The FibroManual: A Complete Fibromyalgia Treatment Guide for You and Your Doctor

by Ginevra Liptan

Imagine constantly idling that car with bad mileage. The combination of constant and inefficient use of muscle energy makes you burn nutrients faster than they can be replaced and builds up painful waste products like lactic acid. Even at rest, fibromyalgia muscles show the level of lactic acid you would expect in someone who has run a 5K race (Gerdle 2010). Nonstop muscle tension is equivalent to nonstop exercise. No wonder we’re tired and our muscles hurt!

Fibromyalgia muscles have lower than normal amounts of the energy-carrying chemical ATP, and people with fibromyalgia have a reduced tolerance for exercise, with muscles that easily fatigue (Park 1998; Gerdle 2013; Bachasson 2013).

Ten Superfoods for Mitochondria Almonds (raw, not roasted) Avocados Blueberries Broccoli Grass-fed beef/buffalo Green tea Pomegranates Salmon (wild, not farm-raised) Seaweed Spinach (organic)

You can find preactivated B vitamins, magnesium, and the right amounts of acetyl-L-carnitine, alpha-lipoic acid, and CoQ10 in a product called RevitalAge Nerve, by Pure Encapsulations. It’s as close as I have found to an all-in-one supplement for mitochondrial support in fibromyalgia, but if you are on a statin you will still need extra CoQ10.

“Dirty Dozen” Fruits and Vegetables Make sure to buy organic! Apples Sweet bell peppers Strawberries Nectarines Grapes Cucumbers Celery Cherry tomatoes Peaches Snap peas Spinach Potatoes

Inflammation, which is an activation of the immune response, is necessary for healing and tissue repair. But it must be kept in check, so the body has both anti-inflammatory and pro-inflammatory chemicals. In fibromyalgia this balance is lost and skews toward systemic inflammation, resulting in flulike feelings of achiness and fatigue that anybody with the disease knows well. Restoring a healthy equilibrium is key to reducing pain and fatigue.

If you have ever had the flu, the achiness you felt was due to your body’s rapid release of a huge amount of inflammatory chemicals called cytokines and immune cells to fight off the virus. Several studies have found levels of inflammatory cytokines in fibromyalgia patients that were as high as those in the blood of someone with the flu (Bazzichi 2007; Wang 2008).

In addition, white blood cells from fibromyalgia patients don’t respond normally when exposed to certain irritating substances in a lab. The cause of this is currently unknown, but it is most likely due to effects of the stress response interfering with immune function.

Curcumin is generally not well absorbed from the GI tract, so oral doses must be high to see an effect. In newer supplements the curcumin is bound to phosphatidylcholine, which is more easily absorbed, letting it piggyback a ride into the bloodstream. Meriva is a curcumin-phosphatidylcholine made by Thorne Research that I have found very effective. Usual dosage is 1,500–2,000 mg daily, divided, taken with meals to avoid nausea. Start low and slowly work up to full dose. It can be taken every day or just as needed for pain. The huge advantage of curcumin over NSAIDs is that it has fewer side effects such as ulcers and does not worsen leaky gut.

To assess the function of the adrenal glands we have to look at the pattern of cortisol secretion over twenty-four hours. Any deviation from the normal cycle indicates strain on the adrenals. Most fibromyalgia patients show mild adrenal burnout, with a flattening of the usual curve of hormonal release throughout the day. Several studies have shown this “blunting” of the normal pattern of cortisol secretion in fibromyalgia patients (Mahdi 2011; Riedel 1998; Riva 2010).

But the adrenal burnout that we see in fibromyalgia does not progress to full adrenal shutdown. Instead, burned-out adrenals will limp along for a lifetime, but cause worsening fatigue over time.

Everyone with fibromyalgia has overworked adrenal glands that need extra support. No matter what the stage of adrenal burnout, there are natural ways to support and improve their function. The Rest and Repair steps of getting more deep sleep, activating the relaxation response, and gentle exercise can help restore more normal patterns of cortisol secretion, and we can eat well, emphasize protein with every meal, and limit stimulants like caffeine, sugar, and alcohol. To perform, the adrenals need vitamins C, B5, B6, folic acid, magnesium, zinc, and copper. Folic acid can be hard for some people to process, so I recommend taking an activated form.

Further support for the adrenals includes drinking plenty of water and increasing salt consumption, especially sea salt. One easy way to do this is by adding one-quarter teaspoon of sea salt to sixteen ounces of water and drinking twice daily (it should be dilute enough that it doesn’t taste salty). Salt helps keeps fluid in your bloodstream to reduce that “peeing all the time but still thirsty” feeling that is so common in fibromyalgia. It also supplies needed minerals to the adrenal glands.

Common genetic variations affect the body’s ability to activate and use supplemental folic acid. L-5-methyl​tetrahyd​rofolate is the universally metabolized and active form, meaning it bypasses several enzymatic activation steps and is directly usable by the body, regardless of functional or genetic variations. I recommend reliable brands such as Thorne Research or Pure Encapsulations, in daily dosage of 400–800 mcg, to support adrenal health.

Rhodiola rosea is a flowering plant that has been shown to reduce the stress response and reduce anxiety and fatigue (Olsson 2009; Panossian 2007; Ishaque 2012). In particular, supplementation of rhodiola helps patients with severe anxiety. The usual dosage is 100–200 mg daily. Ashwagandha (Withania somnifera) is an herb from the Indian Ayurvedic healing tradition that ameliorates the effects of stress in rats and humans (Bhattacharya 2003; Chandrasekhar 2012). The usual dosage is 150–300 mg daily.

Iagen makes SR-Adrenal, which has many of the nutrients needed to support adrenals, along with rhodiola, ashwagandha, and adrenal glandular extract. Another good option is called a-Drenal, made by RLC Labs.

But for some patients prescription antidepressants only partially work. For them, I have found the addition of a specialized folic acid supplement to be helpful. Some people don’t produce enough of an enzyme (MTHFR) that converts folic acid into the active form—L-methylfolate—that the brain uses to make mood-enhancing chemicals, especially serotonin. Those with genes that code for dysfunctional folate-converting enzymes are not able to produce as much of the active form of folic acid, and are more likely to suffer from depression. In fact, one study found that 70 percent of depressed patients had a gene for a dysfunctional MTHFR enzyme (Kelly 2004; Lewis 2006).