Consultation With Dr. Forrest, DCAdded: 08/04/2007SKU: FH001$75.00
Nutritional Support For Fibromyalgia
Elevating Energy Levels in Patients with This Common and Crippling Condition
Jason E. Barker, ND
Fibromyalgia syndrome (FMS) is a chronic condition characterized by widespread muscle pain and stiffness that is often accompanied by joint and bone pain, disturbed sleep and fatigue. Fibromyalgia symptoms may be present for only months at a time, or they may be present for years with each individual experiencing differing degrees of symptom presentation and severity. Termed a “syndrome,” fibromyalgia presents as a collection of signs and symptoms, rather than a well understood disease process. Fibromyalgia is poorly understood, and is a complex challenge to the patient and physician in finding relief. There is no known direct cause of fibromyalgia syndrome; however, there are several contributing theories as to its cause.1
FMS is a relatively common condition, affecting roughly 10 million people in the US alone.2 It can affect children, but it most often strikes adults. Fibromyalgia overwhelmingly affects women compared to men, with 80 percent of cases being women, and typically manifests in the prime of life between the ages of 30 and 60 years.3 FMS is generally considered to be a non-progressing condition; however, those affected by it experience varied periods of worsening and remission. Approximately half of those affected with FMS have symptoms that last under two years, and the other half will have symptoms for more than 2 years.2
Causes of Fibromyalgia
Fibromyalgia has no established cause. Like many disease conditions, researchers are looking at several possible causes for this condition. Because fibromyalgia is so prevalent in women, researchers have studied the link between female hormones and FMS symptoms,4-5 although no distinctive breakthroughs have been made in this area.6 Until the hormone-FMS connection is further established, FMS patients should strive for balanced hormones, as this will contribute to the overall state of well being.
Another evolving area of research has looked at the link between viruses and FMS. Viral infections such as hepatitis C, human T cell lymphotropic virus type I (HTLV-I) and human immunodeficiency virus (HIV) are all associated with FMS.7 Researchers are unsure whether these associations are due to the infection itself or another causative factor.
Newer thinking around FMS involves looking at the central nervous system. Molecules in the body that lead to inflammation (inflammatory cytokines) are thought to activate a substance known as inducible nitric oxide synthase (INOS) in the muscle tissue that in turn sensitizes the central nervous system to pain.8 INOS stimulates pain receptors and creates more oxidants in the tissue. Oxidative damage occurs in the tissues because of this, which leads to tissue breakdown over time.
Diagnosis of FMS
People with fibromyalgia often undergo extensive medical testing and treatment before a diagnosis of fibromyalgia is made. Making a diagnosis is complicated by the fact that there is no single medical test that can say whether a person has the condition or not. However, a more certain diagnosis can be made when adhering to the American College of Rheumatology’s diagnostic guidelines; a person with diffuse pain and tenderness in at least 11 of 18 specific bodily locations and other FMS-like symptoms will be diagnosed with FMS.1 Some of the most common symptoms are listed in Table 1, from most common to least.9
Enhancing the Health of FMS Patients
Conventional treatment for fibromyalgia may involve the use of sleep medication, anti-inflammatory drugs (for pain management), and antidepressants. These medications are used to target the symptoms of FMS, as there is no specific treatment that can address all the symptoms of FMS. Additionally, long-term use of these medications is required for treatment of FMS, all of which have several side effects that may compound the syndrome. A more practical approach is the use of nutritional supplements that assist the body in maintaining healthy function.
Raising energy levels
One of the major symptoms in FMS is fatigue; one hypothesis is that those affected have an irregularity in their ability to produce ATP, the body’s main “energy currency.”10 Providing the nutritional material to assist the body in producing ATP may lead to improvements in energy levels. Three nutritional factors have shown promise in this area:
Magnesium contributes to over 300 enzymatic reactions in the body including the formation of an ATP precursor, metabolism of protein and carbohydrate, and movement of muscular electrical potentials.11-12 Magnesium acts as very gentle muscle relaxant by blocking the effects of calcium-directed muscle contractions.13 Taken in adequate doses, magnesium has the effect of making tight muscle more relaxed, and over time may assist with sleep quality, as low magnesium levels are associated with insomnia.14
Malic acid, when combined with magnesium, has been shown to decrease the pain and tenderness associated with FMS. Although the mechanism of how malic acid works is not fully understood, combined with magnesium it has been shown to improve FMS symptoms.15 Many experts hypothesize that malic acid, a critical component of the Krebs cycle production of cellular energy, is useful due to the possible role that an inherent metabolic imbalance may play in FMS. A simple organic acid test, by examining the many energy pathways, can determine if a metabolic imbalance is present.
