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Nutritional Approaches in Fibromyalgia – Dr. Mark Pellegrino on Deficiencies, Symptoms, and Supplement Strategies

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Excerpted from Dr. Pellegrino’s very popular book Fibromyalgia: Up Close and Personal.* Dr. Pellegrino has seen more than 20,000 FM patients in his practice at the Ohio Rehab Center, and has been a fibromyalgia patient himself since childhood.

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.

Deficiencies in Fibromyalgia

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

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.

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

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.

Low Amine ATP, or 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.

Vitamin B12 Deficiency

I have found many people with fibromyalgia have a relatively low B12 level. Vitamin B12 is important in manufacturing red blood cells (erythropoiesis), improving nerve pathways, improving DNA synthesis, and folate metabolism.

Symptoms of low B12 include:
• Increased fatigue,
• Numbness and tingling,
• And depressed immune system.

Nutritional supplements for B12 include B12 lozenges, sublingual B12 [dissolved under the tongue], or B12 injections. B12 that is taken in a lozenge or sublingual form is absorbed directly into the blood vessels in the mouth. In many, B12 is not absorbed well from the stomach.

I frequently prescribe a B12 injection protocol in which 1 milligram of B12 is injected intramuscularly once a week for 6 weeks or more.

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.

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.

Supplement Strategies for Treating Specific FM Symptoms

We discussed treating specific deficiencies in fibromyalgia, and I wanted to address some specific symptoms of fibromyalgia and supplement strategies available. Later chapters will provide more detail.

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

* * * *

Our Daily Needs
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. This book may be ordered in the ProHealth.com store.

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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2 thoughts on “Nutritional Approaches in Fibromyalgia – Dr. Mark Pellegrino on Deficiencies, Symptoms, and Supplement Strategies”

  1. jacampbell says:

    I am so tired of swallowing pills.

  2. GinnyS1938 says:

    I have times when I have a Fibromyalgia flare-up…I get pain all over my body…I have awful hot spells…All I want to do is sleep…I have no trouble sleeping…

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