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.
Read next : Fibromyalgia:
It may be of autoimmune origin!
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. 
