Articles

Fibromyalgia

Introduction

Fibromyalgia (FM) is a rheumatic autoimmune syndrome that is characterized by widespread musculoskeletal pain, and an array of other symptoms. The symptoms may vary from day to day, ranging from moderate discomfort to severe disability. Other terms have been used to describe this condition including fibromyositis, fibrositis, periarticular fibrositis, muscular rheumatism, chronic muscle pain syndrome, musculoskeletal pain syndrome, and tension myalgia. However, fibromyalgia, which means pain of the muscles and other fibrous tissue, is now the accepted term. Inflammation may not play a significant role in fibromyalgia.

To date, medical science has not been able to determine the cause of fibromyalgia, but there are many events that may be related to its onset. Some of the events that are being evaluated as possible triggers include infections (viral or bacterial), physical trauma such as an automobile accident, or the development of other health problems such as rheumatoid arthritis, lupus, "leaky gut" syndrome, or hypothyroidism. Rather than causing fibromyalgia, these triggering events may awaken an underlying physiological abnormality.

The published clinical definition of fibromyalgia syndrome may not be the best one possible. (1) It has been argued that tender points have been over-emphasized as diagnostic markers. The difference between individuals who meet the criteria for diagnosis of chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) is often only the degree of pain. Indeed, 70 percent of patients diagnosed with fibromyalgia meet all of the diagnostic criteria for CFS. Tracked over time, some individuals initially diagnosed with CFS will subsequently fit the criteria for diagnosis of FMS. More than two-thirds of patients with FMS meet the CDC (Center for Disease Control) criteria for CFS, (2) and two-thirds of patients with CFS meet the criteria for FMS. (3)

Other conditions that may commonly mimic fibromyalgia include hypothyroidism, lupus, Lyme disease, rheumatoid arthritis, and infections. There may be a link between fibromyalgia and sleep disturbance disorder, since most fibromyalgia patients have disruptive sleep patterns. Other factors that may contribute to the development of fibromyalgia or its symptoms are psychological stress, immune or endocrine abnormalities, mitochondrial uncoupling of energy production, or biochemical abnormalities in the central nervous system. Many patients have no apparent underlying disorders, while others who develop fibromyalgia may have conditions such as those mentioned above.

It has been observed that patients with fibromyalgia have alterations in the metabolism and regulation of neurotransmitters such as serotonin, norepinephrine, and dopamine. (4) Substance P is a pain neurotransmitter that has been found to be elevated threefold in the spinal fluid of fibromyalgia patients. (5) Other studies report that patients with fibromyalgia have abnormal levels of cortisol and growth hormone. (6)

A more recent theory postulates a deficiency of a hormone known as relaxin, which is a polypeptide very similar to insulin. In women, relaxin is secreted from the ovaries, uterus, and breast tissue. Relaxin is a hormone that helps regulate muscle, tissue, and organ function in many areas of the body. Relaxin levels are highest during pregnancy and diminish progressively during menopause. Women who are menopausal, or those who have had a hysterectomy, oophorectomy, tubal ligation, or extended use of oral contraceptives, which suppress ovarian functions, may be at greater risk of developing fibromyalgia because their relaxin production has been severely diminished. (7)

For years, the diagnosis of fibromyalgia was difficult because objective signs, such as inflammation and joint deformity, are not associated with the condition. In fact, many clinicians initially thought that fibromyalgia was a psychiatric illness. Today, several well-designed studies have disproved this theory. (8) , (9) Fibromyalgia is now accepted as a physical illness. Although many patients with FM present with anxiety and/or depression, it is now recognized that these conditions are a secondary feature of the illness rather than primary.

In 1986, sixteen medical centers in the United States and Canada joined together in a study to determine the criteria for diagnosing this condition. In 1990, a committee from the American College of Rheumatology (ACR) proposed diagnostic criteria for a diagnosis of fibromyalgia. They suggested that the criteria for fibromyalgia should include the presence of widespread pain in combination with tenderness at 11 or more of the 18 specific tender point sites. (10)

According to the ACR guidelines, pain is considered to be widespread when all of the following are present: pain in the left and right sides of the body, as well as pain above and below the waist. In addition, axial skeletal pain (cervical spine, anterior chest, thoracic and spine, or low back) must be present. In addition to specifying the 18 tender point sites to be evaluated, they stated that digital palpitation should be performed with an approximate force of 4 kilograms of pressure.

