Q&A on fibro excellent article

Discussion in 'Fibromyalgia Main Forum' started by charlenef, Aug 13, 2008.

  1. charlenef

    charlenef New Member

    Fibromyalgia Information - Natural Treatment for Fibromyalgia by Ray Sahelian, M.D. Fibromyalgia Research with Supplements
    Fibromyalgia affects about 3 million to 6 million people in the United States each year. The disorder mostly affects women and typically develops in early-to-middle adulthood. There is no test for the diagnosis of fibromyalgia. Doctors make a diagnosis by conducting physical examinations, evaluating symptoms, and ruling out other conditions.

    Natural fibromyalgia treatment - alternative treatment
    On this page I mention a few herbs or natural supplements that may play a role in fibromyalgia treatment. Research involving natural fibromylagia treatment is quite limited and I will update this page as more alternative treatment information becomes available. What works for one person may not work for another. It may take trial and error to find a supplement or a lifestyle change that works for you.

    Natural supplements for fibromyalgia - new treatment?
    It is suggested that you first try each of these natural fibromyalgia supplements by themselves for a period of a couple of weeks. It is not recommended to take them all together at one time. Learn how each supplement influences your body by itself before considering combinations.

    Eat more cold water fish or take fish oil capsules.
    Acetyl l carnitine has been found to be helpful for fibromyalgia symptom reduction. You can buy Acetyl-l-Carnitine supplement here.
    SAM-e an antidepressant that lifts mood within hours may help some individuals. Daily dose is best kept to below 200 mg with frequent breaks to avoid overstimulation. Preferably half a tablet at 100 mg works well a few times a week as a fibromyalgia supplement.
    CoQ10 combined with ginkgo - see study at bottom of page. Limit CoQ10 to 50 mg or less and ginkgo to 40 or 60 mg.
    Mucuna pruriens could be helpful at about 100 to 200 mg a day. Mucuna pruriens has a high amount of dopamine which may be helpful in this condition.
    Chlorella has been tested in fibromyalgia.
    Ribose - one small study indicates that perhaps ribose may be helpful. At least 2 or 3 more studies showing the same results from different researchers would solidify this finding. Ribose can be found here.

    Subscribe to a FREE Supplement Research Update newsletter at Physician Formulas. Twice a month we email you a brief abstract of several new studies on various supplements and natural medicine topics, including fibromyalgia treatment with supplements and fibromyalgia diet, and their practical interpretation by Ray Sahelian, M.D.

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    Ribose for fibromyalgia
    The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study.
    J Altern Complement Med. 2006 Nov;12(9):857-62. Teitelbaum JE, Johnson C, St Cyr J. Fibromyalgia and Fatigue Centers, Dallas, TX, USA.
    Fibromyalgia and chronic fatigue syndrome are debilitating syndromes that are often associated with impaired cellular energy metabolism. As D-ribose has been shown to increase cellular energy synthesis in heart and skeletal muscle, this open-label uncontrolled pilot study was done to evaluate if D-ribose could improve symptoms in fibromyalgia and/or chronic fatigue syndrome patients. Forty-one patients with a diagnosis of fibromyalgia and/or chronic fatigue syndrome were given D-ribose, a naturally occurring pentose carbohydrate, at a dose of 5 g t.i.d. for a total of 280 g. D-ribose, which was well-tolerated, resulted in a significant improvement in all five visual analog scale (VAS) categories: energy; sleep; mental clarity; pain intensity; and well-being, as well as an improvement in patients' global assessment. Approximately 66% of patients experienced significant improvement while on D-ribose, with an average increase in energy on the VAS of 45% and an average improvement in overall well-being of 30%. D-ribose significantly reduced clinical symptoms in patients suffering from fibromyalgia and chronic fatigue syndrome.

