Fibromyalgia
Written and Researched by Sasha Abiaad
What is Fibromyalgia
Fibromyalgia or FMS is an extremely complicated and multifactorial condition that is most simply characterized by widespread pain throughout the body. It affects about 2-6% of the USA’s population- about 10 million people- affecting adult women 75-90% of the time. This is one of the most frustrating and debilitating conditions out there.
Most conditions or diseases today are well understood by our scientists and practitioners because they have visible or tangible symptoms and can be pinpointed and followed to a source. Fibromyalgia is not one of these conditions.
Often, Fibromyalgia is part of several related pain syndromes that include Chronic Fatigue Syndrome, Chronic Fatigue Immune Deficiency, Irritable Bowel Syndrome, and Myofascial Pain Syndrome. To this day, fibromyalgia is not fully understood since it is intangible, and each case has different sets of accompanying symptoms or disease.
In the past, many doctors in the past referred to as “psychogenic rheumatism” (aka crazy ladies) since most early scientists and doctors were predominantly male, they assumed the symptoms of FMS must be women exaggerating their pain. However, as females came into the field and the understanding of human conditions and scientific technology grew, doctors starts to notice many patients with arthritis complained about these conditions as well. This led scientists to assume this phantom pain may be based in the musculoskeletal system. The name of the condition was changed from “neurasthenia” to “muscular rheumatism” and by 1987 it was officially named “Fibromyalgia” and was officially recognized by the AMA. (Bauman 2017)
Today’s scientists still do not agree with the classification of this condition. Fibromyalgia implies an issue with the fibers, the muscles of the body. However, we now know this condition is not associated with any tangible widespread inflammation and is not focused in the muscle. In fact, many scientists hypothesize that fibromyalgia is pain that is generated and maintained by the body’s own central nervous system! (Clauw 2017)
During my research into the subject, Dr. Andrea Nicol had an amazing analogy for the condition, comparing FMS to a volume knob for sensation and pain in the body in her 2018 talk at the Dublin Health and Wellness Center, saying:
“People who have fibromyalgia have their pain and sensation volume knob turned all the way up instead of at a balanced volume. The trick to relieving symptoms of fibromyalgia is figuring out how to turn that knob down.”
- Dr. Andrea Nicol
This tricky condition is also presents differently in each individual. Meaning that each person will have a unique way of turning their pain volume back down to normal levels.
The sensation and pain knobs can accidentally be turned up for an endless number of reasons, but once they are changed- it indicates an energy crisis in the body manifesting itself through widespread, debilitating pain and nausea which, without the proper information, can seem like an endless hole of suffering.
That is what makes Fibromyalgia one of the most complicated conditions in the human body.
Signs and Symptoms.
Fibromyalgia’s signs and symptoms present differently for everyone and are often hard to diagnose. The key mechanism of Fibromyalgia is known as central sensitization; a state of the brain where it is in hyper reactivity. This can be towards physical sensation, smells, temperature, or taste. In fibromyalgia, it usually shows up as widespread centralized pain. In general, signs, symptoms, and accompanying symptoms of fibromyalgia may also include:
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Causes and Risk Factors
There is no single known cause of fibromyalgia. Many twin studies have shown that it the manifestation of fibromyalgia is 50% genetic and 50% environmental (D’Agnelli 2019). In most patients suffering from fibromyalgia. A common risk factor tends to be early life stress. Whether it be physical trauma, abuse, neglect, or even a chaotic environment growing up. Other risk factors or amplifying and accompanying syndromes are:
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To further complicate the condition, people suffering from Fibromyalgia and other accompanying condition usually experiences multiple types of pain due to having multiple possible sources. While building health in attempts to relieve symptoms of fibromyalgia, it is helpful to work with a practitioner or even introspectively to identify and dissect what type of pain is contributing to daily discomfort.
This diagram by Daniel J. Clauw, M.D. represents all the different ways pain conditions can overlap.
