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Diet & Nutritional Supplement Recommendations from Leading Fibromyalgia & Chronic Fatigue Syndrome Physicians

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By ProHealth Editor • • January 23, 2004

We’ve all heard the expression “you are what you eat.” While there is no question that diet and nutrition have a significant impact on overall good health, the extent to which this is true in people suffering from disease is a subject of much debate and has been the topic of many research studies. When you’re struggling with a chronic illness such as fibromyalgia (FM) or Chronic Fatigue Syndrome (CFS), this expression takes on a whole new meaning and weight. While there is no diet or nutritional regimen that has been proven to eliminate all of the symptoms of FM or CFS, there are nutritional strategies that involve changing what you eat – and the way you eat, that help a great many patients feel better, resolve some symptoms, and function at a much higher level. The dietary and nutritional supplementation advice that follows is provided by respected CFS and FM physicians and experts. While dietary and nutritional changes must be experimented with and tailored to each individual patient according to particular symptoms and deficiencies, the recommendations that follow broadly address the spectrum of nutritional issues that CFS and FM experts regularly encounter with patients, and describe the best solutions they have found. Charles W. Lapp, M.D. Charles Lapp, M.D., is nationally recognized and sought after as a medical consultant regarding CFS and FM. He is Co-Chairman of the Clinical Affairs Committee for the American Association for CFS, medical advisor to the CFIDS Association of America, and a board member of the American FM Syndrome Association. Dr. Lapp is currently Director of the Hunter-Hopkins Center, P.A., Medical Consultations, in Charlotte, North Carolina, where he is a practicing physician, and is also Assistant Consulting Professor at Duke University Medical Center in Durham, North Carolina. For more information about Dr. Lapp, visit his Web site at Diet (foods to eliminate, excitotoxins, etc.): There is very little study of this aspect, but empirically my patients do best on a low fat diet with lots of fresh fruits and vegetables, complex carbs (like rice and potato), and light meats (chicken, turkey, scaly fishes). We have also found that PWCs do not tolerate several items: sugar, caffeine, alcohol, tobacco, and excitotoxins like MSG and aspartame (Nutrasweet, Equal). Saccharin (Sweet N’ Low) is satisfactory, however. These are remembered by the mnemonic SCATE. Many patients with loose stools may find that reducing dairy and gluten (wheat, barley, oats and rye) intake may help. Supplementation (how to address any nutritional deficiencies): The literature confirms several deficiencies in Chronic Fatigue Syndrome and fibromyalgia, including intracellular magnesium and vitamin B-12, whole body potassium, intracellular ATP, glutathione, taurine, serine, and the short-chain fatty acids such as valine, leucine, and isoleucine. While patients may not feel any better by supplementing these, health can at least be optimized. I frequently recommend supplementation with a multivitamin (like Super Multiple II or Cellular Support), magnesium, potassium, NADH (for ATP), glutathione, and an amino acid capsule. Derek Enlander, M.D. Derek Enlander, M.D., is originally from Belfast, Ireland, and is Physician-in-Waiting to the British Royal Family and to several members of the British government during their visits to New York. He is presently in private practice in New York where he sees CFS and FM patients, is on the faculty of Mt. Sinai Medical Center in New York City and serves as President of the Israel Medical Research Foundation. Dr. Enlander has also written and published “The CFS Handbook” which is available through his Web site, Diet (foods to eliminate, excitotoxins, etc.): Many patients do indeed appear to help themselves by eliminating certain foods. Patients seem to come to these foods and substances by either allergy testing or sample diet reactions. There are many books that can be used as a self-help method to follow. I like for patients to maintain a healthy balanced diet low in animal fat and high in fiber with abundant fresh fruits and vegetables. The treatment that I use to help in this area is a product called Immunoprop. I believe it helps patients in better nutrition for the body, as well as addressing other symptoms. Supplementation (how to address any deficiencies): The formula injection that I use in treatment provides many amino acids along with minerals and