Fibromyalgia is a chronic condition, which typically presents with persistent widespread musculoskeletal pain. The pain can be of aching, burning or sore nature. Fibromyalgia sufferers, of which 80 to 90 % are female, may also display sleep disturbance, fatigue, generalised ‘tenderness’ and sensory sensitivity, for example to light, sound and smell. A history of other chronic pain syndromes such as headache, migraine, chest pain, painful menstruation, heartburn and irritable bowel syndrome may be present. Dyscognition (difficulties in clear thinking) or ‘fibro-fog’ is a common complaint, as well as nerve-tingling, restless legs, morning stiffness, and sensation of tissue swelling.
Fibromyalgia used to be diagnosed based on ‘areas of tenderness’, which are called trigger points or tender points. These are places on our bodies, where moderate to even light pressure can cause pain. Today doctors rarely use this method in diagnostics, unless to help to narrow down other possible conditions. Identification of fibromyalgia is primarily based on symptoms of pain, fatigue, and cognitive impairments. However, clinicians should adopt additional diagnostic tests to paint a fuller picture.
2. Possible triggers of fibromyalgia onset
According to Western medicine, the cause of fibromyalgia is unknown. Nonetheless, we can look into other possible triggers of fibromyalgia and look-alike symptoms, manifesting in the human body.
Symptoms of thyroid problems share many similarities with fibromyalgia. Before diagnosing fibromyalgia, a full spectrum thyroid function test should be performed. To really investigate our thyroid health, rather than just checking for TSH, which is, unfortunately, a common practice, a test should include total and free T4, T3, RT3, and possibly thyroid peroxidase antibodies (TPO). This last marker is an indicator of the auto-immune disease of the thyroid, called Hashimoto’s. If hypothyroidism or Hashimoto’s are present, it’s reasonable to treat these conditions at first and see if fibromyalgia symptoms resolve.
Not only are hypothyroidism and fibromyalgia both common, but they frequently occur together. According to one study, the prevalence of fibromyalgia in the general population is 2 to 7 percent, but as high as 30 to 40 percent in people with hypothyroidism (1).
Among people with hypothyroidism, fibromyalgia is more common in overweight patients, who had positive TPO antibodies, and who had been living with thyroid disease for a long period of time. Both conditions are much more common in women.
As I said above, the autoimmune basis of Hashimoto’s disease shows the presence of TPO antibodies. These antibodies are present in nearly all people with Hashimoto’s and in some healthy people too, particularly in women. One study found a potential link to autoimmune disease with fibromyalgia (2), as well as other studies showing higher prevalence of thyroid antibodies in people with fibromyalgia compared to the general population.
Stress altering HPA axis
Fibromyalgia may be stress related. Altered stress systems can in fact cause pain and other symptoms, landmarks in fibromyalgia. The hypothalamus–pituitary–adrenal (HPA) axis plays a significant role in the regulation of responses to stress. Human stress-related disorders such as chronic fatigue syndrome, fibromyalgia, chronic pelvic pain and post-traumatic stress disorder (PTSD) have alterations of the HPA axis activity in common (3).
Fibromyalgia sufferers show evidence of abnormal stress response, including sluggish function of the HPA axis and an increased autonomic nervous system (ANS) reactivity (3).
In support of these findings, some studies suggest that dysfunction of the ANS and HPA axis are related to major early-life traumas, which could be a factor of adult neuro-endocrine imbalance among fibromyalgia sufferers (4).
Research on Israeli war veterans suggests that fibromyalgia may also affect men with PTSD (5). In this study, half of the men with PTSD had tenderness and pain characteristic of fibromyalgia.
Some researchers also suggest, that suppression of the hypothalamus (the part of the brain that releases hormones, regulates emotional responses, controls blood pressure, appetite, sex drive, and much more) may be the root cause of fibromyalgia and thyroid disease. Hypothalamic dysfunction may be caused by tumours, inflammation, infection, mass lesions or interruption of blood supply.
