Nutrimed Labs: Fibromyalgia

Fibromyalgia Syndrome (FMS)-a rheumatic condition characterized by widespread, migrating, and often debilitating pain and fatigue which prevent the patient from accomplishing everyday tasks-strikes mostly women between the ages of 20 and 50.(1,2,3) The National Foundation for Fibromyalgia estimates that as many as 12,000,000 Americans suffer with the disorder, yet remain undiagnosed because of its elusive nature.(2,4) Symptoms range from mild discomfort to complete debility and may vary from day to day.(2)

SYMPTOMS(1,2,3,4)
Persistant Pain (moving, burning, aching, throbbing, shooting, and stabbing) in muscles, joints, and ligaments of neck, shoulder, low back and hip areas. Fatigue (mild or totally drained feeling), Breathlessness, Unrefreshing Sleep, Swollen Lymph Glands, Morning Stiffness, Tender Lymph Nodes, Recurrent Headaches, Hypothyroidism, Irritable Bowel Syndrome, Chronic Fatigue Syndrome, TMJ/TMD, Myofascial Pain Syndrome, PMS, Carpal Tunnel Syndrome, Subjective Swelling, Rheumatic Diseases, Chest Pain, Numbness and Tingling Sensations, Muscle Spasms/Twitching, Cognitive/Memory Impairments, Mitral Valve Prolapse, Irritable Bladder, Mood Swings/Disorders, Dry Eyes and Mouth, Dizziness, Sinus and Allergies, Reynaud's Syndrome, Skin Rashes, Environmental Sensitivity, Frequent Eye Prescription Changes, Impaired Coordination, Sore Throat, Intolerance to Heat or Cold, Frequent Abdominal Pain, poor sleep, over-exertion (physical activity), changes in weather, cold, dampness, or drafty environments, humidity, stress, anxiety, depression, and hormonal fluctuations can all contribute to flare-ups in FMS symptoms.

Presently, no laboratory test can definitively identify a patient with FMS. Diagnosis is difficult since many other diseases and conditions also present similar symptoms. However, two criteria define the syndrome:

WHAT CAUSES FMS?
Research has not identified an exact cause for FMS. However, certain events (such as a viral or bacterial infection, an automobile accident, or the development of another disorder such as rheumatoid arthritis, lupus, or hypothyroidism) may precipitate its onset by awakening an underlying physiological abnormality already present.(3)

METABOLIC ORIGIN
FMS exhibits many of the same symptoms as Chronic Fatigue Syndrome (CFS). Both conditions reveal reduced diurnal glucocorticoid levels, impaired reactivity of the hypothalamic-pituitary-adrenal axis, and reduced ATP production.(l,5) Biopsies conducted on FMS patients indicate mitochondrial damage in the muscle, a metabolic abnormality. An impairment in glycolysis leads to an "energy crisis" with abnormal carbohydrate metabolism and phosphorylation, causing failure of thiamin activation and serotonin depletion.(l ) Blood chemistry findings of FMS patients typically show: (l,5,6,7,8)

DRUGS FOR FIBROMYALGIA
Clinical observations and studies indicate that two of the most commonly prescribed drugs for fibromyalgia--amitriptyline (Elavil)®: and cyclobenzaprine (Flexiril)® -- may be no more effective than placebos and may cause more harm than good.(9,10) Neither have ibuprophen or other NSAIDs proven to be effective, yet they may increase the incidence of kidney disease.(8)

WHAT ABOUT T3?
Many fibromyalgia symptoms mimic those of hypothyroidism. Dr. John C. Lowe found that virtually all FMS patients experience dramatic improvement or even complete recovery from their symptoms with judicious use of T3 (thyroid) therapy--even when thyroid profile tests were normal.(11,12) Many patients resistant to T4 and desiccated thyroid can use T3. Dr. Lowe postulates that hypometabolism, caused by faulty thyroid hormone receptors (rather than measurable T4 deficiency) in the patient’s nervous system and muscle cells due to one or more mutations on chromosome 3, may explain fibromyalgia as a genetic and molecular disease.(l5)