vitamins. With testing results, I may also include additional substances such as potassium, calcium, etc. I find that pills often are not absorbed well, so I prefer to use the injection for better absorption. I am not opposed to discussing other substances that might be of particular help. However, I want patients to recognize that supplements and herbal medicines have many potential side effects and toxic reactions as standard drug therapy. In fact, the dangers increase due to the lack of standards, doses and quality for ingredients. Vitamin E has been recommended in low doses to enhance the fatty acids in the cell membrane, and promote cell function. Daniel J. Clauw, M.D. Daniel J. Clauw, M.D., is Professor of Medicine, Division of Rheumatology, Director, Chronic Pain and Fatigue Research Center, and Interim Director of the Center for the Advancement of Clinical Research at The University of Michigan. Dr. Clauw has been involved in the clinical care of, and research into, overlapping conditions such as fibromyalgia, Chronic Fatigue Syndrome, Gulf War Illnesses, and multiple chemical sensitivity, and is widely recognized as a leading authority on these illnesses. Diet: I don’t think there is any diet than can be recommended except a sensible, healthy diet. Supplementation (how to address any deficiencies): There are a few supplements that may be helpful for FM such as magnesium supplements, or SAM-e, but patients should understand that these are drugs when taken in this way. I am always somewhat amused when a patient comes in to me taking eight different nutritional supplements, and says that he/she doesn’t want to take any drugs. A drug is anything that is ingested to change the body’s physiology – nutritional supplements are drugs. Mark J. Pellegrino, M.D. Mark J. Pellegrino, M.D., is Board Certified in Physical Medicine and Rehabilitation and Electrodiagnostic Medicine, and is one of the nation’s leading experts on fibromyalgia. Dr. Pellegrino is the author of numerous books and articles on FM, and despite having FM himself, he maintains an active medical practice in North Canton, Ohio where he has cared for thousands of FM patients. I often recommend a diet that is higher in protein and lower in carbohydrates to help fibromyalgia. A variety of nutritional supplements can also be used to help the symptoms of fibromyalgia. Magnesium with malic acid, 5-HTP, colostrum and others can be beneficial. Many people who are too sensitive to prescribed medicines may better tolerate nutritional supplements. The research supports that those with fibromyalgia have low or below normal levels of magnesium, thyroid, growth hormone, B-12 levels and serotonin, among others. If low or below normal deficiencies are identified, I recommend specific supplementation. For fatigue, I often recommend supplements that include magnesium and malic acid, colostrum, and NADH, among others. I also recommend specific dietary strategies for fatigue, namely a diet higher in protein and lower in carbohydrates (as I recommend for fibromyalgia). Garth Nicolson, Ph.D. Garth Nicolson, Ph.D., is President, Chief Scientific Officer and a Research Professor at the Institute for Molecular Medicine in Huntington Beach, California. He is engaged in research on the role of chronic infections in a variety of illness, including Chronic Fatigue Syndrome, fibromyalgia, Rheumatoid Arthritis, Gulf War Syndrome, and various autoimmune diseases. For more information about Dr. Nicolson, visit his Web site, At the core of Garth Nicolson, Ph.D.’s approach to CFS and FM are his findings on chronic infections in these disorders. Dr. Nicolson has found through his research studies that the majority of CFS and FM patients have chronic viral and bacterial infections. Infective agents receiving particular attention from Nicolson are mycoplasmas, which he describes as "bacterial microorganisms lacking cell walls that are capable of invading several types of organs, tissues and cells." In his investigations, Dr. Nicolson has found that two-thirds of his patients with CFS or FM test positive for mycoplasmal infections in their blood. Dr. Nicolson does not necessarily believe mycoplasmas are the initial cause of CFS or FM. Rather, he feels that possibly exposures to chemical toxins, acute viral illnesses or trauma of some sort can open the door for these infections. Once in the door, Dr. Nicolson explains that mycoplasmas become "stealth" invaders because "they can avoid immune surveillance and penetrate and hide in various tissues and organs." The results of this invasion are immune suppression, allowing further viral attack and promoting chronic inflammation with associated symptoms of chronic fatigue, muscle weakness and pain. Diet
