Updated: Sep 19, 2018
According to NHS UK, there is currently "no cure" for fibromyalgia. Instead, the conventional treatment aims to reduce symptoms and consists of :
Talking therapies (such as cognitive behavioural therapy)
Lifestyle changes such as exercise and relaxation techniques
Unfortunately, for many individuals these treatments are simply ineffective. The problem with a symptom-suppression-based model is that it does not identify the root cause of the problem. This is common in conventional medicine, and often leaves people in a difficult situation where they are prescribed multiple medications, each with a host of side effects. Many may feel like there are no other viable options and are simply forced to live with this painful condition.
Thankfully, however, there ARE a solutions to fibromyalgia - but they lay within the domain of nutritional science and functional medicine. First of all, to understand how to approach this condition, we need to look at the CAUSES rather than focusing purely on the symptoms. By identifying the causes, effective and individualised therapeutic strategies can be implemented to restore the system back into balance.
Fibromyalgia - What does the research show?
Poor energy metabolism
The cells in the body contain their own little energy-factories called mitochondria. These powerhouses take food and convert it into ATP - the body's "energy currency" - with the use of various minerals and vitamins. ATP is used to fuel most of the activities performed inside the cell. To make enough energy the cells need to have a supply of oxygen, and without energy, every biological process grinds to a halt and things shut down completely. This is actually why people die when they are unable to breathe.
When the mitochondria (energy factories) are deprived of oxygen for short periods of time (such as when someone performs intense exercise), or if there are not enough vitamins and minerals to conduct the process, they use a back-up route that can produce small amounts of energy without the use of oxygen. The by-product of this back-up mechanism is called lactic acid, which is responsible for the burning and painful sensations in the muscles after a bout of strength training or sprinting.
Interestingly enough, research has shown that people with fibromyalgia have higher levels of lactic acid in both the brain, and muscle, along with poor oxygen delivery to various organs, the muscles, and the skin. What does this suggest? It suggests that the cellular energy factories are not functioning properly - a condition referred to clinically as "mitochondrial dysfunction".
Mitochondrial dysfunction has been demonstrated in fibromyalgia and likely underpins the fatigue and pain experienced in this condition. As a result, high levels of free radicals and oxidative stress damages cellular structures, depletes antioxidants, and reduces the body's detoxification abilities.
Causes of mitochondrial dysfunction are multifaceted, ranging from environmental toxins, chronic infections, mold exposure, to nutritional deficiencies. But for the sake of simplicity, we will briefly look at some of the nutrients involved in energy production.
Nutrients improve symptoms
For cells to make energy - they require a vast spectrum of micronutrients. These include:
Vitamins B1, B2, B3, B5, B6, Folate, B12, Biotin, C
Iron, Copper, Manganese, Magnesium, Zinc
When any one of these nutrients is in short supply, energy production is disrupted. Many people believe that nutrient deficiency was a thing of the past, however more and more research is showing that "high-calorie malnutrition" is actually very common with today's modern-day Western diet. And although limited, preliminary data indicates that people with fibromyalgia may be deficient in multiple nutrients like vitamin D, magnesium, CoQ10, and vitamin B12.
Is it any wonder, then, that research using mitochondria-specific nutrients has yielded positive results in fibromyalgia?
Coenzyme Q10 - Significantly reduced pain scores & fatigue, improved clinical markers involved in inflammation and energy metabolism
Transdermal Magnesium - Significant improvement in all measures
High-dose B1 - Up to 80% improvement in pain and fatigue (small study)
L-Carnitine - Significant reduction in pain and improvement in general and mental health
Vitamin B12 & Folate - Yielded positive results in a significant portion of the study group
Whilst a well-formulate ancestral diet based on nutrient-dense foods would surely increase overall dietary nutrient intake (probably 3-fold), in many cases of complex illness extra levels are required in (sometimes) high doses. It is therefore important to work with a qualified health professional who is educated in this area and can support you on this journey.
Disrupted gut health, bad gut bacteria, immune dysregulation & chronic inflammation
Without going into too much detail, digestive health is usually severely compromised in fibromyalgia. Ordinarily, the gut should house a wide variety of beneficial microbes which promote our ability to digest foods, regulate our immune response, and influence our brain & nervous system function. When there are "imbalances" in the microbes, we call this dysbiosis. Evidence suggests that the majority of these people suffer may from a condition known as "small intestinal bacterial overgrowth" - where an overgrowth of dysbiotic bacteria in the digestive tract disrupt proper digestion. It is associated with gas, bloating, reflux, lethargy after meals, nutrient malabsorption, and irritable bowel syndrome-type symptoms. If you can't digest your food and are unable to absorb the nutrition, you pave the way for malourishment.
