What Is The Most Current Theory of Fibromyalgia?
Today, we look at fibromyalgia in a completely different way. There used to be little or no way to “see” this condition as anything other than 18 tender points in a doctor’s examination. (Which is silly, because fibromyalgia patients are sore everywhere!) Today we know that fibromyalgia patients show the following:
• Elevated inflammatory cytokines IL-6 and especially IL-17.
• Neuroimaging of the brain shows altered brain structure and disrupted white matter.
• Endothelial dysfunction disturbing blood vessels
• Sympathetic nervous system dominance
• HPA axis disturbance causing low pituitary and adrenal response to ACTH and cortisol
• Small fiber polyneuropathy is distal body joints are a driver of pain signals
• Non-restorative sleep
• Association with pathogens such as hepatitis B or C, HIV, cocksackie B, parvovirus, and Borrellia.
• Evidence of cell mitochondrial dysfunction
Science refers to fibromyalgia (FMS) as a mosaic disease, in other words, it is a condition that stems from a specific group of any or all causes. All the conditions in this group are part of Central Sensitivity Syndrome (CSS) or the Neuroinflammation Mosaic. Other conditions in the same mosaic include migraine headaches, Irritable Bowel Syndrome (IBS), Chronic Fatigue Syndrome, PTSD, Restless Leg Syndrome, TMJ Disorder and others. Every patient’s mosaic is a little different so the approach to care has to be unique to each patient.
What Does Research Tell Us From Previous Nutrition Studies about FMS?
There are very few studies that give us much information about FMS (Fibromyalgia Syndrome). Two studies from Spain found that there was “remarkable clinical improvement is FMS patients on a gluten-free diet” 1,2 This is consistent with the newest information that says that immunity, infection and inflammatory processes are a driver of CSS. In a random controlled trial in 2013 it was found that 300 mg/day of magnesium for 8 weeks reduced tender points, sensitivity and depression.3
How Do You Address the Four Areas of The Fibromyalgia Mosaic?
1. Immune/Infection/Inflammation: In any inflammatory condition we want to rule out any type of chronic infection causing ongoing chronic inflammation. Many patients with CSS suffer from gut inflammation due to poor gut bacterial balance (dysbiosis). Probiotics may give temporary relief to gut issues that lead to a leaky gut allowing bacteria and proteins to enter the bloodstream uninvited. To control inflammation herbs such as boswellia, turmeric and ginger will lower inflammatory cytokines. Strengthen the immune system with herbs like echinacea and astragalus. Green tea will upregulate your body’s ability to make its own antioxidants (Nrf2 cycle). One area with fibromyalgia that has been shown to help is to add these 5 things to your regular diet to manage inflammation, increase dietary nitrates, and reduce oxidative stress:
a. Boost dietary nitrate by juicing or baking beets and eating them.
b. Increase cocoa intake (dark chocolate 85% or higher) rich in polyphenols
c. Increase berries and cruciferous vegetables for anthocyanins.
d. Eat ½ to 1 clove a day of raw crushed garlic in your food for the hydrogen sulfide.
e. Increase your use of herbs and spices, especially green tea, turmeric and ginger.
f. (Bonus) There was “remarkable clinical improvement” with patients who went on a gluten-free diet.4
2. Endocrine/HPA Axis Support: With fibromyalgia there is a loss of the normal stress response, disturbed sleep patterns and fatigue. The stress response of the body is mediated by the hypothalamus, pituitary and adrenal glands. (HPA Axis) Cortisol is the stress hormone created by the adrenal glands. With dysfunction the adrenals will benefit from adrenal tonic herbs like licorice and rehmannia. Whole food vitamin C is critical for adrenal function. Some herbs help the HPA axis better adapt to stress. They are called adaptogens. Ashwaganda and Rhodiola are two such herbs. Herbs that support sleep like valerian root and kava are also helpful.
3. Mitochondrial Support: 20% of all the mitochondria in the body are found in the brain. Magnesium is a mineral that is very important to energy production in the mitochondria. Herbs and herbal extracts such as gingko, hawthorn and resveratrol are supportive of normal mitochondrial function.
4. Brain/Nervous System Support: Two areas of concentration are important to support the brain; microcirculation and central sensitivity pain. Gingko is known to improve microcirculation in the brain. One of the key features of fibromyalgia is chronic pain. For peripheral pain (pain in the extremities) the best herbs are celery seed, boswellia, turmeric and willow bark. For pain related to the brain and spinal cord herbs such as California poppy, Jamaica dogwood and corydalis are herbs known to help.
You can now understand that fibromyalgia is NOT a figment of science’s imagination, but a real condition with real solutions… and that chiropractic, nutrition and herbs can serve as a solution.
1. Isasi C, et al. Rheumatol Int 2014;34(11):1607-1612
2. Rodrigo L, et al. Arthritis Res Ther 2014;16(4):421
3. Bagis S. et al. Rheumatol Int 2013;33(1): 167-172
4. Isasi C, Colmenero I, Casco F, et al. Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. Rheumatology International. 2014;34(11):1607-1612.