Fibromyalgia is a chronic pain condition that is accompanied by muscle tenderness, disrupted sleep and fatigue. A number of supplements can help. Some, such as vitamin B1 (thiamine), ubiquinol coenzyme Q10, magnesium, acetyl-l-carnitine and ribose improve energy production in muscle cells, while other such as cannabidiol (CBD hemp oil), celadrin, omega-3, vitamin D and turmeric improving pain and inflammation. Other supplements, such as 5-HTP, cherry juice and lavender oil can improve sleep quality.
What is fibromyalgia?
The word ‘fibromyalgia’ describes pain felt in muscle fibres and other connective tissues. Widespread tender points develop on the body that hurt when pressure is applied. Functional magnetic resonance imaging studies show that when a stimulus such as mild pressure is applied to tender points in fibromyalgia, parts of the brain involved in pain response are activated, so that a stimulus that should be perceived as touch is instead experienced as pain. As a result, fibromyalgia is now consider a centralized pain disorder involving abnormal pain perception.
The main symptoms that identify fibromyalgia are widespread chronic pain, fatigue and sleep disorders. Pain often starts during early adulthood and may come and go in different areas, along with abnormal nervous system sensations of numbness, tingling or burning. Other symptoms can include over-sensitivity to bright lights, loud noises or smells, fatigue and headaches. Central nervous system symptoms can include memory problems and difficulty thinking straight, sleep disturbances, anxiety and depression. People with fibromyalgia are also more likely to experience gut symptoms associated with irritable bowel syndrome such as bloating, abdominal pain, diarrhoea or constipation, pelvic pain and, in women, painful periods.
What causes fibromyalgia?
Fibromyalgia is the second most common rheumatic condition after osteoarthritis. Fibromyalgia is believed to affect between 3% and 10% of the population, depending on how it is defined. While women tend to have more tender points than men, new diagnostic criteria place less emphasis on these, so that more men are now being diagnosed with fibromyalgia than in the past. Even so, two out of three people diagnosed with fibromyalgia are female.
Twin studies suggest that around half the risk of developing fibromyalgia and related pain conditions (such as irritable bowel syndrome and migraine) is genetic, while half is related is environmental factors such as stress, exposure to certain infections (eg Epstein-Barr virus, Lyme disease) or to severe trauma (eg motor accidents, surgery).
Some researchers have linked fibromyalgia with abnormal function of mitochondria – the powerhouses that involved in fat burning and energy production in cells. In particular, the level of mitochondrial DNA which regulates the activity of mitochondria, may be reduced in people with fibromyalgia compared with both healthy controls and those with chronic fatigue syndrome.
This might be related to an underlying degree of inflammation in fibromyalgia.
Other recent research has found that people with coeliac disease and non-coeliac gluten sensitivity are more prone to developing fibromyalgia, suggesting that gluten may play a role – at least in some people.
Sleep problems in fibromyalgia
People with fibromyalgia experience lower sleep quality and sleep efficiency, with less time spent in refreshing REM (rapid eye movement, or dreaming) sleep. You are also more likely to sleep lightly, and to wake several times during the night with short sleep durations.
The results from 25 case-controlled studies, involving over 2000 people, show significant differences in wake time after sleep onset, reduced total sleep time, with significantly more time spent in stage 1 light sleep and significantly less time spent in deep, slow-wave sleep in those with fibromyalgia compared with controls.
A number of treatments can help fibromyalgia, including stress reduction programs, cognitive behavioural therapy, structured exercise and drugs that help to normalise pain perception (some of which are also used as antidepressants).
Non-steroidal anti-inflammatory drugs and paracetamol only offer limited effectiveness against chronic pain. Opiate painkillers (eg dihydrocodeine, oxycodone) are best avoided as they can worsen hypersensitivity to pain in people with fibromyalgia (a condition known as opioid-induced hyperalgesia) and are also highly addictive.
Following a gluten-free diet has been helpful in some cases, and is worth trying to see if symptoms improve. You may find it helpful to avoid caffeine, artificial sweeteners (especially aspartame), monosodium glutamate and other artificial additives, too, as these have been associated with increased pain in people with chronic pain conditions such as fibromyalgia.
