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Biochemical and Nutritional Approaches to Fibromyalgia, Inflammation and Pain
By Maile Pouls, Ph.D., Clinical Nutritionist

In my clinical nutrition practice, I do not focus on health symptoms or even “diseases” with which people have been diagnosed. Rather, through a few simple biochemical diagnostic tests and in-depth diet and health histories, in most cases, I am able to see and explain the interrelatedness of each person’s diet, nutritional and biochemical status, and why their body is expressing symptoms or health conditions. I have learned by providing this service to many thousands of people that underlying all symptoms, dis-ease and disease are measurable nutritional deficiencies, related body chemistry imbalances, colon and/or liver toxicity. While each person’s nutritional status and biochemical makeup are completely unique, there are certain underlying ‘common denominators’ related to specific health conditions. I would like to share with you the common denominators I have found for the conditions of fibromyalgia, inflammation and pain.

Although people suffering from fibromyalgia share common symptoms, conventional medicine will tell you that there are no specific tests for fibromyalgia. There are, however, numerous underlying contributing factors to fibromyalgia, inflammation and pain of which most people (and many medical doctors) are not aware. When these underlying stressors are understood, addressed and reduced or eliminated, most people will experience a reduction or remission of their symptoms. These factors fall primarily under five categories:

1. Nutritional status
2. Biochemical status
3. Diet and food allergies
4. Environmental factors
5. Stress

1. Nutritional Status

There are two main categories within nutritional status:

a. Specific nutrient deficiency
Common underlying nutritional deficiencies in people suffering with fibromyalgia, inflammation and pain include:
1. Electrolytes/Trace minerals
2. Calcium and/or magnesium
3. Vitamin C and other antioxidants
4. Essential fatty acids
5. Amino acids (proteins)

b. Therapeutic or “targeted” nutrients or formulas.
‘ Common denominator’ nutrients shown in clinical studies or in my clinical practice to be beneficial for fibromyalgia, inflammation and pain include:

1. For improving energy and decreasing pain, I recommend the combination of magnesium and malic acid. This combination improves the ability of people with pain or fibromyalgia to exercise and recover from exercise and maintain their activities of daily living. Magnesium is found in the UMN Liquid Calcium & Magnesium Support
2. Liquid Ionic Minerals. One of the most important keys to supporting and preserving human health is by maintaining balanced levels of ionic minerals present in all the cells and tissues of the body. I also recommend the topical use of liquid ionic minerals for muscle cramps, pain or spasm. UMN Concentrated Liquid Ionic Mineral Support
3. Essential Fatty Acids (EFA’s). EFA’s are very effective for decreasing inflammation and pain. Depending on the situation, I often recommend the following:
a. Borage oil, Evening Primrose oil, Flax seed oil. UMN Essential Fatty Acid Support
b. Cetyl Myristoleate, or CM, a fatty acid ester and immune ‘modulator’. UMN Joint Lubrication Support
4. Plant-based digestive enzymes. Up to 95% of the US population is deficient in digestive enzymes, due to years of eating cooked and processed foods. This creates a problem of poor digestion, which contributes to gas, bloating, heartburn, acid conditions and/or nutrient deficiencies. Digestive competence is crucial for the utilization of nutrients from your diet and supplements. UMN Digestive Support
5. Calcium and Magnesium. These minerals are essential for proper muscle and nerve function. UMN Liquid Calcium & Magnesium Support
6. Antioxidants. Antioxidants come in many forms, but the most recognized are vitamin A, C, and E. Antioxidants help reduce inflammation in the body by quenching free-radicals and reducing oxidation in the body. UMN Physician's Rx- Daily Multiple Support
7. Liver Support. There are numerous ‘liver support’ formulas available. In my practice, I recommend a hybrid artichoke/sarsaparilla concentrate that contains a complex of flavonoids, including quercetin, rutin, catechin, hesperidin, kaempferol, isorhamnetin, cynarin, silymarin, caffeic acid, and chlorogenic acid; and phytosterols, including ß-sitosterol, campesterol, and stigmasterol. I have seen remarkable results with this formula, for both supporting liver function and gently detoxifying the body of chemicals, metals and toxins. UMN Liver Support
8. B Vitamins. B vitamins help the body deal with stress, whether it is emotional or physical. Other nutrients I recommend for stress include adaptogenic herbs and organic adrenal glandular supplements. UMN Physician's Rx- Daily Multiple Support
9. Bromelain and Protease Enzymes. These plant-based enzymes are recommended for the reduction of inflammation, swelling, redness, and pain. Other nutrients I recommend for this purpose are grape seed extract and the bioflavonoid quercetin. Bromelain is found in the UMN Physician's Rx- Daily Multiple Support