It is now accepted that the following two criteria must be met for a diagnosis of fibromyalgia: widespread musculoskeletal pain in all four quadrants of the body for at least three months duration, in combination with tenderness at 11 or more of the 18 specific "tender point" sites.

It is estimated that about 90 percent of fibromyalgia patients are women with a mean age slightly less than 50 years. (11) Although the condition can develop in childhood and in old age, it most frequently manifests in middle life.

Connection to "Leaky Gut" Syndrome: Epidemiological studies have confirmed that patients with functional gastrointestinal disorders such as irritable bowel syndrome (IBS) frequently overlap with fibromyalgia (FM), suggesting some commonality. Fibromyalgia occurs in up to 60 percent of patients with functional bowel disorders. Up to 50 percent of patients with a diagnosis of FM syndrome complain of symptoms characteristic of functional dyspepsia, and 70 percent have symptoms of IBS. (12) These patients usually have an abnormal microbial population in the gastrointestinal (GI) tract, which results in dysbiosis. This can cause digestive problems and a leaky gut, which can cause multiple food allergies, weakened immunity, increased toxicity, psychological disturbances, nutrient depletions, and low energy.

At the cellular level, it is hypothesized that fibromyalgia patients experience a breakdown or uncoupling of mitochondrial energy production processes. (13) This defect in mitochondrial energy production may be related to or responsible for the chronic fatigue and the characteristic pain and muscle soreness in FM patients. Elevated blood lactate is characteristic in FMS patients. This may explain the muscle soreness and muscular fatigue. It is believed that in FMS, there is a down regulation of lactate and pyruvate conversion to energy within the cell. Elevated lactate mimics the effects of prolonged exercise on muscle tissue (soreness).

Statistic

American College of Rheumatology, 2000.

    Fibromyalgia is common, affecting approximately two percent of the U.S. population. It occurs seven times more frequently in women than in men. It occurs most frequently in women of childbearing age.

National Institute of Arthritis and Musculoskeletal and Skin Diseases, 1999.

    Fibromyalgia primarily occurs in women of childbearing age, but children,the elderly, and men can also be affected.

Fibromyalgia Network, 1999.

    90% of fibromyalgia patients have jaw and facial tenderness that could produce symptoms of TMJD. 50% of all fibromyalgia patients suffer from sensitivities to odors, noise, bright lights, medications, and various foods.

Signs and Symptoms

[span class=alert]The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.[/span]

Several Symptoms must be present in order to confirm a fibromyalgia diagnosis. The first is widespread musculoskeletal pain. Widespread is defined as pain occurring on the right and left sides of the body, above and below the waist and axial skeletal pain. Localized pain upon digital palpitation should also be present in at least 11 of 18 "tender points" generally occurring on the following areas; occiput, low cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter and knee.

Other general, common symptoms include aching, disturbed sleep patterns, fatigue, morning stiffness, depression, recurrent headaches, tender lymph nodes, bowel or bladder disturbances, sensitivity to heat or cold, anxiety, gastrointestinal disturbances, dizziness, heart palpitations, impaired coordination, environmental sensitivity and allergies. The presence of certain diseases is also common with a fibromyalgia diagnosis. Three of the most common diseases are irritable bowel syndrome, Raynaud’s disease and temporal mandibular joint dysfunction.

General

  • Widespread musculoskeletal pain
  • Aching
  • Disturbed sleep patterns
  • Fatigue
  • Morning stiffness
  • Localized tenderness
  • Depression
  • Recurrent headaches
  • Irritable bowel syndrome
  • Raynaud’s syndrome
  • Temporal mandibular joint dysfunction
  • Tender lymph nodes
  • Bowel or bladder disturbances
  • Sensitivity to heat or cold
  • Anxiety
  • Gastrointestinal disturbances
  • Dizziness
  • Heart palpitations
  • Impaired coordination
  • Environmental sensitivity
  • Allergies
  • Stiffness

Treatment Options

Conventional

Anti-inflammatory Drugs: Fibromyalgia generally does not respond to the anti-inflammatory drugs that are used to treat other rheumatic conditions such as NSAIDS, aspirin, and corticosteroids. (14) The tricyclic antidepressants alprazolam (15) and amitriptyline (16) have been used with some degree of success. These drugs apparently improve sleep patterns and induce a level of analgesia due to their effect on serotonergic and noradrenergic synapses.