Follow a diet that is as natural and unprocessed as possible, such as a Mediterranean-style diet. A study involving 486 Spanish women with fibromyalgia found that those who ate the most fish (2 to 5 servings per week) plus fruit, vegetables and dairy products, and the least cured meats and sweetened drinks, had higher levels of optimism and lower levels of depression than those following less healthy diets.
Best supplements for fibromyalgia
The most effective supplements are those that support mitochondrial function, reduce pain, or which promote sleep. The first group of supplements to consider are those that improve energy production in muscle cells, helping muscles to relax and reducing the tightness and worsens pain.
Thiamin (vitamin B1) for fibromyalgia
Vitamin B1 (thiamin or thiamine) is needed for energy production in mitochondria. Researchers have suggested that the chronic fatigue that accompanies inflammatory and autoimmune conditions could be related to mild thiamin deficiency and associated enzyme abnormalities affecting intracellular transport.
The hidden link between fibromyalgia and thiamin deficiency was first suggested twenty years ago, as there are a number of similarities between the symptoms of fibromyalgia and those that occur with thiamin deficiency, including irritability, headaches, fatigue, muscle tenderness and weakness, irritable bowel syndrome and sleep disturbances.
This was recently tested in a small trial which, although it only involved 3 women with fibromyalgia, provides preliminary evidence of benefit. The three women were started on a dose of 600mg thiamine per day, which was increased by 300mg every three days, as necessary, until benefit occurred. The researchers stated that the therapy seems to have an ‘all or nothing’ effect, so that below a certain daily minimum dose, no improvement was observed.
Patient 1 stayed on the starting dose of 600mg thiamine per day due to early benefit, and at the end of the 20 day trial experienced a 71.3% reduction in fatigue and an 80% reduction in pain.
Patient 2 and patient 3 did not notice a benefit until the dose was increased to 1500mg per day, and then had an abrupt improvement when the dose was increased to 1800mg per day.
After 20 days treatment, Patient 2 experienced a 37% reduction in fatigue and a 50% reduction in pain scores, while Patient 3 experienced a 60.7% reduction in fatigue scores and a 60% reduction in pain.
While these are high doses, vitamin B1 is water-soluble and therefore relatively non-toxic. In this study, the researchers stated that ‘No side effects owing to the dose of thiamine administered to the patients were observed during this study. In literature, there is no study that has observed side effects linked to the daily use of high doses of thiamine.’ They added, ‘We believe that this report opens a ray of hope for the therapy of fibromyalgia.’
The upper tolerable level for long-term use of thiamin as a supplement is suggested as 100mg per day. Higher doses can be taken short-term, but if you decide to take them longer term, this is best done under medical supervision.
Magnesium for fibromyalgia
Magnesium is needed for the action of as many as 600 enzymes in the body, and is vital for energy production in cells. Some evidence suggests that fibromyalgia is associated with disturbances in calcium-magnesium flow in and out of cells, which may affect muscle function and the synthesis of melatonin – your natural sleep-inducing hormone.
Magnesium has a relaxing effect on muscles and also helps to reduce cramps and constipation.
People with fibromyalgia may have lower than normal levels of magnesium, according to hair mineral and blood analysis studies, although this is not always the case. One study did not find a difference in magnesium levels between those with and without fibromyalgia, although this study only measured serum levels (magnesium in blood fluid) not magnesium inside red blood cells which is the more accurate measure.
A trial involving 60 women with fibromyalgia compared the effects of taking 300mg magnesium citrate per day against amitriptyline (an antidepressant that reduces pain perception) and both magnesium plus amitriptyline. After 8 weeks of treatment the number of tender points and pain and depression scores decreased significantly in both groups taking the magnesium citrate, with combined amitriptyline plus magnesium citrate treatment proving most effective in all measures except numbness.
Acetyl-l-carnitine for fibromyalgia
Acetyl- l-carnitine is a non-essential amino acid that is made in the liver and is also found in some foods such as red meat, dairy, avocado and soy products. Acetyl-l-carnitine is needed to transport long chain fatty acids into mitochondria so they can be burned to produce energy. L-carnitine is also needed to break down the branched-chain amino acids (leucine, isoleucine and valine) so they can be used as an energy source by muscle cells when other sources of energy are in short supply. If acetyl-l-carnitine is in short supply, muscle cells become less efficient at producing energy, and this may play a role in chronic fatigue and muscle pain in fibromyalgia.
