Fibromyalgia (often shortened to FMS) is a pain disorder, with symptoms ranging from muscle pain and numbness in the extremities to sleep disturbances. Inflammation and the body’s reaction to stress via the complex interactions between the brain and other organs play a role in fibromyalgia.
It may be difficult to avoid the stresses that modern living throws at us, but there is certainly a lot that we have control over that can help to relieve the symptoms of this condition, including lifestyle habit and dietary choices.
Pain is an unpleasant yet unavoidable feature of life. Reactive pain at a young age may begin after falling off your bike, but for some individuals, pain is chronic throughout life and can occur without obvious cause. Long-term unexplained pain is the hardest form to deal with, especially if you are unaware of how to help your symptoms.
Fibromyalgia is a common disorder associated with extreme pain arising from muscles, tendons and ligaments. It is estimated that 2-4% of the general population are affected by fibromyalgia, and that women are more susceptible than men.
Alongside the chronic widespread symptoms of pain with fibromyalgia, it is not unusual to experience a sensation of poor circulation or an apparent feeling of swollen hands and feet, often accompanied by tingling and numbness in the fingers and toes. Individuals may also suffer from headaches, sleep disturbance, digestive disturbances such as bloating, poor concentration or lack of memory, and they may even feel irritable or depressed. Other sensitivities to chemicals and allergies can also exist.FMS is known as a syndrome because it is a collection of symptoms rather than a specific disease.
The cause of fibromyalgia is generally unknown but it is thought to arise from an abnormal response to stress. During a stressful experience there is a complex set of interactions between different parts of the brain (the hypothalamus and the pituitary gland) and the adrenal glands. The adrenal glands sit at the top of each kidney and help the body to deal with stress by releasing hormones. Several types of chemical messengers called neurotransmitters are involved in this system. This network of interactions between the brain and the adrenal glands is known as the HPA-axis.
The HPA-axis is a highly complex system that is triggered in stressful situations and primes the body to cope with whatever situation is presented. Not only does the HPA-axis control reactions to stress, it also regulates other body processes such as digestion, immune health and mood. It is thought that the HPA-axis is dysfunctional in individuals with FMS.
With dysfunction in the HPA-axis, sufferers can have numerous abnormalities in their hormonal, metabolic and brain-chemical activity. This can result in altered levels of neurotransmitters including serotonin and melatonin, which affect sleep and mood, as well as changes in other hormones that can affect response to stress, bone and muscle growth, immune and inflammation regulation and pain perception. Malfunctions in pain processing include the over-sensitisation of nerves responsible for pain transmitting and a dysfunction in the pathways involved in inhibiting pain. The detection of specific inflammatory products called cytokines within the blood provides information on both the degree and severity of this process; increased levels of inflammatory cytokines are common to many chronic pain conditions, including fibromyalgia.
“Studies using MRI brain scanning techniques have shown structural brain changes in FMS patients, in specific areas of the brain that are known to regulate pain perception.”
These pro-inflammatory cytokines have been reported to influence a process called neurogenesis which, put simply, is the method by which nerve cells are generated. Excessive inflammation and the production of cytokines ultimately damage neurones, leading to their death. When cells within the brain die, this causes shrinking, which leads to a loss of grey matter in the brain. Studies using MRI brain scanning techniques have shown structural brain changes in FMS patients, in specific areas of the brain that are known to regulate pain perception. Such changes arise in part through the loss of specific fatty acids from myelin, the fatty sheath that protects nerve cells, but it is possible to prevent and restore these changes through dietary improvements and, specifically, by modifying dietary fat intake.
As with many conditions, genetic predisposition may increase an individual’s risk of developing fibromyalgia. Women are more likely to develop FMS than men, and are at particular risk of its onset during menopause. In total it is believed that around 90% of all FMS patients are women and that their symptoms also tend to be more severe than in men. Those who have recently experienced a traumatic physical injury, especially to the neck, or an emotional event (such as divorce, losing their job, etc.) may be at a higher risk of developing FMS. There is also evidence which suggests that illness, such as ankylosing spondylitis or Lyme disease, can influence the risk of developing FMS. Diagnosis is often difficult and the condition itself is far from simple in its definition.
