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Fibromyalgia Nutrition Basics: Common Deficiencies, Symptoms, and Supplement Strategies

  [ 75 votes ]   [ 9 Comments ]
By Dr. Mark J Pellegrino, MD • • September 8, 2010

Dr. Pellegrino has seen more than 20,000 fibromyalgia patients in his practice at the Ohio Rehab Center, and is himself a fibro patient.* Here he outlines common nutritional deficiencies in people with FM; potentially helpful supplements for key FM symptoms; and guidelines for making prudent decisions about your supplement regimen.


Over the years I’ve used a lot of supplements in the treatment of fibromyalgia, and I believe they are effective in many patients.

Not all patients benefit, but in general supplements are safe to try and, if they help, are relatively inexpensive to continue. Today nutritional supplements are one of the most important treatments I recommend for fibromyalgia.


Let’s review a number of deficiencies and how they may affect our fibromyalgia symptoms, and look at specific supplements that may help.

1. Serotonin Deficiency

Serotonin is an important hormone and neurotransmitter manufactured from the amino acid, tryptophan. Serotonin is important in our food behavior, sleep behavior, neuroendocrine function, mood, and energy.

The clinical symptoms from low serotonin include:

• Depression,

• Fatigue,

• Increased pain,

• And hypoglycemia (low blood sugar).

Nutritional supplements to treat low serotonin are:

5-HTP (5-hydroxy L-tryptophan). A modified amino acid that the body uses to manufacture serotonin. In addition to helping the body produce serotonin, 5-HTP can be an appetite suppressant and a sleep inducer. Typical dosing is 100-300 mg per day. Griffonia seed is a source of natural 5-HTP.

St. John’s Wort. This herbal antidepressant seems to work by raising the serotonin level. Typical dosing is 300 mg up to twice a day. [Note recent research reports St. John’s Wort may reduce the analgesic effect of opioid medications.]

SAM-e (pronounced “Sammy”). A natural medicine used in Europe for 25 years to treat mild to moderate depression. It stands for S-Adenosyl-L-methionine and it helps make the body’s mood enhancing chemicals. Usual dosing is 200-400 mg twice per day on an empty stomach. Side effects can include upset stomach and headaches.

2. Magnesium Deficiency

Magnesium is a common deficiency in the general population but even more so in patients with fibromyalgia. Intracellular magnesium is low, which interferes with the muscles’ ability to relax and make energy. Magnesium is needed to convert 5-HTP to serotonin.

Magnesium facts…

• 27% of magnesium is stored in muscle tissue.

• Every energy-consuming reaction in life needs magnesium to proceed.

• Less than 1% of body magnesium is in the serum [blood].

• Low magnesium intake results in magnesium depletion from muscles and bones to maintain serum magnesium levels.

Symptoms of low magnesium in fibromyalgia include:

• Increased fatigue,

• Increased spasms,

• And increased pain.

Individuals with low magnesium are more prone to injuring their muscles when they exercise, so exercise intolerance or increased pain and spasms after activity is another symptom of low magnesium in fibromyalgia.

• Natural supplements to treat low magnesium include products containing magnesium.

Magnesium glycinate is the preferred bioavailable form. A magnesium supplement works with the muscles to help them manufacture more energy (ATP molecules). When taken as a supplement, magnesium and its co-factor, malic acid, can enter the muscle cells and improve the muscle energy production.

• Studies have shown that this combination reduces pain in fibromyalgia patients and headache patients.(1,2) I have found that 75% of people who use products… (containing magnesium, malic acid, vitamin B1, vitamin B6, vitamin C, and manganese) will report improvement with either decreased pain, improved energy, a more stable baseline, or a combination of these.

• Anywhere from 300 to 500 mg of extra magnesium supplement a day may be needed.

• Taking 5-HTP along with magnesium/malic acid will increase your odds of converting 5-HTP to serotonin.

3. Low Amine ATP (Low Energy Efficiency)

Biochemical studies show that fibromyalgia patients have low ATP or energy molecules in their muscles due to a deficiency of the compounds that make ATP such as oxygen and magnesium.(1)

Swedish investigators, Drs. Bengtsson and Henrikson,(3) have shown that a lower concentration of oxygen than expected is found in fibromyalgia muscles, which contributes to lower ATP levels. This lower concentration is most probably due to poor metabolism of nutrients and not from true hypoxia (lack of oxygen in body).

A lack of ATP contributes to:

• Fatigue,

• Increased pain

• And increased muscle spasms.