Dr. Nicolson recommends a controlled diet, two-thirds of which is composed of vegetables, one-sixth starch and one-sixth protein. The vegetables should be green, orange, and yellow and the majority of vegetables eaten should be cooked. The starch should be whole grain and include complex carbohydrates. The protein can include chicken, fish, beans and lean, well-cooked meats. While some fruit is okay, a large concern of Dr. Nicolson is keeping dietary sugars low. Thus, fruit lower in sugar content is better and fruit juices are discouraged. On the other hand, vegetable juices, herbal teas and plenty of water are beneficial to keep the body cleansed. Dr. Nicolson's concern about sugar is based upon sugar's promotion of mycoplasmas and other harmful microorganisms. For this reason, as much as possible food and drink containing sugars should be eliminated from the diet. Refined, fatty, and yeast containing foods are also good to avoid. Likewise tobacco, alcohol, and caffeine would not be included in a diet most helpful for CFS. Supplements
Dr. Nicolson encourages the use of supplements to strengthen patients’ immune systems and to improve overall health. B complex vitamins in easily assimilated forms, such as sublingual, are important. Vitamins C, E, CoQ10, amino acids, and minerals such as zinc, magnesium and calcium should be taken. Dr. Nicolson also recommends fish, flaxseed oils and mixtures of friendly bacteria including lactobacillus acidophilus. Especially beneficial for a strong immune system are bioactive whey products, lemon/olive drinks, olive leaf extract, fresh garlic, oregano oil and mushroom extracts. Dale Guyer, M.D. Dale Guyer, M.D., is the Medical Director of the Advanced Medical Center in Indianapolis, Indiana. The Advanced Medical Center is a multidisciplinary treatment facility which emphasizes a holistic basis. The center utilizes the collective expertise of an oriental medicine doctor, a naturopathic physician, and is currently in the process of creating a unique spa like environment and personalized training exercise facility to effectively help individual patients navigate an optimal health experience by incorporating the best avenues of mind, body, and spirit. Dr. Guyer’s Web site is I think the digestive - and for that matter the detoxification system, are often the crux or obstacles that get in the way of significant healing, and of course when someone does not digest and absorb effectively, their cellular nutrient profiles are going to be inherently deficient. Therefore, first I like to approach the symptoms with natural therapy such as enteric-coated peppermint oil for bowel spasms, which can be used on an as-needed basis. Secondly, most people need to supplement with digestive enzymes and tailor to the dosing amount that improves overall function and reduces irritable bowel complaints. In addition, some people will need to take small amounts of hydrochloric acid as their own stomach hydrochloric acid output is diminished. Also, most patients have alterations of the intestinal ecology and will need supplementation of probiotic bacteria, and sometimes, initially at least, many patients will need a broad array of different types of probiotics, and so often times for the first several weeks I will have patients take 3 or 4 different brands which provide different spectrums of biologically active probiotic bacteria. Also, there will often tend to be yeast overgrowth, especially in those who have ever been on any kind of antibiotic therapy. It is often beneficial to do a comprehensive digestive stool analysis (Great Smokies Diagnostic Laboratory performs such analyses). If yeast organisms are noted on the comprehensive digestive stool analysis, a sensitivity analysis can be completed that will show what antifungal medicine or natural compound the organisms are sensitive to. Some people will often require multiple antifungal drugs. One of my favorite regimens, at least from the natural options, is oregano oil. This always seems to offer improvement in most patients. Where I find that approach incomplete, I will usually use combinations of Diflucan and Nystatin, and if that is ineffective, I add Amphotericin. This needs to be prepared by a compounding pharmacy and often several weeks of therapy will be required. It is also important when using systemic antifungal agents such as Diflucan to be sure to periodically check on liver function, although I must say in the hundreds of patients I have treated, I have never seen any problems or complications with these specific medical regimens. However, in our patients, we also support liver detoxification with products including milk