    Acetyl l carnitine for fibromyalgia
    Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients.
    Clin Exp Rheumatol. 2007 Mar-April. Rossini M, Di Munno O, Valentini G, Bianchi G, Biasi G, Cacace E, Malesci D, La Montagna G, Viapiana O, Adami S. Rheumatology Unit, University of Verona, Italy.
    It has been recently suggested that fibromyalgia may be associated with metabolic alterations including a deficit of carnitine. One hundred and two patients meeting the American College of Rheumatology criteria for fibromyalgia syndrome were randomized. The treatment consisted of 2 capsules/day of 500 mg acetyl L carnitine or placebo plus one intramuscular injection of either 500 mg acetyl L carnitine or placebo for 2 weeks. During the following 8 weeks the patients took 3 capsules daily containing either 500 mg acetyl L carnitine or placebo. The "total myalgic score" and the number of positive tender points declined significantly and equally in both groups until the 6th week of treatment. At the 10th week both parameters remained unchanged in the placebo group but they continued to improve in the acetyl L carnitine group with a statistically significant between-group difference. A statistically significant between-group difference was observed for depression and musculo-skeletal pain. These results indicate that acetyl L carnitine may be of benefit in patients with fibromyalgia, providing improvement in pain as well as the general and mental health of these patients.

    Fibromyalgia diet and nutrition
    Diet and nutrition plays a role in fibromyalgia, even though most doctors don't make the connection. A fibromyalgia diet should include foods that have low inflammation potential. The ideal fibromyalgia diet would have lots of fish, particularly cold water fish, and lots of vegetables. Have a wide range of vegetables, including fresh vegetable juices. Reduce your intake of sugar, baked goods, and simple carbohydrates. For healthy food choices, see diet.

    Food allergy and fibromyalgia
    Food allergies: In one study, researchers reviewed medical charts of 17 fibromyalgia patients who agreed to eliminate common foods from their diet such as corn, wheat, dairy, citrus, soy and nuts. After 2 weeks without eating any of the potential food allergens, nearly half of the patients reported significant reduction of pain, and most reported a reduction in other symptoms such as headache, fatigue, bloating, and breathing difficulties. Two patients had an increase in symptoms. After the food elimination phase of the study, the patients were then instructed to reintroduce a particular food every 2 or 3 days and monitor their reaction to the food. Some of the reactions to foods were pain, headache, and gastrointestinal distress. The most common problem-causing foods or ingredients for the patients in this study were corn, wheat, dairy, citrus and sugar.

    Exercise is key
    Exercise, or increasing physical activity, is one of the most important things you can do to reduce your fibromyalgia pain. If you take a long walk in the morning, it will help you get a deeper sleep at night. Exercise is often more effective in fibromylagia treatment than medication. Yoga is quite helpful as a fibromyalgia treatment.

    Exercise in fibromyalgia.
    Curr Opin Rheumatol. 2005 Mar;17(2):190-4.
    Several studies have indicated that physical exercise is beneficial for patients with fibromyalgia. The aim of this article is to review the recent literature relating to exercise in fibromyalgia. The recent studies support existing literature on the benefits of exercise for patients with fibromyalgia. The outcomes appear to be related to the program design and the characteristics of the populations studied. As the patients with fibromyalgia form a heterogeneous population, more research is required to identify the characteristics of patients who benefit from specific modes of exercise.

    Fibromyalgia supplement not found to be effective
    DHEA has not been found to be helpful and it may cause side effects if used in high doses for prolonged periods. The hormone supplement DHEA may be a popular choice for people with fibromyalgia, but it is unlikely to be helpful. Supplemental DHEA -- short for dehydroepiandrosterone -- is a synthesized version of a hormone produced by the adrenal glands. DHEA is converted into other steroid hormones, including testosterone and estrogen; its levels in the body naturally peak during the 20s and then taper off as people age. DHEA at 50 mg a day for 3 months was given to 52 women, mostly in their 50s and 60s, who had been diagnosed with fibromyalgia. Overall, the women reported no clear improvement in pain, fatigue, depression and anxiety, and physical and mental function -- with either the supplement or the placebo. Journal of Rheumatology, July 5, 2005.

