Fibromyalgia (FMS) is a musculoskeletal pain and fatigue disorder that is considered more of a syndrome than a disease, for it appears to have many causes. FMS is difficult to diagnose and has no known etiology. It affects nearly 10 million Americans between the ages of 25 and 60, with women accounting for more than 80% of the cases. Also known as fibromyalisis, muscular rheumatism, neuropathic pain, or myofascial pain syndrome, FMS is characterized by widespread pain involving muscles, tendons, and joints, and is associated with chronic aches, a lowered pain threshold, localized areas of tenderness, diffuse myalgia, poor and non-restorative sleep, and fatigue. There is evidence that FMS can be caused by physical as well as emotional trauma; chronic anxiety or depression; physical or sexual abuse; allergies; high levels of toxicity; Lyme’s disease; and more. People who suffer with the constant pain and fatigue of this baffling phenomenon will testify that it affects their entire lives, their family, their job, and their recreation time.
FMS might be a good example of a disease-like state that should be treated both conventionally and with holistic interventions. Every aspect of the patient’s life must be analyzed including diet, relationships, past history, exercise, body mechanics, and relaxation techniques. Traditional medical treatments do not always effectively reduce the pain of FMS. Unfortunately, some physicians believe that FMS does not even exist; they feel it is all in the patient’s “head” and thus offer little or no hope for those who suffer from the myriad symptoms associated with this illness.
Recent discoveries show that FMS patients might have low levels of serotonin in the brain that affect mood, appetite, libido, and perceptions of pain. Prescription anti-depressant drugs frequently have beneficial effects, as do certain herbs used for depression. FMS patients have low levels of human growth hormone (HGH) which can be linked to muscle weakness, pain, and impaired immune function. They also have high levels of substance P, which intensify the sensation of pain, and low levels of endorphines, which block pain.
Since fibromyalgia is listed as a syndrome and not a disease there are various professional theories as to what the cause may be. There is little doubt in my own research that long-time stressors play a significant role, and as the years and decades roll by the muscles of the individual are severely compromised and actually “tear down” causing pain and inflammation.
Research suggests that other causes may be:
- Emotional/physical/mental stress
- Low thyroid function and/or other endocrine disorders
- Impaired adrenal function (low serotonin)
- Chronic viral, mycoplasma, and/or bacterial infections
- Trauma from an accident, surgery or whiplash-type injury.
- Sleep disorders
- Severe stress situations from a younger age (i.e. abuse, divorce, death of a loved one, illness, father left home, alcohol or drug abuse)
The most frequent symptoms associated with FMS are myofacial pain, insomnia, muscle and joint aches, chronic fatigue, irritable bowel, or a “sore all over” feeling. Other common symptoms include muscle pain of the neck, hips or back; carpal tunnel syndrome; cold intolerance; headaches or migraines; dry mouth or eyes; arthritis pain in joints; bladder infections; increased urination; depression; constipation; anxiety/nervousness; heel spurs; low libido; tendonitis; restless legs; numbness or tingling in extremities; allergy symptoms; and diarrhea.
If a chronic yeast infection is also present, treatment is essential. A high percentage of women with fibromyalgia report a history of antibiotic use and a serious sugar addiction.
The Thyroid Connection
There is always concern with thyroid antibodies when treating FMS patients. There are findings that primary hypothyroidism (inadequate thyroid gland production of thyroid hormone) is the mechanism of fibromyalgia in some 10-15 percent of patients.
The Serotonin Pathway
Serotonin is one of the major neurotransmitters in the body. It plays a role in sleep, pain threshold, vascular constriction and dilation, libido, and the dynamics of hunger. It also plays a dominant role in depression, anxiety, and possibly obsessive-compulsive disorders. These facts have lead to the phenomenal growth of drugs like Prozac, Zoloft, Lexapro and Paxil, which operate as selective serotonin re-uptake inhibitors (SSRIs).
