"Fibromyalgia: Causes & Protocols: Part II" References
As discussed in Part I of this article (September 2006), the etiology of fibromyalgia is unknown, which has led many practitioners and consumers to explore alternative therapies. In addition to basic nutritional compounds and natural serotonin modulators, there are many botanical- and plant-based compounds that may have benefit in fibromyalgia.
Ascorbigen is the most prevalent of several dietary indoles shown to have significant physiological activity and may be the essential component making dietary indoles beneficial. Ascorbigen is a skin-permeable form of vitamin C formed from indole-3-carbinol (I3C) in the presence of aqueous ascorbic acid. It is produced naturally in cruciferous juices when the cell walls are broken. It helps prevent absorption of toxins in the digestive tract and may have immunostimulatory properties.A preliminary, open-label study in 12 fibromyalgia patients found 500 mg/d of a blend of 100 mg ascorbigen and 400 mg broccoli powder for one month produced an average 20- percent decrease in physical impairment and a 17-percent decrease in total fibromyalgia impact score.1 In addition, the treatment showed a strong trend toward an increase in mean threshold pain level in tender points.
Chlorella pyrenoidosa has previously been shown to benefit the immune system and inflammatory bowel conditions, suggesting it may have applicability in treating fibromyalgia. One recent double blind, placebo-controlled clinical trial found chlorella relieved symptoms, improved quality of life, and normalized body functions in patients with fibromyalgia, hypertension or ulcerative colitis.2 In an earlier study on fibromyalgia patients, chlorella supplementation resulted in a statistically significant, 22-percent decrease in pain intensity.3 And another clinical study found chlorella supplementation improved scores of pain, anxiety, sleep and gastrointestinal difficulties in fibromyalgia patients.4 The authors concluded that “the results of this randomized, placebo-controlled, double-blind crossover study lead us to conclude that dietary chlorella supplementation may be useful in relieving symptoms of FMS [fibromyalgia syndrome].”
Herbal medicine practitioners often use adaptogenic herbs such as Rhodiola rosea or Panax ginseng in the treatment of fatigue-related conditions such as fibromyalgia or chronic fatigue syndrome, as the non-specific effects of the adaptogens in helping the body adapt to the deleterious effects of stress can improve energy levels and other aspects of the disorders. A case study published in HerbalGram as part of the monograph on rhodiola discussed the case of a female professional who had suffered from refractory depression and fibromyalgia for five years; adding 600 mg/d of rhodiola extract (as Rosavin®) to an antidepressant pharmaceutical regimen resulted in significant improvements in productivity and well-being.5 Panax is a key herb for enhancing energy and performance,and has long been recognized as an adaptogenic herb to help restore the body to a state of equilibrium during periods of stress.6
Another botanical option is aloe, which may address the problem of fibromyalgia from two directions. First, saccharides in aloe have previously exhibited antiviral and immunopotentiating properties; in addition, enzymes in aloe produce anti-inflammatory and analgesic effects by inactivating bradykinin, a vasodilator involved in immune chemistry. In an uncontrolled clinical trial, 50 subjects with a physician diagnosis of fibromyalgia and/or chronic fatigue syndrome consumed nutritional supplements including freeze-dried aloe vera gel extract; a combination of freeze-dried aloe vera gel extract and additional plantderived saccharides; freeze-dried fruits and vegetables in combination with the saccharides; and a formulation of dioscorea (wild yam) complex containing the saccharides and a vitamin/mineral complex.7 The intervention resulted in a remarkable reduction in initial symptom severity, with continued improvement in the period between initial assessment and the follow-up nine months later.
Certain anti-inflammatory herbs may also have application in the treatment of fibromyalgia. Boswellia has been traditionally used for a variety of inflammatory diseases, including osteoarthritis and rheumatoid arthritis (RA). Its boswellic acids have been shown to exert anti-inflammatory effects and inhibit the synthesis of inflammatory leukotrienes.8,9 A clinical investigation on boswellia in RA patients found the treatment reduced morning stiffness, swelling and pain compared to placebo,and improved general health and well-being.10 Boswellia has also been recommended by herbal medicine practitioners for treatment of fibromyalgia.11
Feverfew (Tanacetum parthenium) is well established for its prophylaxis and treatment of migraine, tension headache and associated symptoms,which may make it valuable to fibromyalgia sufferers with these symptoms. In addition, extrapolations from pharmacological research suggest this herb may have anti-inflammatory value for arthritis.12 Some clinicians have also used feverfew as an anti-inflammatory in the treatment of fibromyalgia.13
Although black cohosh (Cimicifuga racemosa) is not specifically antiinflammatory, it does have anti-rheumatic and anti-spasmodic properties, as well as an extensive history of traditional use for arthritis, rheumatism and neuralgia. In addition, a randomized, double blind, placebo-controlled trial with osteo- and RA patients found that a combination of Cimicifuga with willow bark, guaiacum resin, sarsaparilla and poplar bark was statistically significant in decreasing pain.14
Although not a commonly known medicinal herb in modern times, resin obtained from the wood of Guaiacum officinale has a traditional history of use for rheumatoid arthritis, chronic rheumatism and gout, relieving the pain and inflammation between the attacks, and lessening their recurrence if doses are continued.15 Today, it is still used in naturopathic medicine for these same indications.16 The non-specific effects of the adaptogens in helping the body adapt to the deleterious effects of stress can improve energy levels and other aspects of the disorders.