    Fibromyalgia cause
    While the cause of fibromyalgia is unknown, researchers have found pain-processing abnormalities in the spines and brain stems of some people with fibromyalgia. Fibromyalgia research suggests that the condition is a diffuse problem of sensory volume control in which patients' thresholds are altered not just to pain, but to other stimuli such as heat, noise, and strong odors. Indeed, fibromyalgia frequently occurs with other syndromes that are also associated with hypersensitivity, such as irritable bowel syndrome and TMG syndrome. Depression, stress, and poor sleeping habits aggravate fibromyalgia. Many people with fibromyalgia have also suffered from depression, anxiety or other psychiatric conditions at some point in their lives -- suggesting that the disorders have some common causes. Nine in 10 fibromyalgia patients are female.

    Fibromylagia symptoms
    Fibromyalgia has many symptoms including body aches and fatigue. Another fibromyalgia sympto is low mood or depression and fatigue. The fibromyalgia symptom of body aches mostly involves the muscles and tissues surrounding the joints. Some individuals with this condition also have disturbed sleep. Fibromyalgia is a chronic condition marked by widespread muscular and joint pain, as well as specific "tender" points that typically occur in the neck, spine, hips and shoulders. Another fibromyalgia symptom is irritable bowel syndrome.

    Fibromyalgia diagnosis
    Musculoskeletal aches at 3 or more sites for 3 or more months. Severe pain in 5 out of 11 tender point sites (occiput, low cervical, trapezius, suprasinatus, second rib, lateral epicondyle, gluteal, greater trochanter, knee) plus at least 3 out of 10 associated symptoms (fatigue, sleep disturbance, affective disorders, irritable bladder or bowel, chronic headache, perception of swelling, numbness, pain modulated by activity, weather or stress, esophageal dismobility). Laboratory tests are usually normal.

    Medical treatment of fibromyalgia - fibromyalgia medication - fibromyalgia pain relief
    A number of different antidepressant medications have been tried for fibromyalgia including tricyclic and SSRI antidepressants. Ultram (tramadol) is used for fibromyalgia pain. Some patients with severe fibromyalgia symptoms have some pain relief to a drug usually used to treat Parkinson's disease with a improvement in their symptoms. The drug is pramipexole, marketed as Mirapex, which stimulates dopamine receptors in the brain.

    Fibromyalgia drug approved June 2007
    The U.S. Food and Drug Administration approved Lyrica (pregabalin), the first drug to treat fibromyalgia. It is thought that Lyrica reduces pain and improves daily functions for some patients with fibromyalgia. Individuals with fibromyalgia have been shown to experience pain differently from other people. The most common side effects of Lyrica include mild-to-moderate dizziness and sleepiness. Blurred vision, weight gain, dry mouth, and swelling of the hands and feet also were reported in clinical trials. The side effects appeared to be dose-related. Lyrica can impair motor function and cause problems with concentration and attention. FDA advises that patients talk to their doctor or other health care professional about whether use of Lyrica may impair their ability to drive. Lyrica already is approved for treating partial seizures, pain following the rash of shingles and pain associated with diabetes nerve damage. Lyrica is manufactured by New York-based Pfizer Inc. Pfizer has agreed to perform a study of the drug in children with fibromyalgia and a study in breastfeeding women.
    My comments: Only resort to Lyrica if you have tried every natural approach and you are still suffering from fibromyalgia pain.

    Fibromyalgia Research Update
    Here I present some fibromyalgia research, particularly focusing on supplements, diet, and exercise.

    An open, pilot study to evaluate the potential benefits of coenzyme Q10 combined with Ginkgo biloba extract in fibromyalgia syndrome.
    Lister RE. J Int Med Res 2002 Mar-Apr;30(2):195-9.
    An open, uncontrolled study was undertaken to measure the subjective effects of coenzyme Q10 combined with a Ginkgo biloba extract in volunteer subjects with clinically diagnosed fibromyalgia syndrome. Anecdotal reports from patients with fibromyalgia syndrome have claimed benefits from the use of these supplements. The aim of this study was to determine if these reports could be substantiated in a pilot clinical trial. Patient questioning had determined that poor quality of life was a major factor in the condition and a quality-of-life questionnaire was used to measure potential benefit. Subjects were given oral doses of 200 mg coenzyme Q10 and 200 mg Ginkgo biloba extract daily for 84 days. A progressive improvement in the quality-of-life scores was observed over the study period and at the end, the scores showed a significant difference from those at the start. This was matched by an improvement in self-rating with 64% of fibromyalgia patients claiming to be better and only 9% claiming to feel worse. Adverse effects were minor.