FMS patients have been found to have low serotonin levels. In extensive reviews, both low levels of tryptophan and serotonin in the serum, and low levels of tryptophan and 5-HTP in the cerebral spinal fluid were found. Growth hormone was also found to be low in FMS patients. Growth hormone, normally produced by the pituitary during deep sleep, collaborates with the liver to release DHEA from the adrenal glands.
Stressors Affecting the Thyroid-Pituitary-Adrenal Glands
Research confirms that FMS patients report physical and/or emotional stress as an initiating factor, the “trigger,” in acquiring this syndrome. Severe and continual stress (not only anxiety, nervousness, depression and worry) but any “stressor” that affects the thyroid-pituitary-adrenal glands. These stressors can also be poor sleep, toxins, infections, fear, negative emotions, poor diet, too much caffeine, prescription drugs, aches and pain, disease states, allergies, death of a loved one, over exercise, too little exercise, financial worries, inability to relax, and others may equally be the trigger that inflames FMS symptoms. All physical and/or emotional stressors directly affect these glands (no exceptions). Since these glands are directly responsible for aldosterone (potassium-sodium balance) cortisol production (inflammatory response), sex hormones, and neurotransmitters (depression and “fight or flight” response), it is easy to understand how critical they are in treating FMS patients.
Oxygen Deprivation May be the Culprit
Recent research has shown that people with FMS have capillary walls (capillaries are the smallest of blood vessels that bring blood and oxygen to affected muscles) that become thickened and are unable to deliver enough oxygen to fully meet the needs of the tissue. This lack of oxygen creates localized ischemia, draining energy from muscles.
This slow depletion of energy unleashes a cascade of physiological events that cause mild to severe pain, muscle stiffness, soreness, and overwhelming fatigue. The muscles are in a state of “readiness” which implies a cellular energy deprivation. This lack of cellular energy inhibits the activity of the cellular calcium pumps so that calcium can be adequately discharged from the cell following a muscle contraction. The buildup of calcium in the cells sustains the muscle contraction, keeping it tense. Increases in intercellular calcium causes potassium ions to rush out of the cell activating pain receptors. Continued stress causes continued contraction contributing to more muscle stiffness which exacerbates the drain on energy reserves. Stressors need not be only from emotional or psychological problems, but can be from stress due to infections, toxins, heavy metals, fear, poor diet, allergies, lack of exercise, or a myriad of other adrenal stressors.
In time, the poor bioenergetic status of muscles in the fibromyalgia syndrome may be due to reduced blood flow in the affected tissue, which in turn limits the production of ATP (the energy production in the cell).
CONVENTIONAL and HOLISTIC TREATMENTS
Patients should be advised that FMS is a chronic condition with an ever-changing course that has no apparent cure. FMS is almost always exacerbated by stress and anxiety, but it has no link to death, morbidity, or damage to organs.
Exercise is an important aspect of total treatment. Low-impact aerobic exercises, yoga and other stretching exercises, swimming, and walking are helpful. However, patients should be careful not to overdo it, because too much physical activity will often cause a flare-up of symptoms.
Trigger Point Injections
A local anesthetic (with either lidocaine, corticosteroids, or a combination) can be injected into tender points by a physician.
Often the use of tricyclic antidepressant drugs (amitriptyline or nortriptyline) and/or selective serotonin reuptake inhibitors (SSRIs) such as Paxil, Prozac, Zoloft, and Wellbutrin may help certain FMS patients. These drugs often decrease initiating depressed and anxious feelings which can trigger FMS symptoms. Thyroid-replacement therapy may be helpful to FMS patients due to adrenal stress that may contribute to hypothyroidism.
Food allergies can frequently play a negative role in the improvement of FMS symptoms. Dairy products, white flour, and refined sugar may affect the patient, particularly when irritable bowel syndrome is associated with FMS symptoms. Identifying foods that the patient may be allergic to can significantly help.
Rest and relaxation
Rest and relaxation, along with exercise, are crucial. Gentle massage can be helpful.
A complete bowel and liver detoxification once or twice a year may rid the body of heavy metals and other environmental toxins. Silver amalgams which contain 50% mercury may be removed from the teeth. Toxic cleansers should be removed from the home, and the use of perfumes and colognes should be minimized as they are petroleum-based and have strong odors.
