Fibromyalgia is a common disorder affecting approximately 5 million Americans. It is characterized by chronic widespread pain with diffuse muscle tenderness and a variety of other systemic symptoms including brain fog, insomnia, headaches, depression and more.
The conventional treatment approach for fibromyalgia is limited to symptom management with medications like painkillers and anti-depressants. Although this is the most common therapeutic strategy, it is not the most effective way to find long-term relief. To truly heal this illness you must investigate the underlying cause and treat the imbalance that created the symptoms in the first place.
As a functional medicine practitioner I shift my focus from working on alleviating symptoms to identifying and treating the root causes of illness. This approach takes into consideration that each individual is unique and although two people may have the same diagnosis, they may have a different cause of their symptoms and require a unique therapeutic plan in order to truly heal.
Below I have outlined the most common causes of symptoms and treatment strategies I use with patients struggling with fibromyalgia in my practice:
1. Food intolerances – Food should be healing to the body, but in the age of processed and genetically modified “food-like products” we are seeing increases in health disorders. Fibromyalgia is one condition where dietary changes can go a long way. An elimination diet can be a helpful tool used to identify foods triggering inflammation in the body. It typically involves removing the most common immune stimulating and inflammatory foods for at least 30 days and then adding each one back one at a time, carefully monitoring for the return of symptoms.
Foods to Avoid on an Elimination Diet:
- White sugar
- Processed meats
- Coffee, tea, and chocolate
- Artificial food dyes, flavors and sweeteners
If you have fibromyalgia symptoms, you should also consider blood testing to identify delayed sensitivity food reactions and allergies. I recommend using IgG (delayed sensitivity reactions) and IgE (allergy reactions) antibody testing to further personalize your eating plan. A functional medicine practitioner can usually do this type of test for you.
2. Nutritional deficiencies – Studies have found that those diagnosed with fibromyalgia are more likely to have nutritional deficiencies. The most common nutritional deficiencies found in fibromyalgia patients are listed below:
- Magnesium: Magnesium deficiency in itself can cause symptoms similar to fibromyalgia including anxiety, insomnia, fatigue and muscle pain. It has been found that patients diagnosed with fibromyalgia tend to have lower red blood cell (RBC) magnesium levels. I usually recommend patients correct magnesium levels using magnesium glycinate, which is easier on the digestive tract then the citrate form. Try adding 300-600mg of magnesium at night to help sleep, muscle pain and other fibromyalgia symptoms. Additional studies suggest adding malic acid to magnesium dosing may offer extra benefit helping enhance cellular energy. Dosing is 1200–2400 mg of malate.
- Vitamin D: Low levels of Vitamin D have been linked to increased rates of depression and anxiety in patients with fibromyalgia. Aim to get your blood Vitamin D levels between 60-80. If you are deficient, supplement with 5,000-10,000IU daily for 3 months then recheck levels.
- B vitamins: The B vitamins are very important for energy production in the body, which can help ease muscle pain, fatigue, brain fog and improve mood. For fibromyalgia patients it is important to get at least 50 mg of all B vitamins, plus 800 micrograms of folate and 500 micrograms of vitamin B12.
3. Hormone imbalance – There is a definite correlation between imbalances in hormones and the diffuse symptoms experienced in fibromyalgia. This makes sense because our hormones control the body’s communication network and when there is miscommunication in the hormonal system, the effects are felt throughout the body. Symptoms can be far reaching and disabling. Imbalances in thyroid and adrenal function are the most critical hormonal imbalances that must be addressed if you have fibromyalgia.
- Thyroid: Your thyroid effects how the body uses energy and impacts how the brain, heart, muscles, and other organs function. An under-functioning thyroid can cause muscle aches, fatigue, depression and more systemic symptoms. To fully evaluate the thyroid you must minimally check TSH, free T3, free T4 and thyroid autoantibodies. You ideally want your TSH <2, your free T4 and T4 to be above mid range and want no thyroid antibodies. The presence of autoantibodies has been highly correlated with fibromyalgia symptoms indicating an autoimmune process in the body. If you have thyroid autoantibodies work with a functional medicine provider to address the root cause of the autoimmune thyroid disease.
- Cortisol: Your adrenal glands produce several hormones in response to stress, one being cortisol. This intricate hormonal system deemed the “fight or flight response” is designed to keep us safe in acute situations when we may need protection from danger. Various studies have found that patients with fibromyalgia symptoms sustained a significant physical (surgery, infection, accident) or emotional (divorce, death, loss of job) trauma prior to the onset of their symptoms. This initial trauma can cause a prolonged stress (fear) reaction, which causes cortisol levels to remain high. This breaks down the body over time causing many symptoms also correlated with fibromyalgia. A mind-body approach to treating fibromyalgia symptoms is critical which may include counseling, yoga, meditation and energy work.
4. Chronic infections – More research is pointing to chronic infections as the cause of fibromyalgia. This sustained burden on the immune system contributes to the release of inflammatory chemicals called cytokines causing symptoms like fatigue, headaches, memory loss, muscle pain, nausea, gastrointestinal problems, joint pain, lymph node pain, and short-term memory loss. The most common chronic infections in patients with fibromyalgia include:
- Mycoplasma: Studies estimate that around 50-60% of patients diagnosed with fibromyalgia syndrome were found to have mycoplasmal blood infections caused by one of several strains of this type of bacteria. Symptoms were found to improve with a 6-week treatment regimen of antibiotics like doxycycline.
- Candida: This type of chronic fungal overgrowth most commonly impacts diabetics, those talking long-term medications that suppress the immune system (steroids, medications to treat autoimmune diseases) and people who eat a diet high in sugar and processed foods. Prolonged treatment with a herbal or prescription anti-fungal along with a diet low in sugar and starchy carbohydrates.
- Viral infections: Patients with chronic viral infections like Epstein Barr, Hepatitis C, HIV, Human Herpesvirus 6 have been found to have fibromyalgia like symptoms.
Assessing and addressing chronic infections is important in all fibromyalgia patients. In order to get long-term relief when a chronic infection is involved you want to work with a medical provider who can suggest anti-microbial agents to help kill the bug as well as therapies and lifestyle changes to strengthen the immune system.
5. Digestive dysfunction – The digestive tract has long been considered as the foundation for optimal health, but more and more research is pointing to the link between disorders of the gut and how they relate to other systemic illnesses. Research is showing that imbalances in your normal gut flora (good bacteria) and the presence of pathogenic microbes in the gut can cause disorders in almost every other organ system including symptoms of fibromyalgia. Normally the gut maintains a semi-permeable membrane that allows nutrients from food to come into the body and protects the body from pathogens and waste products. If this membrane develops increased permeability, essentially becoming leaky, the immune system of the gut goes on high alert because now toxins and waste products are able to pass. The following factors can predispose you to digestive dysfunction:
- Frequent antibiotic use
- Long term use of proton pump inhibitors for reflux (ex: Nexium)
- A diet high in processed foods
- Chronic physical or emotional stress
- Insufficient dietary fiber found in vegetables, fruits, beans, seeds and nuts
Uncovering the root cause of fibromyalgia symptoms is not always easy but it is the only way to find long-term relief. Work with a medical provider who is experienced in using an integrative or functional medicine approach to treating illness to truly recover from fibromyalgia. Also don’t be afraid to listen to your body’s healing intuition. Many times the path to recovery lies in the simplicity of doing more of the things that making you feel good and avoiding the things that make you feel sick.