Supplements to improve the ATP levels include:


• And another product called Co-enzyme Q10 (CoQ10).

CoQ10 is a vital enzyme in the energy producing pathway of the muscles' energy centers, called the mitochondria. Typical CoQ10 dosing is 100-300 mg daily. Oxygen therapy is not beneficial and could damage the lungs.

4. Vitamin B-12 Deficiency

I have found many people with fibromyalgia have a relatively low B-12 level. Vitamin B-12 is important in manufacturing red blood cells (erythropoiesis), improving nerve pathways, improving DNA synthesis, and folate metabolism.

Symptoms of low B-12 include:

• Increased fatigue,

• Numbness and tingling,

• And depressed immune system.

Nutritional supplements for B-12 include B-12 lozenges, sublingual B-12 [dissolved under the tongue], or B-12 injections.

B-12 that is taken in a lozenge or sublingual form is absorbed directly into the blood vessels in the mouth. In many, B-12 is not absorbed well from the stomach.

I frequently prescribe a B-12 injection protocol in which 1 milligram of B-12 is injected intramuscularly once a week for 6 weeks or more.

5. Low Growth Hormone Level

Dr. Robert Bennett found that people with fibromyalgia have decreased growth hormone levels as measured with IGF-1 (insulin-like growth factor, a derivative of growth hormone).(4)

Symptoms of low growth hormone include:

• Fatigue,

• Increased fibrofog, [see also Dr. Pellegrino's article, “Managing Fibrofog – The Cognitive Dysfunction of Fibromyalgia.”]

• Decreased metabolism,

• And depressed immune system.

Supplements to increase growth hormone level include:

Colostrum, which has growth hormone and immunoglobulins. Bovine (beef) colostrum is taken orally, and is essentially identical to human IGF-1. Bovine colostrum given orally has been found to raise the serum IGF-1 level in humans. I found that over 75% of my patients report improvement in their energy level and concentration abilities when taking colostrum.

• Daily growth hormone injections can increase the IGF-1 level and result in improvement. Growth hormone injections are expensive, averaging about $1,500/month, and they are not routinely covered by insurance, hence limiting the widespread application for fibromyalgia treatment. Growth hormone is available by sublingual form as well.

6. Adrenal Hormone Deficiency

The adrenal glands can become dysfunctional in fibromyalgia and cause problems with the immune system and ability to handle stress.

Supplements that boost the immune system can be considered. These include:

• Colostrums,

• Vitamin C,

• Zinc,

• Echinacea,

• Cinnamon,

• Garlic,

• And golden seal.

Antioxidants are helpful in fighting free radicals, supporting the cellular function, and improving the immune system. Common antioxidants include:

• Vitamins A and E,

• Grapeseed extract,

• And lipoic acid.

Licorice root and Eleuthero (previously known as Siberian ginseng) can help improve adrenal gland function and boost our stress and immune responses.


We discussed treating specific deficiencies in fibromyalgia, and I wanted to address some specific symptoms of fibromyalgia and supplement strategies available….

1. Pain
• Magnesium and malic acid combination
• Natural anti-inflammatories such as glucosamine, chondroitin, MSM and flaxseed oil
• Feverfew for headaches
• Guaifenesin is a [mucus-thinning] cough medicine that is reported to have some success in treating patients with fibromyalgia (Dr. R Paul St. Amand).

2. Fatigue
• Magnesium and malic acid combination
• Colostrum
• Co-enzyme Q10 (CoQ10)
• Vitamin B12
• Ginkgo biloba
• Vinpocetine

3. Poor Sleep
• 5-HTP
• Melatonin
• Valerian root
• …Sleep formula (5-HTP, valerian root, lemon balm, passion flower)

4. Fibrofog
• Colostrum
• Ginkgo biloba
• Vinpocetine
• Acetyl-L-carnitine
• Phosphatidyl serine

5. Irritable Bowel Syndrome
• Fiber supplement
• Acidophilus
• Valerian root
• Peppermint oil (enteric coated)
• Olive leaf extract

6. Mild Depression
• 5-HTP
• St. John’s Wort
• SAME-e
• Flaxseed oil

* * * *


We need to make sure we get our basic balanced minerals and vitamins. Supplements are important to replace deficiencies, but we mustn’t forget that we still have to get all of our daily vitamins and minerals… A complete vitamin and mineral supplement… [can replace]… 30-40 pills a day at a fraction of the cost.

Be Open Minded
Numerous nutritional products are available, and I work with my patients in an open-minded and responsible manner about trying them.

