What Is Fibromyalgia?

What Is Fibromyalgia? Exploring Causes, Treatments, and Lifestyle Strategies

Fibromyalgia (FM) is a complex and often misunderstood condition characterised by widespread chronic pain, fatigue, and cognitive disturbances. While it has long been classified as a neurological disorder affecting pain processing, emerging research suggests links between fibromyalgia and autoimmune diseases. Additionally, factors such as gut health, inflammation, mould exposure, mitochondrial dysfunction, and stress may contribute to its onset. In this blog, we will explore what fibromyalgia is, its symptoms, causes, and evidence-based supplements and lifestyle strategies that may help manage the condition.

What is Fibromyalgia?

Fibromyalgia is a chronic disorder primarily affecting the musculoskeletal system. It is known for causing widespread pain, fatigue, sleep disturbances, and cognitive issues (often referred to as “fibro fog”). Unlike conditions such as arthritis, fibromyalgia does not cause inflammation or damage to the joints, muscles, or soft tissues. Instead, it is thought to be a disorder of pain regulation in the central nervous system.

While the exact cause remains unknown, researchers believe that fibromyalgia results from a combination of genetic, environmental, and psychological factors. It is also commonly associated with other conditions like irritable bowel syndrome (IBS), chronic fatigue syndrome, and autoimmune diseases such as rheumatoid arthritis and lupus.

What Are the Symptoms of Fibromyalgia?

Fibromyalgia symptoms vary from person to person, but some of the most common include:

• Widespread pain: A dull, aching pain that occurs on both sides of the body and above and below the waist.
• Fatigue: Persistent exhaustion that does not improve with rest.
• Cognitive issues (“fibro fog”): Problems with memory, concentration, and mental clarity.
• Sleep disturbances: Difficulty falling or staying asleep, or waking up unrefreshed.
• Headaches and migraines.
• Irritable bowel syndrome (IBS) and digestive issues.
• Depression and anxiety.
• Sensitivity to touch, noise, light, and temperature.
• Tingling or numbness in hands and feet.
• Joint stiffness in the morning.

What Causes Fibromyalgia?

While the exact cause of fibromyalgia remains elusive, multiple factors may contribute to its development. In fact, I would argue that it is often the result of an accumulation of stresses and strains on the mind and body rather than the result of one specific thing. Research aligns with this opinion too (source).

Below though, we explore some of the leading theories and emerging research.

The Gut Microbiome, SIBO, and Leaky Gut

There is increasing evidence that gut health plays a role in fibromyalgia (source, source). In fact the microbiome has been causally associated with fibromyalgia (source).

• Gut Dysbiosis: A 2024 literature review suggests that fibromyalgia patients often have an altered gut microbiome compared to healthy individuals.
• Small Intestinal Bacterial Overgrowth (SIBO): Some fibromyalgia patients also test positive for SIBO, a condition where excessive bacteria in the small intestine cause bloating, pain, and malabsorption. In fact results correlate with degree of pain (source).
• Leaky Gut Syndrome: A compromised intestinal lining may allow toxins and bacteria to enter the bloodstream, triggering systemic inflammation that could contribute to fibromyalgia symptoms (source).

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Chronic Inflammation

Recent studies have shown that fibromyalgia is associated with low-grade inflammation. Elevated levels of pro-inflammatory cytokines (such as IL-6 and TNF-alpha) have been found in fibromyalgia patients, suggesting a potential immune system dysfunction (source, source).

Mould and Mycotoxins

While there is no research in this area, anecdotally practitioners experienced in this area will confirm the link.

Exposure to mould and mycotoxins has been linked to fibromyalgia-like symptoms. Mycotoxins can trigger systemic inflammation, mitochondrial dysfunction, gut issues, and dysregulated immunity – all of which are associated with fibromyalgia.

Autoimmune Disease Connection

Although it is not classified as an autoimmune disease, it frequently coexists with autoimmune conditions (source, source, source) such as:

• Rheumatoid arthritis (RA)
• Lupus (SLE)
• Hashimoto’s thyroiditis
• Sjögren’s syndrome

Mitochondrial Dysfunction

This study (source) looked at the energy-producing structures inside cells (called mitochondria) in people with fibromyalgia (FMS). Researchers compared 50 individuals with FMS to 20 healthy individuals to see if there were differences in how well their cells produced energy.

While the basic energy output of the cells was similar between the two groups, those with fibromyalgia showed lower overall mitochondrial health. This was measured using something called the Bioenergetic Health Index (BHI), which gives a general picture of how well the mitochondria are functioning. On average, people with fibromyalgia had a 22% lower BHI than those without the condition.

The researchers also found that the worse a person’s fibromyalgia symptoms were—based on a score that measures pain and other symptoms—the lower their mitochondrial health tended to be. In other words, people with more severe fibromyalgia symptoms had less efficient energy production in their cells.

The results suggest that fibromyalgia may be linked to a reduced ability of the body’s cells to produce energy, particularly in muscle and connective tissue, rather than in the brain or nervous system.

