Targeted Nutritional Therapies
Although no individual dietary supplement has been proven to be effective for relieving all the common symptoms of fibromyalgia,the following have either been linked to symptom improvements or recommended by experts to overcome deficits that are common among fibromyalgia patients:
Magnesium - Research has revealed that low circulating levels of magnesium may be implicated in the development of fibromyalgia in some individuals (Sendur 2008; Bagis 2012). Magnesium supplementation has been shown to reduce symptoms of fibromyalgia, thus making it a frequently recommended supplement (Holdcraft 2003; Arranz 2011).
In one clinical trial involving 80 women (60 with fibromyalgia and 20 healthy controls), a diagnosis of fibromyalgia was associated with significantly lower red blood cell and serum magnesium levels. Furthermore, lower magnesium levels were associated with more severe fibromyalgia symptoms (Bagis 2012). The trial went on to assess the effect of 8 weeks of supplementation with magnesium citrate (300 mg/d) alone or in combination with amitriptyline (10 mg/d) upon several measures of fibromyalgia severity. While both magnesium and amitriptyline alone effectively improved many of the assessed parameters, the combination of the two was more effective than either alone and significantly improved pain, tender points, depression and anxiety scores, as well as sleep disorders and irritability.
Patients with fibromyalgia should consider having a red blood cell magnesium test to ensure that they are not deficient in this important nutrient.
Melatonin – Melatonin is a hormone that helps regulate the sleep-wake cycle. Clinical studies have found that some fibromyalgia patients often have low circulating levels of melatonin, which can lead to disruptions in the sleep cycle (Hussain 2011). In addition, fibromyalgia patients appear to secrete less melatonin during the night than healthy controls (Mahdi 2011). Among these patients, melatonin supplementation has been shown to decrease symptoms of fibromyalgia (Reiter 2007; Hussain 201).
S-adenosyl-L-methionine (SAMe) – SAMe is a natural compound made from methionine (an amino acid) and adenosine triphosphate (ATP). Supplementation with SAMe has been linked to improvements in morning stiffness, fatigue, quality of sleep, and clinical disease activity among fibromyalgia patients (Jacobsen 1991). In addition, other studies have shown that SAMe provides relief from depression, which sometimes occurs in people with fibromyalgia (Albert 2004; Alok 2011).
D-ribose – D-ribose is a sugar that helps increase cellular energy synthesis in muscle cells. One trial involving 41 fibromyalgia patients found that 5 grams of D-ribose three times daily significantly improved energy, sleep, mental clarity, pain intensity, and general well-being (Teitelbaum 2006). Another small trial found that 3 grams of D-ribose twice daily improved exercise capacity, vitality, and mental outlook in adults 50 and older (Flanigan 2010). Similarly, a case-report of a 37 year-old woman with fibromyalgia indicated that 5 grams of D-ribose twice daily improved her symptoms (Gebhart 2004).
Chlorella – Chlorella is a genus of single-cell green algae. It grows in fresh water and contains high concentrations of important vitamins, minerals, dietary fiber, nucleic acids, amino acids, enzymes, and other substances. Chlorella has been shown to relieve symptoms of fibromyalgia when used as a supplement (Sarac 2006). In a small pilot trial, 18 patients with fibromyalgia experienced an average 22% decrease in pain intensity after taking chlorella daily for two months (Merchant 2000).
5-Hydroxytryptophan (5-HTP) – 5-HTP is an endogenous precursor to serotonin. It can be derived from the seeds of an African plant (Griffonia simplificolia). The potential utility of 5-HTP - a more direct precursor to serotonin than L-tryptophan - in fibromyalgia is supported by data indicating impaired tryptophan metabolism in fibromyalgia patients (Schwarz 2002). Clinical trials have shown that 5-HTP supplementation in fibromyalgia patients is associated with considerable improvements in anxiety, pain intensity, quality of sleep, fatigue, and the number of tender points (Caruso 1990; Sarzi Puttini 1992).
Coenzyme Q10 (CoQ10) – CoQ10 is an essential component of healthy mitochondrial function, as well as a powerful antioxidant (Littarru 2007). CoQ10 has demonstrated anti-inflammatory and analgesic properties in animals (Jung 2009). Researchers believe that low CoQ10 levels may play a role in the development of fibromyalgia symptoms because 1) CoQ10 has been found lacking within the blood cells of many fibromyalgia patients, and 2) subsequent CoQ10 supplementation (300 mg/d for 9 months) has been linked to a significant improvement in symptoms in a small preliminary trial (Cordero 2011). Other data from case reports (see Mitochondrial Dysfunction above) also suggest a role for CoQ10 in relieving fibromyalgia symptoms.