Nutritional Supplementation

Other recommendations based on pharmacology:

    Coenzyme Q10: 60-200mg daily to enhance ATP synthesis and oxygenation of tissues. Some compounding pharmacists are creating 200mg troches. NADH: 2.5-5mg, twice a day to enhance energy production within the cell. Alpha lipoic acid: 50-150mg daily for antioxidant effect and detoxification of heavy metals. Vitamin E: 400 IU daily. N-Acetyl Cysteine: 500mg, 3-4 times a day. Supports glutathione synthesis and assists in detoxification. Multiple Vitamin and Mineral daily.


S-Adenosylmethionine (SAMe)

S-adenosylmethionine is a compound with anti-inflammatory, analgesic, and antidepressant effects. A six-week double-blind trial with 44 patients receiving 800mg/day reported the following results. Improvements were seen for clinical disease activity (p = 0.04), pain experienced during the sixth week (p = 0.002), fatigue (p = 0.02), morning stiffness (p = 0.03), and mood evaluated by Face Scale (p = 0.006) in the actively treated group compared to placebo. (17) In an earlier double-blind crossover trial with 17 patients, SAMe reportedly reduced levels of depression as the amount of pain and number of trigger points decreased, which prompted the researchers to state that SAMe, "seems to be an effective and safe therapy in the management of primary fibromyalgia." (18)


Magnesium, Malic Acid

Many patients with fibromyalgia report significant reductions in pain using a combination of magnesium hydroxide (300-600mg/day) and malic acid (1,200-1,400 mg/day). Pain levels frequently decline within 48 hours as evidenced by decreases in the Tender Point Indexes (TPI), and symptoms of fatigue reportedly improve within two weeks. (19) , (20) Magnesium and malic acid both play important roles in the biochemical pathways leading to the production of ATP. Both substances have oxygen-sparing effects, and a deficiency of either may contribute to the hypoxia commonly found in the muscle tissue of fibromyalgia patients. In general, this combination increases energy production and reduces lactic acid, which is a source of the muscular tenderness and pain that patients experience. Caution should be used in those individuals with IBS symptoms because magnesium malate may contribute to GI distress.


5-Hydroxytryptophan (5-HTP)

Studies have reported that a substantial number of patients with fibromyalgia have abnormalities in the normal serotonin-melatonin metabolic pathways. Two natural substances can be used to stimulate the body’s ability to synthesize serotonin and melatonin. These substances are the essential amino acid tryptophan and 5-hydroxytryptophan (5-HTP). When these precursors are used in the treatment of fibromyalgia, patients report improvements in symptoms of depression, anxiety, insomnia, and body pains. (21) In one double-blind study, 50 patients were given 100mg of 5-HTP three times daily for 30 days. At this dosage level, the patients reported significant clinical improvement in all of their symptoms. (22) Identification of low serum tryptophan and serotonin levels may be the most effective way to identify which individuals will respond well to this approach. Approximately 3,000mg of tryptophan can be used instead of 5-HTP.


Melatonin

One study reported that patients with fibromyalgia syndrome had nighttime melatonin levels that were 31 percent lower than placebo controls. (23) This may contribute to impaired sleep at night, fatigue during the day, and altered pain perception. In a therapeutic trial, patients were given 3mg of melatonin daily at bedtime. After one month, patients reported significant improvement in sleep, tender point count, and severity of pain at selected points. (24)


Lactobacillus acidophilus

L-glutamine: 1,000-3,000mg, 3 times a day (conditionally essential amino acid for GI repair).

Acidophilus/Bifidus (dairy free) with FOS: 10-15 billion units, 2-3 times a day (replenishes beneficial flora).


Digestive Enzymes

Often beneficial for patients whose disease state involves gastrointestinal problems. Since a significant number of patients with fibromyalgia fall into this category, supplementation with a full range digestive enzyme may provide relief from bloating and other GI symptoms.