Stress and Trauma

Fibromyalgia is often triggered by physical trauma, emotional stress, or infections. Chronic stress leads to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, contributing to widespread pain and fatigue.

In fact a systematic review and meta-analysis of case-control studies concluded that there is a significant association between life time stressor exposure and adult fibromyalgia (source).

Nutrient Deficiencies

Nutritional deficiencies that may contribute to fibromyalgia include:

• Magnesium: Essential for muscle relaxation and nerve function.
• Vitamin D: Low levels have been linked to increased pain sensitivity.
• B Vitamins: Deficiencies may affect nerve health and energy metabolism.
• Coenzyme Q10 (CoQ10): May support mitochondrial function and reduce fatigue.

Research has shown that when nutrient status is improved, pain levels usually improve too (source).

Fibromyalgia Treatments

What Supplements Have Evidence for Helping Fibromyalgia?

Several supplements have been studied for their potential to relieve fibromyalgia symptoms:

• Magnesium: Magnesium is often regarded as one of the most promising non-pharmacological options for managing fibromyalgia (FM). Despite its potential, clinical research in this area remains limited, with only two formal trials conducted to date. The first study, published in 1995 by Russell and colleagues, explored the effects of magnesium combined with malic acid in 24 women diagnosed with FM. At lower doses and shorter treatment durations, the intervention had minimal impact on pain or depressive symptoms. However, when the dosage and treatment length were increased, participants experienced notable improvements in pain levels and tenderness. A more recent study examined the combined use of magnesium citrate and amitriptyline compared to amitriptyline alone in 60 women with FM. Findings indicated that the combination therapy yielded greater benefits across all measured outcomes than amitriptyline by itself. (source).
• Vitamin D: In one study, the researchers found that 65.6% of patients had deficiency or severe deficiency in vitamin D levels, and 12.2% had vitamin D insufficiency. 77.8% of the patients required vitamin D replacement. In these patients, there was a significant reduction in pain scores after supplementation.
• CoQ10: Research has consistently shown that low levels of this coenzyme are a common characteristic among fibromyalgia patients, highlighting the potential benefits of supplementation. Over time, studies examining the effectiveness of this approach have grown, suggesting a positive link between CoQ10 supplementation and symptom relief, particularly in reducing fatigue, one of the most prominent symptoms of fibromyalgia (source).
• Omega-3 Fatty Acids: The results of one study showed that a high dose of omega-3 could have a positive effect on the relief of pain, which could be due to an increase in serum Mg and Ca levels (source).
• L-Carnitine: In one study both groups (the placebo group and the experimental group) experienced a significant and comparable reduction in the “total myalgic score” and the number of positive tender points up to the sixth week of treatment. By the tenth week, these measures remained stable in the placebo group but continued to improve in the group supplementing l-carnitine, showing a statistically significant difference between the two. While most scores improved notably in both groups, significant differences emerged between them regarding depression and musculoskeletal pain. Additionally, the supplementation group showed greater improvements across most parameters of the questionnaires compared to the placebo group. (source).
• 5-HTP: There’s research dating back to the 1980’s showing 5-HTP to be helpful for fibromyalgia. One study (source) found that all the clinical parameters studied were significantly improved by treatment with 5-HTP.

What Lifestyle Strategies Help with Fibromyalgia?

Diet

A paper published in Nutrients in 2020 (source) found that various diets reduce the symptoms of fibromyalgia including:

• The administration of olive oil.
• The replacement diet with ancient grains.
• Low-calorie diets.
• The low FODMAPs diet.
• The gluten-free diet.
• The monosodium glutamate and aspartame-free diet.
• Vegetarian diets.
• The Mediterranean diet

This to me suggests that ultimately a whole food, nutrient dense, anti-inflammatory diet may suffice. It also suggests that diet shouldn’t be the focus in any health plan.

Exercise

A Ssystematic review and meta-analysis of randomised clinical trials concluded that aerobic and muscle strengthening exercises are the most effective way of reducing pain and improving global well-being in people with fibromyalgia and that stretching and aerobic exercises increase health-related quality of life. In addition, combined exercise produces the biggest beneficial effect on symptoms of depression (source).

Mindfulness and Stress Reduction

Chronic stress exacerbates fibromyalgia symptoms, making stress management essential. Research-backed techniques include:

• Meditation and Mindfulness-Based Stress Reduction (MBSR) (source)
• Deep breathing exercises (source)
• Cognitive Behavioural Therapy (CBT) (source)
• Acupuncture and Massage Therapy (source)

Conclusion

Fibromyalgia remains a complex and poorly understood condition, but ongoing research is shedding light on its potential causes and management strategies. While it is not officially classified as an autoimmune disease, it shares several characteristics with autoimmune disorders and is often seen in conjunction with them. Addressing gut health, reducing inflammation, managing stress, and incorporating targeted supplements and lifestyle changes can significantly improve symptoms and quality of life.

As research evolves, a more personalised approach to fibromyalgia treatment will likely emerge, helping millions of individuals find relief and reclaim their well-being.