thistle extract and phosphatidylcholine. Michael E. Rosenbaum, M.D. Michael E. Rosenbaum, M.D., is a pioneer in Nutritional Medicine with 25 years experience in alternative healthcare, specializing in the treatment of Chronic Fatigue Syndrome, fibromyalgia, Myofascial Pain, endocrine and metabolic disorders, and allergies. He is currently in private medical practice in Corte Madera, California. A menu of medications, nutrients and herbs help the treatment of sleep, low energy, pain, and depression for CFS and FM patients. The following nutrients and alternative approaches have worked best in my practice: Energy: B Complex vitamins, especially vitamins B-1 and B-12; NADH – a stabilized form of vitamin B-3, and Coenzyme Q10. These vitamins all participate in the formation of ATP energy packets. For muscle energy, creatine, carnitine and branched chain amino acids are often very useful. Cognitive function: I strive to raise brain acetylcholine (a neurotransmitter) with tyrosine, N-acetyl carnitine and DMAE which I find helpful; stabilizing brain cell membrane functions with phosphatidyl serine is also beneficial. Anxiety: Magnesium, and relaxant herbs are helpful. Depression: I recommend amino acid neurotransmitter precursors phenylalanine, tyrosine and tryptophan or 5-HTP. The prominent methylating agent SAM-e is an especially potent mood enhancer which I believe is also useful in helping to reverse chronic nerve damage. Sleep: It is important to preserve stage 4 deep or ‘slow wave sleep.’ Stage 4 sleep is interrupted by benzodiazepines like lorazepam that are frequently used by CFS patients. Tricyclic antidepressants like Elavil and Sinequan are also excellent sleep inducers and enhance stage 4 sleep, but can impair dreaming during REM sleep and cause weight gain. Sonata does not disrupt any of the sleep stages and is particularly useful with middle of the night awakening due to its rapid disappearance from the blood stream. I have found that a combination of calcium 600 to 800 mg and magnesium 300 to 500 mg taken before bedtime has a relaxant effect that is very useful for sound sleep and to prevent restless legs. Melatonin and serotonin inducers like tryptophan and 5-HTP are also very useful. However, too much tryptophan can cause bizarre and unpleasant dreams. GABA, which occupies GABA receptors, helps allay anxiety and induces sleep. Typical dosages are 500 to 1500 mg. Muscle pain: MSM at high doses of 8 to 12 grams a day is useful. DLPA (phenylalanine, an essential amino acid formed from protein) at doses of one to three grams a day increases endorphins. Joint aches: I recommend all antioxidants which are anti-inflammatory. Fish oil supplements – especially those with a high EPA content (an excellent source of Omega-3 fatty acids), are also anti-inflammatory and therefore can be helpful for aching joints. Paul Cheney, M.D. Paul Cheney, M.D., Ph.D., is one of the most recognized names in CFIDS (Chronic Fatigue Immune Deficiency Syndrome) treatment and research. He has treated over 3,000 patients with CFIDS from 48 states and 15 countries. Dr. Cheney has published numerous articles in peer reviewed medical journals, and has lectured around the world. He was a founding Director of the American Association of Chronic Fatigue Syndrome (AACFS), a professional association of scientists and clinicians. Dr. Cheney’s Web site is Basic Diet Recommendations No sugar: Due to defects in utilization, it produces toxins that cause pain, headaches and neuropsychiatric problems. Sugar stimulates the growth of abnormal gut microflora, especially Candida (yeast). It generates a tremendous amount of free radicals and raises insulin levels, both of which are very problematic for patients. If you crave it, try eating carbohydrates instead. If you must, eat sugar (including fruit) with meals, never by itself. Some honey and powdered fructose can be used in cooking, as well as the herbal sweetener stevia. Reduce "bad" fat: limit daily intake to less than 30 grams due to a defect in fat transport across mitochondrial membranes that is seen in patients. Supplementation, however, of essential fats (EFA's omega-3 and omega-6) is necessary. No Nutrasweet: this artificial sugar substitute contains the toxin methanol and can exacerbate neurotoxicity. No red meat: high in the bad kind of fat and difficult to digest, it causes gastrointestinal (GI) tract symptoms and systemic symptoms such as joint pain. No caffeine: or at least limit your intake as much as possible. Be careful with the following: eliminate them entirely or try two separate three-week programs of off/on/off these foods, and note if symptoms improve in the off week. Dairy products (can cause GI and