Different Types of Pain
| Nociceptive Pain | Neuropathic Pain | Centralized pain |
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Caused by inflammation or cell/tissue damage. Pain is localized and consistent. Examples: Autoimmune disorders, cancer, osteoarthritis, gut inflammation. |
Nerve damage or entrapment. Pain follows the pathways of nerves. Examples: Diabetic neuropathy, carpal tunnel syndrome. |
Pain is systemic and widespread, accompanied by fatigue, sleep difficulties, memory difficulties, may be triggered by history of stress or past trauma.' Examples: Fibromyalgia, Functional GI disorders, tension headaches. |
Understanding and categorizing your pain can allow someone suffering from Fibromyalgia to know which category of pain they deal with on a daily basis and can make it easier for the individual and their practitioner to address any pain that can be relieved by other means (like inflammation) and understand exactly what centralized pain caused by fibromyalgia feels like for them in their own body. (Raffaeli 2017)
Fibromyalgia and Fatigue
Fibromyalgia and Fatigue have an interesting relationship and correlation in the body as well. Statistically, fibromyalgia fatigue occurs in more Americans than chronic fatigue syndrome. The U.S. Centers for Disease Control and Prevention believes there are about 5 million people in the United States with fibromyalgia, compared with a little over 1 million people with chronic fatigue syndrome (CDC 2018) and The Arthritis Foundation estimates that 50 to 70 percent of people with fibromyalgia also fit the criteria of chronic fatigue syndrome (AF 2019).
Since both conditions are intangible and deal heavily with feelings that cannot be measured, it is hard to tell for certain that this means many people could be suffering from both conditions. Fibromyalgia and fatigue tend to present together and there are many theories as to why.
One theory is that the fatigue is the result of the body attempting to deal with the constant reaction to pain signals in the nerves making the individual lethargic and exhausted.
Most people with fibromyalgia also have trouble with restorative sleep due to this pain. Non-restorative sleep could easily lead to endocrine imbalances and contribute to the amplification of pain in the body. (Bauman 2017)
Lifestyle Support for FMS
Increasing nutrient density is only half the battle. Building healthy habits, normalizing sleep and building relationships in one’s community all have amazing benefits for people suffering from FMS.
Normalizing Sleep:
An important step to managing FMS is to set the environment up for normalizing the body's circadian rhythm, eating for health, looking for patterns and managing stress.
The bedroom is the most important place for rest. Make sure that the sleep area is clean, comfortable, and free of stimulating lights and sounds. It’s best to keep the light low and warm before bedtime since blue light and fluorescent lights have been proven to negatively impact sleep quality. Adding aromatics like lavender or rose can relax your mind and body before bed as well. When it comes to a path towards healing, a history of understanding your personal sleep pattern is incredibly helpful. Identifying a pattern or just recording your issues in a sleep log can be immensely helpful in correcting the problem.
A simple sleep log records:
~How long it took you to sleep
~Wake and sleep times
~Quality of rest after sleeping
~Number of sleep interruptions
~Types of sleep interruptions
~Time of waking for the day.
Understanding Pain Patterns
This same idea can work with pain. Understanding patterns and triggers to FMS flare-ups are important- especially since every person’s FMS is different.
A simple pain log records:
~When and when did the pain start?
~Where is the pain focused or traveling to?
~How long did the pain last?
~Where there any obvious triggers that amplified the pain?
~Was anything triggering my stress before the pain flared up?
~Could something I ate have triggered my pain?
Exercise:
The idea of exercising with a pain condition does not seem appealing or motivating. Many people suffering from FMS find that doing exercise does in fact eases their fibromyalgia symptoms.
Research on people with depression has found that exercise can be effective in alleviating some symptoms. A 2016 study argues that previous research may have underestimated the effectiveness of exercise for fighting depression, including depression linked to fibromyalgia.
Even just a few minutes of exercise a week is better than no exercise at all. A person with fibromyalgia may wish to start slowly and gradually increase the amount of time spent exercising when they find a type of exercise, they find helpful and enjoyable (Clauw 2010).
Simple low-impact exercise are recommended when starting to move more with FMS.