• Educate yourself by reading up on various products.

• Ask your doctor and basically make these decisions based on your knowledge and expertise and not on the product’s good marketing strategy.

• Try one supplement at a time for one or two months and see if you think the product is helping. If you think it might be helping but you’re not sure, try it for another month and reevaluate its effect.

• Remember to work together with your doctor, and first check with your treating physician regarding any supplements because of the potential for supplements to interact with prescribed medicines.


1. “Management of Fibromyalgia: Rationale for the use of magnesium and malic acid,” Abraham GE, Flechas JD, Journal of Nutritional Medicine 1992; 3:49-59.

2. “Treatment of fibromyalgia syndrome with Super Malic: A randomized, double-blind, placebo-controlled, crossover pilot study,” Russell IJ, Michalek JE, Flechas JD, et al. Journal of Rheumatology 1995; 22:953-8.

3. “Primary fibromyalgia. A clinical and laboratory study of 55 patients,” Bengtsson A, Henriksson KG, Jorfeldt L, et al. Scandinavian Journal of Rheumatology 1986; 15:340-7.

4. “A randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia,” Bennett RM, Clark SC, Walczyk J. American Journal of Medicine 1998; 104(3):227-31.

5. “An open, pilot study to evaluate the potential benefits of Coenzyme Q10 combined with ginkgo biloba extract in fibromyalgia syndrome,” Lister RE. Journal of International Medical Research 2002; 30(2): 195-9.

* This article is excerpted with kind permission from Chapter 17 of Dr. Pellegrino’s highly regarded book Fibromyalgia: Up Close & Personal, © Anadem Publishing, Inc. and Mark Pellegrino, MD, 2005, all rights reserved. Readers wishing to order this book should directly contact Dr. Pellegrino’s practice at the Ohio Rehab Center (phone 330/498-9865 or fax 330/498-9869).

Note: This information has not been reviewed by the FDA. It is generic and is not intended to prevent, diagnose, treat or cure any illness, condition, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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Article Comments Post a Comment

blood tests
Posted by: starstella
Sep 8, 2010
I do take some of these supplements. Since I am already on a antidepressant, I stay away from the "natural" antidepressants due to fear of an unfavorable interaction. "natural supplements" should not be taken lightly and your MD should be aware if you are taking any. What a pity that insurance companies do not allow for blood testing of those with FM to determine if any of these blood abnormalities are present, rather than the patient taking these supplements willy-nilly.
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Posted by: TSauceda
Sep 8, 2010
Also a shame insurance does not allow use of prescription card to cover the costs of these supplements as they are much more beneficial than the prescription drugs that I used to take. I wish I could use my Medical Flex Card to help me pay for them. My budget barely allows for the supplements, as long as nothing else happens like car or house repair.


Posted by: TSauceda
Sep 8, 2010
Also a shame that insurance does not allow use of prescription card for purchasing supplements as they are a lot more beneficial than the prescriptions drugs I used to take. I would love to be able to use my Medical Flex card to purchase them as my budget barely allows for my supplements as long as I don't have car/house repairs to make. Insurances need to consider this as preventative maintenance. It would be a lot less costly to the insurance if they would.
Reply Reply

oxygen therapy
Posted by: Sandy10m
Sep 8, 2010
Dr. Pellegrino needs to clarify his statement "Oxygen therapy is not beneficial and could damage the lungs." How can oxygen hurt the lungs? I have been doing hyperbaric oxygen therapy for 7 months now and feel so much better than before. My fibro has improved because the muscle injuries from years past have begun to heal. The oxygen has been noticeably softening my stiff muscles, which reduces inflammation, which reduces pain. My incessant bronchitis cough is about 40% better now. So I need to know the mechanism behind why oxygen therapy is bad for the lungs, when the lungs' main job is taking oxygen into the body. Please clarify this.
Reply Reply

Hyperbaric Oxygen
Posted by: ScottishSage
Apr 11, 2013
I've learned of the amazing and miraculous benefits through a newsletter. But the machines are rare and expensive. Please tell me where one can get the treatment and how to afford it.


