It is estimated that between 3 and 6 million Americans are afflicted with fibromyalgia (FM) with around 86% being women. Yet its diagnosis is often missed because its symptoms are similar to chronic fatigue syndrome, Epstein-bar virus, candidacies (yeast infection), parasites and even irritable bowel syndrome (IBS).  What complicates this matter even more is that a person who meets the criteria for a diagnosis of fibromyalgia will often have one or more of the other conditions mentioned above which raises the question as to what is causing what.  

        FM is defined as muscle pain located at between 11 and 18 sites distributed throughout the body.  Any type of pressure resulting in pain, to at least 11 of these sites for a period of at least three months is defined as FM.  Some common sites is the area between the neck and the shoulders, either side of the rib cage where the ribs meet the breast bone, the buttock and the general area of the knees. 

        Unfortunately, the cause of FM continues to be less than well defined.  FM often seems to begin after an infection or a severe emotional or physical shock. People with FM are more likely to have allergies, including chemical sensitivities to various environmental pollutants as found in everything from household cleaners to perfumes and paints.  Research shows that in giving brain scans to chemically sensitive patients, the same brain patterns are found that are common to those with FM.  Such research shows a reduction in blood flow to and through specific parts of the brain that deal with memory and concentration as well as pain regulating functions. This circulation disturbance is one of the most important considerations in determining the dynamics of FM.

       The specific differences that are seen in the brain biochemistry of those with FM as compared to those without FM involve the following:

       1. A chemical compound called substance P, which increases the sensitivity of nerves to pain, has been found at elevated levels in the cerebrospinal fluid of people with FM.  This results in an increased awareness of pain in the body.

       2. The neurotransmitter serotonin is found at reduced levels in people with FM which results in interrupted sleep patterns and, therefore, a lack of proper tissue repair in the body. The production of serotonin directly relates to our bodies capacity to experience peaceful sleep.

      3. There is reduced blood circulation to those parts of the brain responsible for controlling memory and the movement of muscles and other body parts.

        Let’s take a look at how interrupted sleep can produce the symptoms of FM.  In normal sleep, we pass through a series of stages that are characterized by different electrical patterns in the brain.  We normally go through four stages of sleep which all occur in the first 90 or so minutes after falling asleep.  We initially enter the alpha stage of sleep where there is rapid eye movement and where our most vivid dreaming takes place.  We then progress into increasingly deeper stages of sleep known as beta, gamma delta stages with delta being the deepest sleep stage of all.  It is during the delta stage of sleep that human growth hormone is secreted by the pituitary gland which facilitates repair of body tissue including muscle tissue.

        Sleep laboratories, where sleep patterns are studied, have found that nearly half of all people with FM have disturbed  delta sleep where alpha wave patterns appear during the delta stage causing an interruption of the deep sleep so necessary for muscle repair.  Lack of muscle repair leads to fatigue and the kind of muscle pain associated with FM.      

       A thirty day study done at the University Of Connecticut School Of Medicine involving 50 women with FM determined that poor sleep patterns resulted in greater pain and the greater pain resulted in less ability to sleep.

       In 1973, Dr. H. Moldofsky did a study where he took six volunteers and had their sleep disrupted for three nights in a row.  All six developed fatigue, widespread aching muscles and tenderness when pressure was applied to those body sites normally associated with FM.   It is interesting to note that people who may suffer from a more generalized form of insomnia do not develop fibromyalgia.  The reason this is the case is that ordinary insomnia does not involve the same degree of disturbance of delta stage sleep by alpha wave patterns that occur with FM. Because delta sleep is not as readily disturbed, growth hormone production remains relatively normal and tissue repair is able to take place.  It is also interesting to note that when sleep disruption is imposed on long distance runners in the same manner as was done in the research by Dr. Moldofsky, there was no fatigue and no pain.  We will consider the role of exercise in the treatment of FM later in this article.

        As indicated above, one of the most common problems identified in FM is reduced blood flow and, therefore, decreased energy production in key sites within the brain. It is felt by many researchers that the crux of the problems that lead to the symptoms of FM lay in the brain and the central nervous system.  Sensation of pain is transmitted through the central nervous system by chemicals called neurotransmitters.  These chemicals can either increase or decrease levels of pain.  As cited above, when there is an increase in substance P, a type of neurotransmitter, sensation of pain will increase.  When there is a decrease in serotonin, there is an increase in pain recognition. This largely occurs because a decrease in serotonin leads to a decrease in the chemicals epinephrine and dopamine which lower pain thresholds in the body.  Since those who suffer with FM have been shown to have both an increase in substance P and a decrease in serotonin you can see why pain is experienced so easily.