Conventional drug treatment
Medical treatments for fibromyalgia focus on pain management and improvement of sleep quality, therefore antidepressants are recommended for the treatment of FMS because they decrease pain and often improve neurotransmitter function.
Antidepressant medication includes tricyclic antidepressants (TCAs), which work by preventing the reabsorption of the neurotransmitters noradrenaline and serotonin back into nerve cells. Another family of antidepressants called selective serotonin re-uptake inhibitors (SSRIs), work selectively on the neurotransmitter serotonin. SSRIs work by preventing the re-uptake of serotonin, allowing levels to become high enough to pass messages effectively between nerve cells. Antidepressants have a very important role to play, not only in FMS, but also in clinical depression, particularly when someone is suicidal and in need of an instant lift. The drawback of taking antidepressants is that nearly all of them have associated side effects, some of which can outweigh the benefits. For this reason many people often find it hard to stick to a course of medication and will look for an alternative, more natural treatment.
Prescription medication to improve sleep quality is also often recommended, which increases levels of GABA in the brain to reduce anxiety and allow rest with less pain. Medications can also suppress the activity of the central nervous system and, by inhibiting nerve and muscle activity, they also limit pain. As with most prescription medicines, there are side effects associated with the above sleep aids and it is recommended that they are used with caution and for short periods where lack of sleep is particularly problematic.
As there is such a strong link between stress and fibromyalgia, lifestyle factors can make a considerable difference to symptoms. Relaxation techniques help to slow down heart rate and lower blood pressure, as well as increase oxygen flow throughout the body. Meditation and muscle relaxation techniques can also help to reduce insomnia as well as stress levels.
“…exercise also helps the body produce more serotonin and adrenalin, which are inhibitors of pain. Exercise can help to reduce tension and stress, increase energy and improve sleep.”
Relaxation techniques can include meditation, yoga, tai chi, Feldenkrais and the Alexander Technique. Other simple lifestyle changes such as giving yourself enough time in the evenings to sit and relax with a good book and have a long soak in the bath can have a huge impact on your stress levels.
Physical activity can also be extremely effective in relieving symptoms of both FMS and mild to moderate depression. When we exercise, we produce chemicals called endorphins, which have not only been shown to help with pain control but are also known to make us feel good. Exercise has proved to be one of the leading natural treatments for FMS. As well as relieving some of the symptoms of FMS, exercise also helps the body produce more serotonin and adrenalin, which are inhibitors of pain. Exercise can help to reduce tension and stress, increase energy and improve sleep.
Diet plays a major role in the symptoms of fibromyalgia, so identifying imbalances and modifying the intake of a variety of food types can produce major improvements in pain, cognition, sleep patterns and energy, to name but a few.
Over the past fifty years there have been dramatic changes to the manufacturing involved in the production of the foods we eat, including processing and refining, the use of pesticides and the introduction of intensive farming. Such changes have increased stress levels on the body a great deal, so nutritional strategies concentrating on nutritious whole foods can help to manage pain, improve mood, modulate sleep patterns and also increase energy levels.
Refined processed foods
It is possible to modulate many symptoms of FMS by simply limiting or eliminating certain foods such as refined sugar, caffeine, alcohol, fried foods, trans fats, red meat and highly processed foods, as these are known to irritate muscles, disrupt sleep and increase sensitivity to pain, as well as compromise the immune system. Refined foods are stripped of nutrients and therefore put stress on the body. In contrast, eating a diet of fresh foods (organic if possible) which do not contain preservatives and additives, may not only ease the symptoms of FMS, but may also reduce the risk of triggering coexisting conditions such as irritable bowel syndrome (IBS).
Carbohydrates and the glycaemic Index
High intake of sugar and refined carbohydrates increases production of the hormone insulin, which will typically worsen pain and dramatically increase sensitivity. The sudden release of insulin causes peaks followed by troughs in blood sugar which will adversely affect behaviour, anxiety, depression and fatigue. It is therefore particularly important for people with fibromyalgia to keep their blood glucose levels even. The glycaemic index (GI) ranks carbohydrates according to their effect on blood glucose levels and is a good guide to informing us which foods to include as part of a healthy diet, and indeed which foods to limit.