systemic symptoms); Gluten (can cause GI and systemic symptoms) which is found in wheat and oats, and thus in cereal, bread and pasta. Gluten-free products are available. Paul St. Amand, M.D. Paul St. Amand, M.D., Assistant Clinical Professor of Endocrinology at Harbor-UCLA (for the past 45 years), believes guaifenesin therapy can significantly help fibromyalgia patients combat their symptoms and lead normal, healthy lives. Dr. St. Amand is also in private medical practice in Marina del Rey, California, and is the co-author of “What Your Doctor May Not Tell You About Fibromyalgia.” Dr. Paul St. Amand’s theory of the medicinal effects of guaifenesin for FM is based on the premise that excess calcium and inorganic phosphate compounds accumulate within cells to produce a state of hyperpermeability. This condition allows excess fluids, ions and other unwanted substances to flow into cell mitochondria, disrupting normal cell function, including production of ATP, the body’s energy source. Dr. St. Amand believes these factors cause the body to experience an energy-deprived state, in which widespread bodily functions are disrupted. Dr. St. Amand also feels a possible genetic defect in FM patients may be responsible for the abnormality in natural phosphate excretion, thus resulting in the buildup of these chemicals and subsequent symptoms. What is Guaifenesin?
Guaifenesin is a common component of many cold and cough remedies that helps loosen and liquefy mucous. It is a safe medication that may even be used by children. Derived from a tree bark extract called guaiacum, it was first used to treat rheumatism during the 16th century. Twenty years ago, the extract was synthesized, pressed into tablets and named guaifenesin. Today, there are many formulations of guaifenesin available, the most popular being extended release tablets that deliver both immediate and long lasting effects. The St. Amand Guaifenesin Protocol
Guaifenesin is regarded by Dr. St. Amand as the most potent drug to date for treating FM. In Dr. St. Amand’s guaifenesin protocol, a physician maps the location, size and degree of hardness of swellings or lesions within muscles, tendons and ligaments all across the body. The map serves as a baseline for future comparisons during guaifenesin treatment. Patients also make note of variations in the amount of pain and fatigue they experience, and the combined input is used to determine the proper guaifenesin dosage and to confirm the regression of the disease. The initial goal of guaifenesin treatment is to exacerbate the patient’s symptoms. Dr. St. Amand stresses that the worsening of FM symptoms, or the appearance of new symptoms indicates that disease reversal has begun. Dosage generally begins with 300mg (one-half tablet) of time released guaifenesin twice daily for one week. If symptoms have not worsened, the dosage is increased to 600mg twice daily. As treatment continues and the reversal process progresses, periods of less intense symptoms appear. As time passes, these periods cluster into days and weeks and lesions begin to clear. He has also reported a 60% increase in phosphate excretion and a 30% increase in oxalate in patients’ urine, indicating that the offending compounds are effectively being removed from the body. Salicylates
An important part of Dr. St. Amand’s protocol focuses on the avoidance of salicylates. In nature, salicylates are manufactured by plants as a defense against bacteria and fungi. Aspirin and other herbal or plant based products contain salicylates or salicylic acid. Any product containing salicylates can completely block the benefits of guaifenesin. The human body easily absorbs salicylates through the skin and intestines, so patients taking guaifenesin must be wary of medicines, supplements, lotions, cosmetics and even garden plants which can neutralize guaifenesin treatment. Harris McIlwain, M.D. Harris McIlwain, M.D., C.M.D. is a rheumatologist, geriatric medical specialist, and founder of the Tampa Medical Group in Florida, and has been in medical practice for twenty-five years. The Tampa Medical Group has four physicians who specialize in rheumatology and internal medicine. Dr. McIlwain and his colleagues see hundreds of patients each week, many suffering with fibromyalgia syndrome. The revised third edition of Dr. McIlwain’s popular book, “The Fibromyalgia Handbook: A 7-Step Program to Halt and Even Reverse Fibromyalgia” is now available (an Owl Book, published by Henry Holt and Company). The following is an excerpt from this book. Follow the Nutritional Plan for Healing Although there are no specific “magic” foods that are proven to cure fibromyalgia, research has shown that there are some positive