Fibromyalgia vitamins, herbs, supplements Information - Natural treatment and remedy, research studies and alternative therapy by Ray Sahelian, M.D.
February 25, 2014

Fibromyalgia affects about 3 million to 6 million people in the United States each year. The disorder mostly affects women and typically develops in early-to-middle adulthood. There is no test for the diagnosis of fibromyalgia. Doctors make a diagnosis by conducting physical examinations, evaluating symptoms, a thorough medical and social history, and ruling out other conditions. It can occur in teenagers, too, although uncommonly. Four out of five teens suffering from juvenile fibromyalgia will continue to have pain and other symptoms in adulthood. About half of these children will end up as grown-ups with full-blown adult form, Cincinnati Children's Hospital Medical Center; March 2014 Pediatrics.

Natural fibromyalgia treatment - alternative therapies
On this page I mention diet along with a few herbs or natural supplements that may play a role in fibromyalgia treatment. Research involving natural remedies is limited and I will update this article as more alternative treatment information becomes available. What works for one person may not work for another. It may take trial and error to find a supplement or a lifestyle change that works for you. In some people, there could be a natural cure. Engaging in daily exercise, doing gentle yoga, sleeping deeper, eating more fish and vegetables, eating a diet with less or no junk foods, and having a positive attitude could all potentially work together to be a natural fibromyalgia cure. Sleep is very important since insomnia can lead to a lower threshold of feeling pain in general and thus getting several hours of uninterrupted deep slumber can ease many types of pain all over the body.

Clin Exp Rheumatol. 2013 Nov-Dec. Complementary and alternative medicine in fibromyalgia: a practical clinical debate of agreements and contrasts. FM is currently classified as a chronic pain syndrome. Its main features are chronic widespread pain in the presence of tender points upon physical examination, sleep disturbances and fatigue, although patients also report a variety of other complaints. Many therapies have been proposed over recent years with mixed results, including various pharmacological therapies for the treatment of symptoms; but there is still no effective drug treatment for the syndrome itself. Non-pharmacological therapies are an important part of the treatment, and there is evidence supporting a number of interventions, including aerobic exercise, strength and stretching training, cognitive-behavioral therapy, and patient education. Complementary and alternative medicine techniques have not yet been fully acknowledged by scientific medicine because little is known about their mechanisms of action and usefulness.

Insomnia treatment
Poor sleep can cause, and/or worsen depression; insomnia invariably lowers pain thresholds, making things hurt that otherwise might not, and things that would hurt anyway, hurt more. Women who often have trouble falling asleep or staying asleep have an increased risk of pain.

Waking up and not feeling rested isn't just annoying. Non-restorative sleep is a risk factor for the development of widespread pain in older adults. Widespread pain that affects different parts of the body -- the main characteristic of fibromyalgia -- affects 15 percent of women and 10 percent of men over age 50. Arthritis & Rheumatology, news release, Feb. 13, 2014.

Physical activity, exercise, movement
Increasing physical activity is one of the most important things you can do to reduce your fibromyalgia pain. Time and time again research shows exercise reduces the muscular discomfort. If you take a long walk in the morning, it will help you get a deeper sleep at night. Exercise is often more effective in treatment than medication. If you have access to a pool, swimming is an excellent option. Yoga is helpful as a fibromyalgia treatment, so are Tai Chi and Pilates. A skilled massage therapist can also provide some relief.

Fibromyalgia diet, food and nutrition
Diet and nutrition plays an important role, even though most doctors don't make the connection. This diet should include foods that have low inflammation potential. The ideal diet would have lots of fish, particularly cold water fish, and lots of vegetables. Have a wide range of vegetables, including fresh vegetable juices. Reduce your intake of sugar, baked goods, and simple carbohydrates. For healthy food choices, see diet. Some motivated individuals have noticed benefits from a raw vegetarian or vegan diet consisting of raw fruits, salads, carrot and vegetable juice, tubers, grain products, nuts, seeds, and a barley grass juice product.