        As indicated above, allergies are often associated with FM.  Allergy is defined as the body experiencing uncomfortable symptoms in response to the immune system reacting to a substance as an unwanted invader or what is commonly referred to as an antigen.  For example, a flu virus is an antigen which the immune system will challenge and the ensuing battle between the forces of the immune system and the virus will create uncomfortable symptoms such as fever, congestion and a variety of aches and pains.  In this case your body is experiencing an allergy to the virus which is a normal and expected response.  In other cases, however, the immune system responds to invaders that are not normally considered a threat to our health resulting in our body experiencing the same or similar symptoms that are normally associated with a viral or bacterial attack. 

        One example of this is food allergies.  One way that the immune system creates an allergic reaction is when, because of what is called a leaky gut, food molecules enter the blood stream in an undigested form causing the immune system to treat them as a foreign agent.  A leaky gut can develop as a result of a Candida yeast infection where the yeast has matured into a fungal organism which then eats its way through the intestinal wall creating microscopic holes through which can pass undigested foods.   Research has shown that those suffering from FM will often have allergic reactions to various foods and other substances, and will often have Candida yeast problems as well. 

        A simple way to determine what foods may be responsible for allergic reactions is to use the simple pulse test. You take your pulse before eating a particular food and then again after having eaten it, at intervals of 20, 40, 60 and 120 minutes.  If the pulse rate changes by at least ten beats per minute, either upwards or downwards, the food is suspect and should be avoided for at least a week before being retested to determine if the same change in pulse rate occurs.  The identification and subsequent elimination of foods that may be causing symptoms that are normally associated with colds and flu may also lead to a reduction in the symptoms associated with FM.

        As indicated above, an overgrowth of the yeast called Candida Albacans appears to be a common problem with those that suffer from FM.  Candida is a normal resident of our intestinal tract and is usually held in check by friendly bacteria such as acidophilus and bifidus.  Unfortunately, our friendly bacteria can be easily destroyed through use of drugs such as antibiotics, birth control pills and a poor diet high in refined sugar.  When our friendly bacteria get destroyed, the yeast organisms proliferate and can quickly become the dominant organisms in the intestinal tract and can also get into the general blood circulation and travel to various tissues of the body.  The presence of yeast overgrowth can be established through blood tests, bio-feedback equipment and what is called a purged stool test. Outward signs such as thrush in the area of the mouth or virgina are also indicative of a yeast overgrowth. 

        The task of eliminating yeast overgrowth is threefold.  Eliminate virtually all simple carbohydrates from the diet.  Take a product, such as grapefruit seed extract, to kill off yeast overgrowth.   Re-culture the intestinal tract with friendly bacteria.  The elimination of yeast overgrowth may lead to a reduction in symptoms associated with FM.

      Since there is evidence that bacterial and viral organisms may be precursors to the development of FM, it is important to do everything possible to build and maintain a strong immune system.  This can only be accomplished by providing the body with nutritionally dense foods, the general elimination of processed and refined foods and supplementation with whole food concentrates. 

       The cause of FM appears to be multifaceted. Therefore, the most successful way of dealing with FM to date, has been to use a multifaceted approach.  The general elimination of processed, refined foods from the diet with their various chemical additives should be a first step in dealing with FM.  Removing any foods and products that cause an allergic reaction will create greater stability and, therefore, provide the body with greater ability to deal with the presence of FM.  Eliminating a yeast overgrowth will also create greater balance and enable the body to better handle FM. 

       As already indicated, diet is critical to treating FM.  Eating a whole food diet, rich in a wide range of fresh fruits and vegetables is very important.  It has been shown that viral and bacterial infection is common in persons with FM and that their immune systems are sub-par.  It has been shown that too much production of a substance called interleukin-6 (IL-6) by the immune system enhances the pain of FM.  IL-6 also interferes with absorption of nutrients from food and supplements which results in less efficient repair of muscle tissue.  Fruits and vegetables have a variety of plant nutrients called sterols and sterolins that help reduce the production of IL-6.

        A product called Moducare has been shown to be helpful with FM.  This product contains plant sterols and sterolins which help regulate the immune system, reduce inflammatory responses and lower auto-antibody reactions.  Moducare provides a concentrated and consistent source for sterols and sterolins.  Moducare is available at Milk ‘N Honey.                 

         It is wise to add a food concentrate to the diet. A product group called The “Garden Trio” made from dehydrated juices of barley grass, carrots and beets makes an easy to take nutritional drink.  We call it a salad in a glass. This product provides a wide range of vitamins, minerals, enzymes, amino acids and plant compounds in an easily absorbable form for quick utilization by the body.  The “Garden Trio” is available at Milk ‘N honey.

       In addition to dietary changes, there are additional ways of dealing with FM that have proven effective.

