Hormonally Challenged: What You Need To Know About Adrenal Hormones, Fatigue, and Fibromyalgia

If you have fibromyalgia and want to reduce your fatigue, this is what you need to know about the critical link between your sleep/wake cycle and adrenal hormones. Your adrenal glands play a vital role in determining your daily energy/fatigue cycle because they produce the important hormones cortisol and DHEA.

The Critical Link Between Adrenal Hormones, and Your Sleep/Wake Cycle

When I got the results of my adrenal function test, I found the explanation for my daily energy and fatigue cycle. This test measures the functioning of your adrenal glands, which are responsible for regulating the production of several critical hormones, including cortisol and DHEA. It can help you figure out your daily energy/fatigue cycle so you can modify your treatment and pacing decisions to best effect.

To be clear, I am not suggesting that the diagnosis of adrenal fatigue,  a controversial condition among medical doctors, is the same as fibromyalgia fatigue. Instead, I believe that research has demonstrated the important role hormones, like cortisol, melatonin and DHEA, play in your daily circadian rhythm (sleep/wake cycle).

Abnormality in circadian rhythm of hormonal profiles has been observed in [fibromyalgia]. Moreover, there are reports of deficiency of serotonin, melatonin, cortisol and cytokines in FMS patients, which are fully regulated by circadian rhythm (Mahdi, et al., 2011).

These hormones are often deficient in people with fibromyalgia. Since cortisol and DHEA are produced by the adrenal glands, I think it is correct to say that ‘adrenal hormones’ are part of the fibromyalgia fatigue puzzle.

What is an Adrenal Function Test?

The test involves taking saliva samples four times during one day (before breakfast, lunch and dinner and at bedtime). My naturopath gave me a kit with four test tubes to spit into, and a plastic envelope to mail the samples across the country to Rocky Mountain Analytical labs (weird, right?). They tested my saliva for the cortisol level from each sample and graphed how it fluctuated during the day. I also had my overall DHEA level tested.

What is Cortisol and Why Should You Care?

Cortisol, also known as the ‘stress hormone’s is produced by the adrenal glands (endocrine glands that sit on top of the kidneys). You may have heard of cortisol and its role in the ‘fight or flight’ response to stressful situation – when the body releases high levels of cortisol , alongside adrenaline, to initiate that heart-pounding mode, pumped up feeling you get in a crisis.

But cortisol also plays a vital role in day-to-day functioning.  Cortisol is released in the morning to help you become alert and focused. It is supposed to decline gradually during the day so that by evening you feel sleepy and ready for bed. Melatonin, the ‘sleep hormone’, rises before bedtime and reduces cortisol production by the adrenal glands. However, in women with fibromyalgia, night-time melatonin has been found to be abnormally low and night-time cortisol abnormally high, probably leading to poor sleep quality.

The green shading on the graph in Fig. 1 shows the ideal downward curve from morning to night. There is a normal range in the population, with people on the upper end going from 7.0 to 1.3 ng/mL from a.m. to p.m. and people on the low end of the range going from 1.0 to 0.2 ng/mL.

In some studies, a pattern of low daytime cortisol and high night-time cortisol is characteristic of a disordered circadian rhythm in some people with fibromyalgia.

 

Fig 1 My Cortisol levels during the day

Fig 1 My Cortisol levels during the day

My results: Mid-afternoon Slump and Energetic Evenings

You can see that my results are all off (above, the dark line connecting dots): high in the morning, low in the afternoon and back up again in the evening. I start the morning at 2.8 ng/ml, decrease to 1.4 by mid-afternoon, then increase back up to 2.6, and finally taper off at 1.0 ng/mL at bedtime. This explains my mid-afternoon slump and energetic evenings. Dr. Love also pointed out that I go from being in the bottom 50% of the normal cortisol range in the morning and afternoon, but by evening I am in the upper 50%, and trying to fall asleep with a relatively high level (l.0 ng/mL cortisol). This is probably contributing to my night time insomnia.

