While conditions like Fibromyalgia and Chronic Fatigue Syndrome may have varying causes, some patients find the food they eat is the enemy. Studies have shown that Fibromyalgia and IBS often co-exist, and that IBS may very well be undiagnosed Celiac Disease or Non-Celiac Gluten Sensitivity. Although gluten is a top food offender, other foods may be problematic as well. Celiac Disease can also masquerade as Chronic Fatigue Syndrome.


Non-coeliac gluten sensitivity is increasingly recognised as a frequent condition with similar manifestations which overlap with those of FM. The elimination of gluten from the diet of FM patients is recently becoming a potential dietary intervention for clinical improvement. In summary, this review reveals the potential benefit of specific dietary interventions as non-pharmacological tools as part of a multidisciplinary treatment for FM patients.
Fibromyalgia and nutrition: what news?
PMID: 25786053  Apr 2015

"The aim of this report was to describe 20 selected patients with FM without CD who improved when placed on a gluten-free diet. An anti-transglutaminase assay, duodenal biopsy, and HLA typing were performed in all cases. CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy. All patients had intraepithelial lymphocytosis without villous atrophy. Clinical response was defined as achieving at least one of the following scenarios: remission of FM pain criteria, return to work, return to normal life, or the discontinuation of opioids. The mean follow-up period was 16 months (range 5-31). This observation supports the hypothesis that non-celiac gluten sensitivity may be an underlying cause of FM syndrome."
Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia.
PMID:24728027  April 2014

"The aim of our case-report was to show that migratory arthralgias can be an extraintestinal manifestation of gluten-sensitive enteropathy."
[Gluten-sensitive enteropathy: a disease to take into consideration - a case report].
PMID:24003682  2013

CONCLUSIONS: Fatigue is a major concern in untreated celiac disease patients, which impacts their quality of life.
Fatigue as a determinant of health in patients with celiac disease.
PMID: 19935081  July 2010

In the FM group, 13 patients had raised gastroduodenal permeability and 15 patients had raised small intestinal permeability, but only one volunteer had increased gastroduodenal permeability (P < 0.0001, chi-square test for the three groups). The IP values were significantly increased in the patient groups (P < 0.0003 for all comparisons, one-way analysis of variance).
Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome.

PMID: 18540025 June 2008

Patients with fibromyalgia (FM) frequently have gastrointestinal symptoms and signs. This article critically reviews the available literature and concludes the following: evidence that inflammatory bowel disease is associated with FM is contradictory, but should be looked for in patients taking concomitant steroids; patients diagnosed with celiac disease often have a history of FM or irritable bowel syndrome (IBS) that may or may not be present; reflux, nonulcer dyspepsia, and noncardiac chest pain are common in FM patients; medications used to manage pain, inflammation, and gastrointestinal complaints confound the management of FM; and IBS affects smooth muscles and the parasympathetic nervous system, while FM patients have complaints of striated muscles and dysfunction of the sympathetic nervous system. Of those patients with FM, 30% to 70% have concurrent IBS.
Fibromyalgia: the gastrointestinal link.

PMID: 15361320  Oct 2004

In the initial survey (N = 1032 respondents), the median age at onset was 46 years, and the diagnosis of adult celiac disease was often delayed (median 12 months, with 21% delayed over 10 years). Only 32% of adults were underweight, and only about 50% reported frequent diarrhea and weight loss. A second survey documented that common presenting symptoms were fatigue (82%), abdominal pain (77%), bloating or gas (73%), and anemia (63%). Initial physician diagnoses were often irritable bowel syndrome (37%), psychological disorders (29%), and fibromyalgia (9%)
Presentations of adult celiac disease in a nationwide patient support group.
PMID: 12741468

Results indicate that 70% (14/20) of the PFM patients had IBS and 65% (13/20) of the IBS patients had PFM. In conclusion, these results indicate that PFM and IBS frequently coexist. A common pathogenetic mechanism for both conditions is therefore suggested.
Primary fibromyalgia and the irritable bowel syndrome: different expressions of a common pathogenetic process.
PMID: 2049586

An association between irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) has been found.
A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing.
PMID: 15020342

This dietary intervention shows that many fibromyalgia subjects can be helped by a mostly raw vegetarian diet.
Fibromyalgia syndrome improved using a mostly raw vegetarian diet: an observational study
PMID: 11602026

The elimination of MSG and other excitotoxins from the diets of patients with fibromyalgia offers a benign treatment option that has the potential for dramatic results in a subset of patients.
Relief of fibromyalgia symptoms following discontinuation of dietary excitotoxins.
PMID: 11408989

Growing evidence suggests that autoantibodies to neuronal or endothelial targets in psychiatric disorders exist and may be pathogenic. This review describes and discusses the possible role of autoantibodies related to the psychiatric manifestations in autoimmune diseases, autoantibodies related to the psychiatric disorders present in post-streptococcal diseases, celiac disease, chronic fatigue syndrome and substance abuse, and autoantibodies related to schizophrenia and autism, disorders now considered of autoimmune origin.
Autoantibodies associated with psychiatric disorders.

PMID: 16719797 May 2006

Chronic fatigue.
PMID: 16908908 Aug 2006  Full text

High prevalence of serum markers of coeliac disease in patients with chronic fatigue syndrome.
PMID: 11304857

Finally, recent evidence suggests celiac disease can present with neurological symptoms in the absence of gastrointestinal symptoms; therefore, celiac disease should be included in the differential diagnosis of CFS.
Chronic fatigue syndrome: oxidative stress and dietary modifications.
PMID: 11703165

Coeliac disease and chronic fatigue syndrome.
PMID: 11219326

Celiac disease or chronic fatigue syndrome--can the current CDC working case definition discriminate?

PMID: 9688026

41-year-old patient with long-term chronic fatigue. Celiac disease.

PMID: 12705185