“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.