Other Beneficial Nutrients for Fibromyalgia:

10. Fiber. I recommend psyllium husks and powder, or fruit pectin for people with more sensitive systems, for regulation of bowel movements and colon detoxification, which can help decrease pain in many instances.
11. ‘Organically raised’ Thymus Gland Concentrate. Thymus glandular helps to support and stimulate the immune system.
12. SAM-e (AKA S-adenosylmethionine). Formed from the amino acid methionine, SAM-e helps to reduce fatigue, pain, and depression. SAM-e usually must be taken for at least four weeks to obtain beneficial effects.
13. Malic Acid is a fruit acid that plays a key part in the metabolism of carbohydrates as well as the formation of adenosine triphosphate (ATP). With malic acid supplementation, energy is produced from the burning of pyruvic acid without the associated buildup of lactic acid. Less lactic acid helps to relieve muscle pain associated with fibromyalgia.

2. Biochemical Status

Common underlying biochemical patterns, which can be measured or evaluated by performing specific urine analysis testing, that I have observed in people with fibromyalgia, inflammation and pain include deficiencies or imbalances in:

1. Electrolytes, micro and macro minerals.
2. Calcium and/or magnesium
3. Essential fatty acids
4. Vitamin C
5. Amino acids
6. Liver or colon toxicity and/or kidney stress are contributing factors for many people with fibromyalgia and/or pain.

These are the 6 panels utilized with the UMN 24-hour urine analysis.

3. Dietary Factors

Acid/Base (pH) Balance, Food Allergies or Sensitivities.
I encourage patients dealing with fibromyalgia, inflammation and pain to eat the following diet:
1. Try to eat many small meals (5-6) throughout the day.
2. Chew your food thoroughly. Up to 50% of the digestion of food should take place in the mouth- by chewing. Swallowing large pieces of food places a burden on your digestive organs.
3. If your digestion is poor, limit raw vegetables at first. Try to eat steamed greens and vegetables as often as possible. I recommend that you buy organic produce, as it is much higher in nutrients and enzymes and much lower in chemicals and heavy metals than commercially grown produce.
4. If you eat meat, include small servings (4-6 oz.) of lean fish and poultry. Avoid commercially raised, “factory-farmed” meats.
5. If you consume dairy products, I recommend that you buy only ‘organic’ butter, milk, and cheese, as commercial dairy products can be loaded with human-made chemicals, hormones, growth promoters, antibiotics, veterinary drugs and traces of herbicides and pesticides.
6. Once you have improved your digestion with the use of supplemental digestive enzymes, add more raw vegetables, and raw nuts and seeds.
7. For a good source of dietary essential fatty acids, I recommend adding 1-2 tablespoons of ground flax seeds to salads, smoothies and any non-cooked foods with which it goes well. Flax seeds are a good source of Omega-3 essential fatty acids, which have been shown in studies to reduce inflammation in the body. Fish oils are another good source of dietary Omega-3 oils that can assist with inflammation.
8. It is very important that you drink sufficient amounts of filtered or “spring” water every day to replace fluids that are excreted or lost through sweating. Your body is 70% water. Dehydration is a primary cause of muscle and joint pain. To determine the correct amount of water for you, divide your weight by two. This equals the number of ounces of water you should drink every day.
9. AVOID: Highly processed, packaged, refined foods- especially those high in sugar and unhealthy oils (hydrogenated and saturated fats). Avoid margarine. Avoid commercially raised meats. Saturated fats, from animal sources, are associated with increased risk for cardiovascular disease, circulatory conditions, inflammation and pain. Avoid diet soda or colas. Avoid or limit alcohol, caffeine and sugar.
10. Food allergies and sensitivities: It has been found that up to 85% of all food allergies or food sensitivities are due to poor digestion, which allows large food particles to pass through the gut wall into the bloodstream (leading to a condition called “Leaky-gut Syndrome”). These too-large proteins in the bloodstream then trigger antibody-antigen reactions, as the body identifies them as foreign invaders or allergens instead of food. With specific digestive enzyme therapy this problem can be greatly reduced or eliminated.
11. In my clinical nutrition practice, I have found that one of the most common denominators of patients suffering with fibromyalgia, inflammation and pain is a urine acid/base (pH) that is acidic (lower than 6.3). You can buy urine pH test strips at any pharmacy to test your own urine. The acidity does not just manifest in the urine, it spreads through the whole body chemistry, creating or contributing to inflammatory, degenerative and painful conditions. The two things I have found to reduce or eliminate this acidity include improving overall digestion and cleansing the body internally. For this I recommend specific digestive enzymes to reduce fermentation, putrefaction, and acid created throughout the gastrointestinal tract. I also highly recommend cellular, colon and liver cleansing to reduce or minimize general (systemic) acidity. Another way you can actively participate in maintaining the proper pH of your body is by eating less acid-forming foods and eating more alkaline-forming foods.

