followed strictly for 5 days each Monday through Friday, and I allow people to splurge a little on the weekends. That is, the diet is 5 days “on” and 2 days not so “on.” This allows people to follow the basic rules during the week (more proteins, good carbs, good fats) but also allows the anticipation of favorite foods over the weekend….

This Fibromyalgia diet can help decrease sugar cravings, help rebalance your body’s chemistry, especially insulin and blood glucose levels, and can help you shed weight.


* Excerpted with kind permission from Fibromyalgia: Up Close & Personal, © 2005 Mark Pellegrino, MD, and Anadem Publishing Inc. all rights reserved. Readers may purchase this book through Dr. Pellegrino's office at Ohio Pain & Rehab Specialists (330-498-9865; toll free 800-529-7500).

** “Neuroendocrine Abnormalities in Fibromyalgia and Related Disorders,” Leslie J. Crofford, MD, American Journal of Medical Science. 1998;315:359-366. Dr. Crofford is Associate Professor of Internal Medicine, Rheumatology, at University of Tennessee Health Sciences Center.

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