by Dr. Joseph Debé
If you experience chronic aches and pains, stiffness, and fatigue, you may be suffering with what is referred to as fibromyalgia. There is no laboratory test to perform to definitively diagnose fibromyalgia. The diagnosis of fibromyalgia is based on the presence of pain both above and below the waist, on both the left and right sides of the body, in combination with tenderness to finger pressure at a minimum of 11 out of 18 specific spots on the body. Additionally, other conditions that can cause the same symptoms need to be excluded before a diagnosis of fibromyalgia can be made. These conditions include thyroid disease, arthritis, Lyme's disease, gout, connective tissue diseases and others.
Women aged about 20 to 55 seem to have the highest incidence of fibromyalgia. Besides pain and fatigue, other symptoms often found in this condition include: restless sleep, irritable bowel syndrome, depression, anxiety, cognitive impairment, and altered immunity.
Fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivities share many similarities, and in each condition the cause is unknown. As in any condition, genetic predisposition plays a role. However, in fibromyalgia, environmental factors are much more important. Although the actual causative factors, symptoms, and successful treatments vary somewhat in each case of fibromyalgia, chronic fatigue syndrome and multiple chemical sensitivities, research has uncovered some important factors that deserve consideration in each individual case.
Perhaps the most important discovery about fibromyalgia is the finding of impaired energy production within muscle cells. Mitochondria are miniature power plants within the cells that convert food and oxygen into energy. When mitochondrial function is disrupted, the drop in energy production causes fatigue and pain. Many factors can contribute to this disrupted aerobic phase of energy production within the mitochondria with chemical toxicity and nutrient deficiency being two important causes. Additionally, oxidative stress (free radical production unopposed by sufficient antioxidant defenses) may alter the structure of mitochondrial membranes and DNA, resulting in damage that is difficult to repair. Another important area to consider regarding cellular energy production is hormonal balance.
To elaborate upon the preceding discussion, both exotoxins and endotoxins may contribute to metabolic aberrations that manifest as fibromyalgia. Exotoxins are poisons derived from sources outside the body such as pesticide residues in food, and lead in drinking water. Even some antibiotics have been found to damage mitochondria. Endotoxins are poisons produced within the body, with chemicals from the hundreds of trillions of bacteria and yeast in the digestive tract being important sources. Toxins from any source may interfere with the complex series of chemical reactions required to convert food into ATP, the body's currency of energy. To help the body recover from the effects of toxins, the following steps are instrumental:
1. REDUCE THE LOAD OF TOXIC SUBSTANCES ENTERING THE BODY. This is accomplished by eating organic hypoallergenic foods, drinking filtered water, and possibly using an air purifier.
2. STRENGTHEN THE BODY'S BARRIERS OF DEFENSE. Key among these is the lining of the gastrointestinal tract. If the intestinal barrier is compromised, then greater amounts of toxins make their way into the bloodstream and throughout the body. Avoiding non-steroidal anti-inflammatory drugs, alcohol, chlorinated water, and food allergens, as well as eradicating any toxic organisms present in the gastrointestinal tract are critical to allow repair of the intestinal wall. Ensuring adequate intake of nutrients that strengthen the intestinal barrier is also necessary.
3. SUPPORT THE BODY'S PROCESSES OF DETOXIFICATION AND ELIMINATION. This primarily involves the intake of specific nutrients shown to be essential in various biochemical detoxification pathways.
Now, what about the role that nutrient deficiencies play in fibromyalgia? Many different nutrients are essential for the proper functioning of the biochemical reactions that convert food into energy. These include: vitamins B1, B2, B3, B5, C, and E; carotenoids; flavanoids; magnesium; sulfur; phosphorus; zinc; copper; manganese; selenium; alpha lipoic acid; glutathione; coenzyme Q10; carnitine; creatine; and cysteine. Studies have demonstrated deficiencies of vitamins B1 and B6 and magnesium in cases of fibromyalgia, although a deficiency of any of the aforementioned nutrients could play a role in a given individual case. A laboratory test called urinary organic acid analysis can help pinpoint which biochemical step in cellular energy production is blocked due to toxic inhibition or deficiency of nutrient cofactors. This information can be used to tailor make a nutrient support program to normalize bioenergetics.
Several amino acids have also been found to be deficient in fibromyalgia patients. These include serine, histidine and tryptophan. Tryptophan is particularly important because it is the precursor to the neurotransmitter serotonin. Serotonin insufficiency can result in insomnia, anxiety, depression, and pain. Organic acid analysis and amino acid analysis can point to disorder in metabolism of these compounds as factors in a given case of fibromyalgia. Tryptophan is currently available in this country only by prescription but a related compound, 5-hydroxy tryptophan is available over the counter.
As previously mentioned, free radical damage to the mitochondria may contribute to fibromyalgia. To combat this, the source of the free radicals must be dealt with appropriately. Free radical sources include toxins, allergens, and viral and bacterial infections. Supplementation with antioxidant nutrients is also important in this regard.
The hormonal influences in fibromyalgia include insulin, cortisol, and DHEA. All these are negatively affected by the ingestion of excess carbohydrates. It is important for fibromyalgia patients to minimize their carbohydrate intake, especially sugars and white flours, as these can contribute to altered cellular energy production in this condition. Mental-emotional, physical, and chemical stressors can all produce abnormalities in cortisol and DHEA output. These hormones play critical roles in energy production, modulation of pain and inflammation, quality of sleep, regulation of cognition and mood, immune system activity, and tissue repair. Not surprisingly, stress management techniques have been shown to improve symptoms of fibromyalgia.
Several other modalities have shown benefit in treating fibromyalgia. Aerobic exercise has helped, possibly by improving blood flow and oxygen delivery to muscle tissue. Impaired micro-circulation and oxygen transport found in fibromyalgia not only interfere with energy production, but result in greater free radical stress.
Studies have found supplementation with malic acid to reduce pain and fatigue in fibromyalgia. Supplemental S-adenosyl-L-methionine has also produced positive results. Four additional treatments proven to reduce pain in people with fibromyalgia are cranial electrotherapy stimulation, homeopathy, electroacupuncture, and topical capsaicin cream. Although formal studies are lacking, I believe that spinal manipulation, massage, physical therapy modalities, and additional nutritional supplements such as essential fatty acids and arabinogalactans can play an important role in the management of fibromyalgia.
In summary, it is important to rule out other conditions before making the diagnosis of fibromyalgia. Then, for best results, seek the assistance of a knowledgeable healthcare professional to guide you through a process of evaluation and individualized treatment.