Fibromyalgia is a syndrome that overall is characterized by diffuse pain and overwhelming fatigue that can be debilitating. There are several characteristics of the fibromyalgia syndrome (FMS). They can include:
Significant joint and muscle pain. Health professionals have identified “trigger points” that are present throughout the body that can elicit pain in particular areas when mild pressure is applied. The affected person with FMS can complain of pain all over the body.
Significant fatigue, especially with moderate physical exertion. Some people report requiring days to recover from what some may consider to be only mild physical exertion.
The person can complain of being unable to get a good night’s sleep.
The person may complain of frequent headaches and may also suffer from depression
Recurrent abdominal pain, diarrhea and/or constipation which may be due to associated Irritable Bowel Syndrome (IBS)
What causes Fibromyalgia Syndrome (FMS)?
The specific cause of fibromyalgia is not known; however, the development of FMS has been typically thought to occur after a significant “stressor.” The stressor may involve a recent illness, including any recent physical or psychological trauma. For some people, the stressor can be as simple as taking an antibiotic that can alter the bowel flora and precipitate a flare of FMS. The role of Candida overgrowth needs to be considered as a significant contributor to the development of FMS.
There has been a lot of research done on the pain receptors in the body. These receptors may do more than just modulate pain; they may also have a role in the development of FMS but also autoimmune diseases/rheumatologic syndromes.
Is Fibromyalgia Syndrome an autoimmune condition?
No, Fibromyalgia Syndrome is NOT an autoimmune condition. Note, however, that FMS may occur on its own but can also occur in the presence of other autoimmune diseases.
What other medical conditions are associated with FMS?
Fibromyalgia can be strongly associated with many other conditions. They can include:
Rheumatoid Arthritis (RA)
Systemic Lupus Erythematosus
Adrenal Fatigue (There is a very close relationship with this condition)
Gastroesophageal Reflux Disease (GERD)
Irritable Bowel Syndrome (IBS)
Interstitial cystitis (IC)
What are the conventional treatments for FMS?
The conventional treatments for FMS involve trying to lessen the pain and disability associated with this condition. Commonly prescribed medications include:
Pregabalin (Lyrica): This medication works by treating nerve and/or muscle pain and is indicated by the FDA for the treatment of FMS. This medication is usually dosed 75 mg twice a day with dose adjustments needing to be made if kidney disease is present.
Side effects can include lethargy, weakness, swelling and allergic reactions.
Duloxetine (Cymbalta): This is a medication also used for the treatment of pain, including nerve pain. It has been used in the treatment of depression as well.
Potential side effects can include drowsiness, easy bruising, decreased appetite and/or constipation.
Tricyclic antidepressants have also been used in the treatment of not only pain but also of depression. Other antidepressants, including Fluoxetine (Prozac) and Sertraline (Zoloft), have also been studied not only for the treatment of depression but also for pain with fibromyalgia.
The medications can have what is called “anticholinergic” side effects which can include dry mouth, constipation, and urinary retention.
Developing a Holistic Treatment Plan for Fibromyalgia Syndrome (FMS)
The treatment of Fibromyalgia Syndrome (FMS) involves an integrative treatment plan that involves treating mind, body, and spirit. Only using prescription medications is simply not enough for the treatment of this condition. The treatment plan includes correcting nutrient deficiencies, treating pain and inflammation, searching for underlying causes of FMS, evaluating for hormonal imbalance, as well as treating the person so she can get a good night’s rest.
Getting a Holistic Based Evaluation
If you have fibromyalgia syndrome (FMS), you need a detailed and personalized evaluation. This means looking for and identifying any causes of inflammation and potential infections, including Lyme disease. In addition, you should ask your healthcare provider about the following:
Hormonal Analysis: Fibromyalgia can be associated with many hormonal imbalances, including decreased levels of the hormones by the adrenal gland (adrenal fatigue). These can include sex hormones. Low hormone levels can also contribute to fatigue and insomnia among others.
The testing mentioned above is a combination of blood, urine, and saliva testing.
Testing for nutrient deficiencies and toxicities: There are some personalized profiles, including hair analysis that should be considered.
Forming a solid nutritional plan is vital as those with FMS may be nutrient-depleted. The pain can be so debilitating that one may not feel like eating. It can be very difficult to eat three meals a day. If the food that one is eating is low in nutritional value and is high in Omega 6 content, this can promote further inflammation and pain. Without proper nutrition, your body will not be able to heal. Modifying your diet and supplementation of the correct nutrient deficiencies are key in the treatment of FMS. Your diet should have high antioxidant and high nutritional value.
A diet that is plant-based in nature and emphasizes fruits and vegetables and whole grains is necessary in the treatment of fibromyalgia. You want to as much as possible eliminate refined foods from your diet. Be aware of any food sensitivities that you may have that can exacerbate underlying inflammation and pain. Any food has the ability to stimulate an inflammatory response. One of the most common examples of this is gluten in celiac disease. On an anti-inflammatory diet, all possible sources of food sensitivities are eliminated and then reintroduced one at a time.