Yes, my results are in the normal range, but fibromyalgia involves increased central nervous system sensitization. My pattern of cortisol production is abnormal and I believe that a sensitized nervous system can interpret sub-optimal levels as intense fatigue.

How To Balance Your Cortisol Levels to Improve Energy

Be wary of many adrenal supplements that lower cortisol – if you have FMS your problem might be cortisol levels that are already too low.  I need to boost my cortisol levels in the afternoon and reduce them in the evening. You can read about my favorite adrenal boosting supplements here.  They include Vitamin C, B5, licorice and rhodiola. For night-time cortisol lowering, I like to use time-release melatonin to improve my sleep.

There are also important lifestyle changes you can make to balance your cortisol levels and improve your fibromyalgia symptoms (New Life Outlook). For example:

  • Relaxing music. Enya is still putting out the tunes, guys. Play it all day or take a break and get lost in it. At a nice low volume, of course.
  • Meditate. Grab your heating pad and a timer. Even just five minutes a day can keep major stress away.
  • Acupuncture. Once a week or once a month, for body and mind relief, I swear by those magic needles!
  • Exercise. Nothing too intense for me. I work with light weights and a slow pace.
  • Eat clean. The more you do it the better you’ll feel. Your body will thank you for not having to work so hard.
  • Consistent sleep schedule. Your body has a natural rhythm, just like Enya. Listen to it… Just like Enya (New Life Outlook).

 What is DHEA and Why Should You Care?

Fig. 2 The numbers

Fig. 2 The numbers

DHEA is produced in the adrenal glands, and is a precursor hormone for estrogens and androgens (male and female sex hormones). This hormone helps to counter the stress effects of cortisol in some tissues, such as the brain and heart, and supports a healthy immune system. It is an important factor in balancing your cortisol levels. Studies have demonstrated that DHEA supplementation can help improve mood and sexual interest in women with adrenal fatigue. It’s role in fibromyalgia is unclear:

A small study published in 2012 suggested that DHEA levels may be low in post-menopausal women with fibromyalgia and that lower levels were linked with reduced pain threshold and tolerance and several measures of illness severity. However, studies have been inconsistent as to whether FMS involves low DHEA levels (VeryWell).

My naturopath recommended 1 start with 5 mg per day (a fairly low dose). I found that my energy is more sustained, even on days where I slept poorly. Processed wild yam and maca root can also increase DHEA.

Update: because I have endometriosis, boosting my estrogen by taking DHEA was worsening my pain levels, so I don’t recommend it for women with endometriosis, fibroids or breast/ovarian cancer. 

Instead, I now take rhodiola when my fatigue is high. Rhodiola is considered to be an adaptogen, and studies demonstrate that taking this supplement improves stress tolerance by “influencing key brain chemicals, such as serotonin and norepinephrine, and natural feel-good opioids such as beta-endorphins” (Life Extension Magazine: Rhodiola).

A Word of Caution About Balancing Hormones

One final note: “In advanced stages of adrenal fatigue, when the body is already exhausted of nutritional reserves, it is inadvisable to take supplements that may stimulate the adrenal glands. Doing so, would be like stepping on the gas pedal in a car that has no gasoline in it. Not only will you not get anywhere, it can actually hurt the car” (Dr. Lam). It’s best to consult with your healthcare provider and to educate yourself about improving your energy by supporting your adrenal glands rather than pumping them up with a bunch of supplements.

I was  made aware of a great new book about Adrenal Fatigue called The Adrenal Fatigue Solution by Dr. Eric Wood and Fawne Hansen. I had previously read a book on adrenal fatigue several years ago, but a lot of research has been done since. This book presents the research in an accessible, easy to read way, along with naturopathic treatments. They also have a helpful website http://adrenalfatiguesolution.com/  with a lot of information there on adrenal insufficiency and treatments. (For full disclosure, the authors contacted me to review the book and provided me with a free copy. I genuinely feel it is a helpful resource on the topic, and have not been compensated for saying so).

