Optimism and Chronic Health Conditions: Is ‘Think Positive’ A Cure, A Daily Boost, Or A False Promise?

Having a positive attitude will not cure you. Saying otherwise to people living with chronic conditions invalidates their experiences. But cultivating optimism can improve your quality of life, and help you to live better with a long-term illness.

Optimism and Chronic Illness

Are There Negatives to ‘Think Positive’ Advice for People with Chronic Conditions?

I was in my physiotherapist’s office when she probed an unexpectedly painful spot. This was the year my body began to fall apart and I had gone to see her in a desperate attempt to relieve the pain in my neck, shoulders, back and pelvis. When she found an agonizing point on my leg, I burst out in frustration: “Stupid body!” The problem, my physiotherapist informed me, was not physical, it was mental. My bad attitude about my body was the source of my pain. If I could learn to let go of my negativity, then my chronic pain would be resolved. Basically, positivity was the cure. I left her office both angry with her for dismissing my very real, body-wide pain, and riddled with self-doubt over whether my outlook on life was in fact the source of my illness. I wasn’t alone in my experience:

The idea that optimism is all you need to achieve anything you want, even recovery from illness, is now conventional wisdom. In her article Smile! You’ve Got Cancer, author Barbara Ehrenreich writes about her experience with breast cancer. Ehrenreich (2010) describes that, when she went online to learn from the experience of other survivors: “The first thing I discovered as I waded out into the relevant sites is that not everyone views the disease with horror and dread. Instead, the appropriate attitude is upbeat and even eagerly acquisitive.” She recounts examples of this kind of thinking, including quotes like this one from Jane Brody: “breast cancer has given me a new life. Breast cancer was something I needed to experience to open my eyes to the joy of living.” Ehrenreich calls this message “the tyranny of positive thinking.”

But, Can a Positive Attitude Actually Improve Chronic Illness?

Is Ehrenreich too fast in dismissing the potential benefits of optimism? Research consistently supports the idea that having a positive outlook can lead to positive health outcomes. In fact, a number of studies have:

…shown that a high level of optimism is linked to both enhanced physiological recovery and psychosocial adjustment to coronary artery bypass surgery, bone marrow transplant, postpartum depression, traumatic brain injury, Alzheimer’s disease, lung cancer, breast cancer, and failed in vitro fertilization (Goodin and Bulls, 2013, p. 329).

Before we go any further, I think it is helpful to define what it means to have a “positive attitude.” Researchers commonly equate positive thinking with optimism. Optimists are defined as “people who expect positive outcomes to occur in their future” and who are “likely to persist in their goal-directed efforts, where as those low in optimism are more likely to withdraw effort, become passive and potentially give up on achieving their goals” (Goodin and Bulls, 2013, p. 329).

The rationale for urging patients to develop a positive attitude is, essentially, that it will enable them to recover from their condition, and improve their quality of life along the way. I think there is a crucial difference between these two claims. The first claim is that a positive attitude will actually change the course of your disease, while the second claim has to do with an improved quality of life while living with illness.

Stop Blaming the Victim: Chronic Conditions Are Not Cured by Positivity

When it comes to the first claim, Ehrenreich (2010) shares her frustration that  “it remains almost axiomatic, within the breast cancer culture, that survival hinges on ‘attitude’.” This message also happens to be wrong – researchers have found that optimism does not increase survival rates for cancer (Medical News Today, 2004).

The positivity dogma shifts the cause of disease from being a physical malfunction to a character flaw – if only you were positive enough you wouldn’t have developed fibromyalgia or your cancer wouldn’t have metastasized. It is the worst kind of blame-the-victim thinking.

And while it might seem easy for people living with illness to dismiss comments suggesting they developed their condition because of their bad attitude, the problem is that illness makes people prone to feelings of guilt. Not only are our own lives changed, but so are the lives of family, friends and colleagues who depend on us. We feel guilty for the burden that our illness places on others, and that makes us vulnerable to self-blame. As the American Cancer Society explains, positivity-as-cure can be a deeply destructive message because it makes the patient culpable for getting sick in the first case and places the burden of recovery on their ability to be cheerful about it along the way (Edmonson, 2017).

The pressure to be optimistic invalidates the normal and natural feelings of grief that accompany illness. To suggest that grieving itself worsens illness, that these feelings should be repressed in favour of positivity, actually makes learning to live with the condition more difficult. If you are a friend or family member of someone living with a chronic illness you should know that attempting help by saying “you should be more positive” dismisses the very real feelings of the person you care about. In fact,

“A study published in the New England Journal of Medicine that analyzed the effects of expressing authentic emotions among breast cancer patients. And guess what? The researchers found that women who were able to reveal honest feelings showed overall mental-health improvements and reported less physical pain than the women who kept things bottled up” (Edmonson, 2017).