Another way is to have your blood tested for food sensitivities.
Be aware that different foods, even among fruits and vegetables, can have different degrees of inflammation. There is a great site at www.nutritiondata.comthat has an inflammatory index that can tell you the inflammatory power of the foods that you are eating. You want to focus on foods that have a high anti-inflammatory index.
Other Nutritional Recommendations:
Stay away from sugar: Sugar can be a potent source of inflammation. Eliminate this from your diet, and you can see a change in how you feel as well. Sugar can also promote Candida overgrowth in the intestine which stimulates an inflammatory response via mycotoxins.
Juicing in the morning is a great way to start the morning and get a great anti-oxidant kick to start your day.
Promoting Intestinal Health:
You read about the connection between Irritable Bowel Syndrome (IBS) and Fibromyalgia Syndrome (FMS). Maintaining a healthy intestinal tract reduces total body inflammation and is very important in the treatment of FMS. This aspect in the treatment of FMS is not emphasized enough. The microflora of the intestinal tract plays such an important role in the modulation of the immune system. Altered gut flora can play a major role in your ability to absorb nutrients, and it can contribute to fungal overgrowth.
Probiotics: These should be a mainstay in any inflammatory condition. They can normalize the bowel flora and replace the bad bacteria with the good intestinal microflora. Studies specific to their benefits in FMS have been mixed, but they do have an effect on immune system modulation and are often included in any anti-inflammatory regimen. In one review article from the Journal of Clinical Gastroenterology, the use of probiotics provided adequate relief in the treatment of diarrhea-predominant IBS.
Digestive enzymes: Consider the use digestive enzymes to help digest food completely which helps in absorption. The ability to maximally absorb nutrients can be affected in those with chronic inflammation.
Fiber: Don’t forget the importance of including fiber in your nutrition program. Not only is it vital for overall bowel health but it can also “bind up” toxins in the intestine and help eliminate them from the body.
There are different supplements that have a role in the treatment of Fibromyalgia Syndrome. Supplements can help increase energy to the cell and the body, reduce pain and inflammation, help you get a good night’s sleep, and provide nutritional value.
Supplements that Boost Energy to the Cell
D-ribose: There are studies concerning fibromyalgia that tout the energy boost of D-ribose. D-ribose increases the energy to all of the cells of the body, especially the muscle cells. Supplementing with D-ribose can provide your heart with the energy boost that it needs.
D-ribose commonly comes in capsule or powdered form. The powdered form is preferred as you can add it to your morning drink.
The recommended starting dose is 2500 mg. Increase by 2500 mg every few weeks to reach a maximum dose of 10,000 mg.
Even though ribose is a “sugar” it will not raise blood glucose levels. Higher doses than 10,000 mg can cause diarrheal symptoms in some people.
Coenzyme Q10 (Ubiquinone): Replacement of this antioxidant can help improve fibromyalgia symptoms. It has been reported that those with fibromyalgia as well as other chronic illnesses can have lower than normal levels of ubiquinone in the body.
Begin with low doses at 50-100 mg daily and increase to twice a day after several weeks. Smaller doses taken during the day maximizes its absorption.
As ubiquinone can lower blood pressure, you need to closely monitor your blood pressure. If you have diabetes, monitor your blood glucose levels as ubiquinone can lower blood glucose levels as well.
Supplements that Help Boost Nutrition:
Magnesium: The role of low magnesium levels in the body and its importance in inflammation, pain, and fatigue is being researched. In one review article, the authors noted lower levels of zinc and magnesium than in the control groups. Magnesium supplementation is necessary to help counteract the fatigue and pain associated with fibromyalgia. Certain medications, such as diuretics, can lower your magnesium levels. There are several ways to increase your magnesium intake:
Increase the amount of leafy green vegetables, seeds (sunflower and sesame for example) and nuts (almonds and Brazil nuts for example) which contain a lot of magnesium. You should strive to at least consume 600-800 mg a day.
If needed, magnesium can also be supplemented either orally or in a gel or oil formulation applied directly to the skin. Chelated magnesium is a form of magnesium taken orally without the heavy metals. This can be started once a day and increased to twice a day for a total dose of 400-600 mg. Note that very high doses of magnesium can cause diarrhea. Magnesium Malate is a form of magnesium that is very well absorbed.
An alternative is to apply Magnesium gel or oil to your skin once or twice daily. If you have been told that you have kidney problems, you may need to have blood levels of your magnesium level followed and limit your magnesium intake.
Vitamin D: The role of Vitamin D deficiency in the development of fibromyalgia is being evaluated; however, in one research article it was noted that in evaluating over seventy-five patients who had been diagnosed with fibromyalgia, over two-thirds had low or low-normal Vitamin D levels. The authors of this study also noted that occurred very frequently in those patients with depression and anxiety. Don’t forget that Vitamin D supplementation is vital for your overall bone and muscle health.
Ask your healthcare provider to measure a Vitamin D level, which is a simple blood test.