White sugar and other refined (simple) carbohydrates, such as those found in processed white bread and white pasta, white rice and most convenience foods, supply few nutrients to the body but use up important B vitamins, which are essential for our nervous and immune systems, as well as for healthy digestion. These foods rank high on the GI, giving a quick spike to the blood sugar level, but dropping quickly, leaving a feeling of hunger and the need for further snacks. Avoiding refined foods and sugar, as well as consuming foods with a low GI value, will help to keep blood sugar levels even, which, in turn, has a positive effect on pain and mood. Good low GI carbohydrates include high fibre cereals, whole-grain products, beans, pulses, brown rice, whole-wheat pasta, some fruit and vegetables. Because these products are not refined or processed they tend to be high in vitamins and minerals such as thiamine, folate and zinc – all known to have a positive role in many metabolic pathways.
Omega-3 fatty acids
As individuals with FMS have been shown to have increased levels of inflammatory cytokines, which are associated with symptoms such as pain, fatigue and lack of sleep, it is important to look at specific fatty acids which can help to reduce these levels.
Fish is a direct source of the long-chain omega-3 polyunsaturated fatty acid EPA, which is known to positively influence serotonin levels and regulate inflammatory cytokine levels. Increasing fish intake can directly influence mood, pain and sleep patterns. Oily fish, in particular, provides good levels of omega-3 fatty acids; try opting for wild salmon, mackerel, sardines or anchovies. Eating two portions weekly (about 100g per portion) provides an average daily intake of approximately 0.5g long-chain omega-3. Be cautious, however, of larger fish such as marlin, swordfish or tuna, which tend to contain higher levels of contaminants than smaller species. Smaller, short-lived fish are not only ‘cleaner’ in terms of PCBs, mercury and dioxins, but due to their short lifecycles, tend to be more sustainable. Tinned tuna is also a poor source of omega-3, because the fatty acids are removed during the canning process.
If consuming tinned fish, avoid those that are stored in sunflower oil, as these are rich in certain undesirable omega-6s, which can increase inflammation if consumed in excess. It is advisable to ensure that your overall omega-6 fatty acid intake is not too high, therefore avoid processed corn and vegetable oils rich in omega-6 fatty acids, and replace this with olive oil and walnut oil, which contain more omega-3 and omega-9 fatty acids. Butter, in moderation, is also more beneficial than refined margarines. Meats contain varying levels of omega-3 and omega-6 fatty acids depending on their feed, so choose grass fed organic meats where possible, as these have a more favourable/healthier ratio.
Vegetarian source of omega-3 fatty acids
Vegetarians, and particularly vegans, generally have low levels of omega-3EPA and DHA in comparison to people who eat fish. Good food sources of vegetarian omega fats include walnuts and tofu, while supplements can provide more concentrated amounts of these important nutrients, to promote the conversion to the mood-regulating long-chain omega-3 fatty acid EPA. Stearidonic acid (SDA), found in echium seed oil, is a closer relative to EPA than the omega-3 alpha linolenic acid (ALA), typically found in flaxseed oil, and therefore is preferable. Our Echiomega capsules contain pure echium seed oil, which delivers 60% more EPA omega-3 than flaxseed oil.
Vitamins and minerals
It is extremely common for FMS sufferers to have low levels of B vitamins and essential minerals such as zinc, selenium and magnesium. Because these essential micronutrients are involved in all metabolic pathways, it is vital to ensure needs are met and, since they are water-soluble, these vitamins and minerals must be consumed daily to avoid depletion. Many heavily processed foods are devoid of these vital nutrients.
Vitamin and mineral deficiencies can hinder the body’s ability to utilise specific omega-3 fatty acids, which lift mood and regulate pain through the regulation of serotonin levels. Eating a good supply of fruit, vegetables, nuts and seeds will provide all the water-soluble vitamins and minerals the body needs. (Note to vegans: marmite is a good source of B12, which is an essential vitamin usually sourced from animal products.)
Protein is comprised of amino acids, which are essential for DNA, cell growth and tissue repair. Eating a variety of meat, fish and eggs will supply all the essential amino acids, providing complete proteins. Consuming protein rich in the amino acid tryptophan – good sources include egg whites, fish and cheese – can help to improve both sleep and pain levels.
