Fibromyalgia: The role of nutrition
and diet.
Blake Graham, B.Sc (Honours)
Clinical Nutritionist
(08) 9487 7409
May 17th 2010
FM pathophysiology.
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Mitochondrial impairment
Oxidative stress
HPA axis dysfunction
ANS dysfunction
Immune activation
Inflammation
Sleep dysfunction
Causes of FM.
Nutrient/dietary imbalances
Gastrointestinal microbiology
imbalances
Acute chemical/allergen
exposure
Toxic chemical accumulation
Lack of quality sleep
Structural/mechanical
Hormone imbalances
Emotional factors/stress
Multi-factorial model.
FM treatment.
• Identify and address contributing factors
rather than trying treatments.
FM treatment.
• Address all contributing factors.
Causes of FM.
Nutrient/dietary imbalances
Gastrointestinal microbiology
imbalances
Acute chemical/allergen
exposure
Toxic chemical accumulation
Lack of quality sleep
Structural/mechanical
Hormone imbalances
Emotional factors/stress
Diet.
Mechanisms of illness modulated by
diet.
1. Nutrient
levels
Mechanisms of illness modulated by
diet.
1. Nutrient levels
2. Inflammation
Mechanisms of illness modulated by
diet.
1. Nutrient levels
2. Inflammation
3. Oxidative
Stress
Mechanisms of illness modulated by
diet.
1. Nutrient levels
2. Inflammation
3. Oxidative Stress
4. Intestinal
microorganism
balance
Mechanisms of illness modulated by
diet.
1.
2.
3.
4.
Nutrient levels
Inflammation
Oxidative Stress
Intestinal micro-organism
balance
5.Detoxification
chemistry
Mechanisms of illness modulated by
diet.
1.
2.
3.
4.
Nutrient levels
Inflammation
Oxidative Stress
Intestinal micro-organism
balance
5. Detoxification chemistry
6. Hormone /
neurotransmitter
balance
Mechanisms of illness modulated by
diet.
1.
2.
3.
4.
5.
6.
Nutrient levels
Inflammation
Oxidative Stress
Intestinal micro-organism
balance
Detoxification chemistry
Hormone /
neurotransmitter balance
7. Intake of toxic
chemicals
Mechanisms of illness modulated by
diet.
1.
2.
3.
4.
5.
6.
7.
Nutrient levels
Inflammation
Oxidative Stress
Intestinal micro-organism
balance
Detoxification chemistry
Hormone /
neurotransmitter balance
Intake of toxic chemicals
8. Immune
function
Mechanisms of illness modulated by
diet.
1.
2.
3.
4.
5.
6.
7.
8.
Nutrient levels
Inflammation
Oxidative Stress
Intestinal micro-organism
balance
Detoxification chemistry
Hormone /
neurotransmitter balance
Intake of toxic chemicals
Immune function
9. Circadian rhythm
/ sleep
Mechanisms of illness modulated by
diet.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Nutrient levels
Inflammation
Oxidative Stress
Intestinal micro-organism balance
Detoxification chemistry
Hormone / neurotransmitter balance
Intake of toxic chemicals
Immune function
Circadian rhythm / sleep
10.Food intolerances
Mechanisms of illness modulated by
diet.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Nutrient levels
Inflammation
Oxidative Stress
Intestinal micro-organism balance
Detoxification chemistry
Hormone / neurotransmitter balance
Intake of toxic chemicals
Immune function
Circadian rhythm / sleep
Food intolerances
11.Genetic expression
Mechanisms of illness modulated by
diet.
1.
2.
3.
4.
Nutrient levels
Inflammation
Oxidative Stress
Intestinal micro-organism
balance
5. Detoxification chemistry
6. Hormone /
neurotransmitter balance
7. Intake of toxic chemicals
8. Immune function
9. Circadian rhythm / sleep
10. Food intolerances
11. Genetic expression
12.Acid/base
balance
Diet.
• Emphasize:
– Extra virgin olive oil
– Berries
– Non-starchy dark
vegetables
– Unrefined meat
– Fish
– Whole grains
– Legumes/lentils
– Herbs/spices
– Filtered water
• Minimize:
– Sunflower/Grapeseed/
Safflower/Sesame oil
– Refined sugar
– Fruit juice
– Refined grains
– Artificial sugars
– Additives/colorings/
flavorings
– Alcohol
Nutrient supplementation
Causes of nutrient imbalances.
1. Poor intake.
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Food choices.
Inc. soil levels, food storage, cooking methods,
etc.
2. Poor absorption.
3. Excess excretion/loss/utilisation.
4. Maldistribution.
Nutrient testing.
• Vitamin D (> 125 nmol/L).
• Iron studies (ferritin > 50 / transferrin saturation
> 22%).
• Urine iodine.
• Amino acid testing.
• Magnesium testing highly unreliable.
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Magnesium deficiency signs/symptoms.
