My Regimen by Miryam Williamson, 

author of Fibromyalgia: A Comprehensive Approach

and

The Fibromyalgia Relief Book

Revision date: May 25, 2000 
Permission is granted to download, print, copy, and distribute this document, as long as you do not sell it. Support group leaders: Accepting contributions to cover copying costs is not the same as selling. 

Here is my regimen for dealing with fibromyalgia. Most of the time it works for me and I am able to function quite well. No two people with fibromyalgia have identical reactions to anything, so I would be irresponsible if I were to tell you to do as I do.  Instead, I suggest you use this as a guide in finding what works best for you.
 

Nutrition: 

Until late in 1997 I ate a what I thought was a very healthy diet: about 50% complex carbohydrates, 20% proteins, and 30% fats (avoiding hydrogenated and saturated fats as much as possible.) Refined sugars were almost entirely absent from my diet and I rarely ate red meat more than once a week. 

Then a combination of circumstances weakened my immune system to the point where the yeast that normally inhabits my gut, as it does with everyone, grew out of control, inspiring me to look for dietary remedies. Now I am on a high protein, low carbohydrate diet consisting almost entirely of animal proteins and vegetables, no starches and no fruits. Yeasts eat starches and sugars; if you deprive them of food, they eventually starve to death. 

I thought I'd go back to a "normal" diet when I was sure my yeast was gone, but I have decided not to do so.  To my surprise, I find the diet quite satisfying.  I have lost all interest in sweets. I am no longer overweight -- by my standards, not the insurance company charts.  (If I weighed what the charts say --and I have, in earlier times -- I'd be gaunt.) I have more energy than ever before in my life.  The reason: in my case, insulin turns carbohydrates into fat instead of energy.  This, I believe, has been the cause of my fatigue in years past. The condition I've just described is called insulin resistance.  It's the subject of my current research.  Eventually I'll write about it.

Instructions for the yeast elimination diet are in in John Trowbridge's 1985 book The Yeast Syndrome.  It's back in print after a long absence.  It is, in my opinion, the best of all the books on yeast. If you want to try this and can't find the book, try instead Dr. Paul St. Amand's suggested diet for hypoglycemia, which you'll find on this site. The way I eat now (I don't consider it a diet in the weight-loss sense) is based on Dr. Atkins' New Diet Revolution by Robert C. Atkins M.D. I count carbohydrates, not calories.  I maintain my weight at 40 grams of carbohydrates a day. A typical slice of bread contains 20 grams of carbs, which gives you an idea of what this way of eating means. It's worth it for me.  If you try this, you must drink at least eight 8-oz. glasses of water a day or risk developing kidney stones.

Nutritional Supplements:

I take one cod liver oil capsule (Vitamins A and D) daily, which helps me to avoid the winter blahs that come to so many of us who live in northern climates where the sun is scarce in the winter. I used to take it only from November through March or April but now I take it year 'round because of the crucial role Vitamin D plays in the absorption of calcium and prevention of osteoporosis.

I also take: 

Beta carotene, equivalent to 10,000 IU vitamin. A. For a few months I took 25,000 IU of regular Vitamin A, as an experiment to see if it will help my hearing. (The cochlea contains 10 times as much Vitamin A as any other part of the body.) It didn't. I wouldn't recommend that anyone else try this experiment, though. Vitamin A becomes toxic at around 40,000 IU per day. An oil based vitamin, A is not excreted in the urine the way the water based vitamins are. (Vitamins D and E are also oil-based.) 

B-100 B complex, 1/day. This is a very high dose, but not enough to be dangerous. (The reported B-6 toxicity case of a few years ago was in a man who was taking 6 grams a day. That's 6000 mg.) I need extra Bs because I was malnourished as a child and that particular deficiency stays with you always. One B-50 or B-100 is good for many people, particularly those with PMS. Get the yeast free variety (Schiff is one manufacturer.)  I read recently that yeast devours B vitamins. Since B vitamins are required for the synthesis of serotonin, yeast overgrowth could cause depression, increased pain, and other problems associated with serotonin deficiency -- and with fibromyalgia. 

Vitamin C, 500 mg./day; more (up to 8000 mg., or 8 grams, 2000 mg at meals and bedtime) if I feel a cold coming on. I had influenza iin 1998, for the first time in 35 years, and the C didn't help me one bit.  But the last time I had a cold was September 1985. I also find zinc (50 mg. at meals and at bedtime) very beneficial for colds. I wouldn't make a habit of taking this much zinc, but for two or three days there's no danger of toxicity. (Overdosing on zinc causes a deficiency in copper, another trace mineral necessary to our well-being in tiny quantities.) 

Vitamin E, 400 I.U. Up to 1,200 is ok, and useful if you have restless legs or leg cramps. Some people find Vitamin E helpful in achieving deeper sleep and take it at bedtime. 