There is also an indirect evidence that fibromyalgia may be a consequence of low androgens. Androgens are hormones that exert anabolic effect and are responsible for the building up of muscles. In fact, fibromyalgia shares many features with androgen-deficiency states, such as muscle pain and fatigue,
Some data suggest that fibromyalgia is related to a neuroendocrine disorder characterised by adrenal hyperactivity because of overproduction of adrenocorticotropic hormone, released by the pituitary gland (6). These findings seem to indicate adrenal insufficiency in fibromyalgia, which might explain for the low energy and impaired muscle performance.
In one study, involving 56 women with fibromyalgia, serum DHEA and testosterone levels were markedly decreased compared to the healthy group (7). Interestingly, low DHEA levels were significantly correlated with pain.
Substance P is a neurotransmitter present throughout the body, with highest levels in the brain, gut, and spinal cord. It can be released from the peripheral nerve fibres in the skin, muscles, and joints. Research shows is possible role in abnormal pain threshold, asthma, psoriasis, inflammatory bowel disease, migraine, depression and anxiety. The brain releases Substance P during stressful situations at a rate proportional to the intensity and frequency of stressor. Substance P may also coordinate the response to stress by interacting with the HPA axis and the sympathetic nervous system, working alongside with other neurotransmitters, most commonly serotonin, noradrenaline and glutamate.
It has been shown that levels of those neurotransmitters are altered in fibromyalgia in ways that could explain patients’ increased pain sensitivity (8, 9). In addition to pain, alterations in serotonin, noradrenaline, and Substance P metabolism may contribute to disturbances in sleep or mood (10).
Family and environmental patterns in fibromyalgia have been studied extensively (11, 12). As a result, the idea that some individuals may be particularly vulnerable to fibromyalgia has some support. If someone is susceptible to fibromyalgia because of their family history, they still need to experience an event to set it off, something must happen in order to trigger it. This can be a viral infection, emotional stress, an accident or injury, or even exposure to toxins and drugs.
Previous viral and bacterial infections
Fibromyalgia type symptoms are shared by people affected with the Epstein-Barr virus (EBV), associated with mononucleosis and people affected by Lyme disease. In fact, patients with Lyme or EBV may experience fatigue, joint pain, insomnia and spread body aches. It is important to notice that the EBV can remain in a dormant state in the human body and reactivate itself due to external factors after years.
Epstein-Barr virus infections may be present in autoimmune diseases. In fact scientists found that components of the virus may resemble proteins in the body. This confuses the immune system, which then produces antibodies that accidentally attack the self. In support of this theory a study revealed that EBV infection raises concentrations of a type of antibody called IgG in patients with fibromyalgia (13).
3. Nutritional approach
Unfortunately, there isn’t a clear and standard approach to fibromyalgia. So, treatment may need to focus on symptoms, if other possible underlining causes have been assessed and are negative, like bacterial infection, thyroid or HPA axis issues.
Fixing nutrient deficiencies
Magnesium, vitamin D3 and B12 are some of the most common nutrient deficiencies in those diagnosed with fibromyalgia. While you can easily check for vitamin D3 and B12 levels with a simple blood test, it is not so easy to measure magnesium levels in the body. However, magnesium deficiency can cause hyperactivity and anxiety, sleep problems, luck of energy and muscles cramps among many others. So you may know if you are deficient.
Seeing many clients in my practice displaying fibromyalgia-like symptoms, I often recommend supplements to support mitochondrial function, sleep, muscle pain relief and energy production, alongside anti-inflammatory nutrients, gut healing supplements and nutrients helping brain cognition. Therefore, some of my favourite supplements are:
- Viridian, D-Ribose Magnesium powder (energy)
- Ubiquinol + PQQ (energy)
- North American Herb and Spice, Canacurmin (healthy inflammatory and pain response)
- North American Herb and Spice, Hempanol PM
- Renew Life, 50 billion probiotic, Everyday Plus (gut health)
For full insights on this subject, please read my stress article.
Step back and RELAX!
So, as the stress bucket fills up, you must find ways to empty it.
I personally practice yoga, meditate, walk in the woods and read, in order to destress.