Vitamin B1

The active form of thiamine, known as thiamine pyrophosphate (TPP), is a coenzyme in the production of energy in the Krebs cycle. The symptoms of thiamine deficiency are similar to many of the symptoms of fibromyalgia such as fatigue, depression, apathy, confusion, paresthesia (numbness or burning in the hands and feet), low blood pressure, low metabolism, and shortness of breath. A dose of 10mg twice daily is a usual dose. Best results are obtained by doing laboratory analysis with the erythrocyte transketolase test and providing the amount of thiamine required to normalize this enzyme function. (25)

Herbal Supplementation


Turmeric

Reports from laboratory and clinical research indicate that turmeric and its phenolics have unique antioxidant and anti-inflammatory properties. (26) Curcuminoids reportedly inhibit enzymes, which participate in the synthesis of inflammatory substances (leukotrienes and prostaglandins) derived from arachidonic acid. It is claimed that they are comparable in activity to the NSAIDs. (27) , (28) In a double-blind study of individuals with rheumatoid arthritis, curcumin produced significant improvement in all subjects studied. (29) Turmeric has been reported to be anti-rheumatic, anti-inflammatory, and antioxidant. (30)


Astragalus

The Chinese have valued astragalus for centuries for its immune-enhancing and adaptogenic properties. As an adaptogen, it may modify and improve the body’s response to stress through action on the adrenal cortex. (31) , (32) The triterpenoids and saponins are structures similar to steroid hormones and precursors that act on the adrenal cortex. The polysaccharides contained in astragalus relate to the improvement in natural killer (NK) cells and T-cell function, as well as interferon production by the immune system. (33) Studies have reported that administration of astragalus for one month increased phagocytosis by spleen cells, decreased T-suppressor cell function, and improved T-killer cell function. (34) Astragalus enhances the effects of interferon, and may increase cellular oxygenation of the heart and cerebrovascular tissue and improve stamina and endurance. (35) , (36) , (37)


Cordyceps

Cordyceps is a unique black mushroom that extracts nutrients from and grows only on a caterpillar found in the high altitudes of Tibet and China. Cordyceps has been used in humans for centuries as a tonic for improving performance and vitality, with the proposed mechanism of action being improved oxygen consumption by the cardiopulmonary system under stress and increased tissue "steady state" energy levels. Cordyceps may modulate immune function and optimize endocrine systems, increasing physical strength and endurance. (38) , (39)

Cordyceps has traditionally been used for its improvement in respiration and in individuals with decreased lung function, such as asthma and bronchitis, by increasing oxygenation (improving VO2 max by 9-15 percent). (40) Cordyceps has been reported to have anticancer effects by decreasing proliferation and differentiation of cancerous cells and has immunomodulatory effects. (41) , (42) , (43) Cordyceps has been used for decreasing the renal toxicity of various toxins, and in individuals with chronic renal failure. (44) , (45) Cordyceps is an antioxidant that increases serum levels of the enzyme superoxide dismutase (SOD), thereby increasing free radical scavenging ability. (46) It has also been reported to positively affect blood lipid metabolism, making it potentially useful in atherosclerosis. (47)


St. John's Wort

St. John’s wort has gained a great deal of attention for its use in minor depression. Its popularity has stemmed from its extensive use by physicians in Europe as the first agent of choice in the treatment of mild to moderate depression. There are a variety of studies which are claimed to support the use of St. John’s wort in treating depression. (48) , (49) , (50) St. John’s wort may amplify and improve the signal produced by serotonin once it binds to its receptor sites in the brain, thereby making it potentially beneficial in fibromyalgia. (51) , (52) Additionally, hypericum in higher dosages has been used as an antiviral agent, including HIV. (53)


Kava

Kava preparations are approved medicines in several European countries for the treatment of nervous anxiety and restlessness. (54) , (55) Studies have reported that kava preparations compare favorably to benzodiazepines in controlling symptoms of anxiety and minor depression, while increasing vigilance, sociability, memory, and reaction time. (56) , (57) Several other studies have reported positive effects of kava when anxiety is present, including in PMS and menopausal complaints, and drug addiction and withdrawal. (58) , (59) Kavalactones appear to act on the limbic system, in particular the amygdala complex, the primitive part of the brain that is the center of the emotional being and basic survival functions. (60) It is thought that kava may promote relaxation, sleep, and rest by altering the way in which the limbic system modulates emotional processes. Kava preparations have also been reported to produce skeletal muscle relaxation (comparable to mephenesin), a benefit in fibromyalgia. (61) Tolerance does not seem to develop with kava use. (62) , (63)

Homeopathic

Lacticum acidum

Typical Dosage: 6X or 6C, 30X or 30CDisturbed cell respiration; Rheumatic complaints

Magnesia phosphorica

Typical Dosage: 6X or 6C, 30X or 30CSudden, intense, spasmodic pains that are cramp-like or neuralgic; Erratic; Better from heat and pressure

Rhus toxicodendron

Typical Dosage: 6X or 6C, 30X or 30CStiff joints; Swollen painful joints; Better from motion; Better from heat and hot applications; Worse in cold, damp weather

