Clinical Perspective on Fibromyalgia – part 3

THERAPEUTIC APPROACH 1 MITOCHONDRIAL SUPPORT

UPREGULATION This part of the mitochondrial protocolinvolves giving the compounds that may help the mitochondria work more efficiently, the ability to produce energy. For example, a key component in mitochondrial energy production is oxygen carried by red blood cells and held in those cells by iron. When somebody has a microcytic anemia (low blood iron), we give iron supplementation to these individuals to overcome this discrepancy – this in essence is what we refer to as upregulation. There are other things that can help the mitochondria with energy production.
■ PROTEIN One of the macronutrients most of my fibromyalgia patients lack is protein, especially in the morning. They often consume only 5–6 g on a good day, but the ideal amount is 20–25 g of protein for breakfast everyday. Often the best way to get sufficient protein is to take a protein powder and mix it with your favourite beverage. Protein is not just important to build muscles, it helps support immune function. More importantly, it helps regulate blood sugar levels as fluctuating blood sugar levels create issues with energy production.
■ UBIQUINOL This is the active form of ubiquinone (CoQ10) which has been shown to be better absorbed and faster acting than ubiquinone. Ubiquinol is found in a number of turbines in the mitochondria and has been shown to help improve energy production. It is recommended that fibromyalgia patients take about 300–400 mg per day in the morning and at lunch.
■ ACETYL-L-CARNITINE A duck can travel 2,000 miles without ever landing, because it uses fat as energy. The mitochondria uses both glucose and fat as macronutrient for energy production. Fat is a little more complex in getting inside the mitochondria, so it needs a carrier, and acetyl-L-carnitine is that carrier. It is suggested to take 500 mg of Acetyl-LCarnitine three times per day.
■ MAGNESIUM GLYCINATE Magnesium is involved in over 200 different enzyme systems throughout the body. It is a key component in energy metabolism and thus recommended for fibromyalgia patients. Magnesium also helps with muscle stiffness as cramping is often experienced by many of our patients. It is suggested to take 600 mg per day as a starting dose.
■ B-COMPLEX (50) The B vitamins are involved in all energy cycles so it goes without saying that this is a highly recommended nutrient. It is suggested to take one capsule with lunch daily.

REDUCTION OXIDATION SUPPORT

Oxygen goes into the mitochondria and electricity comes out. This electricity is what allows us to function on a daily basis, and it is called ATP (adenosine triphosphate). Here is the problem: when oxygen does anything, it creates rust (oxidation). For example, when you slice an apple in half, it browns or rusts because it reacts with the oxygen in the air. If you take another apple, slice it in half and squeeze lemon juice on it, it will not rust because the lemon juice acts as an anti-rust agent, or more commonly called an antioxidant. When oxygen goes through the mitochondria it also produces rust or oxidation, but here is the caveat, the mitochondria CANNOT UNDER ANY CIRCUMSTANCES RUST. If the mitochondria rusts, it dies and if it dies, we die. So, how does the mitochondria prevent itself from rusting? It has powerful lemon juices called glutathione and superoxide dismutase (SOD) which are antioxidants preventing the mitochondria from rusting. Instead of remembering these complicated antioxidant names for simplicity, let’s say that the mitochondria produces 100 lemons per minute. That is a lot of lemons! Now what happens if PAMPs (remember them from the GUT section?) cross over into the blood because of the sympathetic response caused by stress, and enter the mitochondria, and rot 80 of the 100 lemons produced every minute. You now only have 20 lemons per minute giving you an 80% deficit in anti-rust agents. What happens now? Well the first answer would be that the mitochondria would rust; but as you know the mitochondria cannot under any circumstances rust. So again, what happens now? Well, the mitochondria can only do one thing: adapt to this new reality. It reduces the amount of oxygen it uptakes and also reduces the amount of energy it produces by 80%, making one feel very tired and lacking energy. This would occur throughout the body, compromising many systems and resulting in many symptoms. My treatment of choice would be to support the mitochondria with antioxidants. There are numerous beneficial antioxidants.
■ ALPHA-LIPOIC ACID 100 mg twice per day.
■ NAC 2000–3000 mg per day.
■ GRAPE SEED EXTRACT OR PYCNOGENOL 100 mg twice per day, but make sure you get the highest quality dietary supplements.
■ VITAMIN C 2000–5000 mg per day, but I often go with higher doses with bowel tolerance.

THERAPEUTIC APPROACH 2 IMPROVING GI HEALTH

One of the most common symptom complaints when it comes to GI health is gas and bloating. If you have heard me lecture, you’ll know that something I recommend over and over again is enteric-coated peppermint oil (ECPO). This has to be one of the most underrated natural products in the market place. ECPO is an outstanding product relieving gas and bloating on the first dosage. It is fast acting and consistent. Here is what you need to remember about ECPO: enteric coating means that it will NOT break down in an acid environment, only in an alkaline environment of the small intestine. So the idea behind enteric coating is to bypass the stomach (acidic) and get to the small intestine (alkaline) where the gas creating bloating is located. However, if patients are taking antacids and proton pump inhibitors because of gastroesophageal reflux disorder (GERD) or other concomitant conditions, the stomach will become more alkaline due to the acid reduction effects or medications. The end result is that the ECPO will break down in the stomach and not in the small intestine, thus rendering it ineffective. In these scenarios I often recommend patients to take their ECPO with meals. This may help drive the product into the small intestine.
Dosing: Take one capsule to ensure that it bypasses the stomach (you’ll know because you won’t burp it up). With success, begin the therapeutic dosage of 3–4 capsules all at once. If you burp up peppermint, this usually indicates stomach alkalinity. You can take the product with food as this may overcome the problem. The product should work the first time you take it.

THERAPEUTIC APPROACH 3 REDUCING STRESS

Something I recommend to most of my patients is to bring down the sympathetic response (stress response) and upregulate the parasympathetic response (relaxation response). They often tell me this is easier said than done! There actually is an outstanding natural product that can accomplish this without side effects. Pharma GABA®, is a registered trademark sold only through Natural Factors. This well-established nutraceutical can actually stimulate the para-sympathetic response without ever getting to the brain. It works in the periphery by calming the body down, and thus downregulating the sympathetic response. The recommended dosage is 100 mg twice per day and if you don’t get benefits within the first week, increase the dose to 200 mg twice per day. You will see real benefits not only in reduced stress levels, but in symptoms.

LAST THOUGHTS
Fibromyalgia is a complex illness now classified as a Central Sensitivity Syndrome, along with many other complex diseases. We have learned much in the last 20 years and now truly better understand the suffering that so many patients experience with this illness. The good news is that along with our better understanding of this condition, we can offer proven supportive treatments to allow the patients to experience more functionality in their lives. I have presented to you some supportive