Resources

Fatima, G., Das, S. K., Mahdi, A. A., Verma, N. S., Khan, F. H., Tiwari, A. M. K., … Anjum, B. (2013). Circadian Rhythm of Serum Cortisol in Female Patients with Fibromyalgia SyndromeIndian Journal of Clinical Biochemistry28(2), 181–184. http://doi.org/10.1007/s12291-012-0258-z

Life Extension (Rhodiola)

Dr. Lam (Understanding Rhodiola Health Benefits and Adrenal Fatigue Syndrome)

Life Extension (Stress Management)

Mahdi, AA., et al. (2011). Abnormality of circadian rhythm of serum melatonin and other biochemical parameters in fibromyalgia syndrome. Indian J Biochem Biophys.  Apr;48(2):82-7.

New Life Outlook (Cortisol and Fibromyalgia)

Teitelbaum, J. (2007). From Fatigued to Fantastic. Penguin Books: NY.

VeryWell (DHEA Supplementation in Fibro)

Fibromyalgia Fatigue: The Top 8 Supplements I Take to Improve My Energy

Fatigue is a disabling symptom of fibromyalgia – but I have benefited from several supplements which improve my energy. This article explains the difference between adrenal and mitochondrial energy supplements, how they work and what the research says.

This post contains affiliate links, which help support this blog. I only link to products that I use and like – my opinion has been in no way influenced by the makers of the products I recommend.

Tart Cherry

My Christmas present one year was an evil cold. I had been lucky the past several years not to encounter any viruses. After reading about the  negative experiences of other bloggers with FM or CFS who have caught a flu or a cold, I was nervous about the potential consequences. My worries were realized when, after my other cold symptoms cleared up, the extra fatigue didn’t disappear too. My fibro fog and afternoon fatigue were the worst I had ever experienced!  I spent the months after trying to figure out how to recover my energy to my baseline level.

Prior to this cold, my ‘energy envelope’ consisted of:

  •  required 10 hours of sleep
  • most energetic in the late a.m. and evening, lowest in the afternoon
  • able to do 3-4 hrs of blogging per day
  • able to spend one evening per week out

Now, even 11 hours of sleep was unrefreshing. I had to drop my classes because of afternoon crashing. The strangest symptom was visual over-stimulation – for example, difficulty making sense of store displays during an energy crash. My acupuncturist explained my post-viral fatigue as a failure of my body to turn off the sickness response. In other words, your body makes you feel tired and achey when you get sick to induce rest, so energy can be redirected to your immune system. Usually that response stops when you get better, but sometimes your body fails to ‘flip the switch’ from sick mode to healthy mode.

In the last few years I have discovered that my energy is impacted by two primary factors – adrenal function and mitochondrial function. The challenge is to figure out how to best support energy production in your body, both at the cellular level (mitochondrial) and organ system level (circadian rhythm and/or adrenal fatigue).

Adrenal Glands and Energy Production stop scrolling down

In a previous post, I wrote about the results of my adrenal function test. The adrenal gland regulates the production of several critical hormones, including cortisol and DHEA. Cortisol, also known as the ‘stress hormone’ is produced by the adrenal glands (glands that sit on top of the kidneys). Cortisol regulates many of the body’s responses to stress, including blood sugar levels, metabolism, immune responses, blood pressure, and central nervous system activation. Although high levels of cortisol are released, alongside adrenaline, to initiate the ‘fight or flight’ response to stressful situations, it also plays a role in day-to -day functioning. Cortisol is released in the morning to help you become alert and focused. It is supposed to decline gradually during the day so that by evening you feel sleepy and ready for bed. Proponents of the theory of ‘adrenal fatigue’ argue that initially, in stressful circumstances,  adrenal glands overproduce cortisol. But if a high-stress situation persists over time, the fatigued glands begin to under-produce cortisol, resulting in low daytime levels and worsening daytime fatigue (Life Extension: Stress Management).

