Herb & Dietary Supplement Report, September 1999
COMPLEMENTARY TREATMENTS FOR FIBROMYALGIA
By Dan Wagner, RPh, MBA
With no pharmaceuticals specific to this misunderstood disease, many patients opt for alternative approaches to treatment. Lifestyle modifications and a dietary supplement plan offer the most consistent results at this point.
Fibromyalgia is an enigma of a disease with no known etiology, which affects 6 million Americans; women between the ages of 25 and 60 years of age account for 90 percent of cases. Also known as fibrositis, muscular rheumatism, and psychogenic rheumatism, fibromyalgia is characterized by chronic widespread pain involving the muscles, tendons, and joints.
Modem Medical Treatment
Existing medical treatment for fibromyalgia is lacking, and there are n specific drugs for the condition. Hypnotics may be used to improve sleep, SSRIs and other antidepressants for depression, muscle relaxants for cramps, and NSAIDs for joint and muscle pain. Only recently has the medical establishment regarded fibromyalgia as a legitimate disease. Many physicians used to consider it an unimportant, imaginary disease. For these reasons, relief from fibrornyalgia symptoms is usually sought in natural and holistic treatments.
Diet and Lifestyle
*Identify food allergies. Dairy, wheat, eggs, chocolate, citrus fruits, corn, and MSG are common food allergens. By following an elimination diet (eliminating one possible food allergen for 2 weeks), problem foods can be identified and subsequently avoided. It is advisable to avoid sugar as much as possible.
*Evaluate acid/alkaline content of diet. High acid foods consumed over time can lead to a weakened immune system.
*Eat more vegetables. It appears that a vegetable-based diet offers relief to fibromyalgia patients.
*Add more fish to the diet. Fish is a great source of protein and nutrients. It contains anti-inflammatory essential fatty acids.
*Exercise to tolerance. Exercise cannot be overestimated in improving FMS symptoms. Extreme exercise, however, may cause muscle pain.
*Rest and relaxation. Stress reduction may be the most important factor in improving the overall well-being of fibromyalgia patients. Advise patients to get proper rest and relaxation, and to get more sunlight. Meditation and massage may also help.
Suggested Supplement Protocol
Magnesium and Malic Acid. Magnesium relaxes the muscles. It can help alleviate muscle pain, strain, rigidity, and spasms. Most people with fibromyalgia are deficient in magnesium. Malic acid is important in the citric acid cycle, which helps with the overall transport of magnesium through cell membranes. (Russell et al) Dose: Magnesium, 400 to 600 mg/day; malic acid, 600 to 1200 mg/day.
B-Vitamin Complex. All of the B vitamins can play a leading role in energy production, rejuvenating nerve cells, protecting nerve coverings, and metabolizing proteins, carbohydrates, and essential fatty acids. Dose: 25 mg of vitamins B1 and B2, 50 mg of vitamin B6 and inositol, and 100 to 200 mcg of vitamin B12 b.i.d.
Calcium. It should be given in conjunction with magnesium (approximately a 2:1 ratio). Calcium deficiency can cause muscle cramps. (Shrivastava. et al) Dose: 1,000 to 1,500 mg elemental calcium/day.
Vitamin C (ascorbic acid) and Quercetin. Vitamin C is an antioxidant, an anti-inflammatory, and an anti-allergic. Vitamin C and quercetin can decrease histamine levels. (Johnston et al) Dose: vitamin C, 1 to 3 g/day; quercetin, 400 mg t.i.d.
EFAs (Essential Fatty Acids) - fish oil and evening primrose oil. EFAs are natural anti-inflammatories that can help with muscle and bone inflammation. (Kremer et al) Dose: 1 to 3 g/day. Evening primrose oil should be standardized to contain 8 percent gamma linolenic acid.
Proanthocyanidins (grape seed, Pycnogenal). Proanthocyanidins act as antioxidants, protecting against degenerative diseases. They also have anti-inflammatory and circulatory benefits. (Maffei Facino et al) Dose: 100 mg/day.
St John's Wort (Hypericum perforatum). If depression and anxiety accompany or trigger fibromyalgia episodes, St. John's Wort may be appropriate. It is not to be used in conjunction with antidepressant drug therapy. (Vorbach et al) Dose: 300 to 900 mg standardized to 0.3 percent hypericin.
References
Johnston CS, Martin U, Cal X. Antihistamine effect of supplemental ascorbic acid and neutrophil chemotaxis. J Am Coll Nutr. 1992;11(2):172-176.
Kremer JM, Jubiz W, Michalek A, et al. Fish-oil fatty acid supplementation in active rheumatoid arthritis. A double-blinded, controlled, crossover study. Ann Intern Med 1987;106(4):497-503.
Maffei Facino R, Carini M, Aldini G, Bombardelli E, Morazzoni P, Morelli R, Free radicals scavenging action and anti-enzyme activities of procyanidines from Vitis vinifera. A mechanism for their capillary protective action. Arzneimittelforschung. 1994;44(5):592-601.
Russell U, Michalek JE, Flechas JD, Abraham GE Treatment of fibromyalgia syndrome with Super Malic: a randomized double blind, placebo controlled, crossover pilot study. J Rheumatol. 1995;22(5):953-958.
Shrivastava OP, Chatterji S, Kachhawa S, Daga SR. Calcium gluconate pretreatment for prevention of succinylcholine-induced myalgia. Anesth Analg. 1983;62(1):59-62.
Vorbach EU, Hubner WD, Arnoldt KH. Effectiveness and tolerance of the hypericum extract LI 160 in comparison with imipramine: randomized doubleblind study with 135 outpatients. J Geriatr Psychiatry Neurol, 1994;7 (suppl 1):S19-23.
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