Acetyl-L-carnitine – Acetyl-L-carnitine is an acetylated version of the amino acid L-carnitine, which is a mitochondrial membrane compound that aids in the generation of metabolic energy and guards against oxidative damage (Abdul 2006). It has been suggested that fibromyalgia syndrome may be associated with metabolic alterations including a deficit of carnitine (Rossini 2007). In one double-blind, randomized, placebo-controlled trial involving 102 fibromyalgia patients, 1,000 mg (oral) and 500 mg (intramuscular injection) of acetyl-L-carnitine daily significantly improved pain and cognitive symptoms more than placebo (Rossini 2007). The treatment was well tolerated.
Omega-3 fatty acids – Omega-3 fatty acids can only be synthesized to a limited extent by the human body, but are vital for normal metabolism. Omega-3’s modulate several cellular properties and have been shown to reduce inflammation (Calder 2010). Among fibromyalgia patients, omega-3 fatty acid supplementation has been linked to significant improvements in pain severity, tender point counts, fatigue, and depression (Ozgocmen 2000). Another case report indicates that supplementation with fish oil (providing 2,400 – 7,200 mg of EPA/DHA daily) eased neuropathic pain in a small number of subjects with fibromyalgia and/or related neuropathic pain (Ko 2010). Life Extension suggests that the omega-6 to omega-3 ratio be kept at or below 4:1 for optimal health. A convenient blood test called the OmegaScore™ test measures the balance between pro-inflammatory omega-6’s and anti-inflammatory omega-3’s.
Vitamin D - Patients with fibromyalgia syndrome have impaired mobility and therefore get less exposure to sunlight. This contributes to the vitamin D deficiency frequently observed in this population (Bhatty 2010, Olama 2013). In one trial involving 100 women with fibromyalgia, 61% were found to be vitamin D deficient (blood levels of 25-hydroxyvitamin D <30 ng/mL) (Matthana 2011). Upon supplementation with vitamin D, 42 (69%) of those women reported significantly improved symptoms when their vitamin D levels reached ≥ 30 ng/mL; the improvement became more significant when their vitamin D levels exceeded 50 ng/mL. Fibromyalgia patient should have their vitamin D levels checked regularly (Matthana 2011). Life Extension suggests that a 25-hydroxyvitamin D level of 50 – 80 ng/mL should be targeted for optimal health among most aging individuals.
The following nutrients may render additional benefits by providing antioxidant protection and mitochondrial support:
Superoxide Dismutase (SOD) – SOD is an endogenous antioxidant found in decreased amounts among fibromyalgia patients (Bagis 2005). Superoxide dismutase occurs in plants and can thus be extracted from them. In one double blind trial, supplementation with 1,000 mg/day of a plant superoxide dismutase extract (GliSODin®) significantly boosted SOD activity and decreased CRP levels in athletes compared to placebo (Skarpanska-Stejnborn 2011).
Vitamins A, C, E, and the mineral Zinc – Vitamins A, C, E, and the mineral Zinc all provide antioxidant protection. In one study, fibromyalgia patients had lower blood levels of vitamins A and E, as well as increased lipid peroxidation when compared to healthy controls (Akkus 2009). Another study found that fibromyalgia patients had lower zinc and magnesium levels than healthy controls (Sendur 2008). In a survey of over 300 fibromyalgia patients, 35% reported using vitamin C (Wahner-Roedler 2005); and vitamin C combined with vitamin E has been shown to boost antioxidant activity in conditions related to oxidative stress (Karajibani 2010). All of these nutrients are available in a comprehensive multivitamin.
B-vitamins – B-vitamins are important cofactors in a variety of metabolic events. They were reported in a survey to be used by a quarter of fibromyalgia patients (Wahner-Roedler 2005). Homocysteine is a damaging metabolic by-product whose levels are kept in check by adequate B-vitamin intake. In one study, women with fibromyalgia were shown to have higher levels of homocysteine in their cerebrospinal fluid than healthy controls (Regland 1997). Other evidence indicates that a Myers’ Cocktail, which consists of an intravenous infusion of several vitamins (i.e., B-complex vitamins), may be useful in fibromyalgia (Gaby 2002; Ali 2009). Moreover, B-vitamins are essential for maintaining optimal mitochondrial function (Depeint 2006).
NADH – Nicotinamide adenine dinucleotide (NADH) is a coenzyme that supports numerous metabolic reactions critical for optimal cellular function. For example, NADH helps recycle CoQ10, thereby aiding in cellular energy production. It also possesses considerable antioxidant potential.
Supplementation with NADH has been shown to improve energy in people with chronic fatigue syndrome (Forsyth 1999). Similarly, NADH supplementation relieved sleepiness and cognitive deficits in people suffering from jet lag (Birkmayer 2002). In other trials, NADH improved cognitive function among people with Alzheimer’s disease (Demarin 2004) and relieved Parkinson’s disease symptoms (Birkmayer 1993). While NADH has yet to be studied in people with fibromyalgia, these findings are encouraging since fibromyalgia sufferers often experience fatigue and suboptimal cognition.