Weight loss
To help guard against this pain syndrome, it is best to maintain a healthy weight and stay active. A study in women found that being overweight or obese was associated with increased risk of fibromyalgia, especially among women who weren't all that physically active. Arthritis Care and Research, May 2010. A 2011 study at the University of Utah confirmed that obese patients suffer more severe symptoms such as pain, reduced flexibility and sleep disturbances than those of normal weight. But the good news is that losing weight brings some relief.

Natural supplements, vitamins, herbs - new treatment?
It is suggested that you first try each of these natural supplements by itself for a period of a couple of weeks. It is not recommended to take them all together at one time. Learn how each supplement influences your body by itself before considering combinations and discuss the options with your health care provider.

Eat more cold water fish or take fish oil capsules. You can find high quality fish oil
supplements at
Physician Formulas online vitamin store.
Acetyl l carnitine has been found to be helpful for fibromyalgia symptom reduction.
Creatine monohydrate is used by those who want to increase muscle mass. A study shows it provides some pain relief.

SAM-e an antidepressant that lifts mood within hours may help some individuals. Daily SAM-e dose is best kept to below 200 mg with frequent breaks to avoid overstimulation. Preferably half a tablet at 100 mg works well a few times a week as a fibromyalgia supplement.
CoQ10 combined with ginkgo - see study at bottom of page. Limit CoQ10 to 50 mg or less and ginkgo to 40 or 60 mg.
Mucuna pruriens could be helpful at about 100 to 200 mg a day. Mucuna pruriens has a high amount of dopamine which may be helpful in this condition.
Chlorella has been tested in fibromyalgia.
Ribose - one small study indicates that perhaps ribose may be helpful. At least 2 or 3 more studies showing the same results from different researchers would solidify this finding.
Vitamin D is called the "sunshine vitamin" because it is manufactured by the body through sunlight's activity on the skin. Women with fibromyalgia who also had low levels of vitamin D took supplements for 25 weeks. Reporting in the February, 2014 issue of the journal Pain, researchers said those who took supplements reported less pain and morning fatigue over time than those who did not receive the supplements. Although the study was able to find an association between vitamin D supplementation and an easing of pain, it did not prove a cause-and-effect link. In my opinion there is no need to do blood tests, especially if you have to pay out of pocket. Just take 1,000 or 2,000 units a day for a few months. Taking walks outside would combine both sun exposure and exercise.

Acetyl l carnitine
Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients.
Clin Exp Rheumatol. 2007.
One hundred and two patients meeting the American College of Rheumatology criteria for fibromyalgia syndrome were randomized. The treatment consisted of 2 capsules/day of 500 mg acetyl L carnitine or placebo plus one intramuscular injection of either 500 mg acetyl L carnitine or placebo for 2 weeks. During the following 8 weeks the patients took 3 capsules daily containing either 500 mg acetyl L carnitine or placebo. The "total myalgic score" and the number of positive tender points declined significantly and equally in both groups until the 6th week of treatment. At the 10th week both parameters remained unchanged in the placebo group but they continued to improve in the acetyl L carnitine group with a statistically significant between-group difference. A statistically significant between-group difference was observed for depression and musculo-skeletal pain. These results indicate that acetyl L carnitine may be of benefit in patients with fibromyalgia, providing improvement in pain as well as the general and mental health of these patients.

Creatine monohydrate
This study included 30 patients with fibromyalgia. After 8 weeks of receiving creatine, we witnessed a significant improvement in parameters reflecting severity of fibromyalgia, quality of life and sleep, disability, and pain. These results deteriorated 4 weeks after stopping creatine therapy. Ann N Y Acad Sci. 2009. An open-label study adding creatine monohydrate to ongoing medical regimens in patients with the fibromyalgia syndrome.

Mushroom extracts
Email - I have been suffering with fibromyalgia for almost 15 years. I have left no stone unturned and have read and researched as much as I can for things that improve quality of life. The pain is hard but the tiredness is the worst part at times. I started taking a mushroom complex with shitake, maitake, and rieshi mushrooms. They have improved my fatigue remarkably.

