Image by Anastasia Gepp from Pixabay¹

What Causes Irritable Bowel Syndrome?

Irritable bowel syndrome is cluster of symptoms including bloating, gas, abdominal cramps, constipation and/or diarrhea that can be triggered by multiple things including stress and different foods. Between 7 and 15% of the population are affected by IBS symptoms. There is not one clear cause of IBS, but many people who suffer from IBS are sensitive to lactose, fructose, and sorbitol/fodmaps. Gluten, dairy, alcohol, caffeine, etc. can all contribute to IBS flares, depending on what specific foods are triggering for an individual.² Changes in the gut microbiome, the good bacteria that live in the gut, are seen in IBS.³

There is also a link between serotonin and IBS which can help explain why IBS and mood issues like anxiety and depression are so closely tied together. Both production and use of serotonin are altered in people with IBS, thought it is not fully understood why. 95% of serotonin is in the gut and only 5% is in the brain. This can help explain why medications that regulate serotonin can be beneficial for IBS symptoms.⁴

Beyond the serotonin connection, constant concern about severe and embarrassing digestive symptoms triggered by eating different foods can cause more stress which can make the gut more sensitive leading to a vicious circle that needs to be addressed with both dietary and stress management to be successfully alleviate symptoms.⁵

Food Plan and Therapeutic Foods

A low FODMaP diet can be useful for symptom resolution and identifying trigger foods for people suffering from IBS. FODMaPs are highly Fermenatable Oligo-, Di-, and Mono- saccharides and Polyls that are known to contribute to bloating, gas, and other IBS symptoms in a significant number of people with IBS.² The low FODMaP diet is best used for a short time as it can negatively impact the gut microbiota and lead to more digestive issues later.⁶

The Low FODMaP diet includes foods that are lower in fructose like bananas, berries, melons, and maple syrup. Lactose free milk products or rice milk and hard cheeses, vegetables lower in fructans and galectins like carrots, celery, green beans, corn, tomato, and gluten free grains. Sweeteners that end in “-ose” may be included, sweeteners that end in “-ol” are to be avoided. Some foods like beans, legumes, excess wheat and rye, and some fruits and vegetables are to be avoided during the first phase of the diet. This allows the gut to calm down and the identification of which specific foods trigger symptoms when they are introduced back into the diet. The Low FODMaP diet can be used during IBS flares to calm the system then return to a more normal eating pattern and only avoid foods that you know are problematic for you.⁵ A helpful list of foods to include and to limit is available here: https://www.ibsdiets.org/fodmap-diet/fodmap-food-list/⁸

Ginger is helpful for reducing nausea and can settle the intestines by reducing spasms and improving muscle tone. One way to prepare ginger is by making tea using 250-500mg of powdered root or a piece of fresh ginger about the size of the pinkie in 150ml of boiling water for 5-10 and drinking before meals.⁵

Supplements

Probiotics can be helpful in treating IBS symptoms as they help to maintain the good bacteria in the gut. They are also important when using a low FODMaP diet because this eating plan can cause negative shifts in the balance of bacteria in the gut. Bifidobacterium infantis and Lactobaccillus plantarum, are two strains that have been studied and shown to help IBS. People who are immunocompromised or have severe pancreatic disease should be cautioned in the use of probiotics.⁵

Peppermint oil has been shown to improve IBS symptoms. In a randomized control trial, those using enteric-coated sustained release peppermint oil had a 40% reduction in their IBS symptom score with improvements in both individual symptoms and symptom severity.⁷ Using peppermint oil that is not enteric coated can irritate the stomach and cause heartburn.⁵

Conclusion

IBS is a challenging set of symptoms that reduce quality of life and there are no simple solutions, but there are many steps that you can take including identifying food triggers, being able to use a low FODMaP diet to tame symptoms. using ginger, probiotics, and peppermint oil as well as managing stress that can all help you get back in control of your life.

Ready to get started with personalized nutrition care? Click here to book your first session. It may even be covered by your insurance!