Combining nutritional ingredients may have synergistic effects. A study in 72 men and women with fibromyalgia and chronic fatigue syndrome (CFS) examined the impact of placebo (n=34) or an active integrated treatment (n=38) for 101 days.17 Intervention included three 10 mg tablets of melatonin at bedtime, one or two tablets of a valerian (180 mg) and lemon balm (90 mg) combination orally at bedtime, a multivitamin every morning, and two tablets magnesium with malic acid three times daily. At study’s end, the intervention showed a significant trend toward overall improvement; the active group continued to show improvement at almost two years after the trial.
Gene Bruno is the Dean of Academics and on the faculty of Huntington College of Health Sciences (HCHS). HCHS is an accredited distance-learning institution offering undergraduate and graduate degrees, as well as a diploma program in nutrition. To learn more, visit www.hchs.edu or call (800) 290-4226.
"Fibromyalgia: Causes & Protocols: Part II" References
1. Bramwell B et al. "Ascorbigen in the treatment of fibromyalgia patients." Altern Med Rev. 5, 5:455-62, 2000.
2. Merchant RE, Andre CA. "A review of recent clinical trials of the nutritional supplement Chlorella pyrenoidosa in the treatment of fibromyalgia, hypertension, and ulcerative colitis." Altern Ther Health Med. 7, 3:79-91, 2001.
3. Merchant RE, Carmack CA, Wise CM. "Nutritional supplementation with Chlorella pyrenoidosa for patients with fibromyalgia syndrome: a pilot study." Phytother Res. 14, 3:167-73, 2000.
4. Merchant RE, Andre CA, Wise CM. "Nutritional supplementation with Chlorella pyrenoidosa for fibromyalgia syndrome: A double-blind, placebo-controlled, crossover study." J Musculoskel Pain. 9, 4:37-54, 2001.
5. Brown RP, Gerbarg PL, Ramazanov Z. "Rhodiola rosea: A Phytomedicinal Overview." HerbalGram. 56:48, 2002.
6. Mills S, Bone K. Principles and Practice of Phytomedicine. Churchill Livingstone, Edinburgh, Scotland, 2000.
7. Dykman KD et al. "The effects of nutritional supplements on the symptoms of fibromyalgia and chronic fatigue syndrome." Integr Physiol Behav Sci. 33, 1:61-71, 1998.
8. Safayhi H, Sailer ER, Ammon HPT. "5-lipoxygenase inhibition by acetyl-11-keto-b-boswellic acid." Phytomedicine. 3, 1:71-72, 1996.
9. Safayhi H et al. "Boswellic acids: Novel, specific, nonredox inhibitors of 5-lipoxygenase." J Pharmacol Exp Ther. 261:1143-6, 1992.
10. Chopra A et al. "Randomized double blind trial of an Ayurvedic plant derived formulation for treatment of rheumatoid arthritis." J Rheumatol. 27:1365-72, 2000.
11. Advanced Diploma of Herbal Medicine: Module 6 (Circulatory System, Musculoskeletal System). Australian College of Phytotherapy, Warwick, Queensland, 1999.
12. Mills S, Bone K. Principles and Practice of Phytotherapy. Op cit.
13. Fugh-Berman A. "Clinical trials of herbs" Primary Care. 24, 4:889-903, 1997.
14. Mills S, Bone K. Principles and Practice of Phytotherapy. Op cit.
15. Grieve M. A Modern Herbal. www.botanical.com
16. Australian Naturopathic Network. Guaiacum officinale (Guaiacum). www.ann.com.au/herbs/Monographs/guaiacum.htm
17. Teitelbaum J et al. "Effective treatment of chronic fatigue syndrome (CFIDS) & fibromyalgia (FMS): A randomized, double-blind, placebo-controlled, intent to treat study." J Chronic Fatigue Synd. 8, 2:3-28, 2001.