17c. MSK - Fibromyalgia Flashcards
What is fibromyalgia (FM)?
Condition of chronic widespread pain
Abnormal pain-processing mechanisms
Signs/symptoms of FM?
Fatigue
Sleep disturbance
Stiffness
Headaches
Bowel disturbances
Anxiety
Depression
Causes and risk factors for FM
Trauma
Hypothyroidism
Intestinal dysbiosis
Infections
Nutritional deficiencies
Gluten reactivity
Genetics
Heavy metals
Why is hypothyroidism a risk factor for FM?
Thyroid hormones usually inhibit the synthesis and secretion of substance P
What areas of intestinal dysbiosis are common risk factors for FM?
SIBO
Altered composition of SCFA-metabolising bacteria
Which SCFA-metabolising bacteria are lower in FM patients?
Faecalibacterium prausnitzii
Bacteroides
Why is gut bacteria important in FM?
Gut bacteria could modulate nociception (pain) at multiple levels in the CNS
Which infection is implicated as a cause of FM?
EBV
Which nutrients are commonly deficient in FM?
D
B12
Mg
Which genetic SNPs are common in FM?
MTHFR
COMT
GSTM1
Why are heavy metals a risk factor for FM?
Reduces glutathione
Disturb GABA-glutamate balance
Disturb methylation
Increase pro-inflammatory cytokines
Natural approach to supporting FM
Support stress
Support mitochondrial dysfunction
Gluten free diet
Low FODMAP diet
Support thyroid/adrenals/GIT as needed
Reduce glutamate levels
Support methylation
Optimise detoxification and elimination
Sleep
Regular aerobic exercise
Stress support
How can glutamate levels be reduced to support FM?
Increase GAD co-factors - Mg, B6, Zn, C, taurine
(GAD reduces glutamate by converting it to GABA)
Nutrients to support FM
Mg
D
B6
CoQ10
5-HTP
Why is Mg good for FM?
Blocks NMDA receptor channels
Why is vit D good for FM?
Modulates central pain processing
Why is B6 good for FM?
Co-factor for GAD
Needed for conversion of glutamate to GABA
Dosage of B6 to support FM
50-100mg/day
Why is CoQ10 good for FM?
Deficiency common in FM
AO
Key in ETC
Dosage of CoQ10 to support FM
300mg/day
Why is 5-HTP good for FM?
Improve low levels of serotonin and L-tryptophan
Serotonin plays role in descending pain regulation
Supports melatonin synthesis
Dosage of 5-HTP to support FM
100-300mg/day
How can detoxification/elimination be supported for FM?
Reduce toxic load
Optimise levels of metallothionein (binds to heavy metals)
Improve AO status
Improve status of chain-breaking AO
Optimise glutathione levels
Saunas
Hydrotherapy
Which nutrients can be used to optimise metallothionein levels?
Cysteine
Zn
Cu
Se