Ribose natural treatment
The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study.
J Altern Complement Med. 2006.
Fibromyalgia and chronic fatigue syndrome are debilitating syndromes that are often associated with impaired cellular energy metabolism. As D-ribose has been shown to increase cellular energy synthesis in heart and skeletal muscle, this open-label uncontrolled pilot study was done to evaluate if D-ribose could improve symptoms in fibromyalgia and/or chronic fatigue syndrome patients. Forty-one patients with a diagnosis of fibromyalgia and/or chronic fatigue syndrome were given D-ribose, a naturally occurring pentose carbohydrate, at a dose of 5 g t.i.d. for a total of 280 g. D-ribose, which was well-tolerated, resulted in a significant improvement in all five visual analog scale (VAS) categories: energy; sleep; mental clarity; pain intensity; and well-being, as well as an improvement in patients' global assessment. Approximately 66% of patients experienced significant improvement while on D-ribose, with an average increase in energy on the VAS of 45% and an average improvement in overall well-being of 30%. D-ribose significantly reduced clinical symptoms in patients suffering from fibromyalgia and chronic fatigue syndrome.

I started taking Physician Formulas acetyl l-carnitine 300 mg and R alpha lipoic acid 50 mg (one capsule each daily, taken in the morning) several weeks ago for fibromyalgia. I found that the effectiveness of one capsule of each per day does not last throughout the day (I work in the evenings). I began taking another of each in the late afternoon, maintaining the effectiveness of the pain reduction throughout the day, into the evening. My question is, what are the long term effects to the body of taking that much of the supplements? Also, have you considered manufacturing a time release formula of these very helpful supplements for my fibromyalgia?
   The long term effects of taking acetyl l carnitine alone, alpha lipoic acid alone, or the combination has not been studied. Most trials regarding these supplements have lasted at the most a few months. Possible side effects with high doses of these supplements include insomnia, excessive energy and increased heart rate, possible leading to heart rhythm disturbances. The benefits of supplements and medications have to be balanced with their potential side effects. Ideally medications and supplements are taken in the lowest dosage that works and for the shortest period of time. Also, taking breaks, for instance a day a week and a few days a month can significantly minimize potential long term side effects. Perhaps other supplements or medications can be substituted during the breaks if the fibromyalgia symptoms are severe. The scientific knowledge on how to create effective time release formulas of these supplements is not advanced enough to have reliable time release products.

CoQ10 and ginkgo biloba
An open, pilot study to evaluate the potential benefits of coenzyme Q10 combined with Ginkgo biloba extract in fibromyalgia syndrome.
Lister RE. J Int Med Res 2002.
An open, uncontrolled study was undertaken to measure the subjective effects of coenzyme Q10 combined with a Ginkgo biloba extract in volunteer subjects with clinically diagnosed fibromyalgia syndrome. Anecdotal reports from patients with fibromyalgia syndrome have claimed benefits from the use of these supplements. The aim of this study was to determine if these reports could be substantiated in a pilot clinical trial. Patient questioning had determined that poor quality of life was a major factor in the condition and a quality-of-life questionnaire was used to measure potential benefit. Subjects were given oral doses of 200 mg coenzyme Q10 and 200 mg Ginkgo biloba extract daily for 84 days. A progressive improvement in the quality-of-life scores was observed over the study period and at the end, the scores showed a significant difference from those at the start. This was matched by an improvement in self-rating with 64% of fibromyalgia patients claiming to be better and only 9% claiming to feel worse. Adverse effects were minor.

DHEA supplement not found to be effective
DHEA has not been found to be helpful and it may cause side effects if used in high doses for prolonged periods.
The hormone supplement DHEA may be a popular choice for people with fibromyalgia, but it is unlikely to be helpful. Supplemental DHEA -- short for dehydroepiandrosterone -- is a synthesized version of a hormone produced by the adrenal glands. DHEA is converted into other steroid hormones, including testosterone and estrogen; its levels in the body naturally peak during the 20s and then taper off as people age. DHEA at 50 mg a day for 3 months was given to 52 women, mostly in their 50s and 60s, who had been diagnosed with fibromyalgia. Overall, the women reported no clear improvement in pain, fatigue, depression and anxiety, and physical and mental function -- with either the supplement or the placebo. Journal of Rheumatology, 2005.