Mega-multi minerals (bought from Star Pharmaceutical); probably more than you'd need. Our well water has no minerals at all, which can lead to serious health problems. We supplement this way. 

Calcium (1000 mg.) and Magnesium (500 mg.) combination. Also good for pain, especially leg cramps. Calcium is constipating, magnesium can cause diarrhea; the two together give me no problems. The recommended ratio of calcium to magnesium is 2 or 2.5 to 1. 

Co-enzyme Q10, 50 mg. This antioxidant is an essential component of the mitochondria, the energy producing unit of the cells. It is found in virtually all plant and animal foods, but dietary sources are too small for clinical effects. Vegetarians have higher plasma levels than meat eater. Clinical levels of CoQ10 are used for cardiovascular diseases such as congestive heart failure, high blood pressure, cardiomyopathy, and mitral valve prolapse (which is common among people with FM). The usual dose is 50 to 150 mgs per day, or 2 mg. per kg (2.2 lbs.) of body weight. Another plus for people with FM is that CoQ10 can help reduce cardiac side effects of some psychoactive drugs, including phenothiazines, and tricyclic antidepressants. I don't take any such drugs, but I'd take more CoQ10 if it weren't so expensive. 

Pregnenolone, 50 mg. Like 5-htp, pregnenolone is a hormone precursor rather than an end product. It has no known toxicity.  What isn't needed isn't used. It is a known anti-inflammatory. In 1995 the National Academy of Sciences reported that pregnenolone is by far the most effective supplement for improving memory. It is a precursor to DHEA, which is one of the most versatile of hormones in that it can be converted into estrogen, testosterone, progesterone, or adrenaline, depending on what the body needs.  Pregnenolone also increases energy metabolism (the main reason I take it.)  It is also said to have anti-depressant qualities. 

[ Note: I wrote here before about taking Evening Primrose Oil. I know it helps some people with FM, and it has been found to help with eczema, PMS, hypertension, obesity, ADD, psoriasis, and chemical sensitivity.  It contains gamma-linolenic acid, which tends to strengthen the cell membrane, making people less chemically sensitive. I tried it in connection to yeast overgrowth.  It didn't help me, so I stopped it.  It is a source of salicylates, which people taking guaifenesin want to avoid.]

Until recently I took chromium picolinate, 200 mcg. Also supposed to be for energy, but its real purpose for me was to stabilize my blood sugar level and minimize carb cravings. It definitely helped in that department, but the way I eat now, I don't need it. I used to be a reactive hypoglycemic. (Amitriptyline, which I no longer take, causes carb cravings and weight gain. I didn't gain weight in the 17 months I was on amitriptyline, which is quite unusual. I ascribe it to the chromium picolinate, not to any superior will power.) 
 

On awakening, well before breakfast:

Armour thyroid 90 mg, which I've recently substituted for 150 mcg of Levothroid (thyroid replacement hormone).  I was diagnosed as hypothyroid long before my fibromyalgia diagnosis.  An underactive thyroid can produce some of the symptoms associated with fibromyalgia, particularly lethargy, depression, and achiness, and is one of the perpetuating factors for fibromyalgia. Everyone with a fibromyalgia diagnosis should be tested for thyroid function by a doctor who knows how to read the results.  It's a bit more complicated than just looking at numbers.  Ratios of one number to another also count. 

L-tyrosine 500 mg. This is a precursor to dopamine and norepinephrine. I use it to strengthen my adrenals and improve my energy level. It also stimulates the release of thyroid hormone. I started down this road by taking L-phenylalanine, which is a precursor to L-tyrosine, but decided (intuitively, with no research to back me up) that L-tyrosine would be more efficient. For quite a while I thought my thyroid hormone was under-replaced but my doctor is afraid to increase it because too much replacement can cause osteoporosis and heart problems.  Since I've been taking L-tyrosine I no longer feel under-replaced.  Also, many people with fibromyalgia have inadequate adrenal hormones.  I think I am one of those people (my reaction to adrenaline surges is profound and distressing). 
 

For sleep:
 

Before bed I take 5-htp 200 mg.( roughly equivalent to 1000 mg of L-tryptophan), melatonin 1 mg., diphenhydramine (Benadryl) 25 mg. From May 1995 until August 1999 I took 300 mg, and if I had two poor nights in a row, I'd increase the 5-htp to 400 mg. (the approximate equivalent of 2000 mg of L-tryptophan) for a night or two. I read recently that it is possible to use 5-htp to achieve a lasting increase in available serotonin, so I decided to decrease the bedtime dose and find I sleep just as well.  Some time in the future I'll decrease it further and when I'm feeling really brave I'll go without it for a while to see if I really need it at all. 