Acid/Alkaline Foods: From the most acidic to the most alkaline

Sugar: Includes all sweeteners, white sugar, honey, & maple syrup. Sugar provides only empty calories and no nutritional value. Sugar also depletes the immune system for up to 14 hours after ingestion. Alternative: Stevia, a natural sweetener that does not impact blood sugar levels, great for diabetics.

Coffee/Caffeine: The roasted oils in coffee make it acidic. Coffee depletes the adrenal glands, our “stress & shock absorber” gland. Coffee is very hard on the stomach. Alternatives are herbal tea, roasted grain drinks, chai, and Bancha root tea.

Sodas/all carbonated drinks: Avoid diet sodas and anything with nutra-sweet, which adversely alters the chemistry of the brain. Carbonated drinks acidify the body and leach calcium out of our bones. Sodas are dehydrating. One soda may contain up to 10 tsp. of sugar per can. Alternatives: Drink more purified water.

Alcohol: Very high in sugars, so if weight loss is an issue, try to avoid. Alcohol is also very acidic, and hard on the liver. If you drink, consider Liver Support nutrition. Alternatives: Filtered water, teas, and natural juices.

Highly processed and packaged foods are very acidic. Try to eat foods that came out of the ground, or off a tree or plant. Avoid fully or partially hydrogenated oils, they contribute to cancer and heart disease. These oils are found in many cookies, crackers and breads. Read labels on foods as manufacturers will even say “low fat” or even “no fat” and if you look closer they may have partially hydrogenated oils. Try to avoid foods with many chemical ingredients.

Red meats: If you eat red meat, try to eat organic meats, where the animal is raised in a healthy manner and allowed to run around, eat grass, and enjoy the sunshine. Commercially raised animals are given numerous veterinary drugs, including growth enhancers, hormones, and antibiotics, of which trace amounts end up in the tissues that are eaten.

Poultry: The same is true for chickens. Factory farmed chickens are raised in deplorable conditions and fed all kinds of chemicals. Alternatives: Eat free-range poultry, preferably organic. If you can’t find it ask you favorite food stores to order it. Tell your friends.

Fish: Eat the cold-water fish, salmon, cod, fresh albacore, mackerel, as they contain essential omega-3 oils, necessary for joint lubrication, moisturizing the skin, and essential for good brain function. Try to avoid canned fish, large ocean fish, and even certain fresh water fish, which are known to be contaminated with mercury and other heavy metals.