References

1. Image by <a href=”https://pixabay.com/users/nastya_gepp-3773230/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4392164″>Anastasia Gepp</a> from <a href=”https://pixabay.com/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4392164″>Pixabay</a&gt;
2. Altobelli E, Del Negro V, Angeletti PM, Latella G. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis. Nutrients. 2017;9(9):940. Published 2017 Aug 26. doi:10.3390/nu9090940
3. Luo M, Zhuang X, Tian Z, Xiong L. Alterations in short-chain fatty acids and serotonin in irritable bowel syndrome: a systematic review and meta-analysis. BMC Gastroenterol. 2021;21(1):14. Published 2021 Jan 6. doi:10.1186/s12876-020-01577-5
4. Arbab Sikander; Satya Vati Rana; Kaushal Kishor Prasad (2009). Role of serotonin in gastrointestinal motility and irritable bowel syndrome. , 403(1-2), 0–55. doi:10.1016/j.cca.2009.01.028
5. Rakel, D. Integrative Medicine 4^th ed. Elsevier; 2018.
6. Dimidi E, Whelan K. Food supplements and diet as treatment options in irritable bowel syndrome. Neurogastroenterol Motil. 2020;32(8):e13951. doi:10.1111/nmo.13951
7. Alammar N, Wang L, Saberi B, et al. The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC Complement Altern Med. 2019;19(1):21. Published 2019 Jan 17. doi:10.1186/s12906-018-2409-0
8. IBS Diets. FODMAP Food List. Updated 2021. Accessed November 19, 2021. https://www.ibsdiets.org/fodmap-diet/fodmap-food-list/

Image by VSRao from Pixabay⁴

What Is Asthma and What Causes It?

Asthma is the most prevalent chronic lung disorder with approximately 8% of Americans of all ages affected.¹ Characterized by repeated episodes of wheezing and breathlessness, asthma is caused by and contributes to a chronic inflammatory state that makes the lungs overreact to triggers such as allergens, cold air, and exercise. In response to these triggers, the body releases even more inflammatory chemicals which cause the bronchioles or tiny airways in the lungs to constrict and increases mucus production and thickness which leads to an exacerbation with more severe wheezing and trouble breathing.² Since the lungs are more reactive, things like paint fumes, chemicals from plastics production and use, open fires, and vehicle exhaust can all cause a worsening of symptoms, and potentially be part of what causes asthma to develop initially.³

It is unclear what exactly the relationship is between asthma and GERD (gastroesophageal reflux disease), but they are often found together and trigger one another, so it is important to work on treating both at the same time, for example, changing habits that cause GERD, such as eating foods one is sensitive to or lying down after a meal, to prevent the stomach acid and GERD symptoms from irritating the lungs and causing an asthma exacerbation.⁵

Whatever the trigger, the result is an excess of inflammatory chemicals being released from various types of cells in they body’s immune (defense) system, and in asthma, it is the small tubes in the lungs that are being most affected by the inflammation. The lungs are trying to keep whatever the trigger is from getting further into the body, unfortunately, to do that means that air is also not being allowed to get in as it should.²

What Should I Eat to Help with My Asthma?

Because asthma is caused by chronic and acute inflammation, changing your diet to reduce inflammation is your best bet. People with asthma should generally avoid sulfites from dried fruits and food additives, like artificial sweeteners and colors, while eating more anti-inflammatory foods like fruits, vegetables, olive oil, and fish. The simplest way to find specific foods that may be causing inflammation is through what is called an elimination diet, though the purpose is simply to recognize how certain foods affect you, not to eliminate long term if not necessary to do so. To test how your body responds to individual foods, the first step is to determine which foods to test. If there are multiple foods/food groups you want to test, plan ahead and avoid all of them for 2-4 weeks, then reintroduce them one group at a time with at least 3 days between introducing new foods. Again, pay attention to how you feel. If symptoms return or worsen, take it out again and put it at the end of the list to try again later. The ultimate goal is to which specific foods you may need to avoid long term. A common trigger for excess inflammation in asthma is dairy, so should be included in foods to test using the elimination diet method. If you have seasonal allergies, you may also want to look at what foods are cross reactive when them. For example, people who are allergic to ragweed, may also react to bananas, melons, cucumbers, and zucchini.⁶

Foods that are high in antioxidants like and vitamin C like citrus fruits can be especially beneficial, but you do need to be aware of possible interactions with medications. For example, Advair diskus is a common preventative medication for asthma that interacts with grapefruit.⁷ Caffeine is known to relax muscles and open airways so adults may find two to three cups of coffee a day to be helpful.⁸

What Supplements Can Help?

