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Fibromyalgia is a neurosensory disorder that affects the central nervous system’s ability to process stimuli. It is characterized by fatigue and widespread pain and tenderness. Disease dynamics are quite complex and typically involve mitochondrial dysfunction, neurotransmitter imbalances, toxicity, neuroinflammation, and gut dysbiosis. 

Fibromyalgia symptoms are diverse, and in addition to widespread pain and fatigue, also include insomnia, depression, anxiety, brain fog, digestive disturbances and headaches. In some people there is also numbness.

Those with fibromyalgia will have many of the below dynamics: 

  • Neurotransmitter imbalances
    • Suboptimal levels and/or action of serotonin increases pain perception and can also result in lower melatonin levels, affecting sleep. It can also be a contributing factor to anxiety and depression. If suboptimal serotonin is at play, supplementation with its precursor, 5-HTP may be quite helpful (assuming they are not taking a prescription SSRI antidepressant medication). A good starting dose, twice a day, ideally with B6 (P5P) to help ensure conversion to serotonin.
    • An imbalance between GABA and glutamate (the brain and nervous system’s most prevalent calming and excitatory transmitters, respectively) has been found in patients with fibromyalgia. Excessive brain glutamate is believed to cause increased pain, anxiety, and an inability to focus. 
    • Fibromyalgia patients have also been found in some cases to have low levels of other neurotransmitters, including norepinephrine and dopamine.
  • Mitochondrial dysfunction/cellular energy metabolism
    • Both fibromyalgia and chronic fatigue syndrome are often associated with mitochondrial dysfunction. Supplements known to help with cellular energy metabolism such as d-ribose, acetyl-l-carnitine and CoQ10 have shown promise in treating the symptoms of fibromyalgia. 
    • There may also be hormonal limitations to cellular metabolism, especially insulin resistance (and/or cellular hypothyroidism (sluggish thyroid can result in sluggish anything) and/or hypocortisolism. 
    • Oxygen is critical to cellular respiration.  Insufficient oxygen can create high levels of lactate, impairing mitochondrial function and contributing to pain. Consider root causes such as sleep apnea, COPD, shallow breathing, smoking, asthma, snoring, regular mold exposure, and chronic nasorespiratory congestion.
  • Dysbiosis
    • Most patients will have some level of gut dysbiosis.  SIBO is common in patients with fibromyalgia – 78% according to this study. This is not surprising considering the high prevalence of IBS in these patients.
    • Other microbial imbalances that include overgrowth species with high Lactate production (e.g. Streptococcus) may contribute to enhanced intestinal permeability and systemic inflammation.
  • Toxicity
  • Neuroinflammation leading to central nervous system sensitization.  This may have many root causes including enhanced intestinal permeability (leaky gut). 
    • A high quality fish oil with at least 1000 mg of EPA (for systemic inflammation) and DHA (for brain inflammation) taken two to three times a day may be warranted.
    • Curcumin, will also help to reduce inflammation.
  • Food sensitivities

Nutritionally, in addition to removing gluten and other food sensitivities, an anti-inflammatory diet should be a priority. Include a wide variety of antioxidant rich foods, herbs and spices and wild fatty fish, rich in omega 3s.

Avoiding excitotoxins such as glutamate (e.g. monosodium glutamate) and aspartame may also improve symptoms. There have been a few recent systematic reviews of dietary interventions for the management of fibromyalgia…see here and here.

There are some key nutrients and lifestyle modifications to consider prioritizing which I can discuss in more detail if you book in for an individual consult.

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