    Endometriosis -- caused when tissue that normally lines the uterus grows at other sites -- may produce more than pelvic pain. It seems to increase the risk of migraine headache. Previous reports have linked endometriosis with a variety of disabling conditions, such as autoimmune diseases, chronic fatigue syndrome, and fibromyalgia.

    The management of fibromyalgia.
    Drugs Today (Barc). 2004 Jun;40(6):539-54.
    Fibromyalgia is one of a number of overlapping "functional somatic syndromes", including irritable bowel syndrome, tension headache, chronic idiopathic lower back pain, chronic fatigue syndrome and others. These conditions affect females more frequently than males and probably share common underlying neurobiological mechanisms, as well as frequent psychological, cognitive and behavioral comorbidities. Since the pain in these conditions is most likely "central" in origin, classes of drugs such as nonsteroidal antiinflammatory drugs (NSAIDs) and opioids, which are quite effective for "peripheral" pain, are relatively ineffective for the pain seen in these syndromes. Instead, tricyclic and other classes of antidepressants, antiseizure drugs and a number of other neuroactive compounds seem to be more effective. In addition, nonpharmacological therapies such as aerobic exercise and cognitive behavioral therapy are quite effective and frequently underutilized in clinical practice.

    There does not seem to be an association between breast implants and fibromyalgia.

    A medication normally used to quiet a stubborn cough may also help ease the chronic pain of fibromyalgia, a small study suggests. Researchers found that the cough suppressant, dextromethorphan, temporarily diminished pain perception in both fibromyalgia patients and healthy adults. The benefit appears to stem from the fact that dextromethorphan blocks the action of a chemical messenger known as NMDA, which helps relay pain signals to the brain. But that doesn't mean people with fibromyalgia should start downing over-the-counter cough syrup, the researchers caution. Dextromethorphan has side effects. At high doses, patients can have problems related to memory and confusion.

    Internist (Berl). 2004 Aug;45(8):923-34.
    Fibromyalgia is a frequent disorder of the middle aged, particularly in women characterized by diffuse and widespread pain, and tenderness on palpation at characteristic sites, called tender points. Additional characteristic symptoms of fibromyalgia are fatigue, sleep disturbances, irritable bowel and bladder syndrome, chronic headaches, paresthesia, hearing and vestibular dysfunction. The etiology remains poorly understood. Diagnosis is based on characteristic symptoms, presence of tender points and exclusion of similar confounding conditions. Because of the unknown etiology, all therapies are symptomatic. Interdisciplinary combined treatments can relief the pain in about 50% of the patients.

    The cause of vulvodynia -- painful discomfort in the vulva -- is unknown, but researchers have now found that women with the condition are abnormally sensitive to all bodily pain stimuli. This suggests that vulvodynia might respond to treatments aimed at general pain control rather than specifically to the vulvar area.

    Fibromyalgia Treatment questions
    Q. Is there a natural cure for fibromyalgia?
    A. In some people, there could be a natural cure for fibromyalgia. Engaging in exercise, doing gentle yoga, eating more fish and vegetables, and having a positive attitude could all potentially work together to be a natural fibromyalgia cure.

    Q. Dr. Sahelian, I was placed on evening primrose oil to help my breast. Not a lot pain there, but terrible fibromyalgia pain. In 6 years that I have dealt with it I have not had any relief. But I seem now to Have 50 to 75% relief. Only thing else placed on at that time was calcium with D. Any research on fibromyalgia pain relief with primrose.
    A. We haven't come across hardly any research with evening primrose oil for fibromyalgia pain.

