Fibromyalgia, sometimes referred to as Fibromyalgia Syndrome or FMS, is a chronic pain syndrome characterized by muscle aches, general pain, and fatigue. The muscle aches, called myalgias, are usually diffuse and felt throughout the body. Fibromyalgia affects approximately 10 million people in the United States. Worldwide, more than 100 million are affected, ninety percent of which are women. Studies show 68 percent of those with fibromyalgia have tried nutritional supplements to help with their symptoms.
Conventional medicine has not yet discovered the specific cause of fibromyalgia. Many integrative and functional medicine doctors believe that the problem lies within the mitochondria, or the power houses of our cells. A 2011 case report of a patient with a mitochondrial disease, who was initially diagnosed as having fibromyalgia, supports this.
While the cause of fibromyalgia is considered by many to be unknown, it is known that patients affected from FMS have 40 percent less coenzyme Q10 in their blood and decreased antioxidant activity.
Those with FMS also have a decreased quantity of mitochondria in their blood cells. Mitochondria are parts of our cells which give us energy by making the energy molecule Adenosine Triphosphate (ATP). Other researchers have noted that a bacterial overgrowth in the small intestine (known as SIBO or small intestinal bacterial overgrowth) is present in 90-100 percent of patients with fibromyalgia. Many experts believe that SIBO, leaky gut and low production of co-enzyme Q10 may be involved in the cause of fibromyalgia.
Patients with fibromyalgia frequently have other associated conditions. These include migraine headaches, irritable bowel symptoms (bloating, abdominal pain, diarrhea and/or constipation) and interstitial cystitis. Poor sleep or insomnia is also a common complaint.
Over the last 100 years, thousands of chemicals have been created by companies and discarded into our water supply, air, and even home environments. With many of these chemicals, we still have almost no idea how they affect us. However, we do know that many have negative health consequences, and fibromyalgia is likely one of them. Each and every person has toxic chemicals in their bodies—there is no way to completely avoid it. However, we can try to minimize the long-term effects of chemical exposure. Detoxifying the body is crucial to strengthening the body so it heals. Learn more about detoxifying the body.
Many with fibromyalgia have been diagnosed with Irritable Bowel Syndrome (IBS). The evidence suggests that gastrointestinal issues may actually be the cause of fibromyalgia and not simply associated. Studies suggest that Leaky Gut Syndrome, or Small Intestinal Bacterial Overgrowth (SIBO), plays a role in fibromyalgia. In 2004, Dr. Mark Pimentel demonstrated in his study that patients with more bad bacteria in their gut had more pain associated with their fibromyalgia. Dr. Alex Vasquez has also reported that the LPS (Lipopolysaccharide) protein from these bacteria, when injected into a person, could reproduce the pain patients with fibromyalgia experience.
Avoiding processed food is extremely important with any chronic condition. Processed foods have chemicals that are foreign to the human body (xenobiotics) and have effects on us that we don’t quite understand. These include food preservatives and food dyes.
Consuming a diet high in fruits and vegetables is a good place to start. If possible, pesticide-free (organic) fruits and vegetables should be purchased. Also, consume meat that is primarily grass-fed, antibiotic free, and hormone free. While this may be more expensive up front, there is a potential for cost savings if it helps prevent chronic health conditions and improves one’s quality of life.
Artificial sweeteners and MSG should also be avoided. Aspartame (Nutrasweet) has been reported to induce not only migraine headaches but is associated with other neurologic issues. Studies have shown improvement in fibromyalgia symptoms in those who were sensitive to aspartame and MSG (monosodium glutamate) when these chemicals were eliminated from the diet.
A 2017 study in Nutricion Hospitalaria demonstrated that those with fibromyalgia who consumed a low FODMAP diet had reduced pain associated with fibromyalgia. A low FODMAP diet can frequently help improve digestion in those with IBS and leaky gut.
Exercise has been shown to be helpful for those with fibromyalgia. Various studies have confirmed that aerobic exercise helps reduce pain levels while also improving overall functional capacity. Exercise helps improve mitochondrial health.
In my opinion, use of medication should be a last resort, only after sufficient diet and lifestyle changes are made and prove insufficient. Medications are not designed to “cure” fibromyalgia but to allow you to live comfortably while taking the medication indefinitely.
Fibromyalgia Federal Drug Administration (FDA) approved medications include:
Duloxetine (Cymbalta) – 60 mg per day. Cost in the US is $320 for a 1 month supply
Pregabalin (Lyrica) – 150 mg to 225 mg twice per day. Cost range in the US is $415 to $445
Milnacipran (Savella) – 50 mg twice per day. Cost in the US is $397
Other NON-FDA approved drugs frequently used include gabapentin, amitriptyline, fluoxetine. These medications are generic and less expensive and show similar benefit.
Fibromyalgia is frequently treated with narcotics (opiates) despite absolutely no evidence of benefit. Narcotics may actually be more harmful and appear to increase overall pain levels in the long run. Opiates include tramadol, fentanyl, hydrocodone, oxycodone and morphine.