The results from an adrenal function test show that my cortisol curve is all off. I start the morning at the low end of the normal range, but then my cortisol slumps significantly by mid-afternoon, and finally increases to the high end of the normal range by bedtime. These results explain my mid-afternoon crash and energetic evenings (not to mention insomnia). According to my naturopath, this pattern of low daytime cortisol and high nighttime cortisol is characteristic of a disordered circadian rhythm in some people with fibromyalgia.

So how can you improve your overall energy by supporting your adrenal function?

  • Vitamin C and B5 (Pantothenic Acid): Both of these vitamins help promote adrenal function. They are inexpensive and provide a good foundation for re-balancing cortisol production. Vitamin B5 is a lesser known but still important member of the B vitamin family and it is used for energy production in the body. According to Dr. Teitelbaum, “your body’s highest levels of vitamin C are found in the adrenal glands and brain tissues, and the urinary excretion of vitamin C is increased during stress” (From Fatigued to Fantastic p. 90). Vit C formulations can be more or less potent and come with or without added antioxidants. I like Natural Factors Extra C + Bioflavonoids.
  • Licorice Root Extract:  In order to try to sustain cortisol throughout the afternoon to prevent the usual crash, I added licorice tincture on really tired days. It helps slow the breakdown of cortisol in the body, so whatever you do produce stays around longer (Life Extension: Stress Management). (Licorice is not for people with high blood pressure, so please check with a health care provider to see if it is appropriate for you and do your research first). I prefer to use a liquid extracts/tincture because I can tailor the dose – I found the average capsule dose made me jittery but with a liquid I can take just a few drops. Dr. Teitelbaum recommends the equivalent of 100 to 150 mg daily.
  • Time Release Melatonin: In order to improve my circadian rhythm, I added 5mg of sustained / time release melatonin at night.  Melatonin reduces cortisol, so it helps me with my elevated night-time levels (Life Extension: Stress Management). This stuff is quite effective! I have been sleeping through the night more regularly since I added this to my night time pill regimen. (I found regular melatonin did not have this effect).
  • Rhodiola: finally, I am also taking Rhodiola to support my nerve and endocrine system functions. Rhodiola is considered to be an adaptogen, and studies demonstrate that taking this supplement improves stress tolerance by “influencing key brain chemicals, such as serotonin and norepinephrine, and natural feel-good opioids such as beta-endorphins” (Life Extension Magazine: Rhodiola).  Rhodiola helps to promote mental focus and energy – key for those of us with fibro fog!

Fibromyalgia and Mitochondrial Function: Improving Energy One Cell at a Time 

Secondly, mitochondrial function is a critical part of increasing energy in fibromyalgia. Mitochondria are the power plants of our cells.

Studies suggest the energy factories may be running a bit low in FM. Muscle biopsies have found patterns of mitochondrial dysfunction (abnormal mitochondria, mitochondrial defects and muscle fiber abnormalities) similar to those typically found in mitochondrial disorders. Some skin biopsies have shown patterns of neurogenic inflammation and oxidative stress – two factors that negatively impact the mitochondria. Peripheral blood cells have demonstrated CoQ10 deficiency, mitochondrial dysfunction, oxidative stress and mitochondrial degradation (Health Rising: Is FM a Mitohondrial Disorder?).

I’m trying to take a combination of supplements that are factors used by mitochondria in the production of energy.