    Q. I want to give you and your staff an update on the use of mucuna pruriens as a treatment for fibromyalgia symptoms. Mucuna was used in combination with Mirapex daily with remarkable results. Both Mirapex and Mucuna raise dopamine level. The ability to handle stress over time in any situation is the most noticeable change. From January through April while taking Mucuna regularly, there was a definite improvement in sleep, waking up refreshed with improved energy throughout the day. Not as easily overwhelmed; therefore, more activities were accomplished. My chiropractor, who takes careful notes 3xwkly was so impressed with my response to the mucuna that both he and his wife started using it. With limited funds, I stopped taking mucuna in April. The emotional stability using the Mirapex alone is still unmistakably the best in my entire life. However, the Mucuna does provide additional benefit that Mirapex does not, ie improved sleep, perky positive energy, more activities accomplished. Whereas the Mirapex leaves me feeling drugged and sleepy but very calm in the face of stress. Fibro pain and pain in general is definitely reduced. I definitely will be using Mucuna pruriens again soon. In the future, I hope that you, Dr. Sahelian, can develop a natural medication to raise dopamine in the treatment of Fibromyalgia. Mirapex is just too harsh, but it's the best that we have right now. I'm just grateful to have mucuna pruriens. It's certainly an improvement over using Mirapex alone. I am now reducing my dose of Mirapex and relying mostly on mucuna. By reducing Mirapex I have fewer side effects and the Mucuna seems to be as effective. I am convinced that maintaining a normal level of dopamine is the key in the treatment of fibromyalgia.
    Update, May 2006 - To date you have posted several of my responses concerning the use of mucuna pruriens in treating fibromyalgia. Since my last update, I have changed my usage to include both Mirapex, using the treatment level as prescribed by my MD for fibromyalgia, as well as the Mucuna. I discovered that, for me, using the two together produced the best results of 1) reduced pain, 2) increased tolerance of stress and sensory stimulation, 3) perky vitality and mental clarity. I rely on Mirapex for #s 1 and 2 while the Mucuna seems most responsible for #3. I strongly recommend that anyone who is treating their fibro with Mirapex consider combining it with the Mucuna. I have not notice the side effects that you mention, and I'm very satisfied with the results of combining these two very beneficial medications for positive results.

    Q. Can you tell me what the connection is between a magnesium deficiency and fibromyalgia? I am getting varying information from different online sites.
    A. Calcium and magnesium ions play a key role in the physiology of muscular contraction. Most studies show blood levels of calcium and magnesium in fibromyalgia patients are in the normal range. But, in fibromyalgia patients the intracellular calcium and magnesium concentration could be off. I have not come across any studies evaluating the role of a magnesium supplement in fibromyalgia patients, but it would be worthwhile to try for a few weeks since magnesium intake in doses less than 500 mg a day appears to be safe. Trying a magnesium supplement alone, a calcium supplement alone and then combining them each for a few weeks could be tried to see if any of these options is helpful.

    Q. I was reading your information about TMG and you were answering some readers questions. One specific Q was raised as to the benefits of combining MSM with TMG. You requested that you be emailed if anyone has combined them and with what results etc. This is why I am emailing you. I used to work in a Health Food Store and many customers would come in looking for something for their FMS (Fibromyalgia). I would always suggest taking the MSM with the Sam-e. Not only were they extremely happy with the results they were getting regarding the pain..., but it was also helping them with their depression. Many could not afford the Sam-e and so some never got to experience it to see if it helped them, unfortunately. I will say that it was like a mini Clinical Trail as this was effective for this person and others the entire 4 years I worked there.

    Q. Would NADH be helpful for fibromyalgia?
    A. We have not seen studies regarding the use of a NADH supplement and fibromyalgia.

    Q. I have fibromyalgia. Over the past 4 months, I have taken ciprofloxacin twice. Both times there has been a great improvement in my fibromyalgia. There was some slow regression the first time. It has been 8 days since I finished the last ciprofloxacin. I presently have about a 50% improvement overall and about an 80% improvement in my back muscles. I don't know how long these improvements will last. Perhaps you can post this, so other people can ask their doctors about this. I have informed the National Arthritis Foundation and the National Fibromyalgia Research Association. I hope this can help other people.

    Q. What do you recommend for fibromyaligia? Is it a virus which may cause a auto-immmune response. I have a 24 yr old daughter whom suffers daily from fibromyalgia pain, please advise.
    A. We can only offer general fibromyalgia information, not specific advice.