Some studies suggest that acetyl-l-carnitine can improve abnormal nerve symptoms such as the pain, burning sensations, pins and needles and numbness experienced by people with another chronic pain condition, diabetic neuropathy. It appears to promote regeneration of nerve fibres, and to improve sensitivity of nerve fibres to vibration perception as well as reducing pain. The best dose appeared to be at least 2g acetyl-l-carnitine per day to reduce pain scores and improve nerve conduction speed.
Acetyl-l-carnitine was trialled in 102 people with fibromyalgia, who received either 1,500 mg acetyl-l-carnitine per day, or placebo, for 8 weeks. Muscle pain and the number of tender points declined significantly and by 10 weeks, there was a statistically significant reduction in musculo-skeletal pain and depression for those taking acetyl-l-carnitine compared with placebo.
Another study involving 65 women with fibromyalgia found that acetyl-l-carnitine (1,500mg per day) was as effective as the prescribed antidepressant, duloxetine, in improving pain, depression and quality of life.
Ubiquinol coenzyme Q10 for fibromyalgia
Coenzyme Q10 is a powerful antioxidant needed by mitochondria, where it forms a vital part of the electron transport chain that generates energy. Cells with the highest energy requirement have the greatest need for ubiquinol, and it normally becomes concentrated in muscle cells. Low muscle levels of coenzyme Q10 have been implicated in the development of fibromyalgia symptoms.
During energy production, ubiquinol (the active or reduced form of coenzyme Q10), donates an electron and is converted into the depleted form, ubiquinone. Ubiquinone must then accept an electron from another donor to be converted back into active ubiquinol. This cycle repeats itself over and over within the mitochondria. Taking either form of co-enzyme Q10 as a supplement will provide benefit, but taking ubiquinol puts you one step ahead.
People with fibromyalgia appear to have significantly lower blood levels of ubiquinol than normal, and the ratio of depleted ubiquinone to total coenzyme Q10 is significantly increased. This suggests that ubiquinol is the better form of supplement to take for people with fibromyalgia.
Taking ubiquinol supplements can restore levels and reduce fibromyalgia symptoms, including pain and fatigue. In one study, taking 100mg ubiquinol supplements per day, for 12 weeks, resulted in significant improvements in chronic fatigue scores.
Another study involving 20 women with fibromyalgia the effects of taking coenzyme Q10 (100 mg, three times a day) were compared against placebo. After 40 days, significant clinical improvements were seen in those taking the coenzyme Q10, with reductions in pain, fatigue, morning tiredness and number of tender points. Blood tests also showed significant reductions in inflammation, an increase in antioxidant enzymes, new mitochondrial biogenesis, and beneficial changes in gene expression.
Another study involving 22 women with fibromyalgia found that taking 200 mg coenzyme Q10 twice a day significantly improved pain-related outcomes by 24-37%, fatigue (by 22%) and sleep disturbance (by 33%) compared to a period in which they were not taking supplements.
Start with a dose of 100mg ubiquinol and increase to 200mg after a month if necessary. You can also increase further to 300mg to assess the benefits (although this is not a cheap supplement to take).
Ribose for fibromyalgia
Ribose is a sugar which forms part of the backbone of ribonucleic acid (RNA), the strands of genetic material which distribute the code needed for protein synthesis in cells. Phosphorylated derivatives of ribose, such as ATP, FADH, coenzyme-A and NADH are also vital for energy production in cells.
Ribose supplements are absorbed into the circulation intact, ready for use by cells, and saves them having to synthesise their own. Magnetic imaging of skeletal muscle has shown that resting levels of ATP are 15% lower in people with fibromyalgia compared with those without fibromyalgia and ribose helps to replenish the deficit, and helps muscles to relax. Taking ribose increases cellular energy synthesis in heart and skeletal muscle, and is used in the medical treatment of conditions associated with impaired energy metabolism such as chronic heart failure, chronic fatigue syndrome and fibromyalgia.
A study involving 41 people with fibromyalgia and/or chronic fatigue assessed the effects of taking ribose at a dose of 5g, three times a day, mixed with food, water, or another beverage, for around 18 days. Taking ribose significantly improved energy levels, sleep, mental clarity, well-being and reduced pain intensity. Two out of three people experienced significant improvements while taking ribose, with an average increase in subjective energy levels of 45%. While this was a pilot study, with no control group, the medical researchers involved continue to successfully use D-ribose in people with fibromyalgia and fatigue.
