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by
Dr. Mark Percival
Fibromyalgia, a mysteriously debilitating rheumatic
syndrome, is taking an increasing toll on our
population. The condition, which bears striking
resemblance to Chronic Fatigue Syndrome (CFS), mainly
affects women aged 25-50 years (female to male ration
5:1). Both syndromes are characterized by a broad
spectrum of physical and emotional symptoms, and both
are receiving increasing attention from the medical
community. Fibromyalgia (FM), which is generally
classified as a soft tissue musculoskeletal pain,
aching, stiffness, disturbed sleep, depression and
fatigue. While not all patients experience all symptoms,
those with "Tender Point Count" (i.e.,
sensitivity in at least 11 of 18 points) have become the
primary diagnostic factor for FM and helps doctors to
differentiate the syndrome from CFS. ender points are
located over muscles and tendinous insertions, and can
range from mildly irritating to completely debilitating
(Figure 1). Pain in FM patients has been attributed in
part to an unusually high degree of gluconeogenesis.
This increased level of muscle tissue breakdown has been
hypothesized as one of the main reasons for pain, aching
and fatigue. In order to better understand the origin of
the disease, scientists in Sweden conducted several
studies on patients with FM. Muscle morphology,
chemistry and physiology were carefully examined, as
were the most prominent symptoms, including muscle pain,
muscle fatigue and muscle stiffness. A review of the
studies by Bengtsson and Heriksson, 1989, found that
victims of the syndrome appear to have microcirculation
disturbances, along with mitochondrial damage and
abnormally low phosphate counts -- strongly suggesting
an energy deficient state in the muscle tissues. These
scientists hypothesized that FM might be the result of
any condition that could lead to constant muscle
hypoxia, specifically through the establishment of
abnormal motor patterns. Conventional Treatments Fall
Short Despite long years of research and study, the
treatment and management of FM is still not
satisfactory. A tricyelic agent know as amitriptyline
has been shown to provide some short-term relief;
however, the drug is also known to have adverse side
effect, including myocardial infraction, strode,
arrhythmia, coma, seizure and alopecias. Long-term
effects of the drug are still not known. One study found
ibuprofen to be no more beneficial then a placebo. Of
the variety of conventional treatment modalities that
have been tested of FM patients, all have yielded
unsatisfactory results. Since it has become widely
recognized that aluminum overload can lead to major
metabolic disturbances, some researchers have carefully
studied means of eliminating the toxic metal, especially
from the body's vital organs. They found that, in
addition to adequate amounts of magnesium (which helps
prevent the toxic effects of aluminum), supplemental
malic acid may support aluminum detoxification. Malic
acid is a known chelator of aluminum.
Magnesium, Malic Acid and Fibromyalgia
The Journal of Nutritional Medicine published a study on
the combined effects of magnesium and malic acid on FM
patients. The researchers used oral magnesium and malic
acid preparations in an open clinical setting.
Fifteen patients (ages 32 to 60) ingested 1,200 to 2,400
mg of malic acid with 300 to 600 mg of magnesium for a
testing period of 4 to 8 weeks. The results of the study
were encouraging: all patients significant relief
of pain within 48 hours of treatment and, within 4 to 8
weeks, all patients had a significant and measurable
decrease in the Tender Point Index (TPI). TPI
scores were 19.6±2.1 prior to treatment and 8±1.1 and
6.5±0.75 after treatment. Following the 8 weeks study
period, six patients were switched to placebo tablets
for an additional 2 weeks. The TPI values increased from
6.8±0.75 to 21.5±1.4. These results indicate the
possibility of a very promising nutritional approach for
FM.
What's Manganese Got To Do With It?
Fatigue is one of the most prominent features of
fibromyalgia syndrome, and both CFS and FM may have a
common link in manganese-dependent neuroendocrine
changes, especially along the hypothalamic-pituitary
thyroid axis. The cycle begins with hypothalamic
production of thyrotrophin releasing hormone (TRH). TRH
stimulates the pituitary gland to produce thyroid
stimulating hormone (TSH), which in turn stimulates
thyroid production of thyroxin.
This is important, since thyroxin regulates the
metabolic rate. And with fatigue as one the major
complaints among both FM and CFS patients,
hypometabolism due to secondary hypothyroidism fits very
nicely into this hypothesis. Manganese, which
directly influences the metabolic rate through its
involvement in this hypothalamic-pituitary-thyroid axis,
may therefore be an important trace mineral for CFS and
FM patients.
Thiamin also plays a role in the respiratory chain. In
addition, thiamin deficiency symptoms are strikingly
similar to many of the symptoms experienced by FM
patients. These include apathy, confusion, fatigue,
insomnia, depression, paresthesia (numbness or burning
in the hands and feet), low blood pressure, low
metabolism and shortness of breath. Considering the lack
of medical treatments and evidence of nutritional
factors, it makes sense to implement to use of dietary
supplements to optimize the nutritional status of
patients with FM. To summarize the first part of our
discussion, the nutrients to consider here are:
Magnesium and malic acid to support ATP synthesis and
aluminum detoxification (the addition of vitamin B6 can
support this process), manganese to support
neuroendocrine changes and thiamin to support the
respiratory chain.
Calcium: The Building Block of the Body
The two most important minerals are Calcium (hair,
teeth, bones, skin, nails) and Magnesium (relaxes all
the muscle fibers in the body). It is vitally important
that you take the two in conjunction with each other, as
they act synergistically.
The Disease-Toxicity Connection
As with all degenerative conditions it is highly
beneficial to carefully investigate the relationship
between toxicity and the presenting condition. This
involves a close look at the role of the GI tract, liver
function, lymph and cardiovascular function, nervous
system (sympathetic/parasympathetic) balance and immune
regulation.
With a functional understanding of the important role
each of these systems play in both the onset and
effective management of FM and indeed most degenerative
illnesses, it becomes clear that a comprehensive
clinical approach is required. Such an approach focuses
on the patient's: Mental-emotional states and effective
stress management skills. Dietary patterns, i.e., what
they eat (with careful attention to both macro- and
micro-nutrient balance) and how they eat (with attention
to habits that facilitate or inhibit proper digestion).
Postural and exercise habits, and biomechanics.
For a more in-depth discussion of the specific clinical
and education al steps which can be taken.
The clinical thrust is to restore key organ system
function, and in the case of FM (as well as CFIDs)
special attention should be given to resuscitating
mitochondrial function.
In addition, some evidence suggests that cardiovascular
fitness training can help alleviate some the the
symptoms of FM as well. According to a study published
in The American Journal of Medicine. "It is
concluded that cardiovascular fitness training is
feasible in patients with fibrositis/fibromyalgia and
that such training improves subjective measurements of
pain-reporting behavior". In addition to
nutritional support and mild exercise, massage, heat
treatments and rest may also help. Improvements
resulting from these treatment modalities can be
measured by decreased sensitivity at the tender points,
and improved stamina, energy and mobility.
The information presented is intended for education
purposes and is obtained and extrapolated from published
research and books. It is not intended to be
prescriptive nor to replace the case of a licensed
health professional in the diagnosis and treatment of
illness.
Fibromyalgia, a mysteriously
debilitating rheumatic syndrome, is taking an increasing
toll on our population. The condition, which bears
striking resemblance to Chronic Fatigue Syndrome (CFS),
mainly affects women aged 25-50 years (female to male
ration 5:1). Both syndromes are characterized by a broad
spectrum of physical and emotional symptoms, and both
are receiving increasing attention from the medical
community.
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