Low Impact Exercises Include:
Yoga
Tia Chi
Aerobics
Swimming
Walking
Low Resistance Strength Training
Dietary Changes to Support Healing
Antioxidants:
It is normal for cellular respiration in the body to produce free radicals that lead to oxidative stress. The antioxidant defense system normally keeps these free radicals in check. However, recent studies have shown some evidence demonstrating that oxidative stress may have a role in the mechanisms of Fibromyalgia. Muscular alteration and mitochondrial dysfunction, including oxidative stress, have been observed in patients with Fibromyalgia (Cordero 2010). Patients with fibromyalgia produce more damaging free radicals than healthy people, and they have a reduced antioxidant capacity. Oxidative stress is dangerous since it creates chaotic free radicals in the body which can damage cells and cause inflammation, further pain, and more intense side effects like tumor growth. Antioxidants relive oxidative stress, allowing the body for a better environment to produce energy and re-balance itself. (Bauman 2017)
Antioxidants can be found in therapeutic amounts in foods like leafy greens, berries, nuts, seeds, citrus fruits, herbs, and spices.
***Clove spice is the highest gram for gram source of antioxidants in the world.***
Magnesium
One of the most important nutrients in the body. Even a slight deficiency of magnesium can affect the absorption of nutrients and cascade into other problems (WHF). Magnesium is shown to be low in people with Fibromyalgia. This makes sense since magnesium maintains the nervous system balance. It is an essential relaxant, and a precursor to energy and many other reactions in the body. This means low magnesium will eventually lead to increased fatigue, brain fog, spasm, pain, absorption issues, and tension (Bauman 2017).
Magnesium can be found in most greens and whole foods, but is concentrated in foods like spinach, swiss chard, beet greens, pumpkin seeds, turnip greens, and summer squash.
RDA: 400 mg (FDA)
Therapeutic Dosage: 400mg-1000mg
B Vitamins
B vitamins play important roles in the human body. They help convert foods into fuel and are essential to energy production and adrenal health throughout the day. Many doctors give b-complex vitamins to FMS patients. Vitamins B1, B5, B12 have been specifically cited in benefits for pain management in Fibromyalgia. However, all of these vitamins work together to accomplish a goal greater than if they were apart, so intaking B-complex rather than focusing on the individual members of the family is much more beneficial for overall health as well as pain management (Costantini 2013)
B-Vitamins can be found in leafy greens, sea veggies, root veggies, fatty fish, animal meats, seafoods, nuts and seeds.
RDA: B-1: 1.2 mg, B-2: 1.3 mg, B-3: 16 mg, B-5: 5 mg (RDA not established), B-6: 1.3 mg, Biotin: 30 mcg (RDA not established), Folic acid: 400 mcg, B-12: 2.4 mcg (FDA)
Therapeutic Dosage: N/A
Other Synergistic Nutrients
Melatonin:
Insomnia and non-restorative sleep contribute to the energy crisis in FMS (Bauman 2017) as well negatively impacting overall health. Increasing melatonin intake can improve sleep quality and help the endocrine system re-balance. This will help with overall health, oxidative stress, and fatigue that most people with FMS deal with daily.
Melatonin can be found in oats, nuts, seeds, tart cherry juice, sweet corn, rice, bananas, and tomatoes.
Therapeutic Dose: 3–5 mg (Moore 1998)
Tryptophan:
Tryptophan is an essential amino acid found in proteins. This amino acid is highly versatile and essential since it can be converted into several important molecules, including serotonin and melatonin. Serotonin is associated with mood, cognition, and the wake cycle, while Melatonin is associated heavily with the sleep cycle. Increasing Tryptophan in turn increases and supports melatonin and serotonin production which influence many functions in the body, but most importantly, sleep, mood, and behavior (Bauman 2017). People suffering from FMS will benefit greatly from more restorative sleep and healthier functioning hormones.
Tryptophan can be found in tart cherry juice, eggs, animal meats, fatty fish, nuts, seeds, and whole grains.
