A Nutritional supplementation intervention with coenzime Q10, Tryptophan and Magnesium for the management of Fibromyalgia symptoms

Main Article Content

Antonio Gómez-Centeno
Mercedes Ramentol
Maria J. González
Cayetano Alegre

Keywords

fibromyalgia, dietary supplementation, ICAF questionnaire, coenzyme Q10, magnesium, tryptophan

Abstract

Introduction and Objectives: Management of fibromyalgia syndrome (FMS) is challenging and requires a multidisciplinary strategy. This pilot study aimed to investigate the effects of a dietary supplementation (NSC) containing coenzyme Q10, magnesium and tryptophan on reducing fibromyalgia symptoms, and to assess its tolerability. Materials and methods: Patients underwent a 3 month-treatment with NSC followed by 1-month washout and 3 month-treatment with placebo. The Combined Index of Severity of Fibromyalgia (ICAF) was used to evaluate FMS main symptoms. Results: Twenty women completed the study, with a mean age of 51.9 (±7.2) years. Mean time since experiencing fibromyalgia symptoms was 7.7 (±6.3) years. Depression and anxiety were reported in 65.0% (13/20) and 30.0% (6/20) of cases, respectively. Fatigue and functional capacity improved after both treatment periods, whereas pain, sleep quality and impact enhanced only after NSC intake. Depression, anxiety symptoms and patients’ general health did not improve after treatment. Active coping strategies enhanced after study treatment (not after placebo treatment), while passive coping strategies worsened (even more after placebo treatment). The global ICAF improved after NSC treatment and declined after placebo treatment. No significant differences were found in any of the efficacy outcomes. NSC treatment was well tolerated, with a low incidence of adverse events (5.0%, 1/20). Discussion and Conclusions: Supplementation with NSC was effective in improving physical aspects of FMS such as fatigue, pain, sleep quality and functional capacity, as well as global well-being of patients. However, larger studies are needed to confirm the results of this pilot study and whether improvements observed could be statistically significant.