nutritional measures you can take to heal your body. Being at the proper weight and eating healthful foods, including those that are low in fat and high in immunity-boosting antioxidants and phytochemicals, work together to help maximize energy and alertness, while possibly minimizing the constant fatigue and lethargy that accompany this syndrome. Maintaining health and feeling good becomes increasingly more complicated with chronic diseases like fibromyalgia. Good health is more about the precise balance of a sound body, mind, and spirit than just the absence of disease. There are unique links among the brain, the hormone system, and the immune system. Within this balance, these links make feeling our best a total experience – physical, mental and emotional. Taking charge of the areas of your health that you can control helps to optimize how you feel even in the midst of the aches and fatigue of fibromyalgia. Taking Control of Your Disease Eating for wellness is one of the treatment areas that you do have control over. Knowing that you are doing all you can to eat healthily can give you a sense of power to sustain your physical needs and help you cope with the stresses of everyday life and fibromyalgia. The food choices you make can affect your weight; obesity is a significant health problem in the United States as well as in other developed nations. Studies are now being conducted to see if obesity contributes to an impaired immune system. Antioxidants Give Cell Protection Antioxidants are essential nutrients that help protect your body against life’s stressors. Antioxidant food sources are rich in beta carotene and vitamins C and E. Antioxidants are thought to play a role in the body’s cell-protection system and to interfere with aging and the disease process by neutralizing highly reactive and unstable molecules, called free radicals, produced by the body. In research, free radicals have been shown to disrupt and tear apart vital cell structures like cell membranes. Antioxidants have been shown to tie up these free radicals and take away their destructive power, perhaps reducing the risk of a number of chronic diseases and even slowing the aging process. Eating for wellness requires a diet rich in antioxidants. Some researchers think that antioxidants might help prevent damage in some types of arthritis and boost immune function when a system is under stress. Both are important benefits for patients. Understanding Antioxidant Food Sources Beta Carotene: Found in apricots, carrots, cantaloupe, pumpkin, spinach, broccoli, collard greens, tomatoes, papayas and peaches (among other sources), is converted to vitamin A in the body. Because of a great deal of media attention, most people think of only beta carotene as having antioxidant properties, but there are many other carotenoid compounds that do also, including: alpha-carotene (found in carrots, cantaloupe, and pumpkin), gamma-carotene (found in apricots and tomatoes), beta-cryptoxanthin (found in mangoes, nectarines, peaches, and tangerines), lycopene (found in tomatoes, guava, pink grapefruit, and watermelon), lutein and zeaxanthin (found in beets, corn, collard and mustard greens). Vitamin C (ascorbic acid) protects us against infection and aids in wound healing. When the body is under great stress, the blood levels of ascorbic acid have been found to decline. This decline also occurs with age in both men and women. Vitamin C plays a vital role in boosting levels of the energizing brain chemical norepinephrine. Norepinephrine produces a feeling of alertness and increases concentration. A deficiency of vitamin C can therefore influence your mood as well, leaving you less attentive. It is essential to include plenty of vitamin C sources in your diet (broccoli, oranges, cantaloupe, grapefruit, kiwi, peppers, potatoes, strawberries, tomatoes). Vitamin E is important to the body for the maintenance of cell membranes, and this vitamin’s antioxidant effect may slow age-related changes in the body. There is now evidence that vitamin E plays a role in lowering the risk of coronary heart disease and heart attack. Adults with intestinal disorders of malabsorption may be deficient in vitamin E. Because this vitamin is taken in through vegetables and seed oils, it is difficult to ingest large amounts, especially if you are on a low-fat diet. If your diet is low in vitamin E food sources, check with your doctor to see if you should add 200 to 400 IU daily through supplementation. Food sources of vitamin E include nuts and seeds, vegetable oil, and wheat germ. Zinc to Resist Infection
