One of the most prominent features of Fibromyalgia syndrome is fatigue. Studies show both FM and CFS have a common link in manganese dependent neuroendocrine changes, especially along the hypothalamic-pituitary-thyroid axis. The cycle starts with the production of thyrotropin-releasing hormone (TRH) by hypothalamus. TRH stimulates the pituitary gland to produce TSH or thyroid stimulating hormone. TSH, in turn, stimulates the production of thyroxin by thyroid.


Thyroxin regulates the metabolic rate. Since fatigue is one of the chief complaints among both FM and CFS patients, hypometabolism due to secondary hypothyroidism fits in as one of the possible causes. Manganese is a helpful trace mineral supplement for both CFS and FM patients. Manganese directly influences the metabolic rate through its involvement in the hypothalamic-pituitary-thyroid axis.

Thiamine deficiency symptoms are extremely similar to many of the symptoms experienced by FM patients. Symptoms include fatigue, insomnia, apathy, confusion, paresthesia (numbness or burning in the hands or feet), low metabolism, low blood pressure, and shortness of breath. Supplementing with thiamine may assist due to its involvement in the capacity of the respiratory chain.


Medical treatment has fallen short of effective relief. Considering the evidence of nutritional answers, it makes sense to implement the use of dietary supplements in the management of FM. Nutritional support should include:

  1. Magnesium and malic acid for ATP synthesis and aluminum detoxification.
  2. B6 for support of ATP synthesis.
  3. Manganese, for neuroendocrine changes.
  4. Thiamine for nutritional support of respiratory chain. Thiamine can be obtained through a B-complex vitamin, and helps keep the B vitamins in balance.
  5. GABA for anxiety and control of limbic firing in the brain.
  6. Alpha KG for chronic fatigue symptoms.

Recent studies show cardiovascular fitness training helps alleviate some of the symptoms of FM. In The American Journal of Medicine, one study reported, “It is concluded that cardiovascular fitness training is feasible in patients with fibrositis / fibromyalgia and that such training improves subjective measurements of pain-reporting behavior.” Additionally, nutritional support and mild exercise, massage, heat or ice treatments, and rest can help.

Improvements resulting from these treatments, modalities can be measured by improved stamina, energy, mobility, and a decreased sensitivity at the tender sites. Relaxation tapes used on a regular basis help reduce stress, and give relief. Dr. Herbert Benson of Harvard Medical School demonstrated relaxation or meditation decreases the impact of stress hormones such as norepinephrine (noradrenaline) and epinephrine (adrenaline).

Over the past 10 years, we have been evaluating different combinations of nutritional supplements in an effort to find an effective treatment for fibromyalgia. In the past five years, after a review of clinical data in the Journal of Nutritional Medicine, we began using a combination of malic acid, magnesium, Boswellia, chromium picolinate, and Vitamin B6. The malic acid formula contains 800 mg. of malic acid. Malic acid is a naturally occurring, nontoxic organic acid, generally recognized as safe, and classified under food acids by the F.D.A. Malic acid is widely distributed in the vegetable kingdom and is one of the most important of the

FM sufferers often avoid ice therapy or massage. Using a heating pad feels good, but actually promotes swelling and inflammation in your muscles. If you are suffering with trigger points, an ice pack on the trigger point decreases swelling and pain. Sometimes the cold feels irritating at first, but soon the cold decreases the pain. Ice massage is another way to rapidly cool down a muscle and trigger point(s). Place eight ounces of water in a paper cup, and freeze. Then peel the cup so the ice is exposed, and gently without exerting any pressure, glide the ice over the affected muscle. At first, it is very uncomfortable, but as the ice penetrates, the pain reduces quickly. Five minutes is usually the limit, so you don’t experience “frost bite.” If you start feeling a burning sensation, stop immediately. Alternate between moist heat from a shower to cold helps release the muscle. Then stretch the affected muscle as it may release the trigger point(s).

fruits. Due to the high concentration in apples, it is best known under the name of apple acid. Malic acid plays an essential part in sugar metabolism and in the formation of ATP, the energy currency for physical activity and other body functions. The energy you use is obtained from the combustion of these digested food products combined with oxygen, and is stored as ATP, then utilized when energy is needed for all kinds of activities. ATP requires magnesium, oxygen, phosphates, and substrates from the breakdown of food products. When low oxygen conditions, such as hypoxia, occur and when magnesium is below optimum levels, the body accumulates excessive levels of certain products blocking the complete utilization of sugar for the manufacture of ATP. Then the body switches to a very inefficient system of generating ATP. The breakdown of protein occurs in muscles and other tissue, resulting in damage to the affected parts of the body. This is associated with pain, decreased function, and fatigue. Muscle spasms occur in hypoxic tissues creating a vicious cycle that worsens the condition by further decreasing the oxygen supply and food substances needed for ATP production.

