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Fibromyalgia: The role of nutrition and diet.

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.

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  1. Fibromyalgia: The role of nutrition and diet. Blake Graham, B.Sc (Honours) Clinical Nutritionist (08) 9487 7409 May 17th 2010

  2. FM pathophysiology. • Mitochondrial impairment • Oxidative stress • HPA axis dysfunction • ANS dysfunction • Immune activation • Inflammation • Sleep dysfunction

  3. 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

  4. Multi-factorial model.

  5. FM treatment. • Identify and address contributing factors rather than trying treatments.

  6. FM treatment. • Address all contributing factors.

  7. 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

  8. Diet.

  9. Mechanisms of illness modulated by diet. • Nutrient levels

  10. Mechanisms of illness modulated by diet. • Nutrient levels • Inflammation

  11. Mechanisms of illness modulated by diet. • Nutrient levels • Inflammation • Oxidative Stress

  12. Mechanisms of illness modulated by diet. • Nutrient levels • Inflammation • Oxidative Stress • Intestinal micro-organism balance

  13. Mechanisms of illness modulated by diet. • Nutrient levels • Inflammation • Oxidative Stress • Intestinal micro-organism balance • Detoxification chemistry

  14. Mechanisms of illness modulated by diet. • Nutrient levels • Inflammation • Oxidative Stress • Intestinal micro-organism balance • Detoxification chemistry • Hormone / neurotransmitter balance

  15. Mechanisms of illness modulated by diet. • Nutrient levels • Inflammation • Oxidative Stress • Intestinal micro-organism balance • Detoxification chemistry • Hormone / neurotransmitter balance • Intake of toxic chemicals

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. Nutrient supplementation

  23. Causes of nutrient imbalances. • Poor intake. • Food choices. • Inc. soil levels, food storage, cooking methods, etc. • Poor absorption. • Excess excretion/loss/utilisation. • Maldistribution.

  24. Nutrient testing. • Vitamin D (> 125 nmol/L). • Iron studies (ferritin > 50 / transferrin saturation > 22%). • Urine iodine. • Amino acid testing. • Magnesium testing highly unreliable.

  25. 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

  26. 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).

  27. 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

  28. 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

  29. Vitamin D. • Levels should be above 125 nmol/L. • Often requires 4000 IU+/day. • D3 Drops by Bioceuticals. • 333 IU/drop. • www.vitamindcouncil.org

  30. 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)

  31. Fish oil. • 6-12 grams/day. • Anti-inflammatory.

  32. Amino acids. www.metametrix.com

  33. Remove food allergens/intolerances. • Methods of assessment: • Elimination diets. • IgG food intolerance testing.

  34. Elimination diets vs. IgG testing.

  35. 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.

  36. 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/

  37. Recommended reading. • ‘Musculoskeletal Pain: Expanded Clinical Strategies’ • Alex Vasquez, ND, DC • 2008 • Available from www.functionalmedicine.org

  38. Summary - Putting it all together. • Identify causes/contributing factors. • Treat systematically. • Consider role of diet, nutrients and lifestyle factors.

  39. Fibromyalgia: The role of nutrition and diet. Blake Graham, B.Sc (Honours) Clinical Nutritionist (08) 9487 7409 May 17th 2010

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