  • D-ribose:  D-ribose is a sugar produced in the body and taken to alleviate fatigue and pain in fibromyalgia and chronic fatigue syndrome. Dr. Teitelbaum contends that CFS/FMS is caused by “energy crisis” in the body, leading to a cascade of different symptoms like fatigue, pain, sleep disturbance, among others. One root cause of the energy problem, he argues, is that the ability of the mitochondria in your cells to generate energy is suppressed. Mitochondria produce the energy, called ATP, used by your cells to carry out all their functions. D-ribose is essential to the production of ATP. Therefore, taking additional D-ribose should help to support mitochondrial function and improve energy output in fatigued patients.  Dr. Teitelbaum has authored a few pilot studies that have demonstrated some promising results. The most recent study was an open-label study published in 2012. Significant improvements were found; specifically a 61.3% increase in energy, 37% increase in general well-being, 29% improvement in sleep, 30% improvement in mental clarity, 15.6% decrease in pain (Teitelbaum: From Fatigued to Fantastic).
  • CoQ10, a powerful antioxidant, is the catalyst that enables mitochondria to produce 95% of all cellular energy (in the form of the compound ATP). A Spanish research team has conducted several studies that demonstrate a CoQ10 deficiency in people with fibromyalgia, leading to mitochondrial dysfunction and increased oxidative stress. These researchers have also found that supplementing with CoQ10 improves clinical symptoms of fibromyalgia like pain, depression and fatigue (Phoenix Rising: CoQ10).
  • Acetyl-L-Carnitine, is an amino acid produced in the body from l-carnitine which is used to manufacture fuel for energy via mitochondria. This nutrient is also used in bodily processes that regulate muscle movement, as well as heart and brain function. People with fibromyalgia have been found to have low levels of carnitine. Supplementing with acetyl l-carnitine has been found in a double-blind placebo-controlled study to improve pain levels, depression and quality of life among people living with fibromyalgia (Prohealth: L-Carnitine).

Since starting this combination of adrenal and mitochondrial support, my afternoon crashing has evened out. My fatigue does not bottom out in the afternoon (less brain fog and no visual over-stimulation). I finally regained my pre-viral energy envelope. I am sharing all of this in the hope it gives some direction to others finding themselves in a similar situation! Take care of yourselves, dear readers!

 

Life Extension (Rhodiola)

Life Extension (Stress Management)

Health Rising (Is FMS a Mitochondrial Disorder?)

Phoenix Rising: (CoQ10)

Prohealth (L-Carnitine: Typically low in fibromyalgia and ME/CFS; Promotes healthy mood and energy)

Teitelbaum, J. (2007). From Fatigued to Fantastic. Penguin Books: NY.

The 3 Best Diets for Fibromyalgia, According to Science

Learn about 3 diets that improve fibromyalgia symptoms: plant-based, low FODMAP and gluten-free –including an explanation, the science and resources for each diet.

The 3 Best Diets for Fibromyalgia, According to Science

Is Food Really Medicine?

Is there such a thing as a diet to treat fibromyalgia?  While there is no consensus on a single diet to treat FMS, research does point us in a few intriguing directions– specifically, symptoms improvements from plant-based vegetarian diet, a low-FODMAP diet and a gluten-free diet.

Fibromyalgia is difficult to treat. Presently, there are only three prescriptions that are approved by the FDA for fibromyalgia (pregabalin, duloxetine and milnacipran). Unfortunately, although these medications can provide partial relief for some people, none are a magic bullet for treating fibromyalgia. That’s why specialists recommend a multidisciplinary approach to FMS treatment. We know that diet plays an important role in preventing and managing many diseases, such as diabetes and autoimmune diseases, so why not fibromyalgia as well?

In this article, I want to lay out the scientific evidence for three different diet approaches to improving fibromyalgia: plant-based, FODMAP and gluten-free. My hope is that this article can serve as a starting point for you to explore how to use food as medicine to improve your symptoms.

Nutrition can be empowering. That might sound overblown. But, unlike prescriptions or appointments with doctors and physical therapists, there is no intermediary between you and what you choose to eat. Food is personal and what you decide to eat is ultimately up to you. For a person living with fibromyalgia, having the ability to make decisions over something as important as nutrition really is empowering. However, changing daily habits can be a challenge, which is why I have included several free and affordable resources for each diet if you are interested in making any changes.

