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Fibromyalgia and nutraceuticals

St. John's Wort

There are several studies that show St. John's wort is more effective than placebo and as effective as older antidepressants called tricyclics in the short-term treatment of mild or moderate depression. Other studies show St. John's wort is as effective as selective SSRI antidepressants such as Prozac or Zoloft in treating depression. St John's wort is usually well tolerated. The most common side effects are stomach upset, skin reactions, and fatigue.


It's not known exactly how SAM-e works in the body. Some feel this natural supplement increases levels of serotonin and dopamine, two brain neurotransmitters. Although some researchers believe that SAM-e may alter mood and increase restful sleep, current studies do not appear to show any benefit of SAM-e over placebo in reducing the number of tender points or in alleviating depression with fibromyalgia.


The studies are limited, but it's thought that L-carnitine may give some pain relief and treat other symptoms in people with fibromyalgia. In one study, researchers evaluated the effectiveness of L-carnitine in 102 patients with fibromyalgia. Results showed significantly greater symptom improvements in the group that took L-carnitine than in the group that took a placebo. The researchers concluded that while more studies are warranted, L-carnitine may provide pain relief and improvement in the general and mental health of patients with fibromyalgia.


Recently, a new drug l-methylfolate (trade name Deplin), a shortening of the proper name l-methyltetrahydrofolate (MTHF), has been investigated for the treatment of depression. Why? Because folate itself is converted to MTHF, the active chemical that actually produces the results in depression. Suffice it to say some studies have found it to work. Is there a difference between supplementing with MTHF and regular folate? (Folic acid is the synthetic version of folate, which is what is added to foods or contained in multivitamins.) Folic is converted (after four steps) into MTHF. If all enzymes in those steps are working well, or various intermediary steps are not being diverted to create other chemicals, then increasing folic acid would be as good as increasing MTHF. However, supplementing with MTHF is a more direct and reliable way of increasing MTHF. In ordinary circumstances, of course, folate alone is good enough.

These nutritional tips may help reduce symptoms:

Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may want to test for food sensitivities.

Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as kale, spinach, and bell pepper).

Avoid refined foods, such as white breads, pastas, and sugar.

Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.

Use healthy cooking oils, such as olive oil or vegetable oil.

Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.

Avoid alcohol, tobacco, and caffeine, and limit foods that are high in sugar, salt, and fat. Avoid foods with additives such as monosodium glutamate (MSG).

Drink six to eight glasses of filtered water daily.

Nutritional deficiencies may be addressed with the following supplements:

Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tablespoons of oil daily, to help decrease inflammation and improve immunity. Talk to your health care provider before taking omega-3 supplements if you are taking blood thinning medications, such as aspirin or warfarin (Coumadin).

A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.

Vitamin C, 500 - 1,000 mg daily, as an antioxidant and for immune support.

Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.

L-carnitine, 500 - 2,000 mg daily, for muscular support.

Magnesium, 200 mg three times daily, with malic acid 1,200 mg three times daily, for symptoms of fibromyalgia.

Calcium/vitamin D supplement, 1 - 2 tablets daily, for support of muscle and skeletal weakness.

Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.

Chlorella (Chlorella pyrenoidosa), a blue-green algae, may help lessen symptoms. Participants in a clinical study took a specific dose of 10 g of Sun chlorella tablets and 100 ml of the liquid chlorella extract Wasaka Gold and showed significant improvement in symptoms. More studies are needed.

NADH (nicotinamide adenine dinucleotide), 5 - 20 mg daily, for energy.

Melatonin, 0.5 - 3 mg, one time daily before bed, for sleep and immune support.

St. John's wort has many properties similar to amitriptyline, another agent that has been helpful to regulate the sleep disorder characteristic of fibromyalgia. The use of this food supplement may be of some value.

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