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Fibromyalgia: The role of nutrition and diet.
Blake Graham, B.Sc (Honours)Clinical Nutritionist
(08) 9487 7409
May 17th 2010
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FM pathophysiology.
• Mitochondrial impairment• Oxidative stress• HPA axis dysfunction• ANS dysfunction• Immune activation• Inflammation• Sleep dysfunction
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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
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Multi-factorial model.
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FM treatment.
• Identify and address contributing factors rather than trying treatments.
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FM treatment.
• Address all contributing factors.
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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
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Diet.
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Mechanisms of illness modulated by diet.
1. Nutrient levels
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Mechanisms of illness modulated by diet.
1. Nutrient levels
2. Inflammation
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Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation
3. Oxidative Stress
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Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation 3. Oxidative Stress
4. Intestinal micro-organism balance
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Mechanisms of illness modulated by diet.
1. Nutrient levels2. Inflammation 3. Oxidative Stress 4. Intestinal micro-organism
balance
5.Detoxification chemistry
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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
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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
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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
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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
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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
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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
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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
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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
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Nutrient supplementation
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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.
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Nutrient testing.
• Vitamin D (> 125 nmol/L). • Iron studies (ferritin > 50 / transferrin saturation
> 22%).• Urine iodine.• Amino acid testing.• Magnesium testing highly unreliable.
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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
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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).
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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
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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
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Vitamin D.
• Levels should be above 125 nmol/L.• Often requires 4000 IU+/day.• D3 Drops by Bioceuticals.
– 333 IU/drop.
• www.vitamindcouncil.org
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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)
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Fish oil.
• 6-12 grams/day.• Anti-
inflammatory.
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Amino acids.
www.metametrix.com
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Remove food allergens/intolerances.
• Methods of assessment:– Elimination diets.– IgG food intolerance testing.
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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
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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.
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IgG food testing via US BioTek.
DairyBovine-derived
unless specifiedCasein
Cheese, CheddarCheese, Cottage
Cheese, MozzarellaMilk
Milk, GoatWhey
Yogurt
www.usbiotek.com/
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Recommended reading.
• ‘Musculoskeletal Pain: Expanded Clinical Strategies’
• Alex Vasquez, ND, DC• 2008• Available from
www.functionalmedicine.org
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Summary - Putting it all together.
• Identify causes/contributing factors.• Treat systematically.• Consider role of diet, nutrients and lifestyle
factors.
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Fibromyalgia: The role of nutrition and diet.
Blake Graham, B.Sc (Honours)Clinical Nutritionist
(08) 9487 7409
May 17th 2010