If you are a person with a chronic condition, let me be clear – your illness is not your fault, your feelings of grief and anger are natural, and recovering or managing your illness does not hinge on being happy all the time.

But Cultivating Optimism Can Improve Quality of Life for People with Chronic Conditions

The second claim about the benefit of positivity is that your perspective will influence your experience of illness – that being optimistic will help you cope better with your symptoms.  Since symptoms like pain and fatigue are ultimately subjective (based on personal feelings), it seems intuitive that your mental outlook might colour your experience of symptoms. This is not to say anyone should try to be positive all the time, or at the expense of expressing authentic emotions, but that working towards optimism, hope and acceptance can reduce suffering and pain.

It turns out that there is a large body of evidence which supports this notion. Greater optimism has been linked to reduced pain levels in people with different types of cancer, as well as arthritis (Goodin and Bulls, 2013). Interestingly, optimism has also been associated with adjusting better to life with a pain condition because of factors like paying less attention to pain symptoms, better daily mood, and less catastrophizing (thinking the worst; assuming every negative event will be an overwhelming disaster).

The idea that a positive attitude could improve my quality of life with chronic illness feels less blaming and dismissive to me than the dogma “survival hinges on attitude” which Ehrenreich describes . First of all, it doesn’t suggest that developing fibromyalgia was my fault because it makes no claims about cure or recovery. Secondly, it makes positive thinking more of a goal to work towards, if I choose. Grief and acceptance come in waves and learning optimism is not about repressing sad or angry feelings.

The idea that a positive outlook might improve everyday life doesn’t dismiss the reality of grief or other negative feelings, but it does provide an option for cultivating a better relationship with my pain and illness, if I decide that my current state of mind is not helpful to me anymore.

Is a possible to cultivate optimism, hope and acceptance? It appears that optimism, and its related traits of hopefulness and acceptance, can be learned. Our brains have the ability to change by forming new neural connections with repeated practice, a phenomenon called neuroplasticity. I have listed a few resources below if you are interested in science-backed strategies for learning greater optimism.

  • An app called Bliss has a number of proven exercises that can increase optimism, such as expressing daily gratitude, visualizing your best possible future and purposefully savouring the good things that happen each day.
  • One of the most powerful tools that has helped me to cope with my illness is practicing mindfulness, usually defined as “non-judgemental, present moment awareness”. I attended a Mindfulness-Based Stress Reduction course at my pain clinic that introduced me to how cultivating presence could help me manage my pain.  Much of our anxiety comes from worrying about the future or reliving difficult moments from the past, rather than from anything going on directly in front of us at this moment in time. You Are Not Your Pain is an excellent book on learning mindfulness for people living with pain and illness.
  • Buddha’s Brain by Rick Hanson is a wonderful book with practical advice on how to retrain your brain to strengthen positive brain states like calm, joy and compassion.

So, How Does Positive Thinking Affect Chronic Illness?

  • Having a negative perspective does not cause illness.
  • Having a positive attitude will not cure you.
  • Saying otherwise to people living with chronic conditions invalidates their experiences and feelings.
  • It is natural to feel grief and anger over the onset of illness and healthy to express these emotions.
  • Working towards greater acceptance and cultivating optimism can improve your quality of life, and help you to live better despite the challenges of having a long-term illness.

References:

Edmonson, J. (2017, Sept 3). A positive outlook not always in your best interest. The Star.

Ehrenreich, B. (2010, January 2). Smile! You’ve Got Cancer. The Guardian.

Goodin, B. and Bulls, H. (2013). Optimism and the experience of pain: benefits of seeing the glass as half full. Curr Pain Headache Rep, 17(5): 329. doi:10.1007/s11916-013-0329-8.

Medical News Today.(2004, Feb 9). A positive attitude does not help cancer outcome.

 

Advertisements

The 3 Best Diets for Fibromyalgia, According to Science

Learn about 3 diets that improve fibromyalgia symptoms: plant-based, low FODMAP and gluten-free –including an explanation, the science and resources for each diet.

The 3 Best Diets for Fibromyalgia, According to Science

Is Food Really Medicine?

Is there such a thing as a diet to treat fibromyalgia?  While there is no consensus on a single diet to treat FMS, research does point us in a few intriguing directions– specifically, symptoms improvements from plant-based vegetarian diet, a low-FODMAP diet and a gluten-free diet.

Fibromyalgia is difficult to treat. Presently, there are only three prescriptions that are approved by the FDA for fibromyalgia (pregabalin, duloxetine and milnacipran). Unfortunately, although these medications can provide partial relief for some people, none are a magic bullet for treating fibromyalgia. That’s why specialists recommend a multidisciplinary approach to FMS treatment. We know that diet plays an important role in preventing and managing many diseases, such as diabetes and autoimmune diseases, so why not fibromyalgia as well?