Acupuncture & Acupressure

Acupuncture, massage, and cupping
Huang, et al. have combined massage and bloodletting puncturing and cupping to treat 82 cases of scapular levator muscular fibrositis, and reported that 62 cases have been resolved, 10 cases have significantly improved, 8 cases have improved, and 2 cases with no response, tallying an overall effective rate of 97.6%. (64)

Liang has combined cupping and acupuncture with moxibustion-warmed needles to treat 42 cases of muscular fibrositis, and reported satisfactory results. (65)

Yang has combined cupping and external application to treat 133 cases of fibrositis, and reported 86 cases have been resolved, 26 significantly improved, 16 improved, and 5 with no response, tallying an overall effective rate of 91.1%. (66)

Zhu has combined hegu (LI 4) point stimulation and slow motion needling to treat 50 cases of lumbar and back fascial fibrositis, and reported 39 (78%) cases have been resolved, 8 (16%) significantly improved, and 3 (6%) improved. (67)

Wu has used the traditional point prescription acupuncture and the Western "trigger point" acupuncture, respectively, to treat 32 cases of fibromyalgia syndrome, and reported a 97% overall effective rate for the point prescription group, and a 91% overall effective rate for the "trigger point" group. (68)

Ren has used the day-prescription method of acupuncture (far-infrared radiation or cupping was also used in some cases) to treat 51 cases of fibrositis, and reported good results. (69)

Cui has used cupping to treat 1230 cases of muscular fascial fibrositis and reported satisfactory results. Method: locate the trigger point in the affected area, and treat it by plum-blossom needling and flash-fire cupping; after cupping, apply externally an author-prepared plaster (to promote blood circulation and relieve pain) or a dog-skin plaster (by Tongren Hall of Beijing) for three to five days (one treatment cycle calls for the use of two plasters). (70)

Aromatherapy

There is little case study evidence available for the treatment of fibromyalgia with essential oil therapy. However, the use of essential oils in symptoms management may be a positive addition to a full treatment protocol. Essential oils in treatment should be monitored by an aromatherapist. Oils that are rich in cinnamic aldehyde or in phenolic compounds are extremely aggressive and should never be used in their pure state, but rather diluted in order to avoid burns. In addition, unless monitored by an aromatherapist, oils should never be used internally.

There has been some concern that essential oils are best used in individual application as changes in bioactivity occur in mixtures. With this in mind, when managing the symptoms of fibromyalgia the single oils may be used individually and applied to different target areas sequentially or combined into a formula under supervision of an aromatherapist.

Application: Single oils may be mixed in a 1:1 ratio with a vegetable based carrier oil and applied directly to affected area. When applying the oils in massage or to larger surface areas such as the back, the mixture may be reduced to contain 40% essential oil and 60% carrier oil.

Traditional Chinese Medicine

Fibromyalgia

Extensive information regarding the treatment of this health condition using Traditional Chinese Medicine is available through the link above.

Treatment Cycle: Take full dosage for at least 2 weeks to receive the full benefit. Once condition is stabilized, continue to take full dosage for 1-3 months. Formula is suitable for chronic conditions and for long-term use. After 3 months of use, stay off the formula for 7 days for every 30-day period.

In addition to the herbal treatment, the patient should avoid coldness and dampness, get adequate rest, avoid showering and exposure to cold temperatures after perspiring and begin exercising regularly.

Diet & Lifestyle

Be sure that an appropriate diet of plenty of fresh fruits and vegetables and limiting refined foods and sugars is followed. Good sources of dietary magnesium include:

  • Soybean products
  • Whole wheat flour (not in hypersensitive individuals)
  • Buckwheat flour
  • Almonds
  • Cashews
  • Rice
  • Most legumes

Relaxation techniques such as aromatherapy, yoga, and meditation all help in relieving stress, which has been suggested to exacerbate symptoms of fibromyalgia. Taking time out during a hectic day to reflect on the positive aspects of life is essential. Learning to relax and calming the mind will allow the body to do the same.