Imbalances in gut bacteria can also lead to a phenomena known as "leaky gut", also common in fibromyalgia, where the barrier of the intestine becomes excessively permeable and allows undigested food proteins and bacterial toxins into the blood stream. These toxins can evoke systemic inflammation and disrupt the immune system, and can also enter the brain where they induce neuroinflammatory responses (found in fibromyalgia). This cascade of events subsequently reduces hormonal stability, cognitive function, and mental health.
Hence, this is why improving gut health should be the main priority for anyone seeking to overcome fibromyalgia. It is the first place that I look in every one of my clients with chronic health conditions.
Common offenders for disrupting gut function are stress, chronic antibiotic use, exposure to environmental toxins such as heavy metals, pesticides, and xenobiotics, underlying thyroid dysfunction and immune dysregulation, and food sensitivities. In fact, non-coeliac gluten sensitivity is common in fibromyalgia, and removing dietary gluten has been shown to improve symptoms in many.
To add to the above, the current "low saturated fat" guidelines are misguided and lead people to replace healthy fats with toxic vegetable oil alternatives, which are pro-inflammatory in nature and only contribute to the system inflammation observed in fibromyalgia.
Sleep, serotonin, and stress
Fibromyalgia patients are renowned for having poor quality sleep. It turns out that the "sleep hormone" melatonin, along with many other hormones and biochemical mediators, follows a 24 hour cycle called the circadian rhythm. Ordinarily, it should spike in the evening time and is responsible for facilitating restful night's sleep.
In fibromyalgia, the hormonal circadian rhythms are completely skewed - which probably contributes to poor sleep at night and fatigue throughout the daytime. Stress hormone cycles are out of whack, presenting as either very high stress hormones, flatlined stress hormones, or somewhere in between. Considering the detrimental effects of artificial light at night time (to learn me read THIS article), restoring the circadian rhythm should also be top priority - because sleep is the foundation for overall health.
To add another factor into the mix, the hormone serotonin is also significantly altered in fibromyalgia. It is important to know that serotonin is required to synthesis melatonin, and so low serotonin is likely to predispose one to poor sleep quality. To make serotonin, you require a dietary amino acid found in proteins called tryptophan. With gastrointestinal dysfunction and gut issues, undigested sugars can interfere with the absorption of tryptophan. Furthermore, under stressful and toxic conditions, the tryptophan is diverted aware from serotonin-melatonin synthesis, and is pulled towards the synthesis of neurotoxic compounds such as quinollinic acid, which contribute to progressive damage to the brain and nervous system. Ensuring adequate dietary protein is a must, along with ensuring supply and proper absorption of the wide spectrum of nutrients involved in these processes.
Fibromyalgia patients have compromised liver detoxification, and have been shown to have significantly reduced levels of serum antioxidants. This renders these people more susceptible to dietary and environmental toxins.
For example, mercury from amalgam fillings is a direct neurotoxin and likely contributes to fibromyalgia pathology. Other toxic heavy metals including lead, aluminium, arsenic, and cadmium have also been shown to be significantly higher in people suffering from non-degenerative neurological conditions such as fibromyalgia. Aside, other common pollutants such as BPA, Pthalates, BPS, and SLS likely contribute as well.
The ultimate aim is to improve the body's natural clearance of these toxins through providing it with adequate nutrition, sleep, appropriate supplementation, and additional methods like light-therapy, Epsom salts baths, and sauna to help assist detoxification.
However, in many cases, if significant toxicity is present, a comprehensive detoxification protocol is likely going to be required to effectively mobilise and eliminate the waste. This, again, is why it is so important to work with a healthcare professional on this one - preferably one who is familiar with functional medicine.
Fibromyalgia is a complex condition, probably with multiple causes which differ between each different person. However, certain factors are common amongst all of them. These appear to be related to:
Poor cellular energy production
Disrupted gut health
Abnormal hormonal circadian rhythms and immune dyfunction
Toxicity (some form or another)
Thankfully, these things CAN be addressed with the right approach, additional nutrients, and a great deal of patience, willingness to experiment, and determination. Unfortunately, conventional medicine continues to ignore the abundance of research highlighting the fundamental issues which underpin fibromyalgia. In review, it is clear that therapy for support fibromyalgia rests in the domain of nutritional science and functional medicine, using a holistic and individualised approach to identify the root causes and dysfunctions in each different person.
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