What you do to decrease your stress levels should ideally match what you love doing in your spare time, something you are passionate about, something that nourishes your body and mind, something that restores a sense of gratitude and peace. So, please, allow yourself to relax.
If you anyway are on a fast track at the moment and need extra help, you could support your mind and body with a supplement containing some adoptogenic herbs, which may enhance your own ability to sustain stress and fatigue. One product I am very confident with to aid management of stress is Enhanced Rhodiola Complex.
One thing, MEDITATE!
According to Buddhists, if you are stressed, you should meditate 20 minutes every day, but if you are very stressed, you should meditate 1 hour every day.
Meditation may also help alleviating physical pain and symptoms of anxiety and depression. It may also enhance memory, creativity and mental performance. These benefits may be a consequence of alpha brain waves production during meditation and changes within the amygdala region of the brain, which is responsible for processing emotions.
You can practice it everywhere and at any time. I personally practice meditation most days: in the morning, if I have a busy and challenging day ahead, to tune me in; or at night, if I need the extra help to unwind and fall asleep.
Boost your endorphins, EXERCISE!
If possible, find a physical activity that motivates you getting out of the house, or that you enjoy even in your home. If you haven’t been exercising for some time, start very gently and build it up to what feels a pleasurable and satisfying level.
So, lone or group exercise can boost your “feel-good” neurotransmitters, called endorphins. These neurotransmitters are produced by the hypothalamus and can decrease stress by uplifting your moods. They can even relieve pain, because they act similarly to a class of drugs called opioids. So, wait no longer, find your motivation and get moving.
Even though the use of supplements is highly valued, nothing will substitute a very balanced and varied diet. The following recommendations I use in my practice daily:
- Eliminate red and cured meat, as they may increase inflammatory markers and chances to develop more serious diseases.
- Eliminate all dairy products, which are linked to allergies, inflammation, hormonal dysregulation, osteoporosis and other conditions. Put it this way, cow’s milk is for baby cows, not for adult humans.
- Cut down on refined sugar and carbohydrates like pizza, pasta, bread. This is because sugar may increase inflammation, which may exacerbate physical pain.
- Eat as much organic food you can afford, as this will be free from harmful chemicals.
- Adopt a nutrients-dense-whole-plant-based diet, rich in different nutrients, enzymes, antioxidants and anti-inflammatory agents.
- Drink approximately 8 glasses of good quality water daily, never straight from the tap.
- As said above, start with buying as much organic food as possible.
- Invest in more natural and chemical free toiletries.
- Get rid of mildew and black mold in your home. If you have problems with condensation, look into investing into a good dehumidifier. This is the one I use myself.
- If driving in heavy traffic, keep your windows closed and AC off, not to suck in toxic fumes.
4. Final words
Fibromyalgia is a chronic condition, which generally presents with broad musculoskeletal pain. The cause of fibromyalgia is unknown. However there are possible triggers of ‘fibromyalgia like’ symptoms, which may mimic other health conditions. In fact, symptoms of thyroid problems may mimic those of fibromyalgia.
There are existing genetic patterns in fibromyalgia, but also strong environmental correlations.
Dysfunction of stress systems has also been shown as a reason for pain and fatigue in fibromyalgia. It is possible that the chronic pain present in fibromyalgia can give rise to psychological stress. This may cause changes in neuroendocrine axes. However, an essential difficulty with hormones and neurotransmitters imbalance in both stress and fibromyalgia is to determine whether this is the cause or the effect of the condition. Although, low hormones and neurotransmitters levels in fibromyalgia might be a result of chronic pain rather than its cause.
Also, it is worth investigating if altered brain function is caused by dysfunction of gut microbiome. This is because most of the serotonin (substance P antagonist) is produced by specialized gut cells.
A nutritional approach for fibromyalgia is not straight forward, but it may consider addressing individual symptoms.
Author: Sylwia Wyrębek, Naturopathic Nutritionist
Thank You for reading this article, I wish it was valuable to You. Please leave me a comment, so that we can all continue growing together. Also, please introduce people you care about to this website, if you believe it will be useful to them.