"Food as Friend or Enemy": A Qualitative Study of Motivations Underlying Restrictive Dietary Practices in Fibromyalgia.

INTRODUCTION

Despite the absence of official dietary guidelines for fibromyalgia, many patients adopt restrictive diets in an attempt to alleviate symptoms. Understanding their motivations and experiences is essential to inform patient-centred care.

METHODS

This qualitative study included 19 individuals with fibromyalgia who reported following restrictive diets. Data were collected through semi-structured interviews and analyzed using phenomenological thematic analysis.

RESULTS

An overarching theme, "Fibromyalgia in the Fabric of Self", captured how the condition shaped participants' identities, motivations, and eating behaviours. Three main themes emerged. (1) Ambiguous relationship to diets: fluctuating symptoms such as pain, fatigue, and digestive issues made the link between food and symptoms unclear. Food was perceived both as a potential trigger and as a remedy, generating tensions between pleasure, self-control, and fear of adverse effects. (2) Diet as a field of experimentation: in the absence of clear medical guidance, participants conducted self-directed dietary experiments, often with uncertain or placebo-like outcomes. These approaches frequently extended beyond conventional medicine. (3) Available and lacking resources: gaps in medical support fostered mistrust, while peer communities provided crucial informational and emotional support, though sometimes with contradictory advice. Participants expressed a strong need for personalised nutritional guidance from professionals who validate their lived experiences.

CONCLUSIONS

Restrictive diets in fibromyalgia reflect complex processes of self-management and identity construction, often arising as responses to gaps in care. These findings emphasise the need for clinicians to consider restrictive diets with a tailored, evidence-based dietary support that acknowledges patients' subjective experiences while reducing uncertainty and conflicting information.