Fibromyalgia Exercise And Nutrition
Most people with fibromyalgia (FMS) have a low tolerance to exercise. There are some clinicians who blame the fibromyalgic symptoms on lack of exercise, suggesting that if the fibromyalgic person only exercised they would be alright.
That attitude is rather like a mechanic who when confronted with a car that has had its engine stressed by overheating and now burns oil and runs very rough, saying “You just need to drive that car more, that will fix it”. Now any mechanic worth his salt knows that a top overhaul is what’s needed. - Why can’t our clinicians be as smart as a mechanic?
Certainly you can’t take a person with FMS and remove their head for a top overhaul, and fortunately we don’t have to, for unlike the car that requires a mechanic to fix it, the human body can, if given the right conditions, repair itself. A wise doctor said to me once, “We don’t actually cure anything, we just give nature a helping hand and the body cures itself”.
So what can you do to help the person with FMS to heal themselves? You can start by getting them off the typical American high refined carbohydrate diet, and onto a low glycemic diet, free from cereal grains, starches and sugars, with plenty of fresh fruit and vegetables. A high glycemic diet produces high levels if insulin. High insulin levels can not only cause hypoglycaemia an additional factor in FMS, but insulin also increases the body’s inflammatory response (Dr Barry Sears 2005) and that’s the last thing a person with FMS needs.
To get the fibromyalgic’s body running right other deficiencies should be looked for, starting with the thyroid. According to Lowe (”The Metabolic Treatment of Fibromyalgia” 2000), hypothyroidism and resistance to thyroid hormone is very common in sufferers of FMS and Chronic Fatigue (CFS) (more than 50%). Because hypothyroidism is a perpetuating factor for FMS your client will never recover while sub-normal thyroid hormone persists.
Inadequate thyroid regulation is likely to impair anaerobic metabolism by:
1.Decreased storage of ATP and creatine phosphate to release energy.
2.Less oxidative enzymes in the mitochondria.
3.Impaired glycolysis.
On top of that, aerobic metabolism is also likely to be affected in at least two ways:
1. Reduced delivery of energy producing nutrients like glucose through the blood supply to the muscles.
2. Reduced oxidative enzymes in the mitochondria.
These conditions can result in subnormal aerobic power and low energy.
Unfortunately many MDs when asked about thyroid deficiency, only do a Thyroid Stimulating Hormone (TSH) test. When the Pituitary gland recognises that there is not enough thyroid hormone in the system, TSH is increased to cause the thyroid gland to produce more hormone, but what if the pituitary is sub-normal, then the TSH will be normal to low, giving the impression that all is well, yet the thyroid hormone will be low causing excessive tiredness. The Hypothalamus also has a part to play in thyroid regulation as well. For these reasons the only true indication of thyroid inadequacy is a series of tests called a B2T panel. This consists of total T4 free T4 total T3 and TSH (London 1994)
All these tests are all very well for MDs who have access to these tests, even if they won’t use them, but what can you and I do? Well in my clinic if I suspect hypothyroidism I check the client’s basal metabolic rate, by taking their temperature (I use an infrared ear thermometer). Normal temperature is 37oC. A 36.5oC or lower is suspicious, so I refer these clients to a sympathetic MD for thyroid supplementation. (A sympathetic MD is one who is prepared to look at the patient’s condition, and not just the test results - Because there is no such thing as an infallible test.)
As well as the thyroid, another thing that can be done, is to boost Adenosine Triphosphate (ATP) and consequently energy production. Supplementary CoQ10 helps the mitochondria produce ATP. This is most important if the person is taking an anti-cholesterol medication, such as one of the statin group of drugs, as these drugs reduce not only cholesterol but also CoQ10 production in the liver . It’s ironical when you realise that they are taking drugs to reduce the possibility of a heart attack, and at the same time robbing the heart of the large amounts of ATP it needs just to keep on beating.
Other supplements that help produce ATP are Acetyl-L-Carnitine and Alpha lipoic acid. These two can be obtained together in “Thio-Condria” a product from Eagle Pharmaceuticals.
The other main supplements found useful in FMS are Magnesium and Malic acid. Available in “Ultra-Muscleze” or “Fibroplex”.
Magnesium is very useful in muscular relaxation and in preventing calcification, by working with vitamin D to place the calcium in the bones where it belongs, rather than in the muscles. Malic acid has been shown to reduce the pain of FMS.
The vitamin B group are also useful in energy production, and many people are deficient in B vitamins to some extent, because B vitamins are water soluble, and can’t be stored in the body, so must be consumed daily.
Finally if the person has myofascial trigger points these should be addressed before exercise is commenced, as exercising with active trigger points usually makes them worse.
Once the nutrition has been addressed, and myofascial trigger points treated, the fibromyalgic can get some benefit from light exercise. They should never exercise to exhaustion as their energy reserves are limited and too much exercise can cause a painful flare up.
about the author:
Gary A Clark, massage therapist, runs Pain Busters Clinic in Perth Western Australia. He specialises in treating fibromyalgia, chronic pain and myofascial pain sydrome.