NUTRITIONAL IMPLICATIONS
FMS patients have a marked impairment of thiamin status, which responds better to thiamin pyrophosphate than thiamin hydrochloride.(l4) Injectable thiamin may have a beneficial effect. Thiamin-dependent enzymes also require adequate magnesium.(l4)

Remarkable results have been attained using a combination of 300-600 mg. of magnesium hydroxide and 1200-1400 mg. of malic acid per day.(l,l5) All patients following this regimen reported significant improvement in pain symptoms within 48 hours of starting the supplement. Fatigue symptoms responded within 2 weeks. Removal of the supplement resulted in all symptoms returning within 48 hours. (l ,15)

Both magnesium and malic acid play a role in aerobic and anaerobic reactions leading to the production of ATP. Because both substances have an oxygen- sparing effect, a deficiency of either possibly can induce the hypoxia common in muscles of FMS patients.(l 5)

CONCLUSION
Natural, effective approaches exist to deal with the elusive illness called fibromyalgia. Although they might not actually cure the condition, they certainly merit a try over a period of weeks to determine their effect on individual patients. Outright nutritional deficiencies need to be addressed, as well as hormonal influences, since many patients have responded favorably to such therapies.

1. Bland, Jeffrey S.,Ph.D. "Fibromyalgia & Myofascial Pain Syndromes." Applying New Essentials in Nutritional Medicine. Gig Harbor, WA: HealthComm International, Inc., 1995.
2. "What is Fibromyalgia Syndrome?" San Diego: National Foundation for Fibromyalgia.
3. Wilson, Janet. "Her pain now has a name: Fibromyalgia." Austin, TX: Austin American-Statesman, April 10, 1995.
4. "Understanding the invisible disability." San Diego: The National Foundation for Fibromyalgia.
5. Demitrack, Mark A., M.D. Chronic fatigue syndrome: A disease of the hypothalamic-pituitary-adrenal axis? Annals of Medicine 26: 1 -3, 1994.
6. Eisinger, J., M. D., et. al. Glycolysis abnormalities in fibromyalgia. Jour. of the Amer. Cola. of Nutr. 13(2):144-148, 1994.
7. Romano, Thomas, M.D., Ph.D. and Stiller, John W., M.D. Magnesium deficiency and fibromyalgiasyndrome. Jour. of Nutr. Med. 4:165-167, 1994.
8. Yunus, Muhammad B., et. al. Plasma tryptophan and other amino acids in primary fibromyalgia. Jour. of Rheum. 19(1):90-94, 1992.
9. Drs. Carette, S., and Bell, M.J. A controlled trial of amitriptyline, cyclobenzaprine, and placebo in fibromyalgia. Arthritis and Rheum. 35(suppl. 9): 112, 1992.
10. Dr. Carette, S., and Bell, M.J. Comparison of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia. Arthritis and Rheum. 37(1):32-40, 1994.
11. Lowe, John C., M.A., D.C., et. al. Improvement in euthyroid fibromyalgia patients treated with T3 (tri-iodothyronine). Jour. of Myofascial Therapy 1 (2): 16-29, 1994.
12. Lowe, John C., M.A., D.C. T3-induced recovery from fibromyalgia by a hypothyroid patient resistant to T4 and desiccated thyroid. Jour. of Myofascial Therapy 1 (4):26-31, 1995.
13. The Fibromyalgia Research Foundation. "The Hypo-Metabolism Hypothesis: A New Explanation of Fibromyalgia." Houston: The Fibromyalgia Research Foundation, 1995.
14. Eisinger, J., M.D., et. al. Studies of transketolase in chronic pain. Jour. of Advancement in Med. 5(2):105-113, 1992.
15. Abraham, G.E., and Flechas, J.D. "Management of fibromyalgia: Rationale for the use of magnesium and malic acid," Jour. of Nutr. Med. 3 :49-59, 1992.