In nature, ribose occurs in the ‘right-handed’ form known as D-ribose, which is the biologically active version. Its mirror image, L-ribose only occurs synthetically, and is not found in nature, so check supplements provides D-ribose.
Supplements to reduce fibromyalgia related pain
The following supplements are especially helpful for addressing muscle pain in fibromyalgia, and include cannabidiol (CBD), celadrin, omega-3 fish oil, vitamin D and turmeric.
Cannabidiol (CBD) for fibromyalgia pain
Cannabidiol is an active ingredient extracted from the flowers, leaves and stems of industrial hemp plants. These plants are specially selected to ensure high levels of CBD but low levels of the psychoactive substance, THC (tetrahydrocannabinol) found in marijuana. CBD is mixed with olive oil, coconut oil or hemp seed oil to maximise its absorption.
Cannabidiol oil has direct effects on the brain to reduce pain perception, relieve anxiety, lift mood and promote refreshing REM sleep. It works by enhancing the effects of other brain chemicals, such as serotonin, and through effects on the brain’s own endocannabinoid systems. CBD does not produce a ‘high’ and is not addictive.
Cannabidiol oil is antioxidant and has anti-inflammatory effects to improve pain and stiffness. It also has a direct analgesic effects on pain perception in the brain, is relaxing and promotes feelings of well-being.
Celadrin for fibromyalgia pain
Celadrin is a blend of waxy, cetylated fatty acids (CFA) that was first discovered in a strain of mice renowned for their immunity against arthritis. The CFA used in food supplements is derived from monounsaturated fats in olive oil.
Celadrin improves the flexibility and resilience of cell membranes, including those of muscle cells, and their mitochondria, to improve their efficiency. Celadrin also has a natural anti-inflammatory, pain-killing action by blocking an enzyme (5-lipoxygenase) that makes inflammatory substances known as leukotrienes.
Celadrin has been shown to help reduce severe pain triggered by pressure on sensitive points in muscles (myofascial pain syndrome). In a study involving 72 people with pain trigger points in the neck, physiotherapy plus applying a cetylated fatty acid cream twice daily was significantly more effective than those who received physiotherapy plus a placebo cream.
Celadrin can be taken by mouth (1g provides 520mg CFAs) and applied as a cream.
Omega-3 fish oil for fibromyalgia pain
Omega-3 fatty acids (DHA and EPA) derived from algae and oily fish (mackerel, herring, salmon, trout, sardines, pilchards) have a powerful inflammatory action to reduce pain, stiffness and tenderness. Omega-3s also appear to have direct effects on the brain to lift a low mood and normalise pain perception.
If you don’t eat much oily fish, then a supplement is an excellent idea. Even if you do eat oily fish twice a week (the recommended maximum for fertile women due to pollutants) you will not achieve the high intakes needed for optimum anti-inflammatory effects.
A small study involving patients with neuropathic pain (including fibromyalgia) found that taking high doses of fish oil (at least 2.4g/day of EPA-DHA, equivalent to a good sized portion of salmon every day) experienced significant improvements in symptoms.
Vitamin D for fibromyalgia pain
Once upon a time, vitamin D was all about calcium absorption and healthy bones. Now vitamin D is recognised as a hormone that has wide-reaching effects in the body, including cell growth, nerve conduction, muscle fibre contraction, and can help fibromyalgia through the regulation of mood, pain perception, sleep and by reducing fatigue.
Recent studies show that low vitamin D levels are common in people with fibromyalgia. Twelve studies, involving 1,854 people with chronic widespread pain, found they were 63% more likely to have low vitamin D levels than healthy controls. Conversely, those with low vitamin D levels are 93% more likely to experience chronic widespread pain, and 77% more likely to experience depression than those with normal vitamin D levels.
It’s now known that low vitamin D levels can heighten pain sensitivity and increase pain processing, and these association cannot be ignored.
A study involving 30 women with fibromyalgia who were also deficient in vitamin D, gave half oral vitamin D supplements, while the other half received placebo. Within a week, those taking the vitamin D supplements experienced improvements in physical function, with reduced morning fatigue and a marked reduction in pain compared with placebo.