In this article, I want to lay out the scientific evidence for three different diet approaches to improving fibromyalgia: plant-based, FODMAP and gluten-free. My hope is that this article can serve as a starting point for you to explore how to use food as medicine to improve your symptoms.

Nutrition can be empowering. That might sound overblown. But, unlike prescriptions or appointments with doctors and physical therapists, there is no intermediary between you and what you choose to eat. Food is personal and what you decide to eat is ultimately up to you. For a person living with fibromyalgia, having the ability to make decisions over something as important as nutrition really is empowering. However, changing daily habits can be a challenge, which is why I have included several free and affordable resources for each diet if you are interested in making any changes.

Fibromyalgia and Plant-Based Vegetarian/Vegan Eating

At least three studies have shown that people with fibromyalgia benefit from a plant- based vegetarian or vegan diet.[1] It’s important to stress the plant-based focus of this dietary therapy. It is possible to eat a diet that is vegetarian, but primarily made up of processed, nutrient-poor, junk food. This won’t improve your general health or your fibromyalgia symptoms. Plant-based foods, including fruits, veggies, whole grains, beans and nuts, contain vitamins, minerals and antioxidants that provide crucial nutritional benefits. It’s quite possible to also obtain balanced macronutrients (carbs, protein and fats) from these plant sources. While vegans and vegetarians both eat plant-based foods, vegetarians also consume dairy, eggs, honey (and sometimes, fish). Vegans do not eat any animal-sourced foods.

Studies have shown that fibromyalgia is linked to high rates of oxidation (damage to tissues caused by particles known as oxidants). Antioxidants neutralize oxidants and serve an important protective function in the body. Researchers hypothesize that consuming a diet rich in antioxidants might help to improve fibromyalgia symptoms.[2]  One study showed that fibromyalgia patients on a vegetarian diet had an improved antioxidant status; 70% of participants also reported lower pain levels and increased well-being.[3]

Another benefit of eating vegetarian is weight loss. Carrying extra weight worsens pain, sleep, depression, and other fibromyalgia symptoms.[4] However, it can be very difficult to lose weight when you have a condition that makes moderate exercise painful. If you have struggled unsuccessfully to lose weight, could it be time to consider going vegetarian or vegan?

A recent study of diabetic patients found that, compared to a conventional low-calorie diet, a vegetarian diet was almost twice as effective in reducing body weight.[5] In a separate investigation into the effects of eating vegan on fibromyalgia symptoms, research participants who were overweight had a significant reduction in body mass index, as well as cholesterol levels.[6] This 3-month study found that eating vegan resulted in significant improvements in FMS symtoms: reduced pain levels, and joint stiffness and improved quality of sleep and quality of life.

After my diagnosis, I ate a lot of processed, packaged food because of the convenience. But it cost me a lot in terms of my symptoms getting worse and gaining weight. After I switched to eating plant-based vegetarian, I lost about 20 pounds and found that some of my symptoms improved, including more sustained energy, no low blood sugar crashes and greater ease of movement.

If you are interested in going vegetarian/vegan, or just incorporating more meatless main dishes into your diet, here are a few resources to get started:

Fibromyalgia and the Low FODMAP Diet

This is a weird sounding diet, right? FODMAP stands for several types of short chain carbohydrate and sugar alcohols. Research has shown that a diet low in FODMAPs is the most effective diet plan for managing Irritable Bowel Syndrome (which includes symptoms like bloating, nausea and changes in bowel movements). In addition, a low FODMAP diet (LFD) can reduce fatigue, lethargy and poor concentration.[7]

Based on these findings, a new study investigated whether reducing FODMAPs in your diet could improve your fibromyalgia symptoms.[8]  The results were positive – a statistically significant reduction in body pain and gastrointestinal symptoms, as well as an improvement in quality of life. I find it interesting that these results indicated improvements beyond only G.I. symptoms . Research into probiotics and dietary interventions has been pointing to a gut-brain connection. Since fibromyalgia involves a sensitized nervous system, perhaps one way to dial down the sensitivity could be via the gut? It’s important to note that this was a pilot study, with a small sample size, and further research needs to be done. However, if you have IBS or significant G.I. issues along with fibromyalgia, a low FODMAP diet might help you manage digestive symptoms and reduce your pain!

How Does a Low-FODMAP Diet Work?