Zinc also has antioxidant effects and is vital to the body’s resistance to infection and for tissue repair. Many illnesses, such as some cancers, kidney disease, long-term infection, trauma, and cirrhosis of the liver, are associated with zinc deficiency. Medications may also interfere with the absorption in the intestines and cause a zinc deficiency. More research infers that zinc can help to improve the immune system in elderly people. However, cautions must be raised as high doses of zinc are toxic and may, in fact, suppress immune function. Again, check with your physician for what is safe in your situation. Foods high in zinc include seafood, eggs, meats, whole grains, wheat germ, nuts and seeds; tea and coffee may hinder absorption. Magnesium to Reduce Pain
Magnesium is vital for healthy muscle metabolism and function. Yet, when you have a magnesium deficiency, you may experience excessive muscle tension, muscle spasms, restlessness, tics, and twitches. Studies now indicate that magnesium is particularly important for those with fibromyalgia as it inhibits nerve receptors linked to the trigger point pain and regulates the release of neurohormones. In a comprehensive study published in the journal Alternative Medicine Alert (March 2002), researchers found that just 500 milligrams of oral magnesium taken daily can significantly increase muscle magnesium level and influence fibromyalgia symptoms. In another study published in the Cochrane Database of Systematic Reviews (2001), researchers found that magnesium supplementation can help to alleviate painful menstrual cramps, although they are unsure of the exact amount needed. Because magnesium supplementation can cause gastrointestinal symptoms, including watery diarrhea, talk to your doctor first before trying this therapy. Foods high in magnesium include cereals, nuts, sunflower seeds, barley, quinoa, tofu, dairy products, bananas, pineapples, artichokes, avocados, lima beans, spinach, okra, hummus, oysters, mackerel, grouper, cod and sole. B Vitamins May Ease Your FM Symptoms There is strong indication that some foods high in the B vitamins help to alleviate some fibromyalgia symptoms. For instance, folic acid, a B vitamin, seems to be a leader in mood management [Editor’s note: fibromyalgia and Myofascial Pain Syndrome (MPS) researcher Devin Starlanyl has noted that folic acid is often in short supply in FM and MPS patients]. In research performed at Massachusetts General Hospital in Boston and the Baylor Research Institute in Dallas, studies conclude that people with low folic acid levels are more likely to have melancholia, a type of depression characterized by sadness and declines in mental and physical activity. The eight-week study of 213 patients also found that those with low levels of folic acid were significantly less likely to respond to treatment for depression with fluoxetine (Prozac), a common antidepressant medication used for fibromyalgia patients. Vitamin B-12 works closely with folic acid to make red blood cells and prevent anemia, memory loss, nerve damage, muscle weakness, and fatigue (if you are a vegetarian, getting ample vitamin B-12 is difficult, so talk to your doctor to see if supplementation is needed). Food sources of folic acid include green leafy vegetables, asparagus, cantaloupe, spinach, lima beans, kidney beans, pinto beans, navy beans, tofu, sweet potatoes, citrus fruits, and peanuts. Food sources of vitamin B-12 include eggs, dairy products, and oysters. Choose Plant-Based Phytochemicals Nutrition research is now revealing that a variety of food choices can do more than provide optimal nutrient intake. A varied diet can also provide hundreds of nutrient and non-nutrient compounds that may be vital to protection from disease. These compounds found in plant-based foods as a group are referred to as phytochemicals. Phytochemicals appear in all plants. A diet that includes a variety of grains, fruits, and vegetables should provide these substances if you vary your choices and methods of food preparation. Although there are phytochemical supplements and pills available, it is best to get your phytochemicals from a varied diet. Other Immune Boosters A great concern for anyone with a chronic illness is avoiding other illnesses. For example, fibromyalgia can make you feel flu-like with the muscle aches and fatigue. So getting the flu on top of having fibromyalgia is like a double whammy. What about those who have fibromyalgia and also develop osteoporosis or heart disease? It doesn’t have to happen to you, and one way to protect yourself from viruses, infections, and other chronic illnesses is to keep your immune system boosted so it can adequately fight to keep you well. Flavonoids (or bioflavonoids) include about 4,000 compounds that are responsible for the colors of fruits and flowers. Hosts of experiments on bioflavonoids found in the soft white skin of citrus fruits have suggested that these key nutrients increase immune system activation. These biochemically active substances accompany vitamin C in plants and act as an antioxidant. You can find bioflavonoids in grapefruit, oranges, lemons and limes. Rose hips, apricots, cherries, grapes, black currants, plums, blackberries, and papayas are other fruit sources of bioflavonoids. Green peppers, broccoli, eggplant, squash, and tomatoes are some good vegetable sources of bioflavonoids. Tea, red wine, and parsley are also good sources. Quercetin