Fibromyalgia and Plant-Based Vegetarian/Vegan Eating

At least three studies have shown that people with fibromyalgia benefit from a plant- based vegetarian or vegan diet.[1] It’s important to stress the plant-based focus of this dietary therapy. It is possible to eat a diet that is vegetarian, but primarily made up of processed, nutrient-poor, junk food. This won’t improve your general health or your fibromyalgia symptoms. Plant-based foods, including fruits, veggies, whole grains, beans and nuts, contain vitamins, minerals and antioxidants that provide crucial nutritional benefits. It’s quite possible to also obtain balanced macronutrients (carbs, protein and fats) from these plant sources. While vegans and vegetarians both eat plant-based foods, vegetarians also consume dairy, eggs, honey (and sometimes, fish). Vegans do not eat any animal-sourced foods.

Studies have shown that fibromyalgia is linked to high rates of oxidation (damage to tissues caused by particles known as oxidants). Antioxidants neutralize oxidants and serve an important protective function in the body. Researchers hypothesize that consuming a diet rich in antioxidants might help to improve fibromyalgia symptoms.[2]  One study showed that fibromyalgia patients on a vegetarian diet had an improved antioxidant status; 70% of participants also reported lower pain levels and increased well-being.[3]

Another benefit of eating vegetarian is weight loss. Carrying extra weight worsens pain, sleep, depression, and other fibromyalgia symptoms.[4] However, it can be very difficult to lose weight when you have a condition that makes moderate exercise painful. If you have struggled unsuccessfully to lose weight, could it be time to consider going vegetarian or vegan?

A recent study of diabetic patients found that, compared to a conventional low-calorie diet, a vegetarian diet was almost twice as effective in reducing body weight.[5] In a separate investigation into the effects of eating vegan on fibromyalgia symptoms, research participants who were overweight had a significant reduction in body mass index, as well as cholesterol levels.[6] This 3-month study found that eating vegan resulted in significant improvements in FMS symtoms: reduced pain levels, and joint stiffness and improved quality of sleep and quality of life.

After my diagnosis, I ate a lot of processed, packaged food because of the convenience. But it cost me a lot in terms of my symptoms getting worse and gaining weight. After I switched to eating plant-based vegetarian, I lost about 20 pounds and found that some of my symptoms improved, including more sustained energy, no low blood sugar crashes and greater ease of movement.

If you are interested in going vegetarian/vegan, or just incorporating more meatless main dishes into your diet, here are a few resources to get started:

Fibromyalgia and the Low FODMAP Diet

This is a weird sounding diet, right? FODMAP stands for several types of short chain carbohydrate and sugar alcohols. Research has shown that a diet low in FODMAPs is the most effective diet plan for managing Irritable Bowel Syndrome (which includes symptoms like bloating, nausea and changes in bowel movements). In addition, a low FODMAP diet (LFD) can reduce fatigue, lethargy and poor concentration.[7]

Based on these findings, a new study investigated whether reducing FODMAPs in your diet could improve your fibromyalgia symptoms.[8]  The results were positive – a statistically significant reduction in body pain and gastrointestinal symptoms, as well as an improvement in quality of life. I find it interesting that these results indicated improvements beyond only G.I. symptoms . Research into probiotics and dietary interventions has been pointing to a gut-brain connection. Since fibromyalgia involves a sensitized nervous system, perhaps one way to dial down the sensitivity could be via the gut? It’s important to note that this was a pilot study, with a small sample size, and further research needs to be done. However, if you have IBS or significant G.I. issues along with fibromyalgia, a low FODMAP diet might help you manage digestive symptoms and reduce your pain!

How Does a Low-FODMAP Diet Work?