Therapeutic Dosage: 300mg+ The National Academy of Science has not set a tolerable upper limit (WHF)
D-ribose
D-ribose is a sugar in the body that aids in energy production. It’s a component of ATP and RNA. D-ribose has been shown to increase energy in FMS patients and may also aide in rest. (Bauman 2017)
Therapeutic Dosage: 5g three times a day for three weeks. (Bauman 2017
Omega-3’s
Omega 3s play an important role in cell function. One of the most powerful benefits of omega 3s to the body is their ability to reduce inflammation and improve cognitive health. When it comes to sleep, Omega 3s have been shown to improve sleep quality and sleep quantity. Research suggests omega 3 fatty acids from regularly consuming fish may boost your sleep quality, help you fall asleep more quickly and improve your daytime performance. This can be due to the vitamin D content in a lot of foods containing Omega-3’s or due to Omega-3’s abilities to stimulate Melatonin. (Murray 2014)
Omega-threes can be found in fatty fish, nuts, seeds, avocados, coconut oil, olive oil, and soybeans.
Therapeutic Dose: 3,000–5,000 mg (Holmes 2007)
CoQ10
Coenzyme Q10 deficiency inhibits mitochondria function. CoQ10 is an essential electron carrier in the mitochondrial respiratory chain and a strong antioxidant. Recently, CoQ10 deficiency have been showed in blood cells in FMS patients (Richards 2016). Mitochondrial dysfunction may be the origin of oxidative stress in FMS patients and supplementing this enzyme may aide in energy production and mitochondrial health (Bauman 2017).
Therapeutic Dose: 300 mg over 9 months (Bauman 2017)
Wild Lettuce
Wild lettuce is a powerful sedative and pain-relieving herb that may be growing in your backyard. When scratched, this herb plant secretes a milky, white substance known as lactucarium. When dried, this compound resembles opium. In fact, wild lettuce is often referred to as “opium lettuce” due to its analgesic qualities. This herb is also a bitter sedative. Bitter compounds aid in digestion as it’s sedative and analgesic ones may aide in rest.
Therapeutic Dosage: 400–900 mg (Thomas 2016)
Tincture: 5-10ml at 1:2 strength in 50% ethanol. (Holmes 2007)
Sea Greens
Sea veggies offer one of the broadest ranges of minerals of any food, containing virtually all the minerals found in the ocean—and in human blood (WHF). Sea vegetables are an excellent source of iodine, vitamin C, manganese, and vitamin B2. They are also a good sources of vitamin A, copper, protein, pantothenic acid, potassium, iron, zinc, vitamin B6, niacin, phosphorus, and vitamin B1. Nutrient density is essential in FMS and accompanying condition, so adding sea veggies into the daily diet can ensure optimal absorption. The also offer a variety of unique phytonutrients and trance minerals that are often not found in other foods.
Sea veggies include nori, dulse, wakame, seaweed, chlorella, spirulina, and algae.
Therapeutic Dosage: 2 tsp powder daily or 2 tbsp whole veggies
Probiotics
Probiotics are filled with beneficial bacteria that inhabit the gut. Eating probiotics may address several health problems that often occur in fibromyalgia, including irritable bowel syndrome (IBS), vaginal yeast infections, depression, and anxiety (Bauman 2017). They also encourage optimal GI production and cognitive healing. The gut-brain connection is not fully understood, but everyday more and more is being learned about how the gut microbiome dictates the efficiency and function of most body systems and mental comfort.
Probiotic foods include kimchi, sauerkraut, kefir, yogurt, kvass, kombucha, pickles, and hard cheeses.
Therapeutic Dosage: 2 Tbsp Probiotic Foods Daily.
Disclaimer & References:
Disclaimer: The information provided by Cherry & Pepper and Sasha Abiaad is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. None of my services shall be used to diagnose or treat any health problem or disease. I cannot and do not provide medical advice. You should seek prompt medical care for any specific health issues and consult your physician before altering your diet. The information and recipes provided on this site and in my session plans should not be used in place of a consultation with your physician or other health care provider. I do not recommend the self-management of health problems. Should you have any healthcare-related questions, please consult your physician or other health care provider promptly. You should never disregard medical advice or delay in seeking it because of the information provided in this plan.
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