Fibromyalgia
Adapted from “Nutritional Therapies for Fibromyalgia Syndrome”, by Kristi Hughes, ND
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. Various conventional treatment modalities have been tested in fibromyalgia patients; unfortunately, these are often ineffective and may result in adverse side effects. A natural approach that incorporates nutritional support for the body processes implicated in the pathenogenes is of fibromyalgia holds great promise for the millions suffering from 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. Pathology Because FM is a multi-factoral 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 (HPA) dysregulation, toxicity, and intestine/nervous system abnormalities.
Naturopathic Approach
A naturopathic approachto treating someone with fibromyalgia would start with a lengthy initial office visit to best determine what the underlying cause(s) might be that are contributing to the individuals FM. The most common underlying causes are:
Mitochondrial Dysfunction
Malfunction of mitochondria is believed to be a primary factor in the etiology of FM, and abnormalities of the mitochondrial membranes in these patients have been reported. Mitochondria, which are concentrated in muscle tissue, are often referred to as the “powerhouses” 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. Certain nutritional factors play a role in maintaining the integrity and proper functioning of the mitochondria. The following formulas have been used in FM patients in clinical settings:
Mitochondrial Antioxidant Formula: A combination of nutrients known to positively influence mitochondrial energy production, along with antioxidants, may support a higher rate of ATP synthesis, as well as protect mitochondria from free radicals. Nutrients such as lipoic acid and B vitamins serve as cofactors for cellular energy production and metabolism; thiamin supports the activity of enzymes that influence citric acid cycle activity and activities of the respiratory chain; amino acids like creatine allow muscles to regenerate ATP, and N-acetyl-L-carnitine helps transport nutrients (i.e. fatty acids) into the mitochondria for energy production. Furthermore, antioxidants such as coenzyme Q10, L-glutathione, N-acetylcysteine, and vitamins C and E help prevent oxidative damage that can affect cellular and/or mitochondrial function negatively.
Malic Acid/Magnesium Aspartate Complex: Malic acid is a natural compound that is necessary for ATP production.8 Combined supplementation with 1,200 mg of malic acid and 300 mg magnesium administered in a dose-escalated fashion produced significant reductions in the severity of 3 primary pain/tenderness measures in FM patients. In another study, supplementation with malic acid (1,200-2,400 mg) and magnesium (300-600mg) resulted in subjective improvements in myalgia within 48 hours and reduced tender point index scores were
recorded at 8 weeks.9
Magnesium/Potassium Aspartate Complex: Magnesium, potassium, and aspartate have roles in intermediary metabolism (enzyme-catalyzed processes that extract energy from nutrients to build new cells) that may mitigate physical fatigue. In a study examining the effects of potassium, magnesium, and aspartate (1,000 mg potassium aspartate and 1,000 mg magnesium aspartate per day for 1-2 weeks) on 4 subjects undergoing extremely fatiguing physical exercise, non-athletes demonstrated improved physical endurance.10 Potassium-magnesium-aspartate
supplementation of 1.75 g every 6 hours for 4 days was shown to prolong exercise capacity. Researchers postulate that the mechanism behind this anti-fatigue effect was the resynthesis of ATP and phosphocreatine.
HPA Dysregulation
Many patients with FM have had exposure to significant life stress and/or have inordinate responses to daily life stressors. Altered reactivity of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in hyposecretion of adrenal androgens (e.g. cortisol) has been observed in these patients. One study has postulated that HPA dysfunction may involve serotonergic neurotransmission and alterations in the activity of arginine-vassopressin (AVP) and corticotrophin-releasing hormone (CRH). HPA dysregulation is far-reaching and can interfere with proper functioning of the hypothalamus-pituitary-thyroid (HPT) axis. Neuroendocrine abnormalities along the HPT axis are also common in FM patients. Furthermore, due to the association between hypothyroidism and fibrositis and myalgia, it is recommended that FM patients be given a comprehensive thyroid hormone test. The use of adaptogens—herbs that help normalize bodily processes and increases the ability to “adapt” to stress—and B vitamins provide a general approach to managing stress.
Traditional Holy Basil Combination: Adaptogens such as holy basil (Ocimum sanctum), ashwaganda (Withania somnifera), and brahmi (Bacopa monnieri) have a history of use in Ayurvedic medicine and are scientifically well supported to improve stress tolerance. Ashwaganda was shown to enhance adaptability to both physical and chemical stress in animals, showing the ability to suppress adrenal enlargement, as well as adrenal ascorbic acid and corticosterone depletion. Ashwaganda also produces positive changes in stress-related prostaglandin and catecholamine production. In other animal testing, brahmi was shown to improve adaptations in sensory, motor, and motivational systems.24 In humans, it exhibits beneficial effects on anxiety, as well as mental functions such as mental fatigue.
B6/Pantothenic Acid Complex: The B vitamins, pantothenic acid and B6 are important in energy production and the response to stress by supporting adrenal hormone production and regulation. In conjugation with ATP and cysteine, pantothenic acid plays an integral role in the synthesis of coenzyme A, which initiates various metabolic processes including the production of glucocorticoids.27 In an animal study, vitamin B6 was found to stimulate the secretion of adrenal catecholamines.
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.
Toxicity
Toxin exposure has been suggested to play a significant role in the development and progression of both FM and CFS, as approximately 47-67% of patients with FM and 53-67% of patients with CFS have reported at least one episode of symptom exacerbation after specific chemical exposure. (see Detoxification Section)
Intestine/Nervous System Support
Another area of interest is the link between intestinal dysfunction and FM. Although statistics vary, 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 diarrhea, and constipation.34 In comparison with healthy subjects, patients with IBS also tend to experience extra intestinal symptoms that overlap with FM complaints, including increased nerve sensitivity, morning stiffness, headaches,
sleep disturbances, and fatigue. Improved GI health can be achieved with a nutritional regimen known as the 4R® GI Restoration Program, which addresses the four primary stages of healing: Remove, Replace, Reinoculate, and Regenerate. (see Gastrointestinal Section)