Grains: Most grains are acidic except for, millet (easy to digest, soothing to the gut), quinoa (very high protein), amaranth, and buckwheat. Eat a variety of the whole grains and avoid over-processed grains. Try to eat organic grains.

Fruits: Many fruits start out acidic, but in the end become alkaline, unless your pH is acidic, then they remain acidic. If you have a sensitive stomach, try to avoid the citrus fruits. If weight loss is an issue, I recommend you learn about ‘low glycemic index’ fruits. Eat a variety of fruits and vegetables a day. Organic is the best.

Vegetables: All vegetables are alkaline (except tomatoes in any form), and the darker and greener they are, the more alkaline they are and the more calcium and magnesium they contain. Eat veggies that are rich in color. Eat a variety, eat organic. If you can’t find organic, request it from your favorite food stores, look for farmer’s markets, they are fun and cheaper. Try to eat a large variety of vegetables.

4. Environmental Factors

Chronic exposure to low-doses of the thousands of human-made chemicals, heavy metals, and naturally occurring toxins and microorganisms found in our food, air, water, and personal environments can have a major impact on your health. Primary examples include chemical-based cleaning products, personal-care products (commercial toothpaste, shampoo, soaps, etc.), and synthetic chemicals off-gassing from the construction materials in our homes (new carpets, paints, plastics). Become aware and attentive to the “chemical menace” in your personal products and environments. Most health food stores offer non- or low-chemical versions of all personal care and hygiene products. If you are accumulating chemicals, metals and toxins into your body faster than your body’s detoxification pathways can eliminate them, you will eventually experience symptoms, degeneration and disease. “Targeted” nutritional support for the liver, kidneys, lungs, and large intestine can reverse health conditions caused by toxicity and lack of vitality in these organs and glands and prevent future dis-ease and related health conditions. Another important factor is the water you drink and bathe in, as tap water can be a major source of chemicals (especially chlorine), metals and other toxins. I recommend that you have your water tested to see what is actually in it, and I recommend that you drink only filtered or “spring” water and shower and bathe in filtered water. Whole home, under-counter, above-counter water filters, and shower filters are available on many Internet sites and health-oriented retail stores.

5. Stress

Stress is a direct underlying factor to all dis-ease and disease. Your body cannot differentiate between “good” and “bad” stress in your life. Sometimes “good” things like a promotion at work or getting married can be very stressful. Other stressors that can negatively affect your nutritional status include financial stress, emotional stress, fear, anxiety, lack of sleep, over-consumption of caffeine, and excessive work schedules. All stress negatively affects the adrenal, thyroid, and thymus glands, eventually resulting in fatigue and lowered immune function. To reduce stress, it is very important to first identify major sources of stress in your life and modify or eliminate these situations. Second, I recommend that everyone begin a regular physical stress reduction program, whether it is through gentle exercise, swimming, walking, dancing, or through a hobby or community service. Get your mind off of your troubles and have some fun. Sometimes I believe that the “little boy or girl” in each of us gets so fed-up with stressful life situations that your body responds with pain to show you that life changes are needed. Nutrients that have been shown to support the functions of the glands of the body that deal with stress include:

1. B Vitamins: UMN Physician's Rx- Daily Multiple Support
2. Adaptogenic herbs: Ginseng, Schizandra, Ashwaganda UMN Stress & Energy Support
3. Organic Adrenal Glandulars

If you do not provide the essential nutrients to the body that it requires, you will impair its normal functions. Many of the aches, pains, inflammation and general fatigue a majority of American's are experiencing are linked to nutritional deficiencies, colon and liver toxicity, and resulting body chemistry imbalances as a root or contributing cause. Once you are aware of the nutritional 'stressors' in your diet and environments, and begin using specific nutrients to rebalance and repair current conditions, and prevent future imbalances- you will begin to understand and actually 'feel' how nutrition works.