_{©Marilyn J. Kerr RN 1997-2001}

Updated June 26, 2001 and undergoing a major re-write

• Substance P (High)
• L-Carnitine/Acetylcarnitine (Low)
• L-Alanine (Low)
• L-Serine (Low)
• L-Lysine (Low)
• L-Histidine (Low)
• L-Proline (Low)
• L-Threonine (Low)
• Dopamine/Norepinephrine (Low)
• Growth Hormone (Low)
• Calcium (Low)
• Calcitonin (Low)
• Interferon-gamma (High)
• Kynurenine
• DHEAs (Low)
• Magnesium (Low)
• CRH (Low)
• Cytokine (High)
• Serotonin (Low)
• Somatomedin C (Low)
• L-Tryptophan (Low)
• NADP (Low)
• Natural killer (NK) cells (Low)
• Cortisol (Low)
• Pyruvate (High)
• Prolactin (High)
• NADH (Low)
• ATP(Low)
  

Serotonin deficiency can result in non-restorative sleep, depression, increased stress, increased appetite, increased pain perception in the peripheral, spinal, and central nervous system levels, IBS, and influences the function of Substance P. (6) Supplementation of serotonin, in the form of 5HTP, has proven effective in the treatment of migraines. (3)

L-Tryptophan is an essential amino acid whose availability is also required for protein synthesis, so functions that depend on replacement proteins, such as skeletal muscle repair, might suffer. Tryptophan can be metabolized to serotonin or can take an alternate metabolic route through the kynurenine pathway. The deficiency, combined with the deficiency of IFG1and DHEAs may be responsible for the intolerance to and delayed recovery from physical exercise.

The diversion of tryptophan to kynurenine would decrease the level of tryptophan for serotonin synthesis, so the level of serotonin would fall, making pain perception and deep sleep more problematic. (6)

Interferon-gamma is a cytokine that is released in response to viral or bacterial infections. It is unknown why it is elevated in such a non-inflammatory disorder as FMS. It is capable of causing the depletion of serum NADP. (6)

Pyruvate is elevated in the blood, and the pyruvate/lactic acid ratio is abnormal because lactic acid production is diminished. (11) It is thought that this contributes to our muscular pain.

Substance P is normally released in the spinal cord in response to peripheral stimuli. It is then involved in the early stages of pain signaling, so the elevation could amplify the perception of pain. The cerebral spinal fluid (CSF) has three times as much Substance P in FMS than those without, but has found to be of normal levels in blood. CSF Substance P does not increase in response to painful pressure on tenderpoints. The research findings indicate that Substance P is not acting alone, but that it is a "second hit" biochemical abnormality that is possibly related to serotonin. A decrease in brain serotonin which causes a decrease in brain Substance P results in an increase in the CSF Substance P content. The serotonin and Substance P abnormalities may be responsible for the low corticotrophin releasing hormone (CRH), ACTH, and Growth Hormone. (6) (7)

ATP deficiency results in muscle tissue breakdown and mitochondrial damage. NADP is a cofactor of the enzyme KMO which is involved in the tryptophan metabolism. NADH is also part of that metabolism. (6)

Cortisol deficiency indicates poor adrenal function. Cortisol has many roles in body function, including the regulation of protein, carbohydrate, lipid and nucleic acid metabolism. It also stimulates enzyme production in the liver.

DHEA, the most abundant hormone found in the bloodstream, is a weak androgenic steroid with anti-viral, immune system regulating, metabolic and brain enhancing properties. (12) A deficiency is suggested by cold hands, temperature regulation, dry skin, and brittle hair.

Prolactin elevation occurs in some subsets of FMS and they present with more pain than others.

Cytokine elevation results from immune system dysfunction and causes increased vitamin utilization. (4) Cytokines are soluble proteins produced by the cells in the immune system (among other places). They act as messengers between cells and the messages they carry usually deal with cell growth, differentiation, survival, or death. Cytokines alter production of neuroendocrines and neurotransmitters, e.g., Growth Hormone and Nitric Oxide. (9)

Human Growth Hormone is secreted by the pituitary gland in the brain. Like all hormones, it works to regulate the activities of the vital organs, and thus helps maintain health throughout the body. HGH regulates more than growth. Tissue repair, healing, cell replacement, organ health, bone strength, brain function, enzyme production, and the health of the nails, hair, and skin all require adequate amounts of HGH. In addition, this hormone strengthens the immune system and helps the body resist oxidative damage. Deficiency interferes with sleep regulation and, in a Catch 22, is secreted during Stage 4 sleep. L-arginine promotes the production of HGH. It can be stimulated by exercise in normal individuals, but not in FMS.

