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Fibromyalgia: The role of nutrition and diet. Blake Graham, B.Sc (Honours) Clinical Nutritionist (08) 9487 7409 May 17 th 2010 FM pathophysiology. Mitochondrial impairment Oxidative stress HPA axis dysfunction ANS dysfunction Immune activation Inflammation Sleep dysfunction

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Fibromyalgia: The role of nutrition and diet.

Blake Graham, B.Sc (Honours)

Clinical Nutritionist

(08) 9487 7409

May 17th 2010


FM pathophysiology.

  • 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.

  • Nutrient levels


Mechanisms of illness modulated by diet.

  • Nutrient levels

  • Inflammation


Mechanisms of illness modulated by diet.

  • Nutrient levels

  • Inflammation

  • Oxidative Stress


Mechanisms of illness modulated by diet.

  • Nutrient levels

  • Inflammation

  • Oxidative Stress

  • Intestinal micro-organism balance


Mechanisms of illness modulated by diet.

  • Nutrient levels

  • Inflammation

  • Oxidative Stress

  • Intestinal micro-organism balance

  • Detoxification chemistry


Mechanisms of illness modulated by diet.

  • Nutrient levels

  • Inflammation

  • Oxidative Stress

  • Intestinal micro-organism balance

  • Detoxification chemistry

  • Hormone / neurotransmitter balance


Mechanisms of illness modulated by diet.

  • Nutrient levels

  • Inflammation

  • Oxidative Stress

  • Intestinal micro-organism balance

  • Detoxification chemistry

  • Hormone / neurotransmitter balance

  • Intake of toxic chemicals


Mechanisms of illness modulated by diet.

  • Nutrient levels

  • Inflammation

  • Oxidative Stress

  • Intestinal micro-organism balance

  • Detoxification chemistry

  • Hormone / neurotransmitter balance

  • Intake of toxic chemicals

  • Immune function


Mechanisms of illness modulated by diet.

  • Nutrient levels

  • Inflammation

  • Oxidative Stress

  • Intestinal micro-organism balance

  • Detoxification chemistry

  • Hormone / neurotransmitter balance

  • Intake of toxic chemicals

  • Immune function

  • Circadian rhythm / sleep


Mechanisms of illness modulated by diet.

  • 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


Mechanisms of illness modulated by diet.

  • 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

  • Genetic expression


Mechanisms of illness modulated by diet.

  • 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

  • Genetic expression

  • 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.

  • Poor intake.

    • Food choices.

    • Inc. soil levels, food storage, cooking methods, etc.

  • Poor absorption.

  • Excess excretion/loss/utilisation.

  • Maldistribution.


Nutrient testing.

  • Vitamin D (> 125 nmol/L).

  • Iron studies (ferritin > 50 / transferrin saturation > 22%).

  • Urine iodine.

  • Amino acid testing.

  • Magnesium testing highly unreliable.


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.

  • Anti-inflammatory.


Amino acids.

www.metametrix.com


Remove food allergens/intolerances.

  • Methods of assessment:

    • Elimination diets.

    • IgG food intolerance testing.


Elimination diets vs. IgG testing.


Elimination/provocation testing.

  • 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.).

  • 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


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