Fibromyalgia: The role of nutrition and diet. Blake Graham, B.Sc (Honours) Clinical Nutritionist (08) 9487 7409 May 17 th 2010
Mar 26, 2015
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.
Gastrointestinal microbiologyimbalances
Lack of quality sleep
Acute chemical/allergen exposure
Toxic chemical accumulation
Emotional factors/stress
Nutrient/dietary imbalances
Hormone imbalancesStructural/mechanical
Multi-factorial model.
FM treatment.
• Identify and address contributing factors rather than trying treatments.
FM treatment.
• Address all contributing factors.
Causes of FM.
Gastrointestinal microbiologyimbalances
Lack of quality sleep
Acute chemical/allergen exposure
Toxic chemical accumulation
Emotional factors/stress
Nutrient/dietary imbalances
Hormone imbalancesStructural/mechanical
Diet.
Mechanisms of illness modulated by diet.
1. Nutrient levels
Mechanisms of illness modulated by diet.
1. Nutrient levels
2. Inflammation
Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation
3. Oxidative Stress
Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation 3. Oxidative Stress
4. Intestinal micro-organism balance
Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism
balance
5.Detoxification chemistry
Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism
balance 5. Detoxification chemistry
6. Hormone / neurotransmitter balance
Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism
balance 5. Detoxification chemistry 6. Hormone /
neurotransmitter balance
7. Intake of toxic chemicals
Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism
balance 5. Detoxification chemistry 6. Hormone /
neurotransmitter balance 7. Intake of toxic chemicals
8. Immune function
Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism
balance 5. Detoxification chemistry 6. Hormone /
neurotransmitter balance 7. Intake of toxic chemicals 8. Immune function
9. Circadian rhythm / sleep
Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism balance 5. Detoxification chemistry 6. Hormone / neurotransmitter balance 7. Intake of toxic chemicals 8. Immune function 9. Circadian rhythm / sleep
10.Food intolerances
Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism balance 5. Detoxification chemistry 6. Hormone / neurotransmitter balance 7. Intake of toxic chemicals 8. Immune function 9. Circadian rhythm / sleep10. Food intolerances
11.Genetic expression
Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism
balance 5. Detoxification chemistry 6. Hormone / neurotransmitter
balance 7. Intake of toxic chemicals 8. Immune function 9. Circadian rhythm / sleep10. Food intolerances 11. Genetic expression
12.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.
1. Poor intake.• Food choices.• Inc. soil levels, food storage, cooking methods,
etc.
2. Poor absorption.3. Excess excretion/loss/utilisation.4. 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 diets IgG testing
Pro •Free •High reliability for most commonly reactive foods •Tests for non-immune mediated intolerances
•Minimal effort involved •Investigates 96 foods
Con •High effort/motivation required •Only can investigate ~13 foods •A person can’t make any other changes during test period
•Cost (~ $250) •Significant false positive & negative rate •Must have been eating foods in question
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.
DairyBovine-derived
unless specifiedCasein
Cheese, CheddarCheese, Cottage
Cheese, MozzarellaMilk
Milk, GoatWhey
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