Food allergy and fibromyalgia
Food allergies: In one study, researchers reviewed medical charts of 17 patients who agreed to eliminate common foods from their diet such as corn, wheat, dairy, citrus, soy and nuts. After 2 weeks without eating any of the potential food allergens, nearly half of the patients reported significant reduction of pain, and most reported a reduction in other symptoms such as headache, fatigue, bloating, and breathing difficulties. Two patients had an increase in symptoms. After the food elimination phase of the study, the patients were then instructed to reintroduce a particular food every 2 or 3 days and monitor their reaction to the food. Some of the reactions to foods were pain, headache, and gastrointestinal distress. The most common problem-causing foods or ingredients for the patients in this study were corn, wheat, dairy, citrus and sugar.

Fibromyalgia cause
While the cause of fibromyalgia is unknown, researchers have found pain-processing abnormalities in the spines and brain stems of some people. Fibromyalgia research suggests that the condition is a diffuse problem of sensory volume control in which patients' thresholds are altered not just to pain, but to other stimuli such as heat, noise, and strong odors. Indeed, fibromyalgia frequently occurs with other syndromes that are also associated with hypersensitivity, such as irritable bowel syndrome and TMG syndrome. Depression, stress, and poor sleeping habits aggravate fibromyalgia. Many people with fibromyalgia have also suffered from depression, anxiety or other psychiatric conditions at some point in their lives -- suggesting that the disorders have some common causes. Nine in 10 fibromyalgia patients are female.

In 2013 Massachusetts researchers announced that nearly half the patients with the disorder had nerve problems. These individuals experienced damage to nerve fibers located in their skin and also showed evidence of a second illness. Some had a disease known as small-fiber polyneuropathy (SFPN). SFPN is a disorder marked by severe pain attacks that usually originate in the hands or the feet, although some patients experience a more generalized pain over the whole body.

Symptoms
Fibromyalgia has many symptoms including body aches and fatigue. Another fibromyalgia symptom is low mood or depression and fatigue. Body aches mostly involve the muscles and tissues surrounding the joints. Some individuals with this condition also have disturbed sleep. Fibromyalgia is a chronic condition marked by widespread muscular and joint pain, as well as specific "tender" points that typically occur in the neck, spine, hips and shoulders. Another fibromyalgia symptom is irritable bowel syndrome.

Fibromyalgia diagnosis
Musculoskeletal aches at 3 or more sites for 3 or more months. Severe pain in 5 out of 11 tender point sites (occiput, low cervical, trapezius, suprasinatus, second rib, lateral epicondyle, gluteal, greater trochanter, knee) plus at least 3 out of 10 associated symptoms (fatigue, sleep disturbance, affective disorders, irritable bladder or bowel, chronic headache, perception of swelling, numbness, pain modulated by activity, weather or stress, esophageal dismobility). Laboratory tests are usually normal.

Medical treatment of fibromyalgia - medication pain relief
A number of different antidepressant medications have been tried including tricyclic and SSRI antidepressants. Ultram (tramadol) is used for fibromyalgia pain.
Some patients with severe fibromyalgia symptoms have some pain relief to a drug usually used to treat Parkinson's disease with a improvement in their symptoms. The drug is pramipexole, marketed as Mirapex, which stimulates dopamine receptors in the brain.

The management of fibromyalgia.
Drugs Today 2004.
Fibromyalgia is one of a number of overlapping "functional somatic syndromes", including irritable bowel syndrome, tension headache, chronic idiopathic lower back pain, chronic fatigue syndrome and others. These conditions affect females more frequently than males and probably share common underlying neurobiological mechanisms, as well as frequent psychological, cognitive and behavioral comorbidities. Since the pain in these conditions is most likely "central" in origin, classes of drugs such as nonsteroidal antiinflammatory drugs (NSAIDs) and opioids, which are quite effective for "peripheral" pain, are relatively ineffective for the pain seen in these syndromes. Instead, tricyclic and other classes of antidepressants, antiseizure drugs and a number of other neuroactive compounds seem to be more effective. In addition, nonpharmacological therapies such as aerobic exercise and cognitive behavioral therapy are quite effective and frequently underutilized in clinical practice.