Hypoallergenic diet: Although the connection between diet and fibromyalgia has not been well researched, the following information suggests that hypoallergenic diets, in which food and chemical allergic agents are removed, can help many patients. In one study, researchers placed a group of patients with fibromyalgia on a vegetarian diet for three weeks. Numerous biochemical parameters improved, and 70 percent of the volunteers reported significant improvement in feelings of well being. (71)

Clinical Lab Assessment

There are no specific traditional laboratory tests that are characteristically abnormal in fibromyalgia. Although there have been many abnormalities of laboratory and other tests reported in fibromyalgia syndrome, none is sufficiently sensitive or specific to be useful diagnostically, so routine studies are not generally considered appropriate. Thus, it appears justified to address FMS with a comprehensive laboratory assessment program that can be used to classify and monitor various symptomatic patterns and their possible biochemical relationships.

Some of the following laboratory testing can provide information necessary for the diagnosis and treatment of fibromyalgia. In addition, the tests listed may give insight into functional metabolism and functional nutrient status in the body.

Chemistry Profile (Blood)

This profile generally includes the following tests: Albumin, Alkaline Phosphatase, Aspartate Aminotransferase, Bilirubin, Calcium, Creatinine, Lactate Dehydrogenase, Phosphorus, Total Protein, Urea Nitrogen, Uric Acid, and may contain others.

Adrenal Function Profiles

Imbalances in the hypothalamic-pituitary-adrenal axis have commonly been found in FMS. (72) Since adrenal (and thyroid) functional abnormalities are potentially the easiest to identify and address in this endocrine complex, this approach should be considered. Various adrenal function assays can be done with blood, urine, and saliva. The most common laboratory assays for screening and monitoring of adrenal related factors include: Blood: Chemistry, Cortisol, ACTH, Aldosterone, Electrolytes, Leukocyte Differential, Androstenedione, Magnesium, Phosphorus, Calcitonin, Low Density Lipoproteins, Renin, Testosterone, and Pre- and Post Cortisol Stimulation Adrenal Steroid Hormone Analysis from plasma. Urine: Cortisol, Aldosterone, Calcium, Electrolytes, 17-Hydroxycorticosteroids, 17-Ketogenic Steroids, 17-Ketosteroid Fractionation, Hydroxyproline, Pre- and Post Cortisol Stimulation Adrenal Steroid Hormone Analysis from 24-hour urine specimen. Saliva: Cortisol, Dehydroepiandrosterone (DHEA), and Testosterone

Thyroid Profile

Hypothyroidism is diagnosed in a significant number of FMS patients. Proper assessment of thyroid function involves substantially more laboratory testing than is generally performed, and interpretation of laboratory values appears to be inadequate to diagnose and manage thyroid disease. (73) The most used test in the evaluation of hypothyroidism is TSH (Thyroid Stimulating Hormone). Commonly, it is the only lab test relied upon for a diagnosis, even though it is insufficient for a thorough and accurate evaluation.

CBC

Iron-deficiency anemia is frequently present as a result of the mild bone marrow suppression often accompanying chronic illness. Subclinical or functional vitamin B12 deficiency may also be present in fibromyalgia syndrome. The CBC may also suggest the involvement of infectious processes and/or nutrient deficiencies.

Organic Acids

Organic acids analysis is a useful method for measurement of biochemical intermediates in urine. These intermediates can offer information about key enzyme functions and nutrient competence (amino acids, nutrient cofactors, minerals, and fatty acids). Serotonin and its contribution to central nervous system (CNS) function have been studied in relationship to fibromyalgia. (74) The metabolite 5-hydroxyindolacetate (5-HIA) is measured in urine and reflects CNS levels of this product of tryptophan. Low levels of 5-HIA are associated with depression, fatigue, insomnia, suicide, attention deficit and behavioral disorders, as well as FMS. A subset of organic acids can be used to identify the presence of bacterial infection or imbalance in the gastrointestinal tract. This data can be useful in assessment and monitoring of abnormalities implicated in symptoms of FMS such as an irritable bowel.

Amino Acids

Deficiencies or imbalances in amino acids can indicate fundamental reasons for fatigue, pain, insomnia, depression, poor digestion, and other symptoms. For example, tryptophan levels can have direct implications in FMS. Since tryptophan is a precursor for serotonin production, serotonin levels are often implicated in the sleep pattern disturbances common in FMS.

Clinical Notes

The most important aspect to consider for these individuals is that there are a variety of influences that are most likely contributing to their syndrome. Looking for the causal chain is of primary importance in determining the course of action. Diet, food selection, gut integrity, adrenal function, and metabolic support are the first areas to consider.

Heavy metals, thyroid, adrenal, and other hormonal imbalances as well as gut integrity are significant clues that could be disrupting the whole process of cellular metabolism as it relates to lactate build up, energy production, and fatigue.

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