Magnesium deficiency could result in decreased transmission of nerve and muscle impulses, causing irritability, nervousness, confusion, poor digestion, rapid heartrate, seizures, and tantrums. Magnesium deficiencies may be at the root of many cardiovascular problems, hypertension, asthma, fatigue, pain, depression, insomnia, IBS, and pulmonary disorders. (12)

L-Carnitine/Acetyl L-carnitine, a substance related to the B vitamins, is made from the amino acids L-methione and L-lysine, has a major role in the metabolism of fat and in the reduction of triglycerides by increasing fat utilization. It transfers fatty acids across the membranes of the mitochondria where they can be utilized as sources of energy. It can be synthesized in the liver if sufficient amounts of lysine, B1, B6, and iron are available. Carnitine reduces the health risks posed by poor fat metabolism associated with diabetes; inhibits alcohol-induced fatty liver; and lessens the risk of hear disorders. (12) Deficiency has been implicated in some forms of heart disease, immune system depression, fatigue, angina, muscle weakness, and/or confusion. Researchers have found that higher levels of L-carnitine in CFS patients correlated with better functional capacity (2)

Low L-Alanine would cause difficulties in the metabolism of glucose, a simple carbohydrate the body uses for energy. (12)

Low L-Histidine would cause the body to have difficulties in the repair of tissues, ulcers, hyperacidity, and digestion. It is important in the maintenance of the myelin sheaths that protect nerve cells. Normal levels are needed for treatment of allergies, rheumatoid arthritis, anemia, and in the production of white and red blood cells. (12)

L-Lysine is an essential building block for all proteins. It can aid in the lowering of triglycerides. Low levels would cause anemia, enzyme disorders, hair loss, an inability to concentrate, irritability, lack of energy, non-absorbency of calcium, increased susceptibility to herpes and other viruses, decreased ability to produce antibodies, hormones, and enzymes, and the repair of tissues. (12)

Low L-Proline would cause difficulties with collagen formation, healing cartilage, strengthening joints, tendons, and heart muscle. It works with Vitamin C to promote healthy connective tissue. (12)

L-Serine is necessary for the proper metabolism of fats and fatty acids, muscle growth, the maintenance of a healthy immune system, and for the production of immunoglobulin and antibodies. (12)

L-Threonine helps to maintain the proper protein balance in the body. It aids in the formation of collagen, aids liver and lipotropic function when combined with L-aspartic acid and L-methionine. It aids the immune system by aiding in the production of antibodies. (12) It helps control epileptic seizures. (10)

Total and free serum calcium and calcitonin levels were significantly lower in patients with primary FM. (8) This may be the explanation for our osteoporosis. Deficiency of calcium may lead to aching joints, brittle nails, high cholesterol, heart palpitations, high blood pressure, insomnia, nervousness, numbness of the arms or legs, pasty complexion, rheumatoid arthritis, rickets, and tooth decay. Calcium is necessary to prevent muscle cramps, provides energy, and is necessary for the maintenance of proper cell membrane permeability, aids in neuromuscular activity, and helps to keep the skin healthy. (12)

NK cells are consistently decreased in FMS. (5) Low NK cells make it difficult for the immune system to fight candida infections, or cancers.

Depressed levels of Somatomedin C, caused by a deficit of stage 4 sleep-dependent release of HGH, might represent an additional factor in preventing proper development or repair of myoskeletal structures. (1)

References

1. Neuromediator and hormonal perturbations in fibromyalgia syndrome: results of chronic stress? Neeck G; Riedel W; Baillieres Clin Rheumatol, 8:763-75, 1994 Nov

2.Serum levels of carnitine in chronic fatigue syndrome: clinical correlates. Plioplys, AV and Plioplys S.; Neuropsychobiology, 1995, 32: 132-138.

3.Fibromyalgia and migraine, two faces of the same mechanism. Serotonin as the common clue for pathogenesis and therapy.Nicolodi M; Sicuteri F.; Adv Exp Med Biol, 398:373-9, 1996

4.Parkinson's Disease UPDATE Newsletter; Reprint from UPDATE Newsletter, Issue #54, 1995,; Medical Publishing Company, Philadelphia, PA.

5.Review of laboratory findings of patients with chronic fatigue syndrome.; Buchwald D, Komaroff A.; Rev Inf Dis 13 (suppl1):S12-18, 1991

6.Biochemical Abnormalities in Fibromyalgia Syndrome; I.J. Russell, Journal of Musculoskeletal Pain' May 1995

7.Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in patients with chronic fatigue syndrome; Demitrack MA; Dale JK; Straus SE; Laue L; Listwak SJ; Kruesi MJ; Chrousos GP; Gold PW; J Clin Endocrinol Metab, 73:1224-34, 1991 Dec

8.Thyroid function in patients with fibromyalgia syndrome; Neeck G; Riedel W; J Rheumatol, 1992 Jul, 19:7, 1120-2

9. Int Arch Allergy Immunol; 1995 Feb; Krueger JM; Majde JA;

10. Serum amino acids in fibrositis/fibromyalgia syndrome.;Russell IJ; Michalek JE; Vipraio GA; Fletcher EM; Wall K; J Rheumatol Suppl, 1989 Nov, 19:, 158-63

11. Glycolysis abnormalities in fibromyalgia; J Am Coll Nutr 1994 Apr;13(2):144-148; Eisinger J, Plantamura A, Ayavou T

12. Prescription for Nutritional Healing, 2d Ed, JF and PA Balch, 1997, Avery Publishing Group.