Malic acid has the ability to increase the utilization of substances needed for ATP synthesis. Malic acid has an oxygen sparing effect because of its ability to generate ATP efficiently using sugar as fuel even under low oxygen conditions. The increased ATP production under hypoxic conditions reverses the spasms of the blood vessels and increases the amount of oxygen and food substances available to muscles and other tissues. This prevents breakdown of proteins from muscles and other tissues. From all of the scientific data available there are no known contraindications to the use of malic acid.

The other major substance used with malic acid is magnesium. Magnesium is the fourth most abundant mineral in the body and the second most abundant in the muscles as well as other organs. Magnesium is the number one stress mineral in the body. All chronic pain sufferers, especially fibromyalgia sufferers have a deficiency of magnesium. The body must have an adequate amount of magnesium intake for the proper production of ATP action. When a patient reaches the level of magnesium needed for their body, the pain, muscle spasms, and trigger points usually decrease within 48 hours. Often, the level of serum magnesium is



normal, but the patient hurts. Sometimes magnesium needs to be given intramuscularly or intravenously to elevate the level of magnesium.

Malic acid is helpful with liver disease helping the liver eliminate ammonia that is very toxic to the brain. Magnesium is required in adequate amounts for the normal activity of 300 enzymes including the transfer of energy from food to ATP and the transfer of ATP energy to physical and mental activity. ATP works by forming a complex with magnesium. Therefore, adequate magnesium intake is essential for ATP production and action.

The use of magnesium and malic acid in combination was investigated at the University of Texas Health Science Center in San Antonio, Texas. Twenty-four fibromyalgia patients were given malic acid and magnesium in dose escalation trials.


Their finding demonstrated a significant reduction in pain and tenderness after six months of nutritional therapy. The dose amount used was 200 mg. of malic acid with 500 mg. of magnesium, up to 6 tablets, twice daily. Their conclusion was malic acid and magnesium is safe and may be beneficial in the treatment of patients with fibromyalgia.

This study was reported in the Journal of Rheumatology, May 1995.

At the Pain & Stress Center 12 patients out of 12, aged 40 to 55, diagnosed with FM and chronic pain syndrome, noted a remarkable improvement in overall feeling. Patients received 1200 mg. per day, 600 mg. of malic acid in the morning and 600 mg. in the evening combined with magnesium and B6. They reported less stiffness, soreness, and fewer trigger points. About 50% required less trigger point injections after 2 weeks. After 90 days all of the patients were able to return to normal activities and regular exercise such as walking and swimming.

Interviews with FM patients revealed many similar symptoms. The number one problem is pain. Often, the major area is pain between the shoulder blades, followed by head and neck pain. Patients with FM describe a sensation of painful knots in their muscles or the sensation of a hot, burning knife being pressed into their bodies. Sometimes dull aches in the shoulder, thigh, and hip muscles accompany the knotty muscles. About 75% of FM sufferers report morning stiffness and soreness in the shoulders and upper back. Other related conditions that occur in individuals with FM include fatigue, TMJ, mitral valve prolapse, tension headaches, spastic colon, irritable bowel syndrome, hypothyroidism, irritable bladder syndrome, chest pain in the cartilage and muscles of the chest wall, knee cap pain, sleep disturbances, muscle spasms with trigger points, paresthesia (sensations of numbness or tingling) in arms or legs, and feelings of excessive dryness in mouth and eyes. Cognitive problems such as difficulties with thought processes, concentration, thinking and remembering clearly, anxiety, and depression have been reported. Many patients with FM have great difficulty carrying out the tasks of daily life because they have neurotransmitter deficiencies.

Glutamine is an inhibitory neurotransmitter and the precursor for GABA, the anti-anxiety amino acid. Glutamine helps the brain dispose of waste ammonia, a protein breakdown by-product that is irritating to brain cells, even at low levels. Recent scientific research on glutamine demonstrates its link to the most important functions of the body’s vital organs and musculoskeletal system.

Glutamine aids the body in muscle development when illness causes muscle-wasting occurring after a high fever, chronic stress, illness, or a traumatic accident. When glutamine is taken with balanced amino acids, it essentially prevents muscle breakdown (atrophy). Glutamine studies reported those who were intellectually impaired demonstrated an increase in IQ after taking glutamine in combination with Huperzine A and B6.