The butterfly and the purple ribbon are the most commonly recognized symbols for fibromyalgia. Fibromyalgia is a syndrome characterized by generalized musculoskeletal pain and stiffness, chronic aching, fatigue, and multiple areas of local tenderness that can be identified during physical examination. Research studies suggest that fibromyalgia pain may be the result of a combination of factors affecting the activity of muscle cells and the central nervous system. A natural approach that incorporates nutritional support for the body processes implicated in the pathogenesis of fibromyalgia holds great promise for this chronic syndrome.
Fibromyalgia (FM) is a syndrome that presents with concurrent signs and symptoms characterized by fatigue; widespread musculoskeletal pain; and tenderness at specific sites in the neck, spine, shoulders, and hips referred to as “tender points’. Sleep disturbances, morning stiffness, headaches, irritable bowel syndrome (IBS), depression, and anxiety are also commonly associated with this syndrome. Women of childbearing age are primarily affected, but it can and does occur in children, the elderly, and men. Though reports have shown that nearly 30% of FM patients claim they cannot hold down a steady job, the condition has yet to gain recognition as a true “disease.”
Diagnosis
The tender point examination (i.e., tenderness in at least 11 of 18 defined points) has become the diagnostic gold standard for FM. Tender points are located over muscles and tendon insertions, and can range from mildly irritating to completely debilitating.
Pain is the most prominent symptom, which generally begins in one region, such as the neck or shoulders, and seems to spread over time.
It is important to note that FM resembles chronic fatigue syndrome (CFS) in several ways. In both syndromes, patients experience symptoms of chronic musculoskeletal pain, aching, and stiffness, disturbed sleep, depression, and fatigue. While not all patients experience all symptoms, those with FM have a peculiar sensation of tenderness in specific areas of their body. The presence and pattern of these “tender points” separate FM from CFS and other conditions.
Aetiology
A definitive cause of FM has yet to be elucidated. Various theories about disease trigger include stresses such as illness, injury, or trauma that affect the nervous system; hormone levels; muscle metabolism; and immune or endocrine function. In addition, people with FM may often become inactive, depressed, and anxious about their health, all of which can aggravate the disorder.
Treatment
The major classes of medications prescribed to FM patients include antidepressants, sleep-aids, anxiolytics, sedatives, non-steroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants. In controlled clinical trials, none of these agents have shown significant benefit. Additionally, they can also result in adverse side effects, which may include increased appetite, headache, nausea, anxiety, daytime drowsiness, constipation, dry mouth, and gastric bleeding. On a positive note, exercise programs that involve muscle stretching and improve cardiovascular fitness have proven beneficial, most likely due to increased oxygenation of tissues and endorphin release.
Pathology
Because FM is a multi-factorial syndrome that involves a wide range of bodily processes, treating biochemical pathology is helpful. A good treatment program addresses the four main areas that have established roles in the etiology or progression of the disease. These include
• mitochondrial dysfunction,
• hypothalamus- pituitary-adrenal dysregulation,
• toxicity
• Intestine/nervous system abnormalities.
Mitochondrial Dysfunction
Malfunction of mitochondria is believed to be a primary factor in the etiology of FM. Mitochondria, which are concentrated in muscle tissue, are often referred to as the batteries of the cells due to their role in energy (ATP) production. Compromised mitochondrial activity can result in alterations in muscular function, as well as nervous, immune, and cardiac dysfunction.
HPA Dysregulation
Many patients with FM have had exposure to significant life stress and/or have find it difficult to cope with to daily life stressors. Altered reactivity of the hypothalamic-pituitary-adrenal (HPA) axis, results in excess release of the stress hormone cortisol. Due to this association between hypothyroidism and fibromyalgia, it is recommended that FM patients be given a full thyroid hormone test. And with fatigue as one of the major complaints associated with both FM and CFS patients, under active metabolism due to secondary hypothyroidism fits very nicely into this hypothesis.