For some people, FODMAPS are poorly absorbed in the small intestine. When they pass into the large intestine, they are quickly fermented, which contributes to gas, abdominal bloating and pain. They also attract water into the large intestines through osmosis, which can alter bowel movements. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These can be further divided into five groups called fructans, galacto-oligosaccharides, lactose, excess fructose and polyols.

Foods that contain FODMAPS include:  onions, garlic, mushrooms, apples, lentils, wheat, rye and milk. Importantly, not everyone is triggered by all types of FODMAPs. Instead, the FODMAP diet takes an elimination approach. Initially, all FODMAPs are removed from your diet. Gradually, they are re-introduced one by one so you can determine which ones cause you a negative reaction. Only your FODMAP triggers are permanently removed from your meals.

If you are interested in learning more, you can check out these resources:

Fibromyalgia and the Gluten-Free Diet

It’s impossible to have escaped the gluten-free diet fad that has swept the mainstream in recent years. The evidence is seemingly in every grocery store and on every menu. While it may seem like only a fad, there is a scientific rationale behind why some people may benefit from a gluten-free diet, even if they don’t have celiac disease (CD): “Non-celiac gluten sensitivity is increasingly recognized as a frequent clinical condition with symptoms similar to CD in the absence of the diagnostic features of CD.”[9]

Without getting too deep in the weeds on this topic, gluten is a protein found in wheat, rye, barley and similar grains. In some people with a weakened intestinal barrier, consuming gluten triggers an inflammatory immune response. Some of the symptoms of a gluten sensitivity include gastrointestinal problems like bloating, constipation, diarrhea, abdominal pain, and vomiting, as well as muscle and joint pain, brain fog and chronic fatigue. Although the clinical markers of gluten sensitivity are different from celiac disease, scientists have uncovered markers of intestinal cell damage and increased immune activity, which normalized after eliminating gluten for six months.[10]

A small pilot study investigated whether fibromyalgia patients with gluten sensitivity improved after beginning a gluten-free diet. Patients with confirmed gluten sensitivity experienced an improvement in pain, fatigue, neurological and gastrointestinal symptoms after beginning a gluten-free diet. Of the 20 participants in the study, fifteen experienced a significant reduction in body wide pain – some shortly after beginning the diet and others after a few months. The authors conclude that this pilot study suggests non-celiac sensitivity may be a treatable cause of fibromyalgia, but that further research needs to be done.

If you are curious whether gluten might be worsening your symptoms, it’s best to begin with a trial elimination diet. This means eliminating all sources of gluten from your diet for several weeks. During this period, keep a food log of what you eat and what your symptoms are each day. Then reintroduce gluten into your diet, and observe whether your symptoms change or worsen. Since more than half of FM/CFS patients see their symptoms improve when they eliminate certain foods, including corn, wheat, dairy, citrus and sugar, you may want to add other foods to your elimination diet.

If you suspect that gluten may be impacting your fibromyalgia, it’s good to rule out celiac disease first. Start by making an appointment with your doctor (and bringing your food log). In order to rule out non-celiac gluten sensitivity, you may want to consider working with an integrative medical doctor, naturopathic doctor, or nutritionist. Although research supports the existence of gluten sensitivity, the mainstream medical profession lags behind when it comes to accepting this condition, so alternative and complementary health professionals may be better to work with during this process.

Here are a few resources to check out if you are interested in going gluten-free:

 

References

[1] https://vegetarianprescription.org/2016/11/01/the-treatment-of-fibromyalgia-with-a-plant-based-diet/

[2] https://vegetarianprescription.org/2016/11/01/the-treatment-of-fibromyalgia-with-a-plant-based-diet/

[3] Høstmark A, Lystad E, Vellar O, et.al. Reduced plasma fibrinogen, serum peroxides, lipids, and apolipoproteins after a 3-week vegetarian diet. Plant Foods for Human Nutrition. Jan 1993;43(1):55-61.