Light therapy is typically used to treat depression, especially seasonal-affective disorder (SAD). Light therapy has also demonstrated sleep-regulating activity.
This treatment is widely used in the Far East, India, and Cuba to promote health and reduce pain.
Diet can play an exceedingly important role in decreasing the symptoms of FMS. The diet should be more “vegetarian” in nature (try to eat organic), since plant foods, fruits, and whole grain foods are much less inflammatory in the body. Reducing animal fat, junk food, dairy products, refined carbohydrates, poultry, shellfish, red meat, white flour, coffee, and tea is helpful. It is important, though, for the FMS patient to have adequate protein. The best sources may be soy, tofu, chicken, cold-water fish, buckwheat and eggs.
Decreasing acid-forming foods like soda pop (cola), alcohol, caffeine, sugar-laced drinks, citrus fruits, MSG, chocolate, and coffee is critical. More alkaline foods should be introduced into the diet, including legumes, oats, buckwheat, leafy green and yellow vegetables, whole grains, nuts, soy, and starches.
The need to eliminate and/or desensitize food allergies is important. The most common food allergies are to dairy products, wheat gluten, eggs, corn, sugar, and peanuts. Drink 4-8 glasses of pure, filtered water each day. Minimize drinking anything else, except for pure fruit juices. Coffee, tea, iced tea, and milk should be consumed in moderation.
Foods that are high in tryptophan may be beneficial to the FMS patient because there is a link between low tryptophan and the syndrome. Foods high in tryptophan include spirulina, soy nuts, pumpkin seeds, turkey, tofu, almonds, and watermelon seeds.
Diet Do’s and Don’t by Shirley Mitchell
Shirley Mitchell from Maple Ridge, British Columbia, Canada, was a fibromyalgia sufferer for many years. Here is her list of “do and don’t” foods to treat this painful syndrome.
DO: Rye bread 100% only, rice, corn pasta, rice and rye crackers, soy milk, goat milk and cheese, cranberry and grape juice, corn flakes, barley, rolled oats, apples, bananas, pears, figs, pineapples, yams, carrots, broccoli, romaine lettuce, cauliflower, celery, onions, peas, corn, lentils, green beans, avocados, mixed nuts, salmon, herring, oil sardines, ginger, curry, cayenne peppers, garlic, cherries and limited eggs and chicken.
DON’T: Butter, cow’s milk, cheese, yogurt, wheat, alcohol, beer, red meat, pork, tomatoes, potatoes, cucumbers, fried foods, grapefruit, oranges, lemons and sugar.
- MAGNESIUM and MALIC ACID
Magnesium is low in most chronic illness sufferers, in-patients with auto-immune diseases, migraines, and muscle problems. Magnesium is critical to the treatment of fibromyalgia. Magnesium should be found in high concentrations in muscle cells, as it is required for the production of ATP (the energy substance) in muscle cells. Magnesium is involved in immune support and is critical for the relief of muscle pain. Raw apples are natural sources of malic acid. Malic acid is a powerful detoxifier of aluminum and has been shown in clinical studies to reduce the pain associated with FMS. Dosage: Magnesium 400-1,000 mg daily (be careful of loose stools with higher doses); Malic acid 1,200-2,400 mg daily.
- B-COMPLEX VITAMINS
These are especially important to restore the energy production needs of the body, as well as to enhance mental functions. B-complex vitamins also help to regenerate nerve, blood, energy, and hair cells. Studies have demonstrated that people with FMS or chronic fatigue are often deficient in many of the B vitamins, which tends to worsen their symptoms of fatigue and ultimately lead to a weakened immune system. Research has found that levels of B12 are low in the cerebrospinal fluid of fibromyalgia and chronic fatigue syndrome patients. Dosage: 50-100 mg of most B vitamins daily; vitamin B12, 1,000 mcg daily (prefer B12 injections 1-4 times a month).