    Q. I am wondering if CoQ10 has been reported as having in effectiveness for managing fibromyalgia?
    A. There's one study that we are aware of regarding the combination of Coenzyme Q10 and ginkgo for fibromyalgia.

    Q. Have you ever heard that maca can in fact help fibromyalgia sufferers?
    A. we have not heard anything about maca and fibromylagia.

    Q. I'm writing this email to find out the possible uses of mangosteen juice for fibromyalgia. Please let me know if there are testimonies stating that it has helped in any way. My future wife has been diagnosed with fibromyalgia just recently and the pain she suffers is very intense. She has been to pain clinics and the doctors there say she has to much pain for them to manage. Never heard of that before, but any way. Please let me know if mangosteen could help fibromyalgia symptoms. Thank you and have a great day.
    A. We have not seen any research or had any testimonials regarding mangosteen and fibromyalgia.

    Q. My wife has been diagnosed with fibromyalgia. As such, she started taking maca about a week ago. It seems to have worked well and as such I ordered two more bottles. In addition, I also ordered Fish Oil capsules as well as Good Night RX as my wife has trouble sleeping at night. Do you see any problem in taking the above three supplements at once? In addition, please be advised that my wife is also on Cymbalta. I understand that you cannot comment on this and will of course contact my Dr.
    A. We are glad you wife is improving. However, we really can't give any individual treatment suggestions. As a general rule, it is best to learn how each supplement works by itself before considering combining.

    Q. Lyrica is now FDA-approved for the treatment of fibromyalgia, but there are serious concerns about its side effects. Do you recommend that people try natural ways to reduce symptoms first?
    A. I think fibromyalgia is due mainly to diet, lack of exercise, and poor sleep patterns. The use of a drug such as Lyrica as a treatment for fibromyalgia is only a temporary solution and does not address the underlying causes.

    Q. What natural fibromyalgia treatments do you recommend? For example, a study in Italy last year found that mud packs followed by hot baths offered relief. What about other natural approaches, such as a proper balance of rest and exercise? Hydrotherapy such as hot baths? Stress reduction such as meditation and yoga?
    A. All the options you mention and safe ways to ease symptoms of fibromyalgia. I still think that diet has a major role to play. One should focus on consuming an anti-inflammatory diet that has a strong emphasis on fish and vegetables and minimizes the use of sugar and simple carbohydrates. Walking at least an hour a day will help. Any form of daily exercise will improve sleep patterns which could make an enormous impact on fibromyalgia symptoms.

    Q. What are your favorite natural supplements for fibromyalgia? For instance, online I see that you recommend fish oil, Acetyl-L-carnitine, SAM-e and CoQ10 combined with ginkgo.
    A. It is difficult to predict which supplement will be helpful in any one individual without giving it a try. One can start with 300 mg or so of acetyl l-carnitine for a couple of weeks to see if it is helpful, especially in those who wish to be more alert and mentally focused. Fish oils are certainly very high on my list and two to five capsules a day could be helpful. SAM-e is a potent mood lifter and is appropriate in those fibromyalgia patients who have low mood. SAM-e is quite potent and I suggest using only half a 200 mg tablet. If these supplements do not ease fibromyalgia symptoms after a few weeks, then one could try CoQ10 and or ginkgo biloba.

    Q. Just thought I would let you know that I had originally purchased my first serrapeptase from your website. I had no side effects, in fact I felt great. I was able to do normal exercise with resistance bands again which I could not do prior. I have fibromyalgia or muscle trigger points and tender spots all over after an accident and after taking the serrapeptase supplement for a month it over half the points were almost gone or gone. Then I tried another brand and it did NOT work for me as well. So I've gone back to your brand. It did take a few days to notice good effects.
    A. This is interesting. Since long term studies with serrapeptase are not available, it is best to use the least amount that works.

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    Topics discussed on this page include fibromyalgia treatment, fibromyalgia symptoms, and natural supplements for fibromyalgia pain. This page was last updated 2008.

    [This Message was Edited on 08/13/2008]