[4] http://www.arthritis.org/about-arthritis/types/fibromyalgia/articles/obesity-fibromyalgia.php

[5] https://www.sciencedaily.com/releases/2017/06/170612094458.htm

[6][6] Kaartinen K, Lammi K, Hypen M. Vegan diet alleviates fibromyalgia symptoms. Scandinavian Journal of Rheumatology. 2000; 29(5): 308-13.

[7] http://fodmapfriendly.com/what-are-fodmaps/

[8] Marum, A.P. et al. (2016). A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients. Scandinavian Journal of Pain 13:166-72. http://www.scandinavianjournalpain.com/article/S1877-8860(16)30084-2/fulltext?mobileUi=1

[9]Isasi, C. et al. (2014). Fibromyalgia and non–celiac sensitivity: a description with remission of fibromyalgia. Rheumatology International , 34 (11), 1607-16.

[10] http://www.medicalnewstoday.com/articles/312001.php

Natural Treatments for Fibromyalgia: Why you should Try D-Ribose

Natural Treatments for Fibromyalgia: Why you should Try D-RiboseThe first part of my natural treatment protocol for FM was focused on healing my digestive tract (which I described in a previous post). The second phase is to begin incorporating d-ribose.

D-ribose is a sugar produced in the body and taken to alleviate fatigue and pain in fibromyalgia and chronic fatigue syndrome. Here’s what the research says about this supplement.

The biggest advocate for d-ribose is Dr. Teitelbaum, a prominent doctor in the field of chronic fatigue and fibromyalgia medicine. He has developed a program for treating both conditions which includes d-ribose as a core component. Dr. Teitelbaum contends that CFS/FMS is caused by an “energy crisis” in the body, leading to a cascade of different symptoms like fatigue, pain, sleep disturbance, among others. One root cause of the energy problem, he argues, is that the ability of the mitochondria in your cells to generate energy is suppressed. Mitochondria produce the energy, called ATP, used by your cells to carry out all their functions. D-ribose is essential to the production of ATP. Therefore, taking additional D-ribose should help to support mitochondrial function and improve energy output in fatigued patients. (If you are interested in learning more, check out a much longer discussion found on Dr. Teitelbaum’s website here).

The evidence? Dr. Teitelbaum has authored a few pilot studies that have demonstrated some promising results. The most recent study was an open-label study published in 2012. In this multicenter study, 257 patients diagnosed with CFS/FMS were given d-ribose (5 g three times daily for three weeks). Patient symptoms were assessed in terms of subjective change in energy, sleep quality, mental clarity, pain level, and global sense of well-being, and compared to their pre-study baseline. Significant improvements were found; specifically a 61.3% increase in energy, 37% increase in general well-being, 29% improvement in sleep, 30% improvement in mental clarity, 15.6% decrease in pain.

Sounds great, right? There are some limitations to the study. First of all, there was no placebo group so we don’t have a sense of how much a placebo effect might have impacted the results. Secondly, it was quite a short study so long term effects were not captured in the results. Third, I always feel a bit suspicious of studies that lump chronic fatigue and fibromyalgia together because a lot of recent research has demonstrated different causes for the two conditions and mixing them together might conflate the results.

Personally, I have found D-ribose a helpful aid to improving my energy. I would say that it improves my energy by 15-20%. I take 5mg in the morning, and sometimes an additional 5mg in the afternoon. When I stopped taking it, I noticed a worsening of my afternoon brain fog and fatigue. I didn’t notice a worsening of pain or sleep however. I also appreciate that it is easy to take –  just mix a spoonful with a glass of swater- instead of yet another pill. It is also relatively inexpensive.

As with everything fibromyalgia or chronic fatigue related, it is an individual experience, so you have to try it for yourself. In the case of d-ribose, I think it is definitely worth a try!

Check out other great posts on the Fibro Friday Linkup!

References

Teitelbaum JE, et al. “Treatment of chronic fatigue syndrome and fibromyalgia with D-ribose – An open-label, multicenter study.” The Open Pain Journal. 2012, 5,32-37