      The mineral magnesium, which tends to be deficient in the average American diet, is essential for muscle tissue to be able to relax. This mineral is almost always found to be deficient in those with FM.  Magnesium acts as a co-factor in the transport of nutrients across cell membranes and the removal of waste from the cells.  This process is compromised if magnesium is lacking and, therefore, the healthy functioning of muscle tissue could be compromised.  Magnesium helps to block the toxic effects of aluminum in the body.  Aluminum inhibits the breakdown of sugars necessary for the production of the basic energy molecule ATP. 

        Magnesium is mainly found in dark green leafy vegetables and unprocessed whole grains and lean muscle meats.  Green food concentrates are a good source of magnesium.  Magnesium can also be taken supplementally in tablet, capsule or liquid form.  Getting more magnesium into the diet has proven to be helpful in reducing the pain of FM.  A magnesium product that has been shown to be effective is Natural Calm from the company Natural Vitality.  We carry this product at Milk ‘N Honey.

      Malic acid, which is widely distributed in the vegetable kingdom and is found in high concentration in apples, has shown itself helpful in reducing the pain of FM.  Like magnesium, malic acid plays an essential role in sugar metabolism and in the formation of ATP.  It is a very effective detoxifier of aluminum, especially in the brain.  Malic acid has been shown to greatly increase the fecal and urinary excretion of aluminum and decrease the amount of aluminum found in various organs and tissues. Since most FM research indicates that various imbalances in brain chemistry is connected with FM, and since aluminum toxicity in the brain is a suspected cause of brain dysfunction, one can see why both malic acid and magnesium can be important nutrients in the battle against FM.

       A study cited in the Journal of Nutritional Medicine, showed the combined effects that malic acid and magnesium can have on FM.  Fifteen patients, ages 32 to 60, daily ingested 1200 to 2400 mg of malic acid along with 300 to 600 mg of magnesium for a period of 4 to 6 weeks.  All the patients in the study reported significant pain relief within 48 hours of treatment and within 4 to 8 weeks all patients had a lowered Tender Point Index.  While this was a small study and lacking the usual scientific controls, it did, nevertheless, point to the potential of using malic acid and magnesium to treat FM. Another study at the University of Texas Health Science center in San Antonio gave malic acid and magnesium to 24 individuals with FM with the result being a significant reduction in pain and tenderness after six months of treatment.

        In view of the various studies showing relief in symptoms as a result of using malic acid, this nutrient, like magnesium, should be added to your treatment program.  Malic acid can be taken in capsules or tablets and don’t forget those apples which provide ample amounts of this nutrient. Malic acid is available at Milk ‘N Honey.

       As covered earlier, the neurotransmitter serotonin is often found to be deficient in those suffering from FM.  Although serotonin is only found at levels of around 10 mg at any one time in the body, this chemical has some regulatory control over a variety of functions including mood, sleep, pain perception, appetite, sexual behavior and the list goes on and on.   Because a reduction in available serotonin can result in disturbed sleep and disturbed sleep can produce a lack of proper repair of muscle tissue, it becomes important for those with FM to consider levels of serotonin activity as an important dynamic in the overall treatment of FM.

       The production of serotonin in the body is dependent on the presence of the essential amino acid tryptophan which the body converts to 5-HTP tryptophan which then converts to serotonin.  Tryptophan is an essential amino acid which means it must come from the diet as our bodies don’t make it. A deficiency of this nutrient can result in a slowdown of serotonin production. Tryptophan is the least plentiful of the 22 amino acids our bodies use.  It can be obtained from the diet by eating turkey, dairy products, seeds (pumpkin and sunflower), sea vegetables, and garden vegetables such as broccoli and spinach.  Tryptophan is also available as a supplement.  When taking tryptophan as a supplement, it is best to consume it on an empty stomach or with some carbohydrate. Carbohydrate facilitates tryptophan crossing the blood-brain barrier.

        5-HTP tryptophan is not available from the diet as it is something the body produces from tryptophan.  5-HTP will raise serotonin levels in the body by stimulating the body to produce more serotonin.  This is different from drugs such as Prozac which increase serotonin levels by interfering with the bodies natural process of recycling already produced and released serotonin molecules.  Raising serotonin levels can result in better sleep resulting in better muscle repair which can reduce the pain associated with FM.  You can take 5-HTP as a supplement. 5-HTP is derived from the seeds of a West African medicinal plant called Griffonia simplicifolia.  As with supplemental tryptophan, 5 HTP is best taken on an empty stomach.

       5-HTP has been evaluated as a treatment for FM in two major studies in Italy. In one study, fifty patients with diagnosed FM were given either 5-HTP or a placebo for 30 days.  Those taking 5-HTP were shown to experience significant improvement as to better sleep, reduced pain, less fatigue and anxiety and a decline in tender points as compared to the placebo group.  A second study, using 50 people with FM for a period of 90 days, showed similar results.