Research studies
Endometriosis -- caused when tissue that normally lines the uterus grows at other sites -- may produce more than pelvic pain. It seems to increase the risk of migraine headache. Previous reports have linked endometriosis with a variety of disabling conditions, such as autoimmune diseases, chronic fatigue syndrome, and fibromyalgia.

There does not seem to be an association between breast implants and fibromyalgia.

A medication normally used to quiet a stubborn cough may also help ease the chronic pain of fibromyalgia, a small study suggests. Researchers found that the cough suppressant, dextromethorphan, temporarily diminished pain perception in both fibromyalgia patients and healthy adults. The benefit appears to stem from the fact that dextromethorphan blocks the action of a chemical messenger known as NMDA, which helps relay pain signals to the brain. But that doesn't mean people with fibromyalgia should start downing over-the-counter cough syrup, the researchers caution. Dextromethorphan has side effects. At high doses, patients can have problems related to memory and confusion.

Fibromyalgia
Internist. 2004.
Fibromyalgia is a frequent disorder of the middle aged, particularly in women characterized by diffuse and widespread pain, and tenderness on palpation at characteristic sites, called tender points. Additional characteristic symptoms are fatigue, sleep disturbances, irritable bowel and bladder syndrome, chronic headaches, paresthesia, hearing and vestibular dysfunction. The etiology remains poorly understood. Diagnosis is based on characteristic symptoms, presence of tender points and exclusion of similar confounding conditions.

Vulvodynia
The cause of vulvodynia -- painful discomfort in the vulva -- is unknown, but researchers have now found that women with the condition are abnormally sensitive to all bodily pain stimuli. This suggests that vulvodynia might respond to treatments aimed at general pain control rather than specifically to the vulvar area.

Role of acupuncture treatment
Acupuncture may provide some temporary pain relief for people with fibromyalgia, but does not help with fatigue, sleep problems, or physical function. Rheumatology, January 25, 2010.

Fibromyalgia Treatment questions
Q. Dr. Ray Sahelian, M.D., I was placed on evening primrose oil to help my breast. Not a lot pain there, but terrible fibromyalgia pain. In 6 years that I have dealt with it I have not had any relief. But I seem now to Have 50 to 75% relief. Only thing else placed on at that time was calcium with D. Any research on fibromyalgia pain relief with primrose.
   A. We haven't come across hardly any research with evening primrose oil for fibromyalgia pain.

Q. I want to give you and your staff an update on the use of mucuna pruriens as a treatment for fibromyalgia symptoms. Mucuna was used in combination with Mirapex daily with remarkable results. Both Mirapex and Mucuna raise dopamine level. The ability to handle stress over time in any situation is the most noticeable change. From January through April while taking Mucuna regularly, there was a definite improvement in sleep, waking up refreshed with improved energy throughout the day. Not as easily overwhelmed; therefore, more activities were accomplished. My chiropractor, who takes careful notes 3xwkly was so impressed with my response to the mucuna that both he and his wife started using it. With limited funds, I stopped taking mucuna in April. The emotional stability using the Mirapex alone is still unmistakably the best in my entire life. However, the Mucuna does provide additional benefit that Mirapex does not, ie improved sleep, perky positive energy, more activities accomplished. Whereas the Mirapex leaves me feeling drugged and sleepy but very calm in the face of stress. Fibro pain and pain in general is definitely reduced. I definitely will be using Mucuna pruriens again soon. In the future, I hope that you, Dr. Sahelian, can develop a natural medication to raise dopamine in the treatment of Fibromyalgia. Mirapex is just too harsh, but it's the best that we have right now. I'm just grateful to have mucuna pruriens. It's certainly an improvement over using Mirapex alone.  I am now reducing my dose of Mirapex and relying mostly on mucuna. By reducing Mirapex I have fewer side effects and the Mucuna seems to be as effective. I am convinced that maintaining a normal level of dopamine is the key in the treatment of fibromyalgia.
   2006 - To date you have posted several of my responses concerning the use of mucuna pruriens in treating fibromyalgia. Since my last update, I have changed my usage to include both Mirapex, using the treatment level as prescribed by my MD for fibromyalgia, as well as the Mucuna. I discovered that, for me, using the two together produced the best results of 1) reduced pain, 2) increased tolerance of stress and sensory stimulation, 3) perky vitality and mental clarity. I rely on Mirapex for #s 1 and 2 while the Mucuna seems most responsible for #3. I strongly recommend that anyone who is treating their fibro with Mirapex consider combining it with the Mucuna. I have not notice the side effects that you mention, and I'm very satisfied with the results of combining these two very beneficial medications for positive results.