Toxicity
Another area of concern for those with FM surrounds the role of excitotoxins—substances found in a variety of food additives, including monosodium glutamate (MSG), aspartame, hydrolyzed vegetable protein, and sodium caseinates. It is becoming widely accepted that excitotoxins have neurotoxic effects on the human central nervous system, thereby disrupting various hormone levels.
The microbiome
Research suggests that up to 70% of patients with FM complain of symptoms associated with irritable bowel syndrome (IBS). IBS is a functional disorder characterized by chronic abdominal pain with alternating diarrhoea and constipation.
Amino Acid Transport
Several studies suggest that patients with FM have a defect in amino acid balance, in particular, deficiencies in L-tryptophan, L-leucine, L-isoleucine, and L-valine.
The amino acids L-leucine and L-isoleucine are involved in the synthesis of oxytocin, a neuropeptide thought to have antidepressant, antianxiety, and analgesic properties. In a study of FM patients, low levels of oxytocin were significantly correlated with higher scores of depression, stress, and pain. Researchers postulated that together with other neuropeptides and neurotransmitters, oxytocin may play a role in the mechanisms responsible for FM symptoms.
Collectively, leucine, isoleucine, and valine are referred to as branched-chain amino acids (BCAAs)—essential amino acids that are highly concentrated in muscle tissue. BCAAs are metabolized into biochemical compounds that mediate energy production and protein synthesis. Thus, low levels of BCAAs may also partially explain the depleted muscular energy seen in FM patients.
Natural Treatment Approaches
An important nutritional foundation for optimal health and healing in both healthy individuals and patients suffering from chronic conditions (e.g., FM) includes a diet rich in fruits and vegetables, an adequate intake of omega-3 fatty acids, and a balanced multivitamin/mineral supplement.
EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are omega-3 fatty acids that are known to play a key role in maintaining cell membrane structure and modulating inflammatory pathways. The phospholipid-rich cell membrane contains high concentrations of omega-3 fatty acids, which influence tissues throughout the body by improving cell membrane fluidity, receptor function, enzyme transport, and gene expression. Omega-3 fatty acids are also essential to healthy eicosanoid synthesis, protecting tissues from damage by excessive cytokine production that induces painful inflammation.
While a healthy diet and adequate nutrient and essential fatty acid intake are important in maintaining health, patients with FM may also need more intensive support. A basic program that addresses the physiological factors previously discussed may be beneficial for patients with FM (Table 2).
Focus: Mitochondrial Support
Certain nutritional factors play a role in maintaining the integrity and proper functioning of the mitochondria.
Focus: Managing Stress/Normalizing HPA Function
The use of adaptogens—herbs that help normalize bodily processes and increase the ability to “adapt” to stress—and B vitamins provide a general approach to managing stress.
Thyroid Support
While normalizing stress-induced changes in HPA function will have a positive influence on the HPT axes, some patients may need additional thyroid support. Several nutrients are known to support healthy thyroid hormone synthesis, to promote the conversion of thyroxine (T4) to the more bioactive triiodothyronine (T3), and to address receptor dynamics and the expression of thyroid hormone sensitive genes. Such nutrients include iodine, selenium, zinc, and vitamins E, A, and D.
Focus: Microbiome / Maintaining Intestinal Nervous System Health
Maintaining intestinal health is essential to communications along the brain-gut axis. Improved GI health can be achieved with a nutritional regimen known as the 5R GI Restoration Program, which addresses four primary stages of healing: Remove, Replace, Reinoculate, and Regenerate. This regimen focuses on removing pathogenic microbes and toxins, replacing digestive enzymes and other digestive factors that may be lacking, reinoculating the GI with healthy bacteria, and regenerating the GI lining. A basic protocol consisting of probiotics, prebiotics, and other GI-supportive factors can address each of the four areas.
Please this is for information only before making any changes or taking supplements consult a health professional. Thank you for reading..