Also known as pyridoxine, this B-vitamin works in concert with magnesium and malic acid, boosting their effectiveness. Pyridoxine serves to “escort” magnesium into the cells of the body, where it exerts its effects, and by assisting malate in producing ATP.
One of the hallmark symptoms of FMS is interrupted, poor sleep. This alone will lead to fatigue; however it may precede the painful symptoms of FMS. Therefore, the importance of creating a restful sleep pattern is paramount to the treatment of FMS and prevention of worsening symptoms.
Melatonin is a hormone secreted in an area of the brain to assist us with sleep. It is primarily released in response to the darkening light, making us feel sleepy. Available as a supplement, melatonin is widely used by people with sleep difficulties. Its use is widespread due to its promising results in numerous studies looking at insomnia. Additionally, melatonin has been shown to be deficient in people with FMS, thereby making its use all the more important.16 Studies incorporating melatonin as a sleep aid have shown better sleep and decreased need for pharmaceutical sleep aids.18 Melatonin is a safe and effective sleep aid with minimal side effects for people with FMS.
As mentioned earlier, oxidative damage occurs in people with FMS.17-18 This leads to further tissue degeneration, and less than optimal health. There are numerous forms of antioxidants; only a few will be discussed here. Additionally, omega-3 fatty acids are effective at limiting oxidation.19
Incorporation of antioxidant supplements into the FMS treatment regimen should include standard antioxidative vitamin and minerals such as beta-carotene, vitamin C, vitamin E, zinc and selenium. Food sources of antioxidants include darkly colored fruits and vegetables, with blueberries being highest priority due to their overall high antioxidant capacity.20
While definitive links between hormone imbalance and FMS have yet been discovered, achieving hormone balance should be considered in all people, especially in female FMS patients. A salivary hormone test can help determine which hormones are imbalanced and help determine the proper replacement of natural forms of hormones, including estrogen, progesterone, testosterone, DHEA and Cortisol.
Adaptogens and Thyroid Support
Two other substances that have been found to be helpful in clinical experience are adaptogens and iodine (Iodoral®). Adaptogens such as Eleutherococcus senticosus, Manchurian Thorn Tree, Hawthorn, Echinopanax Elatum, Schisandra, Ajuga Turkestanica, Aralia Mandshurica, Rhaponticum Carthamoids, Myricetin and Rhodiola can help support the adrenal glands and thereby improve the health of FMS patients. In addition, some clinicians have theorized that FMS is the result of hypothyroidism and that nourishing the body with iodine in the form of Iodoral can produce positive results.
Fibromyalgia syndrome is a complex condition, with several theories as to its cause. Like other complex conditions, there is not likely a single causative factor, but rather many factors. Proper nutrition can help maintain a healthful state in the body by supplying the necessary nutritive substances to avoid this condition. It is also imperative to ensure proper hydration by consuming a minimum of 64 ounces of pure water per day and a diet rich in fresh vegetables augmented with a daily green drink.
Jason E. Barker, ND
Dr. Barker holds a Doctorate in naturopathic medicine and a B.S. in exercise and sport science with a minor in anatomy and neurobiology. He maintains a private practice with an emphasis on sports medicine, pain management and hormone balance. Dr. Barker serves as a consultant to the nutraceutical and sports medicine industries and has lectured internationally as an expert in nutraceutical applications in medicine. Currently he is actively engaged in clinical research with a focus on nutraceutical agents and human performance.