       Serotonin is also important as the neurotransmitter from which the hormone melatonin is made.  Melatonin is secreted by the pineal gland located at the base of the brain.  This hormone appears to be very much involved in the synchronization of the daily hormonal secretions in the body, a process referred to as the circadian rhythm. This hormone plays an important role in regulating the time of day and night when different hormones are released.  Melatonin produces a chemical called arginine vasotocin which inhibits the adrenal glands secretion of the hormone cortisol. If cortisol levels are not sufficiently reduced at night, sleep becomes difficult and the body does not properly repair.  Increasing serotonin levels can help to increase melatonin levels.  Melatonin can also be taken supplementally to support the sleep process. Tryptophan, 5-HTP tryptophan and melatonin are all available in supplemental form at Milk ‘N Honey.

        A substance called SAM-e (S-adenosyl-methionine) is made in the body from the amino acid methionine. In the presence of vitamin B12 and folic acid, SAM-e gives up what is called a methyl group to neighboring tissues and organs.  This action supports a variety of processes such as the maintenance of cell membranes, the removal of toxic substances from body tissue and the production of neurotransmitters such as dopamine and serotonin.  When SAM-e finishes its work as a methyl donor, it breaks down into sulfur groups which help support the maintenance of cartilage tissue.  Since SAM-e plays a role in the production of serotonin, this substance, when taken supplementally, could be helpful in insuring that adequate levels of serotonin are maintained.

        MSM, (methy-sulfonyl-methane) is a form of organic sulfur which has been found to be helpful in relieving pain associated with muscle and joint tissue.  This mineral plays an important role in the repair and maintenance of muscle tissue, MSM has been found to be helpful with FM as nutritional support to muscle and joint tissue repair.  Sam-E and MSM are available at Milk ‘N Honey.   

        A substance called cetyl myristoleate (CM) was discovered in 1964 and has been shown to be effective in facilitating the lubricating of the joints.  CM has also been shown to act as a natural analgesic and can be effective in the treatment of muscle and joint pain. 

       Exercise is a key component in the treatment of FM.  Exercise will increase muscle tone by increasing oxygen and nutrient flow into the muscle tissue. Exercise improves the flexibility and endurance of muscles, tendons and ligaments.  Aerobic exercise, in particular, will increase serotonin levels, enhance the production of growth hormone and stimulate the production of endorphins.  Endorphins, which are released by the hypothalamus gland in the head, act as the body’s own morphine-like pain killers.   Aerobic exercise, (exercise that allows for the uptake of more oxygen than when resting), will multiply the number of mitochondria (energy factories) in the cells one to two times over that of an unfit person.  The size of the mitochondria can increase up to 40% and the enzymes that are involved in energy production can be increased anywhere from ten to one-hundred percent.  Since fatigue is a major symptom of FM, increasing the ability of cells to produce energy should be an important consideration.

        While exercise may not appear to be very appealing to someone suffering the pain and fatigue associated with FM, it is a critical requirement in order to facilitate relief from pain and insure that degeneration of muscle and connective tissue doesn’t develop.  Walking, running, swimming and rebounding are the best forms of exercise for strengthening and toning the body as a whole.  Resistance exercise such as weight lifting, use of Xertubes (stretch tubes), etc. are also helpful in maintaining overall conditioning. 

        A sound nutritional program is absolutely necessary in order to give the body what it needs to heal from within.  Shifting from the standard American diet of processed and refined foods to a diet made up largely of whole foods where the nutrients are still largely in place, will be of great benefit in facilitating relief from FM.  Avoid sugar and hydrogenated fats.  Eat plenty of fresh fruits and vegetables.  Use flax oil or flax meal as a source of the all important essential fatty acids.  Take a high quality multi-vitamin/mineral supplement and a good green food concentrate.  Insure that you are getting enough anti-oxidant nutrients in the diet such as vitamins C, E, A, and Beta Carotene.  Vitamins B1, B2 and B6 are tied to the conversion of tryptophan to serotonin and are required to be present in the body on a consistent basis for this process to take place.  Supplementing with a B complex can be helpful when suffering from FM.

        Circulation within the brain has been identified as one of the problems associated with FM.  Circulation within the brain and head region can be enhanced by taking the herb Ginkgo Biloba.  Many studies show Ginkgo to increase blood circulation in the brain and thus facilitate better flow of oxygen and nutrients vital to neuro-transmission and other brain activity.   The nutrient CoQ10 has been found to facilitate oxygen uptake by the cells and can, therefore, increase oxygen activity in the brain.   Both Ginkgo and CoQ10 provide strong anti-oxidant activity in addition to their impact on the circulation.

         CONCLUSION: The research that has been done to date presents a mixed picture as to the dynamics involved in FM.  While no one cause of FM has been identified, what has been identified is a variety of health problems that are usually associated with FM.  When these problems are dealt with, the symptoms of FM are reduced or actually disappear.