Muscle cramps, spasms or pain (e.g. leg/foot cramps, back ache, neck ache)
Muscle tension
Muscle twitches, tics or jerks
Muscle weakness
Muscle tremors
Restless legs
Fatigue / sighing
Breathlessness / chest tightness
Heart palpitations / arrhythmias
Numbness or tingling of skin or “creepy-crawly” feeling under skin
Sensitivity to loud noises or sudden bright light
Headaches / migraines
Menstrual cramps / pain
Teeth grinding (bruxism)
Frequent constipation or anal spasms
Anxious, agitated or panic attacks
Difficulty falling asleep or frequent nocturnal awakenings
Magnesium optimisation.
• Magnesium.
• Oral.
– ‘Magnesium Colloid’ by Full Health (10 ml bid)
– ‘Ultra Muscleze’ by Bioceuticals (1 tsp bid)
– ‘Chelated Magnesium’ by MicroGenics (3 bid)
• Topical.
– ‘Magnesium Chloride Oil’ by Essence of Life.
www.echolife.com.au
– 5 ml/day.
– In Perth available from Good Life Subiaco (Shop 9, Subiaco
Centro Shopping Centre, 29 Station St – 08 9381 3999)
• Trial oral + topical combination for 6 weeks.
• Epsom salt baths (e.g. 1 kg/bath).
Vitamin D.
• Symptoms/signs of low levels:
– Regular bone pain or tenderness (e.g. from applying
thumb pressure to sternum/shinbone/forearm)
– Muscle aches/pain/discomfort (esp. low back pain)
– Poor balance or coordination
– Muscle weakness
– Feeling of heaviness in legs
– Symptoms worse (e.g. pain or mood) in winter
Vitamin D and chronic widespread pain in a white middle-aged
British population: evidence from a cross-sectional population
survey. Annals of the Rheumatic Diseases, Jun 2009
Vitamin D levels in women with systemic lupus erythematosus
and fibromyalgia. J Rheumatol, 2001
Vitamin D deficiency is associated with anxiety and depression in
fibromyalgia. Clinical rheumatology, 2007
Vitamin D deficiency and chronic low back pain in Saudi Arabia.
Spine, 2003
Vitamin D.
• Levels should be above 125 nmol/L.
• Often requires 4000 IU+/day.
• D3 Drops by Bioceuticals.
– 333 IU/drop.
• www.vitamindcouncil.org
Iron.
• “having a serum ferritin level <50 ng/ml
caused a 6.5-fold increased risk for FMS … We
suggest that iron as a cofactor in serotonin
and dopamine production may have a role in
the etiology of FMS. ”
• O Ortancil, A Sanli, R Eryuksel, A Basaran and
H Ankarali. Association between serum ferritin
level and fibromyalgia syndrome. European
Journal of Clinical Nutrition 64, 308-312
(March 2010)
Fish oil.
• 6-12 grams/day.
• Antiinflammatory.
Amino acids.
www.metametrix.com
Remove food allergens/intolerances.
• Methods of assessment:
– Elimination diets.
– IgG food intolerance testing.
Elimination diets vs. IgG testing.
Elimination diets
IgG testing
Pro
•Free
•High reliability for most
commonly reactive foods
•Tests for non-immune mediated
intolerances
•Minimal effort involved
•Investigates 96 foods
Con
•High effort/motivation required
•Only can investigate ~13 foods
•A person can’t make any other
changes during test period
•Cost (~ $250)
•Significant false positive & negative
rate
•Must have been eating foods in
question
Elimination/provocation testing.
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1. Dairy products.
2. Wheat/barley/rye/oats/spelt (gluten containing grains).
3. Eggs.
4. Peanuts.
5. Corn.
6. Soy.
7. Cocoa.
8. Yeast (e.g. alcohol, cheese, vinegar, mushrooms, fermented foods, anything containing
brewers/bakers yeast [bread], vegemite, olives, capers, etc.).
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9. Citrus (inc. citrus essence in many sauces/spices/condiments, earl grey tea).
10. Tomatoes.
11. Beef & pork.
12. Coffee & tea.
13. Refined sugar & additives/colorings/preservatives.
IgG food testing via US BioTek.
Dairy
Bovine-derived
unless specified
Casein
Cheese, Cheddar
Cheese, Cottage
Cheese, Mozzarella
Milk
Milk, Goat
Whey
Yogurt
www.usbiotek.com/
Recommended reading.
• ‘Musculoskeletal Pain: Expanded
Clinical Strategies’
• Alex Vasquez, ND, DC
• 2008
• Available from
www.functionalmedicine.org
Summary - Putting it all together.
• Identify causes/contributing factors.
• Treat systematically.
• Consider role of diet, nutrients and lifestyle
factors.
Fibromyalgia: The role of nutrition
and diet.
Blake Graham, B.Sc (Honours)
Clinical Nutritionist
(08) 9487 7409
May 17th 2010