oxygen therapy explained
Posted by: Sandy10m
Sep 9, 2010
I did my own research into this comment about oxygen therapy. Evidently there is big misperception of most in the medical community that "oxygen is bad for you." This stems from the damage that people who are on 100% oxygen AT HIGH PRESSURE for long periods of time can have. Premature babies cannot be on 100% oxygen, and the elderly (with lung problems) cannot be on 100% oxygen, because their oxygen use is very long-term. Scuba divers who dive very deeply for long periods have to use special air tanks so that they don't breathe too much oxygen, which can be bad for you. However, if people with FM or CFS want to use the hyperbaric chambers for oxygen therapy, or use an supplemental oxygen from time to time, this is perfectly safe. The partial pressure of oxygen and the time in the chamber does not even come close to the "dangerous" levels of oxygen therapy. And the higher concentrations of oxygen during these times are extremely beneficial to people like us who already have a problem transporting and using oxygen due to our illnesses. This is why hyperbaric oxygen therapy is so beneficial to me, and might be beneficial to you. I am a scientist, and I absolutely despise generalized statements such as the one that was mentioned in the article, because this misinformation may keep someone from trying a useful therapy. If you want to read more about this, google "oxygen toxicity" and look for the partial pressure and time restrictions chart for divers. Good luck and be well, folks.
Reply Reply

Caution with 5-HTP
Posted by: Steviegal
Sep 9, 2010
Great article, however I would exercise caution when using 5-HTP. I was using 100 mg. a day for about a year to help with sleep. This was on the recommendation of a doctor I was seeing. Finally, my Endocrinologist ran a urine 5-HIAA test, which tests for serotonin metabolites. My levels were 8 TIMES too high! Once we tapered off the 5-HTP (which was NOT pleasant) and retested, both 5-HIAA and blood plasma serotonin levels were normal range. I'm a great believer in supplements and have used many different ones, however there are some that need to be monitored. Imagine if I was taking the 300 mg. recommended? There is something called "serotonin storm" which can be extremely dangerous.
Reply Reply

Ok so. The egg myth ..
Posted by: blewvelevet
Apr 6, 2012
Alright I will summarize this as i sit in a bar i used to frequent for the first time in about 4 years. Im here today enjoying a Kier Royale and researching the dopomine tryptophan vit d deficient fibrmyalgia patient that i am. I'm thinking a lot of the medscape info /research understanding has ben great just in the past 5 years.

I sit here feeling somewhat normal. No tingling humming pain In my lower back and legs. Not going to say its a cure.. But i happened to start an egg diet after blood work came bacl with LDL of 183 to which my doctor prescribed Lipitor. A bit distressed at taking yet another drug. I always had heard an egg is packed with vitamins and minerals in a pure form since its there to create a whole living thing. I had a hip joint issue 10 years ago that a vitamin deficiency totally cured. I mean 10 years later it never came back. But then in 4 years later i got hashimotos which brIngs vit d deficiency and hypothyroidism. Then along came Fibromyalgia

3 weeks ago i started a hard boiled egg diet. Two in the morning and 1 or 2 in the evening. Depending on how hungry i was. But really two eggs totally made me feel not hungry. And really it was so easy. Boil a pot of them on Sun and put a whole bowl of them in the fridge beginning sun night. Throw two in my bag on my way to work.

Im sitting here to say that after two and a half weeks.. A lot of the lower leg and back pain have stopped

The other thing was that my family and everyone was givng me such grief about eating 4 hard bouled eggs a day that it caused me to hunt for the cholesterol egg myth. I didnt have to look far. Its been totally busted by nutritionists and medscape data. I found the egg. The perfect vitamin mineral packed food.
And. In fact, lowering cholesterol

Ive been feeling great for 4 days now. Energy and no drag feeling. Having something now i didnt think i could enjoy. A drink. I will probably wait a couple of weeks to have another...
Reply Reply

You missed to the most important items needed
Posted by: pobrien
Dec 24, 2015
I had extreme COPD, fatigue, sore joints, extreme difficulty sleeping that I kept driving off the road from falling asleep. My breathing was horrid and these are all totally cured now by taking these vitamins and minerals
desiccated thyroid removed arteriosclerosis from the tiny veins in the lungs after the Dr. said my thyroid was working great. But six books I bought said the doctor was wrong. The second thing is a vitamin called K2 M7. This vitamin causes the calcium and magnesium and other minerals and vitamins to be carboxylate so that the calcium in these magnesium, and such can enter the bones. The doctor said my heart valve was very bad I would probably need an of valve replacement. My pulse rate was in the 50s and now it's rated 80 showing that valve is working perfect now. After all the calcium was removed from it by vitamin K2 MK7. The next thing not mentioned that did away with pellagra causing some severe pain in bones is called niacinamide. These things have eliminated even my Parkinson's disease and I now dance 3 to 5 nights a week and am 81 years old. If you would like to learn a lot more go to my website
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