Fibromyalgia: The role of nutrition and diet.

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