Fibromyalgia should be more properly thought of as a syndrome, or constellation of symptoms, without a fully understood etiology, which causes chronic widespread pain often accompanied by fatigue, sleep disorders, cognitive deficits, irritable bowel syndrome and headaches. As you will see, food and nutrients are important in the care of patients with fibromyalgia. Nutrient strategies can improve overall well being and reduce symptoms. Patients with fibromyalgia may have increased their intake of refined carbohydrates, caffeine, salt and highly processed foods in an effort to meet activities of daily living. These unhealthful habits will benefit from lifestyle medicine.
The pathophysiology of fibromyalgia focuses around central sensitization in which there is a change in the way the central nervous system processes sensory stimuli. This would result for example in the perception of stimuli that would not be painful in normal individuals such as light touch, being perceived as painful in the patient with fibromyalgia. This dysfunction of the central nervous system is thought to be caused by acute or chronic stress including pain, physical and psychological trauma. This results in a lowering of the pain threshold and an increase in pain perception. There is a decrease in the neurotransmitter serotonin (the feel good neurotransmitter) as well as changes found to be associated with a hyper-vigilant state in the body (over-activity of the sympathetic nervous system). This explains the comorbid conditions such as irritable bowel, sleep disorders, anxiety and depression.
The patient with symptoms of fibromyalgia needs a medical workup that encompasses the classic symptoms of pain and fatigue, organic medical diseases such as irritable bowel, depression and sleep disorders as well as more subtle metabolic and nutritional disorders. A thorough musculoskeletal workup is also mandatory in order to rule out other potential causes of pain and fatigue.
Medications may help some individuals with widespread pain especially those with central sensitization but usually do nothing more than symptomatic relief without treating the underlying causes of the illness. Lyrica, Cymbalta and Savella are the most common drugs used for these purposes.
Dr. Jacob Teitlebaum developed a treatment protocol in which 91% of patients improve with an average of 90% improvement in the quality of life. The protocol used included treating Sleep, Hormonal dysfunction, Infections, Nutritional support and Exercise and is referred to as the SHINE PROTOCOL.
Patients need eight to nine hours of sleep per night to recover. Agents such as melatonin and 5-HTP are often helpful. Patients must have all hormonal deficiencies corrected and optimized. The most common problems are thyroid and adrenal glands but deficiencies in sex hormones have also been noted. Opportunistic infections need to be treated. Fibromyalgia patients may be prone to reactivation of chronic infections.
Nutritionally it is recommended that these patients eat the things that leave them feeling the best. The majority of patients find they do best with a high protein, low carbohydrate diet. The patient should avoid sugar and other non-caloric artificial sweeteners, excessive caffeine and excess alcohol. A good multivitamin-mineral complex, Vitamin B12, Coenzyme Q-10, ribose and carnitine should also be taken daily and levels optimized. These are effective in creating and sustaining mitochondrial energy so needed in these patients.