by Thomas Incledon, PhD(c), RD, LD/LN, RPT, NSCA-CPT, CSCS
You try all the fad diets. “Eat this and eat that, you’ll feel much better,” they claim. But after taking different supplements, following different diets, you only find temporary relief of your symptoms. Frustrated? You’re not the only one, so are another 3.7 million people, most of whom are women, diagnosed with fibromyalgia [1]. In this article I’ll take an in-depth look at diet and supplementation that may benefit fibromyalgia or at least keep you from making common mistakes.
Diets
Clinicians agree that fibromyalgia is a complex syndrome. The treatment of this syndrome involves patient education, physical measures, submaximal exercise, counseling and perhaps pharmacological approaches. Since many things are necessary for a successful prognosis, this treatment approach is time consuming and seems never-ending. It is normal to get frustrated and the desire to find the “quick fix” can easily take hold. Be wary of diets that promise a fast solution to your symptoms, because there isn’t one. To date there is very little data on the effects of diet on fibromyalgia. Since there is no special fibromyalgia diet, we must rely on the current guidelines for food consumption. Regardless of your dietary preferences, you should try to eat fruits and vegetables every day. Why? Simply, because they provide you with a variety of vitamins, minerals, and other important factors that could benefit you. The current recommendation for Americans is to consume 3-5 servings of vegetables and 2-4 servings of fruit each day [2]. One serving of vegetables is equal to either one cup of raw leafy vegetables, or a fi cup of other vegetables (cooked or chopped raw), or fl cup of vegetable juice. One serving of fruit is equal to a medium sized banana, apple, or orange, or a fi cup of other fruit (chopped, cooked or canned), or fl cup of fruit juice. Despite how simple it is to eat these amounts of foods, many people do not consume these minimal amounts. Plan out your meals ahead of time and make sure that you get your fair share of fruits and vegetables every day.
Nutritional Supplements
In a recent study, subjects self-administering dietary supplements were interviewed and followed to determine changes in their symptoms [3]. Each subject was interviewed before and after nine months of consuming nutritional supplements. The supplements included freeze-dried aloe vera gel extract, a combination of freeze-dried aloe vera gel extract and additional plant-derived saccharides, freeze-dried fruits and vegetables in combination with the saccharides, and a formulation of dioscorea complex containing the saccharides and a vitamin/mineral complex. The results appeared favorable with a remarkable reduction in initial symptom severity, and continued improvement in the period between initial assessment and the follow-up. As positive as this seems, we can’t really draw too much from this study other than the supplements used may have some potential. The placebo effect is very strong and these people may just have believed in the effects of the supplements so much that they made themselves better.
Vitamins
Most people approach vitamin consumption with the philosophy that if a little is good, then more is better. Especially now with all the hype on antioxidants, it may seem like taking loads of Vitamins C and E, beta carotene, and alpha lipoic acid is a good idea. While these supplements may certainly be beneficial for some conditions, in fibromyalgia, antioxidant status and markers of oxidative damage are similar to healthy control subjects [4, 5]. In a syndrome like fibromyalgia, where so much is still unknown, simply taking vitamins without consulting with your physician may not be in your best interest. It is possible that symptoms of soft tissue rheumatism can become worse if patients ingest an excess amount of vitamin A, for example [6]. So make sure to consult with your physician first.
When discussing treatment strategies with your physician, ask him about checking your homocysteine levels and Vitamin B12 levels. In one study, twelve women who fulfilled the criteria for both fibromyalgia and chronic fatigue syndrome were found to have generally normal blood laboratory values [7]. However, in all of the patients, the homocysteine levels were increased in the cerebrospinal fluid. There was a significant positive correlation between cerebrospinal fluid homocysteine levels and fatiguability. In addition, the subjects had low levels of cerebrospinal fluid B12, and this also correlated significantly with fatiguability. Vitamin B12 deficiency was thought to contribute to the increased homocysteine levels found in these subjects. After your doctor checks your levels of homocysteine and B12, you can find out if B12 supplementation or some other treatment approach is warranted.
Magnesium
Studies on magnesium levels in fibromyalgia report mixed results. One comparative study between fibromyalgic patients and age-matched controls, reported increased white blood cell magnesium concentrations and slightly decreased red blood cell magnesium concentrations in fibromyalgia [4]. In another study using 97 patients, no association was found between magnesium deficiency or fibromyalgia [8]. A third study administered Super Malic, a proprietary tablet containing malic acid (200 mg) and magnesium (50 mg), to 24 patients with primary fibromyalgia syndrome [9]. Subjects took three tablets twice per day (bid) as part of a placebo controlled, double blind four week cross-over trial, followed by a 6-month, open label, dose escalation (up to 6 tablets bid) trial. No clear treatment effect attributable to Super Malic was seen after taking three tablets bid. However, after dose escalation and a longer duration of treatment in the open label trial, significant reductions in the severity of primary pain/tenderness measures were obtained. If you are thinking about trying a malic acid/magnesium supplement program, realize that so far only 1,200 mg of malic acid and 300 mg of magnesium per day have been found to be safe. Long term administration of a single mineral (like magnesium) can result in imbalances of other minerals, so it is important to keep your doctor posted on what is going on.