Begin Vitamin D3 at 1000 Units daily with food. Because it is a fat soluble vitamin, it is better absorbed with food.
Vitamin C: Remember that Vitamin C is an antioxidant; in terms of cellular health, because it is an electron donor, it helps to reduce oxidative stress and keep the cells in a reduced or natural state. We think that supplementation with Vitamin C may be beneficial. In one small study, 12 individuals with fibromyalgia were given a combination of 100 mg of Vitamin C and broccoli powder. They were closely followed over a period of one month. By the end of the month the participants in the trial reported an improved quality of life and reduced sensitivity to pain. Deficiency of this vitamin can directly impact adrenal health, and FMS can cause a lot of stress on the adrenal glands and is strongly associated with the development of adrenal fatigue, which is strongly associated with Fibromyalgia Syndrome.
The ester form of Vitamin C is better absorbed than other formulations.
Vitamin C at a dose of 2000 mg a day is a good starting dose.
Supplements that Relieve Pain and Inflammation:
Bioflavonoids: Good antioxidant support is vital in the treatment of Fibromyalgia. Bioflavonoids are excellent antioxidants that can relieve pain and inflammation. Bioflavonoids that have been studied in the treatment of fibromyalgia include turmeric and quercetin. Quercetin may be especially effective as it has antioxidant, anti-inflammatory and anti-allergenic properties.
Turmeric can be taken as a 400 mg capsule daily or as a powder that can be sprinkled on each meal.
Quercetin can be taken as a capsule. Usual starting dose is 500 mg a day.
Wobenzym N: This is an enzyme supplement that is used in the treatment of inflammation and pain. Enzymes in this supplement include bromelain (from pineapple) and papain (from papaya).
If you have allergies to pineapples or papaya, do not take this supplement.
It is best taken on an empty stomach; be aware that you may need to take 6-12 tablets a day for an inflammatory response.
Morinda citrifolia (Noni): This is a tropical plant from East Asia that has been used for many years. It has anti-inflammatory properties and can help in the treatment of pain.
Noni can come in capsule or juice form. If you take the juice form, begin at 1 ounce twice a day and increase slowly to 4-6 oz a day.
Some forms of Noni can have a high potassium content so if you have kidney disease you need to be mindful of this.
Extremely high doses of this may have an adverse effect on the liver, although this is controversial. The several ounces a day that we mention here is very low dosage of this supplement.
Supplements That Can Help You Get a Good Night’s Sleep:
Melatonin: Melatonin is a natural hormone that is helpful in helping you achieve a good night’s sleep. In those with FMS, one research article points out that melatonin levels are lower at night when sleeping compared to someone who does not have fibromyalgia. Supplementation with melatonin may also help pain in addition to improving the quality of sleep.
Start at low doses of 1-2 mg each night before going to sleep each night and increase slowly.
Valerian root: This is an herb that can help you get a good night’s rest. There have been several studies examining the efficacy of valerian root in the treatment of insomnia. In one review, the authors concluded that while further study was needed, valerian root seemed to able to improve the quality of sleep without experiencing any significant side effects.
Carefully Developing an Exercise Program
You need to be very careful when designing an exercise program. Strenuous activity and/or high intensity exercise can actually be counterproductive in someone with fibromyalgia. This does not mean that you will not be able to tolerate any and all exercise regimens. It means that you need to be careful, start slowly, and find out what your own limits are and increase very slowly and carefully. Meditative-based exercises can be very beneficial for someone with fibromyalgia.
Yoga: Yoga is a great way to increase muscle endurance and flexibility. It is important to start slowly and work with a certified instructor to learn the right way to do each exercise. Yoga is especially effective if started in the early stages of this condition.
Tai chi is another great meditative-based exercise that should be incorporated into your regimen.
Muscle Resistance Training: Whether you are using free weights or machines, you need to start with very low weight and lower repetitions. You need to know your limits. A good rule of thumb is to exercise until you begin to experience mild fatigue, but don’t push beyond that point. If you do, again, it can be counterproductive and you can feel worse the next day.
In addition to the exercise regimen mentioned above, you should also consider seeing someone who is holistically trained in helping you regain more function and flexibility. This can include seeing a structural integration specialist, chiropractor, and/or specialist in osteopathic manipulation. In general, gentle myofasical/massage techniques are preferred as again you may not be able to tolerate a deep massage.
Being Mindful and Spiritual
An important aspect of healing with fibromyalgia is recognizing the connection between mind, body and spirit. The mental and emotional aspects of treatment cannot be ignored.
Daily meditation is vital to calm the mind and body.
Daily prayer can help relax the mind and body.
FMS is often associated with trauma, especially emotional trauma. Helping one to recover from emotional trauma is essential to recovery. Talking with a counselor or advisor can be very helpful.
The role of family and friend support cannot be emphasized enough.
Armstrong DJ, Meenagh GK et al. “Vitamin D deficiency is associated with anxiety and depression in fibromyalgia.” Clinical Rheumatology. 2007 Apr;26(4):551-4.