Q. Can you tell me what the connection is between a magnesium deficiency and fibromyalgia? I am getting varying information from different online sites.
   A. Calcium and magnesium ions play a key role in the physiology of muscular contraction. Most studies show blood levels of calcium and magnesium in fibromyalgia patients are in the normal range. But, in fibromyalgia patients the intracellular calcium and magnesium concentration could be off. I have not come across any studies evaluating the role of a magnesium supplement in fibromyalgia patients, but it would be worthwhile to try for a few weeks since magnesium intake  in doses less than 500 mg a day appears to be safe. Trying a magnesium supplement alone, a calcium supplement alone and then combining them each for a few weeks could be tried to see if any of these options is helpful.

Q. I was reading your information about TMG and you were answering some readers questions. One specific Q was raised as to the benefits of combining MSM with TMG. You requested that you be emailed if anyone has combined them and with what results etc. This is why I am emailing you. I used to work in a Health Food Store and many customers would come in looking for something for their FMS (Fibromyalgia). I would always suggest taking the MSM with the Sam-e. Not only were they extremely happy with the results they were getting regarding the pain..., but it was also helping them with their depression. Many could not afford the Sam-e and so some never got to experience it to see if it helped them, unfortunately. I will say that it was like a mini Clinical Trail as this was effective for this person and others the entire 4 years I worked there.

Q. Would NADH be helpful for fibromyalgia?
   A. We have not seen studies regarding the use of a NADH supplement and fibromyalgia.

Q. I have fibromyalgia. Over the past 4 months, I have taken ciprofloxacin twice. Both times there has been a great improvement in my fibromyalgia. There was some slow regression the first time. It has been 8 days since I finished the last ciprofloxacin. I presently have about a 50% improvement overall and about an 80% improvement in my back muscles. I don't know how long these improvements will last. Perhaps you can post this, so other people can ask their doctors about this. I have informed the National Arthritis Foundation and the National Fibromyalgia Research Association. I hope this can help other people.

Q.  I am wondering if CoQ10 has been reported as having in effectiveness for managing fibromyalgia?
   A. There's one study that we are aware of regarding the combination of Coenzyme Q10 and ginkgo for fibromyalgia.

Q. Have you ever heard that maca can in fact help fibromyalgia sufferers?
   A. we have not heard anything about maca and fibromylagia.

Q.  I'm writing this email to find out the possible uses of mangosteen juice for fibromyalgia. Please let me know if there are testimonies stating that it has helped in any way. My future wife has been diagnosed with fibromyalgia just recently and the pain she suffers is very intense. She has been to pain clinics and the doctors there say she has to much pain for them to manage. Never heard of that before, but any way. Please let me know if mangosteen could help fibromyalgia symptoms. Thank you and have a great day.
   A. We have not seen any research or had any testimonials regarding mangosteen and fibromyalgia.