For some people, FODMAPS are poorly absorbed in the small intestine. When they pass into the large intestine, they are quickly fermented, which contributes to gas, abdominal bloating and pain. They also attract water into the large intestines through osmosis, which can alter bowel movements. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These can be further divided into five groups called fructans, galacto-oligosaccharides, lactose, excess fructose and polyols.

Foods that contain FODMAPS include:  onions, garlic, mushrooms, apples, lentils, wheat, rye and milk. Importantly, not everyone is triggered by all types of FODMAPs. Instead, the FODMAP diet takes an elimination approach. Initially, all FODMAPs are removed from your diet. Gradually, they are re-introduced one by one so you can determine which ones cause you a negative reaction. Only your FODMAP triggers are permanently removed from your meals.

If you are interested in learning more, you can check out these resources:

Fibromyalgia and the Gluten-Free Diet

It’s impossible to have escaped the gluten-free diet fad that has swept the mainstream in recent years. The evidence is seemingly in every grocery store and on every menu. While it may seem like only a fad, there is a scientific rationale behind why some people may benefit from a gluten-free diet, even if they don’t have celiac disease (CD): “Non-celiac gluten sensitivity is increasingly recognized as a frequent clinical condition with symptoms similar to CD in the absence of the diagnostic features of CD.”[9]

Without getting too deep in the weeds on this topic, gluten is a protein found in wheat, rye, barley and similar grains. In some people with a weakened intestinal barrier, consuming gluten triggers an inflammatory immune response. Some of the symptoms of a gluten sensitivity include gastrointestinal problems like bloating, constipation, diarrhea, abdominal pain, and vomiting, as well as muscle and joint pain, brain fog and chronic fatigue. Although the clinical markers of gluten sensitivity are different from celiac disease, scientists have uncovered markers of intestinal cell damage and increased immune activity, which normalized after eliminating gluten for six months.[10]

A small pilot study investigated whether fibromyalgia patients with gluten sensitivity improved after beginning a gluten-free diet. Patients with confirmed gluten sensitivity experienced an improvement in pain, fatigue, neurological and gastrointestinal symptoms after beginning a gluten-free diet. Of the 20 participants in the study, fifteen experienced a significant reduction in body wide pain – some shortly after beginning the diet and others after a few months. The authors conclude that this pilot study suggests non-celiac sensitivity may be a treatable cause of fibromyalgia, but that further research needs to be done.

If you are curious whether gluten might be worsening your symptoms, it’s best to begin with a trial elimination diet. This means eliminating all sources of gluten from your diet for several weeks. During this period, keep a food log of what you eat and what your symptoms are each day. Then reintroduce gluten into your diet, and observe whether your symptoms change or worsen. Since more than half of FM/CFS patients see their symptoms improve when they eliminate certain foods, including corn, wheat, dairy, citrus and sugar, you may want to add other foods to your elimination diet.

If you suspect that gluten may be impacting your fibromyalgia, it’s good to rule out celiac disease first. Start by making an appointment with your doctor (and bringing your food log). In order to rule out non-celiac gluten sensitivity, you may want to consider working with an integrative medical doctor, naturopathic doctor, or nutritionist. Although research supports the existence of gluten sensitivity, the mainstream medical profession lags behind when it comes to accepting this condition, so alternative and complementary health professionals may be better to work with during this process.

Here are a few resources to check out if you are interested in going gluten-free:

 

References

[1] https://vegetarianprescription.org/2016/11/01/the-treatment-of-fibromyalgia-with-a-plant-based-diet/

[2] https://vegetarianprescription.org/2016/11/01/the-treatment-of-fibromyalgia-with-a-plant-based-diet/

[3] Høstmark A, Lystad E, Vellar O, et.al. Reduced plasma fibrinogen, serum peroxides, lipids, and apolipoproteins after a 3-week vegetarian diet. Plant Foods for Human Nutrition. Jan 1993;43(1):55-61.

[4] http://www.arthritis.org/about-arthritis/types/fibromyalgia/articles/obesity-fibromyalgia.php

[5] https://www.sciencedaily.com/releases/2017/06/170612094458.htm

[6][6] Kaartinen K, Lammi K, Hypen M. Vegan diet alleviates fibromyalgia symptoms. Scandinavian Journal of Rheumatology. 2000; 29(5): 308-13.

[7] http://fodmapfriendly.com/what-are-fodmaps/

[8] Marum, A.P. et al. (2016). A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients. Scandinavian Journal of Pain 13:166-72. http://www.scandinavianjournalpain.com/article/S1877-8860(16)30084-2/fulltext?mobileUi=1

[9]Isasi, C. et al. (2014). Fibromyalgia and non–celiac sensitivity: a description with remission of fibromyalgia. Rheumatology International , 34 (11), 1607-16.

[10] http://www.medicalnewstoday.com/articles/312001.php