Because of their anti-inflammatory properties, omega 3 fatty acids are a long-term plan for helping lower inflammation in the body, thereby potentially reducing the severity of asthma in the long term. It can take several months for effects to be noticed. It also has the added benefit of being beneficial to health generally, so whether it improves the asthma symptoms or not, you will likely find benefit.

Magnesium is commonly used intravenously for severe asthma attacks. Oral magnesium supplements may be beneficial for improving asthma as it can decrease symptoms, but it does not improve pulmonary function. Magnesium gluconate or magnesium glycinate are best tolerated. Magnesium supplements can cause diarrhea.⁶ One way magnesium could be especially beneficial is if stress or anxiety are a trigger for your asthma, because magnesium can be calming to the body, relaxing the muscles, etc. and if your body is better able to handle the stress, this could in turn help with asthma management.⁹

Who Else Can Help Me?

Chiropractic is an option for helping with quality of life in people with asthma. The basis of chiropractic is reducing subluxations in the spine thereby taking pressure off of nerves and improving communication throughout the body. Chiropractic adjustments have the potential to help improve communication to the lungs and lessen asthma symptoms. Though chiropractic adjustments have not been consistently proven to improve lung function, they are able to help with the spinal and muscular effects that having asthma can cause. Improvement in rib cage mobility, muscle relaxation, etc. make it worth considering chiropractic care.¹⁰

By finding and eliminating triggers, you can help prevent asthma exacerbations and improve your quality of life in general. Lowering inflammation in general can help improve your breathing and allow you to feel better overall.

Ready to get started with personalized nutrition care? Click here to book your first session. It may even be covered by your insurance!

References

1. Centers for Disease Control Asthma. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm accessed January 24, 2022.
2. Barnes PJ. Pathophysiology of asthma. Br J Clin Pharmacol. 1996;42(1):3-10. doi:10.1046/j.1365-2125.1996.03721.x
3. Whyand T, Hurst JR, Beckles M, Caplin ME. Pollution and respiratory disease: can diet or supplements help? A review. Respir Res. 2018;19(1):79. Published 2018 May 2. doi:10.1186/s12931-018-0785-0
4. Image by <a href=”https://pixabay.com/users/vsrao-8105725/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4051083″>VSRao</a&gt; from <a href=”https://pixabay.com/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4051083″>Pixabay</a&gt;
5. Ates F, Vaezi MF. Insight Into the Relationship Between Gastroesophageal Reflux Disease and Asthma. Gastroenterol Hepatol (N Y). 2014;10(11):729-736.
6. Rakel, D. Integrative Medicine 4^th ed. Elsevier; 2018.
7. Advair Diskus (Fluticasone, Salmeterol). Natural Medicines Database [database online]. Therapeutic Research Center, 2021. Accessed January 25, 2022. https://naturalmedicines-therapeuticresearch-com.scnmlib.idm.oclc.org/
8. Escott-Stump, S. Nutrition & Diagnosis-Related Care 8^th ed. Wolters Kluwer; 2015.
9. Boyle NB, Lawton CL, Dye L. The effects of magnesium supplementation on subjective anxiety. The effects of magnesium supplementation on subjective anxiety. Magnes Res. 2016;29(3):120-125. doi:10.1684/mrh.2016.0411
10. Kaminskyj A, Frazier M, Johnstone K, Gleberzon BJ. Chiropractic care for patients with asthma: A systematic review of the literature. J Can Chiropr Assoc. 2010;54(1):24-32.

What Are Migraines and What Causes Them?

Image by luisa Munoz from Pixabay¹

16.2 % of Americans suffer from migraine headaches, making it the most common neurological condition in the US. The exact cause of migraines is not fully understood, but overexcited nervous system responses and improper mitochondrial function in the cells have both been linked to migraines.² In addition, inflammatory chemicals and changes in in the blood vessels are also part of the migraine process.³

Migraines can come in multiple phases, which include the aura, in which a migraine is developing, and symptoms can include visual changes, mood changes, excessive yawning, and abnormal energy levels. The headache itself is generally throbbing pain, can be concentrated around the eye, one side of the head, or be more general. Pain is increased by movement and over sensitivity to light, sound, and smells are common during the headache phase. Other possible symptoms are nausea/vomiting, skin sensitivity, and muscle pain. Migraines can last from a few hours to a few days and can increase in frequency. They are more prevalent in women and are commonly linked to hormonal changes in the menstrual cycle.

In general, migraines are triggered by things like food sensitivities, a strong smell, stress, lack of sleep, or missing a meal. Though it is unclear why exactly some people respond to triggers with migraines while others do not and why the same triggers to not always cause migraines in the same person, it does seem to be the body trying to maintain homeostasis, and by keeping ones eating and sleeping schedule steady, the body will not necessarily overreact as strongly to other triggers. Because of the complexity of causes and triggers, the prevention strategy for each person will be different.⁴

What Can I Eat to Help My Migraines?

There is no one best diet for everyone with migraines, but one important aspect to consider is maintaining blood sugar balance, as drops in blood sugar can be a trigger for migraines. For this reason, a low glycemic diet is a good long term option as it helps maintain stable blood sugar levels by limiting carbohydrate consumption to 40-60 grams a day and is made up of mainly foods that are below 50 on the glycemic index.⁵ The glycemic index gives a number to a food which shows how it affects blood sugar in relation to sugar or white bread. For example, mashed potatoes are 83 (high glycemic) and brown rice is 50 (low glycemic). Including a majority of low glycemic foods like non-starchy vegetables (lettuce, carrots, lima beans, etc), fruits (apples, grapes, plums, and oranges), as well as beans (kidney beans, chickepeas, etc) and whole grains like brown rice and oatmeal, as well as meat and dairy⁶ help to keep the blood sugar stable throughout the day and can help lower inflammation. In a research study, people with migraines who went on a low glycemic diet experienced reductions of both frequency and severity of migraines in three months of the dietary trial.⁵ A major challenge in following a low glycemic food plan is learning where the foods fall on the index. One way to overcome this challenge is to print out a glycemic index chart and post it on your refrigerator so you can check the foods you are going to eat against it. You will learn pretty quickly where your favorite foods rank.

Triptans are medications commonly prescribed for migraines. If you take a triptan, be sure not to consume grapefruit as that is a major interaction with triptans.⁷

Fatty fish like salmon, mackerel, anchovies, herring, etc. can help with migraine prevention due to their omega 3 fatty acids. Studies have shown that higher omega 3 intake through food alone can decrease headache frequency in 9 weeks with continued improvement over the remaining three weeks of the study and food is more effective than omega 3 supplements.³

What Supplements Can Help?

There are multiple supplements that can be helpful in preventing migraine. Two are riboflavin (vitamin B2) and magnesium. Riboflavin plays an important part in cell mitochondria function⁸ and magnesium helps with mitochondrial function as well as balancing the effects of glutamate in the nervous system. In general, glutamate excites and magnesium calms down the nerves.²

Riboflavin (vitamin B2) has been shown to be effective in preventing and treating migraine. High doses like this can turn urine a bright yellow color, but riboflavin is safe and generally well tolerated even in pregnancy.³

Magnesium aspartate has been recommended in at bedtime for the prevention of migraines. High doses can cause diarrhea, and magnesium gluconate may be a good alternative if needed.³

Who Else Can Help Me?

Because migraines can be both a cause and effect of stress, a counselor trained in cognitive behavior therapy can be help you learn strategies for managing stress. In addition, cognitive behavior therapy can help you learn to identify your migraine triggers, deal with emotions and thought patterns that may be impacting your headaches and help with managing the stress that comes along with having migraines. People with migraines who participated in cognitive behavior therapy reported less frequent migraines and better quality of life. It is important to realize that this is a process and the length of time it takes to see results will vary from person to person.⁹

One useful thing to remember when trying to prevent migraines is SEEDS: Seep, Exercise, Eat, Diary, and Stress. Finding ways to balance your life and keep a consistent eating, sleeping, and moving schedule as well as using a diary to track symptoms and manage stress can all help in preventing migraines from taking over your life.¹⁰

Ready to get started with personalized nutrition care? Click here to book your first session. It may even be covered by your insurance!

References

1. Image by <a href=”https://pixabay.com/users/r_r_studio-4513738/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=2058476″>luisa Munoz</a> from <a href=”https://pixabay.com/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=2058476″>Pixabay</a&gt;
2. Kirkland AE, Sarlo GL, Holton KF. The Role of Magnesium in Neurological Disorders. Nutrients. 2018;10(6):730. Published 2018 Jun 6. doi:10.3390/nu10060730
3. Rakel, D. Integrative Medicine 4^th ed. Elsevier; 2018.
4. Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. J Neurosci. 2015;35(17):6619-6629. doi:10.1523/JNEUROSCI.0373-15.2015
5. Razeghi Jahromi S, Ghorbani Z, Martelletti P, Lampl C, Togha M; School of Advanced Studies of the European Headache Federation (EHF-SAS). Association of diet and headache. J Headache Pain. 2019;20(1):106. Published 2019 Nov 14. doi:10.1186/s10194-019-1057-1
6. Johnson-Greene, Chondra. Glycemic Index Chart: GI Ratings for Hundreds of Foods

Glycemic Index Chart | Free Glycemic Index Food List (universityhealthnews.com) Accessed February 4, 2022.

1. Sumatriptan Natural Medicines Database [database online]. Therapeutic Research Center, 2021. Accessed February 4, 2022.  https://naturalmedicines-therapeuticresearch-com.scnmlib.idm.oclc.org/
2. Shaik MM, Gan SH. Vitamin supplementation as possible prophylactic treatment against migraine with aura and menstrual migraine. Biomed Res Int. 2015;2015:469529. doi:10.1155/2015/469529
3. Bae JY, Sung HK, Kwon NY, Go HY, Kim TJ, Shin SM, Lee S. Cognitive Behavioral Therapy for Migraine Headache: A Systematic Review and Meta-Analysis. Medicina (Kaunas). 2021 Dec 28;58(1):44. doi: 10.3390/medicina58010044. PMID: 35056352; PMCID: PMC8777662.
4. Gazerani P. Migraine and Diet. Nutrients. 2020;12(6):1658. Published 2020 Jun 3. doi:10.3390/nu12061658

What Is Fibromyalgia?

Image by Anastasia Gepp from Pixabay¹

Fibromyalgia is diagnosed when one has widespread pain for at least three months without any obvious cause for the pain.² Though 2-8% of people suffer from fibromyalgia, the cause of the condition is still not well understood.³ Fibromyalgia is complex and multiple factors can be at play including hormones, an overly sensitive central nervous system, exposure to environmental toxins⁴, oxidative stress, and mitochondrial imbalance. CoQ10 is a marker of mitochondrial disfunction as well as a way to treat it. Research has shown symptom benefit in fibromyalgia patients treated with CoQ10, indicating that the mitochondria, the energy producing part of the cells, may be at least in part responsible for fibromyalgia symptoms.³

Fibromyalgia is also linked to an overly sensitive central nervous system and imbalance in neurotransmitters, which keeps the body in a constant state of stress and leading to physical pain, inflammation, gastrointestinal symptoms similar to irritable bowel syndrome, and mood challenges like depression and anxiety, and amplifying pain signals. With this understanding, it is clearer why the pain continues and is so closely linked to stress. The body is already in a stressed state, so any small stressor can push it over the edge, the symptoms themselves cause stress, so the person with fibromyalgia is stuck in a vicious circle.⁵

Does What You Eat Affect Fibromyalgia Symptoms?

There is no one diet plan that will help everyone with fibromyalgia, but due to its ability to fuel the mitochondria, reduce pain, and preserve nervous system function as well as its emphasis on reducing toxins and its anti-inflammatory properties, the Mito diet is a good choice for overall health and improving fibromyalgia symptoms. This eating plan focuses on quality of food, which makes it nutrient dense and offers multiple health benefits. The Mito diet is gluten free, low glycemic, includes high-quality protein and fat intake, while avoiding processed foods, excess sugars, and excessive grain and carbohydrate intake, all of which contribute to blood sugar stabilization, brain and nerve health, and lowering inflammation. Another feature of the Mito food plan is a wealth of therapeutic foods like wild caught salmon, grass fed beef, berries (especially blueberries), almonds, green tea, broccoli, and coconut oil, etc. Foods, like dairy, that tend to cause inflammation, especially in people who are sensitive to it, is limited and only included if tolerated by the individual.⁶ The Mito diet also avoids artificial flavorings like MSG and aspartame, which research has shown can reduce fibromyalgia pain, fatigue, and brain fog, and improve sleep.⁷ The Mito food plan can be tailored to individual needs and include things like intermittent fasting, higher healthy fat ratios for a more ketogenic approach.⁶

Due to its anti-inflammatory and pain reducing abilities, turmeric is a good food to include in the diet of someone with fibromyalgia. It is helpful in amounts used for cooking as the therapeutic dose is ½ to 1g (less than ½ tsp).²

Are there Any Supplements That Will Help?

There are many supplements that might be helpful as there are so many different body systems that could use support and may be causing symptoms. Two of the supplements that may help with fibromyalgia muscle specific symptoms are creatine and magnesium.

Creatine is often used by athletes to build muscle, but has also been shown to be useful for people with fibromyalgia. Other symptoms were not particularly improved, but creatine can be used to support muscle function in fibromyalgia.⁸

Because many people with fibromyalgia have low magnesium status and magnesium supplementation can help with muscle relaxation, anxiety, and sleep challenges, magnesium can help with multiple symptoms of fibromyalgia. Magnesium glycinate is well tolerated and is better absorbed in the tissues than other forms.⁹ High doses can cause gastrointestinal upset, so it is important if abdominal cramping or excess bowel movements occur, lower the dose you are taking.²

Fibromyalgia is a complex condition that has not been well understood, but nutrition and lifestyle changes are recognized as the best way to get symptoms under control and improve quality of life.

Ready to get started with personalized nutrition care? Click here to book your first session. It may even be covered by your insurance!

References

1. Image by <a href=”https://pixabay.com/users/nastya_gepp-3773230/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4392171″>Anastasia Gepp</a> from <a href=”https://pixabay.com/?utm_source=link-attribution&amp;utm_medium=referral&amp;utm_campaign=image&amp;utm_content=4392171″>Pixabay</a&gt;
2. Rakel, D. Integrative Medicine 4^th ed. Elsevier; 2018.
3. Martínez-Lara A, Moreno-Fernández AM, Jiménez-Guerrero M, et al. Mitochondrial Imbalance as a New Approach to the Study of Fibromyalgia. Open Access Rheumatol. 2020;12:175-185. Published 2020 Aug 24. doi:10.2147/OARRR.S257470
4. Ross, K. Fibromyalgia and Chronic Fatigue Syndrome (CFS). Recorded Lecture. SCNMInstructure. Accessed December 9, 2021. https://scnm.instructure.com/courses/4047/pages/module-10-lecture?module_item_id=166781
5. Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 2016;338:114-129. doi:10.1016/j.neuroscience.2016.06.006
6. The Institute for Functional Medicine. Mito Food Plan Comprehensive Guide. IFM, 2016.
7. Lowry E, Marley J, McVeigh JG, McSorley E, Allsopp P, Kerr D. Dietary Interventions in the Management of Fibromyalgia: A Systematic Review and Best-Evidence Synthesis. Nutrients. 2020;12(9):2664. Published 2020 Aug 31. doi:10.3390/nu12092664
8. Alves CR, Santiago BM, Lima FR, et al. Creatine supplementation in fibromyalgia: a randomized, double-blind, placebo-controlled trial. Arthritis Care Res (Hoboken). 2013;65(9):1449-1459. doi:10.1002/acr.22020
9. Boulis M, Boulis M, Clauw D. Magnesium and Fibromyalgia: A Literature Review. J Prim Care Community Health. 2021;12:21501327211038433. doi:10.1177/21501327211038433