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According to the American College of Rheumatology “Though not recommended as the first treatment, tramadol may be used to treat fibromyalgia pain. This painkiller is an opioid narcotic. Doctors do not suggest using other opioids for treating fibromyalgia. This is not because of fears of dependence. Rather, evidence suggests these drugs are not of great benefit to most people with fibromyalgia. In fact, they may cause greater pain sensitivity or make pain persist.” |
Various supplements have been shown to be helpful alleviating the symptoms of fibromyalgia. Many take one supplement at a time, do not notice a difference, then stop taking it. Supplements can have a synergistic effect. Those who are successful frequently start with one supplement, add a second and perhaps a third until they notice an improvement. Above all, it’s important to focus on diet and lifestyle changes as discussed above.
Vitamin D – A common symptom of vitamin D deficiency is muscle aches and muscle pain. Studies show that those with fibromyalgia have lower vitamin D levels when compared to controls. A 2017 study in Clinical Rheumatology showed that those with fibromyalgia had less pain when vitamin D was replaced. Many other studies have shown similar findings. Correcting vitamin D deficiency is crucial before diagnosing fibromyalgia since low vitamin D also causes muscle aches. Suggested dose: 2,000 IU- 5,000 IU daily. Learn more about vitamin D.
Magnesium – Studies show magnesium, a natural muscle relaxer, can be helpful in those with fibromyalgia. A 2013 study in Rheumatology International showed that oral magnesium citrate reduced pain in those with fibromyalgia. Further, a 2015 study in the Journal of Integrative Medicine demonstrated that when magnesium chloride was applied to the skin, there was a reduction in pain. Some studies have also shown that a combination of magnesium and malic acid could be helpful. Magnesium is available in capsules, sprays, and lotion formulations. Suggested oral dose: Magnesium chelate 125 mg to 500 mg or as directed on label.
Melatonin – Melatonin is the sleep hormone secreted each night by the pineal gland. This hormone has antioxidant benefits in addition to promoting restful sleep. A 2016 study in Pain and Therapy demonstrated that melatonin could help reduce pain due to fibromyalgia. A 2015 study showed similar benefits. Suggested dose: Melatonin 3 mg to 10 mg each night.
Co-enzyme Q10 – Mitochondrial dysfunction is a popular theory for the cause of fibromyalgia and likely contributes to its symptoms. A 2012 study in PLOS ONE demonstrated that fibromyalgia patients were low in coenzyme Q10, and that supplementation helped reduce headaches in those patients. A study from Spain found women with fibromyalgia who took CoQ10 at a daily dose of 300 mg noticed an improvement in their symptoms. Suggested dose: CoQ10 100 mg to 300 mg daily
SAM-e – There is a double-blind placebo-controlled study from 1991 which showed that SAM-e could be helpful in those with fibromyalgia. Suggested dose: SAM-e 800 mg per day.
Thiamine (Vitamin B1) – A few studies have shown the benefit of thiamine for fibromyalgia patients. In 2013, a BMJ Case Reports study showed improvement of fibromyalgia symptoms when thiamine supplementation was started at 300 mg per day and increased up to 1800 mg per day.
5-Hydroxytryptophan (5-HTP) - A 1990 study in the Journal of International Medical Research showed that 5-HTP could improve symptoms of fibromyalgia. A 1992 study showed similar benefit. Suggested dose: As directed on the label.
L-carnitine - This supplement can be helpful and may reduce pain-related symptoms in fibromyalgia syndrome according to a 2007 study. Suggested dose: As directed on the label.
Spirulina - A small study showed that spirulina may be helpful reducing symptoms of fibromyalgia. This is possibly due to its prebiotic (food for the intestines' good bacteria) capacity and its ability to detoxify the body from toxins.
Essential oils can be applied topically to painful muscles and joints. The recommended oils for fibromyalgia include frankincense, wintergreen, lavender, rosemary, clove and chamomile. Learn more about essential oils and their benefits.
Massage, yoga, acupuncture, qigong and Traditional Chinese Medicine (TCM) are other therapeutic pathways those with fibromyalgia have undertaken to help improve their quality of life and should be included on your journey to wellness.
Overall, fibromyalgia is a very difficult condition that causes suffering for many people. The most important thing is to restore balance and seek health. Avoiding foods which make the condition worse is advised and consuming a diet rich in fruits and vegetables is also strongly encouraged. An elimination diet could also be helpful—start by eliminating dairy, gluten, and corn-based products. Narcotics may make a person feel better but long-term, make fibromyalgia pain worse. Studies have proven exercise is helpful, likely due to its production of additional mitochondria and ability to reduce chronic inflammation. Supplements may also be very helpful. Consider starting with vitamin D replacement first, then add an additional supplement every one to two weeks until your symptoms improve. Eat healthy, think healthy, and be healthy.
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