DHEA
Fibromyalgia is associated with low levels of a variety of hormones. Adrenal androgens like DHEA are lower in fibromyalgic patients and even lower in obese fibromyalgic patients [10]. These studies are only correlative, so while they provide clues for scientists, they don’t tell them how and why. Since DHEA levels are low, DHEA supplementation may be something to consider. The right way to go about this is have your doctor check your baseline levels of DHEA, DHEA-S, testosterone, and estradiol. After trying a supplement routine as recommended by your doctor, then have these hormone levels checked again. Treatment dosages range from 50-200 mg per day. If they were low to begin with, after treatment they should be higher and in the normal range.
S-adenosyl methionine (SAMe)
SAMe is one of the new “wonder” supplements. While popular in Europe, it has yet to receive the same widespread acceptance in the U.S. There are a few studies that looked at the effects of SAMe on fibromyalgia. SAMe treatment improved the depressive state and reduced the number of trigger points in 17 patients with a diagnosis of primary fibromyalgia. [11]. Another study administered 800 mg orally for six weeks to 44 patients with primary fibromyalgia in a placebo controlled, double-blind design [12]. Tender point score, isokinetic muscle strength, disease activity, subjective symptoms (visual analog scale), mood parameters and side effects were evaluated. Improvements were seen for clinical disease activity, pain experienced during the last week, fatigue, morning stiffness, and mood. The tender point score, isokinetic muscle strength, and side effects did not differ between the two treatment groups. A recent study also found no effects of SAMe on tender point change, although a trend was noted for improvements in subjective perceptions [13]. From these studies it appears that SAMe may have some potential in the treatment of fibromyalgia, although it does not appear to improve objective measures.
What To Take With You
Fibromyalgia does not have a specific cure. The best treatment approach will combine patient education, counseling, submaximal exercise, and lifestyle adjustments such as reducing stress and improving dietary habits by eating more fruits and vegetables. Supplements to consider taking under your physician’s supervision include Super Malic, Vitamin B12, DHEA, and SAMe. Understand that the cause of fibromyalgia is still uncertain and that the results of these approaches can vary from person to person.
Reference:
1. Lawrence, R.C., et al., Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States [see comments]. Arthritis Rheum, 1998. 41(5): p. 778-799.
2. U.S.D.A. and U.S.D.H.H.S., Nutrition and Your Health: Dietary Guidelines for Americans. 1995, U.S. Department of Agriculture and U.S. Department of Health and Human Services: Washington. p. 1-43.
3. Dykman, K.D., et al., The effects of nutritional supplements on the symptoms of fibromyalgia and chronic fatigue syndrome. Integr Physiol Behav Sci, 1998. 33(1): p. 61-71.
4. Eisinger, J., et al., Selenium and magnesium status in fibromyalgia. Magnes Res, 1994. 7(3-4): p. 285-288.
5. Eisinger, J., et al., Protein peroxidation, magnesium deficiency and fibromyalgia. Magnes Res, 1996. 9(4): p. 313-316.
6. Romano, T.J., Exacerbation of soft tissue rheumatism by excess vitamin A: case reviews with clinical vignette. W V Med J, 1995. 91(4): p. 147.
7. Regland, B., et al., Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome. Scand J Rheumatol, 1997. 26(4): p. 301-307.
8. Moorkens, G., et al., Magnesium deficit in a sample of the Belgian population presenting with chronic fatigue. Magnes Res, 1997. 10(4): p. 329-337.
9. Russell, I.J., et al., Treatment of fibromyalgia syndrome with Super Malic: a randomized, double blind, placebo controlled, crossover pilot study. J Rheumatol, 1995. 22(5): p. 953-958.
10. Dessein, P.H., et al., Hyposecretion of adrenal androgens and the relation of serum adrenal steroids, serotonin and insulin-like growth factor-1 to clinical features in women with fibromyalgia. Pain, 1999. 83(2): p. 313-319.
11. Tavoni, A., et al., Evaluation of S-adenosylmethionine in primary fibromyalgia. A double- blind crossover study. Am J Med, 1987. 83(5A): p. 107-110.
13. Volkmann, H., et al., Double-blind, placebo-controlled cross-over study of intravenous S- adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol, 1997. 26(3): p. 206-211.
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