Dr. Jeff Gladd, MD
We’ve all been there. The slumped shoulders and trapezius tightness of seeing “fibromyalgia” as the reason for visit before we enter the room. A couple deep breaths. A look at the watch. A sigh in entering the room, knowing we do not have much to offer this unfortunate patient for relief of their chronic pain.
That’s what I used to think too. Until I found a supplement regimen whose benefits can provide energy to tense muscle trigger points and building that into a lifestyle regimen that patients can follow. After following the evidence that exists, trialing it on patients and getting reports of success, I am embracing these visits and enjoy every minute of it.
Most of the pain of fibromyalgia is trigger point-based. Trigger points develop as tight bands of muscle. These contracted bands of muscle form due to local ischemia leading to decreased muscle energy. I describe this to patients by explaining what happens to muscles that undergo rigor mortis. Death, obviously the ultimate form of poor energy delivery to muscles, leaves the muscles stiff and rock hard. What seems to be happening in fibromyalgia is rigor mortis on a smaller scale, leading to tight and tense, painful muscles. The remedy then is enhanced energy delivery to these areas. Supporting the energy production means supporting the mitochondrial function.
The program I suggest for fibromyalgia pain focuses directly on mitochondrial support. Regular, light exercise to support adequate blood flow, but not overwork muscles is essential. Eating a whole foods diet with a variety of colors and options will help calm inflammation and improve blood flow delivery as well. Meditation, or some type of regular relaxation practice helps accomplish this goal as well.
In addition to implementing foundational lifestyle principles, I suggest patients utilize a few nutritional compounds to help energize the muscles as well. My evidence-based recommendations are:
- D-Ribose: D-Ribose is a naturally derived sugar molecule. It plays an essential role in salvage and de-novo adenine nucleotide synthetic pathways, maintaining adenine, ADP, and AMP levels for the resynthesis of ATP, a muscle’s energy currency. In a study of 41 patients with a diagnosis of fibromyalgia and/or chronic fatigue syndrome, 66% of study participants had significant improvement in their symptoms. The dosage used was 5 grams three times a day.
- Acetyl-L-Carnitine: Naturally occurring in the body, and sourced from red meats and dairy products, acetyl-L-carnitine serves as a precursor to acetyl coenzyme A. It also seems to play a role in lowering oxidative stress. In a double-blind trial, acetyl-L-carnitine daily for 10 weeks was more effective than placebo in the improvement of muscle pain and general health in fibromyalgia patients.
- DMG: A key methyl donor which in turn provides support to glutathione levels, which have been shown to be depressed in a patient population exhibiting fibromyalgia symptoms.
- Bromelain: An old standby when it comes to tissue and joint support. The exact modes of action for bromelain’s vast clinical application have not been identified and studied as much as other compounds. However, clinically speaking this proteolytic enzyme provides support not only to joint tissue but also to the cardiovascular system, immune system and digestive system. And when it comes to complex fibromyalgia symptoms, all of the aforementioned systems are typically involved.
Carel Bron et al. Etiology of Myofascial Trigger Points. Curr Pain Headache Rep. 2012 Oct; 16(5): 439–444.
Fox IH, Kelley WN. Phosphoribosylpyrophosphate in man: biochemical and clinical significance. Ann Intern Med 1971;74:424-33.
Teitelbaum JE, Johnson C, St Cyr J. The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study. J Altern Complement Med 2006;12:857-62.
Rossini M, Di Munno O, Valentini G, et al. Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients. Clin Exp Rheumatol 2007;25:182-8.
Rheumatol Int. 2009 Apr;29(6):629-33.
Biotechnol Res Int. 2012; 2012: 976203.