If you try diphenhydramine, be sure it's not mixed with a nasal decongestant. The label should say it's for allergies, and not for colds or sinus problems. 

Throughout the day:
 

From early 1994 until June 1999 I took Guaifenesin 600 mg twice a day. I stopped to test whether I still need it and found that I felt no different without it.  This is the third time I challenged guaifenesin this way; the other two times I felt worse without it and resumed taking it. I know of the study that says its effect is no better than a placebo.  But a placebo effect usually lasts no more than three weeks and it helped me for more than five years. Two articles about guaifenesin by R. Paul St. Amand, MD, a person with FM himself and the originator of the treatment, are here. One is addressed to patients, the other to physicians. I am not as rigorous about avoiding salicylates as I should be to obtain maximum benefit from guaifenesin, but it still helps me.

Sleep hygiene:

I'm in bed between 9:30 and 10 p.m. almost every night, lights out between 10 and 11. I wake up around 6, most days rested and refreshed and ready to start the day. The way I feel during the day is in direct proportion to the quality of my sleep. If I sleep well, cognitive difficulties are rare. This is true of most people with fibromyalgia, if not all. 

Exercise:

Another very important component to my well-being. I do about 15 minutes of floor stretching and strengthening exercises and ride a cross trainer aerobically for 30 minutes at moderate resistance (#8 on a scale of 10). I do this 6 days a week, giving myself Sundays off so it doesn't feel like a life sentence. The effect on me of failing to exercise is truly dramatic. If I stop, within a few days my pain level starts to climb and I start to feel depressed. There is no question about it: the depression is chemical and the exercise raises my endorphin level.  Endorphins are the brain's natural painkillers and also metabolize into serotonin.  Low serotonin, a characteristic of most people with fibromyalgia,  is associated with depression and also with a high level of the neurohormone Substance P, the brain chemical that signals pain. 

One of the most important lessons I have learned is that morning achiness is a trap, trying to keep me from exercising, but if I don't exercise I feel much worse than if I do. Some days I am easier on myself than others in the number of reps of the floor exercises that I do and the amount of resistance on the cross trainer, but even on my worst days I do some aerobic exercise. 
 

Body work:

I have nothing against massage and physical therapy and know that they benefit many people. But instead of that kind of body work, for about 18 months I took lessons in the Alexander Technique of body mechanics. This is a very gentle way of learning to hold your body for maximum mechanical advantage and minimum pain. Alexander teachers (they are not therapists and do not claim cures) can be found in many cities, particularly where there is a good deal of musical activity. Musicians, typists, and anyone whose work requires them to hold their body in a particular position for a long time, are prime candidates to benefit from Alexander lessons. I stopped my Alexander lessons when I felt I was no longer making progress.  If my aches return, I'll be back for more lessons in a flash.  I also plan on taking a refresher course from time to time.  If you want to know more, visit the American Society for the Alexander Technique, but don't forget to come back to this site if you want the rest of the information that is here. 

For Pain:

After a lifetime of chronic pain, I've come to the point where I rarely need anything for pain relief; and when I do, a couple of extra strength acetaminophen (brand name is Tylenol) tablets are sufficient. But I've found something that works for chronic pain in about 85% of people who try it, is not habit forming, and has no known side effects.  It's called DLPA (D-L-phenylalanine) and is available in health food stores.  It is not the same as L-phenylalanine, which I mentioned in the paragraph on L-tyrosine, above; don't get the two substances mixed up.  The typical dose is one 500 mg. capsule three times a day, usually a half hour before meals.  It can take up to three weeks to take full effect, so it's not good for pain that comes on suddenly, but I know of people who have been able to wean themselves off of pain drugs after the DLPA worked its way into their systems.  When I need it, it starts working within 24 hours. 

DLPA works by inhibiting the enzyme that breaks down endorphins, the brain's own morphine-like chemical that relieves pain.  The longer it takes for endorphins to break down, the more pain relief you get. 

According to Leon Chaitow, DO, ND, author of Thorsen's Guide to Amino Acids, and my source of information on this subject, if DLPA doesn't work within three weeks it's ok to double the dose for a week.  If it hasn't worked by then, it's not likely ever to work. 
 

How I am now:

I am sleeping well almost every night, and relatively pain-free (at least I don't have enough pain to complain about, and it doesn't keep me from doing anything I want to do, including sleep.). I do have hypermobile shoulders and knees that hurt sometimes, and a touch of costochondritis, but I rarely have the generalized achiness and shooting pains that used to be a constant part of my life. I have been in remission from significant pain since early May, 1995. 

I hope this helps. Write to me if you have questions. Remember that every person with FM is different. Experiment, take notes on your results, and you'll find your ideal balance, too. Good luck. 

Copyright ©1999, Miryam Ehrlich Williamson - ALL RIGHTS RESERVED



 

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