1. Kasper DL, Braunwald E, et al. Harrison’s Principles of Internal Medicine. 16th ed. New York: McGraw-Hill Medical Publishing Division; 2005.
2. Goldenberg D. Fibromyalgia. New York, NY: Perigee, Penguin Putnam, Inc; 2002.
3. Ataoglu S, Ozcetin A, et al. Evaluation of dexamethasone suppression test in fibromyalgia patients with or without depression. Swiss Med Wkly. 2003 Apr 19;133(15-16):241-4.
4. Adler GK, Manfredsdottir VF, et al. Neuroendocrine abnormalities in fibromyalgia. Curr Pain Headache Rep. 2002 Aug;6(4):289-98.
5. Schochat T, Beckmann C. Sociodemographic characteristics, risk factors, and reproductive history in subjects with fibromyalgia: results of a population-based case-control study [in German]. Z Rheumatol. 2003 Feb;62(1):46-59.
6. Okifuji A, Turk DC. Sex hormones and pain in regularly menstruating women with fibromyalgia syndrome. J Pain. 2006 Nov;7(11):851-9.
7. Cruz BA, Catalan-Soares B, Proietti F. Higher prevalence of fibromyalgia in patients infected with human T cell lymphotropic virus type I. J Rheumatol. 2006 Nov;33(11):2300-3.
8. Bennett R. Fibromyalgia: present to future. Curr Rheumatol Rep. 2005 Oct;7(5):371-6.
9. Wallace D, Wallace J. All About Fibromyalgia. New York, NY: Oxford University Press; 2002.
10. Gebhart B, Jorgenson JA. Benefit of ribose in a patient with fibromyalgia. Pharmacotherapy. 2004 Nov;24(11):1646-8.
11. Shils M, Olson A, Shike M. Modern Nutrition in Health and Disease. 8th ed. Philadelphia, PA: Lea and Febiger, 1994.
12. Covington TR, et al. Handbook of Nonprescription Drugs. Washington, DC: Am Pharmaceutical Assn, 1996.
13. Swain R, Kaplan-Machlis B. Magnesium for the next millennium. South Med J. 1999;92:1040-7.
14. Sabatier M, Arnaud MJ, Kastenmayer P, et al. Meal effect on magnesium bioavailability from mineral water in healthy women. Am J Clin Nutr. 2002;75(1):65-71.
15. Wikner J, Hirsch U, et al. Fibromyalgia: a syndrome associated with decreased nocturnal melatonin secretion. Clin Endocrinol (Oxf). 1998 Aug;49(2):179-83.
16. Citera G, Arias MA, et al. The effect of melatonin in patients with fibromyalgia: a pilot study. Clin Rheumatol. 2000;19(1):9-13.
17. Bagis S, Tamer L, Sahin G, Bilgin R, Guler H, Ercan B, Erdogan C. Free radicals and antioxidants in primary fibromyalgia: an oxidative stress disorder? Rheumatol Int. 2005 Apr;25(3):188-90.
18. Fulle S, Mecocci P, Fano G, Vecchiet I, Vecchini A, Racciotti D, Cherubini A, Pizzigallo E, Vecchiet L, Senin U, Beal MF. Specific oxidative alterations in vastus lateralis muscle of patients with the diagnosis of chronic fatigue syndrome. Free Radic Biol Med. 2000 Dec 15;29(12):1252-9.
19. Egert S, Somoza V, Kannenberg F, Fobker M, Krome K, Erbersdobler HF, Wahrburg U. Influence of three rapeseed oil-rich diets, fortified with alpha-linolenic acid, eicosapentaenoic acid or docosahexaenoic acid on the composition and oxidizability of low-density lipoproteins: results of a controlled study in healthy volunteers. Eur J Clin Nutr. 2007 Mar;61(3):314-25.
20. Ono M, Masuoka C, Koto M, Tateishi M, Komatsu H, Kobayashi H, Igoshi K, Ito Y, Okawa M, Nohara T. Antioxidant ortho-benzoyloxyphenyl acetic acid ester, vaccihein A, from the fruit of rabbiteye blueberry (Vaccinium ashei).