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Fibromyalgia: The role of nutrition and diet. Blake Graham, B.Sc (Honours) Clinical Nutritionist (08) 9487 7409 May 17 th 2010.

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Presentation on theme: "Fibromyalgia: The role of nutrition and diet. Blake Graham, B.Sc (Honours) Clinical Nutritionist (08) 9487 7409 May 17 th 2010."— Presentation transcript:

1 Fibromyalgia: The role of nutrition and diet. Blake Graham, B.Sc (Honours) Clinical Nutritionist (08) May 17 th 2010

2 FM pathophysiology. Mitochondrial impairment Oxidative stress HPA axis dysfunction ANS dysfunction Immune activation Inflammation Sleep dysfunction

3 Causes of FM. Gastrointestinal microbiology imbalances Lack of quality sleep Acute chemical/allergen exposure Toxic chemical accumulation Emotional factors/stress Nutrient/dietary imbalances Hormone imbalancesStructural/mechanical

4 Multi-factorial model.

5 FM treatment. Identify and address contributing factors rather than trying treatments.

6 FM treatment. Address all contributing factors.

7 Causes of FM. Gastrointestinal microbiology imbalances Lack of quality sleep Acute chemical/allergen exposure Toxic chemical accumulation Emotional factors/stress Nutrient/dietary imbalances Hormone imbalancesStructural/mechanical

8 Diet.

9 Mechanisms of illness modulated by diet. 1.Nutrient levels

10 Mechanisms of illness modulated by diet. 1.Nutrient levels 2.Inflammation

11 Mechanisms of illness modulated by diet. 1.Nutrient levels 2.Inflammation 3.Oxidative Stress

12 Mechanisms of illness modulated by diet. 1.Nutrient levels 2.Inflammation 3.Oxidative Stress 4.Intestinal micro- organism balance

13 Mechanisms of illness modulated by diet. 1.Nutrient levels 2.Inflammation 3.Oxidative Stress 4.Intestinal micro-organism balance 5.Detoxification chemistry

14 Mechanisms of illness modulated by diet. 1.Nutrient levels 2.Inflammation 3.Oxidative Stress 4.Intestinal micro-organism balance 5.Detoxification chemistry 6.Hormone / neurotransmitter balance

15 Mechanisms of illness modulated by diet. 1.Nutrient levels 2.Inflammation 3.Oxidative Stress 4.Intestinal micro-organism balance 5.Detoxification chemistry 6.Hormone / neurotransmitter balance 7.Intake of toxic chemicals

16 Mechanisms of illness modulated by diet. 1.Nutrient levels 2.Inflammation 3.Oxidative Stress 4.Intestinal micro-organism balance 5.Detoxification chemistry 6.Hormone / neurotransmitter balance 7.Intake of toxic chemicals 8.Immune function

17 Mechanisms of illness modulated by diet. 1.Nutrient levels 2.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

18 Mechanisms of illness modulated by diet. 1.Nutrient levels 2.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

19 Mechanisms of illness modulated by diet. 1.Nutrient levels 2.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 11.Genetic expression

20 Mechanisms of illness modulated by diet. 1.Nutrient levels 2.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 11.Genetic expression 12.Acid/base balance

21 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

22 Nutrient supplementation

23 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.

24 Nutrient testing. Vitamin D (> 125 nmol/L). Iron studies (ferritin > 50 / transferrin saturation > 22%). Urine iodine. Amino acid testing. Magnesium testing highly unreliable.

25 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

26 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. – 5 ml/day. – In Perth available from Good Life Subiaco (Shop 9, Subiaco Centro Shopping Centre, 29 Station St – ) Trial oral + topical combination for 6 weeks. Epsom salt baths (e.g. 1 kg/bath).

27 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

28 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

29 Vitamin D. Levels should be above 125 nmol/L. Often requires 4000 IU+/day. D3 Drops by Bioceuticals. – 333 IU/drop.

30 Iron. having a serum ferritin level <50ng/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, (March 2010)

31 Fish oil grams/day. Anti- inflammatory.

32 Amino acids.

33 Remove food allergens/intolerances. Methods of assessment: – Elimination diets. – IgG food intolerance testing.

34 Elimination diets vs. IgG testing. Elimination dietsIgG 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 cant make any other changes during test period Cost (~ $250) Significant false positive & negative rate Must have been eating foods in question

35 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.

36 IgG food testing via US BioTek. Dairy Bovine-derived unless specified Casein Cheese, Cheddar Cheese, Cottage Cheese, Mozzarella Milk Milk, Goat Whey Yogurt

37 Recommended reading. Musculoskeletal Pain: Expanded Clinical Strategies Alex Vasquez, ND, DC 2008 Available from

38 Summary - Putting it all together. Identify causes/contributing factors. Treat systematically. Consider role of diet, nutrients and lifestyle factors.

39 Fibromyalgia: The role of nutrition and diet. Blake Graham, B.Sc (Honours) Clinical Nutritionist (08) May 17 th 2010


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