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References

(1) Macfarlane GJ, Kronisch C, Dean L, Atzeni F, Häuser W, Fluss E. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2016; 76:1–11.doi: 10.1136/annrheumdis-2016-209724.
(2) Goldenberg DL. Diagnosis and differential diagnosis of fibromyalgia. Am J Med 2009;122(12 Suppl):S14-21. doi: 10.1016/j.amjmed.2009.09.007.
(3) Moyano S, Kilstein JG, Alegre de Miguel C. New diagnostic criteria for fibromyalgia: Here to stay? [Article in English, Spanish]. Reumatol Clin 2015;11(4):210-4. doi: 10.1016/j.reuma.2014.07.008.
(4) Juuso P, Skär L, Olsson M, Söderberg S. Living with a double burden: Meanings of pain for women with fibromyalgia. Int J Qual Stud Health Well-being 2011;6(3). doi: 10.3402/qhw.v6i3.7184.
(5) Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995;38(1):19-28.
(6) Schmidt-Wilcke T, Diers M. New Insights into the Pathophysiology and Treatment of Fibromyalgia. Biomedicines. Biomedicines 2017;5(2). pii: E22. doi: 10.3390/biomedicines5020022.
(7) Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience 2016;338:114-129. doi: 10.1016/j.neuroscience.2016.06.006.
(8) Gran JT. The epidemiology of chronic generalized musculoskeletal pain. Best Pract Res Clin Rheumatol 2003;17(4):547-61.
(9) Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017;76(2):318-328. doi: 10.1136/annrheumdis-2016-209724.
(10) Ángel García D, Martínez Nicolás I, Saturno Hernández PJ. Clinical approach to fibromyalgia: Synthesis of Evidence-based recommendations, a systematic review. [Article in English, Spanish]. Reumatol Clin 2016;12(2):65-71. doi: 10.1016/j.reuma.2015.06.001.
(11) Bjørklund G, Dadar M, Chirumbolo S, Aaseth J. Fibromyalgia and nutrition: Therapeutic possibilities? Biomed Pharmacother 2018;103:531-538.doi: 10.1016/j.biopha.2018.04.056.
(12) Fatima G, Das SK, Mahdi AA. Oxidative stress and antioxidative parameters and metal ion content in patients with fibromyalgia syndrome: implications in the pathogenesis of the disease. Clin Exp Rheumatol 2013;31(6 Suppl 79):S128-33.
(13) Cordero MD. Estrés oxidativo en la fibromialgia: fisiopatología e implicaciones clínicas. Reumatol Clin 2011;7:281-3.doi: 10.1016/j.reuma.2010.12.007.
(14) Richard DM, Dawes MA, Mathias CW, Acheson A, Hill-Kapturczak N, Dougherty DM. L-Tryptophan: Basic Metabolic Functions, Behavioral Research and Therapeutic Indications. Int J Tryptophan Res. 2009;2:45-60. doi:10.4137/ijtr.s2129
(15) Sawaddiruk P, Apaijai N, Paiboonworachat S, Kaewchur T, Kasitanon N, Jaiwongkam T, et al. Coenzyme Q10 supplementation alleviates pain in pregabalin-treated fibromyalgia patients via reducing brain activity and mitochondrial dysfunction. Free Radic Res 2019; 53(8): 901-909. doi: 10.1080/10715762.2019.1645955.
(16) Cordero MD, Alcocer-Gómez E, de Miguel M, Culic O, Carrión AM, Alvarez-Suarez JM, et al. Can coenzyme q10 improve clinical and molecular parameters in fibromyalgia? Antioxid Redox Signal 2013;19(12):1356-61. doi: 10.1089/ars.2013.5260.
(17) Alcocer-Gómez E, Sánchez-Alcázar JA, Cordero MD. Coenzyme q10 regulates serotonin levels and depressive symptoms in fibromyalgia patients: results of a small clinical trial. J Clin Psychopharmacol 2014;34(2):277-8. doi: 10.1097/JCP.0000000000000097.
(18) Kirkland AE, Sarlo GL, Holton KF. The Role of Magnesium in Neurological Disorders. Nutrients 2018;10(6). pii: E730. doi: 10.3390/nu10060730.
(19) SarziPuttini P, Caruso I. Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90-day open study. J Int Med Res 1992;20(2):182-9.
(20) Juhl JH. Fibromyalgia and the serotonin pathway. Altern Med Rev. 1998 Oct;3(5):367-75.
(21) Lattanzio SM. Fibromyalgia Syndrome: A Metabolic Approach Grounded in Biochemistry for the Remission of Symptoms. Front Med (Lausanne) 2017;4:198. doi: 10.3389/fmed.2017.00198.
(22) Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016 Dec; 46(3):319-329.
(23) Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.
(24) Comeche MI, Ortega J, Rodríguez-Muñoz MF, Díaz MI, Vallejo MA. Estructura y adecuación del inventario de depresión de Beck en pacientes con fibromialgia. Psicothema2012;24(4):668-73.
(25) Vallejo MA, Rivera J, Esteve-Vives J. ICAF Group. Development of a self-reporting tool to obtain a Combined Index of Severity of Fibromyalgia (ICAF). Health Qual Life Outcomes 2010;8:2. doi: 10.1186/1477-7525-8-2.
(26) Romano TJ, Stiller JW. Magnesium deficiency in fibromyalgia syndrome. J Nutr Med 1994;4(2):165–167. https://doi.org/10.3109/13590849409034552.
(27) Maes M, Mihaylova I, Kubera M, Uytterhoeven M, Vrydags N, Bosmans E. Lower plasma Coenzyme Q10 in depression: a marker for treatment resistance and chronic fatigue in depression and a risk factor to cardiovascular disorder in that illness. Neuro Endocrinol Lett 2009;30(4):462-9.
(28) Lattanzio SM, Imbesi F. Fibromyalgia Syndrome: A Case Report on Controlled Remission of Symptoms by a Dietary Strategy. Front Med (Lausanne) 2018;5:94. doi: 10.3389/fmed.2018.00094.
(29) Bhagavan HN, Chopra RK. Coenzyme Q10: Absorption, tissue uptake, metabolism and pharmacokinetics. Free Radic Res 2006;40:445-53.
(30) Ochiai A, Itagaki S, Kurokawa T, Kobayashi M, Hirano T, Iseki K. Improvement in intestinal coenzyme q10 absorption by food intake. YakugakuZasshi 2007;127(8):1251-4.
(31) Neathery MW, Crowe NA, Miller WJ, Crowe CT, Varnadoe JL, Blackmon DM. Effects of dietary aluminum and phosphorus on magnesium metabolism in dairy calves. J Anim Sci 1990;68(4):1133-8.
(32) Moreno-Fernández AM, Cordero MD, Garrido-Maraver J, Alcocer-Gómez E, Casas-Barquero N, Carmona-López MI, et al. Oral treatment with amitriptyline induces coenzyme Q deficiency and oxidative stress in psychiatric patients. J Psychiatr Res 2012;46(3):341-5. doi: 10.1016/j.jpsychires.2011.11.002.
(33) Bagis S, Karabiber M, As I, Tamer L, Erdogan C, Atalay A. Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia?. Rheumatol Int. 2013;33(1):167-172. doi:10.1007/s00296-011-2334-8.
(34) Fernstrom JD. Effects and side effects associated with the non-nutritional use of tryptophan by humans. J Nutr. 2012;142(12):2236S-2244S. doi:10.3945/jn.111.157065.
(35) Levitan RD, Shen JH, Jindal R, Driver HS, Kennedy SH, Shapiro CM. Preliminary randomized double-blind placebo-controlled trial of tryptophan combined with fluoxetine to treat major depressive disorder: antidepressant and hypnotic effects [published correction appears in J Psychiatry Neurosci. 2000 Nov;25(5):439]. J Psychiatry Neurosci. 2000;25(4):337-346.