- COENZYME Q10
Coenzyme Q10 is a powerful antioxidant that is needed by the body to oxygenate tissues, improve immune function, and protect the heart. Coenzyme Q-10 supplementation may increase the patient’s energy level, muscular weakness, and associated heart problems. Dosage: 90-200 mg daily.
- HIGH POTENCY MULTIPLE VITAMIN/MINERAL with GREEN FOODS
Supplementing with a potent multiple vitamin/mineral formula can have a powerful nutritional effect for people with FMS and chronic fatigue. The “superfoods” (i.e. chlorella, spirulina, wheat grass, kale, blue-green algae) are effective antioxidants as well as good sources of dietary fiber. Super foods are alkaline (versus acidic) foods that help to balance the body’s pH level. They increase interferon levels and help rid the body of heavy metals. They are effective in FMS and rheumatoid arthritis. Dosage: As directed on package.
This amino acid converts to serotonin and helps relieve depression. Since low serotonin levels have been observed in FMS patients, supplementation with 5-HTP has resulted in significant improvements in the reduction of pain, morning stiffness, fatigue, insomnia, and anxiety. Dosage: 50-100 mg up to 3 times daily, more specifically at night. NOTE: A tolerance can be quickly developed for this amino acid. Do not take for more than one month without a short break, then resume. See a qualified health practitioner
- ST. JOHN’S WORT
St. John’s wort is reported to increase serotonin levels in the brain, thereby reducing the symptoms of depression. Dr. Michael Murray, ND, recommends St John’s wort combined with 50-100 mg 5-HTP and magnesium (250-500 mg). Do not take with prescription antidepressant drugs. Dosage: 300 mg 1-3 times a day.
Most people with FMS also suffer from alpha-EEG anomaly, a sleep disorder in which the individual’s deep sleep periods are interrupted by bouts of waking-type brain activity, resulting in poor sleep quality. Melatonin taken at bedtime has been found to reduce tender points and improve sleep.
The general health benefits from antioxidant nutrients have been well established for FMS patients. VITAMIN C enhances immune function by increasing natural killer cells. VITAMIN E helps to relieve pain and night-time leg cramps that interfere with sleep. The use of QUERCETIN, BETA CAROTENE, LYCOPENE, GREEN TEA, INOSITOL, SELENIUM, GRAPE SEED EXTRACT, ALPHA-LIPOIC ACID, PYCNOGENOL, and BROMELAIN in combinations can be beneficial. Dosage: As directed on each supplement’s label.
- SAMe (S-ADENOSYLMETHIONINE)
Patients taking SAMe have found anti-inflammatory, pain-controlling, and antidepressant properties. SAMe can reduce disease activity, pain, fatigue, and morning stiffness, and produce mood elevation within 6 weeks. Dosage: 200-800 mg daily. No adverse effects are reported.
- GLUCOSAMINE and CHONDROTIN SULFATE
The musculoskeletal system is comprised of the muscles, the bones, and the joints. FMS is often called the soft tissue arthritis. The use of glucosamine and cartilage hydrolysates (chondroitin sulfate) in the nutritional treatment of arthritic conditions has been well documented. Glucosamine improves inflammatory conditions as well as acting as a free-radical scavenger. Dosage: 500-1,500 mg daily.
Ribose is a simple carbohydrate that plays a role in high-energy phosphate and nucleic acid synthesis. Supplemental ribose has been shown to enhance and rebuild depressed energy pools in both the heart and skeletal muscle after any physical insult (exhaustion). Ribose has been shown to improve the energy recovery time to relieve muscle fatigue, stiffness and soreness. Dosage: As directed on package.
- GINGKO BILOBA
This ancient herb is helpful in improving circulation and brain function. In one study, combining gingko and coenzyme Q10 resulted in progressive improvement in the quality-of-life scores of thousands of patients. At the end of the study, 64% claimed their symptoms improved (whereas only 9% reported feeling worse). Dosage: 60-180 mg daily.
