Fibromyalgia and eating disorders: a hidden link?

By Ana Espino | Published on May 13, 2026 | 3 min read


Fibromyalgia is a chronic condition characterized by widespread pain, severe fatigue, sleep disturbances, and cognitive difficulties. Eating disorders (EDs), such as anorexia nervosa, bulimia nervosa, and binge eating disorder, are psychiatric conditions associated with disturbances in eating behavior and body image.

Although these two conditions have traditionally been studied separately, they share many clinical similarities. Likewise, current treatments for both disorders often remain incomplete and mainly symptomatic. Therapeutic approaches are generally fragmented across different medical specialties, with limited integrated care. In addition, the common biological mechanisms underlying these two conditions remain poorly understood, limiting the development of targeted therapeutic strategies.

The main challenge is understanding why fibromyalgia and eating disorders are frequently associated. The authors focus particularly on the role of oxidative stress and dysfunction of the Nrf2 pathway, a major cellular system involved in antioxidant defense, inflammation, and energy metabolism. They also seek to determine how these mechanisms could be targeted through rehabilitation approaches combining nutrition, physical activity, and multidisciplinary care.

Study objective

The aim of this review is to explore the role of oxidative stress and dysfunction of the Nrf2 pathway as a shared biological mechanism linking fibromyalgia and eating disorders, while evaluating the therapeutic implications of this hypothesis in modern rehabilitation strategies.

Oxidative Stress: The Common Denominator?

The authors analyzed studies focusing on:

• oxidative stress in fibromyalgia and eating disorders;
• the Nrf2-Keap1 molecular pathway;
• the links between inflammation, metabolism, and chronic pain;
• rehabilitation approaches based on physical exercise, nutrition, and natural Nrf2 activators.

The authors show that fibromyalgia is associated with a significant increase in oxidative stress. Patients exhibit elevated levels of oxidative damage markers along with reduced antioxidant defenses. These abnormalities appear to correlate with symptom severity.

Eating disorders also involve abnormalities in oxidative metabolism. In anorexia nervosa in particular, severe dietary restriction leads to mitochondrial dysfunction, increased oxidative stress, and deficiencies in micronutrients essential for antioxidant systems. The authors emphasize that these disturbances may also promote neuroendocrine and inflammatory abnormalities.

The central role of the Nrf2-Keap1 pathway is also highlighted. Nrf2 is described as the primary regulator of cellular antioxidant defenses. Under normal conditions, this protein activates the expression of numerous genes involved in protection against oxidative stress and inflammation. In patients with fibromyalgia or eating disorders, this pathway appears to be impaired, which could contribute to the persistence of chronic symptoms.

The findings of this review also suggest that moderate physical activity may activate the Nrf2 pathway through a phenomenon of mild oxidative stress and stimulation of cellular antioxidant defenses. Conversely, excessively intense exercise could worsen oxidative stress, underscoring the importance of progressive and individualized rehabilitation.

The potential role of nutrition is also discussed. Several foods rich in Nrf2-activating compounds are highlighted, including:

• cruciferous vegetables rich in sulforaphane;
• polyphenols;
• omega-3 fatty acids;
• green tea and certain berries.

A Mediterranean-style diet, rich in anti-inflammatory and antioxidant foods, may represent a promising approach in the management of fibromyalgia and eating disorders.

Finally, the study emphasizes the importance of multidisciplinary care integrating:

• physical rehabilitation;
• psychological support;
• nutritional assessment;
• systematic screening for eating disorders in patients with fibromyalgia.

Rethinking rehabilitation: toward an integrated approach

Fibromyalgia and eating disorders are two complex and often associated conditions involving chronic pain, fatigue, metabolic disturbances, and psychological suffering. The main challenge remains understanding the shared biological mechanisms linking these two diseases and developing therapeutic strategies capable of simultaneously addressing physical, metabolic, and psychological dimensions.

This review aimed to explore the role of oxidative stress and dysfunction of the Nrf2 pathway as a central shared mechanism between fibromyalgia and eating disorders. The authors propose that dysfunction of the Nrf2 pathway may represent a plausible pathophysiological link between fibromyalgia and eating disorders. Rehabilitation approaches combining progressive physical exercise, nutritional optimization, and diets rich in natural Nrf2 activators may represent innovative and integrated therapeutic strategies.

However, the authors note that current evidence remains largely indirect. Most studies have been conducted separately in patients with fibromyalgia or eating disorders, and very few studies have investigated both conditions together. In addition, clinical data on interventions specifically targeting Nrf2 remain limited.

Further clinical trials will be needed to evaluate interventions targeting the Nrf2 pathway, develop personalized rehabilitation programs integrating nutrition and physical activity, and improve screening for eating disorders in patients with fibromyalgia. The authors also stress the importance of a patient-centered multidisciplinary approach.    



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About the author – Ana Espino
PhD in Immunology, specialized in Virology  
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions.