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HPA Dysregulation
Many patients with FM have had exposure to significant life stress and/or have inordinate responses to daily
life stressors.12 Altered reactivity of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in hyposecretion of adrenal androgens (e.g. cortisol) has been observed in these patients.13 One study has postulated that HPA dysfunction may involve serotonergic neurotransmission and alterations in the activity of arginine-vassopressin (AVP) and corticotrophin-releasing hormone (CRH).14
HPA dysregulation is far-reaching and can interfere with proper functioning of the hypothalamus-pituitary-thyroid (HPT) axis. Neuroendocrine abnormalities along the HPT axis are also common in FM patients. 15,16,17 Furthermore, due to the association between hypothyroidism and fibrositis and myalgia, it is recommended that FM patients be given a comprehensive thyroid hormone test. 18,19,20
The use of adaptogens-herbs that help normalize bodily processes and increases the ability to "adapt" to stress-and B vitamins provide a general approach to managing stress.
Traditional Holy Basil Combination: Adaptogens such as holy basil (Ocimum sanctum), ashwaganda (Withania somnifera), and brahmi (Bacopa monnieri) have a history of use in Ayurvedic medicine and are scientifically well supported to improve stress tolerance.21,22 Ashwaganda was shown to enhance adaptability to both physical and chemical stress in animals, showing the ability to suppress adrenal enlargement, as well as adrenal ascorbic acid and corticosterone depletion.23 Ashwaganda also produces positive changes in stress-related prostaglandin and catecholamine production. In other animal testing, brahmi was shown to improve adaptations in sensory, motor, and motivational systems.24 In humans, it exhibits beneficial effects on anxiety, as well as mental functions such
as mental fatigue.
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are important in energy production
and the response to stress by supporting adrenal hormone production and regulation.25,26 In conjugation with
ATP and cysteine, pantothenic acid plays an integral role in the synthesis of coenzyme A, which initiates various
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was found to
stimulate the secretion of adrenal catecholamines.
Thyroid Support: While normalizing stress-induced changes in HPA function will have a positive influence on the HPT axes, some patients may need additional thyroid support. Several nutrients are known to support healthy thyroid hormone synthesis, to promote the conversion of thyroxine (T4) to the more bioactive triiodothyronine (T3), and to address receptor dynamics and the expression of thyroid hormone sensitive genes. Such nutrients include iodine, selenium, zinc, and vitamins E, A, and D.28-33