- ADRENAL GLANULARS
Adrenal glanulars (bovine) contain adrenal nucleoprotein, enzymes, polypeptides, which have been shown to enhance glandular function. These products (together with vital synergistic nutrients such as vitamin C, selenium, zinc, licorice and B-complex) will improve adrenal function, increase energy, and relieve stress on the thyroid gland. Dosage: See a qualified practitioner before beginning glandular therapy.
- CALCIUM (Citrate preferred) with VITAMIN D3
Calcium and vitamin D supplementation helps to regulate the immune functions of the cells in the body. They are best taken in combination with magnesium. Vitamin D3 deficiency is a common consequence of fibromyalgia. Dosage: Calcium 800-1,500 mg daily. Vitamin D3 400-1,600 IU daily.
- PROBIOTICS and PANCREATIC ENZYMES
Probiotics (i.e. acidophius, lactobacillus) are useful for treating irregular bowel flora (causing diarrhea, flatulence, or constipation) and mal-digestion. Fructooligosaccharides (FOS) provides nutrition for good bacteria in the intestinal tract and healthy microflora. Pancreatic enzymes help to break down protein, improve digestion and increase gastric-emptying. If Irritable Bowel Syndrome accompanies fibromyalgia, herbal remedies may include CAT’S CLAW and/or OLIVE LEAF EXTRACT.
- OMEGA 3, 6 FATTY ACIDS
Omega essential fats, especially fish oil, flaxseed, and primrose oil, have anti-inflammatory, mood-regulatory, energy-enhancing, and joint-lubricating properties. Evening primrose oil is usually recommended for FMS. EPO may be combined with cod liver oil (containing vitamin A & D). Dosage: 1,000-4,000 mg daily.
- MSM (powder or capsules)
MSM can be especially helpful for pain and inflammation. MSM is an exciting new treatment for FMS, rheumatoid arthritis, allergies and asthma. It is a natural, organic form of sulfur with few side-effects. Sulphur is concentrated in the skin, bones, and muscles and is needed to produce collagen. Dosage: Ranges from 1-6 capsules (500- 6,000 mg) a day as needed for the severity of symptoms. Take in combination with vitamin C to maximum effect. Sometimes MSM is combined with BOSWELLIA, a traditional Ayurvedic herb, to enhance anti-inflammatory effects.
Rhodiola is an adaptogen herb (it helps the body adapt to stress) that is used in Europe and Asia to alleviate the fatiguing effects of stress and increase feelings of well being. Dosage: 100-400 mg daily.
- GROWTH HORMONE
Growth hormone deficiency shares many features of fibromyalgia. According to one review, 30 percent of patients with FMS had low levels of growth hormone. Dosage: As directed under the supervision of a qualified practitioner.
- NONI JUICE
This “miracle fruit” from the South Pacific has healing benefits by improving the delivery of oxygen to the cells. Noni is believed to increase energy, vitality, stamina, and physical endurance. Dosage: One or two ounces daily.
- CYSTEINE and DERIVATIVES
The combination of abnormally low plasma cysteine and glutamine in combination with muscle fatigue and skeletal muscle wasting, are common conditions in fibromyalgia and chronic fatigue syndrome, Crohn’s disease, ulcerative colitis, and cancer. Cysteine plays a crucial role in the prevention of skeletal muscle wasting and fatigue conditions. Dosage: As instructed.
NADH is short for nicotinamide adenine dinucleotide, an activated form of vitamin B3 (niacin). NADH is required by the body to create chemical energy. NADH is a coenzyme proven to enhance energy and has powerful antioxidant activity. Dosage: 2.5-5 mg daily.
This Chinese herb improves oxygenation of the tissues and adrenal cortex response. Increased adrenal response will stimulate more cortisol which should increase energy. Dosage: 250-750 mg daily.
A patent has been issued for the use of certain creatine preparations for treatment of fibromyalgia and other types of myopathy. Dosage: As directed on package.
- CORDYCEPS MUSHROOMS
This well-known Chinese medicine has qualities similar to ginseng. Cordyceps is a valued fungi proven to boost a weakened immune system and increase energy and endurance. Dosage: As directed on package.
Acupuncture treatment of patients with FMS has been associated with decreased pain levels.
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