This is a very highly concentrated form of bioflavonoids that is found in citrus fruits, red and yellow onions, and broccoli. Quercetin reduces inflammation associated with allergies. Other citrus flavonoids include hesperidin, which is said to raise blood levels of the “good” high-density lipoprotein (HDL fats) and lower the “bad” low-density lipoprotein (LDL fats) and triglycerides, and tangeritin, which induces apoptosis, or programmed cell death, in leukemia cells, but does not harm normal cells. Glutathione
Another nutrient that has been found to strengthen the immune system so it can fight other infections is glutathione. This powerful antioxidant is most plentiful in the red, pulpy area of the watermelon near the rind. It can also be found in cruciferous vegetables. Natural Dietary Supplements Dietary supplements include a host of products that contain vitamins, minerals, herbs and amino acids as well as natural enzymes, organ tissues, metabolites, extracts, or concentrates. Some alternative practitioners recommend the following natural remedies for prevention and treatment of disease. Chromium picolate is a trace mineral important in helping cells break down sugar into energy for the body. Supplements can help to regulate blood sugar, fat, and carbohydrate metabolism. Uncontrolled blood sugar levels can contribute to weight gain, high cholesterol, and high blood pressure. Interestingly, chromium seems to normalize low blood sugar. A recent USDA study of 180 Type 2 diabetics in China documented “spectacular” results from taking 1,000 micrograms of chromium picolinate daily. For those with FMS, taking chromium may help in stabilizing mood swings and anxiety caused by fluctuation in blood sugar levels. Coenzyme Q10 (CoQ10) is a natural substance that improves heart and immune function. It is also an antioxidant that helps to lower cholesterol levels and reduces oxidative damage to blood vessels. Essential Fatty Acids (EFAs) are not manufactured by the body, but these fats are essential to cardiovascular health and normal brain development. EFAs are available in oils containing omega-3 (fish oils) and omega-6 (linolenic and gamma-linolenic, or GLA, which are found in plant oils such as evening primrose, black currant, and borage). Glucosamine and Chondroitin are two substances that the human body produces to make cartilage. In supplement form, glucosamine comes from crab shells, and chondroitin comes from cow cartilage. Although scientific studies have yet to call them the “cure” for arthritis, in some studies of people with arthritis, these supplements were found to ease aches as well as over-the-counter painkillers, but more slowly. Although their long-term safety has never been officially established, they appear to have no side effects, and researchers do not know whether you must take the two supplements together [for maximum benefits] or if one is effective taken all by itself. If you have osteoarthritis along with fibromyalgia, this natural solution might help you. Lecithin is commercially isolated from soybeans, corn, and eggs, and may help with easing the memory glitches that happen with aging. Just two tablespoons of lecithin a day stimulates the body’s output of choline, a brain chemical that is important to recall and memory. Conclusion Now that you’ve read about the approaches some of the leading practitioners recommend to help FM and CFS patients feel better through diet and nutritional supplementation, talk to your healthcare provider or a qualified nutritionist familiar with FM and CFS about the changes you’d like to make in your own life. Will your most aggravating symptoms lessen or disappear altogether through changing your diet? You’ll never know until you try, but chances are, making simple changes to your diet and addressing your nutritional deficiencies will make you feel a whole lot better -- and will make your body stronger to continue on the road to wellness. (c) 2003-2004 Pro Health, Inc., and All rights reserved.

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