fibromyalgia: the role of nutrition and diet. blake graham, b.sc (honours) clinical nutritionist...

Fibromyalgia: The role of nutrition and diet.

Blake Graham, B.Sc (Honours)Clinical Nutritionist

(08) 9487 7409

May 17th 2010

FM pathophysiology.

• Mitochondrial impairment• Oxidative stress• HPA axis dysfunction• ANS dysfunction• Immune activation• Inflammation• Sleep dysfunction

Causes of FM.

Gastrointestinal microbiologyimbalances

Lack of quality sleep

Acute chemical/allergen exposure

Toxic chemical accumulation

Emotional factors/stress

Nutrient/dietary imbalances

Hormone imbalancesStructural/mechanical

Multi-factorial model.

FM treatment.

• Identify and address contributing factors rather than trying treatments.

FM treatment.

• Address all contributing factors.

Causes of FM.

Gastrointestinal microbiologyimbalances

Lack of quality sleep

Acute chemical/allergen exposure

Toxic chemical accumulation

Emotional factors/stress

Nutrient/dietary imbalances

Hormone imbalancesStructural/mechanical

Diet.

Mechanisms of illness modulated by diet.

1. Nutrient levels

Mechanisms of illness modulated by diet.

1. Nutrient levels

2. Inflammation

Mechanisms of illness modulated by diet.

1. Nutrient levels2. Inflammation

3. Oxidative Stress

Mechanisms of illness modulated by diet.

1. Nutrient levels2. Inflammation 3. Oxidative Stress

4. Intestinal micro-organism balance

Mechanisms of illness modulated by diet.

1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism

balance

5.Detoxification chemistry

Mechanisms of illness modulated by diet.

1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism

balance 5. Detoxification chemistry

6. Hormone / neurotransmitter balance

Mechanisms of illness modulated by diet.

1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism

balance 5. Detoxification chemistry 6. Hormone /

neurotransmitter balance

7. Intake of toxic chemicals

Mechanisms of illness modulated by diet.

1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism

balance 5. Detoxification chemistry 6. Hormone /

neurotransmitter balance 7. Intake of toxic chemicals

8. Immune function

Mechanisms of illness modulated by diet.

1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism

balance 5. Detoxification chemistry 6. Hormone /

neurotransmitter balance 7. Intake of toxic chemicals 8. Immune function

9. Circadian rhythm / sleep

Mechanisms of illness modulated by diet.

1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism balance 5. Detoxification chemistry 6. Hormone / neurotransmitter balance 7. Intake of toxic chemicals 8. Immune function 9. Circadian rhythm / sleep

10.Food intolerances

Mechanisms of illness modulated by diet.

1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism balance 5. Detoxification chemistry 6. Hormone / neurotransmitter balance 7. Intake of toxic chemicals 8. Immune function 9. Circadian rhythm / sleep10. Food intolerances

11.Genetic expression

Mechanisms of illness modulated by diet.

1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism

balance 5. Detoxification chemistry 6. Hormone / neurotransmitter

balance 7. Intake of toxic chemicals 8. Immune function 9. Circadian rhythm / sleep10. Food intolerances 11. Genetic expression

12.Acid/base balance

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

Nutrient supplementation

Causes of nutrient imbalances.

1. Poor intake.• Food choices.• Inc. soil levels, food storage, cooking methods,

etc.

2. Poor absorption.3. Excess excretion/loss/utilisation.4. Maldistribution.

Nutrient testing.

• Vitamin D (> 125 nmol/L). • Iron studies (ferritin > 50 / transferrin saturation

> 22%).• Urine iodine.• Amino acid testing.• Magnesium testing highly unreliable.

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

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).

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

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

Vitamin D.

• Levels should be above 125 nmol/L.• Often requires 4000 IU+/day.• D3 Drops by Bioceuticals.

– 333 IU/drop.

• www.vitamindcouncil.org

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)

Fish oil.

• 6-12 grams/day.• Anti-

inflammatory.

Amino acids.

www.metametrix.com

Remove food allergens/intolerances.

• Methods of assessment:– Elimination diets.– IgG food intolerance testing.

Elimination diets vs. IgG testing.Elimination diets IgG testing

Pro •Free •High reliability for most commonly reactive foods •Tests for non-immune mediated intolerances

•Minimal effort involved •Investigates 96 foods

Con •High effort/motivation required •Only can investigate ~13 foods •A person can’t make any other changes during test period

•Cost (~ $250) •Significant false positive & negative rate •Must have been eating foods in question

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.

IgG food testing via US BioTek.

DairyBovine-derived

unless specifiedCasein

Cheese, CheddarCheese, Cottage

Cheese, MozzarellaMilk

Milk, GoatWhey

Yogurt

www.usbiotek.com/

Recommended reading.

• ‘Musculoskeletal Pain: Expanded Clinical Strategies’

• Alex Vasquez, ND, DC• 2008• Available from

www.functionalmedicine.org

Summary - Putting it all together.

• Identify causes/contributing factors.• Treat systematically.• Consider role of diet, nutrients and lifestyle

factors.

Fibromyalgia: The role of nutrition and diet.

Blake Graham, B.Sc (Honours)Clinical Nutritionist

(08) 9487 7409

May 17th 2010