Q. My wife has been diagnosed with fibromyalgia. As such, she started taking maca about a week ago. It seems to have worked well and as such I ordered two more bottles. In addition, I also ordered Fish Oil capsules as well as Good Night RX as my wife has trouble sleeping at night. Do you see any problem in taking the above three supplements at once? In addition, please be advised that my wife is also on Cymbalta. I understand that you cannot comment on this and will of course contact my Dr.
   A. We are glad you wife is improving. However, we really can't give any individual treatment suggestions. As a general rule, it is best to learn how each supplement works by itself before considering combining.

Q. Lyrica is now FDA-approved for the treatment of fibromyalgia, but there are serious concerns about its side effects. Do you recommend that people try natural ways to reduce symptoms first?
   A. I think fibromyalgia is due mainly to diet, lack of exercise, and poor sleep patterns. The use of a drug such as Lyrica as a treatment for fibromyalgia is only a temporary solution and does not address the underlying causes.

Q. What natural fibromyalgia treatments do you recommend? For example, a study in Italy last year found that mud packs followed by hot baths offered relief. What about other natural approaches, such as a proper balance of rest and exercise? Hydrotherapy such as hot baths? Stress reduction such as meditation and yoga?
   A. All the options you mention and safe ways to ease symptoms of fibromyalgia. I still think that diet has a major role to play. One should focus on consuming an anti-inflammatory diet that has a strong emphasis on fish and vegetables and minimizes the use of sugar and simple carbohydrates. Walking at least an hour a day will help. Any form of daily exercise will improve sleep patterns which could make an enormous impact on fibromyalgia symptoms.

Q. What are your favorite natural supplements for fibromyalgia? For instance, online I see that you recommend fish oil, Acetyl-L-carnitine, SAM-e and CoQ10 combined with ginkgo.
   A. It is difficult to predict which supplement will be helpful in any one individual without giving it a try. One can start with 300 mg or so of acetyl l-carnitine for a couple of weeks to see if it is helpful, especially in those who wish to be more alert and mentally focused. Fish oils are certainly very high on my list and two to five capsules a day could be helpful. SAM-e is a potent mood lifter and is appropriate in those fibromyalgia patients who have low mood. SAM-e is quite potent and I suggest using only half a 200 mg tablet. If these supplements do not ease fibromyalgia symptoms after a few weeks, then one could try CoQ10 and or ginkgo biloba.

Q. Just thought I would let you know that I had originally purchased my first serrapeptase from your website. I had no side effects, in fact I felt great. I was able to do normal exercise with resistance bands again which I could not do prior. I have fibromyalgia or muscle trigger points and tender spots all over after an accident and after taking the serrapeptase supplement for a month it over half the points were almost gone or gone. Then I tried another brand and it did NOT work for me as well. So I've gone back to your brand. It did take a few days to notice good effects.
   A. This is interesting. Since long term studies with serrapeptase are not available, it is best to use the least amount that works.

Q. I just read about lithium orotate being useful for fibromyalgia in the energy department of the illness. Have you heard any information on this subject.
   A. A Medline search in December 2009 did not show any studies using the keywords "lithium orotate fibromyalgia." There have been a few anecdotal mentions on the internet that lithium orotate may have helped some people with fibromyalgia. If your doctor approves you may wish to try a low dosage.

Q. Are black cohosh, often used for hot flash, and chaste berry, often used for menopause, helpful as natural treatment for fibromyalgia?
  A. I have not seen any convincing evidence yet that they are effective.

I've been taking 5-HTP since the beginning of 2009, two months ago, and had wonderful results (for anxiety and fibromyalgia pain). However, by the end of June, my fibro pain started to worsen. I increased the dose to 300 mg/day, as I've read that it is a standard dose for fibromyalgia. The 5-HTP continued to help somewhat, but now, 2 months later, I feel as if I'm getting no relief whatsoever. I even went up to 350 mg. Then dropped to 250 mg, thinking I might be having serotonin syndrome. No difference. Today I am back to 350 mg, and I see my psychiatrist in 2 days. We'll discuss Pristiq and Savella, either of which may help. However, I don't want to go back on antidepressants. Is it time to try Tryptophan? Any advice would be greatly appreciated.
    Perhaps you can discuss the info on this page with your doctor.

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