Complete proteins are harder to obtain for vegetarians, but the better vegetable protein sources tend also to offer many other valuable nutrients. Variety is the key to obtaining all the necessary amino acids required for human dietary needs – combining various grains and legumes can provide all 8 essential amino acids. Tryptophan, for example, is found in grains such as corn, but is not present in beans and legumes.
Foods rich in B vitamins also promote the conversion of tryptophan into serotonin. Eating a good variety of vegetables can provide sufficient levels of B vitamins, however it is important not to overcook vegetables since B vitamins are water-soluble and steaming or boiling vegetables can deplete the B vitamin content. Eating or juicing raw vegetables provides the biggest nutrient hit, but lightly and quickly stir frying or steaming still retains nutrients and can be easier to digest.
Omega 3 EPA fish oil
By-products from omega-3 fatty acids such as EPA are anti-inflammatory, while omega-6 by-products are mostly inflammatory (such as AA). GLA and EPA work together to prevent the production of AA from DGLA, providing effective protection against chronic inflammation. (Click on diagram to enlarge.)
Several studies have identified that fibromyalgia patients have imbalances in levels of omega-3 EPA and omega-6 AA fatty acids, with corresponding high levels of the inflammatory cytokines. If AA levels dominate over EPA (as seen in fibromyalgia), this can result in the production of high levels of inflammatory eicosanoids, which can trigger the production of inflammatory cytokines. Supplementing FMS sufferers with high doses of EPA can help balance the AA to EPA ratio and reduce cytokine production, with numerous benefits on brain function and in the regulation of inflammation and pain processing (2;3).Whilst omega-6 by-products are mostly inflammatory (such as omega-6 AA), the omega-6 GLA actually works together with the omega-3 EPA to prevent the production of AA, providing effective protection against chronic inflammation. A supplement combining both omega-3 EPA derived from fish and omega-6 GLA derived from evening primrose oil is therefore additionally beneficial. Not only does omega-3 EPA aid in the regulation of inflammation in the body, it also helps regulate the synthesis and functioning of neurotransmitters such as serotonin and tryptophan, which can determine mood and quality of sleep. If a deficiency in these fatty acids presents and inflammation is unregulated, this can significantly affect levels of neurotransmitters, which are commonly low in those with fibromyalgia.
Individuals with FMS often rely on using selective serotonin reuptake inhibitors (SSRIs) to improve mood, help relieve pain, fatigue and sleep problems. Studies suggest that a combination of EPA and GLA have the same effects as SSRIs and can therefore provide relief from the symptoms of fibromyalgia, though without the side effects sometimes associated with pharmaceutical products.
Supporting healthy cellular omega-3 levels is important for long-term health. If you do not regularly consume oily fish we recommend slowly introducing DHA up to a daily dose of 250mg alongside EPA and GLA into your supplement regime once you have restored optimal omega-3 EPA levels.
This important and powerful antioxidant helps protect the mitochondria (the energy-producing part of a cell) and cell walls from cellular damage. But its most important function in the body is its central role in energy metabolism. Around 95% of the human body’s energy is generated with the help of Coenzyme Q10, and low levels can have a serious impact on the FMS sufferer. CoQ10 can therefore provide support for those suffering with fatigue.
Ko GD, Nowacki NB, Arseneau L, Eitel M & Hum A. Omega-3 fatty acids for neuropathic pain: case series. Clinical Journal of Pain 26:168-72.
Ozgocmen S, Catal SA, Ardicoglu O & Kamanli A. Effect of omega-3 fatty acids in the management of fibromyalgia syndrome. International Journal of Clinical Pharmacology and Therapeutics 38:362-3.
Puri BK, Agour M, Gunatilake KD, Fernando KA, Gurusinghe AI & Treasaden IH. (2010). Reduction in left supplementary motor area grey matter in adult female fibromyalgia sufferers with marked fatigue and without affective disorder: a pilot controlled 3-T magnetic resonance imaging voxel-based morphometry study. Journal of International Medical Research 38:1468-72.