Another study involving 58 people with chronic, widespread muscle pain (including fibromyalgia) and vitamin D deficiency showed that taking vitamin D3 supplements markedly decreased pain, physical weakness, number of tender points and improved mood and waking feeling refreshed. A total of 85% of patients were satisfaction with the treatment results.
Vitamin D supplements offer so many health benefits that I strongly recommend them for everyone – especially during winter months when you cannot synthesise your own. A sensible dose is 50mcg (2000IU) per day, but some people may need 100mcg per day (the upper tolerable safe level for long-term use from supplements) to maintain optimum vitamin D3 status. Ask your doctor for a blood test to determine the dose you need.
Turmeric for fibromyalgia pain
Although turmeric has not been investigated specifically for reducing pain in fibromyalgia, it has powerful anti-inflammatory, analgesic effects. Turmeric suppresses the production of inflammatory chemicals, including TNF-alpha, which is the same molecule targeted by new TNF antibody drugs used to treat severe inflammatory diseases, including inflammatory bowel disease and psoriasis.
Turmeric/curcumin extracts have been shown to halve the level of joint pain in people with ostearthritis, at a dose of 1000 mg curcumin per day. If nothing else has helped your pain and tenderness, turmeric is well worth trying. Some supplements combine curcumin with black pepper (piperine) extracts to boost absorption, while others formulate turmeric in liquid micelles.
Supplements to help fibromyalgia-related sleep problems
The following supplements, 5-HTP, tart cherry juice and lavender oil, improve sleep quality and reduce anxiety which will also help to reduce pain perception.
5-HTP for fibromyalgia and sleep
5-HTP (5-hydroxytryptophan) is an amino acid that acts as a building block to make key brain chemicals such as serotonin (to lift mood) and melatonin (your natural sleep-inducing hormone) and endorphins which are involved in regulating pain perception.
5-HTP is especially helpful for people with fibromyalgia, as the widespread pains, fatigue and sleep disturbance have been linked with low levels of serotonin. Taking 5-HTP helps you fall asleep faster and improves the architecture of sleep so you spend more time in REM (rapid eye movement, or dreaming) sleep, and wake feeling more refreshed.
Studies show that 5-HTP can improve pain and morning stiffness, reduce the number of tender points, anxiety and fatigue, as well as improving sleep patterns in peopel with fibromyalgia.
5-HTP is converted to serotonin by an enzyme which requires vitamin B6 to work properly, and this is often included in 5-HTP supplements.
Start with 100mg at night, increasing if necessary to a maximum of 300mg daily. It may take a few weeks to notice the full effects. NB Do not take 5-HTP if you are on prescribed antidepressants – check with a pharmacist or doctor if uncertain.
Cherry juice for fibromyalgia and sleep
Tart cherries (especially Balaton and Montmorency strains) are a rich source of the sleep-inducing hormone, melatonin, and provide five times more melatonin than other fruit sources such as blackberries and strawberries.
Cherries also contain tryptophan, an essential amino acid needed for the synthesis of melatonin in the brain, and the production of serotonin and dopamine which influence mood.
Research shows that drinking Montmorency cherry juice increases the amount of time spent asleep. When people with insomnia drank cherry juice twice a day, for two weeks, they slept for over 84 minutes longer each night than when drinking placebo.
Cherry juice also has an anti-inflammatory pain killing effect that mimics that of non-steroidal anti-inflammatory drugs.
Lavender oil for fibromyalgia and sleep
When inhaled, lavender oil has a sedative effect and is often sprinkled on a hanky tucked under a pillow to improve sleep. When patients on a hospital intermediate care unit had a jar of 100% pure, therapeutic-grade lavender oil (Eden’s Garden brand) placed beside their bed (from 10pm until 6am) their perception of sleep quality improved, and their also had a lower average blood pressure throughout the night compared to those who did not inhale lavender oil.
Pharmaceutical grade lavender oil capsules are also licensed as a traditional herbal medicine to relieve anxiety, tension and stress, which can interfere with sleep. Clinical trials involving 2,200 people show that lavender oil is as effective as prescribed lorazepam for treating mild anxiety, with benefits seen within two weeks.
Everyone is different, and the supplements that help one person with fibromyalgia may not help another. Please leave comments below to share which supplements have worked best for you. And if you think I’ve missed out any, let me know, and I will update the post. Thanks.
Image credits: Pixabay